bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which Left Ventricular Function Is Impaired Earlier in the Evolution of Diabetic Cardiomyopathy?: An echocardiographic study of young type I diabetic patients
Authors: Raev Dimitar C 
Published: March 2007

OBJECTIVE
To determine whether diastolic dysfunction preceded systolic dysfunction in the evolution of diabetic cardiopathy.

RESEARCH DESIGN AND METHODS
A total of 157 young (mean age 26.6 years) cardiac asymptomatic type 1 diabetic patients and 54 age- and sex-matched healthy (nondiabetic) subjects were studied. The severity of diabetic complications (retinopathy, nephropathy, and cardiac autonomic neuropathy) was evaluated by the diabetic complication index (DCl), a sum of individual scores for each complication. Left ventricular (LV) function was studied by M-mode echocardiography. Impaired systolic and diastolic functions were presumed if at least two echocardiographic variables for systolic function (fractional shortening [FS], mean velocity of circumference fiber shortening, and stroke index) and for diastolic function (slope of anterior mitral leaflet in early diastole, isovolumic relaxation time [IRT], and left atrium emptying index) were out of the control range (mean ± 2 SD).

RESULTS
Diastolic dysfunction was twice as common as systolic dysfunction (27% and 12%, respectively, P &lt; 0.001). Of diabetic patients with systolic dysfunction, 83% had impaired diastolic function, whereas only 30% of diabetic patients with diastolic dysfunction had systolic damage (P &lt; 0.001). On the other hand, only 3 of 157 diabetic patients (1.9%) had systolic dysfunction with preserved diastolic function (P &gt; 0.05). Diastolic dysfunction, represented by the interval from minimal LV dimension to mitral valve opening, was seen in diabetic patients ∼8 years after onset of diabetes and systolic dysfunction represented by FS after ∼18 years. Diastolic dysfunction, represente by 1RT, was found in the presence of mild complications (DCl = 2), and systolic dysfunction, represented by FS, was found in the presence of more severe complications (DCl = 4).

CONCLUSIONS
Our findings indicate that myocardial damage in patients with diabetes affects diastolic function before systolic function. The intentional assessment of diastolic function is advisable for early detection of LV dysfunction before clinical symptoms appear, with follow-up to detect further deterioration of cardiac status.
Differences in Survival Between Black and White Patients With Diabetic End-Stage Renal Disease
Authors: Cowie Catherine C , Port Friedrich K , Rust Keith F , Harris Maureen I 
Published: March 2007

OBJECTIVE
To evaluate whether the longer survival of blacks with diabetic end-stage renal disease (ESRD) relative to whites is due to racial differences in type of diabetes, comorbidity at ESRD onset, and ESRD treatment modality and to examine whether survival differences between blacks and whites occur only in certain population subgroups.

RESEARCH DESIGN AND METHODS
The Michigan Kidney Registry was used to ascertain all blacks and whites (n = 594) with diabetic ESRD in southeastern Michigan, with ESRD onset at age &lt;65 years during 1974–1983. Patients were followed through 1988. Medical records were abstracted for type of diabetes, comorbidity at ESRD onset, and other factors.

RESULTS
Median survival among insulin-dependent diabetes mellitus patients was 27 months in blacks and 17 months in whites, and among non-insulin-dependent diabetes mellitus patients was 30 months in blacks and 16 months in whites. After adjustment for confounding factors by Cox proportional hazards analysis, the death rate was 45% lower in blacks than in whites on dialysis (relative death rate [RDR] = 0.55,95% confidence interval [CI] = 0.44–0.69), but was similar in blacks and whites with a renal transplant (RDR = 0.99, 95% CI = 0.64–1.52). Compared with dialysis, transplantation was associated with lower mortality in both races (whites, RDR = 0.50, 95% CI = 0.36–0.70; blacks, RDR = 0.89, 95% CI = 0.60–1.34), although the effect was not statistically significant in blacks. Racial differences in survival did not vary by type of diabetes or any additional factor.

