bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Diabetic Retinopathy Screening Ratios Using Telemedicine-Based Digital Retinal Imaging Technology
Authors: Taylor Cathy R. , Merin Lawrence M. , Salunga Amy M. , Hepworth Joseph T. , Crutcher Terri D. , O’Day Denis M. , Pilon Bonita A. 
Published: February 2007

OBJECTIVE—To evaluate the impact of a telemedicine, digital retinal imaging strategy on diabetic retinopathy screening rates in an inner-city primary care clinic.
RESEARCH DESIGN AND METHODS—This retrospective cohort study included all diabetic patients aged ≥18 years (n = 495) seen at Vine Hill Community Clinic between 1 September 2003 and 31 August 2004. Patients were offered ophthalmology referral or digital screening. Patients choosing referral received the next available (within 3 months) appointment at the Vanderbilt Eye Clinic; patients choosing digital screening were screened during the visit.
RESULTS—Retinal screening was documented for 293 (59.2%) patients, a significant improvement compared with the 23% baseline rate. Of 293 patients screened, 92 (31.4%) were screened in ophthalmology, and 201 (68.6%) were digitally screened. Among the 201 digitally screened patients, 104 (51.7%) screened negative and were advised to rescreen in 1 year, 75 (37.3%) screened positive and were nonurgently referred to ophthalmology, and 22 (11.0%) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5%. Referral status was associated with race/ethnicity (χ2 = 7.9, P &lt; 0.02) with whites more likely to screen negative than non-whites (62.4 vs. 47.8%, respectively). Sight-threatening disease among non-whites (14.7%) was more than double that observed for whites (5.9%).
CONCLUSIONS—Digital imaging technology in the primary care visit can significantly improve screening rates over conventional methods, increase access to recommended diabetic eye care, and focus specialty care on medically indigent patients with greatest need.
Prediction of Diabetic Nephropathy Using Urine Proteomic Profiling 10 Years Prior to Development of Nephropathy
Authors: Otu Hasan H. , Can Handan , Spentzos Dimitrios , Nelson Robert G. , Hanson Robert L. , Looker Helen C. , Knowler William C. , Monroy Manuel , Libermann Towia A. , Karumanchi S. Ananth , Thadhani Ravi 
Published: February 2007

OBJECTIVE—We examined whether proteomic technologies identify novel urine proteins associated with subsequent development of diabetic nephropathy in subjects with type 2 diabetes before evidence of microalbuminuria.
RESEACH DESIGN AND METHODS—In a nested case-control study of Pima Indians with type 2 diabetes, baseline (serum creatinine &lt;1.2 mg/dl and urine albumin excretion &lt;30 mg/g) and 10-year urine samples were examined. Case subjects (n = 31) developed diabetic nephropathy (urinary albumin–to–creatinine ratio &gt;300 mg/g) over 10 years. Control subjects (n = 31) were matched to case subjects (1:1) according to diabetes duration, age, sex, and BMI but remained normoalbuminuric (albumin–to–creatinine ratio &lt;30 mg/g) over the same 10 years. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) was performed on baseline urine samples, and training (14 cases:14 controls) and validation (17:17) sets were tested.
RESULTS—At baseline, A1C levels differed between case and control subjects. SELDI-TOF MS detected 714 unique urine protein peaks. Of these, a 12-peak proteomic signature correctly predicted 89% of cases of diabetic nepropathy (93% sensitivity, 86% specificity) in the training set. Applying this same signature to the independent validation set yielded an accuracy rate of 74% (71% sensitivity, 76% specificity). In multivariate analyses, the 12-peak signature was independently associated with subsequent diabetic nephropathy when applied to the validation set (odds ratio [OR] 7.9 [95% CI 1.5–43.5], P = 0.017) and the entire dataset (14.5 [3.7–55.6], P = 0.001), and A1C levels were no longer significant.
CONCLUSIONS—Urine proteomic profiling identifies normoalbuminuric subjects with type 2 diabetes who subsequently develop diabetic nephropathy. Further studies are needed to characterize the specific proteins involved in this early prediction.
An Off-the-Shelf Instant Contact Casting Device for the Management of Diabetic Foot Ulcers
Authors: Piaggesi Alberto , Macchiarini Silvia , Rizzo Loredana , Palumbo Francesca , Tedeschi Anna , Nobili Laura Ambrosini , Leporati Elisa , Scire Vincenzo , Teobaldi Ilaria , Del Prato Stefano 
Published: February 2007

