bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproducibility of the Diagnosis of Diabetes Over a 30-Month Follow-Up
Authors: Eschwège Eveline , Charles Marie Aline , Simon Dominique , Thibult Nadine , Balkau Beverley 
Published: March 2007

OBJECTIVE—To describe the change in diabetic status over 30 months.
RESEARCH DESIGN AND METHODS—Cohort study of 5,400 Caucasian men from the Paris Prospective Study, aged 44–55 years, who were not known as having diabetes at baseline. Oral glucose tolerance tests were performed at baseline and after 30 months.
RESULTS—At baseline, diabetes was diagnosed in 2.9% of the men by fasting plasma glucose (FPG) ≥7.0 mmol/l and in 0.9% by isolated postchallenge hyperglycemia (IPH) (FPG &lt;7.0 mmol/l and 2-h plasma glucose concentration ≥11.1 mmol/l), i.e., one in four of all men with newly diagnosed diabetes. Thirty months later, 42% of the men with diabetes diagnosed by FPG reverted to nondiabetic status, compared with 72% of those with diabetes diagnosed by IPH (P &lt; 0.0001). For the men with diabetes diagnosed by FPG at baseline, diabetes had been diagnosed by a physician at 30 months in 11.5%, in contrast to only 3.9% of those with diabetes diagnosed by IPH (P &lt; 0.05). For the 51 men with diabetes diagnosed by IPH at baseline, those who reverted to nondiabetic status had a lower frequency of family history of diabetes (P &lt; 0.1), a higher mean corpuscular volume (P &lt; 0.08), and a significantly higher total cholesterol concentration (P &lt; 0.006) at baseline; in contrast, for the 156 men with diabetes diagnosed by FPG at baseline, the men who reverted to nondiabetic status and those who remained diabetic had similar characteristics.
CONCLUSIONS—In this epidemiological study, diabetes diagnosed by one FPG concentration was more stable than diabetes diagnosed by one IPH; in clinical practice, the diagnosis of diabetes requires confirmation of the hyperglycemia.
Remission of Nephrotic-Range Albuminuria in Type 1 Diabetic Patients
Authors: Hovind Peter , Rossing Peter , Tarnow Lise , Toft Henrik , Parving Jeppe , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—To evaluate the cumulative incidence of nephrotic-range albuminuria (NRA), the frequency of remission, and the impact on progression, we analyzed data from a prospective cohort study of type 1 diabetic patients with diabetic nephropathy.
RESEARCH DESIGN AND METHODS—All of the albuminuric type 1 diabetic patients (n = 321, 121 women), who had at least yearly measurements of glomerular filtration rate (GFR) with a 51Cr-EDTA plasma clearance technique and were followed for at least 3 years, were evaluated. NRA, defined as persistent albuminuria &gt;2,500 mg/24 h, occurred in 126 patients (35 women) aged (mean ± SD) 34 ± 8 years, with duration of diabetes 22 ± 8 years and follow-up time from onset of NRA (median [range]) 8.7 (3.0–20.9) years. Remission of NRA was defined as sustained albuminuria &lt;600 mg/24 h for at least 1 year.
RESULTS—The cumulative incidence of NRA was 39%. Remission was induced in 28 of 126 (22%) patients; 21 were predominantly treated with ACE inhibitors, 7 with non–ACE inhibitor medications. Remission lasted 3.6 (1.0–18.1) years. More women (37%) than men (16%) obtained remission (P = 0.01). In the remission group compared with the no-remission group, mean arterial blood pressure (mean ± SEM) was reduced (102 ± 1 vs. 106 ± 1 mmHg, P &lt; 0.01), the rate of decline in GFR was diminished (3.8 ± 0.6 vs. 7.5 ± 0.5 ml · min–1 · year–1, P &lt; 0.001), and serum cholesterol was lower (5.3 ± 0.2 vs. 6.1 ± 0.1 mmol/l, P &lt; 0.01) during the whole follow-up period. No difference in glycemic control was found between groups (HbA1c 9.2 vs. 9.4%, NS).
CONCLUSIONS—In contrast to observations made before the use of antihypertensive treatment, our prospective observational study suggests that aggressive antihypertensive treatment with and without ACE inhibitors can induce long-lasting remission in a sizeable fraction of type 1 diabetic patients with NRA. The group of patients obtaining remission is characterized by slow progression of diabetic nephropathy and improved cardiovascular risk profile.
Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia
Authors: Valensi Paul , Sachs Régis-Nessim , Harfouche Boubakeur , Lormeau Boris , Paries Jacques , Cosson Emmanuel , Paycha Frédéric , Leutenegger Marc , Attali Jean-Raymond 
Published: March 2007

