bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Oral l-Arginine Administration Improves Peripheral and Hepatic Insulin Sensitivity in Type 2 Diabetic Patients
Authors: Piatti PierMarco , Monti Lucilla D. , Valsecchi Gianpietro , Magni Fulvio , Setola Emanuela , Marchesi Federica , Galli-Kienle Marzia , Pozza Guido , Alberti K. George M.M. 
Published: March 2007

OBJECTIVE—The aim of this study was to evaluate whether long-term administration of l-arginine acting through a normalization of NO/cyclic-guanosine-3′,5′-cyclic monophosphate (cGMP) pathway was able to ameliorate peripheral and hepatic insulin sensitivity in 12 lean type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—A double-blind study was performed for 3 months. In the first month, patients were treated with their usual diet. Then they were randomly allocated into two groups. In group 1, patients were treated with diet plus placebo (orally three times per day) for 2 months. In group 2 patients were treated for 1 month with diet plus placebo (orally, three times per day) and then for 1 month with diet plus l-arginine (3 g three times per day). At the end of the first and the second month of therapy, patients underwent a euglycemic-hyperinsulinemic clamp combined with [6,6-2H2]glucose infusion. A total of 10 normal subjects underwent the same test as control subjects.
RESULTS—In group 1, no changes in basal cGMP levels, systolic blood pressure, forearm blood flow, glucose disposal, and endogenous glucose production were observed throughout. In group 2, l-arginine normalized basal cGMP levels and significantly increased forearm blood flow by 36% and glucose disposal during the clamp by 34%, whereas it decreased systolic blood pressure and endogenous glucose production by 14 and 29%, respectively. However, compared with normal subjects, l-arginine treatment was not able to completely overcome the defect in glucose disposal.
CONCLUSIONS—l-Arginine treatment significantly improves but does not completely normalize peripheral and hepatic insulin sensitivity in type 2 diabetic patients.
Family Characteristics and Life Events Before the Onset of Autoimmune Type 1 Diabetes in Young Adults
Authors: Littorin Bengt , Sundkvist Göran , Nyström Lennarth , Carlson Anita , Landin-Olsson Mona , Östman Jan , Arnqvist Hans J. , Björk Elisabeth , Blohmé Göran , Bolinder Jan , Eriksson Jan W. , Scherstén Bengt , Wibell Lars 
Published: March 2007

OBJECTIVE—To elucidate whether family characteristics and stressful life events were associated with onset of autoimmune type 1 diabetes in young adults.
RESEARCH DESIGN AND METHODS—This investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of newly diagnosed patients aged 15–34 years. Patients clinically classified as type 1 diabetic with antibodies to islet cells and/or to GAD65 were compared with age- and sex-matched control subjects via questionnaire. The questionnaire covered diabetes heredity, social environment, educational level, and life events experienced during the 12 months before diagnosis.
RESULTS—The rate of response was 82% for the diabetic patients and 65% for the control subjects. Questionnaires from 349 diabetic patients and 979 control subjects were considered. Diabetes in relatives was more frequent in the patients (odds ratio [OR]2.6) who were born in Sweden and whose mothers were of Swedish origin. No major stress factors were detected in the diabetic patients; however, in comparison with the control subjects, the diabetic patients had experienced fewer conflicts with their parents and had less often broken contacts with friends.
CONCLUSIONS—Young adults with recent-onset type 1 diabetes were more exposed to heredity for diabetes, but no major prediabetic stress factors were detected. Our study does not directly support the concept that psychosocial stressful life events are involved in the development of autoimmune type 1 diabetes in young adults.
Prevalence of Diabetes in Care Home Residents
Authors: Sinclair Alan J. , Gadsby Roger , Penfold Sue , Croxson Simon C.M. , Bayer Antony J. 
Published: March 2007

