bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Two-Step Strategy for Identification of High-Risk Subjects for a Clinical Trial of Prevention of NIDDM
Authors: Narayan K M Venkat , Hanson Robert L , Pettitt David J , Bennett Peter H , Knowler William C 
Published: March 2007

OBJECTIVE
To evaluate 2-h plasma glucose (2HPG), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1), a combination of FPG and HbA1 (FPG-HbA1), and other factors as screening tests for identifying high-risk subjects for a clinical trial of prevention of NIDDM and to identify strategies to minimize the total number of oral glucose tolerance tests (OGTTs) required to recruit eligible subjects to the trial.

RESEARCH DESIGN AND METHODS
One thousand, one hundred and eight nondiabetic Pima Indians aged 25–64 years were followed for up to 5 years, and factors predicting NIDDM, defined by World Health Organization criteria (2HPG ≥ 11.1 mmol/l), were assessed using Cox's proportional hazards analysis. Various threshold values of FPG, HbA1, and FPG-HbA1 were determined, which, when combined with an OGTT, identified subjects with impaired glucose tolerance (IGT) (2HPG ≥ 7.8 and &lt; 11.1 mmol/l) at a number of specified risks for developing NIDDM in 5 years. The value of each of the three tests was then assessed by calculating (for each threshold) the numbers to be screened, the numbers requiring an OGTT, and the sample size of IGT subjects needed to detect a 33% reduction in NIDDM by an experimental intervention at a power of 80%.

RESULTS
During a median of 4.3 years of follow-up, 91 (8.2%) of the 1.108 nondiabetic subjects developed NIDDM. The estimated 5-year cumulative incidence rate was 13.5%. Each of the variables, 2HPG, FPG, HbA1, FPG-HbA1, BMI, IGT, and systolic (sBP), diastolic (dBP), and mean (MBP) blood pressures, predicted NIDDM (P &lt; 0.05 for each) when controlled for age and sex. In a stepwise proportional hazards analysis model, 2HPG and FPG-HbA1 (P &lt; 0.001 for each) were selected as the best set of predictors of NIDDM and of fasting hyperglycemia (FPG ≥ 7.8 mmol/l).

CONCLUSIONS
A two-step strategy, in which high-risk individuals are first identified by FPG or FPG-HbA1 and then the OGTT is used to select subjects with IGT, requires fewer OGTTs than when using 2HPG as the initial screening test without substantially increasing the numbers that would need to be screened. Such a strategy also offers the advantage of reducing the necessary sample size and is therefore an effective, efficient, and convenient method of identifying eligible subjects for a clinical trial of prevention of NIDDM.
Measurement of Plasma LDL Cholesterol in Patients with Diabetes
Authors: Whiting Malcolm J , Shephard Mark D S , Tallis George A 
Published: March 2007

OBJECTIVE
To assess the accuracy of plasma LDL cholesterol concentrations estimated by the Friedewald formula and a direct immunoseparation method by comparison with a reference ultracentrifugation procedure in patients with diabetes.

RESEARCH DESIGN AND METHODS
Fasting plasma samples with triglyceride concentrations &lt; 4.5 mmol/l were collected from 100 patients with diabetes (28 type I and 72 type II) and LDL cholesterol concentrations were compared by the three methods.

RESULTS
LDL cholesterol values determined by the reference β-quantitation procedure were highly correlated with both the Friedewald formula (r = 0.96) and a direct immunoseparation method (r = 0.92). Calculated (Friedewald) LDL cholesterol coincided with the reference method with &lt; 10% error in 74% of the total diabetic group (82% of type I and 68% of type II diabetic patients). However, agreement between the direct LDL cholesterol and reference methods was significantly less (P = 0.02), with only 44% of patients having an error of &lt; 10% (52% of type I and 41% of type II diabetic patients). The direct immunoseparation method for LDL cholesterol showed a positive bias with increasing triglyceride concentrations, particularly for patients with type II diabetes.

