bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soluble Tumor Necrosis Factor-α Receptors in Young Obese Subjects With Normal and Impaired Glucose Tolerance
Authors: Dzienis-Straczkowska Stella , Straczkowski Marek , Szelachowska Malgorzata , Stepien Agnieszka , Kowalska Irina , Kinalska Ida 
Published: March 2007

OBJECTIVE— Tumor necrosis factor-α (TNF-α) is a possible link between obesity and impaired glucose tolerance (IGT) and type 2 diabetes. Data about TNF-α and soluble forms of its receptors (sTNFR1 and sTNFR2) in IGT are controversial. The aim of the present study was to assess plasma TNF-α, sTNFR1, and sTNFR2 levels and to evaluate the relationships with insulin resistance in obese subjects with IGT.
RESEARCH DESIGN AND METHODS— A total of 104 subjects participated in the present study: 30 obese subjects with IGT (obese-IGT), 32 obese subjects with normal glucose tolerance (obese-NGT), and 42 lean healthy control subjects (control-NGT). Anthropometry and blood biochemical parameters were measured and euglycemic-hyperinsulinemic clamp was performed.
RESULTS— Obese-IGT subjects were more insulin resistant in comparison with obese-NGT and control-NGT groups; obese-NGT subjects were more insulin resistant than control-NGT. Plasma sTNFR1 and sTNFR2 were markedly higher in both groups of obese subjects in comparison with control-NGT and in the obese-IGT versus obese-NGT group. Plasma sTNFR1 and sTNFR2 were inversely related to insulin sensitivity. Both relationships remained significant after adjustment for age, BMI, waist girth, percent body fat, plasma glucose, insulin, nonesterified fatty acids, cholesterol, and triglycerides. Correlation between sTNFR2 and insulin sensitivity was also present in all the groups analyzed separately, but the correlation between sTNFR1 and insulin sensitivity was present only in the obese-NGT group.
CONCLUSIONS— Our data suggest that TNF-α receptors are increased in obese-IGT subjects and are related to insulin resistance. These findings indicate that the TNF-α system might contribute to the development of insulin resistance in glucose-intolerant subjects.
Assessing the Shape of the Glucose Curve During an Oral Glucose Tolerance Test
Authors: Tschritter Otto , Fritsche Andreas , Shirkavand Fatemeh , Machicao Fausto , Häring Hans , Stumvoll Michael 
Published: March 2007

OBJECTIVE—The oral glucose tolerance test (OGTT) is used to define the status of glucose tolerance based on the plasma glucose level at 120 min. The purpose of the present study was to identify parameters that determine the shape of the plasma glucose course measured at 0, 30, 60, 90, and 120 min during an OGTT.
RESEARCH DESIGN AND METHODS—OGTT data from 551 subjects (485 with normal glucose tolerance [NGT] and 66 with impaired glucose tolerance [IGT]) were analyzed. We distinguished between “monophasic,” “biphasic,” and unclassified glucose shapes. A “shape” index based on the extent and the direction of the plasma glucose change in the second hour allowed us to treat shape as a continuous variable.
RESULTS—In the biphasic group, the NGT-to-IGT ratio was slightly higher (173/20 vs. 209/40, P = 0.08) and the male-to-female ratio was lower (60/133 vs. 120/129, P = 0.0003). Subjects with a biphasic shape had significantly lower age, BMI, waist-to-hip ratio (WHR), HbA1c, plasma glucose, and area under the insulin curve (insulinAUC) and a better estimated insulin sensitivity and secretion (using validated indexes) than monophasic subjects (all P &lt; 0.05). By adjusting this shape index for glucoseAUC (as continuous measure of glucose tolerance), correlations with age, BMI, WHR, HbA1c, and insulinAUC were completely abolished. The adjusted shape index was still higher in female than in male subjects but lower in IGT than in NGT subjects (both P = 0.0003). Finally, we tested common polymorphisms in insulin receptor substrate (IRS)-1, IRS-2, calpain-10, hepatic lipase, and peroxisome proliferator-activated receptor-γ for association with the shape index.
CONCLUSIONS—We conclude that the plasma glucose shape during an OGTT depends on glucose tolerance and sex. In addition, genetic factors seem to play a role. The shape index may be a useful metabolic screening parameter in epidemiological and genetic association studies.
Effect of Family History of Type 2 Diabetes on the Intima-Media Thickness of the Common Carotid Artery in Normal-Weight, Overweight, and Obese Glucose-Tolerant Young Adults
Authors: Pannacciulli Nicola , De Pergola Giovanni , Ciccone Marco , Rizzon Paolo , Giorgino Francesco , Giorgino Riccardo 
Published: March 2007

