bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progression to Overt Nephropathy in Type 2 Diabetes
Authors: Bruno Graziella , Merletti Franco , Biggeri Annibale , Bargero Giuseppe , Ferrero Stefania , Pagano Gianfranco , Perin Paolo Cavallo 
Published: March 2007

OBJECTIVE—The first sign of diabetic nephropathy is microalbuminuria, but its predictive role of progression to overt nephropathy in type 2 diabetes has not yet been clarified. The aims of this study were to assess during 7 years of follow-up the incidence rate of overt nephropathy and the predictive role of microalbuminuria and other baseline variables (blood pressure, lipids, fibrinogen, uric acid, smoking, and HbA1c cumulative average during follow-up).
RESEARCH DESIGN AND METHODS—A prospective population-based study was performed in Casale Monferrato, Italy, including 1,253 type 2 diabetic patients recruited at baseline (1991–1992), 765 with normoalbuminuria (albumin excretion rate [AER] &lt;20 μg/min) and 488 with microalbuminuria (AER 20–200 μg/min). All measurements were centralized. A nested case-control study within the cohort was performed, selecting four control subjects, frequency matched for age and attained individual time of follow-up with each case. Conditional regression analysis was performed to assess variables independently associated with risk of progression to overt nephropathy.
RESULTS—Of 1,253 total patients, 1,103 (88.0%) were included in the follow-up examination (median 5.33 years); their age and duration of disease at baseline were 68.4 ± 10.5 years and 10.4 ± 6.6 years, respectively. Cases of overt nephropathy were 202, giving an incidence rate of 37.0/1,000 person-years (95% CI 32.3–42.6). In conditional logistic regression analyses, microalbuminuria provided a 42% increased risk with respect to normoalbuminuria (95% CI 0.98–2.06), independently of duration of diabetes, hypertension, and systolic blood pressure. Other variables independently associated with progression to overt nephropathy were HbA1c cumulative average (P = 0.002), apolipoprotein B (P = 0.013), fibrinogen (P = 0.02), and HDL cholesterol (P = 0.03).
CONCLUSIONS—Of type 2 diabetic patients, 3.7% progress every year to overt nephropathy. Microalbuminuria is associated with a 42% increased risk of progression to overt nephropathy. Other independent predictors are HbA1c, HDL cholesterol, apolipoprotein B, and fibrinogen.
Biologic and Quality-of-Life Outcomes From the Mediterranean Lifestyle Program
Authors: Toobert Deborah J. , Glasgow Russell E. , Strycker Lisa A. , Barrera Manuel , Radcliffe Janice L. , Wander Rosemary C. , Bagdade John D. 
Published: March 2007

OBJECTIVE—Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low–saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA1c, lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed.
RESULTS—Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA1c, BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance.
CONCLUSIONS—These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.
Out-of-Pocket Costs and Diabetes Preventive Services
Authors: Karter Andrew J. , Stevens Mark R. , Herman William H. , Ettner Susan , Marrero David G. , Safford Monika M. , Engelgau Michael M. , Curb J. David , Brown Arleen F. ,   The TRIAD Study Group
Published: March 2007

OBJECTIVE—Despite the increased shifting of health care costs to consumers, little is known about the impact of financial barriers on health care utilization. This study investigated the effect of out-of-pocket expenditures on the utilization of recommended diabetes preventive services.
RESEARCH DESIGN AND METHODS—This was a survey-based observational study (2000–2001) in 10 managed care health plans and 68 provider groups across the U.S. serving ∼180,000 patients with diabetes. From 11,922 diabetic survey respondents, we studied the occurrence of self-reported annual dilated eye exams and diabetes health education and among insulin users, daily self-monitoring of blood glucose (SMBG). Conditional probabilities were estimated for outcomes at each level of self-reported out-of-pocket expenditure by using hierarchical logistic regression models with random intercepts.
RESULTS—Conditional probabilities of utilization (95% CI) varied by expenditure for dilated eye exam [no cost 78% (75–82), copay 79% (75–82), and full price 70% (64–75); P &lt; 0.0001]; diabetes health education [no cost 29% (23–36), copay 29% (23–36), and full price 19% (14–25); P &lt; 0.0001]; and daily SMBG [no cost 75% (68–81), copay 68% (60–75), and full price 59% (49–68); P &lt; 0.0001]. Extensive adjustment for patient factors had no discernible effect on the estimates or their significance, and cost-utilization relationships were similar across income levels and other patient characteristics.
CONCLUSIONS—Benefit packages structured to derive greater fiscal contribution from the health plan membership result in suboptimal use of diabetes preventive services and may thus lead to poorer clinical outcomes, greater future costs, and lower health plan quality ratings.
A Comparison of Postprandial and Preprandial Administration of Insulin Aspart in Children and Adolescents With Type 1 Diabetes
Authors: Danne Thomas , Aman Jan , Schober Edith , Deiss Dorothee , Jacobsen Judith L. , Friberg Hans Henrik , Jensen Lars Hein ,   the ANA 1200 Study Group
Published: March 2007

