bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Variation in the Control of Diabetes Among Elderly Medicare Managed Care Beneficiaries
Authors: McBean A. Marshall , Huang Zhen , Virnig Beth A. , Lurie Nicole , Musgrave Dorothea 
Published: March 2007

OBJECTIVE—To examine racial variation in the poor control of GHb, a GHb value &gt;9.5%, or GHb not tested in 1999 among Medicare beneficiaries aged 65–75 years enrolled in managed care plans.
RESEARCH DESIGN AND METHODS—The National Committee on Quality Assurance provides person-level data regarding diabetes care services and control for Medicare beneficiaries enrolled in managed care to the Centers for Medicare and Medicaid Services (CMS). We merged this information with information on each individual’s race, as well as other person-level and plan-level characteristics obtained from CMS. Bivarate and multivariate analyses were performed.
RESULTS—The overall rate of poor GHb control was 32.7%. The age- and sex-adjusted rate of poor control among whites was 32.0%. This rate was significantly higher than the rate among Asians (24.7%) but significantly lower than the rate among blacks (40.6%) and Hispanics (36.5%) (P &lt; 0.001). An increase in the number of comprehensive diabetes care measures received by an individual was associated with a significantly lower percentage of individuals with poor GHb control in all race groups. After controlling for the individual-level, plan-level, and diabetes care measure variables, the difference in GHb control between Asians and whites disappeared. However, blacks and Hispanics continued to have significantly higher rates of poor control than whites.
CONCLUSIONS—There is room for significant reduction in the number of patients with poor control of GHb among all races, particularly among blacks and Hispanics.
The Combined Effect of Triple Therapy With Rosiglitazone, Metformin, and Insulin Aspart in Type 2 Diabetic Patients
Authors: Poulsen Mikael Kjær , Henriksen Jan Erik , Hother-Nielsen Ole , Beck-Nielsen Henning 
Published: March 2007

OBJECTIVE—Type 2 diabetes is caused by reduced insulin secretion and insulin resistance in skeletal muscle and liver. We tested the combination therapy with insulin aspart, rosiglitazone, and metformin with the purpose of treating all three defects in order to test the hypothesis that this “triple therapy” will normalize glucose metabolism.
RESEARCH DESIGN AND METHODS—Sixteen obese type 2 diabetic outpatients on human NPH or MIX (regular + NPH insulin) insulin twice daily were randomized to either triple therapy, i.e., insulin aspart (a rapid-acting insulin analog) at meals, metformin (which improves hepatic insulin sensitivity), and rosiglitazone (which improves peripheral insulin sensitivity), or to continue their NPH or MIX insulin twice daily for 6 months. Insulin doses were adjusted in both groups based on algorithms. HbA1c, insulin dose, hypoglycemic episodes, insulin sensitivity (clamp), hepatic glucose production (tracer), and diurnal profiles of plasma glucose and insulin were used in evaluating treatment.
RESULTS—In the triple therapy group, HbA1c declined from 8.8 to 6.8% (P &lt; 0.01) without inducing severe hypoglycemic events. Postprandial hyperglycemia was generally avoided, and the diurnal profile of serum insulin showed fast and high peaks without any need to increase insulin dose. In the control group, the insulin dose was increased by 50%, but nevertheless both HbA1c and 24-h blood glucose profiles remained unchanged. Insulin sensitivity improved in both skeletal muscle and the liver in the triple therapy group, whereas no change was observed in the control group.
CONCLUSIONS—We conclude that treatment of the three major pathophysiological defects in type 2 diabetic subjects by triple therapy significantly improved glucose metabolism in obese type 2 diabetic subjects.
Plasma Adiponectin and Endogenous Glucose Production in Humans
Authors: Stefan Norbert , Stumvoll Michael , Vozarova Barbora , Weyer Christian , Funahashi Tohru , Matsuzawa Yuji , Bogardus Clifton , Tataranni P. Antonio 
Published: March 2007

