bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex Hormone-Binding Globulin and Glucose Tolerance in Postmenopausal Women: The Rancho Bernardo Study
Authors: Goodman-Gruen Deborah , Barrett-Connor Elizabeth 
Published: March 2007

OBJECTIVE
Sex hormone-binding globulin (SHBG) has been shown to be associated with several diabetes risk factors, including total body fat, central obesity, and hyperinsulinemic insulin resistance. We examined the cross-sectional association between SHBG and impaired glucose tolerance (IGT) and NIDDM.

RESEARCH DESIGN AND METHODS
We conducted a cross-sectional study including 657 postmenopausal women, aged ≥50 years, who were not using hormone replacement therapy. Blood for SHBG and fasting plasma glucose was obtained concurrently in the morning; all women had a 75-g oral glucose tolerance test and measurement of BMI and waist-to-hip ratio (WHR).

RESULTS
SHBG was significantly associated with age, BMI, and WHR but not with smoking, physical activity, or alcohol intake. In these women, SHBG was significantly and independently inversely associated with IGT and with NIDDM.

CONCLUSIONS
These data strongly support an association between SHBG, or androgenicity, and diabetes in postmenopausal women. Because of the cross-sectional nature of this study, however, the directionality of the association is uncertain.
The Impact of Diabetes on Survival Among Patients With First Myocardial Infarction
Authors: Chun Byung Y , Dobson Annette J , Heller Richard F 
Published: March 2007

OBJECTIVE
The purpose of this paper is to estimate the impact of diabetes on survival among patients with first acute myocardial infarction, using data from the World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) Project in Newcastle, New South Wales, Australia.

RESEARCH DESIGN AND METHODS
The WHO MONICA Project is a community-based surveillance system that monitors coronary heart disease morbidity and mortality. All patients with suspected coronary events were observed for 28 days after the onset of symptoms.

RESULTS
Of 5,322 patients with acute myocardial infarction and no previous history of ischemic heart disease (3,643 men and 1,679 women), 333 men (9%) and 224 women (13%) had a history of diabetes. The age-adjusted 28-day case fatality for women with diabetes (25%) was significantly higher than for women without diabetes (16%); relative risk 1.56 (95% CI: 1.19–2.04). The difference for men was also significant (25% with diabetes and 20% without diabetes); relative risk 1.25 (95% CI: 1.02–1.53). Age-specific case fatality increased significantly with age in both men and women without diabetes, but systematic age effects were not so apparent in patients with diabetes. Case fatality significantly decreased over the study period in patients without diabetes, but not among the diabetic patients.

CONCLUSIONS
The increased risk of death in the diabetic patients remained after accounting for their poorer risk factor profiles; even if they reached the hospital alive, diabetic patients were also less likely to survive than nondiabetic patients. The relative impact of diabetes on survival is greater in women than in men.
Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia
Authors: Eastman Richard C , Javitt Jonathan C , Herman William H , Dasbach Erik J , Copley-Merriman Catherine , Maier William , Dong Fred , Manninen Diane , Zbrozek Arthur S , Kotsanos James , Garfield Sanford A , Harris Maureen 
Published: March 2007

OBJECTIVE
To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia.

RESEARCH DESIGN AND METHODS
Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs).

RESULTS
Comprehensive treatment of NIDDM that maintains an HbA1c value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA1c under standard care.

CONCLUSIONS
The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be ∼ $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.
The Prevalence of Diabetic Retinopathy and Associated Risk Factors Among Sioux Indians
Authors: Berinstein Daniel M , Stahn Ruggles M , Welty Thomas K , Leonardson Gary R , Herlihy John J 
Published: March 2007

OBJECTIVE
To estimate the prevalence of and risk factors for diabetic retinopathy among Sioux Indians of South Dakota.

RESEARCH DESIGN AND METHODS
Strong Heart Study (SHS) participants with diabetes who are members of the Cheyenne River Sioux Tribe and the Oglala Sioux Tribe were invited to have ophthalmological examinations in 1991. A total of 417 people had eye examinations out of the 488 diabetic SHS participants of the two tribes (85% participation rate). Fundus photographs were obtained of each eye and graded for severity of retinopathy using the modified Airlie House Classification Scheme. Risk factors for retinopathy were determined from the SHS database.

