bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Maternal Gestational Diabetes and Adiposity on Neonatal Adiposity and Blood Pressure
Authors: Vohr Betty R , McGarvey Stephen T , Coll Cynthia Garcia 
Published: March 2007

OBJECTIVE
To determine the effects of maternal factors, including prepregnancy maternal adiposity, weight gain during pregnancy, degree of abnormality of the glucose tolerance test, glycemia during pregnancy, and treatment with insulin versus diet therapy, on neonatal body weight, adiposity, and blood pressure in infants of mothers with gestational diabetes (IGDM) and control patients.

RESEARCH DESIGN AND METHODS
A total of 119 term IGDM, including 57 large-for-gestational-age (LGA) and 62 appropriate-for-gestational-age (AGA) infants, and 143 term control infants, including 74 LGA and 69 AGA infants, were prospectively enrolled. Maternal measurements of prepregnancy weight, height, and weight gain were abstracted from medical records. A diagnosis of gestational diabetes was made on the basis of an initial 1-h 50-g glucose screen value ≥130 mg/dl followed by two abnormal values in a 100-g oral glucose tolerance test. Infant anthropometric measurements were obtained, and blood pressure was measured on day 2 of life. Correlation analyses and multiple regression analyses were performed to assess the relationships among maternal factors and neonatal adiposity and blood pressure.

RESULTS
Multiple regression analyses to determine the effects of significant maternal factors on infant body mass index (BMI) revealed that prepregnancy weight and weight gain were significant predictors for both IGDM and control infants. An increased glucose screen predicted BMI for control subjects, whereas the mean 2nd and 3rd trimester glucose values were the significant predictors for IGDM. Also, increased newborn triceps skinfold thickness measurements correlated with increased systolic blood pressure for IGDM (r = 0.29, P &lt; 0.03).

CONCLUSIONS
Increased maternal prepregnancy weight, weight gain in pregnancy, and glycemia in pregnancy all place IGDM at increased risk of macrosomia and adiposity. Increased adiposity in the IGDM appears to be related to increased infant blood pressure. Longitudinal evaluation is needed to determine whether neonatal adiposity in IGDM is predictive of increased adiposity and blood pressure during childhood.
National Data on the Epidemiology of IDDM in Greece: Cases diagnosed in 1992
Authors: Dacou-Voutetakis Catherine , Karavanaki Kyriaki , Tsoka-Gennatas Helen ,   The Hellenic Epidemiology Study Group
Published: March 2007

OBJECTIVE
To detect the incidence, geographic distribution, and seasonal variation of insulin-dependent diabetes mellitus (IDDM) in all of Greece.

RESEARCH DESIGN AND METHODS
One hundred and thirty-seven children (75 boys and 62 girls) up to 14.9 years of age were diagnosed with IDDM in Greece in 1992.

RESULTS
The age-adjusted incidence of IDDM in Greece in 1992 was 6.25/100,000 population (boys: 6.17/100,000;: girls: 6.28/100,000). There was a significant pubertal peak. The incidence of IDDM was significantly higher in metropolitan (10.0/100,000) than in rural (4.21/100,000), semirural (7.48/100,000), or urban areas (5.36/100,000) of Athens. There was a marginal difference between rural and semirural areas. No significant seasonal variation in the incidence of IDDM was observed.

CONCLUSIONS
We conclude that the incidence of IDDM in Greece is among the five lowest in Europe. An impressive clustering of cases was observed in the Athens metropolitan area compared with the rural and semirural areas, an observation that possibly underlines the importance of environmental factors (stressful situations, infections, dietary habits, and others) in the expression of IDDM.
Contribution of Obesity to Defects of Intracellular Glucose Metabolism in NIDDM
Authors: Chung Joyce W , Suh Kyo-Il , Joyce Mary , Ditzler Tim , Henry Robert R 
Published: March 2007

OBJECTIVE
To examine the contribution of obesity to insulin resistance and abnormalities of intracellular glucose and fat metabolism in NIDDM.

RESEARCH DESIGN AND METHODS
Glucose turnover measurements and indirect calorimetry were performed in 10 obese non-insulin-dependent diabetes mellitus (NIDDM) and 10 lean NIDDM subjects (body mass index 35.3 ± 1.0 vs. 24.1 ± 0.5 kg/m2 P &lt; 0.001) in the basal state and during hyperinsuhnemic (720 pmol · m-2 · min-1) euglycemic (5.0-5.5 mmol/1) clamps.

