bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Perindopril and Carvedilol on Endothelium-Dependent Vascular Functions in Patients With Diabetes and Hypertension
Authors: Giugliano Dario , Marfella Raffaele , Acampora Rita , Giunta Riccardo , Coppola Ludovico , D'Onofrio Felice 
Published: March 2007

OBJECTIVE
To compare the effects of the ACE inhibitor perindopril and the β-blocker carvedilol on blood pressure and endothelial functions in N1DDM patients with hypertension.

RESEARCH DESIGN AND METHODS
We conducted a double-blind randomized trial in 26 patients with NIDDM and mild hypertension. A 4-week run-in placebo period preceded the active 12-week treatment with perindopril (4–8 mg daily) or carvedilol (25–50 mg daily). Endothelial functions were assessed by evaluating the hemodynamic (mean blood pressure, leg blood flow) and rheological (platelet aggregation, blood viscosity, and blood filterability) responses to an intravenous bolus of 3 g L-arginine, the natural precursor of nitric oxide.

RESULTS
Both perindopril and carvedilol significantly reduced mean blood pressure (P &lt; 0.001) and increased leg blood flow (P &lt; 0.05) to the same extent; blood filterability remained unchanged in both perindopril- and carvedilol-treated groups. Carvedilol reduced platelet aggregation and blood viscosity significantly (P &lt; 0.05) but perindopril did not. Before treatment, the hemodynamic and rheologic responses to L-arginine were significantly lower in patients (P &lt; 0.05–0.01) than in 20 nondiabetic nonhypertensive control subjects. After 12 weeks of treatment, both drugs normalized the hemodynamic responses to L-arginine. Platelet aggregation response to L-arginine was ameliorated by carvedilol and remained unchanged in the perindopril group.

CONCLUSIONS
At the doses used, both drugs effectively reduce blood pressure and normalize the hemodynamic responses to L-arginine. The implications of the ameliorated endothelial function for the poor cardiovascular outlook of the NIDDM hypertensive patient need further assessment.
Beneficial Effect on Average Lipid Levels From Energy Restriction and Fat Loss in Obese Individuals With or Without Type 2 Diabetes
Authors: Markovic Tania P , Campbell Lesley V , Balasubramanian Santhira , Jenkins Arthur B , Fleury Adriana C , Simons Leon A , Chisholm Donald J 
Published: March 2007

OBJECTIVE
The risk of cardiovascular disease in type 2 diabetes is greater than is accounted for by conventional risk factors. We investigated whether energy restriction or modest fat loss improved the lipid profile in obese subjects with and without type 2 diabetes. The relationship of site of adipose tissue loss to lipid changes was also examined.

RESEARCH DESIGN AND METHODS
Lipid levels were measured in 18 subjects with normal glucose tolerance (NGT) (n = 9, BM1 = 31.5 ± 0.8 [SEM] kg/m2) or type 2 diabetes (n = 9, BMI = 31.8 ± 0.7) before and on the 4th (d4) and 28th (d28) days of a hypocaloric formula diet. Body composition was assessed with dual energy X-ray absorptiometry on dO and d28.
RESULTSL:— Mean daily energy intake during the diet was 1,100 ± 60 kcal (33% protein, 38% carbohydrate, and 29% fat). Mean weight loss was 6.2 ± 0.4 kg. Initial lipid profiles were similar in subjects with or without diabetes, and diabetes did not affect the responses. Dietary intervention resulted in early (d4) and late (d28) changes. Energy restriction(d4) reduced VLDL cholesterol and total triglyceride (TG) concentrations andincreased LDL particle size. With fat loss (d28), there were falls in total LDL cholesterol (free and esterified components), LDL TG, and LDL apolipoprotein B (apoB) concentrations. Reduction in central abdominal fat (but not other body fat) was correlated with a less atherogenic lipid profile: Δ abdominal fat versus Δ LDL free cholesterol, r = 0.65, P = 0.006 and versus Δ apoB, r = 0.64, P = 0.008.

CONCLUSIONS
Even in obese subjects with an average lipid profile, modest weight loss reduces atherogenicity, independently of type 2 diabetes, and abdominal fat loss is specifically related to such improvements.
Why Don't Women With Diabetes Plan Their Pregnancies?
Authors: Holing Emily V , Beyer Carla S , Brown Zane A , Connell Frederick A 
Published: March 2007

OBJECTIVE
To determine why women with diabetes generally do not plan their pregnancies, consequently entering their pregnancies with poor blood glucose control and greatly increasing the risk of birth defects in their infants.