OBJECTIVE—To determine the prevalence of known and undetected diabetes diagnosed either by an elevated fasting baseline sample or by a 2-h post–glucose load sample in a group of residents of care homes in an urban-district setting.
RESEARCH DESIGN AND METHODS—We completed individual interviews with patients and caregivers in 30 care homes (both residential and nursing homes) in two metropolitan districts of Birmingham, West Midlands, U.K. All care homes were under the supervision of primary care physicians (general practitioners). We carried out 75-g oral glucose tolerance tests (OGTTs) in consenting residents without previous known diabetes. Criteria for diagnosis of diabetes were obtained from the World Health Organization (1998) and the American Diabetes Association (1997).
RESULTS—Of 636 residents available for study, 76 residents (12.0%) were known to have diabetes; of the 560 remaining residents, 286 either refused to participate or were deemed too ill or unavailable to undergo testing. Complete data on 274 OGTTs were obtained (median age 83 years, range 45–101). A total of 46 subjects were diagnosed as having diabetes and 94 as having impaired glucose tolerance. Allowing for subjects who refused or were unable to participate, the calculated total prevalence (which includes known and newly detected diabetes) was 26.7% (95% CI 21.9–32.0). The calculated overall prevalence of impaired glucose tolerance was 30.2% (25.2–35.6).
CONCLUSIONS—In a group of care home residents not known to have diabetes and able to undergo testing, a substantial proportion have undetected diabetes based on a 2-h postglucose load. These residents warrant further study as they may be at higher cardiovascular risk and require an intervention.
The Prevalence of Comorbid Depression in Adults With Diabetes
Authors: Anderson Ryan J. , Freedland Kenneth E. , Clouse Ray E. , Lustman Patrick J. 
Published: March 2007

OBJECTIVE—To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes.
RESEARCH DESIGN AND METHODS—MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used χ2 statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design.
RESULTS—A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8–2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%).
CONCLUSIONS—The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.
Declining Insulin Requirement in the Late First Trimester of Diabetic Pregnancy
Authors: Jovanovic Lois , Knopp Robert H. , Brown Zane , Conley Mary R. , Park Eunsik , Mills James L. , Metzger Boyd E. , Aarons Jerome H. , Holmes Lewis B. , Simpson Joe L. ,   and the National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study Group
Published: March 2007

OBJECTIVE—To investigate whether pregnancies complicated by type 1 diabetes are associated with a decrease in first-trimester insulin requirement.
RESEARCH DESIGN AND METHODS—We examined the weekly insulin requirement (as units per kilogram per day) during the first trimester of pregnancy in diabetic women in the Diabetes in Early Pregnancy Study (DIEP) with accurate gestational dating, regular glucose monitoring, daily insulin-dose recording, and monthly glycohemoglobin measurements.
RESULTS—In pregnancies that resulted in live-born full-term singleton infants, a significant 18% increase in mean weekly dosage was observed between weeks 3 and 7 (P = 0.000), followed by a significant 9% decline from week 7 through week 15 (P = 0.000). Further testing localized a significant change in insulin dose in the interval beginning weeks 7–8 and ending weeks 11–12 (P = 0.014). Within this interval, the maximum decrease was between weeks 9 and 10 (mean), 10 and 11 (median), and 8 and 9 (most frequent maximal decrease). To determine whether prior poor glucose control exaggerated these trends, we categorized the women based on their glycohemoglobin values: &lt;2 SDs above the mean of a normal population (subgroup 1), 2–4 SDs (subgroup 2), and &gt;4 SDs (subgroup 3) at baseline. Late first-trimester declines in dosage were statistically significant in subgroup 2 (P = 0.002) and subgroups 2 and 3 together (P = 0.003). Similarly, women with BMI &gt;27.0 had a greater initial insulin rise and then fall compared with leaner women.
CONCLUSIONS—Observations in the DIEP cohort disclose a mid–first-trimester decline in insulin requirement in type 1 diabetic pregnant women. Possible explanations include overinsulinization of previously poorly controlled diabetes, a transient decline in progesterone secretion during the late first-trimester luteo-placental shift in progesterone secretion, or other hormonal shifts. Clinicians should anticipate a clinically meaningful reduction in insulin requirement in the 5-week interval between weeks 7 and 12 of gestation.
Effect of Metformin in Pediatric Patients With Type 2 Diabetes
Authors: Jones Kenneth Lee , Arslanian Silva , Peterokova Valentina A. , Park Jong-Soon , Tomlinson Mark J. 
Published: March 2007