CONCLUSIONS
In the group of diabetic patients studied with plasma triglyceride concentrations &lt; 4.5 mmol/l, the Friedewald formula provided an accurate estimation of LDL cholesterol. The direct immunoseparation method significantly overestimated LDL cholesterol at triglyceride levels between 2 and 4.5 mmol/l.
Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice
Authors: Blaum Caroline S , Velez Lourdes , Hiss Roland G , Halter Jeffrey B 
Published: March 2007

OBJECTIVE
To identify clinical characteristics related to poor glycemic control in patients with NIDDM cared for by Michigan primary care physicians.

RESEARCH DESIGN AND METHODS
This study was a cross-sectional secondary analysis of data from 393 NIDDM patients (mean age, 63 ± 11 years; 54% female; 92% white) in the 1990–1991 Michigan Diabetes in Communities II Study. We evaluated patient demographic, clinical, and physiological characteristics, attitudes toward diabetes, and self-care ability. Logistic regression was used for multivariate evaluation of the characteristics of those patients whose glycosylated hemoglobin (normal GHb 4–8%) was in the upper 25% of the study sample (GHb &gt; 11.6%).

RESULTS
A high meal-stimulated plasma C-peptide was associated with a lower likelihood of poor control (odds ratio [OR] for highest quartile vs. all others = 0.37; 95% CI 0.23-0.58). Longer time since diagnosis (OR for each 5 years duration = 1.28; 95% CI 1.07-1.53), poor self-care ability (OR = 1.85; 95% CI 1.27-2.71), and perceived absence of dietary recommendations (OR = 2.37; 95% CI 1.11–5.08) were also independently associated with presence in the highest GHb quartile. Characteristics that were not significantly related to poor glycemic control included sex, age, obesity, educational level, exercise, self-rated health status, and pharmacological treatment.

CONCLUSIONS
1) Poor glycemic control may reflect progressive failure of islet function, although the independent relationships of C-peptide level and time since diagnosis are consistent with concepts of heterogeneous mechanisms underlying NIDDM. 2) Despite the important relationships of biological characteristics of NIDDM to glycemic control, patient attitudes and self-care ability may be useful targets for designing management strategies for certain poorly controlled patients.
Circulating antibodies to common food antigens in Japanese children with IDDM
Authors: Ahmed Tahmeed , Kamota Tomohiro , Sumazaki Ryo , Shibasaki Masanao , Hirano Takeki , Takita Hitoshi 
Published: March 2007

OBJECTIVE
To investigate the humoral immune response to common food antigens in Japanese children with IDDM.

RESEARCH DESIGN AND METHODS
IgG antibodies to cow's milk, β-lactoglobulin, bovine serum albumin (BSA), alpha-lactalbumin, and hen's egg ovalbumin were examined by enzyme-linked immunosorbent assay in the sera of 33 patients with IDDM, ages 11.8 ± 3.4 years. The data were compared with that of 50 normal subjects, ages 10.3 ± 5.1 years, who acted as control subjects. A positive antibody to a food antigen was defined as an antibody titer greater than the 95th percentile value in normal subjects.

RESULTS
Children with IDDM had significantly higher median titers of IgG antibodies to β-lactoglobulin and ovalbumin (P = 0.03 and P = 0.0005 respectively). More children with IDDM than control subjects had positive IgG antibody to ovalbumin (21 vs. 6%, P = 0.04). Titers, as well as the number of positive antibodies to other food antigens, including BSA, did not differ between the two groups.

CONCLUSIONS
Japanese children with IDDM show an enhanced humoral immune response to β-lactoglobulin and ovalbumin, a phenomenon that may be related to the pathogenesis of the disease.
The Psychosocial Impact of Severe Hypoglycemic Episodes on Spouses of Patients With IDDM
Authors: Gonder-Frederick Linda , Cox Daniel , Kovatchev Boris , Julian Diana , Clarke William 
Published: March 2007

OBJECTIVE
No previous studies have examined the psychosocial impact of severe hypoglycemic episodes in IDDM patients on their spouses. This study compared spouses of IDDM patients with and without a history of recent severe hypoglycemia (SH) using traditional measures of psychosocial status and marital conflict, as well as diabetes-specific measures.

