bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Controlled Evaluation of Staging Dietary Patterns to Reduce the Risk of Diabetes in African-American Women
Authors: Auslander Wendy , Haire-Joshu Debra , Houston Cheryl , Rhee Chaie-Won , Williams James Herbert 
Published: March 2007

OBJECTIVE—This study evaluated the 3-month follow-up data of the Eat Well, Live Well Nutrition Program, a culturally specific, peer-led dietary change program designed to reduce the risk of type 2 diabetes in low-income African-American women. This peer-led program was delivered in the community and was tailored to the participants’ stage of change for individual dietary patterns. We report the results of the 3-month intervention and the extent to which dietary changes and other key outcomes were maintained at a 3-month follow-up assessment.
RESEARCH DESIGN AND METHODS—Using an experimental control group design, 294 overweight African-American women (ages 25–55 years), recruited in collaboration with a neighborhood organization, completed pre- and posttest and 3-month follow-up interviews of dietary behaviors, knowledge, attitudes, fat intake, and weight.
RESULTS—Significant reductions were found in fat intake among women in the treatment condition when compared with women in the control group; these reductions were maintained at 3-month follow-up assessment. Likewise, significant changes in dietary patterns were reported after the study and were maintained, except for one dietary pattern (replacement).
CONCLUSIONS—This model of health promotion, which individually tailors dietary patterns through staging and use of peer educators, has the potential for decreasing fat intake and increasing and maintaining specific low-fat dietary patterns among overweight African-American women at risk for diabetes.
Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Type 1 Diabetic Patients
Authors: Rossing Peter , Hougaard Philip , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—To evaluate prospectively putative risk factors for development of microalbuminuria and macroalbuminuria in type 1 diabetes.
RESEARCH DESIGN AND METHODS—Prospective observational study of a cohort of type 1 diabetic patients followed in the outpatient clinic at Steno Diabetes Center for ≤10 years (median 9 years). We followed 537 patients aged ≥18 years with type 1 diabetes, with duration of diabetes ≥5 years, with normoalbuminuria (urinary albumin excretion rate ≤30 mg/24 h), and who were not taking antihypertensive medication. Risk factors for development of microalbuminuria and macroalbuminuria were evaluated.
RESULTS—The mean progression of urinary albumin excretion rate was 7.6% (SE 0.8) per year. During follow-up, 134 patients (25%) progressed to persistent microalbuminuria or macroalbuminuria (&gt;30 mg/24 h in two of three consecutive urine samples). Cox multiple regression analysis using baseline values of putative predictors of progression showed the following significant predictors of progression from normoalbuminuria to microalbuminuria or macroalbuminuria: baseline log urinary albumin excretion rate 2.63 (relative risk; 95% CI 1.65–4.19), HbA1c 1.13% (1.04–1.23), presence of any retinopathy 1.90 (1.26–2.88), and smoking 1.61 (1.11–2.33). Sex, duration of diabetes, arterial blood pressure, serum creatinine, height, and social class were not risk factors.
CONCLUSIONS—Our study suggests that several potentially modifiable risk factors predict the development of microalbuminuria and macroalbuminuria in type 1 diabetic patients.
Predisposition to Atopic Symptoms to Inhaled Antigens May Protect From Childhood Type 1 Diabetes
Authors: Mattila Petri S. , Tarkkanen Jussi , Saxen Harri , Pitkäniemi Janne , Karvonen Marjatta , Tuomilehto Jaakko ,   the Childhood Diabetes in Finland (DiMe) Study Group
Published: March 2007

