bluuebunny/crossref_metadata_2025_split huggingface dataset:
Explanations for the High Risk of Diabetes-Related Amputation in a Caribbean Population of Black African Descent and Potential for Prevention
Authors: Hennis Anselm J.M. , Fraser Henry S. , Jonnalagadda Ramesh , Fuller John , Chaturvedi Nish 
Published: March 2007

OBJECTIVE—Diabetes-related lower-extremity amputation (LEA) rates are elevated in blacks compared with whites in the U.S., but are lower in African Caribbeans in the U.K., whereas anecdotal reports suggest high rates in the Caribbean. We aimed to establish the incidence and risk factors for diabetes-related LEA in a Caribbean population.
RESEARCH DESIGN AND METHODS—We conducted an incident and prospective case-control study of case patients (individuals with diabetes having a LEA) and community-based control subjects (individuals with diabetes without a LEA) in Barbados, West Indies. Participants completed an interview and examination of risk factors for amputation, including footwear use.
RESULTS—The overall 1-year incidence of LEA (n = 223) was 173 per 105 population and 936 per 105 population with diabetes (557 per 105 for minor amputation and 379 per 105 for major amputation). Women had higher amputation rates than those reported in the Global Lower Extremity Amputation Study, apart from the U.S. Navajo population. Independent risk factors for all diabetes-related LEAs were poor footwear (odds ratio [OR] 2.71 [95% CI 1.23–5.97]), elevated GHb (1.40 per percent increase [1.26–1.57]), peripheral neuropathy (1.05 per volt increase [1.03–1.08]), and peripheral vascular disease.
CONCLUSIONS—Diabetes LEA rates in Barbados are among the highest in the world. Inadequate footwear independently tripled amputation risk. Education of professionals and patients, particularly about footwear and foot care, coupled with improved diabetes clinical care, is key to reducing amputation risk in this population.
The Impact of Abnormalities in IGF and Inflammatory Systems on the Metabolic Syndrome
Authors: Kaushal Kalpana , Heald Adrian H. , Siddals Kirk W. , Sandhu Manjinder S. , Dunger David B. , Gibson John M. , Wareham Nick J. 
Published: March 2007

OBJECTIVE—Low plasma levels of IGF-I, particularly when coupled with low levels of the potentially inhibitory IGF binding protein (IGFBP)-1 and higher levels of C-reactive protein (CRP), have been implicated in the pathogenesis of metabolic syndrome X and cardiovascular disease. We report the relative contributions of IGFBP-1 and CRP to the occurrence of the metabolic syndrome in a healthy population cohort to establish the extent to which these factors may contribute to subsequent risk of cardiovascular disease.
RESEARCH DESIGN AND METHODS—The volunteers in the study were all participants in the Ely study, a continuing population-based cohort in Ely, Cambridgeshire, U.K. Of 839 individuals studied, 154 (18.4%) fulfilled criteria for the metabolic syndrome.
RESULTS—Subjects with the metabolic syndrome had lower IGFBP-1 (14.4 μg/l [95% CI 12.9–16.0] vs. 25.4 [24.1–26.7], P &lt; 0.001) and higher CRP (1.9 mg/l [1.6–2.2] vs. 1.0 [0.9–1.1], P &lt; 0.001). Logistic regression, adjusted for age, sex, fasting insulin, and IGF-I, demonstrated a striking 14-fold increased risk for the metabolic syndrome (odds ratio 14.1 [4.1–48.4], P &lt; 0.001) in individuals with a CRP value in the highest tertile and IGFBP-1 levels below the median.
CONCLUSIONS—The combination of a high CRP concentration coupled with a low IGFBP-1 results in a dramatic increase in an individual’s risk of having the metabolic syndrome. Further elucidation of the biological processes linking the IGF and inflammatory systems may allow the identification of novel therapeutic targets for cardiovascular risk reduction.
Sympathetic and Parasympathetic Neuropathy Are Frequent in Both Type 1 and Type 2 Diabetic Patients
Authors: Freccero Carolin , Svensson Henry , Bornmyr Siv , Wollmer Per , Sundkvist Göran 
Published: March 2007

