bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Resistance and Arteriosclerosis Obliterans in Patients With NIDDM
Authors: Matsumoto Kazunari , Miyake Seibei , Yano Mayumi , Ueki Yukitaka , Yamaguchi Yoshihiko , Akazawa Shoichi , Tominaga Yuko 
Published: March 2007

OBJECTIVE
To investigate the risk factors for arteriosclerosis obliterans (ASO) in NIDDM, we measured insulin sensitivity and other risk factors including lipoprotein(a) [Lp(a)] in NIDDM patients with and without ASO.

RESEARCH DESIGN AND METHODS
A case-control study in 100 patients with NIDDM, 35 with and 65 without ASO, was performed. Insulin sensitivity was assessed by the short insulin tolerance test's K index (KITT). Duration of diabetes, a history of smoking, prevalence of hypertension, prevalence of coronary artery disease (CAD), serum C-peptide, 24-h urinary C-peptide, serum lipids, and Lp(a) were compared in the two groups.

RESULTS
Age, BMI, HbA1c, and fasting plasma glucose were comparable in the two groups. Patients with ASO were significantly more insulin resistant than patients without ASO (KITT 2.16 ± 0.16 vs. 3.00 ± 0.13%/min, P &lt; 0.0001, respectively), had a longer duration of diabetes (10.3 ± 1.2 vs. 7.5 ± 0.8 years, P &lt; 0.05), included a greater number of smokers (68.6 vs. 40.0%, P &lt; 0.01), had a higher prevalence of CAD (60.0 vs. 16.9%, P &lt; 0.01), and had a greater percentage of insulin therapy (48.6 vs. 29.2%, P &lt; 0.05). However, urinary and serum C-peptide levels, serum lipids, and Lp(a) levels were comparable in the two groups. Multiple logistic regression analysis indicated that a history of smoking (odds ratio 3.70, P = 0.011), insulin resistance (odds ratio 3.68, P &lt; 0.001), and an elevated Lp(a) level (odds ratio 1.03, P = 0.020) were independently related to ASO. When patients with CAD were removed from the logistic regression analysis, insulin resistance was most strongly related to ASO (odds ratio 20.9, P &lt; 0.001).

CONCLUSIONS
Patients with ASO were characterized by a higher prevalence of CAD, a greater percentage of smokers, a greater percentage of insulin therapy, and a higher insulin resistance than were patients without ASO. Insulin resistance, especially, may be the most powerfully related to ASO. Lp(a) may play a minor role in the development of ASO.
GLP-1 Tablet in Type 2 Diabetes in Fasting and Postprandial Conditions
Authors: Gutniak Mark K , Larsson Hillevi , Sanders Steven W , Juneskans Olof , Holst Jens J , Ahrén Bo 
Published: March 2007

OBJECTIVE
To examine the absorption of glucagon-like peptide (GLP)-1(7-36) amide from the buccal mucosa of type 2 diabetic patients. Previously, the effects of the peptide have been studied following intravenous and subcutaneous injection. Now, a mucoadhesive, biodegradable buccal GLP-1 tablet (9 mm) containing 119 nmol has been developed as a possible alternative to injection.

RESEARCH DESIGN AND METHODS
A total of 10 type 2 diabetic patients received a single tablet under fasting conditions and before a standard meal in this randomized placebo-controlled study.

RESULTS
The mean peak GLP-1 concentration was 125.1 pmol/l and occurred 30 min after application. The mean placebo-adjusted area under the curve was 5,334 min pmol/l, consistent with a relative bioavailability of 6% vs. intravenous injection and 42% vs. subcutaneous injection. The half-life of total peptide activity after buccal administration was 17 min. The placebo-adjusted glucose concentrations decreased by 1.4 mmol/l in fasting experiments and by 4.2 mmol/l after a standard mixed meal. In the fasting state at 30 min, plasma insulin increased by 185% and glucagon decreased by 20%, consistent with the increase in plasma GLP-1 concentrations. The peptide exerted a significant insulinotropic effect during meals (calculated as an insulinogenic index, 0–120 min; 84.1 vs. 45.7 in placebo experiments).