OBJECTIVE—To evaluate the effect of a first-degree family history of type 2 diabetes on the intima-media thickness of the common carotid artery (IMT-CCA), a surrogate marker of coronary atherosclerosis, in glucose-tolerant young adults.
RESEARCH DESIGN AND METHODS—IMT-CCA was measured by high-resolution B-mode ultrasound imaging in 401 individuals aged 18–45 years with normal glucose tolerance (NGT). A total of 213 subjects had no family history of type 2 diabetes until the third generation (FH−), and 188 subjects had a family history of type 2 diabetes (FH+), defined as having one or both parents with type 2 diabetes. Other measurements included: central fat accumulation, evaluated by waist circumference; insulin resistance, estimated by homeostasis model assessment for insulin resistance (HOMAIR); systolic and diastolic blood pressure; fasting and postload concentrations of glucose; fasting insulin levels; and lipid profile.
RESULTS—IMT-CCA and both 1- and 2-h postchallenge glucose concentrations were significantly higher in FH+ than in FH− subjects. IMT-CCA was positively correlated with age, BMI, waist circumference, triglycerides, systolic and diastolic blood pressure levels, basal glucose concentrations, 1- and 2-h postchallenge glucose concentrations, and HOMAIR. IMT-CCA was inversely associated with HDL cholesterol. After multivariate analysis, IMT-CCA maintained a significant association with family history of type 2 diabetes, BMI, waist circumference, HDL cholesterol, diastolic blood pressure, and fasting glucose.
CONCLUSIONS—This study indicates that a genetic predisposition to type 2 diabetes, probably in association with slightly elevated glucose levels, may accelerate the development of atherosclerosis and increase the risk for coronary heart disease in glucose-tolerant individuals.
Carotid Atherosclerosis and Coronary Heart Disease in the Metabolic Syndrome
Authors: Bonora Enzo , Kiechl Stefan , Willeit Johann , Oberhollenzer Friedrich , Egger Georg , Bonadonna Riccardo C. , Muggeo Michele 
Published: March 2007

OBJECTIVE— The present study aimed at prospectively evaluating carotid atherosclerosis and coronary heart disease (CHD) in subjects with the metabolic syndrome.
RESEARCH DESIGN AND METHODS— Within a prospective population-based survey examining 888 subjects aged 40–79 years, 303 subjects were identified as fulfilling World Health Organization (WHO) criteria and 158 as fulfilling the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP)-III criteria for diagnosing the metabolic syndrome. The 5-year change in carotid status, as assessed by echo-duplex scanning, and incident fatal and nonfatal CHD, as assessed by medical history and death certificates, were compared in subjects with the metabolic syndrome and in the rest of the sample (control subjects).
RESULTS— Compared with the control subjects, subjects with the metabolic syndrome by WHO criteria had an increased 5-year incidence and progression of carotid atherosclerosis: 51 vs. 35% developed new plaques (P = 0.021) and 34 vs. 19% developed carotid stenosis &gt;40% (P = 0.002) after adjusting for several confounders. Subjects with the metabolic syndrome by these criteria also had an increased incidence of CHD during follow-up: 8 vs. 3% in control subjects (P = 0.012). Similar results were found when the NCEP-ATPIII criteria were used.
CONCLUSIONS— Subjects with the metabolic syndrome are at increased risk for both progressive carotid atherosclerosis and CHD.
Motivational Brochures Increase the Number of Medicare-Eligible Persons With Diabetes Making Therapeutic Footwear Claims
Authors: LeMaster Joseph W. , Sugarman Jonathan R. , Baumgardner Greg , Reiber Gayle E. 
Published: March 2007

