bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Rates, Risk Factors, and Outcomes of Gestational Diabetes Between Aboriginal and Non-Aboriginal Women in the Saskatoon Health District
Authors: Dyck Roland , Klomp Helena , Tan Leonard K. , Turnell Roger W. , Boctor Makram A. 
Published: March 2007

OBJECTIVE—To determine possible differences in gestational diabetes mellitus (GDM) between aboriginal and non-aboriginal people in the Saskatoon Health District.RESEARCH DESIGN AND METHODS—This was a prospective survey of all women admitted for childbirth to the Saskatoon Royal University Hospital between January and July 1998. We compared prevalence rates, risk factors, and outcomes of GDM between aboriginal and non-aboriginal women.RESULTS—Information was obtained from 2,006 women, of whom 252 aboriginal and 1,360 non-aboriginal subjects had been tested for GDM. The overall rates of GDM were 3.5% for women in the general population and 11.5% for aboriginal women. For those living within the Saskatoon Health District, GDM rates were 3.7 and 6.4%, respectively. Multivariate analysis demonstrated that aboriginal ethnicity, most notably when combined with obesity, was an independent predictor for GDM. Pregravid BMI ≥27 kg/m2 and maternal age ≥33 years were the most important risk factors for GDM in aboriginal women, whereas previous GDM, family history of diabetes, and maternal age ≥38 years were the strongest predictors for GDM in non-aboriginal women.CONCLUSIONS—There may be fundamental differences in GDM between aboriginal and non-aboriginal people. Because GDM contributes to an increased risk for type 2 diabetes in aboriginal women and their offspring, the impact of prevention and optimal treatment of GDM on the type 2 diabetes epidemic in susceptible populations are important areas for further investigation.
Differential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes
Authors: Chu Neelima V. , Kong Alice P. S. , Kim Dennis D. , Armstrong Debra , Baxi Sunita , Deutsch Reena , Caulfield Michael , Mudaliar Sunder R. , Reitz Richard , Henry Robert R. , Reaven Peter D. 
Published: March 2007

OBJECTIVE—Traditional cardiovascular risk factors (CVRF) only partly explain the excessive risk of cardiovascular disease in patients with type 2 diabetes. There is now an increasing appreciation for many novel CVRF that occur largely as a result of insulin resistance and hyperinsulinemia. Therefore, we investigated whether diabetes medications that vary in their mechanism of action and ability to reduce insulin resistance may differ in their effects on both traditional and novel CVRF.
RESEARCH DESIGN AND METHODS—We compared the addition of metformin or troglitazone therapy on CVRF in 22 subjects with type 2 diabetes who remained in poor glycemic control (with HbA1c &gt;8.5%) while taking glyburide 10 mg twice daily. Subjects were initially randomized to either metformin 850 mg once daily or troglitazone 200 mg once daily. Both medications were then titrated upward as needed to achieve fasting plasma glucose &lt;120 mg/dl. Measures of glucose control, insulin resistance, and CVRF (blood pressure, lipids, plasminogen activator inhibitor-1, C-reactive protein, fibrinogen, and small dense LDL) were assessed both before and after therapy.
RESULTS—After 4 months of treatment, both metformin and troglitazone led to similar decreases in fasting plasma glucose and HbA1c. The reduction in insulin resistance determined by hyperinsulinemic-euglycemic clamp was nearly twofold greater with troglitazone than metformin. Metformin did not induce significant changes in blood pressure, LDL cholesterol, LDL size, HDL cholesterol, triglycerides, or plasminogen activator inhibitor-1. However, C-reactive protein did decrease by 33% (6± 1 to 4± 1 ng/l; P &lt; 0.01). Troglitazone therapy was associated with increases in LDL size (26.21± 0.22 to 26.56 ±0.25 nm; P=0.04) and HDL cholesterol (33 ±3 to 36± 3 mg/dl; P=0.05) and decreases in triglycerides (197± 19 to 155± 23 mg/dl; P=0.07) and C-reactive protein by 60% (8± 3 to 3± 1 ng/l, P &lt; 0.01).
CONCLUSIONS—For patients with type 2 diabetes in whom maximal sulfonylurea therapy failed, the addition of the insulin sensitizer troglitazone seemed to have greater benefits on several traditional and novel CVRF than metformin therapy. These differences were not related to glycemic improvement but reflected, in part, the greater reduction in insulin resistance obtained with addition of troglitazone. These data suggest that medications that more effectively address this underlying metabolic defect may be more beneficial in reducing cardiovascular risk in type 2 diabetes.
A Low-Sodium Diet Potentiates the Effects of Losartan in Type 2 Diabetes
Authors: Houlihan Christine A. , Allen Terri J. , Baxter Amynta L. , Panangiotopoulos Sianna , Casley David J. , Cooper Mark E. , Jerums George 
Published: March 2007