RESULTS
The prevalence of diabetic retinopathy among participants from these tribes was 45.3%. Risk factors associated with severity of retinopathy include mean fasting glucose, level. HbA1c, systolic blood pressure, urinary albumin-to-creatinine ratio, renal dialysis, and duration of diabetes.

CONCLUSIONS
The prevalence of diabetic retinopathy among diabetic Sioux Indians is similar to or higher than the prevalence in other diabetic Indian and non-Indian populations. Aggressive glycemic and blood pressure control is urgently needed to reduce this high rate, and annual eye examinations to detect and treat diabetic retinopathy should be emphasized.
The Problem Areas in Diabetes Scale: An evaluation of its clinical utility
Authors: Welch Garry W , Jacobson Alan M , Polonsky William H 
Published: March 2007

OBJECTIVE
To evaluate the reliability and concurrent and discriminant validity of the Problem Areas in Diabetes (PAID) scale, a new measure of emotional functioning in diabetes.

RESEARCH DESIGN AND METHODS
A battery of questionnaires, including the PAID, was completed by 256 volunteer diabetic outpatients. In our analyses, we examined the PAID's internal structure and compared mean IDDM and NIDDM treatment group scores in regression analyses to explore its discriminant validity. We also evaluated concurrent validity from the correlations between the PAID and diabetes-specific measures of coping and health attitudes and HbA1c.

RESULTS
Principal component analyses identified a large emotional adjustment factor, supporting the use of the total score. Significant sizable correlations were found between the PAID and a range of selected health attitudinal measures. There were significant differences (with small-to-moderate effect sizes) in PAID scores between IDDM and NIDDM patients and between IDDM and NIDDM insulin- and tablet-treated subgroups; no differences were found between NIDDM insulin- and tablet-treated subgroups.

CONCLUSIONS
The study findings provided support for the construct validity of the PAID, including evidence for discriminant validity from its ability to detect differences between IDDM and NIDDM treatment groups expected to differ in the emotional impact of life with diabetes. Future studies should explore the PAID's performance in nonspecialist treatment settings as well as its responsiveness to clinical change.
Observations of Diabetes Care in Long-Term Institutional Settings With Measures of Cognitive Function and Dependency
Authors: Sinclair Alan J , Allard Imelda , Bayer Antony 
Published: March 2007

OBJECTIVE
To document the prevalence of known diabetes and quantity of diabetes care delivered in long-term institutional settings in South Glamorgan, Wales; to measure physical and mental performance of diabetic residents; and to ascertain the level of basic diabetes knowledge of both staff and diabetic residents.

RESEARCH DESIGN AND METHODS
A postal questionnaire survey was sent to 31 nursing or dual registered homes and 88 residential homes in South Wales to determine the prevalence of known diabetes. Medical examination and a semistructured interview of 109 diabetic and 106 age- and sex-matched nondiabetic residents was followed by assessment of dependency (Barthel Activities of Daily Living Scale [15]; Behavioral Rating Scale [16]) and cognitive performance (Mini-Mental State Exam [12]).

RESULTS
The prevalence of known diabetes was 7.2%. Forty percent of diabetic residents were taking long-acting sulfonylureas. Only half of the residents in both homes had regular blood glucose monitoring. Less than 1 in 10 diabetic residents were being followed in a hospital-based diabetic clinic. Diabetic residents had had more hospital admissions in the preceding year than nondiabetic control subjects, and their length of stay was double that of nondiabetic control subjects (P &lt; 0.05). Health professional input was fragmented, with involvement of community nurses and dietitians being rare. Diabetic residents had significantly higher levels of arterial disease (P &lt; 0.05), foot ulceration (P &lt; 0.01), and dementia (P &lt; 0.01), and more severe cognitive impairment and higher levels of dependency (P &lt; 0.01). Knowledge of diabetes was poor among both diabetic and nondiabetic residents and care staff.

