bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pentamidine-Induced Derangements of Glucose Homeostasis: Determinant roles of renal failure and drug accumulation: A study of 128 patients
Authors: Assan Roger , Perronne Christian , Assan Dominique , Chotard Laurence , Mayaud Charles , Matheron Sophie , Zucman David 
Published: March 2007

OBJECTIVE
To assess the prevalence, presentation, and risk factors of pentami-dine-induced dysglycernia.

RESEARCH DESIGN AND METHODS
Blood glucose values were screened in 244 consecutive immunocompromised patients with Pneumocystis carinii pneumonia: 116 being treated with cotrimoxazole and 128 others with pentamidine.

RESULTS
Two cotrimoxazole patients developed diabetes as a result of necrotiz-ing pancreatitis (1.7%); the others remained euglycemic. Forty-eight pentamidine-treated patients (38.5%) developed severe glucose homeostasis disorders: hypoglyce-mia in 7, hypoglycemia and then diabetes in 18, and diabetes alone in 23 (P &lt; 0.001 vs. the cotrimoxazole group). Hypoglycemia was early, sudden, often recurrent, and life-threatening, associated with inappropriately high insulin levels in plasma; the B-cell response to stimuli was poor. Of the 41 diabetic patients, 26 required insulin therapy; their plasma C-peptide levels were lower than normal, and the B-cell secretory responses to stimuli were poor. Islet cell antibodies, insulin antibodies, and insulitis were not detected. The pentamidine-treated dysglycemic patients differed from their euglycemic counterparts by higher pentamidine doses (P &lt; 0.001), higher plasma creatinine levels (P &lt; 0.001), and more severe anoxia (P &lt; 0.05) and shock (P &lt; 0.001). Most of them had received pentamidine mesylate parenterally (n = 36; 75%); six others received the isethionate salt and six exclusively pentamidine aerosols.

CONCLUSIONS
Pentamidine-induced dysglycemic accidents are primarily due to inappropriate insulin release and toxicity to the islet B-cells. Drug accumulation due to excessive doses, iterative courses, and/or renal impairment is the determining risk factor.
Diagnostic Procedures for Catheter Malfunction in Programmable Impiantante Intraperitoneal Insulin Infusion Devices
Authors: Olsen Craig L , Turner Dee S , Iravani Mohamad , Waxman Kenneth , Selam Jean-Louis , Charles M Arthur 
Published: March 2007

OBJECTIVE
To evaluate the roles of 1) abdominal radiography, 2) a pressure diagnostic procedure (PDP) using a standardized diluent infusion into the catheter sideport, and 3) radiocontrast imaging of the catheter lumen as procedures for diagnosing catheter malfunction in diabetic patients implanted with a programmable intraperitoneal infusion device.

RESEARCH DESIGN AND METHODS
Sixteen type I diabetic patients implanted with Infusaid programmable intraperitoneal insulin pumps were studied. The ability of the above three procedures to assist diagnosis of catheter malfunction and distinguish between occlusion and catheter breakage was retrospectively analyzed. Glycated hemoglobin was measured to determine the clinical importance of catheter malfunctions and decreases in pump flow due to insulin aggregation in the pump chamber.

RESULTS
; Mean glycated hemoglobin levels increased significantly from 8.0 ± 0.3 to 9.0 ± 0.4% (P &lt; 0.05) before and after catheter malfunction, but not during pump flow slowdowns. Mean peak pressure during PDP was 1.96 ± 0.14 psi (P &lt; 0.01 vs. normal) in reversibly occluded catheters and 1.86 ± 0.35 psi (P &lt; 0.05 vs. normal) in broken catheters, compared with 1.32 ± 0.23 psi in normal catheters. Decay times during PDP were &gt;50 s for both reversibly occluded and broken catheters (P &lt; 0.001 vs. normal of 3.6 ± 0.82 s). Abdominal radiographs and sideport injections of contrast material were used to distinguish the types of broken catheters.