CONCLUSIONS
Potentially therapeutic plasma levels of GLP-1 were achieved after administration of a single buccal tablet in type 2 diabetic patients. The peptide had a marked glucose-lowering effect during the first 2 h. This new GLP-1 tablet may become a feasible alternative treatment for type 2 diabetic patients, although a more prolonged pharmacokinetic profile is required.
Hepatitis B Vaccination in Diabetic Patients: Randomized trial comparing recombinant vaccines containing and not containing pre-S2 antigen
Authors: Douvin Catherine , Simon Dominique , Charles Marie Aline , Deforges Lionel , Bierling Philippe , Lehner Valérie , Budkowska Agata , Dhumeaux Daniel 
Published: March 2007

OBJECTIVE
To investigate the immunogenicity of two recombinant hepatitis B vaccines containing S antigen alone (Engerix B) or both S and pre-S2 antigens (GenHevac B) in diabetic patients.

RESEARCH DESIGN AND METHODS
Of the adult diabetic patients, 71 (26 IDDM, 45 NIDDM) were randomized to receive Engerix B or GenHevac B at 0, 1, 2, and 12 months in a single-blind clinical trial; if the antibody to hepatitis B surface antigen (anti-HBs) titers were &lt; 10 &lt;10 IU/1 at month 4, a fourth injection of vaccine was given. A positive response was defined by anti-HBs titer ≥ 10 IU/l at month 13.

RESULTS
The anti-HBs response rate and the titers of anti-HBs did not differ significantly between the two types of vaccine. Overall, &gt; 90% of the patients responded at month 13. In patients vaccinated with GenHevac B, anti-pre-S2 antibodies appeared earlier than anti-HBs. The anti-HBs response tended to decrease with age (P = 0.07) and tended to be higher in IDDM patients than in NIDDM patients (P = 0.06). Metabolic control, as assessed by HbA1c level, did not influence the response rate. The presence of the HLA DQ2 allele was associated with a low response.

CONCLUSIONS
A large majority of diabetic patients can be efficiently vaccinated against the hepatitis B virus using a booster dose at month 4. The choice of the vaccine (with or without pre-S2 antigen) appears to have little influence, if any, on the response rate.
Meal Composition is a Determinant of Lispro-Induced Hypoglycemia in IDDM
Authors: Burge Mark R , Castillo Kristen R , Schade David S 
Published: March 2007

OBJECTIVE
Lispro is a newly FDA-approved analog of human insulin that will be widely used in patients with IDDM. This insulin, however, may have an increased potential for hypoglycemia because of its very rapid subcutaneous absorption, especially in a setting of decreased carbohydrate intake. Using a short-term prospective randomized parallel group-study design, we studied the incidence of hypoglycemia when lispro was given before breakfast compared with regular human insulin. Since carbohydrate intake is a determinant of postprandial glycemia, we administered three isocaloric meals characterized by low, average, and high carbohydrate content.

RESEARCH DESIGN AND METHODS
Two groups of six IDDM subjects were randomized to receive 0.15 U/kg of lispro or regular human insulin subcutaneously before the ingestion of three 500-kcal breakfast meals of differing carbohydrate content on separate days. Lispro was administered at mealtime, and regular insulin was administered 30 min before mealtime.

RESULTS
Postprandial plasma glucose concentrations were decreased in the lispro group compared with the regular-insulin group for all three meal types (P &lt; 0.05), and hypoglycemia developed more frequently and rapidly in the lispro group, compared with the regular-insulin group by survival analysis. Additionally, peak insulin concentrations were higher (P &lt; 0.001) and peaked more rapidly (P &lt; 0.05) in the lispro group, compared with the regular-insulin group.

CONCLUSIONS
We conclude that lispro has a tendency for early postprandial hypoglycemia compared with regular insulin in the setting of reduced carbohydrate intake. This fact should be told to patients who decide to switch from regular insulin to lispro. Health care professionals should instruct their IDDM patients to monitor glucose levels frequently after switching to lispro since adjustments in their carbohydrate intake and/or their lispro dosage may be necessary to avoid hypoglycemia.
A Comparison of Global Versus Disease-Specific Quality-of-Life Measures in Patients With NIDDM
Authors: Anderson Robert M , Fitzgerald James T , Wisdom Kimberlydawn , Davis Wayne K , Hiss Roland G 
Published: March 2007

OBJECTIVE
This study was conducted to compare the Short Form 36 (SF-36) (a global measure of health-related quality of life) and the Diabetes Care Profile (DCP) (a diabetes-specific measure of self-care and diabetes-related quality of life) in patients with NIDDM.

RESEARCH DESIGN AND METHODS
This study was conducted as part of a larger study initiated in 1991 using a randomly selected sample of communities, physicians, and patients with diabetes located throughout Michigan. A total of 255 patients with NIDDM participated. The study examined the relationship between the two measures and diabetes variables, such as glycosylated hemoglobin level and number of complications.