OBJECTIVE—Metformin is the most commonly prescribed oral antidiabetic agent in the U.S. for adults with type 2 diabetes. The incidence of type 2 diabetes in children has increased dramatically over the past 10 years, and yet, metformin has never been formally studied in children with type 2 diabetes.RESEARCH DESIGN AND METHODS—This study evaluated the safety and efficacy of metformin at doses up to 1,000 mg twice daily in 82 subjects aged 10–16 years for up to 16 weeks in a randomized double-blind placebo-controlled trial from September 1998 to November 1999. Subjects with type 2 diabetes were enrolled if they had a fasting plasma glucose (FPG) levels ≥7.0 and ≤13.3 mmol/l (≥126 and ≤240 mg/dl), HbA1c ≥7.0%, stimulated C-peptide ≥0.5 nmol/l (≥1.5 ng/ml), and a BMI &gt;50th percentile for age.RESULTS—Metformin significantly improved glycemic control. At the last double-blind visit, the adjusted mean change from baseline in FPG was −2.4 mmol/l (−42.9 mg/dl) for metformin compared with +1.2 mmol/l (+21.4 mg/dl) for placebo (P &lt; 0.001). Mean HbA1c values, adjusted for baseline levels, were also significantly lower for metformin compared with placebo (7.5 vs. 8.6%, respectively; P &lt; 0.001). Improvement in FPG was seen in both sexes and in all race subgroups. Metformin did not have a negative impact on body weight or lipid profile. Adverse events were similar to those reported in adults treated with metformin.CONCLUSION—Metformin was shown to be safe and effective for treatment of type 2 diabetes in pediatric patients.
Fetal Growth Spurt and Pregestational Diabetic Pregnancy
Authors: Wong Shell Fean , Chan Fung Yee , Oats Jeremy J.N. , McIntyre David H. 
Published: March 2007

OBJECTIVE—To assess the timing of fetal growth spurt among pre-existing diabetic pregnancies (types 1 and 2) and its relationship with diabetic control. To correlate fetal growth acceleration with factors that might influence fetal growth.
RESEARCH DESIGN AND METHODS—This retrospective study involved all pregestational diabetic pregnancies delivered at a tertiary obstetric hospital in Australia between 1 January 1994 and 31 December 1999. Pregnancies with major congenital fetal anomalies, multiple pregnancies, small-for-gestational-age pregnancies (&lt;10th centile), and those that were terminated before 20 weeks were excluded. In this cohort, pregnancies delivered at term had at least four ultrasound scans performed. The first scans were performed before 14 weeks of gestation and were regarded as dating scans. Abdominal circumference measurements were retrieved from the ultrasound reports. The z-scores for abdominal circumferences, according to the gestational age, were calculated. The gestations when the ultrasound scans were performed were stratified at four weekly intervals beginning at 18 weeks and continuing through the rest of the study. Majority of these diabetic pregnancies had ultrasound scans performed at 18, 28, 32, and 36 weeks. The abdominal circumference z-scores for pregnancies with large-for-gestational-age (LGA) babies (&gt;90th centile for gestation) were compared with babies with normal birth weights.
RESULTS—A total of 101 diabetic pregnancies were included. Diabetic mothers, who had LGA babies, had significantly higher prepregnancy body weight and BMI (P &lt; 0.05). There were no differences in maternal age or parity among the two groups. There were also no differences in the first-, second-, and third-trimester HbA1c levels between the two groups. The abdominal circumference z-scores were significantly higher for LGA babies from 18 weeks and thereafter. The differences increased progressively as the gestation advanced. Maximum difference was noted in the third trimester (30–38 weeks).
CONCLUSIONS—Fetal growth acceleration in LGA fetuses of diabetic mothers starts in the second trimester, from as early as 18 weeks. In this study, glucose control did not appear to have a direct effect on the incidence of LGA babies, and such observation might result from the effects of other confounding factors.
Inside Guidelines
Authors: Burgers Jako S. , Bailey Julia V. , Klazinga Niek S. , Van der Bij Akke K. , Grol Richard , Feder Gene ,   for the AGREE Collaboration
Published: March 2007