CONCLUSIONS
Catheter breakage and occlusion are complications in im-plantable insulin infusion systems and result in metabolic deterioration. The presence of a sideport allows pressure data and radiographie procedures to assist in determining the cause of catheter malfunction. A diagnostic algorithm was generated to improve efficiency in investigating catheter problems.
Pancreatic Transplantation: Impact on the quality of life of diabetic renal transplant recipients
Authors: Milde Frances K , Hart Laura K , Zehr Pamela S 
Published: March 2007

OBJECTIVE
To determine the impact of pancreas transplantation on the quality of life of renal transplant recipients with diabetes.

RESEARCH DESIGN AND METHODS
In this quasi-experimental comparative study of 41 successful pancreas transplant (SP) recipients, 13 failed pancreas transplant (FP) recipients, and 28 kidney alone (KA) transplant recipients, we collected data from individuals who had their pancreas/kidney or kidney alone transplants ≥6 months before at a university tertiary care center. This study was an extension of a 1992 study of SP and FP recipients. The subject group was enlarged with additional pancreas/kidney recipients and a control group of KA recipients. Five dimensions of life quality were measured.

RESULTS
Groups did not differ significantly regarding age, gender, marital status, comorbidity, type of prior dialysis, current kidney function, length of time since transplant, physical activity, symptom burden, emotional state, and feelings of well-being. A significant time by group interaction occurred for quality of life (P = 0.0023) and health (P = 0.0001). Patients in the SP and KA groups perceived their past life and health quality to be significantly lower and their present and future life and health quality to be significantly better than did the FP group. The groups' major concerns differed significantly. The FP group's concern related to diabetes, the SP group's to immunosuppression, and the KA group's to graft rejection.

CONCLUSION
Patients with failed pancreas but successful kidney transplants see less improvement in their quality of life than do patients who meet their transplant goals, irrespective of whether they receive a pancreas.
Effects of Insulin on Cholesterol Synthesis in Type II Diabetes Patients
Authors: Scoppola Alessandro , Testa Guido , Frontoni Simona , Maddaloni Elvira , Gambardella Sergio , Menzinger Guido , Lala Alberto 
Published: March 2007

OBJECTIVE
To evaluate the effects of intensive insulin therapy and subsequent optimized metabolic control on daily urinary mevalonic acid (MVA) excretion, an index of whole-body cholesterol synthesis, and the acute effects of insulin on plasma MVA concentrations in type II diabetes.

RESEARCH DESIGN AND METHODS
Ten (five men and five postmenopausal women) nonobese, normolipidemic (total cholesterol &lt; 6.2 mmol/l, triglycerides &lt; 2.82 mmol/l), type II diabetic patients in poor metabolic control (HbA1c &gt; 10%, fasting plasma glucose &gt; 11 mmol/l) and receiving sulfonylurea treatment were selected. The 24-h urinary MVA excretion and plasma lipid values were determined before and after intensive insulin therapy. The acute effects of insulin on plasma MVA concentrations were also evaluated during a 3-h euglycemic hyperinsulinemic clamp study.

RESULTS
Urinary MVA excretion rates (μmol/24h) were 1.82 ± 0.21 in control subjects and 2.49 ± 0.35 (P &lt; 0.01 vs. control subjects) and 1.78 ± 0.28 in patients before and after intensive insulin therapy, respectively. Total cholesterol, low-density-lipoprotein (LDL) cholesterol, and triglycerides decreased by 9, 8, and 12%, respectively, after blood glucose optimization. Acute insulin infusion during the euglycemic clamp studies reduced mean plasma MVA concentrations at 120 and 180 min by 29 and 38%, respectively (P &lt; 0.01 for both vs. baseline).

