bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Therapy for Diabetic Ketoacidosis: Bolus insulin injection versus continuous insulin infusion
Authors: Butkiewicz Eryn K , Leibson Cynthia L , O'Brien Peter C , Palumbo Pasquale J , Rizza Robert A 
Published: March 2007

OBJECTIVE
Despite widespread acceptance of continuous insulin infusion (CII) over bolus insulin injection (BII) for treatment of diabetic ketoacidosis (DKA), there are no population-based studies demonstrating whether CII has resulted in lower morbidity and mortality.

RESEARCH DESIGN AND METHODS
We addressed this issue using a provider-linked database and retrospectively reviewing the complete medical records of all incidence cases of diabetes among Rochester, Minnesota, residents from 1950 to 1989 with a discharge diagnosis of DKA. This population-based study describes the consequences of the widespread change in treatment modality outside the confines of a controlled clinical trial.

RESULTS
Among the diabetes incident cohort, there were 59 subjects with confirmed first episodes of DKA during 1950-1992; 29 of 30 subjects treated with BII occurred before 1970. All 29 CII cases occurred between 1976 and 1992. Sex, etiology, diabetes duration, and age at DKA were similar for the two groups. The proportion of obese individuals (BII = 2/28, CII = 8/21; P = 0.01) differed between groups. The CII group exhibited higher glucose values (BII = 24.9 ± 8.5 mmol/l, CII = 37.1 ± 15.1 mmol/l; P = 0.002) and lower bicarbonate values (BII = 7.7 ± 3.0 nmol/l, CII = 6.2 ± 2.9 nmol/l; P = 0.04) upon admission. The mean quantity of insulin administered was higher in the BII group than in the CII group (179 ± 140 and 99 ± 70 U, P &lt; 0.006). The outcome of hypoglycemia occurred more frequently in the BII group than in the CII group (BII = 8/30, CII = 1/29; P = 0.03). The proportion with hypokalemia, neurological deficit, myocardial arrhythmia, or mortality did not differ significantly between groups.

CONCLUSIONS
Our findings suggest the introduction of CII was accompanied by a decreased incidence of hypoglycemia.
Effects of a Behavioral Weight Loss Program Stressing Calorie Restriction Versus Calorie Plus Fat Restriction in Obese Individuals With NIDDM or a Family History of Diabetes
Authors: Pascale Randy W , Wing Rena R , Butler Betsy A , Mullen Monica , Bononi Patricia 
Published: March 2007

OBJECTIVE
The aim of this randomized trial was to compare the effects of a behavioral intervention focusing on either calorie restriction alone or calorie plus fat restriction on weight loss and changes in lipids and glycemic control in individuals with non-insulin-dependent diabetes mellitus (NIDDM) or a family history of diabetes.

RESEARCH DESIGN AND METHODS
We recruited 44 obese women with NIDDM and 46 obese women with a family history of NIDDM and randomly assigned these subjects to calorie restriction (CAL) or to calorie plus fat restriction (CAL + FAT). All subjects participated in a 16-week behavioral weight loss program, with training in diet, exercise, and behavior modification. Subjects assigned to the CAL condition were given a 1,000−1,500 kcal/day goal and self-monitored calories consumed. Subjects assigned to the CAL + FAT condition had the same calorie goal, but were also given a fat goal (grams of fat/day), to produce a diet with &lt; 20% of calories from fat; this group monitored both calories and fat grams.

RESULTS
Among NIDDM subjects, weight loss of the subjects in the CAL+FAT condition was significantly &gt; subjects in the CAL condition (7.7 vs. 4.6 kg) and the CAL+FAT condition group also maintained their weight loss better at the 1-year follow-up (5.2 vs. 1.0 kg). Significant decreases in glucose, high-density lipoprotein (HDL) cholesterol, and total cholesterol were seen after 16 weeks of treatment among NIDDM subjects; these changes were similar in CAL and CAL+FAT groups, but a greater proportion of subjects in CAL condition required oral hypoglycemic medication. At the 1-year follow-up, all parameters had returned to baseline. No significant differences in weight loss or physiological changes were seen between CAL and CAL+FAT conditions in subjects with a family history of diabetes.

