bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperinsulinemia in Cord Blood in Mothers With Type 2 Diabetes and Gestational Diabetes Mellitus in New Zealand
Authors: Westgate Jenny A. , Lindsay Robert S. , Beattie Judith , Pattison Neil S. , Gamble Greg , Mildenhall Lindsay F.J. , Breier Bernhard H. , Johnstone Frank D. 
Published: May 2006

OBJECTIVE—In genetically diabetes-prone populations, maternal diabetes during pregnancy increases the risk of their children developing diabetes and obesity (the vicious cycle of type 2 diabetes). Fetal hyperinsulinemia at birth acts as a marker of this risk. We therefore examined whether cord insulin and leptin concentrations are increased in offspring of Maori and Pacific Island mothers with type 2 and gestational diabetes mellitus (GDM) and varying degrees of glycemic control (HbA1c).
RESEARCH DESIGNS AND METHODS—Maori and Pacific Island mothers were prospectively recruited at Middlemore Hospital, South Auckland. Cord blood was taken from umbilical vein at birth from singleton babies born after 32 weeks of gestation to 138 mothers with GDM, 39 mothers with type 2 diabetes, and 95 control mothers.
RESULTS—Babies born to mothers with both type 2 diabetes and GDM had higher birth weight and skinfold thickness and markedly higher concentrations of insulin (median [interquartile range] type 2 diabetes 77 pmol/l [42–143], GDM 67 pmol/l [42–235], and control subjects 33 pmol/l [18–62]; P &lt; 0.001) and leptin (type 2 diabetes 39 ng/ml [18–75], GDM 31 ng/ml [17–58], and control subjects 13 ng/ml [8–22]; P &lt; 0.001) in cord blood. Cord insulin concentrations &gt;120 pmol/l were found in 29% of offspring of mothers with GDM and 31% of mothers with type 2 diabetes. Many mothers with GDM had abnormalities of glucose tolerance postpartum (20% type 2 diabetes, 34% impaired glucose tolerance or impaired fasting glucose). Higher cord insulin (57 pmol/l [40–94]) and leptin (26 ng/ml [17–39]) concentrations were found even in offspring of GDM mothers with normal glucose tolerance postpartum.
CONCLUSIONS—Raised cord insulin and leptin concentrations are a common finding in offspring of mothers with type 2 diabetes and GDM in this population.
An Evaluation of Cost Sharing to Finance a Diet and Physical Activity Intervention to Prevent Diabetes
Authors: Ackermann Ronald T. , Marrero David G. , Hicks Katherine A. , Hoerger Thomas J. , Sorensen Stephen , Zhang Ping , Engelgau Michael M. , Ratner Robert E. , Herman William H. 
Published: May 2006

OBJECTIVE—The Diabetes Prevention Program (DPP) lifestyle intervention is a cost-effective strategy to prevent type 2 diabetes, but it is unclear how this intervention could be financed. We explored whether this intervention could be offered in a way that allows return on investment for private health insurers while remaining attractive for consumers, employers, and Medicare.
RESEARCH DESIGN AND METHODS—We used the DPP and other published reports to build a Markov simulation model to estimate the lifetime progression of disease, costs, and quality of life for adults with impaired glucose tolerance. The model assumed a health-payer perspective and compared DPP lifestyle and placebo interventions. Primary outcomes included cumulative incidence of diabetes, direct medical costs, quality-adjusted life-years (QALYs), and cost per QALY gained.
RESULTS—Compared with placebo, providing the lifestyle intervention at age 50 years could prevent 37% of new cases of diabetes before age 65, at a cost of $1,288 per QALY gained. A private payer could reimburse $655 (24%) of the $2,715 in total discounted intervention costs during the first 3 intervention years and still recover all of these costs in the form of medical costs avoided. If Medicare paid up to $2,136 in intervention costs over the 15-year period before participants reached age 65, it could recover those costs in the form of future medical costs avoided beginning at age 65.
CONCLUSIONS—Cost-sharing strategies to offer the DPP lifestyle intervention for eligible people between ages 50 and 64 could provide financial return on investment for private payers and long-term benefits for Medicare.
Measurement of the High–Molecular Weight Form of Adiponectin in Plasma Is Useful for the Prediction of Insulin Resistance and Metabolic Syndrome
Authors: Hara Kazuo , Horikoshi Momoko , Yamauchi Toshimasa , Yago Hirokazu , Miyazaki Osamu , Ebinuma Hiroyuki , Imai Yasushi , Nagai Ryozo , Kadowaki Takashi 
Published: May 2006

