bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Type 2 Diabetes a Different Disease in Obese and Nenobese Patients?
Authors: Prando Romano , Cheli Valeria , Melga Pierluigi , Giusti Roberta , Ciuchi Emanuela , Odetti Patrizio 
Published: March 2007

OBJECTIVE
The main purpose of this work was to study the possible differences in insulin secretion in a large group of type 2 diabetic patients in relation to diabetes duration, obesity, and the presence of secondary failure after treatment with oral hypoglycemic agents.

RESEARCH DESIGN AND METHODS
There were 147 nonobese and 215 obese type 2 diabetic subjects, aged 35–80 years, investigated in a cross-sectional descriptive study. Subjects were grouped according to whether glycemic control was good (mean blood glucose &lt;8.5 mmol/l) or poor. β-Cell function was assessed by measuring meal-stimulated insulin and C-peptide concentrations, as the mean of the three postprandial increments above the premeal value.

RESULTS
Basal C-peptide concentrations were significantly higher in obese than nonobese patients of both groups. The mean of meal-stimulated C-peptide concentrations was also significantly higher in obese than nonobese patients with good glycemic control, but not in the secondary failure groups. In nonobese and obese patients considered separately, a significant negative correlation between the mean of daily blood glucose and meal-stimulated C-peptide was observed (r = −0.705 and r = −0.679, respectively, P &lt; 0.001) and the residual β-cell function was significantly correlated with the known duration of diabetes and metabolic control, but not with BMI, in both groups.

CONCLUSIONS
On average, obese diabetic subjects showed higher meal-stimulated Cpeptide than nonobese subjects only in well-controlled groups. In both obese and nonobese patients, an inverse association between meal-stimulated insulin secretion and duration of diabetes was observed. In obese patients, as in nonobese patients, the lower β-cell function seems likely to be the major pathogenetic factor in the appearance of secondary failure, while being overweight plays only a minor role, thus showing that type 2 diabetes is the same disease in obese and nonobese patients.
The 1997 American Diabetes Association Criteria Versus the 1985 World Health Organization Criteria for the Diagnosis of Abnormal Glucose Tolerance: Poor agreement in the Hoorn Study
Authors: Vegt Femmie De , Dekker Jacqueline M , Stehouwer Coen D A , Nijpels Giel , Bouter Lex M , Heine Robert J 
Published: March 2007

OBJECTIVE
Recently, the American Diabetes Association (ADA) introduced new diagnostic criteria. These new criteria are based on fasting plasma glucose levels, avoiding the burdensome oral glucose tolerance test (OGTT). We compared the 1997 ADA criteria with the 1985 World Health Organization (WHO) criteria with respect to the prevalence of diabetes and the cardiovascular risk profile in the population of the Hoorn Study.

RESEARCH DESIGN AND METHODS
The Hoorn Study is a population-based survey of 2,484 men and women, aged 50–75 years. An OGTT was performed and cardiovascular risk factors were determined in 2,378 subjects without known diabetes. Subjects were categorized according to both sets of diagnostic criteria.

RESULTS
Although the prevalence of diabetes was similar for both sets of criteria, 47 of 120 (39.2%) subjects who were diagnosed with diabetes according to the 1997 ADA criteria were not classified as having diabetes when using the 1985 WHO criteria. Similarly, of 285 subjects diagnosed with impaired fasting glucose by the 1997 ADA criteria, 195 (68.4%) were classified as having normal glucose tolerance by the 1985 WHO criteria. The overall agreement was poor (K 0.33; 95% CI 0.28−0.38). Subjects who were diagnosed as having diabetes by either set of criteria had an adverse cardiovascular risk profile, which was between the cardiovascular risk profiles of concordant normal and concordant diabetic subjects.

CONCLUSIONS
In this study, both sets of criteria diagnosed a similar number of diabetic subjects, but many of the subjects shifted between glucose intolerance categories. With either set of criteria, a considerable number of subjects at risk of developing diabetes and subjects carrying an increased risk of cardiovascular disease, as reflected by an adverse cardiovascular risk profile, will be missed.
Effect of Domperidone on the Health-Related Quality of Life of Patients With Symptoms of Diabetic Gastroparesis
Authors: Farup Christina E , Leidy Nancy K , Murray Miranda , Williams G Rhys , Helbers Lawrence , Quigley Eamonn M M 
Published: March 2007

OBJECTIVE
To describe the health-related quality of life (HRQOL) of patients with insulin-treated diabetes and symptoms of diabetic gastroparesis and to assess the impact of domperidone on HRQOL in these patients.