CONCLUSIONS
Survival after ESRD onset is longer in blacks than in whites treated with dialysis, even after adjusting for comorbidity and other factors that affect survival. Survival does not differ by race among transplant patients.
The Incidence of Childhood IDDM in New South Wales, Australia
Authors: Verge Charles F , Silink Martin , Howard Neville J 
Published: March 2007

OBJECTIVE
To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children 0–14 years of age in the state of New South Wales, Australia, which has a total population of 5.73 million.

RESEARCH DESIGN AND METHODS
We established a prospective register, identifying 361 incident cases over a 2-year period (1990–1991) with two independent sources of case ascertainment. The primary source was the reporting of newly diagnosed patients by physicians and diabetes educators. The secondary source was a subsidized syringe scheme.

RESULTS
Using the capture-recapture method, ascertainment was estimated to be 99.4% complete. The age-standardized incidence rate was 14.5 per 100,000 person-years (95% confidence interval: 13.0–16.0). No significant differences were found when comparing the first and second years of the register, boys and girls, geographical areas, or Aboriginal and non-Aboriginal children. There was seasonal variation in the onset (with more cases in winter), which was evident in the 10- to 14-year age-group (P = 0.01), but not in younger age-groups. A first-degree relative was already affected in 6.9% of the cases. No significant difference was noted in the age at onset when comparing cases with and without an affected first-degree relative.

CONCLUSIONS
The incidence of childhood IDDM in New South Wales is similar to rates found in other predominantly Anglo-Saxon populations. IDDM occurs in Aboriginal children with a frequency comparable to that in the rest of the population.
Sodium-lithium Transport in Adolescents With IDDM: Relationship to incipient nephropathy and glycemic control
Authors: Crompton Charles H , Balfe J Williamson , Balfe Judith A , Chatzilias Alice , Daneman Denis 
Published: March 2007

OBJECTIVE
The aims of this study were to examine genetic and environmental influences in the development of early diabetic nephropathy and to assess the value of measuring membrane sodium transport as a marker for early nephropathy.

RESEARCH DESIGN AND METHODS
We measured erythrocyte sodium- lithium (Na-Li) countertransport, blood pressure (BP), HbA1c, and microalbuminuria (MA) in 84 adolescents with insulin-dependent diabetes mellitus (IDDM), 29 of whom had MA. Twenty-nine non-MA patients were selected and matched for age, sex, and IDDM duration with the 29 diabetic subjects with MA. The 84 diabetic adolescents were also compared with 85 nondiabetic siblings.

RESULTS
The erythrocyte Na-Li countertransport was significantly greater in the IDDM group than in the sibling group (mean ± SD, 0.41 ± 0.14 vs. 0.30 ±0.11 mmol Li · liters of erythrocytes–1 · h–1, respectively, P &lt; 0.0001), but a significant correlation was noted between the results in IDDM subjects and their siblings (r = 0.42, P &lt; 0.0008). Na-Li countertransport was not different in the diabetic subjects with or without MA (0.43 ± 0.13 vs. 0.37 ± 0.13 mmol Li · liters of erythrocytes–1 · h–1, respectively). There was a significant correlation in the IDDM group between recent diabetic control (HbA1c) and Na-Li countertransport (r = 0.37, P &lt; 0.003). Diastolic BP was significantly higher in the IDDM group with MA than in those without MA (60 ± 6 vs. 55 ± 6 mmHg, respectively, P &lt; 0.03).

CONCLUSIONS
These results suggest that erythrocyte Na-Li countertransport is influenced by the diabetic milieu. However, there was also evidence in our subjects of a genetic contribution to Na-Li countertransport as seen by the correlation between levels in the IDDM subjects and their siblings. Using Na-Li countertransport, we were not able to segregate those IDDM adolescents with and without early nephropathy.
Metabolic Control Is Not Altered When Using Indwelling Catheters for Insulin Inactions
Authors: Ragnar Hanas S , Ludvigsson Johnny 
Published: March 2007

OBJECTIVE
To determine if the use of indwelling catheters for insulin injections affects the long- and short-term metabolic control of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
Sixteen children and adolescents 9–20 years of age were included in a randomized 10-week crossover study using indwelling catheters (Insuflon, Pharma-Plast, Lynge, Denmark; CHRONIMED, Minnetonka, Minnesota) for insulin injections. Their diabetes duration was 7.5 ± 3.3 years (range 2–14), and they used multiple injection therapy with 4–5 doses/day. C-peptide was &lt;0.15 nM fasting and ≤0.30 nM postprandial.