RESEARCH DESIGN AND METHODS
A total of 61 nondiabetic spouses (23 wives and 38 husbands) of IDDM patients participated in the study. Spouses completed a battery of traditional psychometric measures (depression, anxiety, marital conflict) and diabetes-specific measures (fear of hypoglycemia, marital conflict over diabetes, sleep disturbance caused by hypoglycemia). Scores of spouses of IDDM patients with and without a recent history of SH were compared with t tests.

RESULTS
Spouses of IDDM patients with and without a recent history of SH showed no differences on traditional psychometric measures of depression, anxiety, and marital conflict. However, spouses of patients with a recent history of SH showed significantly more fear of hypoglycemia, marital conflict about diabetes management, and sleep disturbances caused by hypoglycemia. Exploratory analyses of variance (ANOVAs) found no differences on psychometric measures between wives and husbands, with the exception that husbands of SH patients reported more sleep disturbance. Nondiabetic spouses, on average, showed greater fear of hypoglycemia than their diabetic partners.

CONCLUSIONS
Although SH in IDDM patients can have a significant impact on the psychosocial status of their spouses, in this study the negative impact was restricted to areas of life that are directly related to diabetes and its management. Thus, SH per se is not necessarily associated with significant increases in spousal anxiety, depression, or marital conflict, but may be associated with types of diabetes-specific psychosocial distress that are not easily identified by traditional psychometric measures.
Associations of GAD65- and IA-2-Autoantibodies With Genetic Risk Markers in New-Onset IDDM Patients and Their Siblings. The Belgian Diabetes Registry
Authors: Vandewalle Christina L , Falorni Alberto , Lernmark Åke , Goubert Patrick , Dorchy Harry , Coucke Willy , Semakula Crispin , Van Der Auwera Bart , Kaufman Leon , Schuit Frans C , Pipeleers Daniël G , Gorus Frans K 
Published: March 2007

OBJECTIVE
To investigate the association of GAD (65-kDa) autoantibodies (GAD65-Abs) and IA-2 autoantibodies (IA-2-Abs) with human leukocyte antigen (HLA)-DQ and insulin gene (INS) risk markers in patients with recent-onset IDDM and their siblings.

RESEARCH DESIGN AND METHODS
Blood was sampled from 608 recent-onset IDDM patients and 480 siblings, aged 0–39 years and consecutively recruited by the Belgian Diabetes Registry, to determine GAD65- and IA-2-Ab (radiobinding assay), HLA-DQ- (allele-specific oligonucleotyping), and INS-genotypes (restriction fragment length polymorphism analysis; siblings, n = 439).

RESULTS
At the onset of IDDM, GAD65-Abs were preferentially associated with two populations at genetic risk but only in the 20- to 39-year age-group: 1) their prevalence was higher in carriers of DQA1*0301-DQB1*0302 (88 vs. 73% in non[DQA1*0301-DQB1*0302], P = 0.001), and 2) an association was found in patients lacking this haplotype but carrying DQA1*0501-DQB1*0201, together with INS I/I (87 vs. 54% vs. non[INS I/I], P = 0.003). Siblings of IDDM patients also presented the association of GAD65-Abs with DQA1*0301-DQB1*0302 (13 vs. 2% non[DQA1*0301-DQB1*0302], P &lt; 0.001), while associations with the second genetic risk group could not yet be assessed. At the onset of IDDM, IA-2-Ab prevalence was higher in carriers of DQA1*0301-DQB1*0302 (69 vs. 39% non[DQA1*0301-DQB1*0302], P &lt; 0.001) but not of DQA1*0501-DQB1*0201 or INS I/I. This association was present in both the 0- to 19- and the 20- to 39-year age-groups. It was also found in siblings of IDDM patients (4 vs. 0% non[DQA1*0301-DQB1*0302], P &lt; 0.001).

