bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the Diabetes Quality Improvement Project Measures in Maine From 1994 to 1999
Authors: McClain Monica R. , Wennberg David E. , Sherwin Roger W. , Steinmann William C. , Rice Janet C. 
Published: March 2007

OBJECTIVE—To examine changes in the management of patients with diabetes from 1994 to 1999 using the claims-based Diabetes Quality Improvement Project (DQIP) accountability measures.
RESEARCH DESIGN AND METHODS—Administrative claims from an employer-based health insurance cohort in Maine were used to describe the prevalence of claims-based DQIP accountability measures—HbA1c testing, dilated eye examination, lipid profile, and monitoring for diabetic nephropathy—from 1994 (n = 1,151) to 1999 (n = 2,221) in a 100% sample of adults (18–64 years of age) with diabetes. The Mantel-Haenszel χ2 test for trend was performed on each measure. Prevalence estimates were also stratified by three insurance products: health maintenance organization (HMO), point of service, and indemnity.
RESULTS—There was a positive trend for all outcome measures (P &lt; 0.001). The baseline and final frequencies (percent increase) for lipid testing, HbA1c, dilated eye examination, and screening for diabetic nephropathy were as follows: 13–50% (257%), 37–69% (92%), 30–46% (53%), and 37–50% (36%), respectively. Individuals with diabetes and indemnity insurance were much less likely to receive these measures than individuals with other types of insurance, whereas people in HMOs were more likely to receive HbA1c testing and lipid profiles.
CONCLUSIONS—The proportion of patients with diabetes receiving DQIP accountability measures significantly increased from 1994 to 1999. There is large variation in prevalence among these measures and insurance products. It is urgent to identify effective mechanisms for delivering consistent preventive care that are congruent with defined standards of benefit.
Fatty Acid Composition of Serum Lipid Fractions in Type 2 Diabetic Patients With Microalbuminuria
Authors: Perassolo Magda S. , Almeida Jussara C. , Prá Ronivan L. , Mello Vanessa D. , Maia Ana L. , Moulin Cileide C. , Camargo Joíza L. , Zelmanovitz Themis , Azevedo Mirela J. , Gross Jorge L. 
Published: March 2007

OBJECTIVE—To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] &lt;20 μg/min), and 35 were microalbuminuric (UAER 20–200 μg/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymatic-colorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl2, and dextran sulfate; and apolipoprotein B by immunoturbidimetry.
RESULTS—Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 ± 11.0%), especially of the n-6 family (21.7 ± 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 ± 11.3%, P = 0.001 and 31.4 ± 11.5%, P &lt; 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 ± 18.0% vs. 34.7 ± 13.1%, P = 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85–0.98, P = 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo- and microalbuminuric patients.
CONCLUSION—Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease.
Estimated Number of Adults With Prediabetes in the U.S. in 2000
Authors: Benjamin Stephanie M. , Valdez Rodolfo , Geiss Linda S. , Rolka Deborah B. , Narayan K.M. Venkat 
Published: March 2007

OBJECTIVE—To estimate the percent and number of overweight adults in the U.S. with prediabetes who would be potential candidates for diabetes prevention as per the American Diabetes Association Position Statement (12).
RESEARCH DESIGN AND METHODS—We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994) and projected our estimates to the year 2000. We defined impaired glucose tolerance (IGT; 2-h glucose 140–199 mg/dl), impaired fasting glucose (IFG; fasting glucose 110–125 mg/dl), and prediabetes (IGT or IFG) per American Diabetes Association (ADA) criteria. The ADA recently recommended that all overweight people (BMI ≥25 kg/m2) who are ≥45 years of age with prediabetes could be potential candidates for diabetes prevention, as could prediabetic people aged &gt;25 years with risk factors. In NHANES III, 2-h postload glucose concentrations were done only among subjects aged 40–74 years. Because we were interested in overweight people who had both the 2-h glucose and fasting glucose tests, we limited our estimates of IGT, IFG, and prediabetes to those aged 45–74 years.
RESULTS—Overall, 17.1% of overweight adults aged 45–74 years had IGT, 11.9% had IFG, 22.6% had prediabetes, and 5.6% had both IGT and IFG. Based on those data, we estimated that in the year 2000, 9.1 million overweight adults aged 45–74 had IGT, 5.8 million had IFG, 11.9 million had prediabetes, and 3.0 million had IGT and IFG.
CONCLUSIONS—Almost 12 million overweight individuals aged 45–74 years in the U.S. may benefit from diabetes prevention interventions. The number will be substantially higher if estimation is extended to individuals aged &gt;75 and 25–44 years.
Community-Based Screening for Diabetes in Michigan
Authors: Tabaei Bahman P. , Burke Ray , Constance Ann , Hare Jean , May-Aldrich Glenda , Parker Sandra A. , Scott Ann , Stys Anne , Chickering Jean , Herman William H. 
Published: March 2007