OBJECTIVE—The aim of this study was to evaluate the frequency of sympathetic versus parasympathetic neuropathy among type 1 and type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—There were 43 patients with type 1 and 17 with type 2 diabetes who were investigated. Sympathetic nerve function was assessed by measurement of the vasoconstriction (VAC) index by laser Doppler perfusion imaging of a locally heated finger followed by indirect cooling. Parasympathetic nerve function was assessed by R-R interval variation during deep breathing as measured by the expiration/inspiration (E/I) ratio. Results were expressed as age-corrected z scores in SD; VAC index &gt;1.64 SD and E/I ratio &lt;−1.64 SD were considered abnormal.
RESULTS—VAC index was abnormal in 40% with type 1 and 41% with type 2 diabetes, whereas the E/I ratio was abnormal in 42% with type 1 and 65% with type 2 diabetes. There was a clear association between VAC index and E/I ratio among type 1 (rs = 0.525; P = 0.0002) but not among type 2 (rs = 0.10) diabetic patients. Among type 2 diabetic patients, the degree of dysfunction was most severe regarding parasympathetic function (P = 0.0167).
CONCLUSIONS—Sympathetic and parasympathetic neuropathy were frequent in both type 1 and type 2 diabetic patients. However, there was a difference between the two types of diabetes. Sympathetic and parasympathetic nerve functions correlated in type 1 but not in type 2 diabetic patients. The explanation for this discrepancy might be that parasympathetic nerve function was most severely affected among type 2 diabetic patients.
Health Literacy and Pregnancy Preparedness in Pregestational Diabetes
Authors: Endres Loraine K. , Sharp Lisa K. , Haney Elaine , Dooley Sharon L. 
Published: March 2007

OBJECTIVE—We investigated the association between functional health literacy and markers of pregnancy preparedness in women with pregestational diabetes.
RESEARCH DESIGN AND METHODS—English- and Spanish-speaking pregnant women with pregestational diabetes were recruited. Women completed the Test of Functional Health Literacy in Adults (TOFHLA) short form and a questionnaire. A TOFHLA score of ≤30 was defined as low functional health literacy.
RESULTS—Of 74 women participating in the study, 16 (22%) were classified as having low functional health literacy. Compared with women with adequate health literacy, those with low health literacy were significantly more likely to have an unplanned pregnancy (P = 0.02) and significantly less likely to have either discussed pregnancy ahead of time with an endocrinologist or obstetrician (P = 0.01) or taken folic acid (P = 0.001).
CONCLUSIONS—The results of this study suggest that low functional health literacy among women with pregestational diabetes is associated with several factors that may adversely impact birth outcomes.
The Effect of the PREMIER Interventions on Insulin Sensitivity
Authors: Ard Jamy D. , Grambow Steve C. , Liu Di , Slentz Cris A. , Kraus William E. , Svetkey Laura P. 
Published: March 2007

OBJECTIVE—This ancillary study of PREMIER sought to determine the effects on insulin sensitivity of a comprehensive behavioral intervention for hypertension with and without the Dietary Approaches to Stop Hypertension (DASH) dietary pattern.
RESEARCH DESIGN AND METHODS— Participants were assigned to one of three nonpharmacologic interventions for blood pressure (group A, advice only; group B, established; and group C, established plus DASH). The established intervention included weight loss, reduced sodium intake, increased physical activity, and moderate alcohol intake; the DASH dietary pattern was added to the established intervention for those in group C. The DASH dietary pattern is high in fruits, vegetables, and low-fat dairy products while being lower in total fat, saturated fat, and cholesterol. It is abundant in nutrients such as magnesium, calcium, and protein, which have been associated with improved insulin sensitivity. Insulin sensitivity was measured at baseline and at 6 months using the frequently sampled intravenous glucose tolerance test with minimal model analysis.
RESULTS—Both intervention groups decreased total calories, percentage of calories from fat, and sodium intake to similar levels, with similar amounts of energy expenditure and weight loss. Covariate differences seen only in group C included increased intake of protein, potassium, calcium, and magnesium. Compared with control subjects, insulin sensitivity improved significantly only in group C, from 1.96 to 2.95 (P = 0.047). Group B did have a significant decrease in fasting insulin and glucose, but the changes in insulin sensitivity did not reach statistical significance when compared with control subjects.
CONCLUSIONS—These results suggest that including the DASH dietary pattern as part of a comprehensive intervention for blood pressure control enhances insulin action beyond the effects of a comprehensive intervention that does not include DASH.
A Comparison of Self-Reported Energy Intake With Total Energy Expenditure Estimated by Accelerometer and Basal Metabolic Rate in African-American Women With Type 2 Diabetes
Authors: Samuel-Hodge Carmen D. , Fernandez Louise M. , Henríquez-Roldán Carlos F. , Johnston Larry F. , Keyserling Thomas C. 
Published: March 2007

