bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitance of Diabetic Retinopathy and Proteinuria Accelerates the Rate of Decline of Kidney Function in Type 2 Diabetic Patients
Authors: Trevisan Roberto , Vedovato Monica , Mazzon Cinzia , Coracina Anna , Iori Elisabetta , Tiengo Antonio , Del Prato Stefano 
Published: March 2007

OBJECTIVE—To evaluate the rate of progression of renal disease in proteinuric type 2 diabetic patients with and without retinopathy.
RESEARCH DESIGN AND METHODS—Thirty-eight proteinuric type 2 diabetic patients with diabetic retinopathy and 27 without were enrolled in an observational study for the evaluation of rate of glomerular filtration rate (GFR) decline and followed up for a median period of 6 years. GFR was determined at least once per year, and blood pressure, glycated hemoglobin, and proteinuria were determined every 4 months.
RESULTS—Although the two groups had comparable GFR, albuminuria, blood pressure, and HbA1c at entry of the study, the rate of decline of GFR was higher in type 2 diabetic patients with retinopathy (−6.5 ± 4.4 ml/year) than in those without (−1.8 ± 4.8 ml/year; P &lt; 0.0001). Protein and albumin excretion rate increased significantly in patients with retinopathy, while they did not change in those without. Mean blood pressure between the two groups of patients were similar both at entry and during the follow-up, although the proportion of patients treated with at least two antihypertensive drugs was higher in patients with retinopathy. On a multiple regression analysis, only mean blood pressure and proteinuria were significant determinants of progression of renal disease in type 2 diabetic patients with retinopathy.
CONCLUSIONS—The rate of progression of renal disease in proteinuric type 2 diabetic patients with retinopathy is faster than that observed in those without retinopathy. The screening for retinopathy identifies patients at high risk for rapid deterioration of kidney function.
Validation of the Toronto Clinical Scoring System for Diabetic Polyneuropathy
Authors: Bril Vera , Perkins Bruce A. 
Published: March 2007

OBJECTIVE—The aim of the current study was to determine the validity of the Toronto Clinical Scoring System (CSS) in reflecting the presence and severity of diabetic peripheral sensorimotor polyneuropathy (DSP) as determined by myelinated fiber density (FD) on sural nerve biopsy.
RESEARCH DESIGN AND METHODS—Eighty-nine patients with both type 1 and type 2 diabetes, ascertained from a large therapeutic randomized controlled trial, were included in this cross-sectional, observational cohort study. Morphological severity of DSP was expressed as the FD in the sural nerve biopsy. The Toronto CSS was applied to all patients to determine a clinical neuropathy score. General linear regression models were used to assess the relationship between the morphological severity of DSP and the Toronto CSS.
RESULTS—The Toronto CSS showed a significant negative correlation with sural nerve FD (R2 = 0.256, P &lt; 0.0001). The Toronto CSS was lower in those with better glycemic control (HbA1c ≤8%). Sural nerve FD and the Toronto CSS showed strong correlations with electrophysiology, by both summed amplitude and summed conduction velocity values.
CONCLUSIONS—The Toronto CSS is a valid instrument to reflect the presence and severity of DSP as measured by sural nerve morphology and electrophysiology. The results of the current study underscore the interrelationships between clinical deficits, electrophysiological findings, and morphological changes in DSP. This evidence suggests that the Toronto CSS may prove useful in documenting and monitoring DSP in the clinic and in clinical research trials.
Indices of Insulin Action, Disposal, and Secretion Derived From Fasting Samples and Clamps in Normal Glucose-Tolerant Black and White Children
Authors: Uwaifo Gabriel I. , Fallon Erica M. , Chin Jeff , Elberg Jane , Parikh Shamik J. , Yanovski Jack A. 
Published: March 2007