OBJECTIVE— The aim of this study was to determine the predictive value of silent myocardial ischemia (SMI) and cardiac autonomic neuropathy (CAN) in asymptomatic diabetic patients.
RESEARCH DESIGN AND METHODS— We recruited 120 diabetic patients with no history of myocardial infarction or angina, a normal 12-lead electrocardiogram (ECG), and two or more additional risk factors. SMI assessment was carried out by means of an ECG stress test, a thallium-201 myocardial scintigraphy with dipyridamole, and 48-h ECG monitoring. CAN was searched for by standardized tests evaluating heart rate variations. Accurate follow-up information for 3-7 years (mean 4.5) was obtained in 107 patients.
RESULTS— There was evidence of SMI in 33 patients (30.7%). CAN was detected in 33 of the 75 patients (38.9%) who were tested, and a major cardiac event occurred in 11 of them. Among these 75 patients, the proportion of major cardiac events in the SMI+ patients was not significantly higher than that in the SMI- patients (6 of 25 vs. 5 of 50 patients), whereas it was significantly higher in the CAN+ patients than in the CAN- patients (8 of 33 vs. 3 of 42 patients; P= 0.04), with a relative risk of 4.16 (95% CI 1.01-17.19) and was the highest in the patients with both SMI and CAN (5 of 10 patients). After adjusting for SMI, there was a significant association between CAN and major cardiac events(P = 0.04).
CONCLUSIONS— In asymptomatic diabetic patients, CAN appears to be a better predictor of major cardiac events than SMI. The risk linked to CAN appears to be independent of SMI and is the highest when CAN is associated with SMI.
Improved Glycemic Control and Enhanced Insulin Sensitivity in Type 2 Diabetic Subjects Treated With Pioglitazone
Authors: Miyazaki Yoshinori , Mahankali Archana , Matsuda Masafumi , Glass Leonard , Mahankali Srikanth , Ferrannini Eleuterio , Cusi Kenneth , Mandarino Lawrence J. , DeFronzo Ralph A. 
Published: March 2007