OBJECTIVE—High plasma adiponectin is associated with reduced risk of type 2 diabetes, probably a consequence of its insulin-sensitizing properties. In vivo data in rodents suggest that the insulin-sensitization responsible for improvement of glycemia occurs in muscle and liver. Whereas associations of plasma adiponectin with muscle insulin sensitivity in humans have been examined, this has not been done for the liver.
RESEARCH DESIGN AND METHODS—We therefore analyzed the relationship between fasting plasma adiponectin and basal endogenous glucose production [EGP]-basal) and insulin-suppressed EGP (EGP-insulin, isotope dilution technique) in 143 Pima Indians (94 with normal glucose tolerance, 36 with impaired glucose tolerance, and 16 with type 2 diabetes).
RESULTS—Fasting plasma adiponectin concentrations were negatively correlated with EGP-basal and EGP-insulin before (P = 0.006 and P &lt; 0.0001, respectively) as well as after adjustment for age, sex, percent body fat, and insulin-stimulated whole-body glucose uptake (P = 0.007 and P = 0.0005, respectively).
CONCLUSIONS—These findings are compatible with the hypothesis that adiponectin increases hepatic insulin sensitivity. Consistent with data in animals, adiponectin may have generalized insulin-sensitizing effects in humans.
Did Publication of a Clinical Practice Guideline Recommendation to Screen for Type 2 Diabetes in Women With Gestational Diabetes Change Practice?
Authors: Clark Heather D. , Walraven Carl van , Code Cathy , Karovitch Alan , Keely Erin 
Published: March 2007

OBJECTIVE—To determine whether women with previous gestational diabetes mellitus (GDM) were screened postpartum for type 2 diabetes according to the Canadian Diabetes Association (CDA) guidelines.
RESEARCH DESIGN AND METHODS—The 1998 CDA guidelines recommend that all women diagnosed with GDM be screened postpartum for type 2 diabetes using a 2-h 75-g oral glucose tolerance test (OGTT). The impact of and compliance with this expert opinion-based recommendation is unknown. All women who delivered at the Ottawa Hospital in 1997 (pre-guideline) and 2000 (post-guideline) with confirmed GDM were identified. Using population-based administrative databases, we determined the proportion of these women who had an OGTT, serum glucose test, or glycated hemoglobin (GHb) test in the first postpartum year. Women who had not undergone any blood work were excluded.
RESULTS—There were 131 women in 1997 and 123 women in 2000 with confirmed GDM. Of these, only 69 women in 1997 and 52 women in 2000 had blood work recorded in the database. None of these women had an OGTT performed in either period. We found a significant increase in the measurement of serum glucose (50 women pre-guideline [72.1%], 48 women post-guideline [92.3%], P &lt; 0.05) and GHb (8 women pre-guideline [11.6%], 20 women post-guideline [38.5%], P &lt; 0.01).
CONCLUSIONS—In our region, physicians are not following the CDA recommendations to screen women with GDM postpartum with an OGTT. However, we did find a significant increase in the measurement of serum glucose and GHb. Publication of expert opinion-based guidelines did not change the postpartum use of an OGTT in these women but may have increased the use of less reliable screening tests for type 2 diabetes.
Acarbose Improves Glycemic Control in Overweight Type 2 Diabetic Patients Insufficiently Treated With Metformin
Authors: Phillips Patrick , Karrasch Jeff , Scott Russell , Wilson Dennis , Moses Robert 
Published: March 2007