OBJECTIVE—This study was designed to test the safety, effectiveness, and costs of off-loading with a novel, off-the-shelf irremovable device in the management of diabetic foot ulceration (DFU).
RESEARCH DESIGN AND METHODS—We prospectively evaluated off-loading of neuropathic plantar ulcers in 40 diabetic outpatients attending our diabetic foot clinic and compared healing rates at the 12-week follow-up, number and severity of adverse events, healing time, costs and applicability of the device, and patients’ satisfaction between those randomly assigned to total contact casting (TCC; group A) or to the Optima Diab walker (group B). Deep or infected ulcers were excluded.
RESULTS—No difference between groups A and B was observed in healing rates at 12 weeks (95 vs. 85%), healing time (6.5 ± 4.4 vs. 6.7 ± 3.4 weeks), and number of adverse events (six versus four). Treatment was significantly less expensive in group B, which showed a mean reduction of costs of 78% compared with group A (P &lt; 0.001). Practicability was more favorable in group B, with a reduction of 77 and 58% of the time required for application and removal of the devices, respectively (P &lt; 0.001). Patients’ satisfaction with the treatment was higher in group B (P &lt; 0.01).
CONCLUSIONS—The Optima Diab walker is as safe and effective as TCC in the management of DFU, but its lower costs and better applicability may be of help in spreading the practice of off-loading among the centers that manage the diabetic foot.
Insulin Secretion and Insulin Sensitivity in Relation to Fasting Glucose in Healthy Subjects
Authors: Ahrén Bo 
Published: February 2007

OBJECTIVE—This study evaluated insulin secretion and insulin sensitivity in healthy subjects with normal fasting glucose.
RESEARCH DESIGN AND METHODS—A total of 148 healthy women (aged 53–70 years) underwent a glucose-dependent arginine stimulation test and a 2-h euglycemic-hyperinsulinemic clamp. In the arginine test, arginine (5 g) was injected intravenously under baseline (fasting) conditions and after raising the glucose levels to 15 and &gt;28 mmol/l. From this test, the acute insulin response (AIR) to arginine during the three glucose levels (AIR1, AIR2, and AIR3) were estimated. The subjects were divided into quartiles of fasting glucose (n = 37 in each group [range &lt;4.32; 4.33–4.84; 4.85–5.22; and 5.23–6.1 mmol/l, respectively).
RESULTS—The results show that 1) AIR1 was higher in subjects in the two highest quartiles (P = 0.004), 2) AIR3 was higher in the quartile with the highest fasting glucose (P = 0.012), and 3) insulin sensitivity was reduced in subjects in the highest quartile (P = 0.026) compared with the lower quartiles. The results also show, in contrast, that AIR2 did not show a similar trend to be increased at higher fasting glucose.
CONCLUSIONS—It is concluded that 1) raised fasting glucose (albeit still within normal values) augments baseline and maximal arginine-induced insulin secretion in healthy subjects, and 2) this is associated with reduced insulin sensitivity. This suggests that high, but still normal, fasting glucose may contribute to the augmented insulin secretion in subjects with low insulin sensitivity.
Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-Phase Treatment of Major Depressive Disorder With Bupropion
Authors: Lustman Patrick J. , Williams Monique M. , Sayuk Gregory S. , Nix Billy D. , Clouse Ray E. 
Published: February 2007

OBJECTIVE—Depression management in both short- and longer-term treatment studies has been associated with improvement in glycemic control. We used bupropion hydrochloride (Wellbutrin XL) to determine whether this improvement could be attributed to changes in anthropometrics or diabetes self-care.
RESEARCH DESIGN AND METHODS—Ninety-three patients with type 2 diabetes and major depressive disorder (MDD) received bupropion hydrochloride in a two-phase, open-label treatment trial. Those who completed the acute phase (10 weeks; n = 75) and whose depression remitted (n = 63) continued bupropion at the remission dose and were followed in the maintenance phase (24 weeks) until attrition (n = 8) or relapse of MDD (n = 0). Self-report scales were used to measure depression symptom severity and diabetes self-care behaviors. Body composition and glycemic control were determined using dual-energy X-ray absorptiometry and serial determinations of A1C.
RESULTS—BMI, total fat mass, and A1C decreased and composite diabetes self-care improved over the acute phase (−0.5 kg/m2, −0.7 kg, −0.5%, and +0.4, respectively, P &lt; 0.01 for each), effects that persisted through the maintenance phase for BMI, A1C, and self-care (P ≤ 0.01 for each). Reductions in BMI (B = 0.30, P = 0.01) and depression severity (B = 0.04, P = 0.046) independently predicted lower A1C after acute-phase treatment, whereas only reduction in depression severity (B = 0.08, P = 0.001) predicted A1C over the maintenance interval.
CONCLUSIONS—In the short term, improvement in glycemic control during bupropion treatment is predicted independently by improvements in mood and body composition. Longer-term improvements in glycemic control are predicted primarily by sustained improvement in mood via mechanisms independent of anthropometric and self-care modifications.
Pesticide Exposure and Self-Reported Gestational Diabetes Mellitus in the Agricultural Health Study
Authors: Saldana Tina M. , Basso Olga , Hoppin Jane A. , Baird Donna D. , Knott Charles , Blair Aaron , Alavanja Michael C.R. , Sandler Dale P. 
Published: February 2007