OBJECTIVE—The aim of this study was to compare the glycemic control of preprandial versus postprandial injections of the new rapid-acting insulin analogue aspart in children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Forty-two children (aged 6–12 years) and 34 adolescents (13–17 years) were randomized to preprandial (immediately before meal start) and postprandial (immediately after a meal or a maximum of 30 min after meal start) treatment with insulin aspart (at least thrice daily) as part of a basal/bolus regimen in a multicenter study with an open labeled, two-period cross-over design (6-week periods). Of this group, 49% were boys, 55% were aged ≤13 years, and duration of diabetes was 4.4 years (range 1.0–9.4).
RESULTS—Glycemic control for postprandial treatment was not worse than preprandial treatment as assessed by fructosamine week 0 vs. 6 (mean ± SD, preprandial 367 ± 74 vs. 378 ± 90 μmol/l; postprandial 383 ± 83 vs. 385 ± 77 μmol/l) and HbA1c (preprandial 7.9 ± 1.3 vs. 8.0 ± 1.5%; postprandial 8.0 ± 1.4 vs. 8.3 ± 1.5%, P = 0.14). The only statistically significant finding from the seven-point blood glucose profiles and derived parameters between preprandial and postprandial treatment was a lower postprandial glucose level 120 min after breakfast (mean ± SEM, −2.08 ± 0.74 mmol/l, P = 0.016). The relative risk of hypoglycemia (blood glucose &lt;3.9 mmol/l) preprandially to postprandially was not significantly different (mean 1.1; 95% CI 0.91–1.35; P = 0.31). Overall treatment satisfaction was equally high for both regimens with both patients and parents.
CONCLUSIONS—Although preprandial administration of insulin aspart is generally preferable, this study shows that in children and adolescents, postprandial administration of insulin aspart is a safe and effective alternative.
Antiatherogenic Effect of Pioglitazone in Type 2 Diabetic Patients Irrespective of the Responsiveness to Its Antidiabetic Effect
Authors: Satoh Noriko , Ogawa Yoshihiro , Usui Takeshi , Tagami Tetsuya , Kono Shigeo , Uesugi Hiroko , Sugiyama Hiroyuki , Sugawara Akira , Yamada Kazunori , Shimatsu Akira , Kuzuya Hideshi , Nakao Kazuwa 
Published: March 2007

OBJECTIVE—Thiazolidinediones (TZDs), a class of insulin-sensitizing agents used clinically to treat type 2 diabetes, are also antiatherogenic. This study was designed to elucidate the relationship between the antiatherogenic and antidiabetic effects of pioglitazone, a TZD, in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—A total of 136 Japanese type 2 diabetic patients were included and divided into two groups: the pioglitazone-treated group (30 mg daily for 3 months) (n = 70) and the untreated control group (n = 66). The changes in glycolipid metabolism as well as plasma high-sensitivity C-reactive protein (CRP), leptin, adiponectin, and pulse wave velocity (PWV) were monitored to analyze the relationship between the antiatherogenic and antidiabetic effects of pioglitazone.
RESULTS—The pioglitazone treatment significantly reduced hyperglycemia, hyperinsulinemia, and HbA1c levels and increased plasma adiponectin concentrations relative to the control group (P &lt; 0.01). It also significantly decreased CRP and PWV (P &lt; 0.01). The antiatherogenic effect was observed in both the nonresponders showing &lt;1% of reduction in HbA1c (n = 30) and responders showing &gt;1% of reduction (n = 40). ANCOVA revealed that treatment with pioglitazone was associated with a low CRP and PWV, independent of the changes in parameters related to glucose metabolism.
CONCLUSIONS—This study represents the first demonstration of the antiatherogenic effect of pioglitazone in both nonresponders and responders with respect to its antidiabetic effect and suggests that pioglitazone can exert its antiatherogenic effect independently of its antidiabetic effect.
Weight, Adiposity, and Physical Activity as Determinants of an Insulin Sensitivity Index in Pima Indian Children
Authors: Bunt Joy C. , Salbe Arline D. , Harper Inge T. , Hanson Robert L. , Tataranni P. Antonio 
Published: March 2007

