bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Magnesium Supplementation Improves Insulin Sensitivity and Metabolic Control in Type 2 Diabetic Subjects
Authors: Rodríguez-Morán Martha , Guerrero-Romero Fernando 
Published: March 2007

OBJECTIVE—To determine whether oral magnesium supplementation (as magnesium chloride [MgCl2] solution) improves both insulin sensitivity and metabolic control in type 2 diabetic subjects with decreased serum magnesium levels.
RESEARCH DESIGN AND METHODS—This study was a clinical randomized double-blind placebo-controlled trial. A total of 63 subjects with type 2 diabetes and decreased serum magnesium (serum magnesium levels ≤0.74 mmol/l) treated by glibenclamide received either 50 ml MgCl2 solution (containing 50 g MgCl2 per 1,000 ml solution) or placebo daily for 16 weeks. Chronic diarrhea, alcoholism, use of diuretic and/or calcium antagonist drugs, and reduced renal function were exclusion criteria. Homeostasis model assessment for insulin resistance (HOMA-IR) was used as the parameter of insulin sensitivity and glucose and HbA1c as parameters of metabolic control.
RESULTS—At the end of the study, subjects who received magnesium supplementation showed significant higher serum magnesium concentration (0.74 ± 0.10 vs. 0.65 ± 0.07 mmol/l, P = 0.02) and lower HOMA-IR index (3.8 ± 1.1 vs. 5.0 ± 1.3, P = 0.005), fasting glucose levels (8.0 ± 2.4 vs. 10.3 ± 2.1 mmol/l, P = 0.01), and HbA1c (8.0 ± 2.4 vs. 10.1 ± 3.3%, P = 0.04) than control subjects.
CONCLUSIONS—Oral supplementation with MgCl2 solution restores serum magnesium levels, improving insulin sensitivity and metabolic control in type 2 diabetic patients with decreased serum magnesium levels.
Progression of Retinopathy During Pregnancy in Type 1 Diabetic Women Treated With Insulin Lispro
Authors: Loukovaara Sirpa , Immonen Ilkka , Teramo Kari Atle , Kaaja Risto 
Published: March 2007

OBJECTIVE— To evaluate the progression of retinopathy during pregnancy and postpartum in (insulin-dependent) women with type 1 diabetes treated with insulin lispro or with regular human insulin.
RESEARCH DESIGN AND METHODS— A prospective open study of 69 pregnant women with diabetes was performed. A total of 36 of the women were treated with insulin lispro (lispro group) and 33 were treated with conventional short-acting human insulin (regular insulin group). The retinopathy level was estimated by color fundus photography every trimester and postpartum. Glycemic control during pregnancy, hypoglycemia (blood glucose level &lt;3 mmol/l) in 24-h glucose profile, blood pressure, and proteinuria were registered.
RESULTS— HbA1c values were similar at baseline in the first trimester but thereafter were lower in the lispro group than in the regular insulin group throughout pregnancy (P = 0.022, repeated-measures ANOVA). The number of hypoglycemic episodes did not differ between the treatment groups. In multivariable logistic regression analysis with retinopathy severity (Diabetes Control and Complications Trial level) in the third trimester as the dependent variable, only nulliparity qualified as a predictor in the model [Exp(B) = 4.0, 95% CI 1.1–13.7, P = 0.030]. Factors such as duration of diabetes, type of insulin used, mean HbA1c level throughout pregnancy, blood pressure (systolic or diastolic), preeclampsia in the current pregnancy, smoking, or prepregnancy planning did not explain the retinopathy progression.
CONCLUSIONS— Insulin lispro improves glycemic control during diabetic pregnancy compared with regular insulin with no adverse impact on progression of diabetic retinopathy.
Factors Responsible for Development From Normal Glucose Tolerance to Isolated Postchallenge Hyperglycemia
Authors: Suzuki Haruhiko , Fukushima Mitsuo , Usami Masaru , Ikeda Masaki , Taniguchi Ataru , Nakai Yosikatsu , Matsuura Toshifumi , Kuroe Akira , Yasuda Koichiro , Kurose Takeshi , Seino Yutaka , Yamada Yuichiro 
Published: March 2007