RESEARCH DESIGN AND METHODS
This two-phase multicenter study was part of a safety and efficacy investigation. Phase 1 involved 4-week single-blind treatment with domperidone 20 mg q.i.d. (n = 269). Patients demonstrating significant symptomatic improvement (n = 208) continued to phase II, a 4-week, double-blind, parallel-group study with patients receiving placebo (n = 103) or domperidone (n = 105). Patients completed the Medical Outcomes Study Short-Form-36 Health Survey at selection and at the end of each phase. Physical component summary (PCS) and mental component summary (MCS) scores served as primary parameters, and the eight subscales were secondary parameters.

RESULTS
HRQOL scores of subjects enrolled in the trial were significantly lower than norms from the general population and people with diabetes (P &lt; 0.001). Subjects experiencing symptomatic improvement after 4 weeks of single-blind treatment demonstrated significant improvement in all HRQOL parameters (P &lt; 0.001); PCS, MCS, and six subscale scores of nonresponders did not change. Between-group change score differences were significant for PCS, MCS, and seven subscales (P &lt; 0.05 to P &lt; 0.001). During phase II, the domperidone group maintained their HRQOL; the placebo group showed a significant decline in PCS and four subscales (P &lt; 0.05). The between-group difference in the PCS score change was statistically significant (−1.77 vs. 0.65, P = 0.05).

CONCLUSIONS
Results suggest that patients with symptoms of diabetic gastroparesis experience notable HRQOL impairment and that symptomatic relief with domperidone is accompanied by improvements in HRQOL that can be sustained over 4 weeks of treatment.
Use of Services by Diabetes Patients in Managed Care Organizations: Development of a diabetes surveillance system
Authors: Engelgau Michael M , Geiss Linda S , Manninen Diane L , Orians Carlyn E , Wagner Edward H , Friedman Neal M , Hurley Judith S , Trinkaus Kathryn M , Shatin Deborah , Vorst Krista A Van ,   CDC Diabetes In Managed Care Work Group
Published: March 2007

OBJECTIVE
Computerized inpatient, pharmacy, outpatient,and laboratory records were used to develop an algorithm to identifydiabetes patients and to develop surveillance indicators common to the three participating MCOs. Using 1993 data, the availability, specifications, and limitations of various surveillance indicators weredetermined.

RESEARCH DESIGN AND METHODS
Computerized inpatient, pharmacy, outpatient, and laboratory records were used to develop an algorithm to identify diabetes patients and to develop surveillance indicators common to the three participating MCOs. Using 1993 data, the availability, specifications, and limitations of various surveillance indicators were determined

RESULTS
An extensive set of diabetes surveillance indicators was identified from the four sources of data. Consistent data specifications across MCOs needed to consider variation in the type of data collected, a lack of documentation on level of coverage, differences in codingdata, and different models of health care delivery. A total of 16,363 diabetes patients were identified. The age-adjusted prevalence of diabetes ranged from 24 to 29 per 1,000 enrollees. Approximately one-third of patients with diabetes (32–34%) were taking insulin. The majority had one or more visits to a primary care physician during the year (72–;94%). Visits to specialists were less frequent. Ophthalmologists and optometrists were the most commonly used specialists: 29–;60% of the patients with diabetes at the three MCOs had visited an ophthalmologist or optometrist. About one-fifth had an overnight hospital stay during the year.

CONCLUSIONS
This diabetes surveillance system is a useful tool for MCOs to track trends in prevalence of diabetes, use of health services, and delivery of preventive care to individuals with diabetes. This system may also be useful for health care planning and for assessing use changes after new developments in diabetes care or new quality management initiatives.
Effect of Troglitazene on Microalbuminuria in Patients With Incipient Diabetic Nephropathy
Authors: Imano Eiichi , Kanda Tsutomu , Nakatani Yoshihisa , Nishida Tsutomu , Arai Katsumi , Motomura Masaaki , Kajimoto Yoshitaka , Yamasaki Yoshimitsu , Hori Masatsugu 
Published: March 2007

OBJECTIVE
Although some studies have suggested a direct action of troglitazone on vascular cells, its effects on diabetic vascular diseases have not been reported. We therefore investigated the effect of troglitazone on microalbuminuria in patients with incipient diabetic nephropathy.

RESEARCH DESIGN AND METHODS
A total of 30 patients with type 2 diabetes associated with microalbuminuria (urinary albumin-to-creatinine ratio [ACR] [milligrams per gram creatinine] ranging from 30 to 300 mg/g creatinine) were studied. They were randomly divided into two groups: patients treated with metformin (500 mg/day, n = 13) or with troglitazone (400 mg/day, n = 17) for 12 weeks. ACR, lipid profile, blood pressure, glycated hemoglobin, and plasma glucose during meal-load tests were measured every 4 weeks.