CONCLUSIONS
These results suggest that using the combination of calorie and fat restriction may help promote weight loss in obese NIDDM patients. No other long-term benefits of this regimen were observed.
Comparative Validity of a Food Frequency Questionnaire for Adults with IDDM
Authors: Riley Malcolm D , Blizzard Leigh 
Published: March 2007

OBJECTIVE
To investigate the characteristics of a food frequency questionnaire (FFQ) in measuring dietary intake in an adult insulin-dependent diabetes mellitus (IDDM) population. FFQs have been widely used in developed countries to assess usual dietary intake; however, information regarding the application of the method to individuals advised to follow a specific dietary regimen (such as people with IDDM) is scarce.

RESEARCH DESIGN AND METHODS
The measurement of energy and macronutrients by an interviewer-administered FFQ was assessed in 84 adults, who were representative of adults with IDDM in Tasmania, Australia, by comparing it with 2 days of weighed dietary records. Mean daily energy and macronutrient intakes by each method were compared, and Pearson correlation coefficients were calculated for both unadjusted and energy-adjusted macronutrient intakes.

RESULTS
The ratio of within-person to between-person variance in dietary estimates from weighed records was 0.53 for energy, 0.70 for fat, 2.55 for protein, 0.50 for carbohydrate, 0.78 for saturated fat, and 3.56 for dietary cholesterol. The correlation coefficient between the FFQ and a 2-day weighed dietary record for the same nutrients ranged from 0.38 for protein intake to 0.60 for saturated fat intake. The correlation coefficient between the FFQ and true usual dietary intake was estimated to be 0.60 for energy-adjusted fat intake, 0.36 for energy-adjusted protein intake, 0.72 for energy-adjusted carbohydrate intake, 0.55 for energy-adjusted saturated fat intake, and 0.77 for energy-adjusted cholesterol intake.

CONCLUSIONS
People with IDDM had a low ratio of within-person to between-person variance in daily energy, fat, carbohydrate, saturate fat, and cholesterol intake. The performance of the FFQ in the IDDM population is consistent with similar questionnaires in nondiabetic populations; however, there was a significant decrease in the dietary energy estimate upon readministration of the questionnaire. Validation studies such as this are important to provide information to guide the design and analysis of investigations that use dietary questionnaires.
Prevalence and Determinants of Glucose Intolerance in a Dutch Caucasian Population: The Hoorn Study
Authors: Mooy Johanna M , Grootenhuis Peter A , Vries Hendrik de , Valkenburg Hans A , Bouter Lex M , Kostense Pieter J , Heine Robert J 
Published: March 2007

OBJECTIVE
To study the prevalence and determinants of glucose intolerance in a general Caucasian population.

RESEARCH DESIGN AND METHODS
A random sample of 50- to 74-year old Caucasians (n = 2,484) underwent oral glucose tolerance tests. Multiple regression analyses were performed to study the association of 2-h postload plasma glucose values with potential determinants.

RESULTS
Prevalence of known and newly detected diabetes and impaired glucose tolerance was 3.6, 4.8, and 10.3%, respectively. In women, but not in men, the association of body mass index with 2-h glucose was fully accounted for by the waist-to-hip ratio. Maternal history of diabetes was twice as prevalent as paternal history, but paternal history only was associated with 2-h glucose. In addition, paternal history was a stronger determinant in men than in women. An independent positive association with 2-h plasma glucose was found for alcohol use of &gt; 30 g/day in women and for intake of total protein, animal protein, and polyunsaturated fatty acids in men. An independent inverse association with 2-h plasma glucose was demonstrated for height (both sexes), alcohol use of ≤ 30 g/day (both sexes), energy intake (in men), and, unexpectedly, current smoking (in men).