CONCLUSIONS
There is an important need for a reappraisal of diabetes care in institutional settings.
Comparison of Fasting and 2-Hour Glucose and HbA1c Levels for Diagnosing Diabetes: Diagnostic criteria and performance revisited
Authors: Engelgau Michael M , Thompson Theodore J , Herman William H , Boyle James P , Aubert Ronald E , Kenny Susan J , Badran Ahmed , Sous Edward S , Ali Mohamed A 
Published: March 2007

OBJECTIVE
Nearly two decades ago, the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) Expert Committee on Diabetes Mellitus published diagnostic criteria for diabetes. We undertook this study to compare the performance of three glycemic measures for diagnosing diabetes and to evaluate the performance of the WHO criteria.

RESEARCH DESIGN AND METHODS
In a cross-sectional population-based sample of 1,018 Egyptians ≥ 20 years of age, fasting and 2-h glucose and HbA1c levels were measured, and diabetic retinopathy was assessed by retinal photograph. Evidence for bimodal distributions was examined for each glycemic measure by fitting models for the mixture of two distributions using maximum likelihood estimates. Sensitivity and specificity for cutpoints of each glycemic measure were calculated by defining the true diabetes state (gold standard) as 1) the upper (diabetic) component of the fitted bimodal distribution for each glycemic measure, and 2) the presence of diabetic retinopathy. Receiver operating characteristic (ROC) curves were constructed to determine the performance of the glycemic measures in detecting diabetes as defined by diabetic retinopathy.

RESULTS
In the total population, the point of intersection of the lower and upper components that minimized misclassification for the fasting and 2-h glucose and HbA1c were 7.2 mmol/l (129 mg/dl), 11.5 mmol/l (207 mg/dl), and 6.7%, respectively. When diabetic retinopathy was used to define diabetes, ROC curve analyses found that fasting and 2-h glucose values were superior to HbA1c (P &lt; 0.01). The performance of a fasting glucose of 7.8 mmol/l (140 mg/dl) was similar to a 2-h glucose of 12.2–12.8 mmol/l (220–230 mg/dl), and the performance of a 11.1 mmol/l (200 mg/dl) 2-h glucose was similar to a fasting glucose of 6.9–7.2 mmol/l (125–130 mg/dl).

CONCLUSIONS
Optimal cutpoints for defining diabetes differ according to how diabetes itself is defined. When diabetes is defined as the upper component of the bimodal population distribution, a fasting glucose level somewhat lower than the current WHO cutpoint and a 2-h glucose level somewhat higher than the current WHO cutpoint minimized misclassification. When diabetic retinopathy defines diabetes, we found that the current fasting diagnostic criterion favors specificity and the current 2-h criterion favors sensitivity. These results should prove valuable for defining the optimal tests and cutpoint values for diagnosing diabetes.
Insulin and Cognitive Function in an Elderly Population: The Rotterdam Study
Authors: Stolk Ronald P , Breteler Monique M B , Ott Alewijn , Pols Huibert A P , Lamberts Steven W J , Grobbee Dlederick E , Hofman Albert 
Published: March 2007

OBJECTIVE
To examine the association between insulin and cognitive function in the population-based Rotterdam Study.

RESEARCH DESIGN AND METHODS
Serum insulin was measured 2 h after an oral glucose load, while global cognitive function was assessed by the Mini Mental State Examination in 5,510 subjects, aged 55 years and over.

RESULTS
An increase in postload insulin only in women was associated with a decrease in cognitive function (age-adjusted regression coefficient −0.10 per 50 mU/l insulin; 95% CI −0.16 to −0.04). The association between insulin resistance, assessed by the ratio of postload insulin over glucose, and cognitive function was not statistically significant. Further adjustment for the individual risk factors of serum glucose, BMI, HDL, systolic blood pressure, smoking, or use of estrogen did not change the results. The association was present in women with and without cardiovascular disease and present after excluding subjects with diabetes. Women with dementia, the extreme of cognitive dysfunction, had increased age-adjusted insulin levels (76.3 ± 4.9 vs. 66.8 ± 1.0 mU/l [means ± SE], P = 0.06).

CONCLUSIONS
The results of this study suggest that increased serum insulin may be associated with decreased cognitive function and dementia in women. These findings are more compatible with a direct effect of insulin on the brain than with an effect through an increase in cardiovascular risk factors.
Attentional Functioning in Children and Adolescents With IDDM
Authors: Rovet Joanne , Alvarez Miguel 
Published: March 2007

OBJECTIVE
To determine whether specific attentional cognitive processes are disrupted in children and adolescents with IDDM.