RESULTS
Anthropometric indices (BMI and percent fat), lipid profile, and blood pressure did not change with either treatment. Fasting and postmeal glucose levels decreased similarly in the two groups. Decrements in glycated hemoglobin were greater in the metformin group at 4 and 8 weeks after the initiation of treatment (P &lt; 0.05). Troglitazone reduced ACR (median [25–75th percentiles]) from 70 (49–195) to 40 (31–90) mg/g creatinine at 4 weeks (P = 0.021) and maintained these reduced levels throughout the treatment period (8 weeks: 35 [26–68], P = 0.007; 12 weeks: 43 [26–103], P = 0.047). Metformin did not change ACR throughout the 12 weeks.

CONCLUSIONS
Troglitazone ameliorated microalbuminuria in diabetic nephropathy. Furthermore, our findings suggest that troglitazone has some effects on vascular cells other than lowering plasma glucose levels. Troglitazone might be useful for diabetic angiopathy, including nephropathy and coronary artery disease.
U-Shaped and J-Shaped Relationships Between Serum Insulin and Coronary Heart Disease in the General Population: The Bruneck Study
Authors: Bonora Enzo , Willeit Johann , Kiechl Stefan , Oberhollenzer Friedrich , Egger Georg , Bonadonna Riccardo , Muggeo Michele 
Published: March 2007

OBJECTIVE
To evaluate the relationship existing between serum insulin and coronary heart disease (CHD) in the general population.

RESEARCH DESIGN AND METHODS
In a cross-sectional survey on atherosclerosis and its risk factors, 500 men and 500 women aged 40–79 years were randomly selected from the population of Bruneck, Italy. Clinical, biochemical, and behavioral risk factors of atherosclerosis were assessed in the 936 subjects who participated in the study. Serum insulin was measured at fasting (n = 888) and 2 h (n = 811, known diabetic subjects were excluded) after an oral glucose load. CHD was ascertained by an abnormal electrocardiogram and/or a history of angina or myocardial infarction.

RESULTS
Subjects were stratified according to serum insulin quintiles at fasting or 2 h after glucose loading. After adjustment for sex, age, BMI, smoking, physical activity, alcohol intake, and socioeconomic status (analysis of covariance), cardiovascular risk factors clustered in subjects of the top insulin quintile. Multiple logistic regression analysis, including sex and age in model 1, sex, age, BMI, glucose tolerance, socioeconomic status, and behavioral variables in model 2, or this set of variables together with triglycerides and apoproteins Al and B, fibrinogen, and blood pressure status in model 3, revealed a significant association between high serum insulin and CHD when median insulin quintile was used as the reference class. Moreover, low serum insulin levels, such as those found in subjects of the lowest quintile, were independently related to CHD. These results were found either before (model 1) or after (models 2 and 3) adjusting for several covariates. Consistent results were found in men and women, as well as in younger and older subjects.

CONCLUSIONS
Results of the present study suggest that both hyperinsulinemia and “hypoinsulinemia” are independent indicators of CHD. Furthermore, it is proposed that the relationship between CHD and fasting insulin is U-shaped, whereas that between CHD and postglucose insulin may be J-shaped.
Lifestyle Intervention in Overweight Individuals With a Family History of Diabetes
Authors: Wing Rena R , Venditti Elizabeth , Jakicic John M , Polley Betsy A , Lang Wei 
Published: March 2007

OBJECTIVE
To assess the effect of lifestyle intervention over 2 years on changes in weight, coronary heart disease (CHD) risk factors, and incidence of diabetes in overweight individuals with a parental history of diabetes.

RESEARCH DESIGN AND METHODS
Participants (n = 154), who were 30–100% over ideal body weight, had one or both parents with diabetes, and were currently nondiabetic, were randomly assigned to 2-year treatments focused on diet (decreasing calories and fat intake), exercise (goal of 1,500 kcal/week of moderate activity), or the combination of diet plus exercise or to a no-treatment control group. Subjects were reassessed at 6 months, 1 year, and 2 years.

RESULTS
At 6 months, the groups differed significantly on measures of eating, exercise, and fitness; weight losses in the diet and diet-plus-exercise groups were significantly &gt; in the exercise and control conditions. Weight losses were associated with positive changes in CHD risk factors. After 6 months, there was gradual deterioration of behavioral and physiological changes, so that at 2 years, almost no between-group differences were maintained. Differences between groups in risk of developing diabetes were of borderline significance (P = 0.08). Strongest predictors were impaired glucose tolerance at baseline, which was positively related to risk of developing diabetes, and weight loss from baseline to 2 years, which was negatively related; in all treatment groups, a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by ∼ 30% compared with no weight loss.