OBJECTIVE—To elucidate the effects of pioglitazone treatment on glucose and lipid metabolism in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 23 diabetic patients (age 30–70 years, BMI &lt; 36 kg/m2) who were being treated with a stable dose of sulfonylurea were randomly assigned to receive either placebo (n = 11) or pioglitazone (45 mg/day) (n = 12) for 16 weeks. Before and after 16 weeks of treatment, all subjects received a 75-g oral glucose tolerance test (OGTT); and hepatic and peripheral insulin sensitivity was measured with a two-step euglycemic insulin (40 and 160 mU · min−1 · m–2) clamp performed with 3-[3H]glucose and indirect calorimetry. HbA1c was measured monthly throughout the study period.
RESULTS—After 16 weeks of pioglitazone treatment, the fasting plasma glucose (FPG; 184 ± 15 to 135 ± 11 mg/dl, P &lt; 0.01), mean plasma glucose during OGTT (293 ± 12 to 225 ± 14 mg/dl, P &lt; 0.01), and HbA1c (8.9 ± 0.3 to 7.2 ± 0.5%, P &lt; 0.01) decreased significantly without change in fasting or glucose-stimulated insulin/C-peptide concentrations. Fasting plasma free fatty acid (FFA; 647 ± 39 to 478 ± 49 μEq/l, P &lt; 0.01) and mean plasma FFA during OGTT (485 ± 30 to 347 ± 33 μEq/l, P &lt; 0.01) decreased significantly after pioglitazone treatment. Before and after pioglitazone treatment, basal endogenous glucose production (EGP) and FPG were strongly correlated (r = 0.67, P &lt; 0.01). EGP during the first insulin clamp step was significantly decreased after pioglitazone treatment (P &lt; 0.05), whereas insulin-stimulated total and nonoxidative glucose disposal during the second insulin clamp was increased (P &lt; 0.01). The change in FPG was related to the change in basal EGP, EGP during the first insulin clamp step, and total glucose disposal during the second insulin clamp step. The change in mean plasma glucose concentration during the OGTT was strongly related to the change in total body glucose disposal during the second insulin clamp step.
CONCLUSIONS—These results suggest that pioglitazone therapy in type 2 diabetic patients decreases fasting and postprandial plasma glucose levels by improving hepatic and peripheral (muscle) tissue sensitivity to insulin.
Lower-Limb Vascularization in Diabetic Patients
Authors: Cosson Emmanuel , Paycha Frédéric , Tellier Philippe , Sachs Régis Nessim , Ramadan Arabi , Paries Jacques , Attali Jean-Raymond , Valensi Paul 
Published: March 2007

OBJECTIVE—To investigate, by thallium-201 scanning, circulation in the muscles of the lower limb (LL) in diabetic patients without clinical peripheral vascular disease but with a high cardiovascular risk profile.
RESEARCH DESIGN AND METHODS—A total of 80 diabetic patients (76 patients with type 2 diabetes, mean age 57.3 years, duration of diabetes 13.0 ± 7.5 years) with more than one additional cardiovascular risk factor but no claudication were investigated. After stress testing, 1.5 MBq/kg thallium-201 was administered to perform myocardial single-photon emission computed tomography followed by LL scanning. Muscle blood flow was considered abnormal if the asymmetry in thallium-201 uptake between the two buttocks and/or thighs and/or calves was &gt;10%.
RESULTS—Muscle perfusion defects were found in 42% of the patients, mainly in the calves. These defects correlated with retinopathy (P = 0.042) and the HbA1c level (P = 0.044). In patients with defects in the buttock and/or thigh, the prevalence of nephropathy and retinopathy was higher than in those with isolated defects in the calf (P = 0.032 and 0.023, respectively).
CONCLUSIONS—This study suggests that LL scanning coupled with myocardial scintigraphy is a convenient method of investigating peripheral muscle circulation. Proximal perfusion defects in patients without clinical arterial disease are associated with increased prevalence of retinopathy and nephropathy and, therefore, may be due to microvascular disease of LL muscle. Distal defects may indicate silent macrovascular disease of the LL.
Impaired Microvascular Vasodilatory Function in 3-Month-Old Infants of Low Birth Weight
Authors: Goh Kah Lay , Shore Angela C. , Quinn Michael , Tooke John E. 
Published: March 2007