OBJECTIVE—To validate fasting indices of insulin sensitivity and secretion in a diverse pediatric population against gold standard estimates from euglycemic and hyperglycemic clamps.
RESEARCH DESIGN AND METHODS—A total of 31 children (mean BMI 25.1 ± 4.9 kg/m2, mean age 8.7 ± 1.4 years, 15 girls and 16 boys, 12 black and 19 white) underwent euglycemic and hyperglycemic clamps 2–6 weeks apart to derive insulin sensitivity indices (SI Eug clamp and SI Hyper clamp). Fasting samples were used to derive the homeostasis model assessment of insulin resistance index (HOMA-IR), HOMA of percent β-cell function (HOMA-B%), quantitative insulin sensitivity check index (QUICKI), insulinogenic index, antilipolytic insulin sensitivity index (ISI-FFA), and C-peptide–to–insulin ratio.
RESULTS—The QUICKI correlated best with SI Eug clamp (r = 0.69, P &lt; 0.05) and had greater correlations to SI Eug clamp than did either SI Hyper clamp (r = 0.45, P &lt; 0.05) or the HOMA-IR (r = −0.51, P &lt; 0.05). Both fasting insulin and the insulinogenic index correlated well with first- and steady-phase insulin secretion (r’s from 0.79 to 0.86, P &lt; 0.05). HOMA-B% was not as highly correlated (r = 0.69–0.72, P &lt; 0.05). Fasting C-peptide–to–insulin ratio was not significantly correlated with clamp-derived metabolic clearance rate of insulin. ISI-FFA was not correlated with the degree of free fatty acid suppression obtained from the clamps.
CONCLUSIONS—The QUICKI, fasting insulin, and the insulinogenic index all closely correlate with corresponding clamp-derived indices of insulin sensitivity and secretion in this diverse pediatric cohort. These results, if replicated in similarly diverse populations, suggest that estimates based on fasting samples can be used to rank order insulin secretion and sensitivity in pediatric cohorts.
Fasting Blood Sample-Based Assessment of Insulin Sensitivity in Kidney-Pancreas-Transplanted Patients
Authors: Perseghin Gianluca , Caumo Andrea , Sereni Lucia Piceni , Battezzati Alberto , Luzi Livio 
Published: March 2007

OBJECTIVE—To ascertain whether simple indexes of insulin sensitivity based on a fasting blood sample may be reliable measures of insulin sensitivity in combined kidney-pancreas- transplanted patients.
RESEARCH DESIGN AND METHODS—Estimates of insulin sensitivity based on fasting plasma glucose, insulin (homeostasis model assessment of insulin sensitivity [HOMA-IS], Quantitative Insulin Sensitivity Check Index [QUICKI]), and free fatty acid (revised QUICKI) concentrations were compared with insulin sensitivity as assessed with the gold standard technique (euglycemic-hyperinsulinemic clamp) in 22 patients who had undergone kidney-pancreas transplantation (KP-Tx) and 18 matched healthy subjects (NOR).
RESULTS—In KP-Tx patients, indexes based on the glucose-insulin product, HOMA-IS (r = 0.47, P = 0.03) and QUICKI (r = 0.47, P = 0.03), were shown to be reliable measures of insulin sensitivity. The introduction of fasting plasma free fatty acid concentration in the revised QUICKI (r = 0.76, P &lt; 0.0001) considerably improved the power of prediction of the clamp-based measure of insulin sensitivity as observed in the healthy control subjects (r = 0.83, P &lt; 0.0001).
CONCLUSIONS—This study shows that in KP-Tx patients, HOMA-IS and QUICKI are reliable measures of insulin sensitivity; the additional incorporation of fasting plasma free fatty acid concentration into the glucose-insulin product (revised QUICKI) resulted in a considerably more powerful index.
Variation in Diabetes Care Among States
Authors: Arday David R. , Fleming Barbara B. , Keller Dana K. , Pendergrass Peter W. , Vaughn Robert J. , Turpin James M. , Nicewander David A. 
Published: March 2007

OBJECTIVE—To examine state variability in diabetes care for Medicare beneficiaries and the impact of certain beneficiary characteristics on those variations.
RESEARCH DESIGN AND METHODS—Medicare beneficiaries with diabetes, aged 18–75 years, were identified from 1997 to 1999 claims data. Claims data were used to construct rates for three quality of care measures (HbA1c tests, eye examinations, and lipid profiles). Person-level variables (e.g., age, sex, race, and socioeconomic status) were used to adjust state rates using logistic regression.
RESULTS—A third of 2 million beneficiaries with diabetes aged 18–75 years did not have annual HbA1c tests, biennial eye examinations, or biennial lipid profiles. There was wide variability in the measures among states (e.g., receipt of HbA1c tests ranged from 52 to 83%). Adjustment using person-level variables reduced the variance in HbA1c tests, eye examinations, and lipid profiles by 30, 23, and 27%, respectively, but considerable variability remained. The impact of the adjustment variables was also inconsistent across measures.
CONCLUSIONS—Opportunities remain for improvement in diabetes care. Large variations in care among states were reduced significantly by adjustment for characteristics of state residents. However, much variability remained unexplained. Variability of measures within states and variable impact of the adjustment variables argues against systems effects operating with uniformity on the three measures. These findings suggest that a single approach to quality improvement is unlikely to be effective. Further understanding variability will be important to improving quality.
Insulin-Induced Decreases in Aortic Wave Reflection and Central Systolic Pressure Are Impaired in Type 2 Diabetes
Authors: Tamminen Marjo , Westerbacka Jukka , Vehkavaara Satu , Yki-Järvinen Hannele 
Published: March 2007