RESEARCH DESIGN AND METHODS
We tested 103 children and adolescents with IDDM and 100 healthy control subjects (age range 9.3–18.3 years) for intelligence and attention. Subjects were given multiple clinical tests of attention and a computerized vigilance test, all of which served to provide information about multiple components of attentional processing. Specific components studied were the abilities to focus, select, shift, suppress, inhibit, and sustain attention. A diabetic history was obtained for the IDDM group, and blood glucose levels were determined before and after computerized attention testing.

RESULTS
Across tests, IDDM subjects differed from control subjects only in the select component of attention, which was accounted for mainly by the poorer performance of children with early-onset diabetes (&lt; 6 years). When subgrouped by history of seizures from hypoglycemia, those having had seizures demonstrated a lower verbal IQ and greater difficulty with select, focus, and inhibit attentional components, whereas sustain, suppress, and shift attentional components were unaffected. Correlation analyses showed that higher concurrent blood glucose levels were associated with less adequate ability to inhibit impulsive responses, whereas multiple regression analyses indicated that inhibit and focus were best predicted by onset age and concurrent blood glucose.

CONCLUSIONS
In children and adolescents with IDDM, attention is poorer in several but not all aspects of attention; these aspects are affected by a history of seizures from hypoglycemia and higher ambient blood glucose levels at time of testing. These results suggest both organizational and activational effects of diabetes on specific subcomponents of attention in diabetes.
A Multicenter Study on the Prevalence of Diabetic Neuropathy in Italy
Authors: Fedele Domenico , Comi Giancarlo , Coscelli Carlo , Cucinotta Domenico , Feldman Eva L , Ghirlanda Giovanni , Greene Douglas A , Negrin Paolo , Santeusanio Fausto ,   The Italian Diabetic Neuropathy Committee
Published: March 2007

OBJECTIVE
The prevalence of neuropathy, a common complication of diabetes, was determined in diabetic patients recruited from 109 outpatient diabetes clinics in Italy.

RESEARCH DESIGN AND METHODS
Neuropathy was diagnosed using the Diabetic Neuropathy Index (DNI), a standardized examination developed for use in the outpatient setting. A total of 8,757 diabetic patients were studied, 51.2% men and 48.8% women, with average and median ages of 56 and 58 years, respectively.

RESULTS
Of the 8,757 patients, 32.3% had neuropathy, defined as a positive score of &gt; 2 points on the DNI. A total of 2,033 (49.6% men and 50.4% women) were administered the Diabetic Neuropathy Score (DNS), the second component of the screening program, by a neurologist. This component consists of a quantitative neurological examination and nerve conduction studies that together provide a summated score. A total of 335 patients (16.5%) were not neuropathic, and 395 (19.4%) had borderline, 453 (22.3%) mild, 592 (29.1%) moderate, and 258 (12.7%) severe neuropathy. The concordance between a positive score on the DNI and a DNS indicating neuropathy was 83.5%. The severity of neuropathy increased with both age and disease duration. Of patients with neuropathy, 64.1% had an average age between 58 and 59 years with a disease duration between 12.4 ± 8.4 years (mild neuropathy) and 15.6 ± 9.7 years (severe neuropathy).

CONCLUSIONS
Neuropathy is a common complication of diabetes and, in this study, was present in 32.3% of all patients. An increased awareness of the high prevalence of neuropathy can lead to early therapeutic intervention and possible prevention of later neuropathic complications, such as infection and foot ulcers.
Existence of Early-Onset NIDDM Japanese Demonstrating Severe Diabetic Complications
Authors: Yokoyama Hiroki , Okudaira Maki , Otani Toshika , Takaike Hiroko , Miura Junnoske , Saeki Akiko , Uchigata Yasuko , Omori Yasue 
Published: March 2007

OBJECTIVE
To identify the clinical characteristics of early-onset NIDDM patients with severe diabetic complications.