OBJECTIVE—This study assesses the validity of dietary data from African-American women with type 2 diabetes by comparing reported energy intake (EI) with total energy expenditure (TEE) estimated by an accelerometer and basal metabolic rate (BMR).
RESEARCH DESIGN AND METHODS—EI of 200 African-American women was assessed by three telephone-administered 24-h diet recalls using a multiple-pass approach. Physical activity was measured over a 7-day period by accelerometer, which also provided an estimate of TEE. Underreporting of EI was determined by using cutoffs for EI-to-TEE and EI-to-BMR ratios.
RESULTS—Participants, on average, were 59 years of age, with a BMI of 35.7, 10.5 years of diagnosed diabetes, and 10.7 years of education. Mean EI was 1,299 kcal/day; mean EI-to-TEE and EI-to-BMR ratios were 0.65 and 0.88, respectively. Among the 185 subjects with complete dietary data, 81% (n = 150) were classified as energy underreporters using the EI-to-TEE ratio cutoff; 58% (n = 107) were classified as energy underreporters using the EI-to-BMR ratio. Energy underreporters had significantly lower reported fat, higher protein, but similar carbohydrate intakes compared with non-underreporters. The EI-to-TEE ratio was not significantly associated with any demographic variables or following a diet for diabetes, but it was inversely associated with BMI (r = −0.37, P &lt; 0.0001). In a multivariate model, demographic variables, BMI, and following a diet for diabetes explained 16% of the variance in the EI-to-TEE ratio, with the latter two variables being the only significant predictors (inversely associated).
CONCLUSIONS—Widespread energy underreporting among this group of overweight African-American women with type 2 diabetes severely compromised the validity of self-reported dietary data.
Relationship Between GHb Concentration and Erythrocyte Survival Determined From Breath Carbon Monoxide Concentration
Authors: Virtue Mark A. , Furne Julie K. , Nuttall Frank Q. , Levitt Michael D. 
Published: March 2007

OBJECTIVE—Subjects with decreased erythrocyte survival have an unusually low GHb percentage. The goal of this study was to determine whether hyperglycemia, as reflected by GHb percentage, is associated with decreased erythrocyte survival.
RESEARCH DESIGN AND METHODS—Erythrocyte survival was quantitated in 23 subjects with type 2 diabetes, and these values were correlated with the subjects’ GHb percentage. Erythrocyte survival was determined from the difference between the subjects’ alveolar carbon monoxide (CO) concentration and atmospheric CO concentration. Reticulocyte counts were obtained in 16 subjects.
RESULTS—Although the vast majority of the subjects had erythrocyte life spans that fell within the normal range (123 ± 23 days), there was a highly significant inverse correlation (r = −0.66, P &lt; 0.01) between life span and GHb percentage, with an average decline in life span of 6.9 days for each 1% rise in GHb. The reticulocyte count inversely correlated with erythrocyte life span (r = −0.77, P &lt; 0.01).
CONCLUSIONS—Hyperglycemia, as evidenced by high GHb percentage, is associated with an appreciable decrease in erythrocyte life span. Because GHb appears to be formed over the lifetime of the erythrocyte, this decreased erythrocyte survival suggests that high GHb percentages may systematically underestimate the true degree of hyperglycemia.
Eighteen Years of Fair Glycemic Control Preserves Cardiac Autonomic Function in Type 1 Diabetes
Authors: Larsen Jakob R. , Sjøholm Hans , Berg Tore J. , Sandvik Leiv , Brekke Magne , Hanssen Kristian F. , Dahl-Jørgensen Knut 
Published: March 2007