CONCLUSIONS
Our study demonstrates that in nonobese, normolipidemic, type II diabetic patients under poor metabolic control, an increased cholesterol synthesis is normalized by insulin therapy. Hyperinsulinemia in the presence of euglycemia acutely decreases the circulating levels of MVA, the immediate product of hydroxymethylglutaryl-CoA reductase activity and an index of whole-body cholesterol synthesis.
Risk Factors for Poor Glycemic Control in Diabetic Children in France
Authors: Tubiana-Rufi Nadia , Moret Leila , Czernichow Paul , Chwalow Judith 
Published: March 2007

OBJECTIVE
To test whether immigrant versus nonimmigrant origin, among other factors, is associated with differences in glycemic control in diabetic children.

RESEARCH DESIGN AND METHODS
A cross-sectional multicenter survey was performed in 165 French diabetic children aged 7–13 years and their parents. HbA1c was measured by high-performance liquid chromatography in a single laboratory (reference value: 5.1 ± 0.6%). Standardized questionnaires were used to evaluate cognitive, familial, and socioeconomic factors and adherence to diabetes regimen.

RESULTS
The mother's place of birth was found to account for 6.6% of the HbA1c variance. Two groups of children were identified with French-speaking immigrant (n = 27) and native French mothers (n = 138) who had significantly different HbA1c values of 9.1 ± 8% vs. 8.1 ± 1.4%, respectively (P &lt; 0.001). Adherence to diabetes treatment was significantly lower in immigrant mothers for diet and insulin changes (P &lt; 0.01), as well as their level of diabetes knowledge (P &lt; 0.01). This immigrant group had no significant differences in parents' socioeconomic status, educational background, family status, family functioning, diabetes education background, and social support compared with the native French mothers' group.

CONCLUSIONS
Despite no differences in socioeconomic status, a group of children with less well-controlled diabetes was identified by the mother's place of birth. Cultural factors have a crucial importance in glycemic control in diabetic children and in parents' adherence to treatment and must be taken into account in the development of educational programs.
Progression of Retinopathy After Change of Treatment From Oral Antihyperglycemic Agents to Insulin in Patients With NIDDM
Authors: Henricsson Marianne , Janzon Lars , Groop Leif 
Published: March 2007

OBJECTIVE
In insulin-dependent diabetes mellitus, institution of good glycemic control has been shown to retard development of retinopathy even though temporary progression has occurred. Few data have been available from patients with non-insulin-dependent diabetes mellitus (NIDDM). To determine the impact of improved glycemic control on retinopathy in patients with NIDDM, we examined, in a case-control study, the progression of retinopathy in 94 patients who changed treatment from oral antihyperglycemic agents to insulin.

RESEARCH DESIGN AND METHODS
We used the Wisconsin retinopathy scale and related progression of retinopathy during a 2-year observation period to changes in HbA1c after institution of insulin therapy.

RESULTS
Progression of retinopathy ≥3 levels occurred in 23% of the patients and was significantly more common in the patient group in which HbA1c was lowered ≥3% compared with progression in the group in which HbA1c was lowered &lt;3% (P = 0.0001; relative risk 3.2; 95% confidence interval 1.5–6.9).

CONCLUSIONS
Improved glycemic control as achieved by insulin therapy may be associated with worsening of retinopathy in patients with NIDDM.
Effect of Glipizide Treatment on Response to an Infused Glucose Load in Patients With NIDDM
Authors: Sheu Wayne H H , Jeng Chii-Yuan , Fuh Martin M T , Chen Y D Ida , Reaven Gerald M 
Published: March 2007

OBJECTIVE
This study was initiated to compare the effect of sulfonylurea treatment on the response to an infused glucose load of patients with non-insulin-dependent diabetes mellitus (NIDDM) at a basal insulin concentration and in response to physiological hyperinsulinemia.

RESEARCH DESIGN AND METHODS
We used the insulin suppression test, in which subjects were infused for 180 min with somatostatin, exogenous insulin, and glucose. Since similar steady-state plasma insulin (SSPI) concentrations are reached in all subjects, the resultant steady-state plasma glucose (SSPG) concentration permits comparison of the ability of a given individual to maintain glucose homeostasis in response to the infused glucose load.