RESULTS
Obese and lean NIDDM subjects demonstrated similar basal rates of glucose uptake (GU) (1.15 ± 0.08 vs. 1.26 ± 0.08 mmol/min, NS) as well as oxidative (0.49 ± 0.07 vs. 0.53 ± 0.05 mmol/min, NS) and nonoxidative (0.67 ± 0.10 vs. 0.73 ± 0.12 mmol/min, NS) glucose metabolism. During hyperinsuhnemic glucose clamp studies, rates of GU were lower in obese NIDDM subjects (34.1 ± 2.3 vs. 55.2 ± 3.8 μmol · kg fat-free mass [FFM]-1 · min-1, P ≥ 0.001) as were rates of oxidative (14.1 ± 1.3 vs. 22.1 ± 2.1 μmol · kg FFM-1 · min-1 P &lt; 0.005) and nonoxidative (20.0 ± 2.3 vs. 33.1 ± 3.6 μmol · kg FFM-1 · min-1 P &lt; 0.01) glucose metabolism. Although absolute rates of insulin-stimulated GU were decreased in the obese group, the relative distribution into glucose oxidation (Gox) and nonoxidative glucose metabolism (Nox) was comparable in both groups (Gox 42% in obese and 41% in lean subjects; Nox 58% in obese and 59% in lean subjects). The NIDDM groups had similar basal free fatty acid levels that were suppressed equally during hyperinsulinemic clamps. However, basal fat oxidation (Fox) was greater in the obese NIDDM group (103 ± 11 vs. 73 ± 8 μmol/min, P ≥ 0.05) and was less suppressed to insulin (74 ± 13 vs. 16 ± 3 μmol/ min, P &lt; 0.001).

CONCLUSIONS
These results indicate that when obesity is present in NIDDM subjects with this degree of hyperglycemia, insulin-stimulated GU is lower by 35-40%. Reduced GU in obese NIDDM subjects leads to decreased intracellular substrate availability and lower rates of oxidative and nonoxidative glucose metabolism. Insulin suppression of Fox is also impaired when obesity is present and may contribute to decreased insulin-mediated GU in NIDDM. We conclude that obesity increases insulin resistance in NIDDM primarily by effects on GU rather than the intracellular pathways of glucose metabolism.
Safety and Efficacy of Normalizing Fasting Glucose With Bedtime NPH Insulin Alone in NIDDM
Authors: Cusi Kenneth , Cunningham Glenn R , Comstock John P 
Published: March 2007

OBJECTIVE
To examine the safety and overall clinical effects of normalizing the fasting plasma glucose (FPG) level with bedtime NPH insulin alone in patients with non-insulin-dependent diabetes mellitus (NIDDM) that is poorly controlled with maximal doses of sulfonylureas.

RESEARCH DESIGN AND METHODS
Twelve obese male NIDDM subjects were treated for 16 weeks with bedtime insulin after a 4-week sulfonylurea washout. The insulin dosage was increased until the FPG level was normalized. The 24-h plasma glucose profiles and lipid and HbA1c levels were measured at the beginning and end of the study, and the incidence and severity of hypoglycemic episodes were closely monitored. In addition, hyperglycemic clamp studies were performed to assess insulin secretion and provide an indirect measurement of insulin sensitivity.

RESULTS
FPG (14.6 ± 0.9 mmol/l at week 0) was normalized (&lt;6.4 mmol/l) within 6 weeks (5.9 ± 0.6 mmol/l) and remained at target levels until the end of the study (4.0 ± 0.03 mmol/l at week 16, P &lt; 0.001). The insulin dose was 80 ± 9 U/day (0.86 ± 0.10 U/kg). Improved glycemic control was confirmed by a reduction in HbA1c (10.9 ± 0.05 vs. 7.2 ± 0.2%, P &lt; 0.001) and mean 24-h glucose (17.2 ± 0.2 vs. 7.4 ± 0.2 mmol/l, P &lt; 0.001). The incidence of mild or moderate hypoglycemic episodes was 3.4 ± 1/patient for the entire 16-week study, and no patient experienced severe hypoglycemia. Bedtime insulin significantly improved total cholesterol, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and triglyceride levels (P &lt; 0.01). Weight gain was 2.4 ± 0.7 kg, and blood pressure was unchanged. During the hyperglycemic clamp, there was an improvement in the first phase (P &lt; 0.001) and in the second phase (P &lt; 0.01) of insulin secretion. There also was an increase in the rate of exogenous glucose infused (M)(P &lt; 0.01) and in the M/C-peptide ratio (P &lt; 0.02), suggesting enhanced insulin sensitivity.