OBJECTIVE—To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence.
RESEARCH DESIGN AND METHODS—We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using qualitative methods to compare the recommendations and bibliometric methods to measure the extent of overlap in citations used by different guidelines. A further qualitative analysis of recommendations and cited evidence for two specific issues in diabetes care explored the apparent discrepancy between recommendations and evidence.
RESULTS—The recommendations made in the guidelines were in agreement about the general management of type 2 diabetes, with some important differences in treatment details. There was little overlap in evidence cited by the guidelines, with 18% (185/1,033) of citations shared with any other guideline, and only 10 studies (1%) appearing in six or more guidelines. The measurable overlap in evidence between guidelines increases if multiple publications from the same study and the use of reviews are taken into account. Research originating from the U.S. predominated (40% of citations); however, nearly all (11/12) guidelines were significantly more likely to cite evidence originating from their own countries.
CONCLUSIONS—Despite the variation in cited evidence and preferential citation of evidence from a guideline’s country of origin, we found a high degree of international consensus in recommendations made for the clinical care of type 2 diabetes. The influence of professional bodies such as the American Diabetes Association may be an important factor in explaining international consensus. Globalization of recommended management of diabetes is not a simple consequence of the globalization of research evidence.
Influence of Metabolic Control on Splanchnic Glucose Uptake, Insulin Sensitivity, and the Time Required for Glucose Absorption in Patients With Type 1 Diabetes
Authors: Georg Petra , Kautzky-Willer Alexandra , Mahdjoobian Katja , Hofer Astrid , Prager Rudolf , Pacini Giovanni , Ludvik Bernhard H. 
Published: March 2007

OBJECTIVE—The relationship between splanchnic glucose uptake (SGU) after oral glucose administration and metabolic control in type 1 diabetic patients is controversial. We estimated SGU as well as peripheral glucose uptake and the time required for glucose absorption by a validated method, the oral glucose (OG) clamp, in type 1 diabetic patients with different levels of long-term glycemic control.
RESEARCH DESIGN AND METHODS—An OG clamp (which combines a hyperinsulinemic clamp [120 mU · m−2 · min−1] with an OR load [75 g] during steady-state glucose uptake) was performed in eight type 1 diabetic patients with good metabolic control (DG) (HbA1c 6.1 ± 0.2%, BMI 23.1 ± 0.7 kg/m2), eight type 1 diabetic patients with poor metabolic control (DP) (HbA1c 8.5 ± 0.3%, BMI 25.4 ± 1.4 kg/m2), and eight healthy matched control subjects (C) (HbA1c 5.1 ± 0.1%, BMI 25 ± 1.3 kg/m2) to determine SGU, glucose uptake, and glucose absorption.
RESULTS—Glucose uptake calculated from 120 to 180 min during the clamp was 9.13 ± 0.55 mg · kg−1 · min−1 in C, 8.18 ± 0.71 mg · kg−1 · min−1 in DG, and 7.42 ± 0.96 mg · kg−1 · min−1 in DP (NS). Glucose absorption was 140 ± 6 min in C, 156 ± 4 min in DG, and 143 ± 7 min in DP (NS). The respective calculated SGU was 14.5 ± 5.6% in C, 17.8 ± 3.1% in DG, and 18.8 ± 4.2% in DP (NS) and did not correlate with HbA1c values.
CONCLUSIONS—Peripheral glucose uptake, SGU after oral glucose administration, and the glucose absorption time were not different in type 1 diabetic patients independent of glycemic control when compared with healthy subjects.
Control of Postprandial Hyperglycemia
Authors: Carroll Mary F. , Izard Ahmad , Riboni Katrina , Burge Mark R. , Schade David S. 
Published: March 2007