CONCLUSIONS
The prevalence of diabetes in elderly Caucasians was 8.3%. In men, dietary habits may unfavorably influence glucose tolerance independent of obesity.
Simultaneous Acute Cerebral and Pulmonary Edema Complicating Diabetic Ketoacidosis
Authors: Young Martin C 
Published: March 2007

OBJECTIVE
To report on a child with diabetic ketoacidosis (DKA) who developed simultaneous acute cerebral edema (CE) and pulmonary edema (PE), required extracorporeal membrane oxygenation (ECMO), and yet survived without significant neurological or pulmonary handicap.

CASE SUMMARY
A 3-year-old girl with DKA as the first manifestation of insulin-dependent diabetes mellitus (IDDM) sustained coincident acute CE and PE 9 h into therapy. The former responded to mannitol, but the latter matured into adult respiratory distress syndrome (ARDS) resistant to conventional management and requiring ECMO.

CONCLUSIONS
CE, PE, and ARDS can complicate DKA. Survival without sequelae is possible with aggressive treatment.
Variation in the Incidence and Proportion of Diabetes-Related Amputations in Minorities
Authors: Lavery Lawrence A , Ashry Hisham R , Van Houtum William , Pugh Jacqualine A , Harkless Lawrence B , Basu Srabashi 
Published: March 2007

OBJECTIVE
To identify the age-adjusted and level-specific incidence of amputations associated with diabetes in Hispanics, African-Americans, and non-Hispanic whites.

RESEARCH DESIGN AND METHODS
We used a database from the Office of Statewide Planning and Development in California that identified all hospitalizations for lower-extremity amputations in the state in 1991. Amputation level was defined by ICD-9-CM codes 84.11–84.18 and were categorized as toe, foot, leg, and thigh amputations.

RESULTS
The age-adjusted incidence of diabetes-related amputation per 10,000 persons with diabetes in 1991 was 95.25 in African-Americans, 55.98 in non-Hispanic whites, and 44.43 in Hispanics. Hispanics had a higher proportion of amputations (82.7%) associated with diabetes than did African-Americans (61.6%) or non-Hispanic whites (56.8%) (P &lt; 0.001). African-Americans had the highest age-adjusted incidence rate for each level in people with and without diabetes. African-Americans underwent more proximal amputations compared with non-Hispanic whites and Hispanics (P &lt; 0.001). Diabetes-related amputations were 1.72 and 2.17 times more likely in African-Americans compared with non-Hispanic whites and Hispanics, respectively.

CONCLUSIONS
Hispanics had proportionally more amputations associated with diabetes than did African-Americans or non-Hispanic whites. A significant excess incidence of both diabetes- and non-diabetes-related amputations and proportionally more proximal amputations were identified in African-Americans compared with Hispanics and non-Hispanic whites. A possible explanation could be the higher prevalence of peripheral vascular disease in African-Americans. Public health initiatives, which have been demonstrated to reduce the incidence of diabetes-related lower-extremity amputations, should be implemented, and additional work should focus on minority groups.
Polymorphism of Complement C4 and Susceptibility to IDDM and Microvascular Complications
Authors: Lhotta Karl , Auinger Martin , Kronenberg Florian , Irsigler Karl , König Paul 
Published: March 2007

OBJECTIVE
The aim of this study was to investigate whether or not the inherited polymorphism of complement C4 is associated with genetic susceptibility to microvascular complications in IDDM as previously reported.

RESEARCH DESIGN AND METHODS
We determined C4 phenotypes in 241 patients with IDDM and 140 healthy control subjects by agarose gel electrophoresis and immunoprecipitation. C4 allotype frequencies were compared between patients and healthy control subjects. In addition, we compared allotype frequencies of 83 patients with nephropathy with those of 80 patients without nephropathy and compared those of 50 patients with proliferative retinopathy with those of 68 patients without retinopathy or background retinopathy. Duration of IDDM in control patients was at least 21 years.