OBJECTIVE—To investigate the efficacy and safety of acarbose as add-on therapy in overweight type 2 patients with diabetes inadequately controlled by metformin.
RESEARCH DESIGN AND METHODS—This study adopted a multicenter, randomized, double-blind, placebo-controlled, parallel group design. After a 4-week placebo run-in period, subjects were randomized to either acarbose (titrated up to 100 mg b.i.d.) or placebo. The primary efficacy variable was the change in HbA1c from baseline to the end of the 24-week treatment period. Change in fasting blood glucose was assessed as a secondary efficacy parameter.
RESULTS—The intention-to-treat analysis from baseline to week 24 (81 patients for HbA1c and 82 for fasting blood glucose) showed statistically significant differences between acarbose and placebo treatment in HbA1c (1.02%; 95% CI 0.543–1.497; P = 0.0001) and fasting blood glucose (1.132 mmol/l; 95% CI 0.056–2.208; P = 0.0395) (adjusted least square means). In all, 18 patients (47%) in the acarbose group were classified as responders with a ≥5% reduction in HbA1c (relative to baseline) at the end point compared to 6 (14%) in the placebo group (P = 0.001). The safety profiles were similar for both treatment groups except for the higher incidence of gastrointestinal side effects during acarbose therapy.
CONCLUSIONS—The addition of acarbose to metformin monotherapy provides an efficacious and safe alternative for glycemic improvement in overweight type 2 patients inadequately controlled by metformin alone.
Sildenafil Citrate for Treatment of Erectile Dysfunction in Men With Type 1 Diabetes
Authors: Stuckey Bronwyn G.A. , Jadzinsky Mauricio N. , Murphy Liam J. , Montorsi Francesco , Kadioglu Ates , Fraige Fadlo , Manzano Pilar , Deerochanawong Chaicharn 
Published: March 2007

OBJECTIVE—In the 5–10% of diabetic men with type 1 diabetes, erectile dysfunction (ED) may be a particularly common and unwanted complication. This is the first study focusing exclusively on the effects of sildenafil in men with type 1 diabetes and ED.RESEARCH DESIGN AND METHODS—A total of 188 patients were entered into a double-blind, placebo-controlled, parallel-group, flexible-dose study and were randomized to receive sildenafil (25–100 mg; n = 95) or placebo (n = 93) for 12 weeks. Efficacy was evaluated using questions three (Q3; achieving an erection) and four (Q4; maintaining an erection) from the International Index of Erectile Function (IIEF), a global efficacy question (GEQ; “Did treatment improve your erections?”), and a patient event log of sexual activity.RESULTS—Improvements in mean scores from baseline to end-of-treatment for IIEF Q3 (35.7 vs. 19.9%) and Q4 (68.4 vs. 26.5%) were significant in patients receiving sildenafil compared with those receiving placebo (P = 0.0001). Moreover, the percent of improved erections (GEQ, 66.6 vs. 28.6%) and successful intercourse attempts (63 vs. 33%) was significantly increased with sildenafil compared with placebo. Improvements in sexual function were seen irrespective of the degree of ED severity. Adverse events were generally mild to moderate in severity, with headache (20 vs. 8%), flushing (18 vs. 3%), and dyspepsia (8 vs. 1%) reported more often in the sildenafil than in placebo-treated patients.CONCLUSIONS—Treatment with sildenafil for ED was effective, resulting in an increased percentage of successful attempts at intercourse, and was well tolerated among men with type 1 diabetes.
Diagnostic Strategies to Detect Glucose Intolerance in a Multiethnic Population
Authors: Anand Sonia S. , Razak Fahad , Vuksan Vlad , Gerstein Hertzel C. , Malmberg Klas , Yi Qilong , Teo Koon K. , Yusuf Salim 
Published: March 2007