CONCLUSIONS
NPH insulin given at bedtime in amounts sufficient to achieve a normal FPG level does not cause excessive or severe hypoglycemia and does lead to good glycemic and lipid control in NIDDM. Bedtime insulin therapy also is accompanied by improved insulin secretion and insulin sensitivity. We conclude that a single dose of insulin alone at bedtime merits consideration as a therapeutic strategy in patients with poorly controlled NIDDM.
Diabetes in Urban African-Americans: II. High prevalence of microalbuminuria and nephropathy in African-Americans with diabetes
Authors: Goldschmid Merilyn G , Domin William S , Ziemer David C , Gallina Daniel L , Phillips Lawrence S 
Published: March 2007

OBJECTIVE
African-Americans with diabetes have an increased risk of endstage renal disease, but underlying mechanisms are poorly understood. We undertook this study to evaluate prevalence and risk factors for renal disease in an African-American population with diabetes.

RESEARCH DESIGN AND METHODS
We measured urine albumin excretion in 578 consecutive patients presenting for the first time to the Grady Memorial Hospital Diabetes Unit in Atlanta, GA. The unit serves an urban population that is predominantly African-American; 85% of patients have non-insulin-dependent diabetes mellitus (NIDDM). Subjects provided 24-h and/or ∼ 3-h urine collections for measurement of albumin and creatinine.

RESULTS
Correlation of the albumin/creatinine ratio (μg/mg) with the 24-h albumin excretion rate was 0.89 (P &lt; 0.001, n = 123). Although the median duration of diabetes was only 1 year, among all subjects, the estimated prevalence of microalbuminuria (30–300 mg albumin/24 h) was 25% and that of nephropathy (&gt; 300 mg albumin/24 h) was 11%. Among African-Americans with NIDDM (n = 466), the estimated prevalence of microalbuminuria was 24% and that of nephropathy was 12% prevalence remained high (25 and 5%, respectively) among 219 patients with &lt; 1 year known duration of diabetes. Metabolic control was not associated with disease. However, among all subjects with NIDDM, the odds ratio for nephropathy among subjects with disease duration &gt; 5 years compared with those with disease duration &lt; 1 year was 4.65 (95% confidence interval [CI] 2.24–9.79), and the odds ratio for nephropathy among subjects with hypertension compared with those without hypertension was 2.64 (CI 1.42–4.93). Odds ratios were comparable among African-Americans with NIDDM. Trends were similar but less significant for subjects with microalbuminuria.

CONCLUSIONS
Albuminuria can be identified reliably and conveniently by the albumin/creatinine ratio in brief urine collections. In our patients, clinically significant albuminuria occurred in 36% of persons at first presentation. Since increased risk was associated with hypertension and control of hypertension can slow progression of renal disease, screening for albuminuria and treatment of hypertension should be aggressive in urban populations of African-Americans with diabetes.
Apolipoprotein E Polymorphism and Insulin Levels in a Biethnic Population
Authors: Valdez Rodolfo , Howard Barbara V , Stern Michael P , Haffner Steven M 
Published: March 2007

OBJECTIVE
To study the association of apolipoprotein E (apoE) polymorphism with important cardiovascular risk factors other than cholesterol levels, such as insulinemia and insulin resistance.

RESEARCH DESIGN AND METHODS
In this report, we study the association of three major apoE phenotypes (apoE 3/2, apoE 3/3, and apoE 4/3) with indicators of insulin resistance such as fasting insulin, glucose, and lipid levels in 320 nondiabetic Mexican-Americans and non-Hispanic whites from San Antonio, TX.

RESULTS
The two ethnic groups differed in the frequencies of the three major apoE phenotypes. However, the associations of these phenotypes with lipid and insulin levels were similar in both ethnic groups and in both sexes. Compared with the other two major apoE phenotypes, the apoE 3/2 phenotype was associated with lower levels of total and low-density lipoprotein cholesterol and lower levels of fasting and 2-h postload insulin.

CONCLUSIONS
In addition to the association with cholesterol levels, the variability at the apoE locus may be associated with a much broader set of metabolic factors that relate to insulin resistance.
Variability in Diagnostic Evaluation and Criteria for Gestational Diabetes
Authors: Solomon Caren G , Willett Walter C , Rich-Edwards Janet , Hunter David J , Stampfer Meir J , Colditz Graham A , Manson Joann E 
Published: March 2007

OBJECTIVE
To determine the frequency of screening for gestational diabetes mellitus (GDM) among a population receiving regular prenatal care and to assess the extent to which National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM are used by practicing obstetricians.