OBJECTIVE—To assess the inverse association between type 1 diabetes and asthma to establish whether environmental and/or genetic factors predisposing to asthma or to atopic symptoms to inhaled antigens protect from diabetes.
RESEACH DESIGN AND METHODS—Questionnaires were returned by 306 probands with childhood type 1 diabetes, their 506 nonaffected siblings, and 406 age- and sex-matched unaffected population control subjects. The main outcome measures were self-reported physician-diagnosed asthma and atopic symptoms to animal dust and pollen.
RESULTS—Risk of diabetes was inversely associated with asthma (odds ratio 0.49 [95% CI 0.24–1.00]), allergy to animal dust (0.67 [0.45–0.99]), and to a lesser degree to pollen (0.74 [0.51–1.07]) when the probands were compared with the population control subjects. Among the children of the families of an affected proband, the risk of diabetes appeared to be inversely associated with asthma (0.54 [0.27–1.09]) but not with allergy to animal dust (0.99 [0.66–1.47]) nor allergy to pollen (0.88 [0.62–1.27]).
CONCLUSIONS—The frequency of asthma and atopic symptoms to some inhaled antigens is decreased in individuals with childhood type 1 diabetes. Factors predisposing to atopic symptoms to inhaled antigens may protect from childhood type 1 diabetes.
Renal Outcome in Type 2 Diabetic Patients With or Without Coexisting Nondiabetic Nephropathies
Authors: Wong Teresa Yuk Hwa , Choi Paul Cheung Lung , Szeto Chun Cheuk , To Ka Fai , Tang Nelson Leung Sang , Chan Anthony Wing Hung , Li Philip Kam Tao , Lai Fernand Mac-Moune 
Published: March 2007

OBJECTIVE—To determine the risk factors for adverse renal outcome in type 2 diabetic patients who underwent renal biopsy and were followed-up longitudinally.
RESEARCH DESIGN AND METHODS—We examined 68 consecutive patients with type 2 diabetes during the period of 1985–1999 who underwent renal biopsy for proteinuria ≥1 g/day, renal involvement (proteinuria or renal impairment) at the absence of retinopathy, renal involvement with duration of diabetes &lt;5 years, or unexplained hematuria of glomerular origin. Their clinical features and underlying renal lesion were correlated with the renal outcome after longitudinal follow-up. Three groups of patients were defined based on their renal pathology: group I consisted of 24 patients (35%) with diabetic glomerulosclerosis (DGS) alone, group II consisted of 13 patients (19%) with nondiabetic nephropathy (NDN) superimposed on DGS, and group III consisted of 31 patients (46%) with NDN alone without evidence of DGS.
RESULTS—After a mean follow-up of 123 months from the diagnosis of type 2 diabetes (74 months from the time of renal biopsy), univariate analysis showed that risk factors for reaching end-stage renal disease (requiring maintenance dialysis, or a serum creatinine [SCr] ≥700 μmol/l) included proteinuria ≥2 g/day (P = 0.0087), SCr &gt;120 μmol/l (P = 0.0005), presence of retinopathy (P &lt; 0.00001) at the time of biopsy, and biopsy showing DGS (groups I and II) (P = 0.035). On multivariate analysis, retinopathy was the only independent variable correlated with end-stage renal failure. This study also showed that the association of hematuria or proteinuria with the absence of retinopathy constitutes the strongest indication for a nondiabetic lesion (positive predictive values of 94%).
CONCLUSIONS—Patients with type 2 diabetes undergoing renal biopsy constitute a heterogeneous group by their clinical presentations and underlying pathology, but longitudinal studies on the renal outcome of these patients remain limited. Our study showed that renal biopsy is indicated in selective diabetic patients because of potentially treatable nephropathy and of a better prognosis than DGS.
The Association Between Diabetes Metabolic Control and Drug Adherence in an Indigent Population
Authors: Schectman Joel M. , Nadkarni Mohan M. , Voss John D. 
Published: March 2007

OBJECTIVE—Studies of the association between diabetes metabolic control and adherence to drug therapy have yielded conflicting results. Because low socioeconomic and minority populations have poorer diabetes outcomes and greater barriers to adherence, we examined the relationship between adherence and diabetes metabolic control in a large indigent population.
RESEARCH DESIGN AND METHODS—The study population consisted of patients receiving medical care from a university-based internal medicine clinic serving a low-income population in rural central Virginia. The sample comprised 810 patients with type 2 diabetes who received oral diabetes medications from the clinic pharmacy and had at least one HbA1c determination during the study period. Multiple linear regression was used to examine the association of HbA1c level as well as change in HbA1c level with medication adherence, demographic, and clinical characteristics.
RESULTS—Better metabolic control was independently associated with greater medication adherence, increasing age, white (versus African-American) race, and lower intensity of drug therapy. For each 10% increment in drug adherence, HbA1c decreased by 0.16% (P &lt; 0.0001). Controlling for other demographic and clinical variables, the mean HbA1c of African-Americans was 0.29% higher than that of whites (P = 0.04). Additionally, the intensity of diabetes drug therapy for African-Americans was lower, as was their measured adherence to it. There was no association between metabolic control and gender, income, encounter frequency, frequency of HbA1c testing, or continuity of care.
CONCLUSIONS—Adherence to medication regimens for type 2 diabetes is strongly associated with metabolic control in an indigent population; African-Americans have lower adherence and worse metabolic control. Greater efforts are clearly needed to facilitate diabetes self-management behaviors of low-income populations and foster culturally sensitive and appropriate care for minority groups.
Young Men With High-Normal Blood Pressure Have Lower Serum Adiponectin, Smaller LDL Size, and Higher Elevated Heart Rate Than Those With Optimal Blood Pressure
Authors: Kazumi Tsutomu , Kawaguchi Akira , Sakai Keiko , Hirano Tsutomu , Yoshino Gen 
Published: March 2007