OBJECTIVE—To determine whether large arteries are resistant to insulin.
RESEARCH DESIGN AND METHODS—Insulin normally acutely decreases central systolic pressure by decreasing wave reflection in vivo. This effect occurs before any changes in peripheral vascular resistance or heart rate under normoglycemic conditions. We determined whether the ability of insulin to decrease central aortic pressure is altered in uncomplicated type 2 diabetes. The study subjects consisted of 16 type 2 diabetic patients (age 54 ± 2 years, BMI 29 ± 1 kg/m2) and 19 matched nondiabetic individuals (51 ± 2 years, 29 ± 1 kg/m2) studied under normoglycemic-hyperinsulinemic conditions. Central aortic pressure waveforms were synthesized from those recorded in the periphery using applanation tonometry and a validated reverse transfer function to construct the central aortic pressure waveform every 30 min. This method allowed determination of aortic augmentation (the pressure difference between the first and second central systolic pressure waves) and the augmentation index (augmentation divided by pulse pressure).
RESULTS—Whole-body insulin sensitivity was 31% lower (P &lt; 0.05) in the type 2 diabetic patients than in the normal subjects. Basally, before the insulin infusion, augmentation averaged 8.9 ± 1.3 and 11.1 ± 1.2 mmHg (NS) and the augmentation index averaged 23.1 ± 2.1 and 27.5 ± 2.1% (NS) in the normal subjects and diabetic patients, respectively. After 30 min of hyperinsulinemia, augmentation decreased significantly to 6.1 ± 1.1 mmHg (P &lt; 0.001) in the normal subjects but remained unchanged at 9.1 ± 1.1 mmHg (NS) in type 2 diabetic patients. At 30 min, the augmentation index had decreased significantly (30 ± 7% decrease) to 17.9 ± 2.6% in the normal subjects but remained at 24.4 ± 2.4% in the diabetic patients (13 ± 4% decrease, P &lt; 0.05 for change vs. normal subjects). Central systolic pressure decreased significantly by 30 min in the normal subjects but only after 120 min in the type 2 diabetic patients. There were no significant changes in heart rate, pulse pressure, or forearm blood flow during the first 120 min of the insulin infusion.
CONCLUSIONS—Insulin resistance in type 2 diabetes involves a delay in the ability of insulin to decrease central aortic pressure. This defect could predispose these patients to develop systolic hypertension.
Circulating and Urinary Transforming Growth Factor β1, Amadori Albumin, and Complications of Type 1 Diabetes
Authors: Chaturvedi Nish , Schalkwijk Casper G. , Abrahamian Heidemarie , Fuller John H. , Stehouwer Coen D.A. 
Published: March 2007

OBJECTIVE—Transforming growth factor (TGF)-β1 is overexpressed in diabetes as a consequence of hyperglycemia and the creation of early glycated end products and may be responsible for the characteristic structural renal changes associated with diabetes. We sought to examine the role of both urinary and circulating TGF-β1 and its promoter Amadori albumin in the vascular complications of type 1 diabetes.
RESEARCH DESIGN AND METHODS—The present article reports on a nested case-control study from the EURODIAB Prospective Complications Study of Europeans with type 1 diabetes. Case subjects (n = 356) were all individuals with one or more complications of diabetes; control subjects (n = 185) were all individuals with no evidence of complications.
RESULTS—Urinary TGF-β1 and Amadori albumin were elevated in patients with micro- or macroalbuminuria. Standardized regression effects (SREs) for macroalbuminuria versus normoalbuminuria were 2.45 (95% CI 1.88–3.18, P = 0.0001 for urinary TGF-β1) and 1.67 (1.34–2.07, P = 0.001 for Amadori albumin). The SRE for urinary TGF-β1 remained statistically significant when adjusted for HbA1c, Amadori albumin, and blood pressure. Circulating TGF-β1 was elevated in individuals with proliferative retinopathy compared with individuals without retinopathy (SRE 1.29 [1.07–1.550], P = 0.007). This result was attenuated to 1.16 (0.95–1.43, P = 0.2) in the multivariate model, largely because of HbA1c.
CONCLUSIONS—Elevated levels of urinary TGF-β1 in macroalbuminuria were associated with elevations in Amadori albumin and HbA1c and also in blood pressure. In contrast, only circulating TGF-β1 was related to proliferative retinopathy, and HbA1c largely accounted for this. These findings may indicate novel pathways for understanding mechanisms and therapeutic interventions.
Assessment of Group Versus Individual Diabetes Education
Authors: Rickheim Patti. L. , Weaver Todd W. , Flader Jill. L. , Kendall David. M. 
Published: March 2007