OBJECTIVE—The high–molecular weight (HMW) form of adiponectin, an adipocyte-derived insulin-sensitizing hormone, has been reported to be the most active form of this hormone. We investigated whether measurement of plasma HMW adiponectin levels, using our newly developed enzyme-linked immunosorbent assay system for selective measurement of human HMW adiponectin level, may be useful for the prediction of insulin resistance and metabolic syndrome.
RESEARCH DESIGN AND METHODS—A total of 298 patients admitted for diabetes treatment or coronary angiography served as study subjects. Receiver operator characteristic (ROC) curves for the HMW ratio (HMWR; ratio of plasma level of HMW adiponectin to that of total adiponectin) and plasma total adiponectin levels were plotted to predict the presence of insulin resistance and metabolic syndrome.
RESULTS—The area under the ROC curve (AUC) of the HMWR values to predict the presence of insulin resistance was significantly larger than that of plasma total adiponectin level in total subjects (0.713 [95% CI 0.620–0.805] vs. 0.615 [0.522–0.708], P = 0.0160). The AUC for the HMWR values to predict the presence of metabolic syndrome was significantly larger than that for plasma total adiponectin levels in men (0.806 [0.747–0.865] vs. 0.730 [0.660–0.800], P = 0.0025) and in women (0.743 [0.659–0.828] vs. 0.637 [0.532–0.742], P = 0.0458).
CONCLUSIONS—The HMWR value has better predictive power for the prediction of insulin resistance and metabolic syndrome than plasma total adiponectin level.
Impact of Office Systems and Improvement Strategies on Costs of Care for Adults With Diabetes
Authors: Gilmer Todd P. , O’Connor Patrick J. , Rush William A. , Crain A. Lauren , Whitebird Robin R. , Hanson Anne M. , Solberg Leif I. 
Published: May 2006

OBJECTIVE—To assess the impact of organizational features and improvement strategies of primary care clinics on health care costs of adults with diabetes.
RESEARCH DESIGN AND METHODS—This study included a prospective cohort study of 1,628 adults with diabetes in a large, health care organization receiving care in 84 clinics within 18 medical groups. Data from surveys of patients, clinic medical directors and managers, and medical record reviews were merged with 3 years of medical claims. Costs were estimated using health plan data on resource use and common Medicare payment methodologies. Generalized linear regression models were used to analyze costs related to clinic characteristics, adjusting for individual patient comorbidity, demographic, and socioeconomic factors.
RESULTS—Clinics with regular clinician meetings to discuss patient care problems and clinics that used diabetes registries to prioritize patients based on cardiovascular risk were associated with lower 3-year costs: −$3,962 (P = 0.002) and −$2,916 (P = 0.019), respectively. The use of databases to monitor lab results was associated with higher costs ($2,439, P = 0.038). Quality improvement strategies focused on resource use related to diabetes care (−$2,883, P = 0.017) or heart disease care (−$3,228, P = 0.014) were associated with lowered costs, whereas quality improvement strategies that emphasized pharmacy use for patients with heart disease ($3,059, P = 0.029) or depression ($2,962, P = 0.038) were associated with increased costs.
CONCLUSIONS—Several organizational features of primary care offices were significant predictors of future health care costs for adults with diabetes. The mechanism by which such factors affect costs of care and the relationship of costs to clinical outcomes merits further evaluation.
Derivation and Validation of a Prediction Score for Major Coronary Heart Disease Events in a U.K. Type 2 Diabetic Population
Authors: Donnan Peter T. , Donnelly Louise , New John P. , Morris Andrew D. 
Published: May 2006

OBJECTIVE—To derive and validate an absolute risk algorithm for major coronary heart disease (CHD) events in the U.K. population with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A population cohort with type 2 diabetes was constructed in Tayside, Scotland, U.K., and longitudinally followed-up to June 2004. Participants were all people with type 2 diabetes registered with general practices and the Diabetes Audit and Research in Tayside, Scotland, database (97% sensitive) with no previous CHD event and with complete measurements (n = 4,569). The main outcome measure was risk of CHD defined as fatal or nonfatal myocardial infarction or CHD death, derived from the Weibull accelerated failure-time model. Validation of the algorithm was performed on an independent dataset from Salford, England, U.K.
RESULTS—There were a total of 243 subjects (5.3%) with a fatal or nonfatal myocardial infarction or CHD death over the follow-up period from 1 January 1995 to 30 June 2004 (maximum follow-up 9.5 years). The final Weibull model included the significant predictors of age at diagnosis, duration of diabetes, HbA1c, smoking (current, past, never), sex, systolic blood pressure, treated hypertension, total cholesterol, and height. Assessment of discrimination and calibration in the Salford validation dataset demonstrated a good fit (c = 0.71 [95% CI 0.63–0.79]).
CONCLUSIONS—This study provides the first validated, population-derived model for prediction of absolute risk of CHD in people with type 2 diabetes. It provides a useful additional decision aid for the clinician treating type 2 diabetes by indicating appropriate early action to decrease the risk of adverse outcomes.
Prediction of Diabetic Foot Ulcer Occurrence Using Commonly Available Clinical Information
Authors: Boyko Edward J. , Ahroni Jessie H. , Cohen Victoria , Nelson Karin M. , Heagerty Patrick J. 
Published: May 2006