OBJECTIVE—Three measures—heart rate, a global index of the influence of the autonomic nervous system on the heart; circulating concentrations of adiponectin, an adipose-specific protein; and C-reactive protein (CRP), a sensitive marker of inflammation—have been reported to be closely associated with insulin resistance. Patients with borderline hypertension are known to be more insulin resistant and dyslipidemic than those with normal blood pressure (BP). BP can be classified into three categories: optimal, normal, and high-normal. The present study examined whether those with high-normal BP have any of these three conditions as compared with those with optimal BP in young healthy men.
RESEARCH DESIGN AND METHODS—Anthropometric, blood pressure, heart rate, and blood tests, including tests for adiponectin and CRP, were conducted in 198 male students, ages 18–26 years, who had fasted overnight. Insulin resistance (IR) and insulin secretion (β-cell levels) were calculated using the homeostasis model assessment (HOMA), and LDL size was measured by PAGE.
RESULTS—Compared with the 90 men who had optimal BP, the 46 men with high-normal BP had increased heart rate, BMI, percent body fat, and serum leptin levels. In addition, they had greater serum insulin, HOMA IR, and β-cell levels, lower adiponectin levels, and comparable CRP levels. Furthermore, the 46 men with high-normal BP had higher serum triglyceride and apolipoprotein (apo) B levels, and smaller LDL size; however, there was no difference in LDL and HDL cholesterol and apoA-I between men with optimal and high-normal BP. After adjusting for BMI, differences were still significant in serum adiponectin, heart rate, and LDL particle size. As BP rose, there was an increase in heart rate (BMI-adjusted least square means were 63, 65, and 70 bpm in men with optimal, normal, and high-normal BP, respectively; P = 0.005), whereas serum adiponectin (7.5, 6.6, and 6.4 mg/l; P = 0.007) and LDL particle size (271, 269, and 269 Å; P = 0.008) decreased.
CONCLUSIONS—Young men with high-normal BP have a faster heart rate, lower serum adiponectin levels, and smaller LDL size than men with optimal BP, even after adjustment for BMI. These results suggest the necessity of preventing further development of cardiac and metabolic diseases in young people who have high-normal BP.
Longitudinal Association of Glycemia and Microalbuminuria
Authors: Meigs James B. , D’Agostino Ralph B. , Nathan David M. , Rifai Nader , Wilson Peter W.F. 
Published: March 2007