OBJECTIVE—To examine the association between pesticide use during pregnancy and gestational diabetes mellitus (GDM) among wives of licensed pesticide applicators.
RESEARCH DESIGN AND METHODS—Using data from the Agricultural Health Study (AHS), we estimated the association between self-reported pesticide-related activities during the first trimester of the most recent pregnancy and GDM among 11,273 women whose pregnancy occurred within 25 years of enrollment.
RESULTS—A total of 506 (4.5%) women reported having had GDM. Women who reported agricultural pesticide exposure (mixing or applying pesticides to crops or repairing pesticide application equipment) during pregnancy were more likely to report GDM (odds ratio [OR] 2.2 [95% CI 1.5–3.3]). We saw no association between residential pesticide exposure (applying pesticides in the home and garden during pregnancy) and GDM (1.0 [0.8–1.3]). Among women who reported agricultural exposure during pregnancy, risk of GDM was associated with ever-use of four herbicides (2,4,5-T; 2,4,5-TP; atrazine; or butylate) and three insecticides (diazinon, phorate, or carbofuran).
CONCLUSIONS—These findings suggest that activities involving exposure to agricultural pesticides during the first trimester of pregnancy may increase the risk of GDM.
Television Viewing Is Associated With Prevalence of Metabolic Syndrome in Hispanic Elders
Authors: Gao Xiang , Nelson Miriam E. , Tucker Katherine L. 
Published: February 2007

OBJECTIVE—We examined associations between television viewing and prevalence of the metabolic syndrome among a representative sample of Caribbean-origin Hispanic elders living in Massachusetts.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional analysis of 350 Puerto Rican and 105 Dominican elders (≥60 years). Information on television viewing hours was collected by a questionnaire. The metabolic syndrome was defined by using the definition from the National Cholesterol Education Program.
RESULTS—Prevalences for the metabolic syndrome were 50.1 and 56.9% among Puerto Ricans and Dominicans, respectively. Of the subjects, 82.6% had high blood pressure and 61.4% had high fasting glucose. Prevalence of the syndrome was significantly associated with television viewing. Each additional hour of television viewing was associated with a 19% greater likelihood of having the metabolic syndrome (odds ratio [OR] 1.19, 95% CI 1.1–1.3, P for trend 0.002), after adjusting for age, sex, ethnicity, BMI, education, alcohol use, smoking, household arrangement, physical activity, intake of energy and fat, and activities-of-daily-living score. We did not observe significant interactions of television viewing with sex, smoking status, alcohol use, or BMI (P for interaction &gt;0.15 for all) in relation to presence of the metabolic syndrome.
CONCLUSIONS—A high prevalence of the metabolic syndrome in a representative sample of Caribbean-origin Hispanic elders was associated with prolonged television viewing, independent of physical activity and energy intake. Longitudinal studies are needed to clarify the causality of this relationship.
Increasing Incidence of Type 1 Diabetes in 0- to 17-Year-Old Colorado Youth
Authors: Vehik Kendra , Hamman Richard F. , Lezotte Dennis , Norris Jill M. , Klingensmith Georgeanna , Bloch Clifford , Rewers Marian , Dabelea Dana 
Published: February 2007

OBJECTIVE—We sought to assess the long-term trends in the incidence of type 1 diabetes among non-Hispanic white and Hispanic youth aged 0–17 years from Colorado using data from the Colorado IDDM Study Registry (1978–1988) and SEARCH for Diabetes in Youth (2002–2004).
RESEARCH DESIGN AND METHODS—Cases of diabetes were ascertained through physician reporting and hospital databases. Type 1 diabetes was defined as use of insulin within 2 weeks from diagnosis. Completeness of ascertainment was estimated as 97%. Annual average incidence rates (per 100,000/year) and 95% CIs for the time periods were computed. Trends in incidence were assessed by Poisson regression.
RESULTS—The incidence of type 1 diabetes was 14.8 (95% CI 14.0–15.6) in 1978–1988 and 23.9 (22.2–25.6) in 2002–2004 for the state of Colorado (P &lt; 0.0001). From 1978 to 2004, the incidence of type 1 diabetes increased by 2.3% (1.6–3.1) per year (P &lt; 0.0001). The increase in incidence was significant for both non-Hispanic white (2.7% [95% CI 1.9–3.6] per year, P &lt; 0.0001) and Hispanic youth (1.6% [0.2–3.1] per year, P = 0.013).
CONCLUSIONS—The incidence of type 1 diabetes has increased 1.6-fold among Colorado youth from 1978–1988 to 2002–2004, and both non-Hispanic white and Hispanic youth are affected by this trend.
Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes
Authors: Jeon Christie Y. , Lokken R. Peter , Hu Frank B. , van Dam Rob M. 
Published: February 2007