OBJECTIVE—Isolated postchallenge hyperglycemia (IPH), defined as fasting plasma glucose (FPG) level &lt;7.0 mmol/l and 2-h plasma glucose (PG) level ≥11.1 mmol/l, is a subtype of early-stage diabetes. This study evaluates the metabolic profiles of insulin secretion and insulin sensitivity in IPH to clarify the factors responsible for development of this form of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted cross-sectional analysis of 231 Japanese men aged 20–70 years. The subjects were classified into the following three groups, based on the results of a 75-g oral glucose tolerance test (OGTT): 1) normal glucose tolerance (NGT), defined as FPG level &lt;6.1 mmol/l and 2-h PG level &lt;7.8 mmol/l (n = 89); 2) impaired glucose tolerance (IGT), defined as FPG level &lt;7.0 mmol/l and 2-h PG level of 7.8–11.1 mmol/l (n = 94); and 3) IPH (n = 48). We compared the three groups for insulin secretion (insulinogenic index) and insulin sensitivity (index of insulin resistance using homeostasis model assessment [HOMA-IR]).
RESULTS—The insulinogenic index in IPH was the lowest of the three groups (P &lt; 0.001 versus NGT). The HOMA-IR in the IGT and IPH groups were significantly higher than in the NGT group (P &lt; 0.001), but both were similar. By linear regression analysis, the insulinogenic index rather than fasting insulin or HOMA-IR was the more significant factor in the 2-h PG level in IGT and IPH.
CONCLUSIONS—Subjects with IPH exhibited distinctly impaired early-phase insulin secretion and only mild insulin resistance, indicating that reduced insulin secretion is the primary determinant of deterioration from NGT to IGT and IPH in development of type 2 diabetes in these subjects.
Common Cholesteryl Ester Transfer Protein Gene Polymorphisms and the Effect of Atorvastatin Therapy in Type 2 Diabetes
Authors: van Venrooij Francine V. , Stolk Ronald P. , Banga Jan-Dirk , Sijmonsma Tjeerd P. , van Tol Arie , Erkelens D. Willem , Dallinga-Thie Geesje M. ,   for the DALI study group
Published: March 2007

OBJECTIVE—The cholesteryl ester transfer protein (CETP) plays a key role in the remodeling of triglyceride (TG)-rich and HDL particles. Sequence variations in the CETP gene may interfere with the effect of lipid-lowering treatment in type 2 diabetes.
RESEARCH DESIGN AND METHODS—We performed a 30-week randomized double-blind placebo-controlled trial with atorvastatin 10 mg (A10) and 80 mg (A80) in 217 unrelated patients with diabetes.
RESULTS—CETP TaqIB and A-629C polymorphisms were tightly concordant (P &lt; 0.001). At baseline, B1B1 carriers had lower plasma HDL cholesterol (0.99 ± 0.2 vs. 1.11 ± 0.2 mmol/l, P &lt; 0.05), higher CETP mass (2.62 ± 0.8 vs. 2.05 ± 0.4 mg/l, P &lt; 0.001), and slightly increased, though not significant, plasma TGs (2.7 ± 1.05 vs. 2.47 ± 0.86, P = 0.34) compared with B2B2 carriers. Atorvastatin treatment significantly reduced CETP mass dose-dependently by 18% (A10) and 29% (A80; both vs. placebo P &lt; 0.001, A10-A80 P &lt; 0.001). CETP mass and activity were strongly correlated (r = 0.854, P &lt; 0.0001). CETP TaqIB polymorphism appeared to modify the effect of atorvastatin on HDL cholesterol elevation (B1B1 7.2%, B1B2 6.1%, B2B2 0.5%; P &lt; 0.05), TG reduction (B1B1 39.7%, B1B2 38.4%, B2B2 18.4%; P = 0.08), and CETP mass reduction (B1B1 32.1%, B1B2 29.6%, B2B2 21.9%; P = 0.27, NS). Similar results were obtained for the A-629C polymorphism.
CONCLUSIONS—In conclusion, the B1B1/CC carriers of the CETP polymorphisms have a more atherogenic lipid profile, including low HDL, and they respond better to statin therapy. These results favor the hypothesis that CETP polymorphisms modify the effect of statin treatment and may help to identify patients who will benefit most from statin therapy.
The National Diabetes Register in Sweden
Authors: Gudbjörnsdottir Soffia , Cederholm Jan , Nilsson Peter M. , Eliasson Björn ,   for the Steering Committee of the Swedish National Diabetes Register
Published: March 2007