OBJECTIVE—Identifying individuals who have elevated glucose concentrations is important for clinicians so that preventive strategies can be invoked, and it is useful for researchers who study associations between elevated glucose and adverse health outcomes. These methods should be applicable worldwide across different ethnic groups. Therefore, the objective of our analysis was to determine whether using the fasting glucose and HbA1c together could improve the classification of individuals with impaired glucose tolerance and diabetes in a multiethnic cohort randomly assembled in Canada.
RESEARCH DESIGN AND METHODS—We determined the optimum diagnostic criteria to identify people with abnormal glucose tolerance using fasting plasma glucose, 2-h post-glucose load plasma glucose, and HbA1c in 936 Canadians of South Asian, Chinese, and European descent.
RESULTS—The sensitivity of the American Diabetes Association (ADA) criteria to diagnose diabetes compared with the World Health Organization definitions was poor at 48.3% (95% confidence interval [CI] 35.7–61.0). Using a receiver operator characteristic curve, the optimum combined cut-point using fasting glucose and HbA1c to diagnose diabetes was a fasting glucose ≥5.7 mmol/l and an HbA1c ≥5.9%. These cut-points were associated with a sensitivity and specificity of 71.7% (60.3–83.1) and 95.0% (93.5–96.4), respectively, a positive likelihood ratio (LR) of 14.3 (9.6–19.0), and a negative LR of 0.3 (0.2–0.4). Significant ethnic variation in the sensitivity and specificity of this approach was observed: 47.4% (24.9–69.8) and 97.6% (95.9–99.4) among Europeans, 78.6% (57.1–100) and 95.9% (93.6–98.2) among Chinese, and 85.2% (71.8–98.6) and 91.3% (88.1–94.6) among South Asians, respectively. Participants with impaired glucose tolerance could not be identified reliably using the fasting glucose or HbA1c alone or in combination.
CONCLUSIONS—The sensitivity of the ADA criteria to diagnose diabetes is low, and there is substantial variation between ethnic groups. Fasting glucose and HbA1c may be used together to improve the identification of individuals who have diabetes, allowing clinicians to streamline the use of the oral glucose tolerance test.
Gestational Diabetes Mellitus
Authors: Daniells Suzie , Grenyer Brin F. S. , Davis Warren S. , Coleman Keith J. , Burgess Julie-Anne P. , Moses Robert G. 
Published: March 2007

OBJECTIVE—To examine anxiety levels of women diagnosed with gestational diabetes mellitus (GDM) and to compare these with glucose-tolerant (GT) women at similar stages of pregnancy.
RESEARCH DESIGN AND METHODS—Prospective longitudinal study conducted on 50 women with GDM and 50 GT women. All women completed the Mental Health Inventory (MHI-5) forms and the Speilberger State-Trait Anxiety Inventory (STAI) at the beginning of the third trimester, antepartum, and 6 weeks postpartum. Specific questions were also assessed using a Likert scale.
RESULTS—Women with GDM, compared with GT women, had a higher level of anxiety (state rather than trait) at the time of the first assessment. However, before delivery and in the postpartum period, there were no significant differences in anxiety scores between the two groups. Women in both groups were positive about being tested for GDM and wished to be tested during future pregnancies.
CONCLUSIONS—There were no sustained increased levels of anxiety for women diagnosed with GDM. Concerns expressed about causing sustained maternal anxiety by testing for GDM could not be substantiated.
Pulse Wave Velocity as an Indicator of Atherosclerosis in Impaired Fasting Glucose
Authors: Ohnishi Hirofumi , Saitoh Shigeyuki , Takagi Satoru , Ohata Jun-ichi , Isobe Takeshi , Kikuchi Yuka , Takeuchi Hiroshi , Shimamoto Kazuaki 
Published: March 2007