RESULTS
We found no significant difference between those with and without Insuflon in degree of metabolic control reflected by HbA1c (with Insuflon, 7.3 ± 2.6%; without, 7.1 ± 2.2%), 24-h profiles of blood glucose and free insulin, 24-h samples of glucosuria, or ketonuria. Weight, insulin doses per kilogram per 24 h, and insulin antibodies were all the same in the two groups.

CONCLUSIONS
The long- and short-term metabolic control of IDDM was not altered by the use of indwelling catheters for insulin injections. Insuflon can be offered as an alternative to patients with IDDM who find regular injections uncomfortable.
Frequency and Determinants of Diabetes Patient Education Among Adults in the U.S.Population
Authors: Coonrod Beth Ann , Betschart Jean , Harris Maureen I 
Published: March 2007

OBJECTIVE
To determine the proportion of adults with diabetesin the U.S. who have received diabetes patient education and to assess factors that determine whether patients receive this education.

RESEARCH DESIGN AND METHODS
A questionnaire on diabetes was administered to a representative sample of 2,405 diabetic individual≥18 years of age in the U.S. population. The questionnaire inquired about whether these individuals had ever attended a diabetes education class or program. Sociodemographic and clinical factors that may influence participation in patient education were also determined.

RESULTS
Of all people with diabetes, 35.1% had attended a class or program about diabetes at some time during the course of their disease,including 58.6% of individuals with insulin-dependent diabetes mellitus, 48.9% of insulin-treated individuals with non-insulin-dependent diabetes mellitus (NIDDM), and 23.7% of NIDDM individuals not treated with insulin. Younger age, black race, residence in the midwest region of the U.S., higher level of education, and presence of diabetes complications were consistentlyassociated with having had diabetes education for people with NIDDM. Although increasing income was associated with patient education for NIDDM individuals not treated with insulin, it was not an independent determinant for insulin-treated NIDDM individuals. NIDDM individuals not treated with insulin who lived alone were more likely to have had patient education than those who did not live alone. Not having a diabetes physician or not visiting onein the past year was associated with a higher likelihood of patient education for non-insulin-treated NIDDM individuals.

CONCLUSIONS
A large proportion of patients with diabetes has never received , diabetes education. Patient education has been recognized for its contributions to reducing the morbidity and mortality of diabetes. Consequently, special attention should be directed to the subgroups of individuals, such as those not taking insulin, those with lower socioeconomic status, and those living outside urban areas, in which the frequency of diabetes patient education is particularly low.
Nurse Practitioner Practice Patterns Based on Standards of Medical Care for Patients With Diabetes
Authors: Fain James A , Melkus Gail D'Eramo 
Published: March 2007

OBJECTIVE
To determine to what extent nurse practitioner (NP) practice patterns of diabetes care are consistent with standards of care suggested by the American Diabetes Association (ADA).

RESEARCH DESIGN AND METHODS
A descriptive study was conducted to examine practice patterns. A convenience sample of 78 charts was audited, representing a proportionate number of charts for each of the six masters-prepared, certified NPs employed in an ambulatory primary-care center.

RESULTS
Practice patterns related to diabetes care revealed a discrepancy between established standards of care and the degree to which care was documented. All six NPs acknowledged that they became clinically competent to care for patients with diabeteson the job.

CONCLUSIONS
Results of this small study suggest that NPs are not consistently following standards of care suggested by the ADA.
Complications of the Pump Pocket May Represent a Significant Cause of Incidents With Implanted Systems for Intraperitoneal Insulin Delivery
Authors: Renard Eric , Bringer Jacques , Jacques-Apostol Dominique , Lauton Dominique , Mestre Christéle , Costalat Guy , Jaffiol Claude 
Published: March 2007

OBJECTIVE
To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs).