OBJECTIVE—This study was designed to compare the efficacy of acute premeal administration of glipizide versus nateglinide in controlling postprandial hyperglycemia in subjects with non-insulin-requiring type 2 diabetes.RESEARCH DESIGN AND METHODS—A total of 20 subjects (10 female, 10 male) with non-insulin-requiring type 2 diabetes were admitted overnight to the General Clinical Research Center on four occasions. In random order, 10 mg glipizide (30 min premeal), 120 mg nateglinide (15 min premeal), 10 mg glipizide plus nateglinide (30 and 15 min premeal, respectively), or placebo pills (30 and 15 min premeal) were administered in a double-blind fashion before a standardized breakfast. Blood was drawn for analysis of glucose, insulin, and C-peptide at −0.05, 0, 0.5, 1, 2, 3, and 4 h relative to the meal.RESULTS—The subjects were aged 56 ± 2 years and were moderately obese (BMI 31 ± 1 kg/m2), with a mean HbA1c of 7.4 ± 0.4%. The peak postprandial glucose excursion above baseline was higher with placebo (6.1 ± 0.5 mmol/l) than glipizide (4.3 ± 0.6 mmol/l, P = 0.002), nateglinide (4.2 ± 0.4 mmol/l, P = 0.001), or glipizide plus nateglinide (4.1 ± 0.5 mmol/l, P = 0.001). The area under the curve for the glucose excursion above baseline was also higher with placebo (14.1 ± 1.8 mmol/h · l) compared with glipizide (6.9 ± 2.4 mmol/h · l, P = 0.002), nateglinide (9.7 ± 2 mmol/h · l, P = 0.004), or glipizide plus nateglinide (5.6 ± 2.2 mmol/h · l, P &lt; 0.001). Peak and integrated glucose excursions did not differ significantly between glipizide and nateglinide. However, by 4 h postmeal, plasma glucose levels were significantly higher with nateglinide (9 ± 0.9 mmol/l) compared with the premeal baseline (7.8 ± 0.6 mmol/l, P = 0.04) and compared with the 4-h postprandial glucose level after administration of glipizide (7.6 ± 0.6 mmol/l, P = 0.02). Integrated postprandial insulin levels were higher with glipizide (1,556 ± 349 pmol/h · l) than nateglinide (1,364 ± 231 pmol/h · l; P = 0.03). Early insulin secretion, as measured by insulin levels at 30 min postmeal, did not differ between glipizide and nateglinide.CONCLUSIONS—Acute premeal administration of nateglinide or glipizide has equal efficacy in controlling postbreakfast hyperglycemia in type 2 diabetes when each drug is administered at the optimum time before the meal. Glipizide causes a more pronounced and sustained postmeal insulin secretory response compared with nateglinide. Glipizide facilitates the return to near-fasting glucose levels at 4 h postmeal, but with the possible risk of increased frequency of postmeal hypoglycemia in drug-naive patients. The clinical decision to use glipizide versus nateglinide should be based on factors other than the control of postprandial hyperglycemia in type 2 diabetes.
Blood Letting in High-Ferritin Type 2 Diabetes
Authors: Fernández-Real José Manuel , Peñarroja Georgina , Castro Antoni , García-Bragado Fernando , López-Bermejo Abel , Ricart Wifredo 
Published: March 2007

OBJECTIVE—In a recent study, iron chelation with deferoxamine led to improvement of endothelial dysfunction in patients with coronary artery disease. We tested the hypothesis that decreasing circulating iron stores might improve vascular dysfunction in patients with type 2 diabetes and increased serum ferritin concentration.
RESEARCH DESIGN AND METHODS—A total of 28 type 2 diabetic male patients with serum ferritin levels &gt;200 ng/ml (∼18% of consecutive type 2 diabetic men attending our outpatient clinic) were randomized to iron depletion (three extractions of 500 ml blood at 2-week intervals; group 1A) or to observation (group 1B). C282Y mutation was absent in all patients. Vascular reactivity (high-resolution external ultrasound) was evaluated at baseline and at 4 and 12 months thereafter. The two groups of patients were matched for age, BMI, pharmacological treatment, and chronic diabetic complications.
RESULTS—Endothelium-dependent vasodilation remained essentially unchanged in both groups of patients. In contrast, the vasodilation induced by glyceryl trinitrate (GTN) improved significantly after iron depletion (P = 0.006). These changes occurred in parallel to decreases in transferrin saturation index and HbA1c levels (−0.6%, P &lt; 0.05) only in group 1A patients. The best predictor of the modifications in endothelium-independent vasodilation was the change in HbA1c levels. Changes in endothelium-independent vasodilation also correlated with the change in serum ferritin (r = −0.45, P = 0.04). At 12 months, transferrin saturation index and GTN-induced vasodilation returned to values similar to those at baseline in both groups of subjects.
CONCLUSIONS—Iron depletion improves vascular dysfunction in type 2 diabetic patients with high ferritin concentrations. The mechanisms by which these changes occur should be further investigated.