OBJECTIVE—This study tests the hypothesis that Medicare beneficiaries at high risk of foot complications who are mailed a motivational brochure describing the Medicare diabetes-related therapeutic footwear benefit will increase their therapeutic footwear–related Medicare claims.
RESEARCH DESIGN AND METHODS—In this quasi-experimental study, a motivational brochure was mailed in the summer of 1997 to 5,872 Medicare beneficiaries in Washington, Alaska, and Idaho who were identified as being at high risk for foot-related claims on the basis of their prior Medicare claims history. Beneficiaries were identified through footwear claims made in these states—and also in three comparison states (Oregon, Montana, and Wyoming)—during the 18 months before and after the mailing. Linear regression was used to compare the number of persons making claims in the intervention states with the comparison states before, at the time of, and after the mailing.
RESULTS—Before the intervention, the number of persons making claims was increasing in the nonintervention states and decreasing in the intervention states. During the first month after the intervention mailing, the number of persons making claims remained nearly the same in nonintervention states, but increased 13 persons per month in intervention states (95% CI 3.5–11 persons/month). After the intervention, the number of persons making claims continued to increase similarly in both intervention and nonintervention states.
CONCLUSIONS—Mailed motivational brochures were associated with an increase in the number of persons making therapeutic footwear claims. Randomized trials should confirm these findings.
Surrogate End Points for the Treatment of Diabetic Neuropathic Foot Ulcers
Authors: Margolis David J. , Gelfand Joel M. , Hoffstad Ole , Berlin Jesse A. 
Published: March 2007

OBJECTIVE—The goal of this study was to determine whether surrogate markers based primarily on changes in the size of a wound can be used to correctly predict which individuals with diabetic neuropathic foot ulcers will heal after 12 or 20 weeks of care.
RESEARCH DESIGN AND METHODS—This is a retrospective cohort study using the Curative Health Services database. As many as 39,918 neuropathic wounds on 20,213 individuals with diabetes were evaluated. Seven surrogates based on changes in wound size were evaluated.
RESULTS—Surrogates measured after 2, 4, or 8 weeks of care and based on percentage change in area, log healing rate, and log area ratio discriminated well with respect to differentiating between those wounds that healed and those that did not heal by the 12th or 20th week of care. For example, after 4 weeks of care, the percentage change in area can be used to correctly discriminate 76% of the time between those that healed and those that did not by the 20th week of care.
CONCLUSIONS—The surrogate markers can be used in clinical trials such that shorter and smaller trials can be conducted with reasonable accuracy in order to determine which potential new therapeutics should be studied in larger, longer trials. In addition, the surrogates may also benefit clinicians when they are trying to decide whether a wound care therapy will ultimately be successful.
Effect of Nurse-Directed Diabetes Care in a Minority Population
Authors: Davidson Mayer B. 
Published: March 2007

OBJECTIVE—To determine whether diabetes care directed by nurses following detailed protocols and algorithms and supervised by a diabetologist results in meeting the evidence-based American Diabetes Association (ADA) process and outcome measures more often than care directed under usual care in a minority population.
RESEARCH DESIGN AND METHODS—Studies were mainly conducted in two Los Angeles County clinics. In clinic A, nurse-directed diabetes care was provided to 252 patients (92% Hispanic and 2% African-American) referred by their primary care providers. These patients were hierarchically matched with 252 diabetic patients in clinic B (79% Hispanic and 19% African American). When nurse-directed care was abruptly discontinued in clinic A for administrative reasons, it was reestablished in clinic B. Those patients were randomly selected from a teaching clinic, and the outcomes in 114 patients who completed 1 year were compared with outcomes derived the year before receiving nurses’ care. The following process and outcome measures were assessed in the study: 1) number of visits, 2) diabetes education, 3) nutritional counseling, 4) HbA1c, 5) lipid profiles, 6) eye exams, 7) foot exams, 8) renal evaluations, and 9) ACE inhibitor therapy in appropriate patients.
RESULTS—For patients under nurse-directed diabetes care in both clinics A and B, almost all process measures were carried out significantly more frequently than for the appropriate control patients. Under the care of nurses in clinic A, HbA1c levels fell 3.5% from 13.3 to 9.8% in the 120 patients who were followed for at least 6 months, as compared with a 1.5% fall from 12.3 to 10.8% under usual (physician-directed) care in clinic B. During the year before enrolling in nurse-directed care in clinic B, mean HbA1c levels decreased from 10.0 to 8.5%. At the end of a year under the nurses’ care, the values fell further to 7.1%. The median value fell from 8.3 to 6.6%.
CONCLUSIONS—Specially trained nurses who follow detailed protocols and algorithms under the supervision of a diabetologist can markedly improve diabetes outcomes in a minority population. This approach could help blunt the increased morbidity and mortality noted in minority populations.
Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes
Authors:   Diabetes Prevention Program Research Group
Published: March 2007