RESEARCH DESIGN AND METHODS
The clinical cases of a large number of diabetic patients who visited a diabetes center within the period 1970–1990 were reviewed. Of a total of 16,842 diabetic patients, 1,065 (6.3%) had early-onset NIDDM (diabetes diagnosed before 30 years of age). These 1,065 patients were divided into two groups, those who developed proliferative retinopathy before the age of 35 (n = 135) and those who did not (n = 930). Development of proliferative retinopathy, nephropathy, renal failure, blindness, and atherosclerotic vascular disease were compared between the two groups.

RESULTS
The subgroup of 135 patients was characterized by poor glycemic control, often requiring insulin therapy and a higher familial prevalence of diabetes, and contained a greater proportion of women than the subgroup of 930 patients. Of the 135 patients, 99 (67%) developed proliferative retinopathy before the first visit. The 135 patients developed severe progressive complications in contrast to the 930 patients. A total of 81 patients (60%) developed diabetic nephropathy at a mean age of 31 years, 31 (23%) developed renal failure requiring dialysis at a mean age of 35 years, 32 (24%) became blind at a mean age of 32 years, and 14 (10%) developed atherosclerotic vascular disease at a mean age of 36 years.

CONCLUSIONS
Some Japanese early-onset NIDDM patients develop severe diabetic complications in their youth. Most of them had no symptoms nor regular treatment regarding diabetes until they were noticed to have developed severe diabetic complications. Although the relevant prevalence and the pathogenetic mechanism underlying the rapid onset of the complications remain to be determined, prolonged inadequate treatment of and familial predisposition to diabetes may be contributing factors. Careful diabetes care in the twenties, not only for IDDM but also for NIDDM patients, is warranted.
Gestational Diabetes: Should It Be Added to the Syndrome of Insulin Resistance?
Authors: Clark Charles M , Qiu Chunfu , Amerman Barbara , Porter Beverly , Fineberg Naomi , Aldasouqi Saleh , Golichowski Alan 
Published: March 2007

OBJECTIVE
The significance of gestational diabetes mellitus (GDM) results from its short-term detrimental effects on the fetus and its long-term prediction of NIDDM in the mother. We compared several variables associated with insulin resistance between GDM and non-GDM pregnant women to show the similarities between GDM and NIDDM (and thus insulin resistance).

RESEARCH DESIGN AND METHODS
On the basis of a 3-h oral glucose tolerance test (OGTT), 52 GDM patients and 127 non-GDM patients were recruited from pregnant, non-diabetic women who had a nonfasting 1-h-50-g glucose screening test ≥ 7.2 mmol/l (130 mg/dl) performed between 16 and 33 weeks of gestation (a total of 518 of 3,041 women drawn from six community health care prenatal clinics were screened positive). During the OGTT, several potential markers of insulin resistance were measured at fasting and 2-h time points, in addition to the standard glucose measurements. The relationship of these variables with the diagnosis of GDM was studied.

RESULTS
GDM patients, compared with non-GDM patients, had 1) higher prepregnancy weight (P = 0.011), prepregnancy BMI (P = 0.006), C-peptide at fasting (P = 0.002) and at 2 h (P &lt; 0.001), insulin at fasting (P = 0.001) and at 2 h (P &lt; 0.001), triglycerides at fasting (P = 0.005) and at 2 h (P = 0.003), free fatty acids at fasting (P = 0.017), β-hydroxybutyrate at fasting (P = 0.007); and 2) lower HDL cholesterol at fasting (P = 0.029). These variables were all predictive of GDM (P &lt; 0.036) individually. Using stepwise logistic regression with all of these variables available, fasting (P = 0.019) and 2-h (P &lt; 0.001) insulin levels, fasting free fatty acids (P = 0.031), and fasting β-hydroxybutyrate (P = 0.036) were statistically significant as jointly predictive of GDM. Comparisons between GDM patients and non-GDM patients matched by BMI confirmed that the metabolic abnormalities persisted when difference in BMI was taken into account. Concomitant blood pressure measurements in women with GDM did not differ significantly from those without GDM.

CONCLUSIONS
Our results show that many of the known metabolic components of the syndrome of insulin resistance (syndrome X) are predictive of GDM. These results are in keeping with the argument that GDM is one phase of the syndrome of insulin resistance. We suggest that GDM be looked upon as a component of the syndrome of insulin resistance that provides an excellent model for the study and prevention of NIDDM in a relatively young age-group.