OBJECTIVE—To study the association between 18 years of mean HbA1c and cardiac autonomic function in type 1 diabetic patients having used intensive insulin treatment.
RESEARCH DESIGN AND METHODS—A total of 39 patients with type 1 diabetes were followed during 18 years, and HbA1c was measured yearly. At 18 years follow-up heart rate variability (HRV) measurements were used to assess cardiac autonomic function. Standard cardiac autonomic tests during normal breathing, deep breathing, the Valsalva maneuver, and the tilt test were performed. Maximal heart rate increase during exercise electrocardiogram and minimal heart rate during sleep were also used to describe cardiac autonomic function.
RESULTS—We present the results for patients with mean HbA1c &lt;8.4% (two lowest HbA1c tertiles) compared with those with HbA1c ≥8.4% (highest HbA1c tertile). All of the cardiac autonomic tests were significantly different in the high- and the low-HbA1c groups, and the most favorable scores for all tests were seen in the low-HbA1c group. In the low-HbA1c group, the HRV was 40% during deep breathing, and in the high-HbA1c group, the HRV was 19.9% (P = 0.005). Minimal heart rate at night was significantly lower in the low-HbA1c groups than in the high-HbA1c group (P = 0.039). With maximal exercise, the increase in heart rate was significantly higher in the low-HbA1c group compared with the high-HbA1c group (P = 0.001).
CONCLUSIONS—Mean HbA1c during 18 years was associated with cardiac autonomic function. Cardiac autonomic function was preserved with HbA1c &lt;8.4%, whereas cardiac autonomic dysfunction was impaired in the group with HbA1c ≥8.4%.
Natural Progression of Diabetic Peripheral Neuropathy in the Zenarestat Study Population
Authors: Brown Mark J. , Bird Shawn J. , Watling Sharon , Kaleta Hong , Hayes Lee , Eckert Stephen , Foyt Howard L. 
Published: March 2007

OBJECTIVE—The aim of this study was to report the baseline and natural progression of diabetic peripheral neuropathy over 12 months in a large mild-to-moderate neuropathy population.
RESEARCH DESIGN AND METHODS—Patients from a multicentered trial of zenarestat, an aldose reductase inhibitor, had serial measures of neurologic function, including nerve conduction studies (NCSs), quantitative sensory testing (QST), and clinical neuropathy rating scores at baseline and at 12 months. Baseline population descriptors and changes in neurologic function in placebo-treated patients were analyzed.
RESULTS—Sural sensory velocity (P = 0.0008 [95% CI −1.04 to −0.27]), median sensory amplitude (P = 0.0021 [−1.3 to −0.29]), median distal motor latency (P = 0.002 [0.09–0.28]), cool thermal QST (P = 0.0005 [0.27–0.94]), and Michigan Neuropathy Screening Instrument results (P = 0.0087 [0.04–0.30]) declined significantly from baseline in the placebo population. NCS changes from baseline were independent of baseline HbA1c stratification.
CONCLUSIONS—The neurologic decline over 12 months is evident when measured by NCS and cool thermal QST. Other measures (vibration QST, neuropathy rating scores, monofilament examination) are insensitive to changes over 12 months in a mild-to-moderate affected population of this size.
Biological Variation in HbA1c Predicts Risk of Retinopathy and Nephropathy in Type 1 Diabetes
Authors: McCarter Robert J. , Hempe James M. , Gomez Ricardo , Chalew Stuart A. 
Published: March 2007