OBJECTIVE—Diabetic subjects have a high prevalence of hypertension, increased total body exchangeable sodium levels, and an impaired ability to excrete a sodium load. This study assessed the effect of dietary sodium restriction on the efficacy of losartan in hypertensive subjects with type 2 diabetes and albumin excretion rates of 10–200 μg/min.
RESEARCH DESIGN AND METHODS—In this study, 20 subjects were randomized to losartan 50 mg/day (n = 10) or placebo (n = 10). Drug therapy was given in two 4-week phases separated by a washout period. In the last 2 weeks of each phase, patients were assigned to low- or regular-sodium diets, in random order. In each phase, 24-h ambulatory blood pressure, urinary albumin-to-creatinine ratio (ACR), and renal hemodynamics were measured.
RESULTS—Achieved urinary sodium on a low-sodium diet was 85 ± 14 and 80 ± 22 mmol/day in the losartan and placebo groups, respectively. In the losartan group, the additional blood pressure-lowering effects of a low-sodium diet compared with a regular-sodium diet for 24-h systolic, diastolic, and mean arterial blood pressures were 9.7 mmHg (95% confidence interval [CI], 2.2−17.2; P = 0.002), 5.5 mmHg (2.6−8.4; P = 0.002), and 7.3 mmHg (3.3− 11.3; P = 0.003), respectively. In the losartan group, the ACR decreased significantly on a low-sodium diet versus on a regular-sodium diet (−29% [CI −50.0 to −8.5%] vs. + 14% [−19.4 to 47.9%], respectively; P = 0.02). There was a strong correlation between fall in blood pressure and percent reduction in the ACR (r = 0.7, P = 0.02). In the placebo group, there were no significant changes in blood pressure or ACR between regular- and low-sodium diets. There were no significant changes in renal hemodynamics in either group.
CONCLUSIONS—These data demonstrated that a low-sodium diet potentiates the antihypertensive and antiproteinuric effects of losartan in type 2 diabetes. The blood pressure reduction resulting from the addition of a low-sodium diet to losartan was of similar magnitude to that predicted from the addition of a second antihypertensive agent.
Association of Parity With Risk of Type 2 Diabetes and Related Metabolic Disorders
Authors: Hanley Anthony J.G. , McKeown-Eyssen Gail , Harris Stewart B. , Hegele Robert A. , Wolever Thomas M.S. , Kwan Jeremy , Zinman Bernard 
Published: March 2007

OBJECTIVE—The relationship between parity and risk of diabetes is controversial, and little information is available regarding associations between parity and measures of insulin resistance and β-cell function. The objective of this study was to investigate the association between parity and risk of glucose intolerance and related metabolic disorders using data from a population-based study in a Native Canadian community.
RESEARCH DESIGN AND METHODS—Female participants (n = 383, aged 12–79 years) provided fasting blood samples for the determination of glucose, insulin, C-peptide, and proinsulin concentrations. A 75-g oral glucose tolerance test was administered, and diabetes and impaired glucose tolerance were diagnosed according to World Health Organization criteria. Waist circumference and percent body fat were determined. Information regarding occurrence of live births and previously diagnosed diabetes was obtained from interviewer-administered questionnaires.
RESULTS—Parity was associated with a significantly reduced risk of diabetes (nulliparous vs. ≥1 birth, odds ratio 0.43, 95% CI 0.19– 0.94, P &lt; 0.05) after adjustment for age and waist circumference. In addition, nondiabetic nulliparous women had significantly elevated concentrations of fasting insulin and proinsulin relative to nondiabetic parous women (all P &lt; 0.05) in analyses adjusted for age and waist circumference.
CONCLUSIONS—Our results are consistent with those from other populations experiencing high rates of diabetes and suggest the presence of a diabetes-prone phenotype within the nulliparous subcohort of this population, which may contribute to infertility.
Hostility, Race, and Glucose Metabolism in Nondiabetic Individuals
Authors: Surwit Richard S. , Williams Redford B. , Siegler Ilene C. , Lane James D. , Helms Michael , Applegate Katherine L. , Zucker Nancy , Feinglos Mark N. , McCaskill Cynthia M. , Barefoot John C. 
Published: March 2007