RESEARCH DESIGN AND METHODS
A population-based sample of 85 women with diabetes diagnosed before the index pregnancy were recruited within 6 months postpartum from 15 hospitals in the state of Washington. Women with planned and unplanned pregnancies were compared using qualitative and quantitative analysis of personal interviews, self-administered questionnaires, and medical record review.

RESULTS
Although most women (79%) knew they should optimize their blood glucose levels before conception, fewer than half (41%) of their pregnancies were planned. Women with planned pregnancies had significantly higher income and more education; were more likely to have private health insurance, to see an endocrinologist before pregnancy, to be happily married, and to be Caucasian; and were less likely to use tobacco. Most unplanned pregnancies were not contraceptive failures, but may have been consciously or subconsciously intended. Women with planned pregnancies generally described an ongoing and positive relationship with their health care providers. Women who felt that their doctors discouraged pregnancy were more likely to have an unplanned pregnancy than were women who had been reassured they could have a healthy baby.

CONCLUSIONS
Many women with diabetes still perceive negative messages about pregnancies and become pregnant without optimal planning. We believe there are many opportunities for increasing the proportion of women with diabetes who plan their pregnancies, particularly in the areas of prepregnancy information, support that women are given, and the quality of the relationships they experience within the health care system. It is crucial that couples be reassured that with pre-conception glucose control, almost all women with diabetes can have healthy babies.
Well-Being and Treatment Satisfaction in Older People With Diabetes
Authors: Petterson Tim , Lee Pauline , Hollis Sally , Young Bob , Newton Peggy , Dornan Tim 
Published: March 2007

OBJECTIVE
To measure well-being and treatment satisfaction and their correlates in older people with diabetes.

RESEARCH DESIGN AND METHODS
A postal survey was conducted of 1,000 diabetic patients aged ≥ 60 years, representing 56% of the resident older diabetic population in an inner-city health district with a largely indigenous population of 230,000 people and a widely varied socioeconomic mix. Well-being and treatment satisfaction were measured with diabetes-specific instruments and correlated with patient data held in a central register.

RESULTS
There was an 81% response. The general well-being scores (median [interquartile range]) for patients on diet alone, tablets, and insulin were 54 (44–60), 53 (42–61), and 48 (35–56) (P &lt; 0.001 comparing insulin with diet and tablets) compared with a scale maximum of 66. Treatment satisfaction scores were 35 (31–36), 35 (32–36), and 34 (30–36) (P &lt; 0.001 comparing insulin with diet and tablets), scale maximum 36. Mean HbA1c concentrations were 5.0 ± 1.4% (for patients on diet alone), 5.8 ± 1.6% (tablets), and 6.6 ± 1.7% (insulin) (P &lt; 0.001 for each difference). Neither well-being nor treatment satisfaction correlated with HbA1c. Insulin-treated patients were younger and had been diabetic longer than non-insulin-treated patients; their well-being remained slightly, but significantly, lower when adjusted for age, sex, BMI, and diabetes duration, but treatment satisfaction was no longer significantly different. Women had lower well-being than men.

CONCLUSIONS
It has proved possible to measure well-being and treatment satisfaction in a large community-based samples of older people with diabetes. At the level of glycemic control in this population, neither parameter correlated with HbA1c. The lower well-being in insulin-treated patients remained significant in multivariate analysis.
Association of Helicobacter pylori Infection With Cardiovascular and Cerebrovascular Disease in Diabetic Patients
Authors: de Luis Daniel A , Lahera Marcos , Cantón Rafael , Boixeda Daniel , San Román Antonio L , Aller Rocio , de La Calle Hermenegildo 
Published: March 2007

OBJECTIVE
Infection by Helicobacter pylori has been epidemiologically linked to some extradigestive conditions, including ischemic heart disease. Diabetic patients are an at-risk population for cardiovascular and thrombo-occlusive cerebral disease. The aim of the study was to examine a possible relationship between H. pylori infection and cardiovascular or cerebrovascular disease in diabetic patients.

RESEARCH DESIGN AND METHODS
This was a cross-sectional case-control study with 127 diabetic patients (both IDDM and NIDDM). Special emphasis was placed on the detection of clinical macro- and microvascular complications, cardiovascular risk factors, acute phase reactants, and serological markers of increased cardiovascular disease risk. H. pylori infection was assessed through the determination of specific Ig-G titers, measured by a commercial enzyme-linked immunosorbent assay.