RESULTS
Patients and healthy control subjects differed at both the C4A (P &lt; 0.00001) and C4B (P &lt; 0.0005) loci. The C4 null allele C4AQ0 was significantly increased in IDDM patients (26.8 vs. 11.8%, P &lt; 0.005). C4B2 was more frequently observed in patients (14.5 vs. 6.8%, P &lt; 0.05) compared with healthy control subjects. No differences were observed in C4 allotype distribution between patients with and without nephropathy or retinopathy.

CONCLUSIONS
These data confirm previous reports of an association between the C4 null allele C4AQ0 and IDDM. Our results do not support an association of the inherited polymorphism of complement C4 with genetic susceptibility to microvascular complications in patients with IDDM.
Glimepiride, a New Once-Daily Sulfonylurea: A double-blind placebo-controlled study of NIDDM patients
Authors: Rosenstock Julio , Samols Ellis , Muchmore Douglas B , Schneider Jill ,   The Glimepiride Study Group
Published: March 2007

OBJECTIVE
To compare the efficacy and safety of two daily doses of the new sulfonylurea, glimepiride (Amaryl), each as a once-daily dose or in two divided doses, in patients with NIDDM.

RESEARCH DESIGN AND METHODS
Of the previously treated NIDDM patients, 416 entered this multicenter randomized double-blind placebo-controlled fixed-dose study. After a 3-week placebo washout, patients received a 14-week course of placebo or glimepiride 8 mg q.d., 4 mg b.i.d., 16 mg q.d., or 8 mg b.i.d.

RESULTS
Fasting plasma glucose (FPG) and HbA1c values were similar at baseline in all treatment groups. The placebo group's FPG value increased from 13.0 mmol/l at baseline to 14.5 mmol/l at the last evaluation endpoint (P ≤ 0.001). In contrast, FPG values in the four glimepiride groups decreased from a range of 12.4–12.9 mmol/l at baseline to a range of 8.6–9.8 mmol/l at endpoint (P ≤ 0.001, within-group change from baseline; P ≤ 0.001, between-group change [vs. placebo] from baseline). Two-hour postprandial plasma glucose (PPG) findings were consistent with FPG findings. In the placebo group, the HbA1c value increased from 7.7% at baseline to 9.7% at endpoint (P ≤ 0.001), whereas HbA1c values for the glimepiride groups were 7.9–8.1% at baseline and 7.4–7.6% at endpoint (P ≤ 0.001, within-group change from baseline; P ≤ 0.001, between-group change from baseline). There were no meaningful differences in glycemic variables between daily doses of 8 and 16 mg or between once- and twice-daily dosing. Adverse events and laboratory data demonstrate that glimepiride has a favorable safety profile.

CONCLUSIONS
Glimepiride is an effective and well-tolerated oral glucose-lowering agent. The results of this study demonstrate maximum effectiveness can be achieved with 8 mg q.d. of glimepiride in NIDDM subjects.
Treatment of Osteomyelitis in the Diabetic Foot: Contribution of conservative surgery
Authors: Ha Van Georges , Siney Hubert , Danan Jean-Paul , Sachon Claude , Grimaldi André 
Published: March 2007

OBJECTIVE
To compare the duration of healing of foot ulcers with osteomyelitis in diabetic patients treated by medical treatment versus medical treatment associated with conservative orthopedic surgery.

RESEARCH DESIGN AND METHODS
We entered into the study 67 diabetic patients who had a foot ulcer with osteomyelitis without ischemia requiring a peripheral arterial reconstruction. Thirty-two diabetic patients were included in a first historic group from 1986 to 1993, treated by antibiotic therapy, offloading, and wound care. Thirty-two patients were included from September 1993 to March 1995, treated by the same medical treatment and conservative orthopedic surgery.