OBJECTIVE—Brachial-ankle pulse wave velocity (baPWV), as an indicator of atherosclerosis in impaired fasting glucose (IFG), was studied in 232 subjects randomly selected from inhabitants of two rural communities in Japan.
RESEARCH DESIGN AND METHODS—BMI, systolic blood pressure (SBP), fasting blood glucose (FBS), lipid parameters, ankle brachial pressure index (ABI), and baPWV were measured in each subject. ABI and baPWV were measured using the recently developed device, form ABI/PWV. The subjects were divided into three groups according FBS level: a normal group consisting of subjects with FBS &lt;110 mg/dl, an IFG group consisting of subjects with FBS 110–125 mg/dl, and a diabetic group consisting of subjects with FBS ≥126 mg/dl and subjects taking hypoglycemic agents. The parameters in the three groups were compared.
RESULTS—It was found that the baPWV value increased with increasing plasma glucose level. Significant differences were found between the baPWV values in the normal and IFG groups (1,518 vs. 1,673 cm/s, P = 0.01) and in the normal and diabetic groups (1,518 vs. 1,771 cm/s, P &lt; 0.0001). The results of multiple regression analysis showed that FBS was closely related to baPWV as well as to age and SBP.
CONCLUSIONS—The relationship between IFG and atherosclerosis remains controversial. Further studies are needed to evaluate whether strict control of blood glucose level in patients with IFG will result in the prevention of atherosclerosis progression.
Similar Genetic Features and Different Islet Cell Autoantibody Pattern of Latent Autoimmune Diabetes in Adults (LADA) Compared With Adult-Onset Type 1 Diabetes With Rapid Progression
Authors: Hosszúfalusi Nóra , Vatay Ágnes , Rajczy Katalin , Prohászka Zoltán , Pozsonyi Éva , Horváth Laura , Grosz Andrea , Gerõ László , Madácsy László , Romics László , Karádi István , Füst George , Pánczél Pál 
Published: March 2007

OBJECTIVE—To compare the clinical parameters, C-peptide levels, pattern of islet cell-specific autoantibodies, and prevalence of predisposing genotypes in subjects with latent autoimmune diabetes in adults (LADA) and those with adult-onset type 1 diabetes with rapid progression.
RESEARCH DESIGN AND METHODS—We evaluated the clinical parameters, C-peptide levels, and islet cell-specific autoantibodies in 54 LADA, 57 adult-onset type 1 diabetic, and 190 type 2 diabetic patients. Islet cell autoantibodies were also compared between subgroups of newly diagnosed patients with LADA and those with newly diagnosed adult-onset and childhood-onset type 1 diabetes. The genetic study was performed in subjects with LADA and those with adult-onset type 1 diabetes in comparison with a control population.
RESULTS—There were no differences in the clinical parameters between LADA and adult-onset type 1 diabetes. Patients with LADA had lower BMI (P &lt; 0.0001), waist-to-hip ratio (0.0029), total cholesterol (P = 0.001), and triglycerides (P = 0.001); higher HDL cholesterol levels (P &lt; 0.0001); and lower prevalence of hypertension (P = 0.0028) compared with patients with type 2 diabetes. C-peptide levels were similar at onset (P = 0.403) but decreased less rapidly in LADA than in adult-onset type 1 diabetes (P = 0.0253). Single-autoantibody positivity was more often seen in LADA than in type 1 diabetes (P = 0.0001). The prevalence of predisposing HLA-DQB1*0302, -DR4, -DR3, and -DR3/DR4 genotypes and the DR4-DQB1*0302 haplotype were increased in both LADA and adult-onset type 1 diabetic subjects compared with the control population. There were no differences in the frequencies of these risk alleles and haplotypes between the two patient groups.
CONCLUSIONS—Subjects with LADA had clinical characteristics similar to those with adult-onset type 1 diabetes with rapid progression. C-peptide levels did not differ at onset but decreased less rapidly in LADA. Patients with LADA rather had single islet cell-specific autoantibody positivity. The prevalence of HLA-DQB1*0302, -DR4, -DR3, and -DR3/DR4 risk alleles and the DR4-DQB1*0302 high-risk haplotype did not differ in the two forms of autoimmune diabetes.
Clinical Performance of CGMS in Type 1 Diabetic Patients Treated by Continuous Subcutaneous Insulin Infusion Using Insulin Analogs
Authors: Guerci Bruno , Floriot Michèle , Böhme Philip , Durain Danielle , Benichou Muriel , Jellimann Stéphanie , Drouin Pierre 
Published: March 2007