OBJECTIVE—Low birth weight has been linked to an increased risk of type 2 diabetes and cardiovascular disease in adult life. The fetal insulin hypothesis proposed that a genetic predisposition to insulin resistance may also influence vascular development. Therefore, impaired vascular function may be an intrinsic abnormality in low–birth weight infants that antedates clinical features of the insulin resistance syndrome.
RESEARCH DESIGN AND METHODS—Two groups of 3-month-old term infants were included in the study: 17 infants of lowest quartile birth weight (LQBW) and 21 infants of highest quartile birth weight (HQBW). Three aspects of skin microvascular function were examined; response to local heating, response to acetylcholine iontophoresis, and capillary density.
RESULTS—Median (interquartile ranges) birth weights of the LQBW and HQBW infants were 3,140 g (2,738–3,254) and 3,920 g (3,750–4,020), respectively. Skin maximal hyperemic response to local heating was 2.14 V (1.68–2.30) in the LQBW group vs. 2.44 V (1.96–2.90) in the HQBW group (P = 0.020), and the endothelium-dependent vasodilatory response was 1.03 V (0.62–1.32) in the LQBW group vs. 0.78 V (0.45–1.32) in the HQBW group (P = 0.297). Capillary density in the LQBW and HQBW groups were 46.3 mm−2 (40.1–53.7) and 44.1 mm−2 (41.7–56.0), respectively (P = 0.736).
CONCLUSIONS—Skin maximal hyperemic response was lower in LQBW infants, although no reduction in capillary density or defect in endothelium-dependent vasodilatation was observed. Such a lower maximal hyperemic response in early life in LQBW subjects who are at risk for type 2 diabetes and cardiovascular disease supports the hypothesis that impaired microvascular function is an early antecedent to diabetes in later life.
Windows of Opportunity to Improve Diabetes Care When Patients With Diabetes Are Hospitalized for Other Conditions
Authors: Roman Sheila H. , Chassin Mark R. 
Published: March 2007

OBJECTIVE—The overwhelming majority of hospitalizations for patients with diabetes occur for treatment of comorbid conditions. This study assessed broad-based interventions to improve diabetes care for patients hospitalized with cardiac conditions.
RESEARCH DESIGN AND METHODS—A pre-post quasi-experimental study design was used to evaluate the implementation of two quality improvement interventions: 1) revision of the hospital’s capillary blood glucose monitoring form into a color-coded process control chart and 2) a clinical path for type 2 diabetes as a secondary diagnosis. Interventions were implemented on the medical and surgical cardiac care units (not including the intensive care units on these services) of a tertiary academic medical center. A chart abstraction sample included 328 subjects with no exposure to the interventions and 336 subjects hospitalized after both interventions were implemented. Telephone surveys were conducted after discharge on 446 patients.
RESULTS—The frequency of patients with severe hyperglycemia (at least one glucose level &gt;400 mg/dl) and prolonged hyperglycemia (at least three consecutive glucose levels &gt;250 mg/dl) decreased from 12 and 17% preintervention to 6.6 and 10% postintervention (P = 0.017 and P = 0.013, respectively). We found that 9% of the patients preintervention and 5% of the patients postintervention (P = 0.05) had nosocomial infections. Patient-reported receipt of self-care instruction varied from 44 to 69% on nine survey items preintervention. Postintervention linear regression slopes for receipt of self-care instruction were all greater than preintervention slopes, but the differences did not achieve statistical significance. We found that 40% of the patients had important diabetes knowledge deficits.
CONCLUSIONS—Our broad-based interventions were associated with a decreased frequency of prolonged and severe hyperglycemia and a decreased frequency of nosocomial infections. We also identified opportunities to improve diabetes self-care instruction before discharge and to address important knowledge deficits of patients.
The Marital Relationship and Psychosocial Adaptation and Glycemic Control of Individuals With Diabetes
Authors: Trief Paula M. , Himes Christine L. , Orendorff Rebecca , Weinstock Ruth S. 
Published: March 2007

OBJECTIVE—To explore the relationship between marital relationship domains (i.e., intimacy and adjustment) and glycemic control and psychosocial adaptation to diabetes.
RESEARCH DESIGN AND METHODS—A total of 78 insulin-treated adults with both type 1 and type 2 diabetes were assessed on a single occasion. They completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) and four quality-of-life measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey, Problem Areas in Diabetes Scale, and Positive and Negative Affect Scale). Glycemic control was assessed by HbA1c. Demographic data (age, sex, type and duration of diabetes, years married, other medical conditions, family history, disability, and years of education) were gathered from the chart and questionnaires.
RESULTS—Concerning psychosocial adaptation, both of the marital quality measures were predictors of aspects of adaptation. Better marital satisfaction was related to higher levels of diabetes-related satisfaction and less impact, as well as less diabetes-related distress and better general quality of life. Higher levels of marital intimacy were related to better diabetes-specific and general quality of life. Concerning glycemic control, there was a nonsignificant trend for marital adjustment scores to relate to HbA1c (P = 0.0568).
CONCLUSIONS—For insulin-treated adults with diabetes, quality of marriage is associated with adaptation to diabetes and other aspects of health-related quality of life. The suggestive finding that marital adjustment may relate to glycemic control warrants further study. Future work should also explore the impact of couples-focused interventions on adaptation, adherence, and glycemic control.
The Sulfonylurea Glyburide Induces Impairment of Glucagon and Growth Hormone Responses During Mild Insulin-Induced Hypoglycemia
Authors: ter Braak Edith W.M.T. , Appelman Alexander M.M.F. , van der Tweel Ingeborg , Erkelens D. Willem , van Haeften Timon W. 
Published: March 2007