RESULTS
We studied 15 nonobese patients at two different SSPI concentrations, before and after glipizide treatment, at basal (68 ± 4 pmol/l) and high (470 ± 31 pmol/l) levels. Values for SSPG concentrations were lower after treatment at both the basal (15.3 ± 0.5 vs. 18.5 ± 0.6 mmol/l; P &lt; 0.001) and the high (10.6 ± 0.7 vs. 14.2 ± 0.7 mmol/l; P &lt; 0.001) SSPI concentrations. To compare the responses of each patient before and after treatment, we calculated the fractional glucose metabolic rate, i.e., (glucose infusion rate — urinary glucose loss) ÷ by SSPG. To provide an alternative method of comparing the effect of sulfonylurea treatment, we divided the incremental increase in fractional metabolic glucose rate between the studies done at the low and high SSPI by the incremental increase in SSPI between the two studies (insulin sensitivity index [S1]).

CONCLUSIONS
The results of these calculations indicated that glipizide treatment was associated with a significant increase in fractional glucose metabolic rate at a basal insulin concentration (29 ± 3 to 42 ± 2 ml · m−2 · min−1, P &lt; 0.001), and in response to the incremental change in SSPI (14 ± 4 to 23 ± 3 ml · m−2 · min−1, P &lt; 0.02). Finally, S1 also increased in association with sulfonylurea (0.24 ± 0.06 to 0.43 ± 0.07 ml · m−2 · min−1/μU · ml−1, P &lt; 0.001).
Infected Puncture Wounds in Diabetic and Nondiabetic Adults
Authors: Lavery Lawrence A , Walker Steven C , Harkless Lawrence B , Felder-Johnson Kim 
Published: March 2007

OBJECTIVE
To evaluate bone and soft tissue pathogens resulting from puncture wounds among diabetic and nondiabetic adults.

RESEARCH DESIGN AND METHODS
We used a case-control design to compare bacterial pathogens in diabetic and nondiabetic subjects with foot infections precipitated by puncture injuries. We used ICD-9-CM code E920.8 to identify 77 diabetic and 69 nondiabetic patients admitted to the hospital for infected puncture wounds. We identified surgical bone and soft tissue cultures and number and type of organisms per culture.

RESULTS
Nondiabetic subjects had significantly less osteomyelitis (13 vs. 35%, P &lt; 0.01) than diabetic subjects and were infected by fewer organisms. Pseudomonas was the most common cause of osteomyelitis among nondiabetic subjects (P &lt; 0.001). Staphylococcus aureus was more common in diabetic bone (P &lt; 0.001) and soft tissue (P &lt; 0.001) infections. Polymicrobial osteomyelitis was more common in diabetic subjects. There was a longer delay until diabetic subjects received medical treatment compared with nondiabetic subjects (8.7 vs. 5.3 days, P &lt; 0.002). Diabetic subjects were more likely to have neuropathy (P &lt; 0.001) and to have sustained their injuries while barefoot (P &lt; 0.006).

CONCLUSIONS
Puncture wounds in diabetic subjects were commonly associated with polymicrobial infections. Pseudomonas was the most common cause of nondiabetic osteomyelitis. These results have implications for differential emergent and chronic treatment of puncture wounds in diabetic versus nondiabetic subjects.
Biomedical and Psychiatric Risk Factors for Retinopathy Among Children With IDDM
Authors: Kovacs Maria , Mukerji Protap , Drash Allan , Iyengar Satish 
Published: March 2007

OBJECTIVE
Illness duration and glycemic control influence the development of retinopathy in childhood-onset insulin-dependent diabetes mellitus (IDDM). Psychiatric disorders and sociodemographic factors also affect diabetes-related outcomes. However, biomedical and psychosocial factors have not been examined together in modeling the risk of retinopathy.