RESULTS
The SF-36 and the DCP have both common and discrete measurement domains. Both instruments have acceptable subscale reliability. The DCP has predictive validity regarding glycemic control, whereas the SF-36 does not. Both measures correlate with the number of complications for patients who have NIDDM treated with insulin.

CONCLUSIONS
This study suggests that for examining relationships within diabetes, e.g., the impact of acute complications and/or regimen on quality of life, the DCP is the appropriate measure. Conversely, when examining relationships between the patient's experience of living with diabetes and quality of life and other chronic diseases, the SF-36 would be an appropriate measure. Both instruments can be used to illuminate the experience and behavior of patients living with and caring for NIDDM.
Severe Hypoglycemia in Children With IDDM: A prospective population study, 1992–1994
Authors: Nordfeldt Sam , Ludvigsson Johnny 
Published: March 2007

OBJECTIVE
Is an increased incidence of severe hypoglycemia an unavoidable effect of improved metabolic control? And, if so, to what extent?

RESEARCH DESIGN AND METHODS
In 1992–1994, severe hypoglycemia was prospectively registered in our intensively treated IDDM population, 146 children 1–18 years of age with &gt; 90% of the patients on ≥ 4 insulin injections per day. The two categories, “severe hypoglycemia with unconsciousness” (U hypoglycemia) and “severe hypoglycemia without unconsciousness but needing the assistance of another person” (NU hypoglycemia), were analyzed in relation to yearly mean HbA1c levels, insulin doses and proportion of short-acting insulin, age at onset, duration of diabetes, age, sex, and weight-to-height ratio.

RESULTS
Yearly mean HbA1c levels improved from 8.1 ± 1.6% in 1992 to 6.9 ± 1.3% in 1994. The yearly incidence of U hypoglycemia was 0.15–0.19 events per patient-year, seen in 10–16% of patients, showing no significant increase from 1992–1994. For NU hypoglycemia, slightly increasing figures from 1.01 to 1.26 events per patient-year, seen in 27–38% of patients yearly, were reported. There was no significant correlation between severe (U or NU) hypoglycemia and HbA1c, but still an association was seen in certain calculations. In multiple regression analysis, U hypoglycemia was not related to any factor, but the square root of the rate of NU hypoglycemia was related to lower HbA1c levels (P = 0.0003), higher insulin doses (IU · kg−1 · 24 h−1) (P = 0.0024), and a lower proportion of short-acting insulin out of the total daily insulin dose (P = 0.031).

CONCLUSIONS
Multiple-dose insulin therapy with rather low yearly mean HbA1c values causes a slight increase of NU hypoglycemia but no increase of U hypoglycemia in our population of children with IDDM. Near physiological HbA1c levels may be achieved without any pronounced risk of increasing the incidence of severe hypoglycemia when multiple-injection insulin therapy is combined with adequate self-control based on psychosocial support and active education.
Incidence and Prevalence of Diabetes in Children Aged 0–14 Years in Manitoba, Canada, 1985–1993
Authors: Blanchard James F , Dean Heather , Anderson Kristin , Wajda Andre , Ludwig Sora , Depew Noella 
Published: March 2007

OBJECTIVE
To estimate the incidence and prevalence of type I diabetes among Manitoba children aged 0–14 years from 1985–1993.

RESEARCH DESIGN AND METHODS
The Manitoba Diabetes Database (a population-based database of individuals diagnosed with diabetes based on Manitoba's health insurance system) was used to estimate the annual incidence of diabetes for the years 1985–1993 and the point prevalence of diabetes at 31 March 1993 for Manitoba children aged 0–14 years. The Diabetes Education Resource for Children and Adolescents program database was used to correct incidence and prevalence rates for ascertainment using the two-source capture-recapture method.

RESULTS
The overall ascertainment rate of the Manitoba Diabetes Database was 95% for incident cases and 93% for prevalent cases. The average annual incidence was 20.4 per 100,000 for children aged 0–14 years. The annual incidence appears to be stable for all age-groups 0–14 years over the past decade. The point prevalence of diabetes among children was 120.4 per 100,000.

CONCLUSIONS
The incidence of type I diabetes in children aged 0–14 years in Manitoba is higher than reported previously in other urban regions of Canada, but similar to population-based estimates from Prince Edward Island. The incidence appears stable in Manitoba over the past decade even in the 0–4 year age-group. The Manitoba Diabetes Database appears to be a highly accurate population-based source of data on the epidemiology of diabetes in children.
The Receiver Operating Characteristics Curve in the Evaluation of a Random Urine Specimen as a Screening Test for Diabetic Nephropathy
Authors: Zelmanovitz Themis , Gross Jorge L , Oliveira Jarbas R , Paggi Alexandre , Tatsch Mariana , Azevedo Mirela J 
Published: March 2007

OBJECTIVE
To assess the performance of measurements of urinary albumin concentration (UAC) and urinary albumin:creatinine ratio (UACR) in a diurnal random urine specimen (RUS) for the screening of diabetic nephropathy.