RESULTS
Coronary heart disease was more prevalent in diabetic patients with than without H. pylori (odds ratio [OR] 4.07; 95% Cl 1.21–13.6; P &lt; 0.05). A history of thrombo-occlusive cerebral disease was also more frequent in H. pylori–positive diabetic patients (OR 4.8; 95% CI 1.24–18.51; P &lt; 0.05). Other complications such as peripheral arteriopathy, advanced nephropathy, neuropathy, or retinopathy were no differently distributed according to serological status. Alterations in the levels of the following acute-phase reactants and blood chemistry determinations were significantly more profound in H. pylori–positive diabetic patients: high fibrinogen (P &lt; 0.05), high erythrocyte sedimentation rate (P &lt; 0.001), high triglycerides (P &lt; 0.001), and low HDL cholesterol (P &lt; 0.001). These values were also more deeply altered in H. pylori–positive diabetic patients with a history of coronary heart disease, thrombo-occlusive cerebral disease, or both, when compared with H. pylori–positive diabetic patients without those complications.

CONCLUSIONS
Our data indicate a possible association of H. pylori infection and the development of coronary heart disease, thrombo-occlusive cerebral disease, or both, in diabetic patients. The importance of this link is highlighted by the possibility of an effective intervention against H. pylori infection.
Successful Treatment With Plasmapheresis, Cyclophosphamide, and Cyclosporin A in Type B Syndrome of Insulin Resistance: Case report
Authors: Eriksson Jan W , Bremell Tomas , Eliasson Björn , Fowelin Jesper , Fredriksson Linda , Yu Zhi-Wen 
Published: March 2007

CASE HISTORY
A woman born in 1949 was diagnosed in 1990 with systemic lupus erythematosus. She was treated with prednisolone, and &lt; 1 year later she presented with marked hyperglycemia. Large doses of insulin were given four times per day. Even though the patient was thin (BMI 17.4 kg/m2), very little improvement was seen.

INVESTIGATIONS AND TREATMENT
Serum insulin levels were high, and a euglycemic clamp investigation confirmed severe insulin resistance. The patient's serum contained insulin receptor antibodies inhibiting insulin binding, and thus the patient had a type B syndrome of insulin resistance. After diet and exercise, glycemic control stabilized and insulin treatment was withdrawn. However, in late 1993 she was in a catabolic and hyperglycemic state even though prednisolone doses were increased and azathioprin was added. In early 1994 she was treated with plasmapheresis and cyclophosphamide i.v. Subsequently, cyclosporin A was started as a maintenance therapy in addition to azathioprin. There was a rapid and sustained clinical improvement. Since late 1994 and onward, there is no sign of diabetes or glucose intolerance and there are no demonstrable insulin receptor antibodies in the patient's serum.

DISCUSSION
Severe type B insulin resistance may respond favorably to treatment with plasmapheresis and cyclophosphamide followed by cyclosporin A in combination with azathioprin.
Growth Changes in Children and Adolescents With Short-Term Diabetes
Authors: Bognetti Emilio , Riva Maria Cristina , Bonfanti Riccardo , Meschi Franco , Viscardi Matteo , Chiumello Giuseppe 
Published: March 2007

OBJECTIVE
Height and weight changes during the first 3 years of diabetes were prospectively followed in 152 diabetic children and adolescents.

RESEARCH DESIGN AND METHODS
The study sample consisted of 152 Caucasian diabetic patients (84 boys; 68 girls) followed from diabetes onset in the Paediatric Diabetes Unit and 80 Caucasian normal subjects (49 boys; 31 girls) assessed in the Outpatient General Paediatric Clinic of the same hospital for routine examination and not affected by problems that might influence growth. Diabetic patients and control subjects were consecutively enrolled in the study between 1989 and 1992; diabetic patients with positive markers for celiac disease (positive antiendomysial antibodies) and thyroid disease (positive antimicrosomial antibodies) or any other chronic disease were not considered in the study. Mean age of diabetic patients (8.9 ± 4.1 years) and control subjects (8.5 ± 4.2 years) at recruitment in the study was similar.

RESULTS
At onset of diabetes, the mean height expressed as the height standard deviation score (HSDS) was significantly greater than the expected values (P &lt; 0.0001) and was independent of sex and pubertal stage. During the first 3 years of diabetes, HSDS decreased significantly (F = 6.9; P &lt; 0.001). Meanwhile, growth velocity as standard deviation score (SDS) decreased significantly between the 1st and 2nd year (−0.12 ± 2.1; −0.76 ± 2.6, respectively; P &lt; 0.05), but it was similar between the 2nd and 3rd year of diabetes. Weight expressed as SDS increased significantly during the first 2 years of diabetes but not thereafter. Height changes during the study period were independent from pubertal stage and sex. Metabolic control and insulin requirement, in our series, were not clearly related to height and weight changes.