OBJECTIVES— The current study was conducted to compare the effectiveness of delivering diabetes education in either a group or individual setting using a consistent, evidence-based curriculum.
RESEARCH DESIGN AND METHODS— A total of 170 subjects with type 2 diabetes were randomly assigned to either group (n = 87) or individual (n = 83) educational settings. Subjects received education in four sequential sessions delivered at consistent time intervals over a 6-month period. Outcomes included changes in knowledge, self-management behaviors, weight, BMI, HbA1c, health-related quality of life, patient attitudes, and medication regimen. Changes were assessed at baseline and after the 2-week, 3-month, and 6-month education sessions.
RESULTS— Both educational settings had similar improvements in knowledge, BMI, health-related quality of life, attitudes, and all other measured indicators. HbA1c decreased from 8.5 ± 1.8% at baseline to 6.5 ± 0.8% at 6 months (P &lt; 0.01) in the study population as a whole. Subjects assigned to the individual setting had a 1.7 ± 1.9% reduction in HbA1c (P &lt; 0.01), whereas subjects assigned to the group setting had a 2.5 ± 1.8% reduction in HbA1c (P &lt; 0.01). The difference in HbA1c improvement was marginally greater in subjects assigned to group education versus individualized education (P = 0.05).
CONCLUSIONS— This study demonstrates that diabetes education delivered in a group setting, when compared with an individual setting, was equally effective at providing equivalent or slightly greater improvements in glycemic control. Group diabetes education was similarly effective in delivering key educational components and may allow for more efficient and cost-effective methods in the delivery of diabetes education programs.
Defining the Relationship Between Plasma Glucose and HbA1c
Authors: Rohlfing Curt L. , Wiedmeyer Hsiao-Mei , Little Randie R. , England Jack D. , Tennill Alethea , Goldstein David E. 
Published: March 2007

OBJECTIVE— To define the relationship between HbA1c and plasma glucose (PG) levels in patients with type 1 diabetes using data from the Diabetes Control and Complications Trial (DCCT).
RESEARCH DESIGN AND METHODS— The DCCT was a multicenter, randomized clinical trial designed to compare intensive and conventional therapies and their relative effects on the development and progression of diabetic complications in patients with type 1 diabetes. Quarterly HbA1c and corresponding seven-point capillary blood glucose profiles (premeal, postmeal, and bedtime) obtained in the DCCT were analyzed to define the relationship between HbA1c and PG. Only data from complete profiles with corresponding HbA1c were used (n = 26,056). Of the 1,441 subjects who participated in the study, 2 were excluded due to missing data. Mean plasma glucose (MPG) was estimated by multiplying capillary blood glucose by 1.11. Linear regression analysis weighted by the number of observations per subject was used to correlate MPG and HbA1c.
RESULTS— Linear regression analysis, using MPG and HbA1c summarized by patient (n = 1,439), produced a relationship of MPG (mmol/l) = (1.98 ○1 HbA1c) - 4.29 or MPG (mg/dl) = (35.6 ○1 HbA1c) - 77.3, r = 0.82). Among individual time points, afternoon and evening PG (postlunch, predinner, postdinner, and bedtime) showed higher correlations with HbA1c than the morning time points (prebreakfast, postbreakfast, and prelunch).
CONCLUSIONS— We have defined the relationship between HbA1c and PG as assessed in the DCCT. Knowing this relationship can help patients with diabetes and their healthcare providers set day-to-day targets for PG to achieve specific HbA1c goals.
Regional Variation in Cardiovascular Disease Risk Factors Among American Indians and Alaska Natives With Diabetes
Authors: Rith-Najarian Stephen J. , Gohdes Dorothy M. , Shields Raymond , Skipper Betty , Moore Kelly R. , Tolbert Bernadine , Raymer Terry , Acton Kelly J. 
Published: March 2007