OBJECTIVE—To monitor glycemic control, treatable risk factors, and treatment profile for quality assessment of diabetes care on a national scale.
RESEARCH DESIGN AND METHODS—Four samples of 23,546, 32,903, 30,311, and 29,769 patients with diabetes (1996–1999) were studied based on a repeated national screening and quality assessment of diabetes care by the National Diabetes Register, Sweden, with participation of both hospitals and primary health care. Clinical characteristics included were age, sex, diabetes duration and treatment, glycemic control (HbA1c), office blood pressure (BP), BMI, smoking habits, and use of lipid-lowering drugs in patients with type 1 or type 2 diabetes.
RESULTS—Favorable decreases of mean HbA1c and BP values were registered during the 4-year study period for both type 1 (HbA1c 7.5–7.3% and BP 130/75–130/74 mmHg) and type 2 diabetic patients (HbA1c 7.0–6.7% and BP 151/82–147/80 mmHg). Treatment aims of HbA1c and BP levels were also achieved in increasing proportions for type 1 (HbA1c &lt;7.5%: 50–58% and BP ≤140/85 mmHg: 77–79%), and type 2 diabetic patients (HbA1c &lt;7.5%: 66–73% and BP ≤140/85 mmHg: 32–42%). The use of lipid-lowering drugs increased for type 1 (4–11%) and type 2 diabetic patients (10–22%). In type 2 diabetic patients, treatment with oral agents alone decreased, but combination therapy (insulin and oral agents) increased during the study period. Mean BMI increased during 1996–1999 in type 2 diabetic patients. High HbA1c and BP values in 1999 were predicted by high BMI values 1996 and by high increase of BMI during the period, independent of diabetes duration, age, and sex.
CONCLUSIONS—Decreasing mean HbA1c and BP levels and the wider use of lipid-lowering drugs during the late 1990s in patients with diabetes in a national sample from Sweden should translate into clinical benefits regarding micro- and macrovascular complications as well as diabetes-related mortality.
Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes
Authors: Yeh Gloria Y. , Eisenberg David M. , Kaptchuk Ted J. , Phillips Russell S. 
Published: March 2007

OBJECTIVE—To conduct a systematic review of the published literature on the efficacy and safety of herbal therapies and vitamin/mineral supplements for glucose control in patients with diabetes.
RESEARCH DESIGN AND METHODS—We conducted an electronic literature search of MEDLINE, OLDMEDLINE, Cochrane Library Database, and HealthSTAR, from database inception to May 2002, in addition to performing hand searches and consulting with experts in the field. Available clinical studies published in the English language that used human participants and examined glycemic control were included. Data were extracted in a standardized manner, and two independent investigators assessed methodological quality of randomized controlled trials using the Jadad scale.
RESULTS—A total of 108 trials examining 36 herbs (single or in combination) and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes or impaired glucose tolerance, met the inclusion criteria and were analyzed. There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomized and 16 nonrandomized trials). Most studies involved patients with type 2 diabetes. Heterogeneity and the small number of studies per supplement precluded formal meta-analyses. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Very few adverse effects were reported.
CONCLUSIONS—There is still insufficient evidence to draw definitive conclusions about the efficacy of individual herbs and supplements for diabetes; however, they appear to be generally safe. The available data suggest that several supplements may warrant further study. The best evidence for efficacy from adequately designed randomized controlled trials (RCTs) is available for Coccinia indica and American ginseng. Chromium has been the most widely studied supplement. Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal.
Processes and Outcomes of Care for Diabetic Acute Myocardial Infarction Patients in Ontario
Authors: Alter David A. , Khaykin Yaariv , Austin Peter C. , Tu Jack V. , Hux Janet E. 
Published: March 2007

OBJECTIVE—To compare the health service utilization and long-term outcomes of acute myocardial infarction (AMI) patients with and without diabetes in Ontario.RESEARCH DESIGN AND METHODS—We examined 25,697 patients from Ontario (6,052 and 19,645 patients with and without diabetes, respectively) who were hospitalized because of AMI between 1 April 1992 and 31 December 1993. Using linked administrative databases, we determined the use of invasive cardiac procedures at 1 year as well as the intensity of specialty follow-up care and use of evidence-based pharmacotherapies (among elderly individuals) within the first 90 days of hospital discharge. Outcomes examined included mortality and recurrent cardiac admissions at 30 days and 5 years post AMI. Multivariable analyses adjusted for sociodemographic and case-mix characteristics, attending physician specialty, and admitting hospital characteristics.RESULTS—Despite being at significantly higher risk for death at baseline, diabetic patients were less likely to be followed-up by a cardiologist (22.2 vs. 25.6%, P &lt; 0.001), to receive myocardial revascularization (12.6 vs. 14.9%, P &lt; 0.001), to receive β-blockers (34.2 vs. 44.0%, P &lt; 0.001), and to receive aspirin therapy (59.7 vs. 63.5%, P &lt; 0.001) after AMI than their nondiabetic counterparts. Diabetes was an important independent predictor of 5-year morbidity (adjusted hazard ratio 1.52, 95% CI 1.45–1.59) and 5-year mortality outcomes (1.57, 1.50–1.63). Variations in processes of care were marginally associated with higher nonfatal complication rates for diabetic patients.CONCLUSIONS—When managing AMI patients with diabetes in Ontario, physician treatment aggressiveness does not correspond appropriately to the baseline risk of patients.
Association of Hypoglycemia and Cardiac Ischemia
Authors: Desouza Cyrus , Salazar Holger , Cheong Benjamin , Murgo Joseph , Fonseca Vivian 
Published: March 2007