OBJECTIVE—The sulfonylurea (SU) glyburide may cause severe and prolonged episodes of hypoglycemia. We aimed at investigating the impact of glyburide on glucose counterregulatory hormones during stepwise hypoglycemic clamp studies.
RESEARCH DESIGN AND METHODS—We performed stepwise hypoglycemic clamp studies in 16 healthy volunteers (7 women and 9 men aged 44 ± 10 years). We investigated counterregulatory hormonal and symptom responses at arterialized venous plasma glucose levels (PG) of 3.8, 3.2, and 2.6 mmol/l, comparing 10 mg glyburide orally and placebo in a double-blind, randomized crossover fashion.
RESULTS—The increase in plasma glucagon with time from PG = 3.8 onward was smaller for glyburide than for placebo (P = 0.014). Plasma glucagon area under the curve (AUC)60–180 was lower after glyburide than after placebo (1,774 ± 715 vs. 2,161 ± 856 pmol · l–1 · min, P = 0.014). From PG = 3.8 onward, plasma growth hormone (GH) levels with placebo were nearly two times (1.9 [95% CI 1.2–2.9]) as high as with glyburide (P = 0.011). AUC60–180 for GH was lower after glyburide than after placebo (geometric mean [range] 665 [356–1,275] and 1,058 [392–1,818] mU · l–1 · min, respectively; P = 0.04). No significant differences were observed for plasma cortisol, epinephrine and norepinephrine, or incremental symptom scores.
CONCLUSIONS—The SU glyburide induces multiple defects in glucose counterregulatory hormonal responses, notably decreases in both glucagon and GH release.
Endogenous Sex Hormones and the Development of Type 2 Diabetes in Older Men and Women: the Rancho Bernardo Study
Authors: Oh Jee-Young , Barrett-Connor Elizabeth , Wedick Nicole M. , Wingard Deborah L. 
Published: March 2007

OBJECTIVE—To determine the prospective association between endogenous sex hormones and the development of type 2 diabetes in older men and women.
RESEARCH DESIGN AND METHODS—A standardized medical history was obtained, an oral glucose tolerance test was performed, and plasma samples for sex hormones and covariates were collected from ambulatory, community-dwelling men and women at baseline from 1984 to 1987. Approximately 8 years later (1992–1996), another medical history was obtained, an oral glucose tolerance test was performed, fasting and 2-h insulin levels were measured, and the homeostasis model assessment for insulin resistance (HOMA-IR) was evaluated. This report is based on the 294 men and 233 women, aged 55–89 years, who completed both visits and who did not have diabetes as determined by history or glucose tolerance test at baseline, as well as women who were postmenopausal and not taking replacement estrogen.
RESULTS—In age-adjusted correlation analyses, total testosterone was inversely and significantly related to subsequent levels of fasting and postchallenge glucose and insulin in men, whereas bioavailable testosterone and bioavailable estradiol were positively and significantly related to fasting and postchallenge glucose and insulin in women (all P &lt;0.05). There was similar significant association with insulin resistance (HOMA-IR) in unadjusted and multiply adjusted analyses (P &lt;0.05). There were 26 men and 17 women with new (incident) diabetes. The odds for new diabetes were 2.7 (95% CI 1.1–6.6) for men in the lowest quartile of total testosterone and 2.9 (1.1–8.4) for women in the highest quartile of bioavailable testosterone.
CONCLUSIONS—Low testosterone levels in men and high testosterone levels in women predict insulin resistance and incident type 2 diabetes in older adults.
Evaluating Once- and Twice-Daily Self-Monitored Blood Glucose Testing Strategies for Stable Insulin-Treated Patients With Type 2 Diabetes
Authors: Hoffman Richard M. , Shah Jayendra H. , Wendel Christopher S. , Duckworth William C. , Adam Karen D. , Bokhari Syed U. , Dalton Cheri , Murata Glen H. 
Published: March 2007