CONCLUSIONS
Although initially successful, the interventions studied here were not effective in producing long-term changes in behavior, weight, or physiological parameters. However, weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes. Since modest weight loss significantly reduced risk of type 2 diabetes, further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss.
Ethnic Differences in Correlates of Microalbuminuria in NIDDM: The role of the acute-phase response
Authors: Islam Niaz , Kazmi Fahrat , Chusney Gary D , Mattock Martin B , Zaini A , Pickup John C 
Published: March 2007

OBJECTIVE
To investigate whether microalbuminuria is associated with markers of the acute-phase response in NIDDM and whether there are ethnic differences in this association among the three main racial groups in Malaysia.

RESEARCH DESIGN AND METHODS
NIDDM patients of Chinese, Indian, and Malay origin attending a diabetic clinic in Kuala Lumpur, Malaysia, were matched for age, sex, diabetes duration, and glycemic control (n = 34 in each group). Urinary albumin-to-creatinine ratio was measured in an early morning urine sample. Biochemical measurements included markers of the acute-phase response: serum sialic acid, triglyceride, and (lowered) HDL cholesterol.

RESULTS
The frequency of microalbuminuria did not differ among the Chinese, Indian, and Malay patients (44, 41, and 47%, respectively). In Chinese patients, those with microalbuminuria had evidence of an augmented acute-phase response, with higher serum sialic acid and triglyceride and lower HDL cholesterol levels; and urinary albumin-to-creatinine ratio was correlated with serum sialic acid and triglyceride. The acute-phase response markers were not different in Indians, with microalbuminuria being high in even the normoalbuminuric Indians; only the mean arterial blood pressure was correlated with urinary albumin-to-creatinine ratio in the Indians. Malay NIDDM subjects had an association of microalbuminuria with acute-phase markers, but this was weaker than in the Chinese subjects.

CONCLUSIONS
Microalbuminuria is associated with an acute-phase response in Chinese NIDDM patients in Malaysia, as previously found in Caucasian NIDDM subjects. Elevated urinary albumin excretion has different correlates in other racial groups, such as those originating from the Indian subcontinent. The acute-phase response may have an etiological role in microalbuminuria.
Diabetes and Long-Term Risk of Mortality From Coronary and Other Causes in Middle-Aged Swedish Men: A general population study
Authors: Adlerberth Annika M , Rosengren Annika , Wilhelmsen Lars 
Published: March 2007

OBJECTIVE
To assess the relation between cardiovascular risk factors and long-term cause-specific mortality risk in middle-aged diabetic men, compared with men without diabetes.

RESEARCH DESIGN AND METHODS
This prospective study analyzes a large random population sample of men over a follow-up of 16 years. At baseline in 1974–1977, 249 men with diabetes and 6,851 men without diabetes, all aged 51–59 years, were identified. There were 2,126 deaths, 724 of which were due to coronary heart disease (CHD) and 1,001 deaths were due to any cardiovascular disease (CVD) cause.

RESULTS
After adjustment for age, serum cholesterol, systolic blood pressure, smoking, BMI, and coronary disease at baseline, the relative risk of dying from any cause was 2.50 (95% CI, 2.11–2.95) in men with diabetes, compared with nondiabetic men, and 2.87 (2.31–3.57) for cardiovascular death. Men with diabetes had no significant excessive risk of dying from cancer or violent causes, but the relative risk of dying from any other noncardiovascular cause was 3.69 (2.55–5.34). Most of these deaths were due to diabetes and its complications. Hypercholesterolemia, smoking, and elevated systolic blood pressure predicted both coronary and allcause mortality in diabetic as well as in nondiabetic men. Men with diabetes and serum cholesterol &gt;7.2 mmol/1 had a risk of dying from coronary disease of 45.3 and from any cause of 76.1 per 1,000 observation-years. In men with diabetes, the relative risk of dying associated with serum cholesterol &gt;7.2 mmol/1, as compared with &lt;5.2 mmol/1, was 1.78 (95% CI, 1.05–3.02). The corresponding risk for nondiabetic men was 1.23 (1.04–1.46), and there was a statistically significant interaction between serum cholesterol and diabetes (P = 0.004).