CONCLUSIONS
Both GAD65- and IA-2-Abs exhibit higher prevalences in presence of HLA-DQ- and/or INS-genetic risk markers. Their respective associations differ with age at clinical onset, suggesting a possible usefulness in the identification of subgroups in this heterogeneous disease.
Glucose Tolerance, Insulin Secretion, and Insulin Sensitivity in Nonobese and Obese Japanese Subjects
Authors: Matsumoto Kazunari , Miyake Seibei , Yano Mayumi , Ueki Yukitaka , Yamaguchi Yoshihiko , Akazawa Shoichi , Tominaga Yuko 
Published: March 2007

OBJECTIVE
To investigate the relative contributions of insulin secretion and insulin resistance to the development of glucose intolerance in Japanese subjects.

RESEARCH DESIGN AND METHODS
A cross-sectional study of 756 Japanese subjects (530 nonobese, 226 obese) was performed. A 75-g oral glucose tolerance test (OGTT) was given, and subjects were classified according to the World Health Organization (WHO) criteria (normal glucose tolerance [NGT], impaired glucose tolerance [IGT], and diabetes). Early-phase insulin secretion was assessed by the insulinogenic index (the ratio of the increment of insulin to that of plasma glucose [PG] 30 min after a glucose load [ΔIRI0-30 min/Δ PG0-30 min]). Total insulin secretion was assessed by mean immunoreactive insulin (IRI) during the OGTT, and insulin resistance was assessed by use of the homeostasis model [HOMA(R)].

RESULTS
Early-phase insulin secretion was significantly decreased in IGT, compared with patients with NGT, in both the nonobese and obese subjects (0.70 ± 0.05 vs. 0.37 ± 0.03, P &lt; 0.01 and 1.36 ± 0.19 vs. 0.73 ± 0.08, P &lt; 0.01, respectively). However, mean IRI and HOMA(R) in both nonobese and obese subjects with IGT and NGT were not statistically different. Subjects with diabetes showed a significant decline in early-phase and total insulin secretion and a significantly higher level of insulin resistance than did subjects with IGT. When the fasting glucose (FPG) exceeded 100 mg/dl, early-phase insulin decreased progressively. The graphed relationship between FPG and mean IRI did not show an inverted U-shape, and mean IRI decreased progressively when FPG exceeded 100–130 mg/dl. The pattern of changes in insulin secretion and insulin resistance associated with the progression of glucose intolerance was similar in both the nonobese and obese subjects.

CONCLUSIONS
The worsening from NGT to IGT in Japanese subjects may be associated with a decrease in early-phase insulin secretion in nonobese as well as in obese subjects. Hyperinsulinemia in IGT is not common. We suggest that impaired early-phase insulin secretion may be the initial abnormality in the development of glucose intolerance in Japanese people. Insulin resistance may be a consequence of hyperglycemia and/or obesity.
Insulin Response in a Triethnic Population: Effects of Sex, Ethnic Origin, and Body Fat: The Miami Community Health Study
Authors: Donahue Richard P , Bean Judy A , DeCarlo Donahue Rosemary A , Goldberg Ronald B , Prineas Ronald J 
Published: March 2007

OBJECTIVE
To assess sex and ethnic differences in hyperinsulinemia/insulin resistance and to examine the impact of percent body fat on such differences.

RESEARCH DESIGN AND METHODS
A cross-sectional epidemiological study was performed in a normoglycemic population of African-Americans (n = 159), Cuban Americans (n = 128), and non-Hispanic whites (n = 207) who resided in Dade County, Florida, from 1990 to 1995. The insulin area under the curve (AUC) in response to a standard 75-g oral glucose tolerance test (OGTT) was used as an indicator of hyperinsulinemia/insulin resistance. Analysis of covariance was performed to compare sex and ethnic differences in the insulin AUC. Multiple linear regression was used to evaluate the independent correlates of the insulin AUC.