OBJECTIVE—The present study was designed to determine whether hostility is differentially related to measures of glucose metabolism in African-Americans and Caucasians.
RESEARCH DESIGN AND METHODS—The relationship of hostility, as measured by a subset of the Cook-Medley hostility scale (CMHOST) inventory items, to various parameters of glucose metabolism were examined in a young, healthy sample of male and female African-American and Caucasian volunteers. Fasting blood samples were collected during an inpatient admission, at which time the CMHOST was also administered.
RESULTS—In the entire sample, the CMHOST was found to be significantly correlated with fasting glucose and insulin sensitivity, as measured by the homeostatic model assessment (HOMA). However, the relationship of hostility to these parameters of glucose metabolism was different in African-American and Caucasian subjects. Hostility was significantly related to fasting glucose in African-Americans and to insulin sensitivity and fasting insulin in Caucasian subjects. The relationship of hostility to insulin sensitivity and fasting insulin was partially dependent on BMI in Caucasians, but the relationship of hostility to fasting glucose was unrelated to BMI in African-Americans.
CONCLUSIONS—Our data suggest that the relationship of hostility to measures of glucose metabolism is mediated differently in these two ethnic groups. Therefore, hostility seems to be part of a constellation of risk-related behaviors related to BMI in Caucasians but independently related to fasting glucose in African-Americans.
Gestational Diabetes Mellitus in Women of Single Gravidity in Tianjin City, China
Authors: Yang Xilin , Hsu-Hage Bridget , Zhang Hong , Yu Lichun , Dong Ling , Li Jingchun , Shao Ping , Zhang Changjun 
Published: March 2007

OBJECTIVE—The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) and risk factors for the development of GDM in pregnant women in Tianjin, China, where the prevalence of GDM is still unknown.
STUDY DESIGN AND METHODS—A total of 9,471 pregnant women living in the six urban districts of Tianjin, China, took part in the initial screening between December 1998 and December 1999. The screening test consisted of a 50-g 1-h glucose test. Women with a reading ≥7.8 mmol/l at the initial screening were invited to undergo a 75-g 2-h oral glucose tolerance test (OGTT). GDM was confirmed using the World Health Organization’s diagnostic criteria.
RESULTS—At the initial screening test, 888 women had a glucose reading of ≥7.8 mmol/l. A total of 701 (79%) women took a subsequent OGTT. Of these, 174 women were confirmed to have GDM (154 with impaired glucose tolerance [IGT] and 20 with diabetes). The prevalence of GDM was 2.31% (2.03% for IGT and 0.28% for diabetes), adjusting for serum glucose levels at the initial screening test. Independent predictors for GDM were maternal age, stature, prepregnancy BMI, weight gain in pregnancy before screening, diabetes in first-degree relatives, and habitual cigarette smoking during pregnancy. Women who smoked or had a short stature are more likely to develop GDM than their counterparts.
CONCLUSIONS—The prevalence of GDM in pregnant women in the city of Tianjin, China, was 2.31%. Short stature and smoking in pregnancy were additional risk factors for GDM.
Association of Acanthosis Nigricans With Hyperinsulinemia Compared With Other Selected Risk Factors for Type 2 Diabetes in Cherokee Indians
Authors: Stoddart Martha L. , Blevins Kathleen S. , Lee Elisa T. , Wang Wenyu , Blackett Piers R. 
Published: March 2007