CONCLUSIONS
In men with diabetes, hypercholesterolemia, smoking, and hypertension predict coronary mortality risk, as well as mortality risk from all causes. Men with both diabetes and hypercholesterolemia have severely compromised survival and should be targeted for intervention aimed at lowering their lipid levels.
An Electronic Case Manager for Diabetes Control
Authors: Meneghini Luigi F , Albisser A Michael , Goldberg Ronald B , Mintz Daniel H 
Published: March 2007

OBJECTIVE
To evaluate the usage and safety of an electronic case manager (ECM) system designed to facilitate the task of glycemic control. Sustained improvement in blood glucose control is the proven treatment outcome that will reduce or eliminate the long-term complications of diabetes.

RESEARCH DESIGN AND METHODS
A customized microcomputer system served as the ECM. Located at the clinic, this voice-interactive system required the remote patient to need only a touch-tone telephone. Patients accessed the system to report daily selfmeasured glucose levels or hypoglycemic symptoms together with associated lifestyle events. System beta-testing was in an open-case series (n = 184) in an academic diabetes center with the goal of evaluating the ECM in terms of utilization, frequency of crises, and fiscal matters.

RESULTS
Of the patients, 58% (n = 107) actively used the ECM for their daily diabetes care, accumulating 788 patient-months of follow-up. Over 45,000 telephone calls were received by the ECM during the start-up year. Each call was processed instantly and automatically. Patients benefited from having 24-h access to the ECM. Prevalence of diabetes-related crises (hyperglycemia =400 mg/dl [22 mmol/1] or hypoglycemia &lt;50 mg/dl [2.8 mmol/1]) decreased approximately threefold (P &lt; 0.05), with a concomitant statistically significant decrease in HbA1c of 0.8% at 6 months (n = 45, P = 0.024) and 0.9% at 12 months (n = 30, P = 0.044). The ECM provided 24-h on-line assistance in adjusting daily insulin and/or tablet therapy, automatic generation of standardized medical reports, electronic medical-legal documentation, as well as a marked reduction in the time spent on the phone with patients. Clinic visits in managing complex diabetes were reduced approximately twofold (P &lt; 0.0001), and the effort spent by case managers was estimated.

CONCLUSIONS
Patients with diabetes who accessed the ECM system received timely, cost-effective, and reliable medical intervention. This reduced the incidence of diabetic crises and the need for frequent clinic visits. The ECM empowers case managers to provide safer and superior diabetes care.
Relationship Between Serum 1,5-Anhydroglucitol and Urinary Excretion of N-Acetylalucosaminidase and Albumin Determined at Onset of NIDDM With 3-Year Follow-up
Authors: Yamanouchi Toshikazu , Kawasaki Takahiro , Yoshimura Tomoe , Inoue Tae , Koshibu Eri , Ogata Nobuyuki , Funato Hirono , Akaoka Ieo , Miyashita Hideo 
Published: March 2007

OBJECTIVE
This prospective study was designed to elucidate the relationship between the serum level of 1,5-anhydroglucitol (1,5AG) and the urinary excretion of N-acetylglucosaminidase (NAG) and albumin in patients who were in the early stages of diabetes.

RESEARCH DESIGN AND METHODS
A total of 1,062 male nondiabetic subjects with impaired glucose tolerance were monitored for blood glucose level once every 2–3 months, and the values were evaluated. Of these 1,062 subjects, 112 showed a worsening of glycemia during the observation period to the level seen in diabetes. We began to monitor the glycemia and parameters of renal damage in the 112 patients from the onset of diabetes.

RESULTS
The urinary excretion of NAG and albumin were elevated even at the onset of diabetes. The abnormal excretion of NAG and albumin was associated with a change in serum 1,5AG and was quickly reversible when the serum 1,5AG improved. In the 3 years after the onset of diabetes, we obtained at least 18 measurements of one parameter for each patient and calculated the mean. Urinary NAG was found to be significantly correlated with the fasting plasma level of glucose (FPG; r = 0.512, P &lt; 0.0001), the level of HbA1 (r = 0.351, P = 0.001), and the level of 1,5AG (r = −0.790, P &lt; 0.0001). The urinary excretion of albumin was weakly but significantly correlated with levels of FPG (r = 0.383, P &lt; 0.0001) and HbA1 (r = 0.337, P = 0.0001), but it was more strongly correlated with 1,5AG (r = −0.632, P &lt; 0.0001). The level of 1,5AG was significantly correlated with FPG (r = −0.681, P &lt; 0.0001) and HbA1 (r = −0.609, P &lt; 0.0001).

CONCLUSIONS
When the renal damage is not severe, the serum level of 1,5AG appeared to be an indicator of the reversible renal damage caused by hyperglycemia, as well as of the severity of the glycemia itself.