OBJECTIVE—To describe and evaluate a community-based diabetes screening program supported by the Michigan Department of Community Health.
RESEARCH DESIGN AND METHODS—Between 1 June 1999 and 31 December 1999, community screening for diabetes was conducted by voluntary organizations using a standard protocol, American Diabetes Association (ADA) questionnaires, and ADA capillary plasma glucose criteria.
RESULTS—A total of 3,506 individuals were screened, 14% of whom did not meet criteria for screening. Of the 3,031 individuals appropriately screened, 57% were classified as being at high risk based on the ADA questionnaire and 5% had positive screening tests based on ADA capillary plasma glucose criteria. Despite systematic follow-up, the screening program’s yield of individuals with undiagnosed diabetes was &lt;1%.
CONCLUSIONS—Community screening for diabetes conducted according to ADA recommendations was extremely inefficient at identifying individuals with undiagnosed diabetes. The ADA diabetes screening questionnaire resulted in many false positive tests, and the ADA criteria for positive plasma glucose tests likely missed a substantial portion of individuals with undiagnosed diabetes. Relying on biochemical tests such as random plasma glucose, changing the criteria for a positive plasma glucose test, targeting racial and ethnic minority groups, and targeting medically underserved individuals might improve the yield of community-based diabetes screening.
Is the Current Definition for Diabetes Relevant to Mortality Risk From All Causes and Cardiovascular and Noncardiovascular Diseases?
Authors:   The DECODE Study Group,   on behalf of the European Diabetes Epidemiology Group
Published: March 2007

OBJECTIVE—To assess the relation between fasting plasma glucose (FPG) or 2-h plasma glucose (2hPG) and mortality from all causes, cardiovascular disease (CVD), and non-CVD and to determine whether the relationship is graded or threshold.
RESEARCH DESIGN AND METHODS—Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria in Europe (DECODE) is a collaborative prospective study of 22 cohorts in Europe with baseline glucose measurements for 29,714 subjects aged 30–89 years who were followed-up for 11 years (329,050 person-years). Hazard ratio (HR) for death was estimated using Cox regression analysis.
RESULTS—High glucose concentrations as well as very low glucose levels were associated with increased risk of death. Compared with an FPG of 4.50–6.09 mmol/l, the multivariate-adjusted HR (95% CI) for FPG &lt;4.50 mmol/l was 1.2 (1.0–1.4) for all-cause, 1.3 (1.0–1.8) for CVD, and 1.1 (0.9–1.4) for non-CVD mortality; the corresponding HRs for diabetes (FPG ≥7.0 mmol/l) were 1.6 (1.4–1.8), 1.6 (1.3–1.9), and 1.6 (1.4–1.9), respectively. For a 2hPG of 3.01–4.50 mmol/l, as compared with a 2hPG of 4.51–5.50 mmol/l, the HRs were 1.1 (1.0–1.2), 1.1 (0.9–1.3), and 1.1 (1.0–1.3), respectively; the corresponding HRs for diabetes (2hPG ≥11.1 mmol/l) were 2.0 (1.7–2.3), 1.9 (1.5–2.4), and 2.1 (1.7–2.5), respectively. The HR for previously undetected diabetes defined by 2hPG was not significantly different from that for known diabetes, which was significantly higher than that for undetected diabetes based on FPG. Subjects with a 2hPG of 10.01–11.09 mmol/l had mortality risks similar to those diabetic subjects defined by an FPG ≥7.0 mmol/l.
CONCLUSIONS—The relation between mortality and glucose was J shaped rather than showing threshold effect at high glucose levels, except for CVD mortality and 2hPG, where the relation was graded and increasing.
Diabetes and Sleep Disturbances
Authors: Resnick Helaine E. , Redline Susan , Shahar Eyal , Gilpin Adele , Newman Anne , Walter Robert , Ewy Gordon A. , Howard Barbara V. , Punjabi Naresh M. 
Published: March 2007