OBJECTIVE—To compare by region risk factors for cardiovascular disease among American Indian populations with diabetes.
RESEARCH DESIGN AND METHODS—Trained providers from 185 federal, urban, and tribally operated facilities reviewed the records from systematic random samples of the patients included in the local diabetes registries in the 1998 Indian Health Service (IHS) Diabetes Care and Outcomes Audit. Selected measures of cardiovascular risk were aggregated by region and adjusted to calculate regional rates for patients &lt;45 years of age (n = 2,595) and those aged ≥45 years (n = 8,294).
RESULTS—Among the younger group of patients with diabetes, the rates of elevated HbA1c (≥9%) and tobacco use varied significantly among regions. High rates of obesity (78%) and elevated HbA1c (56%) were found in the Southwest. High rates of tobacco use (55%) but the lowest rates of elevated HbA1c (27%) were found in Alaska. Among patients aged ≥45 years, all measures including rates of proteinuria, cholesterol ≥200 mg/dl, and mean blood pressure ≥130/85 varied significantly among all regions. Tobacco use was highest in the Great Lakes (44%) and Great Plains (42%) regions and lowest in the Southwest (14%) and Colorado Plateau (8%) regions. Proteinuria was found most frequently in the Southwest (35%), Colorado Plateau (30%), and Pacific regions (35%). Older individuals with diabetes were more likely than younger individuals to have proteinuria and blood pressure ≥130/85.
CONCLUSIONS—American Indians and Alaska Natives with diabetes carry a large burden of potentially modifiable cardiovascular risk factors, but there is significant regional variation.
Increased Fructose Concentrations in Blood and Urine in Patients With Diabetes
Authors: Kawasaki Takahiro , Akanuma Hiroshi , Yamanouchi Toshikazu 
Published: March 2007

OBJECTIVE—To investigate fructose metabolic changes in patients with diabetes.
RESEARCH DESIGN AND METHODS—Serum and urinary fructose concentrations were determined in healthy subjects (n = 23) and in nondiabetic (n = 23) and diabetic patients (n = 26). Fructose was measured using our newly developed method, and 13C6-fructose was used as the internal standard. After adding sample to a fixed amount of internal standard, ion-exchange resins and high-performance liquid chromatography pretreatments were performed. Then, the amount of fructose in the sample was measured by gas chromatography-mass spectrometry.
RESULTS—Serum fructose concentrations in patients with diabetes (12.0 ± 3.8 μmol/l) were significantly higher than those in healthy subjects (8.1 ± 1.0 μmol/l, P &lt; 0.001) and nondiabetic patients (7.7 ± 1.6 μmol/l, P &lt; 0.001), and daily urinary fructose excretion was significantly greater in patients with diabetes (127.8 ± 106.7 μmol/day) than in nondiabetic patients (37.7 ± 23.0 μmol/day, P &lt; 0.001). In patients with diabetes (n = 20), serum fructose concentrations (8.6 ± 1.8 μmol/l, P &lt; 0.001) and daily urinary fructose excretion (63.4 ± 63.8 μmol/day, P &lt; 0.01) significantly decreased by week 2 after admission.
CONCLUSIONS—The present results differed from those of previous studies in that we found that the serum and urinary fructose concentrations decreased rapidly, concomitant with an improvement in glycemia. Therefore, hyperglycemia was associated with increased serum and urinary fructose concentrations in patients with diabetes.
Effects of an Energy-Restrictive Diet With or Without Exercise on Abdominal Fat, Intermuscular Fat, and Metabolic Risk Factors in Obese Women
Authors: Janssen Ian , Fortier Anne , Hudson Robert , Ross Robert 
Published: March 2007

OBJECTIVE—The primary objective was to examine whether the combination of diet and aerobic exercise (DA) or diet and resistance exercise (DR) is associated with greater improvements in metabolic risk factors by comparison to diet only (DO) in obese women. A second objective considered whether reductions in metabolic risk factors are related to concurrent changes in abdominal and/or intermuscular fat distribution.
RESEARCH DESIGN AND METHODS—A total of 38 premenopausal obese women were randomly assigned to one of three 16-week treatments: DO (n=13), DA (n=11), or DR (n=14). Plasma glucose, insulin, and lipid levels were measured in a fasting state and after a 75-g oral glucose challenge (oral glucose tolerance test [OGTT]). Total, abdominal subcutaneous, visceral, and intermuscular fat were measured by magnetic resonance imaging.
RESULTS—Significant reductions (P &lt; 0.02) in body weight (∼10 kg or 10%) and in total, abdominal subcutaneous, visceral, and intermuscular fat were observed within each group. Fasting and OGTT insulin, total cholesterol, LDL cholesterol, and apolipoprotein B also decreased within each group (P ≤ 0.02). The changes in the body fat and metabolic variables were not different across treatment (P &gt; 0.05). Visceral fat alone was related to the metabolic risk factors both before and after the treatment.
CONCLUSIONS—Weight loss was associated with reductions in metabolic risk factors in obese women. The improvement in the metabolic profile was not enhanced by the addition of aerobic or resistance exercise. The findings reinforce the importance of diminished visceral fat in the treatment of insulin resistance.