OBJECTIVE—The ability of readily available clinical information to predict the occurrence of diabetic foot ulcer has not been extensively studied. We conducted a prospective study of the individual and combined effects of commonly available clinical information in the prediction of diabetic foot ulcer occurrence.
RESEARCH DESIGN AND METHODS—We followed 1,285 diabetic veterans without foot ulcer for this outcome with annual clinical evaluations and quarterly mailed questionnaires to identify foot problems. At baseline we assessed age; race; weight; current smoking; diabetes duration and treatment; HbA1c (A1C); visual acuity; history of laser photocoagulation treatment, foot ulcer, and amputation; foot shape; claudication; foot insensitivity to the 10-g monofilament; foot callus; pedal edema; hallux limitus; tinea pedis; and onychomycosis. Cox proportional hazards modeling was used with backwards stepwise elimination to develop a prediction model for the first foot ulcer occurrence after the baseline examination.
RESULTS—At baseline, subjects were 62.4 years of age on average and 98% male. Mean follow-up duration was 3.38 years, during which time 216 foot ulcers occurred, for an incidence of 5.0/100 person-years. Significant predictors (P ≤ 0.05) of foot ulcer in the final model (hazard ratio, 95% CI) included A1C (1.10, 1.06–1.15), impaired vision (1.48, 1.00–2.18), prior foot ulcer (2.18, 1.61–2.95), prior amputation (2.57, 1.60–4.12), monofilament insensitivity (2.03, 1.50–2.76), tinea pedis (0.73, 0.54–0.98), and onychomycosis (1.58, 1.16–2.16). Area under the receiver operating characteristic curve was 0.81 at 1 year and 0.76 at 5 years.
CONCLUSIONS—Readily available clinical information has substantial predictive power for the development of diabetic foot ulcer and may help in accurately targeting persons at high risk of this outcome for preventive interventions.
Idiosyncratic Personal Explanations for Blood Glucose Events Are Associated With Poorer Self-Management and Glycemic Control in Adult Patients With Long-Standing Type 1 Diabetes
Authors: Wearden Alison J. , Hynd Kathryn , Smith Helen , Davies Rob , Tarrier Nicholas 
Published: May 2006

OBJECTIVE—To examine whether spontaneous causal attributions for blood glucose events were associated with blood glucose control (HbA1c [A1C]), self-management, and adjustment to diabetes.
RESEARCH DESIGN AND METHODS—A total of 62 adults (31 female) with type 1 diabetes, recruited from a diabetes specialist clinic, with a mean age of 42.3 years and a mean illness duration of 19.6 years, were interviewed about the onset, history, course, and management of their diabetes. Spontaneous causal attributions for fluctuations in blood glucose level were extracted from the interviews and coded in accordance with the Leeds Attributional Coding System. Participants completed questionnaire measures of anxiety, depression, and appraisal of diabetes. Glycemic control (A1C) at the time of interview and 1 year later was extracted from notes.
RESULTS—Participants who made proportionally more personal, or idiosyncratic, explanations for blood glucose fluctuations or events (such as hypoglycemic episodes) had higher A1C levels at time 1 and 1 year later and were judged to manage their diabetes less well. Furthermore, the association between personal attributions and A1C was partly accounted for by self-management behavior. Participants who made personal and stable attributions appraised their diabetes more negatively.
CONCLUSIONS—Clinicians should be sensitive to patients’ causal explanations for blood glucose events. Helping patients consider alternative explanations may produce benefits in terms of better management and control of diabetes.
High-Risk Individuals’ Willingness to Pay for Diabetes Risk-Reduction Programs
Authors: Johnson F. Reed , Manjunath Ranjani , Mansfield Carol A. , Clayton Laurel J. , Hoerger Thomas J. , Zhang Ping 
Published: May 2006