OBJECTIVE—The Diabetes Prevention Program (DPP) demonstrated that intensive lifestyle and metformin interventions reduced the incidence of type 2 diabetes compared with a placebo intervention. The aim of this study was to assess the cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention.
RESEARCH DESIGN AND METHODS—Analyses were performed from a health system perspective that considered direct medical costs only and a societal perspective that considered direct medical costs, direct nonmedical costs, and indirect costs. Analyses were performed with the interventions as implemented in the DPP and as they might be implemented in clinical practice.
RESULTS—The lifestyle and metformin interventions required more resources than the placebo intervention from a health system perspective, and over 3 years they cost approximately $2,250 more per participant. As implemented in the DPP and from a societal perspective, the lifestyle and metformin interventions cost $24,400 and $34,500, respectively, per case of diabetes delayed or prevented and $51,600 and $99,200 per quality-adjusted life-year (QALY) gained. As the interventions might be implemented in routine clinical practice and from a societal perspective, the lifestyle and metformin interventions cost $13,200 and $14,300, respectively, per case of diabetes delayed or prevented and $27,100 and $35,000 per QALY gained. From a health system perspective, costs per case of diabetes delayed or prevented and costs per QALY gained tended to be lower.
CONCLUSIONS—Over 3 years, the lifestyle and metformin interventions were effective and were cost-effective from the perspective of a health system and society. Both interventions are likely to be affordable in routine clinical practice, especially if implemented in a group format and with generic medication pricing.
Effect of Moderate Alcohol Consumption on Adiponectin, Tumor Necrosis Factor-α, and Insulin Sensitivity
Authors: Sierksma Aafje , Patel Hamina , Ouchi Noriyuki , Kihara Shinji , Funahashi Tohru , Heine Robert J. , Grobbee Diederick E. , Kluft Cornelis , Hendriks Henk F.J. 
Published: March 2007

OBJECTIVE—Epidemiological studies suggest that moderate alcohol consumers have enhanced insulin sensitivity and a reduced risk of type 2 diabetes. Adiponectin, an adipocyte-derived plasma protein, has been found to be negatively associated with adiposity and positively associated with insulin sensitivity. Moderate alcohol consumption may increase adiponectin, which in turn causes a decrease of tumor necrosis factor (TNF)-α. A decreased TNF-α level may consequently increase insulin sensitivity.
RESEARCH DESIGN AND METHODS—To test this hypothesis, we performed a randomized crossover partially diet-controlled study. A total of 23 healthy middle-aged male subjects consumed daily four glasses of whisky (40 g ethanol) or tap water with dinner during two successive periods of 17 days.
RESULTS—Moderate alcohol consumption increased plasma adiponectin level (11%; P = 0.0002) but did not affect plasma TNF-α level. An increase in insulin sensitivity index was observed in an insulin-resistant subgroup (21%; P = 0.11), which positively correlated with the relative alcohol-induced increase in plasma adiponectin level (r = 0.73, P = 0.02).
CONCLUSIONS—The experimental results are in agreement with observational data. Moderate alcohol consumption improved insulin sensitivity in relatively insulin-resistant middle-aged men, an effect that may be mediated through alcohol-induced increases in adiponectin.
A Standardized Triglyceride and Carbohydrate Challenge
Authors: Mohanlal Nina , Holman Rury R. 
Published: March 2007

OBJECTIVE—A standardized method of assessing postprandial triglyceride changes is not available. We evaluated an oral triglyceride tolerance test (OTTT) designed for routine clinical and research use.
RESEARCH DESIGN AND METHODS—A 200-ml strawberry-flavored test drink (50 g fat, 50 g carbohydrate) was administered twice to 30 diabetic and 20 nondiabetic subjects. Venous plasma triglyceride and glucose levels were measured when fasting and every 2 h for 8 h after the drink. Fingerprick plasma triglyceride levels were measured when fasting and at 6 and 8 h after the drink.
RESULTS—The drink was consumed within 3 min and well tolerated by all subjects. The median triglyceride rise at 6 h was similar in diabetic and nondiabetic subjects (0.23 vs. 0.42 mmol/l, NS) and correlated with glucose increase at 2 h (r = 0.429, P = 0.018 and r = 0.509, P = 0.026; respectively). Diabetic subjects had higher 6-h geometric mean (1 SD range) triglyceride levels (1.82 [1.87 to 3.23] vs. 1.11 [0.66 to 1.11 mmol/l], P &lt; 0.003) but a similar coefficient of variation (17.5 vs. 17.0%, NS) and a similar median (interquartile range) time to achieve maximal concentration (Tmax) (6.0 [4.0 to 6.0] vs. 5.0 [4.0 to 6.0] h, NS). Capillary triglyceride values were equivalent to simultaneous venous samples but consistently 10% greater.
CONCLUSIONS—The OTTT permits simple evaluation of postchallenge triglyceride levels, is acceptable to subjects, and can be performed with capillary sampling. It could be used to monitor triglyceride-lowering therapies and to provide additional information concerning cardiovascular disease risk, particularly in diabetic subjects.
The Effect of Diabetes on B-Type Natriuretic Peptide Concentrations in Patients With Acute Dyspnea
Authors: Wu Alan H.B. , Omland Torbjørn , Duc Philippe , McCord James , Nowak Richard M. , Hollander Judd E. , Herrmann Howard C. , Steg Philippe G. , Wold Knudsen Cathrine , Storrow Alan B. , Abraham William T. , Perez Alberto , Kamin Richard , Clopton Paul , Maisel Alan S. , McCullough Peter A. ,   for the Breathing Not Properly Multinational Study Investigators
Published: March 2007