OBJECTIVE—To determine whether measures of physical activity are related to an insulin sensitivity index ([ISI] 104/fasting insulin × glucose) independent of weight or adiposity in children.
RESEARCH DESIGN AND METHODS—We conducted a longitudinal study of 90 Pima Indian children (39 boys and 51 girls) at 5 and 10 years of age measuring adiposity (dual-energy X-ray absorptiometry), physical activity behavior (questionnaire: number of activities per week [ACT], average hours per week [TIME]), and energy expenditure (doubly labeled water: physical activity level [PAL]).
RESULTS—In cross-sectional analyses, ACT was correlated with ISI at 5 years of age (r = 0.24, P = 0.02) and at 10 years of age (r = 0.21, P = 0.05), but these relationships were not independent of weight or adiposity. PAL was correlated with ISI at 10 years of age (r = 0.39, P = 0.03) but was not independent of weight or adiposity. Longitudinally, ISI decreased from 5 to 10 years of age, and increases in weight and adiposity were associated with decreases in ISI (r = −0.51 and −0.41, respectively; both P &lt; 0.0001). ACT decreased from 5 to 10 years of age, but children who had smaller decreases in ACT had smaller decreases in ISI, independent of increases in weight or adiposity (partial r = 0.22, P = 0.04 adjusted for either weight or adiposity).
CONCLUSIONS—These data suggest that early establishment and maintenance of an active lifestyle can have a beneficial effect on ISI that is partially independent of changes in weight or adiposity. This is particularly relevant considering the current epidemics of both obesity and type 2 diabetes in children.
Do Measures of Body Fat Distribution Provide Information on the Risk of Type 2 Diabetes in Addition to Measures of General Obesity?
Authors: Tulloch-Reid Marshall K. , Williams Desmond E. , Looker Helen C. , Hanson Robert L. , Knowler William C. 
Published: March 2007

OBJECTIVE—To investigate which anthropometric measurements of obesity best predict type 2 diabetes in a population of Pima Indians and whether additional information on diabetes risk could be obtained by combining measures of general obesity with measures of body fat distribution.
RESEARCH DESIGN AND METHODS—We conducted a prospective study of 624 men and 990 nonpregnant women &gt;18 years of age without diabetes. Subjects were followed a mean of 5.25 years for the development of type 2 diabetes (using 1997 American Diabetes Association criteria).
RESULTS—A total of 322 new cases of type 2 diabetes (107 men and 215 women) were diagnosed during follow-up. Baseline obesity measurements were highly correlated and predicted diabetes in proportional hazards models adjusted for age. BMI had the highest hazard ratio in men and women, with age-adjusted hazard ratios per SD of 1.73 (95% CI 1.44–2.07) and 1.67 (1.45–1.91), respectively. According to receiver-operating characteristic analysis, BMI and waist-to-height ratio were the best predictors of diabetes in men, while in women BMI, waist-to-height ratio, waist circumference, and waist-to-thigh ratio were the best predictors. The predictive abilities of models containing BMI were not significantly improved by including other measures of general obesity or measures of the body fat distribution.
CONCLUSIONS—Throughout its range, BMI was an excellent predictor of type 2 diabetes risk in Pima Indians and was not significantly improved by combining it with other measures of general adiposity or body fat distribution.
A Meta-Analysis of the Association Between Childhood Type 1 Diabetes and Atopic Disease
Authors: Cardwell Chris R. , Shields Mike D. , Carson Dennis J. , Patterson Chris C. 
Published: March 2007