RESEARCH DESIGN AND METHODS
We conducted a single-site prospective longitudinal study of 66 children (aged 8-13 years) newly diagnosed with IDDM. Repeated assessments served to derive psychiatric diagnoses. Poor glycemic control was defined as the upper 15th percentile of all HbA1 values. After a median follow-up of 10 years, severity of retinopathy was determined. It was modeled with a stepwise polychotomous regression procedure using antecedent biomedical and psychosocial variables.

RESULTS
Young adults with childhood-onset IDDM were found to be at increased risk of retinopathy the longer they had IDDM, the more persistently they evidenced poor antecedent glycemic control, and the longer they suffered from depressive illness. These three factors operated individually and additively, with duration of IDDM conferring a baseline level of risk. In depressed patients (27%), depression onset antedated the detection of retinopathy generally by 7 years.

CONCLUSIONS
Duration of childhood-onset IDDM confers a baseline level of risk of retinopathy irrespective of glycemic control; antecedent clinical depression is also a risk factor. Depression therefore may serve as a marker of vulnerability and help to identify a subgroup of patients at risk for complications. The findings raise the question whether timely treatment of depression could forestall diabetic retinopathy.
Incidence and Determinants of Elevated Urinary Albumin Excretion in Pima Indians With NIDDM
Authors: Nelson Robert G , Knowler William C , Pettitt David J , Hanson Robert L , Bennett Peter H 
Published: March 2007

OBJECTIVE
To examine the incidence and determinants of elevated urinary albumin excretion in Pima Indians with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
The incidence of elevated urinary albumin excretion (≥30 mg albumin/g creatinine) and its relationship with baseline characteristics was determined in 456 Pima Indians ≥15 years old with NIDDM who were followed for up to 11.6 years (median 4.7 years).

RESULTS
Of these 456 subjects, 192 (42%; 58 men, 134 women) developed elevated urinary albumin excretion, 172 of whom (90%) were within the microalbu-minuric range (30–299 mg/g). The incidence of elevated urinary albumin excretion was related to retinopathy, type of diabetes treatment, longer duration of diabetes, lower body mass index, and higher values of mean arterial pressure, HbA1, and fasting and 2-h postload plasma glucose concentration at the baseline examination, but not to sex. A relationship with cholesterol was found in durations of diabetes of ≥10 years. The cumulative incidence of elevated albumin excretion was 17% after 5 years of NIDDM.

CONCLUSIONS
The incidence of elevated urinary albumin excretion in Pima Indians with NIDDM is at least as high as that reported previously in insulin-dependent diabetes mellitus, and its major determinants are the same as those shown previously to predict the development of more advanced renal disease in this population.
No Association of Antibodies to Glutamic Acid Decarboxylase and Diabetic Complications in Patients With IDDM
Authors: Roll Ursula , Nuber Axel , Schröder Anja , Gerlach Evelin , Janka Hans-U , Ziegler Anette-G 
Published: March 2007

OBJECTIVE
To evaluate the association of antibodies to glutamic acid decarboxylase (GAD-ab) and diabetic complications (neuropathy, retinopathy, and nephropa-thy) in patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
We examined the prevalence of GAD-ab (immunoprecipitation assay) and islet cell antibodies (ICAs) (indirect immu-nofluorescence) in a representative sample of IDDM patients (n = 146) with different disease duration (2–52 years, median 13.2 years). Of all patients characterized for the existence of diabetic complications, 56 of 146 had peripheral neuropathy, 24 of 142 had autonomie neuropathy, 67 of 141 had retinopathy, and 39 of 146 had nephrop-athy.