OBJECTIVE—To evaluate once- and twice-daily self-monitored blood glucose testing strategies in assessing glycemic control and detecting hypoglycemia or hyperglycemia in patients with stable insulin-treated type 2 diabetes.
RESEARCH DESIGN AND METHODS—Subjects with stable insulin-treated type 2 diabetes monitored blood glucose four times daily (prebreakfast, prelunch, predinner, and bedtime) for 8 weeks. We correlated mean blood glucose values with HbA1c measured after 8 weeks and determined the number of hypoglycemic (≤3.33 mmol/l) and hyperglycemic (≥22.20 mmol/l) readings captured at the various testing times.
RESULTS—A total of 150 subjects completed the monitoring period; their average age was 67 years, 90% were men, and the mean HbA1c at baseline was 8.0 ± 1.8%. The overall correlation of glucose testing and HbA1c was 0.79 (P &lt; 0.0001). Mean blood glucose values for each of the four once-daily testing strategies were significantly correlated with HbA1c (r = 0.65–0.70, P &lt; 0.0001), as were mean blood glucose values for each of the six twice-daily testing strategies (r = 0.73–0.75, P &lt; 0.0001). The prebreakfast/prelunch measurements captured the largest proportion (63.6%) of the hypoglycemic readings, the predinner/bedtime measurements captured the largest proportion (66.2%) of hyperglycemic readings, and the prelunch/predinner measurements captured the largest proportion (57.7%) of all out-of-range readings.
CONCLUSIONS—Twice-daily testing strategies, particularly prelunch/predinner, effectively assess glycemic control and capture a substantial proportion of out-of-range readings. However, personal testing strategies will vary depending on an individual’s risk for hypoglycemia and hyperglycemia.
Predicting Future Cardiovascular Disease
Authors: Stern Michael P. , Fatehi Pedram , Williams Ken , Haffner Steven M. 
Published: March 2007

OBJECTIVE—Our objective was to compare the performance of oral glucose tolerance tests (OGTTs) and multivariate models incorporating commonly available clinical variables in their ability to predict future cardiovascular disease (CVD).
RESEARCH DESIGN AND METHODS—We randomly selected 2,662 Mexican-Americans and 1,595 non-Hispanic whites, 25–64 years of age, who were free of both CVD and known diabetes at baseline from several San Antonio census tracts. Medical history, cigarette smoking history, BMI, blood pressure, fasting and 2-h plasma glucose and serum insulin levels, triglyceride level, and fasting serum total, LDL, and HDL cholesterol levels were obtained at baseline. CVD developed in 88 Mexican-Americans and 71 non-Hispanic whites after 7–8 years of follow-up. Stepwise multiple logistic regression models were developed to predict incident CVD. The areas under receiver operator characteristic (ROC) curves were used to assess the predictive power of these models.
RESULTS—The area under the 2-h glucose ROC curve was modestly but not significantly greater than under the fasting glucose curve, but both were relatively weak predictors of CVD. The areas under the ROC curves for the multivariate models incorporating readily available clinical variables other than 2-h glucose were substantially and significantly greater than under the glucose ROC curves. Addition of 2-h glucose to these models did not improve their predicting power.
CONCLUSIONS—Better identification of individuals at high risk for CVD can be achieved with simple predicting models than with OGTTs, and the addition of the latter adds little if anything to the predictive power of the model.