OBJECTIVE—To test the hypothesis that diabetes is independently associated with sleep-disordered breathing (SDB), and in particular that diabetes is associated with sleep abnormalities of a central, rather than obstructive, nature.RESEARCH DESIGN AND METHODS—Using baseline data from the Sleep Heart Health Study (SHHS), we related diabetes to 1) the respiratory disturbance index (RDI; number of apneas plus hypopneas per h of sleep); 2) obstructive apnea index (OAI; ≥3 apneas/h of sleep associated with obstruction of the upper airway); 3) percent of sleep time &lt; 90% O2 saturation; 4) central apnea index (CAI; ≥3 apneas [without respiratory effort]/h sleep); 5) occurrence of a periodic breathing (Cheyne Stokes) pattern; and 6) sleep stages. Initial analyses excluding persons with prevalent cardiovascular disease (CVD) were repeated including these participants.RESULTS—Of the 5,874 participants included in this report, 692 (11.8%) reported diabetes or were taking oral hypoglycemic medications or insulin and 1,002 had prevalent CVD. Among the 4,872 persons without CVD, 470 (9.6%) had diabetes. Diabetic participants had worse CVD risk factor profiles than their nondiabetic counterparts, including higher BMI, waist and neck circumferences, triglycerides, higher prevalence of hypertension, and lower HDL cholesterol (P &lt; 0.001, all). Descriptive analyses indicated differences between diabetic and nondiabetic participants in RDI, sleep stages, sleep time &lt;90% O2 saturation, CAI, and periodic breathing (P &lt; 0.05, all). However, multivariable regression analyses that adjusted for age, sex, BMI, race, and neck circumference eliminated these differences for all sleep measures except percent time in rapid eye movement (REM) sleep (19.0% among diabetic vs. 20.1% among nondiabetic subjects, P &lt; 0.001) and prevalence of periodic breathing (odds ratio [OR] for diabetic subjects versus nondiabetic subjects 1.80, 95% CI 1.02–3.15). Additionally, adjusted analyses showed diabetes was associated with nonstatistically significant elevations in the odds of an increased central breathing index (OR 1.42, 95% CI 0.80–2.55). Addition to the analysis of the 1,002 persons with prevalent CVD (including 222 people with diabetes) did not materially change these results.CONCLUSIONS—These data suggest that diabetes is associated with periodic breathing, a respiratory abnormality associated with abnormalities in the central control of ventilation. Some sleep disturbances may result from diabetes through the deleterious effects of diabetes on central control of respiration. The high prevalence of SDB in diabetes, although largely explained by obesity and other confounders, suggests the presence of a potentially treatable risk factor for CVD in the diabetic population.
The Diabetes Risk Score
Authors: Lindström Jaana , Tuomilehto Jaakko 
Published: March 2007

OBJECTIVE—Interventions to prevent type 2 diabetes should be directed toward individuals at increased risk for the disease. To identify such individuals without laboratory tests, we developed the Diabetes Risk Score.
RESEARCH DESIGN AND METHODS—A random population sample of 35- to 64-year-old men and women with no antidiabetic drug treatment at baseline were followed for 10 years. New cases of drug-treated type 2 diabetes were ascertained from the National Drug Registry. Multivariate logistic regression model coefficients were used to assign each variable category a score. The Diabetes Risk Score was composed as the sum of these individual scores. The validity of the score was tested in an independent population survey performed in 1992 with prospective follow-up for 5 years.
RESULTS—Age, BMI, waist circumference, history of antihypertensive drug treatment and high blood glucose, physical activity, and daily consumption of fruits, berries, or vegetables were selected as categorical variables. Complete baseline risk data were found in 4,435 subjects with 182 incident cases of diabetes. The Diabetes Risk Score value varied from 0 to 20. To predict drug-treated diabetes, the score value ≥9 had sensitivity of 0.78 and 0.81, specificity of 0.77 and 0.76, and positive predictive value of 0.13 and 0.05 in the 1987 and 1992 cohorts, respectively.
CONCLUSIONS—The Diabetes Risk Score is a simple, fast, inexpensive, noninvasive, and reliable tool to identify individuals at high risk for type 2 diabetes.
Vardenafil, a New Phosphodiesterase Type 5 Inhibitor, in the Treatment of Erectile Dysfunction in Men With Diabetes
Authors: Goldstein Irwin , Young Jay M. , Fischer Jerome , Bangerter Keith , Segerson Thomas , Taylor Terry ,   The Vardenafil Diabetes Study Group
Published: March 2007