OBJECTIVE—To systematically evaluate the evidence for an association between physical activity of moderate intensity and risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We searched EMBASE and Medline through March 2006 and examined reference lists of retrieved articles. We excluded studies that did not assess physical activity of moderate intensity independent of activities of vigorous intensity (more than six times the resting metabolic rate). Information on study design, participant characteristics, assessment of physical activity, and outcomes and estimates of associations were extracted independently by two investigators. We calculated summary relative risks (RRs) using a random-effects model for the highest versus the lowest reported duration of activities.
RESULTS—We identified 10 prospective cohort studies of physical activity of moderate intensity and type 2 diabetes, including a total of 301,221 participants and 9,367 incident cases. Five of these studies specifically investigated the role of walking. The summary RR of type 2 diabetes was 0.69 (95% CI 0.58–0.83) for regular participation in physical activity of moderate intensity as compared with being sedentary. Similarly, the RR was 0.70 (0.58–0.84) for regular walking (typically ≥2.5 h/week brisk walking) as compared with almost no walking. The associations remained significant after adjustment for BMI. Similar associations were observed in men and women and in the U.S. and Europe.
CONCLUSIONS—These findings indicate that adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes.
Insulin Resistance, the Metabolic Syndrome, and Complication Risk in Type 1 Diabetes
Authors: Kilpatrick Eric S. , Rigby Alan S. , Atkin Stephen L. 
Published: February 2007

OBJECTIVE—The presence of insulin resistance and the metabolic syndrome are known risk markers for macrovascular disease in patients with and without type 2 diabetes. This study has examined whether these also were predictors of micro- and macrovascular complications in type 1 diabetic patients participating in the Diabetes Control and Complications Trial (DCCT).RESEARCH DESIGN AND METHODS—International Diabetes Federation (IDF) criteria were used to identify the metabolic syndrome in 1,337 Caucasian DCCT patients at baseline. Insulin resistance was calculated using their estimated glucose disposal rate (eGDR). Insulin dose (units/kg) was also used as a separate marker of insulin resistance.RESULTS—The eGDR (but not insulin dose or metabolic syndrome) at baseline strongly predicted the development of retinopathy, nephropathy, and cardiovascular disease (hazard ratios 0.75, 0.88, and 0.70, respectively, per mg · kg−1 · min−1 change; P &lt; 0.001, P = 0.005, and P = 0.002, respectively). Through mainly weight gain, the prevalence of the metabolic syndrome increased steadily from baseline to year 9 in conventionally treated (from 15.5 to 27.2%) and especially in the intensively treated (from 13.7 to 45.4%) patients.CONCLUSIONS—Higher insulin resistance at baseline in the DCCT (as estimated by eGDR) was associated with increased subsequent risk of both micro- and macrovascular complications. Insulin dose and the presence of IDF-defined metabolic syndrome were poor predictors by comparison. Although intensive treatment was associated with a higher subsequent prevalence of metabolic syndrome, the benefits of improved glycemia appear to outweigh the risks related to development of the metabolic syndrome.
Simultaneous Control of Hyperglycemia and Oxidative Stress Normalizes Endothelial Function in Type 1 Diabetes
Authors: Ceriello Antonio , Kumar Sudhesh , Piconi Ludovica , Esposito Katerine , Giugliano Dario 
Published: February 2007