CONCLUSIONS
Diabetic patients at onset of diabetes are taller than age- and sex-matched nondiabetic subjects. During the first years of the disease, linear growth decreases independently of metabolic control and weight changes.
Fasting Plasma Glucose Is a Useful Test for the Detection of Gestational Diabetes
Authors: Reichelt Angela J , Spichler Ethel R , Branchtein Leandro , Nucci Luciana B , Franco Laércio J , Schmidt Maria Inês ,   Brazilian Study of Gestational Diabetes (EBDG) Working Group
Published: March 2007

OBJECTIVE
To evaluate fasting plasma glucose as a screening test for states of gestational diabetes.

RESEARCH DESIGN AND METHODS
Baseline data of a cohort conducted in general prenatal care units in Brazil, enrolling 5,579 women aged ≥ 20 years with gestational ages of 24–28 weeks at the time of testing and no previous diagnosis of diabetes. A standardized 2-h 75-g oral glucose tolerance test was performed in 5,010 women. Gestational diabetes and its subcategories—diabetes and impaired glucose tolerance—were defined according to the 1994 World Health Organization panel recommendations. We evaluated screening properties of calculated sensitivity and specificity for fasting plasma glucose with receiver operator characteristic curves.

RESULTS
For detection of the subcategory diabetes, a fasting plasma glucose of 89 mg/dl jointly maximizes sensitivity (88%) and specificity (78%), identifying 22% of the women as test-positive. For detection of impaired glucose tolerance, a value of 85 mg/dl jointly maximizes sensitivity and specificity (68%), identifying as test-positive 35% of the women. Lowering the cut point to 81 mg/dl increases sensitivity to 81%, but decreases specificity to 54%, labeling as test-positive 49% of the women.

CONCLUSIONS
Fasting plasma glucose is a useful test for the screening of both subcategories of gestational diabetes, a threshold of 85 mg/dl being an acceptable option. Effective screening for the subcategory diabetes can be achieved using a cut point of 89 mg/dl. If greater emphasis is placed on the detection of impaired glucose tolerance, a lower value, 81 mg/dl, may be needed.
Ethnicity and Cardiovascular Disease: The incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type 2 diabetes (U.K. Prospective Diabetes Study 32)
Authors:   U.K. Prospective Diabetes Study Group
Published: March 2007

OBJECTIVE
To estimate the incidence of myocardial infarction (MI) by ethnicity in subjects with diabetes and to examine the effect of ethnicity, adjusting for differences in cardiovascular risk factors.

RESEARCH DESIGN AND METHODS
For a prospective study, 4,974 patients with newly diagnosed type 2 diabetes, aged 25–65 years, were recruited from 23 clinics around the U.K. between 1977 and 1991. Of these subjects, 82% were white, 10% were South Asians, and 8% were Afro-Caribbeans. Fatal and first nonfatal MIs were defined by criteria based on the World Health Organization's Multinational Study of Vascular Disease. Age-standardized incidence rates were calculated. Cox regression was used to assess the independent effect of ethnicity controlling for risk factors for MI measured at study entry.

RESULTS
Of the subjects, 295 had a fatal MI and 558 had a fatal or a first nonfatal MI. The age-standardized rate per 1,000 person years for fatal or nonfatal MI for whites was 14.6 (95% CI, 13.3–15.9), for Afro-Caribbeans 4.3 (2.5–7.0), and for South Asians 15.4 (10.6–21.4). The hazard ratio associated with Afro-Caribbean ethnicity for MI relative to whites was 0.3 (0.2–0.6) after adjusting for age, sex, year of study entry, systolic blood pressure, smoking, social class, total cholesterol, and HDL cholesterol, whereas the hazard ratio for South Asians was 1.2 (0.9–1.7).

CONCLUSIONS
This study found that after adjusting for conventional cardiovascular risk factors, U.K. Afro-Caribbean subjects with diabetes had a lower risk for MI than whites, whereas South Asians did not have a risk different from that of whites.
Role of Orlistat in the Treatment of Obese Patients With Type 2 Diabetes: A 1-year randomized double-blind study
Authors: Hollander Priscilla A , Elbein Steven C , Hirsch Irl B , Kelley David , McGill Janet , Taylor Terry , Weiss Stuart R , Crockett Samuel E , Kaplan Roy A , Comstock John , Lucas Charles P , Lodewick Peter A , Canovatchel William , Chung Jain , Hauptman Jonathan 
Published: March 2007

OBJECTIVE
Obesity is an important risk factor for type 2 diabetes. Weight loss in patients with type 2 diabetes is associated with improved glycemic control and reduced cardiovascular disease risk factors, but weight loss is notably difficult to achieve and sustain with caloric restriction and exercise. The purpose of this study was to assess the impact of treatment with orlistat, a pancreatic lipase inhibitor, on weight loss, glycemic control, and serum lipid levels in obese patients with type 2 diabetes on sulfonylurea medications.