RESULTS
GAD-ab (&gt;2 SD) were detected more frequently than ICA (&gt;5 Juvenile Diabetes Foundation units) in IDDM patients of different disease duration (GAD-ab+ 37% [54 of 146] vs. ICA+ 22% [32 of 146], P = 0.011; diabetes duration less than median: GAD-ab+ 47% vs. ICA+ 23%, P = 0.0046; diabetes duration greater than median: GAD-ab+ 27% vs. ICA+ 22%, P &lt; 0.05). For GAD-ab and for ICA, respectively, no difference was observed in frequency of positivity or titers between patients with or without diabetic complications.

CONCLUSIONS
Both GAD-ab and, to a lesser extent, ICA persist for a long time in several individuals. This persistence is not related to diabetic neuropathy or any other diabetic complication.
Prospective Study of Lipoprotein(a) as a Risk Factor for Atherosclerotic Cardiovascular Disease in Patients With Diabetes
Authors: Hiraga Takaki , Kobayashi Tetsuro , Okubo Minoru , Nakanishi Kohji , Sugimoto Tadao , Ohashi Yasuo , Murase Toshio 
Published: March 2007

OBJECTIVE
To assess whether lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease in diabetes.

RESEARCH DESIGN AND METHODS
We studied 221 patients with non-insulin-dependent diabetes mellitus (NIDDM) without diabetic complications who were followed for 2.2–3.1 years. Their serum Lp(a) levels were semiquantified by a rapid electrophoretic method that accurately discriminates high from low serum Lp(a) at the 20 mg/dl level.

RESULTS
Seven of 105 diabetic patients with a high serum Lp(a) experienced a clinical event related to atherosclerotic cardiovascular disease. This incidence was significantly higher than that of the 110 diabetic patients with a low serum Lp(a). The logistic regression analysis revealed that Lp(a) was an independent risk factor for the event.

CONCLUSIONS
Lp(a) is a significant risk factor for atherosclerotic cardiovascular disease in NIDDM.
Improvement of Impaired Counterregulatory Hormone Response and Symptom Perception by Snort-Term Avoidance of Hypoglycemia in IDDM
Authors: Lingenfelser Thomas , Buettner Ulrich , Martin Juergen , Tobis Mark , Renn walter , Kaschel Rainer , Jakober Bernhard 
Published: March 2007

OBJECTIVE
To test the hypothesis that impaired counterregulatory hormone response and symptom perception, induced by recurrent Hypoglycemic episodes over 2 days, may be improved by short–term (2–day) avoidance of hypoglycemia.

RESEARCH DESIGN AND METHODS
We examined two groups of insulin-dependent diabetes mellitus (IDDM) patients (n = 16), none of whom exhibited signs of peripheral or autonomie neuropathy. Two sequential euglycemic-hypoglycemic clamp studies were performed applying stable glycemie plateaus of 5.6, 3.3, 2.2, and 1.7 mmol/l, at which the patients' awareness of and responses to hypoglycemia were evaluated. In the intervention group (n = 11), three short-term Hypoglycemic (&lt;2.2 mmol/l) episodes (days 1–3) preceded the first clamp study (day 4), whereas the second clamp study (day 6) followed a 2-day interval of strict avoidance of hypoglycemia. A control group (n = 5) was introduced to detect adaptation effects caused by the study procedure per se.

RESULTS
This short-term avoidance of hypoglycemia caused improvement of the impaired counterregulatory hormone response during insulin-induced hypoglycemia involving adrenaline (P &lt; 0.05), adrenocorticotrophic hormone (P &lt; 0.03), and cortisol (P &lt; 0.05). Improvement of hypoglycemia symptom awareness encompassed overall symptom perception (multiple analysis of variance, P &lt; 0.04) and the autonomie symptoms of heart pounding (P &lt; 0.05) and sweating (P &lt; 0.05).

CONCLUSIONS
The previously reported compromised neuroendocrine coun-terregulation and symptom awareness, occurring as a consequence of repetitive Hypoglycemic episodes over 2 days, may be improved by a single 2-day interval of strict avoidance of hypoglycemia.