OBJECTIVE—This study evaluated the efficacy and safety of vardenafil treatment for erectile dysfunction (ED) in men with diabetes.RESEARCH DESIGN AND METHODS—In this prospective multicenter double-blind placebo-controlled fixed-dose parallel-group phase III trial, 452 patients with diabetes (type 1 or type 2) and ED were randomized to take 10 or 20 mg vardenafil or placebo as needed for 12 weeks. Efficacy responses were assessed by International Index of Erectile Function domain scores, rates of vaginal penetration and successful intercourse, and a global assessment question (GAQ) about erection improvement during the previous 4 weeks.RESULTS—After 12 weeks of treatment, a dose-dependent (P = 0.02) improvement in erections was noted for the GAQ, with 57 and 72% of men taking 10 mg or 20 mg vardenafil, respectively, reporting improved erections, in contrast to 13% after taking placebo (P &lt; 0.0001). For the erectile function domain, dose-dependent (P = 0.03) final scores for the 10- and 20-mg dose were 17.1 and 19.0 compared with 12.6 for placebo (P &lt; 0.0001). Both vardenafil doses significantly enhanced the rates of successful penetration (P &lt; 0.0001) and successful intercourse (P &lt; 0.0001) compared with placebo. Vardenafil treatment was effective in increasing intercourse success rates at all levels of baseline ED severity, at each level of plasma HbA1c, and for type 1 and 2 diabetes. Treatment-emergent adverse events were primarily mild to moderate headache (≤13%), flushing (≤10%), and rhinitis (≤10%).CONCLUSIONS—Vardenafil statistically improved erectile function and was generally well tolerated in these diabetic patients with ED.
First-Trimester C-Reactive Protein and Subsequent Gestational Diabetes
Authors: Wolf Myles , Sandler Laura , Hsu Karen , Vossen-Smirnakis Karen , Ecker Jeffrey L. , Thadhani Ravi 
Published: March 2007

OBJECTIVE—Systemic inflammation is associated with the development of type 2 diabetes. We tested the hypothesis that increased inflammation, measured early in pregnancy, is associated with the subsequent development of gestational diabetes mellitus (GDM), a precursor of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a prospective nested case-control study in a pregnancy cohort. First-trimester C-reactive protein (CRP) levels were measured using a high-resolution assay in 43 women who subsequently developed GDM and in a random sample of 94 women who remained euglycemic throughout pregnancy. Median CRP levels were compared using Wilcoxon’s rank-sum test. Logistic regression was used to compute unadjusted and multivariable-adjusted odds ratios for developing GDM among CRP tertiles.
RESULTS—First-trimester CRP levels were significantly increased among women who subsequently developed GDM compared with control subjects (3.1 vs. 2.1 mg/l, P &lt; 0.01). The risk of developing GDM among women in the highest CRP tertile compared with the lowest tertile was 3.2 (95% CI 1.2–8.8). After adjusting for age, race/ethnicity, smoking, parity, blood pressure, and gestational age at CRP sampling, the risk of developing GDM among women in the highest compared with the lowest tertile was 3.6 (95% CI 1.2–11.4). When BMI was included in the model, however, the association between increased CRP and GDM was attenuated (odds ratio for the highest compared with lowest tertile 1.5 [95% CI 0.4–5.5]).
CONCLUSIONS—In women who develop GDM, there is evidence of increased inflammation during the first trimester. This association is mediated in part by increased BMI. Larger studies are needed to verify these results.
Analysis of the Relationship Between the Pro12Ala Variant in the PPAR-γ2 Gene and the Response Rate to Therapy With Pioglitazone in Patients With Type 2 Diabetes
Authors: Blüher Matthias , Lübben Georg , Paschke Ralf 
Published: March 2007