RESEARCH DESIGN AND METHODS
We studied participants in the Nurses' Health Study II, a large prospective cohort study of 116,678 nurses aged 25–42 years in 1989. A total of 422 women who reported a first diagnosis of GDM between 1989 and 1991 were sent supplementary questionnaires regarding diagnosis and treatment, and medical records were requested for a subset of 120 to validate self-reported GDM and assess criteria used for diagnosis. A sample of 100 women who reported a pregnancy not complicated by GDM were sent questionnaires addressing GDM screening and prenatal care.

RESULTS
Among a sample of 93 women who reported a pregnancy not complicated by GDM and responded to the supplementary questionnaire, 16 (17%) reported no glucose loading test; 69% of unscreened women had one or more risk factors for GDM. Among a sample of 114 women who self-reported GDM in a singleton pregnancy and whose medical records were available for review, a physician diagnosis of GDM was confirmed in 107 (94%). Records and supplementary questionnaires indicated that oral glucose tolerance tests (OGTTs) were performed in 96 (86%) of these women. Of women with a physician diagnosis of GDM whose OGTT results were available, 25% failed to meet NDDG criteria for this diagnosis, although all had evidence of abnormal glucose homeostasis.

CONCLUSIONS
Screening for GDM is not universal, even among a group of health professionals in whom screening prevalence is likely to be higher than in the general population. Diagnostic criteria for GDM among obstetricians in practice remain nonstandard despite NDDG recommendations. Better understanding of the implications of differing degrees of glucose intolerance and of varying GDM screening and management strategies is required to make policy recommendations for appropriate and cost-effective care.
Increased Molar Proinsulin-to-Insulin Ratio in Women With Previous Gestational Diabetes Does Not Predict Later Impairment of Glucose Tolerance
Authors: Hanson Ulf , Persson Bengt , Hartling Svend G , Binder Christian 
Published: March 2007

OBJECTIVE
To evaluate if an increased proinsulin-to-insulin ratio (PI/I) in former gestational diabetes mellitus (GDM) subjects could be a marker for later impairment of glucose tolerance.

RESEARCH DESIGN AND METHODS
This study is a prospective follow-up. In a previous follow-up study of former GDM subjects 3–4 years after an index pregnancy, an increased PI/I was found also in normoglycemic nonobese former GDM subjects compared with control subjects. A 75–g oral glucose tolerance test (OGTT) was performed 3 years after the first follow-up, i.e., 6–7 years after the index pregnancy in 97 of the former GDM subjects and in 23 control subjects. A 75-g OGTT according to the World Health Organization was performed. Glucose, insulin, proinsulin, and C-peptide were determined at 0, 30, 60, 90, 120, 150, and 180 min after the glucose intake.

RESULTS
Since the first follow-up, an additional 3 in 97 (3.1%) and 15 in 97 (15.5%) of the former GDM subjects had NIDDM or impaired glucosetolerance (IGT), respectively. All control subjects still had a normal OGTT. The fasting PI/I at follow-ups 1 and 2 was significantly correlated in the former GDM subjects (r = 0.41, P&lt; 0.001) and in the control group (r = 0.46, P &lt; 0.05). There was no significant correlation between the PI/I in follow-up 1 and the fasting or 2-h glucose values at follow-up 2. If GDM subjects with a PI/I in the upper quartile in the first follow-up were compared with those with a lower PI/I, there were no significant differences in outcome of OGTT in the second follow-up.

CONCLUSIONS
The hypothesis that an increased fasting PI/I is a marker for later development of NIDDM or IGT in former GDM subjects could not be supported.
Can Caretakers of Children with IDDM Accurately Measure Small Insulin Doses and Dose Changes?
Authors: Silva Sheryl R , Clark Loretta , Goodman Steven N , Plotnick Leslie P 
Published: March 2007

OBJECTIVE
To determine if caretakers of young children with IDDM could consistently reproduce small incremental measurements of insulin (U100).

RESEARCH DESIGN AND METHODS
Fifteen caretakers of children with IDDM were asked to deliver repeated small doses of insulin, including doses separated by only 0.25 U of insulin. A sensitive gravimetric technique was used to determine the error in measurement of these low doses of insulin. Statistical analysis was used to evaluate accuracy and internal consistency of each caretaker at each dose.

RESULTS
The means ± SD at each dose level were as follows: 2.75 ± 0.13 U at 2.5 U, 3.19 ± 0.13 U at 3.0 U, 3.55 ± 0.13 U at 3.25 U, and 3.70 ± 0.11 U at 3.5 U. All doses were biased toward overadministration. There was as statistically significant difference in the dose delivered when the target doses were varied by only 0.25 U. The average differences and standard errors between 2.5 U and 3.0 U, 3.0 U and 3.25 U, and 3.25 U and 3.5 U were 0.44 ± 0.20 U, 0.36 ± 0.018 U, and 0.15 ± 0.017 U, respectively.