OBJECTIVE—To review the published literature and perform a meta-analysis summarizing the evidence in support of an inverse association between type 1 diabetes and the atopic disorders: asthma, eczema, and allergic rhinitis in children.
RESEARCH DESIGN AND METHODS—MEDLINE, Web of Science, and PubMed were searched to identify relevant studies. These were assessed on quality criteria, and odds ratios (ORs) and 95% CIs were calculated for each study from the reported prevalences of atopy in children with diabetes and in control children. Meta-analysis was then used to derive a combined OR and test for heterogeneity in findings between studies.
RESULTS—Twenty-five studies were identified. Heterogeneity in the findings from different studies was evident but was considerably reduced when the asthma and rhinitis analyses were restricted to those studies judged to be of adequate design. The meta-analysis revealed an inverse association between asthma and type 1 diabetes, but the finding only attained significance when analysis was restricted to the studies of adequate design (OR 0.82, 95% CI 0.68–0.99). In this subset an association of similar magnitude was observed between eczema and type 1 diabetes (0.82, 0.62–1.10) although this failed to attain statistical significance, and heterogeneity between studies was still present. There was little evidence of an association between rhinitis and type 1 diabetes (0.97, 0.82–1.16) in this subset of studies.
CONCLUSIONS—Our analysis suggests that there is a small but significant reduction in the prevalence of asthma in children with type 1 diabetes, but the findings for the other atopic diseases are less conclusive.
Pioglitazone Reduces Atherogenic Dense LDL Particles in Nondiabetic Patients With Arterial Hypertension
Authors: Winkler Karl , Konrad Thomas , Füllert Stefanie , Friedrich Isolde , Destani Ramadan , Baumstark Manfred W. , Krebs Kristin , Wieland Heinrich , März Winfried 
Published: March 2007

OBJECTIVE—The oral antidiabetic agent pioglitazone improves insulin sensitivity and glycemic control and appears to lower atherogenic dense LDL in type 2 diabetes. Insulin resistance may occur frequently in nondiabetic patients with hypertension. This study is the first to report the effect of pioglitazone on LDL subfractions in normolipidemic, nondiabetic patients with arterial hypertension.
RESEARCH DESIGN AND METHODS—We performed a monocentric, double-blind, randomized, parallel-group comparison of 45 mg pioglitazone (n = 26) and a placebo (n = 28), each given once daily for 16 weeks. Fifty-four moderately hypertensive patients (LDL cholesterol, 2.8 ± 0.8 mmol/l; HDL cholesterol, 1.1 ± 0.3 mmol/l; triglycerides, 1.4 mmol/l (median; range 0.5–7.1) were studied at baseline and on treatment.
RESULTS—At baseline, dense LDLs were elevated (apolipoprotein [apo]B in LDL-5 plus LDL-6 &gt;250 mg/l) in 63% of all patients. Sixteen weeks of treatment with pioglitazone did not significantly change triglycerides, total, LDL, and HDL cholesterol. However, pioglitazone reduced dense LDLs by 22% (P = 0.024). The mean diameter of LDL particles increased from 19.83 ± 0.30 to 20.13 ± 0.33 nm (P &lt; 0.001 vs. placebo), whereas the mean LDL density decreased from 1.0384 ± 0.0024 to 1.0371 ± 0.0024 kg/l (P = 0.005 vs. placebo). The effect of pioglitazone on LDL size and density was independent of fasting triglycerides and HDL cholesterol at baseline and of changes in fasting triglycerides and HDL cholesterol.
CONCLUSIONS—The prevalence of atherogenic dense LDL in nondiabetic, hypertensive patients is similar to patients with type 2 diabetes. Pioglitazone significantly reduces dense LDL independent from fasting triglycerides and HDL cholesterol. The antiatherogenic potential of pioglitazone may thus be greater than that expected from its effects on triglycerides, LDL, and HDL cholesterol alone.
Activity Patterns of Patients With Diabetic Foot Ulceration
Authors: Armstrong David G. , Lavery Lawrence A. , Kimbriel Heather R. , Nixon Brent P. , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE—To evaluate the activity of patients with diabetic foot ulcerations and their adherence to their pressure off-loading device.
RESEARCH DESIGN AND METHODS—We enrolled 20 subjects treated for neuropathic diabetic foot wounds corresponding to University of Texas grade 1 stage A. All were off-loaded using a removable cast walker (RCW). We recorded the total activity (measured in activity steps per day) taken on a waist-worn computerized accelerometer. We subsequently correlated this to activity recorded on an RCW-mounted accelerometer, which was not readily accessible to the patient.
RESULTS—There were a mean 1,219.1 ± 821.2 activity units (steps) taken per patient per day. Patients logged significantly more daily activity units with the protective RCW off than with it on (873.7 ± 828.0 vs. 345.3 ± 219.1, P = 0.01). This amounts to only 28% of total daily activity recorded while patients were wearing their RCW. Although a total of 30% of the patients in the study recorded more daily activity units while wearing the device, this subset most adherent to their off-loading regimen still only wore the device for a total of 60% of their total daily activity.
CONCLUSIONS—Subjects with diabetic foot ulcerations appear to wear their off-loading devices for only a minority of steps taken each day. This may partially explain the poor results reported from many trials of agents designed to help speed the healing of these wounds. Control of this important aspect of care with less easily removable devices may increase the prevalence of healing.
The Performance of a Risk Score as a Screening Test for Undiagnosed Hyperglycemia in Ethnic Minority Groups
Authors: Spijkerman Annemieke M.W. , Yuyun Matthew F. , Griffin Simon J. , Dekker Jacqueline M. , Nijpels Giel , Wareham Nicholas J. 
Published: March 2007