OBJECTIVE—Diabetes has been implicated in reduced myocardial compliance and changes in the intercellular matrix of the myocardium. We determined the effect of diabetes on B-type natriuretic peptide (BNP) concentrations in patients presenting to the emergency department with dyspnea.
RESEARCH DESIGN AND METHODS—The Breathing Not Properly Multinational Study was a prospective evaluation of 1,586 patients. A subset of 922 patients was obtained and subdivided into the following groups: group 1 (n = 324), neither diabetes nor heart failure; group 2 (n = 107), diabetes and no heart failure; group 3 (n = 247), no diabetes and heart failure; group 4 (n = 183), both diabetes and heart failure; group 5 (n = 41), heart failure history with no diabetes; and group 6 (n = 20), heart failure history with diabetes. Patients from groups 1, 3, and 5 were matched to groups 2, 4, and 6, respectively, to have the same mean age, sex distribution, BMI, renal function, and New York Heart Association (NYHA) classification (for heart failure).
RESULTS—There was no significant difference in median BNP levels between diabetes and no diabetes among no heart failure patients (32.4 vs.32.9 pg/ml), heart failure patients (587 vs. 494 pg/ml), and those with a heart failure history (180 vs. 120 pg/ml). Receiver-operating characteristic curve analysis of the area under the curve for BNP was not different in diabetic versus nondiabetic patients (0.888 vs. 0.878, respectively). However, in a multivariate model, diabetes was an independent predictor of a final diagnosis of heart failure (odds ratio 1.51, 95% CI 1.03–2.02; P &lt; 0.05).
CONCLUSIONS—History of diabetes does not impact BNP levels measured in patients with acute dyspnea in the emergency department. Despite the impact of diabetes on the cardiovascular system, diabetes does not appear to confound BNP levels in the emergency department diagnosis of heart failure.
Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances
Authors: Nilsson Peter M. , Rööst Mattias , Engström Gunnar , Hedblad Bo , Berglund Göran 
Published: March 2007

OBJECTIVE—Sleep deprivation in healthy men has been experimentally found to result in disturbances in glucose metabolism and in sympathovagal imbalance. The aim of the present study was to investigate whether sleep disturbances and elevated resting heart rate are associated with increased risk of developing diabetes.
RESEARCH DESIGN AND METHODS—A group of 6,599 initially healthy, nondiabetic men aged 44.5 ± 4.0 years took part in a prospective, population-based study in Malmö, Sweden. The incidence of diabetes during a mean follow-up of 14.8 ± 2.4 years was examined in relation to self-reported difficulties in falling asleep and resting heart rate at baseline. Diabetes was assessed at follow-up in all subjects by questionnaire and in a subgroup of 1,551 men by blood glucose measurement.
RESULTS—A total of 615 (9.3%) subjects reported either difficulties in falling asleep or regular use of hypnotics (seen as markers of sleep disturbances), and 158 (2.4%) subjects reported both of these. Altogether, 281 (4.3%) of the men developed diabetes during the follow-up period. Logistic regression models showed difficulties in falling asleep or regular use of hypnotics (odds ratio [OR] 1.52 [95% CI 1.05–2.20]) and resting heart rate (OR per 10 bpm 1.13 [0.99–1.30]) to be associated with development of diabetes when full adjustments were made for baseline age, biological risk factors, lifestyle, family history of diabetes, and social class.
CONCLUSIONS—The results suggest that sleep disturbances and, possibly, elevated resting heart rate, in middle-aged men, are associated with an increased risk of diabetes.