RESULTS
The healing rate was 57% in the group treated by the medical treatment alone versus 78% in the surgical group (P &lt; 0.008). The duration of healing was 462 ± 98 days versus 181 ± 30 days (P &lt; 0.008).

CONCLUSIONS
Conservative surgery contributes to an increase in the healing rate of foot ulcers with osteomyelitis compared with a medical treatment alone.
Abnormal Glucose Tolerance and Other Coronary Heart Disease Risk Factors in an Isolated Aboriginal Community in Central Australia
Authors: Gault Andrew , O'Dea Kerin , Rowley Kevin G , McLeay Toby , Traianedes Kathy 
Published: March 2007

OBJECTIVE
To determine the age- and sex-specific prevalence of diabetes, impaired glucose tolerance (IGT), and coronary heart disease risk factors in a remote central Australian Aboriginal community maintaining some degree of traditional lifestyle, living in homeland communities on their ancestral land.

RESEARCH DESIGN AND METHODS
A cross-sectional survey of 437 subjects ≥ 15 years of age (189 men, 248 women), representing 80% of the adult population residing in the community at the time of the survey, was performed and the following parameters measured: BMI, glucose tolerance, circulating insulin and lipids, and blood pressure.

RESULTS
The mean BMI for this population was 22.9 ± 4.8 kg/m2. The prevalence of diabetes in the age group of 15–34 years (103 men and 140 women) was 2 and 6% for men and women, respectively. In the 35-years-and-older age group (86 men and 108 women), diabetes prevalence was 19 and 13% for men and women, respectively. Over half the diabetic subjects did not exhibit fasting hyperglycemia. IGT occurred in 8 and 15% of younger men and women, respectively, and in 17 and 32% of older men and women, respectively. Smoking was common among men (53% current smokers) but rare among women (2% current smokers). The prevalence of hypercholesterolemia, hypertriglyceridemia, hypertension, and overweight rose with increasing degrees of glucose intolerance. The two communities adjacent to the only store in the area had a higher prevalence of abnormal glucose tolerance than did the more remote homeland communities (odds ratio for abnormal glucose tolerance: 2.92; 95% CI 1.51−5.63).

CONCLUSIONS
Despite their relative leanness, this Aboriginal population exhibited relatively high prevalences of IGT and diabetes without fasting hyperglycemia. The data suggest a protective effect of a decentralized mode of living, as opposed to a more urbanized lifestyle, on the occurrence of glucose intolerance. Abnormal lipid profiles (particularly high triglycerides and low HDL cholesterol) and the high prevalence of smoking in men indicated a high-risk profile for coronary heart disease in this population.
NIDDM in the elderly
Authors: Meneilly Graydon S , Elliott Thomas , Tessier Daniel , Hards Lori , Tildesley Hugh 
Published: March 2007

OBJECTIVE
We conducted this study to assess the metabolic alterations in elderly patients with NIDDM.

RESEARCH DESIGN AND METHODS
Healthy, lean (n = 15; age, 73 ± 1 years; BMI, 23.8 ± 0.5 kg/m2), and obese (n = 10; age, 71 ± 1 years; BMI, 28.9 ± 1.2 kg/m2) control subjects and lean (n = 10; age, 75 ± 2 years; BMI, 24.0 ± 0.5 kg/m2) and obese (n = 23; age, 73 ± 1 years; BMI, 29.9 ± 0.7 kg/m2) NIDDM patients underwent a 3-h glucose tolerance test, a 2-h hyperglycemic glucose clamp study, and a 3-h euglycemic glucose clamp study with tritiated glucose methodology to measure glucose production and disposal rates.