OBJECTIVE—In some studies intensive diabetes treatment in patients with type 2 diabetes may be associated with increased cardiovascular events. It is not clear whether these events are related to hypoglycemic episodes. To determine whether episodes of hypoglycemia were more likely to be associated with cardiac ischemia than normoglycemia or hyperglycemia, we carried out a study in 21 patients with coronary artery disease (CAD) and type 2 diabetes treated with insulin who had good glycemic control.
RESEARCH DESIGN AND METHODS—We carried out 72-h continuous glucose monitoring along with simultaneous cardiac Holter monitoring for ischemia. Patients also recorded symptoms of cardiac ischemia (chest pain) and symptoms of hypoglycemia.
RESULTS—Satisfactory continuous glucose monitoring system recordings were obtained in 19 patients. We recorded 54 episodes of hypoglycemia (blood glucose &lt;70 mg/dl; 26 of these were symptomatic) and 59 episodes of hyperglycemia (blood glucose &gt;200 mg/dl; none symptomatic). Of the 54 episodes of hypoglycemia, 10 were associated with symptoms of chest pain, during 4 of which electrocardiographic abnormalities were documented. In contrast, only 1 episode of chest pain occurred during 59 episodes of hyperglycemia. No chest pain or electrocardiographic abnormalities occurred when the blood glucose was within the normal range. The difference between the frequency of ischemia during hypoglycemia and the frequency during both hyperglycemia and normoglycemia was statistically significant (P &lt; 0.01). There were 50 episodes during which the blood glucose changed by &gt;100 mg over a 60-min period, and ischemic symptoms occurred during 9 of these episodes (P &lt; 0.01 compared with stable normoglycemia or hyperglycemia).
CONCLUSIONS—Hypoglycemia is more likely to be associated with cardiac ischemia and symptoms than normoglycemia and hyperglycemia, and it is particularly common in patients who experience considerable swings in blood glucose. These data may be important in the institution of insulin treatment and attempting near-normal glycemia in patients with known CAD. Further research is needed to determine strategies to prevent ischemia associated with hypoglycemia.
Long-Term Renoprotective Effects of Losartan in Diabetic Nephropathy
Authors: Andersen Steen , Tarnow Lise , Cambien Francois , Rossing Peter , Juhl Tina R. , Deinum Jaap , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—Several observational follow-up studies have found that the D allele of the insertion (I)/deletion (D) polymorphism of the ACE gene (ACE/ID) is associated with an increased risk of renal function loss, even during ACE inhibition. Therefore, we investigated the long-term effect of the angiotensin II subtype-1 (AT1) receptor antagonist losartan (100 mg o.d.) on kidney function in II and DD type 1 diabetic patients with diabetic nephropathy.
RESEARCH DESIGN AND METHODS—A total of 54 hypertensive type 1 diabetic patients with diabetic nephropathy homozygous for the insertion (n = 26) or the deletion (n = 28) allele were included in the study. After a 4-week washout, the patients received losartan (tablet, 100 mg o.d.) and were followed prospectively with a mean follow-up period of 36 months. Patients and investigators were blinded to ACE genotypes. At baseline, after 2 and 4 months and every 6 months thereafter, glomerular filtration rate (GFR), albuminuria, and 24-h blood pressure were determined.
RESULTS—At baseline, GFR, albuminuria, and blood pressure were similar in the two genotype groups, II versus DD: mean (SD), 86 (22) vs. 88 (24) ml · min–1 · 1.73 m–2; median (interquartile range), 1,134 (598–2,023) vs. 1,451 (893–1,766) mg/24 h; and mean (SD), 156/82 (17/9) vs. 153/80 (17/11) mmHg, respectively. GFR decreased similarly in both genotype groups, versus DD, respectively (P = 0.4): geometric mean (95% CI), 2.9 (2.0–4.2) vs. 3.4 (2.3–5.1) ml · min–1 · year–1. Albuminuria and arterial blood pressure were significantly reduced during the study; no differences were noted between groups. During follow-up, albuminuria was decreased by 75% (95% CI 59–85) and 73% (56–83) in the II and DD groups, respectively (P &lt; 0.01 vs. baseline). Mean systolic and diastolic blood pressures were 139/74 mmHg (14/8) in both genotype groups during the study (P &lt; 0.01 vs. baseline).
CONCLUSIONS—In contrast to previous observational studies with ACE inhibitors, long-term treatment with losartan has similar beneficial renoprotective effects on progression of diabetic nephropathy in hypertensive type 1 diabetic patients with ACE II and DD genotypes.
Insulin Resistance and Cardiovascular Events With Low HDL Cholesterol
Authors: Robins Sander J. , Rubins Hanna Bloomfield , Faas Fred H. , Schaefer Ernst J. , Elam Marshall B. , Anderson James W. , Collins Dorothea ,   on behalf of the VA-HIT Study Group
Published: March 2007