OBJECTIVE—Previous studies have shown that in type 1 diabetes endothelial dysfunction persists even when glycemia is normalized. Moreover, oxidative stress has recently been demonstrated to be the mediator of hyperglycemia-induced endothelial dysfunction.
RESEARCH DESIGN AND METHODS—Thirty-six type 1 diabetic patients and 12 control subjects were enrolled. The diabetic patients were divided into three groups. The first group was treated for 24 h with insulin, achieving a near-normalization of glycemia. After 12 h of this treatment, vitamin C was added for the remaining 12 h. The second group was treated for 24 h with vitamin C. After 12 h of this treatment, insulin was started, with achievement of near-normalization of glycemia for the remaining 12 h. The third group was treated for 24 h with both vitamin C and insulin, achieving near-normalization of glycemia.
RESULTS—Neither normalization of glycemia nor vitamin C treatment alone was able to normalize endothelial dysfunction or oxidative stress. However, a combination of insulin and vitamin C normalized endothelial dysfunction and decreased oxidative stress to normal levels.
CONCLUSIONS—This study suggests that long-lasting hyperglycemia in type 1 diabetic patients induces permanent alterations in endothelial cells, which may contribute to endothelial dysfunction by increased oxidative stress even when hyperglycemia is normalized.
Proteomic Identification of Urinary Biomarkers of Diabetic Nephropathy
Authors: Rao Paturi V. , Lu Xinfang , Standley Melissa , Pattee Patrick , Neelima Gundupalle , Girisesh Gudige , Dakshinamurthy K.V. , Roberts Charles T. , Nagalla Srinivasa R. 
Published: February 2007

OBJECTIVE—Diabetic nephropathy is a serious complication of both type 1 and type 2 diabetes, and, unless arrested, leads to end-stage renal disease. Current diagnosis consists of urine assays of microalbuminuria, which have inadequate specificity and sensitivity.
RESEARCH DESIGN AND METHODS—We used proteomic analyses to identify novel biomarkers of nephropathy in urine from type 2 diabetic patients with demonstrated normo-, micro-, or macroalbuminuria. Samples were analyzed by fluorescence two-dimensional (2-D) differential in-gel electrophoresis (DIGE), and protein identification was performed by liquid chromatography-tandem mass spectrometry.
RESULTS—2-D DIGE analysis of the urinary proteome in diabetes with nephropathy identified 195 protein spots representing 62 unique proteins. These proteins belonged to several functional groups, i.e., cell development, cell organization, defense response, metabolism, and signal transduction. Comparisons between control and diabetic subjects with different stages of renal dysfunction revealed the differential expression of several proteins. Spot volume quantification identified 7 proteins that were progressively upregulated with increasing albuminuria and 4 proteins that exhibited progressive downregulation. The majority of these potential candidate biomarkers were glycoproteins.
CONCLUSIONS—These data demonstrate the ability of proteomic analyses to reveal potential biomarkers for diabetic nephropathy in urine, an important step forward in advancing accurate diagnosis and our understanding of disease mechanisms.
An Accurate Risk Score Based on Anthropometric, Dietary, and Lifestyle Factors to Predict the Development of Type 2 Diabetes
Authors: Schulze Matthias B. , Hoffmann Kurt , Boeing Heiner , Linseisen Jakob , Rohrmann Sabine , Möhlig Matthias , Pfeiffer Andreas F.H. , Spranger Joachim , Thamer Claus , Häring Hans-Ulrich , Fritsche Andreas , Joost Hans-Georg 
Published: February 2007

OBJECTIVE—We aimed to develop a precise risk score for the screening of large populations for individuals at high risk of developing type 2 diabetes based on noninvasive measurements of major risk factors in German study populations.
RESEARCH DESIGN AND METHODS—A prospective cohort study (European Prospective Investigation into Cancer and Nutrition [EPIC]-Potsdam study) of 9,729 men and 15,438 women aged 35–65 years was used to derive a risk score predicting incident type 2 diabetes. Multivariate Cox regression model coefficients were used to weigh each variable in the calculation of the score. Data from the EPIC-Heidelberg, the Tübingen Family Study for Type 2 Diabetes (TÜF), and the Metabolic Syndrome Berlin Potsdam (MeSyBePo) study were used to validate this score.
RESULTS—Information on age, waist circumference, height, history of hypertension, physical activity, smoking, and consumption of red meat, whole-grain bread, coffee, and alcohol formed the German Diabetes Risk Score (mean 446 points [range 118–983]). The probability of developing diabetes within 5 years in the EPIC-Potsdam study increased from 0.3% for 300 to 23.2% for 750 score points. The area under the receiver-operator characteristic (ROC) curve was 0.84 in the EPIC-Potsdam and 0.82 in the EPIC-Heidelberg studies. Correlation coefficients between the German Diabetes Risk Score and insulin sensitivity in nondiabetic individuals were −0.56 in the TÜF and −0.45 in the MeSyBePo studies. ROC values for undiagnosed diabetes were 0.83 in the TÜF and 0.75 in the MeSyBePo studies.
CONCLUSIONS—The German Diabetes Risk Score (available at www.dife.de) is an accurate tool to identify individuals at high risk for or with undiagnosed type 2 diabetes.