RESULTS
Waist-to-hip ratio (WHR) was greater in both lean and obese NIDDM patients than in control subjects. Insulin responses during the oral glucose tolerance test were similar in obese subjects (control subjects: 417 ± 64 pmol/l; NIDDM patients: 392 ± 47 pmol/l) but were reduced in lean NIDDM patients (control subjects: 374 ± 34 pmol/l; NIDDM patients: 217 ± 20 pmol/l, P &lt; 0.01). Lean and obese NIDDM patients had absent first-phase insulin responses during the hyperglycemic clamp. Second-phase insulin responses were reduced in lean (P &lt; 0.01 vs. control subjects by analysis of variance) but not obese NIDDM patients. Hepatic glucose output was not increased in lean or obese NIDDM patients. Steady-state (150–180 min) glucose disposal rates were 16% less in lean NIDDM patients (control subjects: 8.93 ± 0.37 mg.kg LBM (lean body mass)−1 · min−1; NIDDM patients: 7.50 ± 0.28 mg · kg LBM−1 · min−1, P &lt; 0.05) and 37% less in obese NIDDM patients (control subjects: 8.17 ± 0.38 mg · kg LBM−1 · min−1; NIDDM patients: 5.03 ± 0.36 mg · kg LBM−1 · min−1, P &lt; 0.001).

CONCLUSIONS
Lean elderly NIDDM patients have a profound impairment in glucose-induced insulin release but mild resistance to insulin-mediated glucose disposal. Obese elderly NIDDM patients have adequate circulating insulin, but marked resistance to insulin-mediated glucose disposal. Hepatic glucose output is not increased in elderly NIDDM patients.
Comparison of Different Insulin Regimens in Elderly Patients With NIDDM
Authors: Wolffenbuttel Bruce H R , Sels Jean-Pierre J E , Rondas-Colbers Gabrielle J W M , Menheere Paul P C A , Kruseman Arie C Nieuwenhuijzen 
Published: March 2007

OBJECTIVE
To compare the metabolic effects of three different frequently used regimens of insulin administration on blood glucose control and serum lipids, and the costs associated with this treatment, in subjects with NIDDM, who were poorly controlled with oral antihyperglycemic agents.

RESEARCH DESIGN AND METHODS
We studied 95 elderly patients with NIDDM (age 68 ± 9 years, BMI 26.0 ± 4.6 kg/m2, and median time since diagnosis of diabetes 9 years [range 1–37]; 37 men, 58 women), who were poorly controlled, despite diet and maximal doses of oral antihyperglycemic agents. Three insulin administration regimens were compared during a 6-month period: patients were randomized for treatment with a two-injection scheme (regimen A) or a combination of glibenclamide with one injection of NPH insulin, administered either at bedtime (regimen B) or before breakfast (regimen C), and insulin treatment was mainly instituted in an outpatient setting.

RESULTS
After 6 months of insulin treatment, fasting blood glucose of the total patient population had decreased from an average of 14.1 ± 2.2 to 8.3 ± 2.0 mmol/l (P &lt; 0.001), and HbA1c fell from 11.0 ± 1.3 to 8.3 ± 1.2% (P &lt; 0.001); 34 patients reached HbA1c levels below 8.0%, 25 of them even below 7.5%. With two insulin injections daily, HbA1c decreased from 11.2 ± 1.3 to 8.2 ± 1.2%, while during combined treatment, HbA1c fell from 10.5 ± 1.2 to 8.1 ± 1.1% (regimen B) and from 11.1 ± 1.3 to 8.5 ± 1.1% (regimen C). Comparable improvement of the other measures of glycemic control, lipids and lipoproteins, was observed in the different treatment regimens. Body weight increase was moderate (mean ± 4.0 kg) and similar in all patient groups. One-third of patients starting with one insulin injection daily needed a second injection to control glycemia. One episode of severe hypoglycemia was observed. Combined insulin-sulfonylurea treatment was almost 20% more expensive than twice-daily administration of insulin alone.

CONCLUSIONS
Insulin treatment can safely be instituted in elderly patients with NIDDM. However, it is difficult to obtain optimal glycemic control. Insulin has moderate beneficial effects on serum lipoproteins. Although on the basis of glycemic control and weight gain, no preference for any treatment regimen can be discerned, twice-daily insulin administration is the most simple and cost-effective regimen.