OBJECTIVE—We hypothesized that biological variation in HbA1c, distinct from variation attributable to mean blood glucose (MBG), would predict risk for microvascular complications in the Diabetes Control and Complications Trial (DCCT).
RESEARCH DESIGN AND METHODS—A longitudinal multiple regression model was developed from MBG and HbA1c measured in the 1,441 DCCT participants at quarterly visits. A hemoglobin glycation index (HGI = observed HbA1c - predicted HbA1c) was calculated for each visit to assess biological variation based on the directional deviation of observed HbA1c from that predicted by MBG in the model. The population was subdivided by thirds into high-, moderate-, and low-HGI groups based on mean participant HGI during the study. Cox proportional hazard analysis compared risk for development or progression of retinopathy and nephropathy between HGI groups controlled for MBG, age, treatment group, strata, and duration of diabetes.
RESULTS—Likelihood ratio and t tests on HGI rejected the assumption that HbA1c levels were determined by MBG alone. At 7 years’ follow-up, patients in the high-HGI group (higher-than-predicted HbA1c) had three times greater risk of retinopathy (30 vs. 9%, P &lt; 0.001) and six times greater risk of nephropathy (6 vs. 1%, P &lt; 0.001) compared with the low-HGI group.
CONCLUSIONS—Between-individual biological variation in HbA1c, which is distinct from that attributable to MBG, was evident among type 1 diabetic patients in the DCCT and was a strong predictor of risk for diabetes complications. Identification of the processes responsible for biological variation in HbA1c could lead to novel therapies to augment treatments directed at lowering blood glucose levels and preventing diabetes complications.
Neuroendocrine Tumor Markers and Enterochromaffin-Like Cell Hyper/Dysplasia in Type 1 Diabetes
Authors: De Block Christophe E.M. , Colpin Gert , Thielemans Kristof , Coopmans Willy , Bogers Johannes J.P.M. , Pelckmans Paul A. , Van Marck Eric A.E. , Van Hoof Viviane , Martin Manou , De Leeuw Ivo H. , Bouillon Roger , Van Gaal Luc F. 
Published: March 2007

OBJECTIVE—Parietal cell antibodies (PCAs) are found in 20% of type 1 diabetic patients, denoting autoimmune gastritis and pernicious anemia, which may predispose to enterochromaffin-like (ECL) cell hyper/dysplasia and gastric carcinoid tumors. We evaluated whether chromogranin A (CgA), 5-hydroxyindole acetic acid (5-HIAA), and neuron-specific enolase (NSE) contribute to screening for ECL cell hyper/dysplasia.
RESEARCH DESIGN AND METHODS—Sera from 93 type 1 diabetic patients (53 men and 40 women, 31 PCA+ and 62 PCA−, aged 45 ± 13 years) were analyzed for PCAs by indirect immunofluorescence and for CgA, NSE, and gastrin by radioimmunoassay. Urinary 5-HIAA was tested by high-performance liquid chromatography. Corpus atrophy and ECL cell proliferation were assessed in gastric biopsies.
RESULTS—PCA+ patients had higher gastrin (P &lt; 0.0001) and CgA levels (P = 0.003) and were more prone to autoimmune gastritis (odds ratio [OR] 17, P &lt; 0.0001) and ECL cell hyper/dysplasia (OR = 23, P = 0.005) than PCA− subjects. ECL cell hyper/dysplasia was present in seven PCA+ patients who showed higher CgA levels (P &lt; 0.0001) than subjects without ECL cell hyper/dysplasia, but NSE and 5-HIAA levels were similar. CgA levels correlated with gastrinemia (r = 0.50, P &lt; 0.0001), PCA titer (r = 0.42, P = 0.001), and 5-HIAA levels (r = 0.38, P = 0.012). Logistic regression identified the CgA level (β = 0.01, P = 0.027) as an independent risk factor for ECL cell hyper/dysplasia when PCA, CgA, 5-HIAA, NSE, gastrin, sex, and age were tested. Multivariate linear regression demonstrated that CgA level was determined by ECL cell density (r = 0.59, P &lt; 0.0001) and gastrin level (r = 0.67, P = 0.02). One PCA+ patient with elevated gastrin, CgA, and 5-HIAA levels had a gastric carcinoid tumor.
CONCLUSIONS—PCA+ patients, particularly those with high gastrin and CgA levels, risk developing ECL cell hyper/dysplasia. The determination of CgA, but not NSE and 5-HIAA, may complement histology in evaluating ECL cell mass.
Excess Hospitalizations, Hospital Days, and Inpatient Costs Among People With Diabetes in Andalusia, Spain
Authors: Olveira-Fuster Gabriel , Olvera-Márquez Pilar , Carral-Sanlaureano Florentino , González-Romero Stella , Aguilar-Diosdado Manuel , Soriguer-Escofet Federico 
Published: March 2007