OBJECTIVE—To report prevalence rates of acanthosis nigricans (AN) and hyperinsulinemia and the association of AN with hyperinsulinemia compared with other known or suspected risk factors for type 2 diabetes in young American Indians.
RESEARCH DESIGN AND METHODS—A random sample of Cherokee Nation members aged 5–40 years was invited to participate in the Cherokee Diabetes Study, a cross-sectional study of type 2 diabetes and its risk factors in a young American Indian population. Data were collected by personal interview, medical history, physical examination (including anthropometric and blood pressure measurements and examination of the neck for AN), and laboratory analyses of blood specimens. Levels of insulin, lipids, and glucose were measured on fasting blood specimens. Diabetes status was determined according to the American Diabetes Association criteria.
RESULTS—A total of 2,205 participants were examined. Overall prevalence rates for AN and hyperinsulinemia were 34.2 and 47.2%, respectively. In general, the rates for both increased with age and degree of Indian heritage and were higher in female subjects, overweight/obese individuals, those with type 2 diabetes, and those with a parental history of type 2 diabetes. In addition, both had significantly higher age- and sex-adjusted means for selected known or suspected risk factors for type 2 diabetes. AN remained significantly associated with hyperinsulinemia (P = 0.0001) in multivariate analysis.
CONCLUSIONS—AN is independently associated with hyperinsulinemia and therefore may be useful as an early indicator of high risk for diabetes.
Urinary Transforming Growth Factor-β Excretion in Patients With Hypertension, Type 2 Diabetes, and Elevated Albumin Excretion Rate
Authors: Houlihan Christine A. , Akdeniz Aysel , Tsalamandris Con , Cooper Mark E. , Jerums George , Gilbert Richard E. 
Published: March 2007

OBJECTIVE—Transforming growth factor-β (TGF-β) is a prosclerotic growth factor implicated in the pathogenesis of diabetic nephropathy. In addition to high glucose, other factors implicated in renal fibrosis and increased TGF-β synthesis include angiotensin II and high dietary sodium intake. The aim of this study was to examine the effect of angiotensin receptor blockade (ARB) and dietary sodium restriction on the plasma concentration and urinary excretion of TGF-β in hypertensive patients with type 2 diabetes and elevated albumin excretion rate (AER).
RESEARCH DESIGN AND METHODS—Twenty-one subjects with hypertension and AER between 10 and 200 μg/min were randomized to receive either 50 mg losartan daily (n = 11) or placebo (n = 10). Drug therapy was given in two 4-week phases, separated by a 4-week washout period. In the last 2 weeks of each phase, patients were assigned to regular- or low-sodium diets in random order. Parameters measured at week 0 and 4 of each phase included plasma TGF-β concentration, TGF-β urinary excretion, AER, clinic mean arterial blood pressure, and urinary sodium excretion.
RESULTS—Plasma TGF-β was unaffected by losartan treatment or sodium intake. In the losartan group, urinary TGF-β excretion decreased by 23.2% (−39.2 and 13.6) [median (interquartile range)] and 38.5% (−46.8 and −6.1) in the regular- and low-sodium phases, respectively (P &lt; 0.05 for drug effect). In the placebo group, median changes of 0.0% (−12.1 and 44.4) and 0.0% (−29.2 and 110.7) occurred in the regular- and low-sodium phases, respectively. Sodium restriction did not affect urinary TGF-β excretion in either losartan- or placebo-treated patients (P = 0.54 for overall dietary effect), and there was no evidence of interaction between drug and diet (P = 0.29).
CONCLUSIONS—In hypertensive type 2 diabetic patients with elevated AER, the ARB losartan, but not sodium restriction, reduced urinary TGF-β excretion. These data suggest that the renoprotective effects of losartan in patients with type 2 diabetes and nephropathy may include a reduction in renal TGF-β production.
Glucose Monitoring at the Arm
Authors: Jungheim Karsten , Koschinsky Theodor 
Published: March 2007