OBJECTIVE—To assess current and long-term associations of glycemia with microalbuminuria, a marker of generalized endothelial injury.
RESEARCH DESIGN AND METHODS—We measured clinical characteristics, fasting plasma glucose, and the urinary albumin-to-creatinine ratio (UACR) in 1,311 men and 1,518 women attending the sixth examination cycle (1995–1998) of the Framingham Offspring Study. After excluding participants with diabetes or cardiovascular disease (CVD) at the baseline examination (1971–1974), we used fasting glucose measured at baseline, examination 6, and at least two additional examinations from 1974 to 1995 in regression models to predict risk for microalbuminuria (UACR ≥30 mg/g) associated with baseline, current, and 24-year time-integrated glycemia.
RESULTS—Microalbuminuria was present in 9.5% of men and 13.4% of women. Among men, age-adjusted odds ratios (95% CI) for microalbuminuria associated with each 0.28 mmol/l (5 mg/dl) increase in baseline, current, and time-integrated glucose levels were 1.12 (1.00–1.16), 1.08 (1.05–1.10), and 1.16 (1.11–1.21), respectively. These effects persisted after adjustment for systolic blood pressure and other confounders. Higher glucose levels also predicted incident diabetes and CVD. Mean time-integrated glucose levels were highest among men who developed both CVD and microalbuminuria (SE 6.82 ± 0.16 mmol/l), intermediate among men with either condition (6.03 ± 0.65 mmol/l), and lowest among men with neither condition (5.49 ± 0.02 mmol/l; P &lt; 0.001 for all pairwise comparisons). We observed similar associations in women.
CONCLUSIONS—Long-term hyperglycemia and subdiabetic glycemia increase risk for microalbuminuria. Microalbuminuria, type 2 diabetes, and CVD seem to arise together over the course of decades, consistent with the hypothesis that they share a common antecedent.
A Prospective Study of Obesity and Risk of Coronary Heart Disease Among Diabetic Women
Authors: Cho Eunyoung , Manson Joann E. , Stampfer Meir J. , Solomon Caren G. , Colditz Graham A. , Speizer Frank E. , Willett Walter C. , Hu Frank B. 
Published: March 2007

OBJECTIVE—To examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes.RESEARCH DESIGN AND METHODS—We followed 5,897 women with type 2 diabetes in the Nurses’ Health Study for ≤20 years. Women were aged 40–74 years and had no history of cardiovascular disease or cancer at the beginning of the follow-up period. BMI values from three time points (age 18 years, year 1976, and current) were derived from the reported height (1976) and corresponding reported weight. Weight changes between age 18 years and 1976 and after diagnosis of diabetes were calculated. Women reported diagnoses of diabetes and CHD every 2 years. Incident CHD cases were confirmed by medical record review.RESULTS—During follow-up, we documented 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI was strongly associated with increased risk of CHD among diabetic women. The multivariate relative risks across increasing categories of BMI (&lt;23.0, 23.0–24.9, 25.0–26.9, 27.0–29.9, 30.0–34.9, and ≥35.0 kg/m2) were 1.0, 1.58, 1.85, 1.95, 2.80, and 3.21, respectively (P for trend &lt;0.001). Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes was not associated with risk of CHD.CONCLUSIONS—These findings provide strong evidence that obesity and weight gain before diagnosis of diabetes are associated with future risk of CHD among women with type 2 diabetes.
Diabetes Care in the U.S. and Canada
Authors: Booth Gillian L. , Zinman Bernard , Redelmeier Donald A. 
Published: March 2007

OBJECTIVE—To compare the glycemic control of patients with type 1 diabetes treated in the U.S. and Canada.
RESEARCH DESIGN AND METHODS—A large multicenter randomized clinical trial conducted in the U.S. and Canada was analyzed. Patients with type 1 diabetes, screened from 1983 to 1989 for enrollment in the Diabetes Control and Complications Trial (DCCT), were categorized as treated in the U.S. (n = 2,604) or Canada (n = 245). HbA1c levels were compared between U.S. and Canadian patients, both before and after adjustment for predictors of HbA1c.
RESULTS—In general, volunteers screened for the DCCT were highly educated and following healthy lifestyles. Canadians were somewhat younger (25 vs. 27 years of age, P = 0.002), less likely to be college educated (62 vs. 71%, P = 0.002), more likely to receive care through a family doctor (41 vs. 28%, P = 0.001), and had a higher frequency of out-patient visits (4 vs. 3 per year, P = 0.004). Despite these differences in health care delivery, the mean HbA1c at baseline was identical in the two countries (8.9 vs. 9.0, P = 0.40). Adjustment for demographic, lifestyle, and clinical predictors of HbA1c yielded similar findings (9.0 vs. 9.2, P = 0.15). Equal percentages of American and Canadian patients who were screened ultimately entered the trial (21 vs. 19%, P = 0.20), and those randomized to conventional care achieved similar mean HbA1c levels (9.1 vs. 9.2, P = 0.50).
CONCLUSIONS—Differences in care delivery patterns do not yield large differences in glycemic control for patients with type 1 diabetes who were recruited in the U.S. and Canada for a large randomized trial.
A Prospective Analysis of Marital Relationship Factors and Quality of Life in Diabetes
Authors: Trief Paula M. , Wade Michael J. , Britton Kirsten Dee , Weinstock Ruth S. 
Published: March 2007