OBJECTIVE—To assess the effect of insulin resistance and the benefit of the fibrate, gemfibrozil, on the incidence of major cardiovascular events in subjects with low HDL cholesterol and a broad range of triglyceride values who participated in the Veterans Affairs High Density Lipoprotein Intervention Trial (VA-HIT).
RESEARCH DESIGN AND METHODS—This intention-to-treat analysis, specified as a secondary objective in VA-HIT, determined using Cox proportional hazards models the 5-year combined incidence of nonfatal myocardial infarction, coronary heart disease (CHD) death, or stroke in relation to the presence or absence of insulin resistance (defined by the highest tertile of the homeostasis model assessment of insulin resistance, HOMA-IR) in conjunction with lower and higher levels of HDL cholesterol and triglycerides. The study population consisted of 2,283 men with known coronary heart disease (CHD), treated with either placebo or gemfibrozil, who could be subdivided into groups with diabetes with or without insulin resistance, with no diabetes but insulin resistance, and with neither diabetes nor insulin resistance.
RESULTS—With insulin resistance there was a significantly higher relative risk (RR) of a cardiovascular event both with diabetes (RR of 1.62 with 95% CI of 1.28–2.06) and without diabetes (RR of 1.43 with 95% CI of 1.03–1.98) than without insulin resistance. Throughout both lower and higher ranges of HDL cholesterol and triglycerides, the rate of new cardiovascular events and the reduction of events with gemfibrozil was greater in subjects with insulin resistance than without, despite the finding that an increase in HDL cholesterol and a decrease in triglycerides with gemfibrozil was less with insulin resistance than without insulin resistance.
CONCLUSIONS—Results show that in VA-HIT the occurrence of a new cardiovascular event and the benefit of fibrate therapy was much less dependent on levels of HDL cholesterol or triglycerides than on the presence or absence of insulin resistance.
Developing a Screening Program to Detect Sight-Threatening Diabetic Retinopathy in South India
Authors: Namperumalsamy Perumalsamy , Nirmalan Praveen K. , Ramasamy Kim 
Published: March 2007

OBJECTIVE—To develop a screening protocol for detection of sight-threatening diabetic retinopathy in south India.
RESEARCH DESIGN AND METHODS—We performed ophthalmic examinations, including posterior segment examination, using indirect ophthalmoscopy to detect sight-threatening retinopathy in patients with diabetes in screening camps targeting a high-risk population.
RESULTS—We examined 3,949 persons with diabetes in 32 screening camps over a 13-month period beginning July 2001. Most of the patients (93.6%) were aware of their diabetic status, and 84.2% of those aware of their diabetes status were on treatment. One-fifth of those screened had evidence for any retinopathy; only 6.1% of these persons had evidence of past ophthalmic treatment for retinopathy. Only one-quarter of those diagnosed with worse than mild retinopathy came for follow-up to the base hospital within 2 months.
CONCLUSIONS—Screening high-risk groups for sight-threatening retinopathy using indirect ophthalmoscopy may be a useful short-term alternative for India until retinal photography becomes affordable. In addition to strategies to improve coverage, strategies for better follow-up of subjects screened also need to be evolved.