OBJECTIVE—The purpose of this study was to estimate how much at-risk individuals are willing to pay for type 2 diabetes primary prevention programs.
RESEARCH DESIGN AND METHODS—An Internet-based, choice-format conjoint survey was presented to individuals at elevated risk for type 2 diabetes. Hypothetical diabetes risk-reduction programs included seven features: diet, exercise, counseling, medication, weight loss goal, risk reduction, and program costs. The sample included 582 individuals aged ≥45 years, two-thirds of whom were obese. Conditional logit models were used to calculate participants’ willingness to pay for risk reduction programs. Each respondent’s self-assessed risk of developing diabetes was compared with an objective measure based on a diabetes screening tool.
RESULTS—Many respondents underestimated their personal risk of developing diabetes. Those with a low perceived risk were less likely to indicate that they would participate in a diabetes prevention program. Individuals had the strongest preference for programs with large weight loss goals, fewer restrictions on diet, and larger reductions in the risk of diabetes. Respondents were willing to pay ∼$1,500 over 3 years to participate in a lifestyle intervention program similar to the Diabetes Prevention Program. Individuals with a high perceived risk were willing to pay more than individuals with lower perceived risk.
CONCLUSIONS—Many individuals will be willing to participate in interventions to delay or prevent diabetes if the interventions are subsidized, but most will be unwilling to pay the full program cost. Our results also offer insights for designing risk-reduction programs that appeal to potential participants.
Dietary Fat Intake Predicts 1-Year Change in Body Fat in Adolescent Girls With Type 1 Diabetes
Authors: Särnblad Stefan , Ekelund Ulf , Åman Jan 
Published: May 2006

OBJECTIVE—The purpose of this study was to determine whether objectively measured physical activity and dietary macronutrient intake differentially predict body fat in adolescent girls with type 1 diabetes and control girls.
RESEARCH DESIGN AND METHODS—This study comprised 23 girls (12–19 years) with type 1 diabetes and 19 age-matched healthy control girls. At baseline, physical activity and energy intake were assessed for 7 consecutive days by accelerometry and a structured food diary, respectively. Body composition was measured by dual-energy X-ray absorptiometry at baseline and after 1 year.
RESULTS—Fat intake was positively related to a 1-year change in percentage body fat (P = 0.006), after adjustment for total energy intake. No significant interaction was observed (case-control group × main exposure), indicating that the association between fat intake and gain in body fat was similar in both groups. Physical activity did not predict gain in body fat; however, total physical activity was positively associated with a gain in lean body mass (P &lt; 0.01). Girls treated with six daily dosages of insulin increased their percentage of body fat significantly more than those treated with four daily injections (P &lt; 0.05).
CONCLUSIONS—In this prospective case-control study, we found that fat intake predicted gain in percentage of body fat in both adolescent girls with type 1 diabetes and healthy control girls. The number of daily insulin injections seems to influence the accumulation of body fat in girls with type 1 diabetes.
Clinical Evaluation of Alternative-Site Glucose Measurements in Patients After Major Cardiac Surgery
Authors: Ellmerer Martin , Haluzik Martin , Blaha Jan , Kremen Jaromir , Svacina Stepan , Toller Wolfgang , Mader Julia , Schaupp Lukas , Plank Johannes , Pieber Thomas 
Published: May 2006

OBJECTIVE—Tight glycemic control improves outcome in critically ill patients but requires frequent glucose measurements. Subcutaneous adipose tissue (SAT) has been characterized as promising for glucose monitoring in diabetes, but it remains unknown whether it can also be used as an alternative site in critically ill patients. The present study was performed to clinically evaluate the relation of glucose in SAT compared with arterial blood in patients after major cardiac surgery.
RESEARCH DESIGN AND METHODS—Forty critically ill patients were investigated at two clinical centers after major cardiac surgery. Arterial blood and SAT microdialysis samples were taken in hourly intervals for a period of up to 48 h. The glucose concentration in dialysate was calibrated using a two-step approach, first using the ionic reference technique to calculate the SAT glucose concentration (SATg) and second using a one-point calibration procedure to obtain a glucose profile comparable to SAT-derived blood glucose (BgSAT). Clinical validation of the data was performed by introducing data analysis based on an insulin titration algorithm.
RESULTS—Correlation between dialysate glucose and blood glucose (median 0.80 [interquartile range 0.68–0.88]) was significantly improved using the ionic reference calibration technique (SATg vs.blood glucose 0.90 [0.83–0.94]; P &lt; 0.001). Clinical evaluation of the data indicated that 96.1% of glucose readings from SAT would allow acceptable treatment according to a well-established insulin titration protocol.
CONCLUSIONS—The results indicate good correlation between SATg and blood glucose in patients after major cardiac surgery. Clinical evaluation of the data suggests that with minor limitations, glucose from SAT can be used to establish tight glycemic control in this patient group.
Cardiovascular Death and the Metabolic Syndrome
Authors: Langenberg Claudia , Bergstrom Jaclyn , Scheidt-Nave Christa , Pfeilschifter Johannes , Barrett-Connor Elizabeth 
Published: May 2006