CASES
There were 7 cases of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors.

RESULTS
Seven of 40 type I diabetic patients treated by PIP presented severe complications of the pump-pocket, resulting in five definitive explantations and nine other surgical interventions. The lesions included an exudative reaction in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative staphylococcus was identified in the pump-pocket in four patients, including three cases of skin erosion. No specific risk of local complications could be attributed to age, sex, duration of diabetes, body mass index, presence of retinopathy or peripheral neuropathy, HbA1c level since implantation, depth of implantation in the abdominal wall, or duration of experience with PIP. Usual physical activity corresponding to &gt;2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor.

CONCLUSIONS
From these results, we suggest that physical activity should be limited to moderate exercise and exclude vigorous efforts in diabetic patients treated by PIP to avoid an increased risk of complications at the implantation site.
Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men
Authors: Chan June M , Rimm Eric B , Colditz Graham A , Stampfer Meir J , Willett Walter C 
Published: March 2007

OBJECTIVE
To investigate the relation between obesity, fat distribution, and weight gain through adulthood and the risk of non-insulin-dependent diabetes melli-tus (NIDDM).

RESEARCH DESIGN AND METHODS
We analyzed data from a cohort of 51,529 U.S. male health professionals, 40-75 years of age in 1986, who completed biennial questionnaires sent out in 1986, 1988, 1990, and 1992. During 5 years of follow-up (1987-1992), 272 cases of NIDDM were diagnosed among men without a history of diabetes, heart disease, and cancer in 1986 and who provided complete health information. Relative risks (RRs) associated with different anthropometrie measures were calculated controlling for age, and multivariate RRs were calculated controlling for smoking, family history of diabetes, and age.

RESULTS
We found a strong positive association between overall obesity as measured by body mass index (BMI) and risk of diabetes. Men with a BMI of ≥35 kg/m2 had a multivariate RR of 42.1 (95% confidence interval [CI] 22.0-80.6) compared with men with a BMI &lt;23.0 kg/m2. BMI at age 21 and absolute weight gain throughout adulthood were also significant independent risk factors for diabetes. Fat distribution, measured by waist-to-hip ratio (WHR), was a good predictor of diabetes only among the top 5%, while waist circumference was positively associated with the risk of diabetes among the top 20% of the cohort.

CONCLUSIONS
These data suggest that waist circumference may be a better indicator than WHR of the relationship between abdominal adiposity and risk of diabetes. Although early obesity, absolute weight gain throughout adulthood, and waist circumference were good predictors of diabetes, attained BMI was the dominant risk factor for NIDDM; even men of average relative weight had significantly elevated RRs.
Maximizing Foot Salvage by a Combined Approach to Foot Ischemia and Neuropathic Ulceration in Patients With Diabetes: A 5-year experience
Authors: Rosenblum Barry I , Pomposelli Frank B , Giurini John M , Gibbons Gary W , Freeman Dorothy V , Chrzan James S , Campbell David R , Habershaw Geoffrey M , LoGerfo Frank W 
Published: March 2007

OBJECTIVE
The combination of peripheral neuropathy and arterial insufficiency in patients with diabetes frequently results in chronic non-healing foot ulcers. These patients often have a protracted course that commonly ends in limb amputation.

RESEARCH DESIGN AND METHODS
Since 1987, 39 diabetic patients presented with 42 neuropathic ulcerations beneath the lesser metatarsal heads, complicated by severe arterial insufficiency. A variety of vascular reconstructions were performed to improve circulation to the foot. After successful vascular reconstruction, 14 patients with deep ulcers underwent resection of the involved bone or joint through a plantar elliptical incision with excision of the ulcer and primary closure (33%). Five patients required a simultaneous panmetatarsal head resection (12%). For fifteen superficial ulcers, metatarsal osteotomy through a dorsal approach was performed (36%). Eight patients underwent a fifth metatarsal head resection through a dorsal approach (19%).