OBJECTIVE—Performance criteria have been established for in vitro blood glucose monitoring, particularly for the self-monitoring of blood glucose using glucose meters. Devices intended for use in the future, such as the continuous glucose monitoring system (CGMS), should satisfy similar criteria, particularly in diabetic patients under intensive therapy.
RESEARCH DESIGN AND METHODS—The analysis was conducted on 18 type 1 diabetic patients (not controlled, HbA1c &gt;7.5%) treated by external pump using insulin analogs. Each patient received a glucose sensor for 3 days during his/her hospitalization and was instructed in its operation. Medtronic criteria were used to determine the accuracy of the CGMS. In addition, the data were analyzed according to American Diabetes Association (ADA) criteria, Clarke Error Grid analysis, and method of residuals, with the glucose oxidase method using a Beckman analyzer used as the reference method. Specificity and sensitivity were evaluated from the viewpoint of accuracy in the detection of hypoglycemia. For nine patients, two glucose sensors were simultaneously inserted into an abdominal site to determine the reproducibility of the system.
RESULTS—Among the 33 glucose sensors inserted, 6 (18%) were nonfunctional. The mean duration of CGMS recording was 63 ± 12 h. From all of the 692 sets of data that paired glucose readings and CGMS, the coefficients of correlation ranged from 0.87 to 0.92 and the mean absolute error ranged from 12.8 to 15.7%. The time experienced in hypoglycemia (&lt;55 mg/dl) was reported at 86 ± 62 min/day. Only 39% of the CGMS values satisfied the ADA precision criteria to within ±10%, and 19% of these values satisfied the future ADA precision criteria of accuracy to within ±5%. The means of difference method showed that the CGMS slightly underestimated the plasma glucose values (mean = −12 mg/dl). Error grid analysis showed only 77% of the glucose sensor values were in zone A, and 98.9% were in zones A and B. Two values fell in zone C and a single value fell in zone D. The sensitivity and specificity of the CGMS to detect hypoglycemia were 33 and 96%, respectively. A total of 6,666 paired sensor values were recorded with a coefficient of correlation of 0.84 with a coefficient of variation of 8.25%.
CONCLUSIONS—CGMS could be useful in routine clinical practice to provide much more information on the glucose profile than intermittent self-monitoring of blood glucose (SMBG). However, CGMS cannot be used as a replacement for glucose meters because it does not satisfy the conventional performance goals set down for in vitro glucose measurements and could therefore lead to clinically incorrect treatment decisions.
Dietary Fat Predicts Coronary Heart Disease Events in Subjects With Type 2 Diabetes
Authors: Soinio Minna , Laakso Markku , Lehto Seppo , Hakala Paula , Rönnemaa Tapani 
Published: March 2007

OBJECTIVE—To investigate whether quantity or quality of dietary fat predicts coronary heart disease (CHD) events in middle-aged type 2 diabetic subjects.
RESEARCH DESIGN AND METHODS—The dietary habits of 366 type 2 diabetic men and 295 women, aged 45–64 years and free from CHD, were assessed with a 53-item food frequency questionnaire. They were followed up for 7 years.
RESULTS—Men in the highest tertile of the polyunsaturated/saturated fat (P/S) ratio (&gt;0.28) had a significantly lower risk for CHD death than men in the two lowest tertiles (5.0 vs. 14.2%, P = 0.009). The risk for all CHD events was 14.2 vs. 23.2%, respectively (P = 0.044). P/S ratio did not predict CHD events in women. In Cox multiple regression analyses taking into account other cardiovascular risk factors, the highest P/S ratio tertile was associated with the lowest rate of CHD death in men (P = 0.048).
CONCLUSIONS—Low P/S ratio in men predicted future CHD events in type 2 diabetic subjects independently of conventional CHD risk factors.