OBJECTIVE—To investigate the influence of peroxisome proliferator-activated receptor-γ (PPAR-γ) gene variants on the response rate to therapy with the thiazolidinedione (TZD) pioglitazone, because in vitro studies have suggested that genetic variants of the PPAR-γ gene may influence the drug efficacy of TZD.
RESEARCH DESIGN AND METHODS—A total of 131 patients were treated in an open-label, randomized, multicenter study with pioglitazone (45 mg o.d.) during a course of ≥26 weeks. Response to the pioglitazone therapy was defined by either a &gt;20% decrease in fasting plasma glucose or a &gt;15% decrease in HbA1c values after 26 weeks of pioglitazone treatment. We evaluated the association between the PPAR-γ genotype and the response rate to pioglitazone treatment.
RESULTS—The Pro12Ala and the Pro12Pro variants in the PPAR-γ gene are not associated with the response rate to pioglitazone treatment in patients with type 2 diabetes. However, we identified initial fasting plasma glucose level &gt;11.0 mmol/l, HbA1c value &gt;9.0%, BMI &gt;32 kg/m2, and fasting C-peptide concentrations at baseline &gt;2.5 pmol/l as predominant confounding factors for the responder frequency to pioglitazone treatment.
CONCLUSIONS—The Pro12Ala variant in the PPAR-γ gene does not affect the therapy efficacy of pioglitazone, suggesting that the drug-treatment response is independent from pharmacogenetic effects between PPAR-γ and its ligand pioglitazone. Whether the Ala12Ala genotype plays a role in the response rate to TZD therapy remains to be determined.
Effect of Glucagon-Like Peptide 1 (7-36 Amide) on Insulin-Mediated Glucose Uptake in Patients With Type 1 Diabetes
Authors: Meneilly Graydon S. , McIntosh Christopher H.S. , Pederson Raymond A. , Habener Joel F. , Ehlers Mario R.W. , Egan Josephine M. , Elahi Dariush 
Published: March 2007

OBJECTIVE—To examine the insulinomimetic insulin-independent effects of glucagon-like peptide (GLP)-1 on glucose uptake in type 1 diabetic patients.
RESEARCH DESIGN AND METHODS—We used the hyperinsulinemic-euglycemic clamp (480 pmol · m−2 · min−1) in paired randomized studies of six women and five men with type 1 diabetes. In the course of one of the paired studies, the subjects also received GLP-1 at a dose of 1.5 pmol · kg−1 · min−1. The patients were 41 ± 3 years old with a BMI of 25 ± 1 kg/m2. The mean duration of diabetes was 23 ± 3 years.
RESULTS—Plasma glucose was allowed to fall from a fasting level of ∼11 mmol/l to 5.3 mmol/l in each study and thereafter was held stable at that level. Plasma insulin levels during both studies were ∼900 pmol/l. Plasma C-peptide levels did not change during the studies. In the GLP-1 study, plasma total GLP-1 levels were elevated from the fasting level of 31 ± 3 to 150 ± 17 pmol/l. Plasma glucagon levels fell from the fasting levels of ∼14 pmol/l to 9 pmol/l during both paired studies. Hepatic glucose production was suppressed during the glucose clamps in all studies. Glucose uptake was not different between the two studies (∼40 μmol · kg−1 · min−1).
CONCLUSIONS—GLP-1 does not augment insulin-mediated glucose uptake in lean type 1 diabetic patients.
Association of the CTLA-4 Gene 49 A/G Polymorphism With Type 1 Diabetes and Autoimmune Thyroid Disease in Japanese Children
Authors: Mochizuki Mie , Amemiya Shin , Kobayashi Kisho , Kobayashi Koji , Shimura Yoshie , Ishihara Toshihide , Nakagomi Yoshiko , Onigata Kazumichi , Tamai Shinya , Kasuga Akira , Nanazawa Shinpei 
Published: March 2007

OBJECTIVE—To clarify the role of the T-lymphocyte–associated-4 (CTLA-4) polymorphism in the susceptibility to child-onset type 1 diabetes with regard to its clinical characteristics and complications with autoimmune thyroid disease (AITD) in the Japanese population.
RESEARCH DESIGN AND METHODS—The CTLA-4 49 A/G polymorphism was detected by the PCR-restriction fragment–length polymorphism (RFLP) method in 97 type 1 diabetic subjects and 20 patients with Graves’ disease, a cohort which included 4 patients who also had type 1 diabetes.
RESULTS—The genotypes and allele frequencies of this polymorphism did not differ between the type 1 diabetic subjects and the control subjects. The G allele frequency was 63.9% in the type 1 diabetic subjects. The G allele frequency in the subgroup of patients with a high titer of autoantibodies to the GAD antibody (Ab) was 72.9% (P = 0.0499 vs. control subjects); in the subgroup of patients without HLA DRB1*0405, it was 72.6% (P = 0.0271 vs. control subjects); and in the subgroup of patients with a residual β-cell function, it was 78.6% (P = 0.0391 vs. control subjects). The G allele frequency in the patients with Graves’ disease was also significantly higher at 78.1% (P = 0.0405 vs. control subjects). Furthermore, the frequency in our diabetic subjects complicated with Graves’ disease was even higher (87.5%).
CONCLUSIONS—We have demonstrated that a distinct association exists between the G allele of CTLA-4 and high values of GAD Ab, residual β-cell function, and the absence of HLA-DRB1*0405.