RESEARCH DESIGN AND METHODS
A total of 95 ambulatory NIDDM patients (49 women, ages 40–75 years) collected 123 RUSs during the morning after completing a timed 24-h urine collection. Albumin was measured by immunoturbidimetry. According to timed urinary albumin excretion rate (UAER) measured in the 24-h collection (criterion standard), samples were classified as normoalbuminuric (UAER &lt; 20 μg/min; n = 54), microalbuminuric (UAER 20–200 μg/min; n = 44), and macroalbuminuric (UAER &gt; 200 μg/min; n = 25). The receiver operating characteristics (ROC) curve approach was used. The ROC curves of UAC and UACR in RUS for screening of microalbuminuria (normo- and microalbuminuric samples; n = 98) and macroalbuminuria (micro- and macroalbuminuric samples; n = 69) were plotted.

RESULTS
Spearman's coefficients of correlation of 24-h UAER vs. UAC and UACR were 0.91 and 0.92, respectively (P &lt; 0.001). The calculated areas (± SE) under the ROC curves to screen microalbuminuria for UAC (0.9766 ± 0.015) and UACR (0.9689 ± 0.014) were similar (P &gt; 0.05) as were the corresponding areas for macroalbuminuria (0.9868 ± 0.0094 and 0.9614 ± 0.0241, respectively; P &gt; 0.05). The first point with 100% sensitivity and the point of intersection with a 100%-to-100% diagonal for microalbuminuria were as follows: 16.9 and 33.6 mg/l for UAC and 15.0 and 26.8 mg/g for UACR; for macroalbuminuria 174.0 and 296.2 mg/l for UAC and 116.0 and 334.3 mg/g for UACR, respectively.

CONCLUSIONS
Albumin measurements (UAC and UACR) in an RUS presented almost perfect accuracy for the screening of micro- and macroalbuminuria and UAC measured in an RUS is simpler and less expensive than UACR and UAER. It is suggested as a valid test for use in screening for diabetic nephropathy.
Quality of Life and Associated Characteristics in a Large National Sample of Adults With Diabetes
Authors: Glasgow Russell E , Ruggiero Laurie , Eakin Elizabeth G , Dryfoos Janet , Chobanian Lisa 
Published: March 2007

OBJECTIVE
This study investigated the quality of life and the demographic, medical-history, and self-management characteristics associated with it.

RESEARCH DESIGN AND METHODS
A diabetes self-management survey was sent to 2,800 adults with diabetes throughout the U.S. who were part of a marketing company national sample. The response rate was 73%. The final sample of 2,056 persons was heterogeneous: the average age was 59 years (range, 18–92 years); 53% had high school education or less; 86% had type II diabetes; 62% were female; and 31% reported being on an intensive management plan, such as the one used in the Diabetes Control and Complications Trial. Quality-of-life items included the social, physical, and mental health dimensions of the Short Form (SF-20) of the General Health Survey.

RESULTS
Overall, respondents reported a moderate to low quality of life, relative to previous studies. Factors related to lower quality of life included: less education, lower income, older age, being female, type of health insurance (no medical insurance or Medicare/Medicaid recipients reported lower quality of life than those with either a health maintenance organization or private insurance), number of diabetes complications, number of comorbid illnesses, and lower levels of physical activity. Multiple regression analyses revealed that the level of self-reported exercise was the only significant self-management behavior to predict the quality of life, after controlling for demographic and medical variables.

CONCLUSIONS
If the findings regarding physical activity are replicated, it may be that moderate-intensity physical activity programs could be initiated with diabetic individuals at risk of low quality of life. Quality of life is an important and understudied topic in diabetes that appears to be related to demographic, medical-history, and self-management factors.
Levels and Risks of Depression and Anxiety Symptomatology Among Diabetic Adults
Authors: Peyrot Mark , Rubin Richard R 
Published: March 2007

OBJECTIVE
To determine levels of depression and anxiety symptoms among adults with diabetes and identify factors associated with increased risk.

RESEARCH DESIGN AND METHODS
This study administered self-report symptom inventories to patients at the beginning (n = 634) and end (n = 578) of an outpatient diabetes education program. Subjects (n = 246) contacted by mail 6 months later completed the same instruments.