RESULTS
In follow-up of 2–64 months (mean 21.2 months), 35 extremities with patent bypass grafts achieved and maintained primary healing of their local foot procedure (83%). Two feet required subsequent revision but ultimately healed (5%). Three feet (7%) developed a new plantar ulceration adjacent to the original one. In two extremities, the foot remained healed in spite of thrombosis of their grafts (5%). One patient with a thrombosed graft required a below-knee amputation. One patient died before the foot healed with a patent bypass graft. Overall, 40 of 42 extremities (95%) ultimately healed over the course of the follow-up period.

CONCLUSIONS
We conclude that complex neuropathic ulcers in diabetic patients can be successfully treated by an aggressive surgical approach that removes infected bone and ulcers and corrects underlying structural abnormalities provided arterial insufficiency is corrected first.
Structure and Correlates of Diabetes-Specific Locus of Control
Authors: Peyrot Mark , Rubin Richard R 
Published: March 2007

OBJECTIVE
To examine the structure and correlates of diabetes-specific locus of control.

RESEARCH DESIGN AND METHODS
Study participants were 165 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program. The protocol included measures of diabetes locus of control (DLC), glycemie control, self-care behavior, and emotional well-being.

RESULTS
Scales measuring internal and powerful other DLC each had two components. One component of internal DLC, autonomy, was significantly associated with positive outcomes, and the other component, self-blame, was related to negative outcomes. The two components of powerful other DLC were differently correlated with various aspects of strict regimen adherence, and chance DLC was associated with a variety of measures reflecting a pattern of dysfunction.

CONCLUSIONS
The concept of DLC appears to have explanatory power in accounting for health outcomes, especially when internal DLC measures of autonomy and self-blame are differentiated. It is important to find educational interventions that work effectively with patients who believe that health outcomes are controlled by chance, because they seem to be at special risk for health-related problems.
Increased Transcapillary Escape Rate of Albumin in Microalbuminuric Type II Diabetic Patients
Authors: Nannipieri Monica , Rlzzo Loredana , Rapuano Antonella , Pilo Alessandro , Penno Giuseppe , Navalesi Renzo 
Published: March 2007

OBJECTIVE
To evaluate microvascular permeability by the transcapillary escape rate of albumin (TERalb) in type II diabetic patients with normo- and microalbuminuria.

RESEARCH DESIGN AND METHODS
The TERalb has been measured following intravenous injection of 125I-labeled human serum albumin in 32 normotensive type II diabetic patients and 9 healthy control subjects matched for sex and age. Type II diabetic subjects were grouped in normoalbuminuric, albumin excretion rate (AER) &lt;20 μg/min (n = 18), and microalbuminuric, AER 20-200 μg/min (n = 14) categories.

RESULTS
In type II diabetic patients, no differences were noted between normo- and microalbuminuric groups for known diabetes duration (8.3 ± 5.9 vs. 11.7 ± 8.0 years), blood pressure (BP) (129/76 ± 16/8 vs. 131/76 ± 14/5 mmHg), current metabolic control (HbA1c: 8.0 ± 1.4 vs. 8.5 ± 1.6%), and serum lipids. However, previous 2-year mean HbA1c levels were significantly higher in microalbuminuric patients (8.7 ± 1.45 vs. 7.6 ± 1.29%; P &lt; 0.05). The TERalb was similar in control subjects and normoalbuminuric patients (5.16 ± 1.09 vs. 5.71 ± 1.66 %/h) and significantly higher in the microalbuminuric group (8.98 ± 1.35 %/h; P &lt; 0.0001). The increased leak of albumin was not explained by differences in diabetes duration, BP, or metabolic control at the time of investigation and was independently related to the presence of microalbuminuria (r = 0.63, percent explained variance ∼40) and mean “historical” HbA1c (multiple r = 0.705; total explained variance ∼50%).

CONCLUSIONS
Type II diabetic patients with microalbuminuria show an increased TERalb, i.e., a widespread microvascular damage that may be important in the pathogenesis of long-term complications. Our findings may contribute to the explanation of why albuminuria seems to be an independent cardiovascular risk factor in type II diabetes.