RESULTS
After covariate adjustment for percent body fat, men displayed a significantly higher insulin AUC than did women (P &lt; 0.001). African-Americans and Cuban-Americans each had a significantly higher insulin AUC than did non-Hispanic white participants (P = 0.01). Alcohol consumption was inversely related to AUC (P = 0.04).

CONCLUSIONS
Despite the greater percentage of body fat in women, the insulin AUC was similar in women and men. After adjustment for the sex difference in percent body fat, women displayed a lower insulin AUC than did men, indicating enhanced insulin sensitivity. These differences by sex and ethnicity in insulin resistance are consistent with established differences in heart-disease risk (i.e., higher in men and African-Americans) and suggest that hyperinsulinemia/insulin resistance may partly underlie such differences.
U.K. Prospective Diabetes Study 27: Plasma lipids and lipoproteins at diagnosis of NIDDM by age and sex
Authors:   U.K. Prospective Diabetes Study Group
Published: March 2007

OBJECTIVE
To compare fasting plasma lipids and lipoproteins in male and female patients at diagnosis of NIDDM and to examine age and sex differences in lipid concentrations.

RESEARCH DESIGN AND METHODS
Cross-sectional study of fasting plasma total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride in 2,139 male and 1,574 female white patients, aged 25–65 years, at diagnosis of NIDDM.

RESULTS
At diagnosis of NIDDM, the mean age ± SD for men was 52 ± 9 and 53 ± 9 years for women; BMI was 28.3 ± 4.9 and 30.8 ± 6.7 kg/m2, and fasting plasma glucose was 11.6 ± 3.6 and 12.4 ± 3.8 mmol/l, respectively. The mean total and LDL cholesterol were higher in female than in male NIDDM patients, 5.8 ± 1.2 vs. 5.5 ± 1.1 and 3.9 ± 1.1 vs. 3.6 ± 1.0 mmol/l (both P &lt; 0.001), respectively, while triglyceride levels were similar: geometric mean (1 SD interval) for men and women was 1.8 (1.1–3.1) vs. 1.8 (1.1–2.9) mmol/l. HDL cholesterol was higher in female than in male NIDDM patients, 1.09 ± 0.2 vs. 1.01 ± 0.24 mmol/l (P &lt; 0.001); the sex differential for HDL cholesterol was 7% in NIDDM patients compared with 22% in the general population. Data analysis by 5-year age bands showed a significant trend toward lower total cholesterol and triglyceride and higher HDL cholesterol in men diagnosed above the age of 50 years. In female NIDDM patients, lipid concentrations increased with age of diagnosis but reached a plateau above the age of 50 years.

CONCLUSIONS
The effect of NIDDM, observed at diagnosis, on plasma lipid and lipoprotein levels is more pronounced in women than in men. This may explain in part why the cardiovascular risk is proportionally higher in female patients.
Lipoprotein(a) in Android Obesity and NIDDM
Authors: Wassef Nicola , Sidhom Gloria , El-Khayat Zakareya , El-Kholy Mohamed 
Published: March 2007

OBJECTIVE
To assess the level of serum lipoprotein(a) [Lp(a)] in nonobese and obese NIDDM subjects with android body distribution.

RESEARCH DESIGN AND METHODS
Serum Lp(a) levels were measured in 30 long-standing NIDDM patients (duration of diabetes 12.5 ± 3 years, mean ± SD), with 15 of the patients being obese of android distribution (BMI &gt; 30 kg/m2 and waist-to-hip ratio &gt; 0.8). In addition, there were 15 android obese nondiabetic subjects and 10 healthy subjects serving as the control group.