RESULTS
Rates of disturbance for depression (41.3%; 95% CI: 37.4–45.2%) and anxiety (49.2%; 95% CI: 45.3–53.1%) were higher than those typical in the general population (10–20%). Probability of disturbance ranged from 5–7% for those with the lowest risk profile to 82–92% for those with the highest risk profile. Diabetes-related complications were the only disease factor associated with significantly increased risk of disturbance. Women and those with less education were at much higher risk. Only 13% of those followed for 6 months were disturbed at all three time-points.

CONCLUSIONS
Diabetes is associated with increased risk of psychological disturbance, especially for those with more diabetes-related complications. Sociodemographic factors account for much of the risk differential among people with diabetes.
Cholesterol Lowering With Simvastatin Improves Prognosis of Diabetic Patients With Coronary Heart Disease: A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)
Authors: Pyörälä K , Pedersen Terje R , Kjekshus John , Faergeman Ole , Olsson Anders G , Thorgeirsson Gudmundur ,   The Scandinavian Simvastatin Survival Study (4S) Group
Published: March 2007

OBJECTIVE
To assess in diabetic patients with coronary heart disease (CHD) the effect of cholesterol lowering with simvastatin on mortality and the risk of CHD and other atherosclerotic events.

RESEARCH DESIGN AND METHODS
A post hoc subgroup analysis was carried out on data from 202 diabetic patients and 4,242 nondiabetic patients with previous myocardial infarction or angina pectoris, serum total cholesterol 5.5–8.0 mmol/l, and serum triglycerides ≤ 2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S). Participants in the 4S were randomly assigned to double-blind treatment with simvastatin, 20 mg daily, with blinded dosage titration up to 40 mg daily, according to cholesterol response during the first 6–18 weeks, or placebo. Endpoints were 1) total mortality, 2) major CHD events (CHD death or nonfatal myocardial infarction), 3) other acute atherosclerotic events, 4) myocardial revascularization procedures.

RESULTS
Over the 5.4-year median follow-up period, simvastatin treatment produced mean changes in serum lipids in diabetic patients similar to those observed in nondiabetic patients. The relative risks (RRs) of main endpoints in simvastatin-treated diabetic patients were as follows: total mortality 0.57 (95% CI, 0.30–1.08; P = 0.087), major CHD events 0.45 (95% CI, 0.27–0.74; P = 0.002), and any atherosclerotic event 0.63 (95% CI, 0.43–0.92; P = 0.018). The corresponding RRs in nondiabetic patients were the following: 0.71 (95% CI, 0.58–0.87; P = 0.001), 0.68 (95% CI, 0.60–0.77; P &lt; 0.0001), and 0.74 (95% CI, 0.68–0.82; P &lt; 0.0001).

CONCLUSIONS
The results strongly suggest that cholesterol lowering with simvastatin improves the prognosis of diabetic patients with CHD. The absolute clinical benefit achieved by cholesterol lowering may be greater in diabetic than in nondiabetic patients with CHD because diabetic patients have a higher absolute risk of recurrent CHD events and other atherosclerotic events.
The Tactile Circumferential Discriminator: A new, simple screening device to identify diabetic patients at risk of foot ulceration
Authors: Vileikyte L , Hutchings G , Hollis S , Boulton A J M 
Published: March 2007

OBJECTIVE
To evaluate the tactile circumferential discriminator (TCD) (Tacticon Medical Enterprises, West Chester, PA), a new, simple, handheld quantitative sensory testing device, in the identification of patients at potential risk of neuropathic ulceration.

RESEARCH DESIGN AND METHODS
Patients with diabetes (n = 133) attending the Manchester Diabetes Centre or diabetic foot clinic seen within a 5-week period were assessed using the TCD, monofilaments, and vibration perception threshold (VPT) measured over the hallux. The sensitivity and specificity of each method in the identification of “high-risk” patients were compared.

RESULTS
The TCD was easy to use, and there was a highly significant correlation between the results obtained compared with both filaments and VPT (P &lt; 0.0001). Similarly, in the identification of patients at risk of ulceration, the TCD agreed with VPT in 75.2% of cases and with the monofilaments in 78.9%. In the identification of the 37 foot ulcer patients, TCD was highly sensitive (100%) but less specific (58.3%) than VPT (86.5%; 79.2%) and the monofilaments (91.9%; 76.0%).

CONCLUSIONS
These data suggest that the TCD is a simple and reliable new technique for population screening for neuropathy and foot ulcer risk.