OBJECTIVE—To prospectively assess the relation between marital relationship domains (i.e., intimacy and adjustment) and health-related quality of life (HRQoL) and glycemic control of individuals with diabetes.
RESEARCH DESIGN AND METHODS—A previous cross-sectional study assessed the relationship between marital quality and adaptation to diabetes for 78 insulin-treated adults. Each participant completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) at time 1 (T1). A total of 61 subjects were contacted two years later (time 2 [T2]) and re-administered four HRQoL measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey-SF36, Problem Areas in Diabetes Scale, and Positive and Negative Affect Schedule). Glycemic control was assessed by HbA1c. Demographic data (age, sex, type and duration of diabetes, years married, other medical problems, family history, and years of education) were gathered from charts and questionnaires. Linear regression analyses were used to assess the ability of the two marital measures at T1 to predict HRQoL at T2, controlling for confounding HRQoL and baseline subject variables.
RESULTS—Both of the marital quality measures at T1 were prospective predictors of aspects of HRQoL at T2. Less diabetes-related distress at T2 was predicted by better marital adjustment at T1. Greater satisfaction with aspects of the diabetes care regimen at T2 was predicted by better marital adjustment and greater perceived marital intimacy at T1. Neither marital measure predicted general HRQoL or glycemic control.
CONCLUSIONS—For insulin-treated adults with diabetes, quality of marriage prospectively predicts diabetes-related quality of life. This study highlights the sensitivity of diabetes-specific measures. Future work should explore the value of interventions that target the spouse and/or couple.
Self-Management Education for Adults With Type 2 Diabetes
Authors: Norris Susan L. , Lau Joseph , Smith S. Jay , Schmid Christopher H. , Engelgau Michael M. 
Published: March 2007

OBJECTIVE—To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We searched for English language trials in Medline (1980–1999), Cinahl (1982–1999), and the Educational Resources Information Center database (ERIC) (1980–1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb.
RESULTS—On average, the intervention decreased GHb by 0.76% (95% CI 0.34–1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1–3 months of follow-up; and by 0.26% (0.05–0.48) at ≥4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3–105.4) of contact.
CONCLUSIONS—Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1–3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.
Reproducibility of Glucose Measurements Using the Glucose Sensor
Authors: Metzger Muriel , Leibowitz Gil , Wainstein Julio , Glaser Benjamin , Raz Itamar 
Published: March 2007

OBJECTIVE—Recent studies have confirmed that improved glycemic control decreases the risk of diabetic complications in type 1 and type 2 diabetic patients. The Minimed glucose sensor allows continuous 72-h glucose monitoring and represents a potentially important tool to improve diabetes management. Its use is currently limited to the health care team. Our aim was to evaluate the reproducibility of data provided by the device by comparing data provided by two sensors worn simultaneously by the same subject.
RESEARCH DESIGN AND METHODS—A total of 11 subjects (6 type 1 and 3 type 2 diabetic patients and 2 healthy subjects) agreed to wear two sensors and perform at least four daily finger-stick glucose determinations during 72 h. The simultaneous glucose values provided by the sensors were compared. To determine the clinical implications of the glucose data, each day was divided into eight periods, and for each period the glucose range was rated as satisfactory, too high, or too low by a blinded clinician experienced in interpreting glucose sensor data in the clinical setting. The evaluation of glycemic levels based on the recordings of the two sensors were compared for each paired time interval.
RESULTS—We discarded 18% of the sensor data for technical reasons. Examined as a group, the remaining 3,370 paired data points in all 11 patients were highly correlated (r = 0.84). However, when individual pairs were evaluated, large differences in the glucose values were apparent, with differences of &gt;10% in 70% of the measurements and &gt;50% in 7% of the measurements. Moreover, clinical evaluation of the glucose range provided simultaneously by two sensors was concordant for only 65% of the evaluation periods.
CONCLUSION—In a real-life setting, the accuracy of data provided by the Minimed glucose sensor may be less than expected. To avoid therapeutic errors, sensor findings should be confirmed by independent means before clinical decisions are made.