OBJECTIVE—The goal of this study was to estimate the excess hospitalizations, hospital days, and inpatient costs attributable to diabetes in Andalusia, Spain (37 hospitals, 7,236,459 inhabitants), during 1999 compared with those without diabetes.
RESEARCH DESIGN AND METHODS—This study was an analysis of all hospital discharges. Those with an ICD-9-CM code of 250 as either the main or secondary diagnosis were considered to have been admissions of individuals with diabetes. An estimate of costs was applied to each inpatient admission by assigning a cost weight based on the diagnostic-related group (DRG) related to each admission.
RESULTS—A total of 538,580 admissions generated 4,310,654 hospital bed-days and total costs of €940,026,949. People with diabetes accounted for 9.7% of all hospital discharges, 13.8% of total stays, and 14.1% of the total cost. Of the total cost for individuals with diabetes (€132,509,217), 58.3% were excess costs, of which 47% was attributable to cardiovascular complications and 43% to admissions for comorbid diseases. Individuals 45–75 years of age accounted for 75% of the excess costs. The rate of admissions during the study year was 145 per 1,000 inhabitants for individuals with diabetes compared with 70 admissions per 1,000 inhabitants for individuals without diabetes.
CONCLUSIONS—The costs arising from hospitalization of individuals with diabetes are disproportionate in relation to their prevalence. For those aged ≥45 years, cardiovascular complications were clearly the most important factor determining increased costs from diabetes.
Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by Elevated LDL Cholesterol or by Decreased HDL Cholesterol?
Authors: Drexel Heinz , Aczel Stefan , Marte Thomas , Benzer Werner , Langer Peter , Moll Willi , Saely Christoph H. 
Published: March 2007

OBJECTIVE—To evaluate the atherogenicity of lipids in coronary patients with normal fasting glucose (NFG), impaired fasting glucose (IFG), and type 2 diabetes.
RESEARCH DESIGN AND METHODS—Serum lipid values, the presence of angiographic coronary artery disease (CAD) at baseline, and the incidence of vascular events over 2.3 years were recorded in 750 consecutive patients undergoing coronary angiography.
RESULTS—Triglycerides significantly (P &lt; 0.001) increased and HDL cholesterol (P &lt; 0.001) as well as LDL particle diameter (P &lt; 0.001) significantly decreased from subjects with NFG &lt;5.6 mmol/l (n = 272) over patients with IFG ≥5.6 mmol/l (n = 314) to patients with type 2 diabetes (n = 164). Factor analysis revealed two factors in the lipid profiles of our patients: triglycerides, HDL cholesterol, apolipoprotein A1, and LDL particle diameter loaded high on an HDL-related factor, and total cholesterol, LDL cholesterol, and apolipoprotein B loaded high on an LDL-related factor. In patients with type 2 diabetes, the HDL-related factor (odds ratio 0.648 [95% CI 0.464–0.904]; P = 0.011), but not the LDL-related factor (0.921 [0.677–1.251]; P = 0.597), was associated with significant coronary stenoses ≥50%. Consistently, in the prospective study, the HDL-related factor (0.708 [0.506–0.990]; P = 0.044), but not the LDL-related factor (1.362 [0.985–1.883]; P = 0.061), proved significantly predictive for vascular events in patients with type 2 diabetes.
CONCLUSIONS—The low HDL cholesterol/high triglyceride pattern is associated with the degree of hyperglycemia. In coronary patients with type 2 diabetes, this pattern correlates with the prevalence of CAD and significantly predicts the incidence of vascular events.