RESEARCH DESIGN AND METHODS
In a multicenter 57-week randomized double-blind placebo-controlled study, 120 mg orlistat or placebo was administered orally three times a day with a mildly hypocaloric diet to 391 obese men and women with type 2 diabetes who were aged &gt; 18 years, had a BMI of 28–40 kg/m2, and were clinically stable on oral sulfonylureas. Changes in body weight, glycemic control, lipid levels, and drug tolerability were measured.

RESULTS
After 1 year of treatment, the orlistat group lost 6.2 ± 0.45% (mean ± SEM) of initial body weight vs. 4.3 ± 0.49% in the placebo group (P &lt; 0.001). Twice as many patients receiving orlistat (49 vs. 23%) lost ≥ 5% of initial body weight (P &lt; 0.001). Orlistat treatment plus diet compared with placebo plus diet was associated with significant improvement in glycemic control, as reflected in decreases in HbA1c (P &lt; 0.001) and fasting plasma glucose (P &lt; 0.001) and in dosage reductions of oral sulfonylurea medication (P &lt; 0.01). Orlistat therapy also resulted in significantly greater improvements than placebo in several lipid parameters, namely, greater reductions in total cholesterol, (P &lt; 0.001), LDL cholesterol (P &lt; 0.001), triglycerides (P &lt; 0.05), apolipoprotein B (P &lt; 0.001), and the LDL-to-HDL cholesterol ratio (P &lt; 0.001). Mild to moderate and transient gastrointestinal events were reported with orlistat therapy, although their association with study withdrawal was low. Fat-soluble vitamin levels generally remained within the reference range, and vitamin supplementation was required in only a few patients.

CONCLUSIONS
Orlistat is an effective treatment modality in obese patients with type 2 diabetes with respect to clinically meaningful weight loss and maintenance of weight loss, improved glycemic control, and improved lipid profile.
Distortion-Product Otoacoustic Emissions and Selective Sensorineural Loss in IDDM
Authors: Nardo Walter Di , Ghirlanda Giovanni , Paludetti Gaetano , Cercone Stefania , Saponara Caterina , Ninno Massimiliano Del , Girolamo Stefano Di , Magnani Paolo , Leo Mauro A S Di 
Published: March 2007

OBJECTIVE
To provide information about possible subclinical damage of the cochlear outer hair cells (OHCs) by means of transiently evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs) in subjects with IDDM.

RESEARCH DESIGN AND METHODS
TEOAEs and DPOAEs were recorded in 47 IDDM patients with normal hearing and in age- and sex-matched nondiabetic subjects. Peripheral neuropathy was diagnosed by nerve conduction velocity (NCV) at the peroneal and surral nerves.

RESULTS
A subclinical peripheral neuropathy was found in 15 diabetic patients. Mean TEOAE amplitude was found to be significantly reduced in diabetic patients with a reduced NCV (7.6 ± 3.2 dB; Scheffé's test: P = 0.03), but not in those without neuropathy (9.5 ± 4.3 dB), with respect to control subjects (11 ± 3.1 dB). Neuropathic patients also showed mean reduced DPOAE amplitude values in the region of middle and high frequencies from 1,306 to 5,200 Hz (P &lt; 0.05), whereas no difference was found at the lowest-frequency amplitudes. A frequency-selective reduction of DPOAEs was also found in non-neuropathic patients (P &lt; 0.05) in the region of higher frequencies at 3,284, 4,126, and 5,200 Hz compared with control subjects. No correlations were found among duration of diabetes, HbA1c values, TEOAEs and DPOAEs.

CONCLUSIONS
Our results suggest that IDDM patients show an early abnormality of the micromechanical properties of the OHCs. In IDDM patients without a subclinical peripheral neuropathy, damage is limited to the higher frequencies and can be detected only by DPOAEs, whereas in IDDM patients with neuropathy, damage also involves the middle range of frequencies and can be detected by TEOAEs and DPOAEs. Therefore, DPOAEs seem to be able to detect the earliest cochlear selective-frequency dysfunction in IDDM patients without peripheral neuropathy. DPOAEs appear to be of greater clinical interest than TEOAEs; the former seem to be frequency specific and can be recorded at any chosen frequency, including high frequencies.