OBJECTIVE—To assess the performance of the Cambridge Risk Score (CRS) to predict undiagnosed hyperglycemia in Caribbean and South Asian people living in the U.K.
RESEARCH DESIGN AND METHODS—The CRS uses routinely available data from primary care records to identify people at high risk for undiagnosed type 2 diabetes. The sensitivity, specificity, and area under the receiver operator characteristic (ROC) curve for the CRS cut point of 0.199 were 77, 72, and 80% (95% CI 68–91), respectively. The risk score was calculated for 248 Caribbean and 555 South Asian participants aged 40–75 years in the 1999 Health Survey for England. Undiagnosed hyperglycemia was considered present if fasting plasma glucose was ≥7.0 mmol/l or HbA1c was ≥6.5%. Sensitivity, specificity, and predictive values were calculated for various cut points of the risk score, and ROC curves were constructed.
RESULTS—The area under the ROC curve was 67% (59–76) and 72% (67–78) for Caribbeans and South Asians, respectively. The optimal cut point in Caribbean participants was 0.236, sensitivity was 63% (46–77), and specificity was 63% (56–69). In the South Asian population, the optimal cut point was and 0.127, sensitivity was 69% (60–78), and specificity was 64% (60–69).
CONCLUSIONS—The CRS, using routinely available data, can be used in a strategy to detect undiagnosed hyperglycemia in Caribbean and South Asian populations. The existence of ethnic group–specific cut points must be further established in future studies.
Depressive Symptoms and Risk of Type 2 Diabetes in Women
Authors: Arroyo Cassandra , Hu Frank B. , Ryan Louise M. , Kawachi Ichiro , Colditz Graham A. , Speizer Frank E. , Manson JoAnn 
Published: March 2007

OBJECTIVE—To explore the relationship between depressive symptoms and incidence of type 2 diabetes in women.
RESEARCH DESIGN AND METHODS—We conducted an analysis of 72,178 female nurses aged 45–72 years who did not have diagnosed diabetes and who answered the Medical Outcomes Study 36-Item Short-Form Health Status Survey (SF-36) at baseline in 1992. We calculated relative risks (RR) of type 2 diabetes for women with presence of depressive symptoms (i.e., Five-Item Mental Health Index [MHI-5] score &gt;52).
RESULTS—During 4 years of follow-up (282,317 person-years), 973 incident cases of type 2 diabetes were documented. Age-adjusted RR of developing type 2 diabetes for women with presence of depressive symptoms was 1.55 (95% CI 1.27–1.90). Additional adjustment for BMI resulted in a RR of developing type 2 diabetes of 1.36 (1.11–1.67). The multivariate RR of developing type 2 diabetes was 1.22 (1.00–1.50). After excluding women diagnosed with diabetes between 1992 and 1994, 472 incident cases of type 2 diabetes were documented for the follow-up period from 1994 to 1996 (148,889 person-years). The multivariate RR of developing type 2 diabetes for women with depressive symptoms was 1.29 (0.96–1.72).
CONCLUSIONS—Our data suggest that depressive symptoms are associated with a modest increase in the risk of type 2 diabetes.