RESULTS
All groups of patients in this study (diabetic, obese, and obese diabetic) showed significantly higher levels of Lp(a) than the healthy control group. Lp(a) concentrations were significantly higher in NIDDM patients with android type of obesity than in nondiabetic androids (24.1 ± 5.6 vs. 14.8 ± 2.4 mg/dl, P &lt; 0.001). Significantly greater levels of Lp(a) were found in nonobese subjects with diabetes when compared with obese subjects without diabetes (22.3 ± 4.1 vs. 14.8 ± 2.4 mg/dl, P &lt; 0.001). Furthermore, Lp(a) serum concentrations were not dependent on the degree of glycemic control (controlled NIDDM 23.6 ± 5.0 vs. uncontrolled NIDDM 21.4 ± 2.7 mg/dl, NS), but were much greater in subjects with diabetes complicated by vascular disease (complicated 26.3 ± 5.0 vs. uncomplicated 20.5 ± 2.7 mg/dl, P &lt; 0.001). No correlation was found between Lp(a) and other lipid parameters in this study.

CONCLUSIONS
Lp(a) levels are significantly elevated in both android-obese and nonobese NIDDM patients regardless of the degree of glycemic control. Lp(a) is an independent risk factor showing greater elevations in those subjects complicated with diabetic vascular diseases.
Impairment of Peripheral Blood Flow Responses in Diabetes Resembles an Enhanced Aging Effect
Authors: Stansberry Kevin B , Hill Michael A , Shapiro Shane A , McNitt Patricia M , Bhatt Bankim A , Vinik Aaron I 
Published: March 2007

OBJECTIVE
To test the hypothesis that skin blood flow responses in the fingertip of diabetic patients are impaired and to examine the role of aging in both healthy control subjects and diabetic patients.

RESEARCH DESIGN AND METHODS
We measured cutaneous blood flow using laser Doppler techniques in 40 people with diabetes and in 20 age- and sex-matched healthy control subjects. To induce vasoconstriction, subjects were asked to perform three 1-min stressor tasks: mental arithmetic, contralateral hand grip, and immersion of the contralateral hand in ice water. To induce vasodilatation, a local heat stimulus of 45 degrees C was applied for 5 min.

RESULTS
Basal blood flow did not differ between groups, but vasoconstrictive responses induced by arithmetic or immersion of the contralateral hand in ice-cold water and vasodilatation induced by local heating were severely impaired in diabetic subjects, compared with healthy control subjects (P &lt; 0.01). These responses correlated with autonomic nerve function and deteriorated significantly with advancing age in control subjects, but not in diabetic subjects. Blood flow in younger diabetic subjects resembled that of older control subjects.

CONCLUSIONS
These data demonstrate that diabetes has effects on precapillaries that may by direct or mediated via autonomic nerves, which result in a deficit that resembles premature aging.
Visual Function in Young IDDM Patients Over 8 Years of Age: A 4-year longitudinal study
Authors: North Rachel V , Farrell Una , Banford Denise , Jones Colin , Gregory John W , Butler Gary , Owens David R 
Published: March 2007

OBJECTIVE
To carry out a longitudinal study of visual functions in young patients over the age of 8 years with IDDM and to assess the impact of metabolic control on the presence of diabetic retinopathy.

RESEARCH DESIGN AND METHODS
There were 37 young IDDM patients from the Paediatric and Adolescent Clinic at the University Hospital of Wales studied annually for 4 years, with a control group of 24 healthy subjects observed over a 2-year period. Assessment of visual functions included visual acuity, color vision, and contrast sensitivity. Ophthalmoscopy and retinal photography were used to determine the presence or absence of diabetic retinopathy. In addition, pubertal status and metabolic control (glycosylated hemoglobin) were determined at each visit.

RESULTS
Patients with IDDM demonstrate abnormal color vision and contrast sensitivity compared with the control group (P &lt; 0.05), but visual acuity was unaffected. Visual functions were not significantly different between those IDDM patients with and without retinopathy. After 4 years, diabetic retinopathy was present in 43% of the group and was related to diabetes duration and metabolic control (P &lt; 0.05).

CONCLUSIONS
Visual function testing could not distinguish between those IDDM patients with and without retinopathy, but the color vision and contrast sensitivity in those with IDDM were significantly impaired compared with the control group. The presence of retinopathy was related to the duration of diabetes and metabolic control. It is important to ensure that good glycemic control and regular attendance for retinopathy screening is encouraged in the adolescent patients.