CONCLUSIONS
Participants were not accurate in measuring small insulin doses, consistently overdrawing insulin by an average of 0.22 U. Caretakers are reasonably internally consistent with a given dose, since participants were able to measure statistically significant differences in 0.25 U dose changes. The error in insulin measurement does not vary with the intended dose level. Caretakers in the same family deliver insulin doses as variable from each other as they are from the population as a whole; however, when two or more individuals are responsible for one insulin dose in a child with IDDM, they have a combined variability that is ∼40% greater than a single individual's variability.
Evaluation of Delayed Gastric Emptying in Diabetic Patients With Autonomic Neuropathy by a New Magnetic Resonance Imaging Technique and Radio-Opaque Markers
Authors: Lehmann Roger , Borovicka Jan , Kunz Patrik , Crelier Gerard , Boesiger Peter , Fried Michael , Schwizer Werner , Spinas Giatgen A 
Published: March 2007

OBJECTIVE
Our objective was to validate a new noninvasive magnetic resonance imaging (MRI) technique for diagnosis of delayed gastric emptying by using radio-opaque markers (ROMs) in diabetic patients with and without cardiovascular autonomic (CAN) and peripheral sensomotoric neuropathy (PSN).

RESEARCH DESIGN AND METHODS
Fifteen diabetic outpatients were recruited, eight with CAN and PSN (group A, age 28–61 years, mean diabetes duration 27 years) and seven without CAN (group B, age 28–60 years, mean diabetes duration 16 years). Gastric emptying and motility were assessed with ROMs and MRI in random order. After an overnight fast either a test meal (451 kcal) containing a capsule with 10 ROMs is eaten and a supine plain abdominal × ray is taken after 6 h or 500 ml intralipid 10% (550 kcal) is swallowed for the MRI study, using a 1.5 Tesla Gyroscan ACS II (Philips, Eindohoven, The Netherlands). Computer-assisted segmentation of images was used to measure gastric emptying (T1/2, min) over 125 min, contraction frequency (F, min−1), mean contraction amplitude (CA, % basal), and velocity (V, cm/s). Blood glucose was kept constant at 5.0–8.0 mmol/l.

RESULTS
In group A, 6.1 ± 1.36 ROMs (mean ± SE) were retained in the stomach after 6 h and 0 ROM in group B, indicating a significant delay of gastric emptying in patients with CAN. The MRI study revealed a significantly longer gastric emptying (P &lt; 0.005) in group A (T1/2 = 124 ± 10 min) as compared with group B (T1/2 = 85 ± 18 min). There was no difference in F, CA, and V between the two groups: F 2.9 ± 0.07 and 2.7 ± 0.1 (min−1), CA 26.8 ± 1.2 and 29.6 ± 1.6 (% basal), V 0.43 ± 0.02 and 0.40 ± 0.02 (cm/s), respectively.

CONCLUSIONS
MRI offers the possibility of visualizing and examining exactly the mechanisms responsible for gastric emptying and is characterized by a high specificity but a lower sensitivity as compared with ROMs, which proved to be an ideal screening test for diagnosis of gastroparesis in clinical practice.
Relationship of Locus of Control to Physical Activity Among People With and Without Diabetes
Authors: Gregg Edward W , Kriska Andrea M , Narayan KM Venkat , Knowler William C 
Published: March 2007

OBJECTIVE
To examine the relationship between locus of control (LOC) (internal and external) and physical activity in Pima Indians and to determine whether this relationship is affected by the presence of diabetes.

RESEARCH DESIGN AND METHODS
A population-based sample of 580 Pima Indians was recruited from an ongoing research study. LOC was measured on a 1–40 modified Rotter scale, and past year total physical activity (leisure and work physical activity levels combined) was measured by interviewer-administered questionnaire.

RESULTS
Among both men and women without diabetes, individuals with an internal LOC (score 1–16) were significantly (P &lt; 0.01) more active than those with an external (score 17–40) LOC (70 vs. 30 median metabolic equivalent [MET] hours per week for men: 12 vs. 5 median MET hours per week for women). Controlled for age and BMI, an internal LOC was significantly associated with a higher level of physical activity among men (P = 0.04) and women (P = 0.001) without diabetes, but not among those with diabetes.

CONCLUSIONS
Nondiabetic Pima Indians with an internal LOC are more physically active than those with an external LOC. Enhancing perceptions of internal control may influence physical activity and thus have implications for diabetes prevention.