OBJECTIVE—We have examined whether rapid changes in blood glucose (BG) result in clinically relevant differences between capillary BG values measured at the forearm and the fingertip and whether local rubbing of the skin before blood sampling can diminish such differences.
RESEARCH DESIGN AND METHODS—Capillary BG samples were collected every 15 min for 3–5 h from the fingertip and the forearm of 17 insulin-treated diabetic patients and analyzed with different glucose monitors (FreeStyle, One Touch Ultra, and Soft-Sense). In a subgroup of patients (n = 8), local rubbing of the forearm skin was performed before blood sampling. A rapid increase in BG was induced by oral administration of glucose, and subsequently, a rapid decrease in glucose was induced by intravenous administration of insulin.
RESULTS—In the fasting state, the BG values at the fingertip and at the forearm were similar (7.8 ± 2.4 vs. 7.2 ± 2.3 mmol/l, P = 0.06). However, during rapid increase in glucose, BG values at the fingertip were consistently higher than at the forearm (maximal difference 4.6 ± 1.2 mmol/l, P &lt; 0.001). During rapid decrease in glucose, lower BG values were recorded at the fingertip (maximal difference to forearm 5.0 ± 1.0 mmol/l, P &lt; 0.001). At the forearm, BG was delayed by a median of 35 min (P &lt; 0.01) in relation to the fingertip. Rubbing of forearm skin decreased the observed differences but with a large intraindividual and interindividual variability. There were no obvious device-specific differences.
CONCLUSIONS—To avoid risky delays of hyperglycemia and hypoglycemia detection, BG monitoring at the arm should be limited to situations in which ongoing rapid changes in BG can be excluded.
Aspirin Use and Counseling About Aspirin Among Patients With Diabetes
Authors: Krein Sarah L. , Vijan Sandeep , Pogach Leonard M. , Hogan Mary M. , Kerr Eve A. 
Published: March 2007

OBJECTIVE—Despite being a safe, effective therapy for lowering cardiovascular risk, only 20% of diabetic patients were using aspirin in the early 1990s. This study examines current physician practices and the use of aspirin therapy by individuals with diabetes.
RESEARCH DESIGN AND METHODS—A random sample of diabetic patients receiving care in the Department of Veterans Affairs health care system were surveyed during January-March 2000. The association between aspirin counseling, aspirin use, and reported coronary vascular disease (CVD) and classical CVD risk factors were examined using logistic regression. The effect of increasing aspirin use on risk of myocardial infarction (MI) and cardiovascular mortality was demonstrated by simulation.
RESULTS—Seventy-one percent of respondents reported being counseled about aspirin use, and 66% were taking daily aspirin. Individuals with known CVD were more likely to be counseled (odds ratio [OR] 4.9, 95% CI 2.9–8.1) and to use aspirin (2.1, 1.2–3.7). The factor most strongly associated with aspirin use was having been counseled about aspirin therapy by a doctor. We estimate that for this population, increasing daily aspirin use to 90% could prevent an additional 11,000 MIs and potentially save &gt;8,000 lives.
CONCLUSIONS—Compared with previous reports, a substantial proportion of these diabetic patients have been counseled about and use aspirin. Most clinicians recognize aspirin as an important treatment for patients with preexisting coronary disease. However, since diabetes is now considered a CVD equivalent, it is imperative that clinicians include counseling about aspirin therapy as a care priority for all their diabetic patients, as this simple intervention may prevent many cardiovascular events and deaths.
The Performance of a Risk Score in Predicting Undiagnosed Hyperglycemia
Authors: Park P.J. , Griffin S.J. , Sargeant L. , Wareham N. J. 
Published: March 2007

OBJECTIVE—Type 2 diabetes is a serious disease that is commonly undetected and for which screening is sometimes advocated. A number of risk factors are associated with prevalent undiagnosed diabetes. The use of routinely available information on these factors has been proposed as a simple and effective way of identifying individuals at high risk for having the disease. The objective of this study was to assess the effectiveness of the Cambridge risk score in a large and representative population.
RESEARCH DESIGN AND METHODS—A risk score derived from data in a previous study was tested for its ability to detect prevalent undiagnosed hyperglycemia as measured by a GHb ≥6.0, 6.5, or 7% in 6,567 subjects aged 39–78 years in the European Prospective Investigation of Cancer−Norfolk cohort.
RESULTS—For a specificity of 78%, the risk score predicted a GHb of ≥7.0% in subjects aged 39–78 years, with a sensitivity of 51% (95% CI 40–62). The areas under the receiver-operating characteristic (ROC) curve for GHb ≥6.0, 6.5, and 7% were 65.7% (63.8–67.6), 71.2% (68.4–75.2), and 74.2% (69.5–79.0), respectively. The area under the ROC curve was not significantly reduced if data on family and smoking history were unavailable for any of the cut-offs for GHb.
CONCLUSIONS—The risk score performed as well as other previously reported models in all age groups. We concluded that a simple risk score using data routinely available in primary care can identify people with an elevated GHb with reasonable sensitivity and specificity, and it could therefore form part of a strategy for early detection of type 2 diabetes.