OBJECTIVE— Levels of adiposity-signaling hormones and inflammatory markers are less favorable in individuals with the metabolic syndrome; their role in the association between the metabolic syndrome and cardiovascular mortality remains unclear.
RESEARCH DESIGN AND METHODS— We conducted a prospective study of 977 men and 1,141 women aged 40–94 years in 1984–1987, followed for mortality for a maximum of 20 years. Adiponectin, leptin, ghrelin, interleukin-6 (IL-6), C-reactive protein (CRP), and Adult Treatment Panel III–defined metabolic syndrome components were measured in fasting blood samples obtained in 1984–1987. Cox-proportional hazards models were used in survival analyses.
RESULTS— The age- and sex-adjusted hazard ratio (HR) (95% CI) for coronary heart disease (CHD) mortality associated with the metabolic syndrome was 1.65 (1.25–2.18) (P &lt; 0.001); this association did not differ significantly by sex, age, or diabetic status (P &gt; 0.2 for each interaction). The association between the metabolic syndrome and CHD mortality was not materially changed after adjustment for adiponectin, leptin, and ghrelin; it was attenuated by 25% after adjustment for IL-6 and 35% after adjustment for CRP. CHD mortality increased linearly with greater levels of IL-6 and CRP (Ptrend &lt; 0.001 for each); the age- and sex-adjusted HRs comparing highest versus lowest quarter were 3.0 (1.87–4.89) for IL-6 and 2.1 (1.41–3.21) for CRP. IL-6, but not CRP, remained a significant predictor of CHD mortality in models including both inflammatory markers and the metabolic syndrome.
CONCLUSIONS— Adiposity-signaling hormones and inflammatory markers explain little to some of the association between the metabolic syndrome and CHD mortality. IL-6 levels predict CHD mortality independently of CRP.
Lipid Profile, Glucose Homeostasis, Blood Pressure, and Obesity-Anthropometric Markers in Macrosomic Offspring of Nondiabetic Mothers
Authors: Evagelidou Eleni N. , Kiortsis Dimitrios N. , Bairaktari Eleni T. , Giapros Vasileios I. , Cholevas Vasileios K. , Tzallas Christos S. , Andronikou Styliani K. 
Published: May 2006

OBJECTIVE—The study was to determine whether being the macrosomic offspring of a mother without detected glucose intolerance during pregnancy has an impact on lipid profile, glucose homeostasis, and blood pressure during childhood.
RESEARCH DESIGN AND METHODS—Plasma total, HDL, and LDL cholesterol; triglycerides; apolipoprotein (Apo) A-1, -B, and -E; lipoprotein (a); fasting glucose and insulin; homeostasis model assessment of insulin resistance (HOMA-IR) index; blood pressure; BMI; and detailed anthropometry were evaluated in 85 children aged 3–10 years old, born appropriate for gestational age (AGA; n = 48) and large for gestational age (LGA; n = 37) of healthy mothers.
RESULTS—At the time of the assessment, body weight, height, skinfold thickness, BMI, waist circumference, and blood pressure did not differ between the LGA and AGA groups with the exception of head circumference (P &lt; 0.01). There were no significant differences in plasma total or LDL cholesterol; triglycerides; Apo A-1, -B, or -E; lipoprotein (a); Apo B–to–Apo A-1 ratio; or glucose levels between the groups. The LGA group had significantly higher HDL cholesterol levels (P &lt; 0.01), fasting insulin levels (P &lt; 0.01), and HOMA-IR index (P &lt; 0.01) but lower values of the glucose-to-insulin ratio (P &lt; 0.01) as compared with the AGA group.
CONCLUSIONS—Children born LGA of mothers without confirmed impaired glucose tolerance during pregnancy show higher insulin concentrations than AGAs.