bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes Prevalence and Hospital and Pharmacy Use in the Veterans Health Administration (1994): Use of an ambulatory care pharmacy-derived database
Authors: Pogach Leonard M , Hawley Gerald , Weinstock Ruth , Sawin Clark , Schiebe Harlan , Cutler Franklin , Zieve Franklin , Bates Mary , Repke Denis 
Published: March 2007

OBJECTIVE
To develop a diabetes registry from an outpatient pharmacy database to systematically analyze the prevalence of diabetes, patterns of glycemic medication and glucose monitoring, pharmacy costs, and hospital use related to diabetes care in the Veterans Health Administration (VHA) in fiscal year (FY) 1994.

RESEARCH DESIGN AND METHODS
Veterans with diabetes were identified using a software program that extracted the social security number (SSN) of patients receiving insulin, sulfonylurea agents, or glucose-monitoring supplies. The cumulative FY94 cost for a drug was calculated by multiplying the units dispensed times the unit cost for each fill, using the actual drug cost that was in effect at the time of dispensing. Admission data were obtained by crossmatching the SSN registry with the VHA Austin Mainframe Patient Treatment Files to retrieve associated diagnosis-related groups (DRG), Physicians' Current Procedural Terminology (CPT), and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes.

RESULTS
From among 1,180,260 unique patients, 139,646 veterans with diabetes receiving insulin, oral agents, or glucose-monitoring strips were identified, accounting for a prevalence of 11.83% from 62 Veterans Administration medical centers. There were 63,078 individuals (52%) who received oral agents, of whom 26.3% also received blood glucose-monitoring supplies; 46,664 individuals (39%) received insulin, of whom 53.2% received blood glucose-monitoring supplies; and 9,440 individuals (8%) received both oral agents and insulin during FY94, with 64.4% receiving blood glucose-monitoring supplies. Only 1,482 (1.2%) individuals received monitoring supplies alone, and 129 patients (0.1%) were provided with an insulin pump. Using an adjusted data set, 12% of veterans accounted for 24% of all outpatient pharmacy costs, with an average expenditure of $622 for veterans with diabetes compared with $276 for veterans without diabetes. There was $454 (73%) for non-diabetes-specific prescriptions and $168 (27%) for prescriptions related to glycemic control. Of pharmacy expenditures for glycemic control, $101 (60.1%) was attributed to insulin, oral agents, and supplies, while $67 (39.9%) was attributable to glucose monitoring. Veterans with diabetes were admitted 1.6 times as frequently as veterans without diabetes.

CONCLUSIONS
This study demonstrates the feasibility of using a pharmacy-based electronic diabetes database in a payor system that can track both claims and individual classes of medication based on a unique identifier number. While the prevalence of diabetes in the VHA is high relative to other health care systems and the general population, patterns of medication usage, pharmacy costs, and relative admission frequency are comparable to results from the private sector.
Cognitive Function in an Elderly Population With Persistent Impaired Glucose Tolerance
Authors: Vanhanen Matti , Koivisto Keijo , Kuusisto Johanna , Mykkänen Leena , Helkala Eeva-Liisa , Hänninen Tuomo , Riekkinen Paavo , Soininen Hilkka , Laakso Markku 
Published: March 2007

OBJECTIVE
To study cognitive function in an elderly population with persistent impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS
Fasting and postload 2-h plasma glucose and insulin levels were determined at baseline in a population-based sample of 1,300 people and repeated an average of 3.5 years later in 980 subjects. At follow-up, cognitive function was evaluated in subjects with persistent normal glucose tolerance (NGT; n = 506) and IGT (n = 80) with a brief neuropsychological test battery.

RESULTS
Subjects with persistent IGT scored lower in the Mini-Mental State Examination (MMSE) and in the Buschke Selective Reminding Test long-term memory scores. Multiple linear regression analysis revealed that age, education, and insulin levels (either fasting or 2-h value) were associated with the MMSE score in subjects with persistent IGT. Other potential risk factors for impaired cognitive function were not significantly associated with the MMSE score.

CONCLUSIONS
Our study showed that persistent IGT in the elderly is associated with mildly impaired cognitive function, and hyperinsulinemia may account for this association.
Chronic Treatment of African-American Type 2 Diabetic Patients With β-Glucosidase Inhibition
Authors: Johnston Peter S , Feig Peter U , Coniff Robert F , Krol Alice , Kelley David E , Mooradian Arshag D 
Published: March 2007

OBJECTIVE
To evaluate the long-term efficacy, safety, and tolerability of the alpha-glucosidase inhibitor miglitol in the treatment of African-American patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
A total of 345 African-American type 2 diabetic patients (mean age 55.6 years, BMI 31.9 kg/m2, duration of diabetes 4.9 years, baseline HbA1C 8.7%) treated with either diet alone or sulfonylurea were randomized to 1 year of double-blind treatment with either placebo (n = 117) or miglitol (n = 228) at doses of 50 or 100 mg t.i.d., titrated based on tolerability. The primary efficacy criterion was change from baseline in HbA1C at the 6-month visit. Secondarily efficacy parameters included changes from baseline in plasma glucose and serum insulin (both fasting and 120 min after a standardized test meal), fasting lipids, and urinary albumin-to-creatinine ratio. Safety and tolerability evaluations were primarily based on reporting of adverse events and symptoms and on periodic laboratory analyses.

RESULTS
Miglitol treatment was associated with a mean placebo-subtracted reduction in HbA1C from baseline of 1.19% at 6 months. Fasting and 120-min postprandial plasma glucose levels were reduced in parallel to HbA1C, in association with miglitol treatment. Significant reductions versus placebo in 120-min postprandial insulin levels, in LDL cholesterol, and in fasting triglycerides, were also seen in the miglitol group at individual study time points. Softer, more frequent stools and flatulence were significantly more common in the miglitol group. Urinary tract infections, hematuria, and herpes simplex infections were significantly more common in the placebo group.

CONCLUSIONS
Miglitol treatment appears to be at least as efficacious in the African-American type 2 population as in the U.S. type 2 population at large, with comparable tolerability. alpha-Glucosidase treatment may be an important therapeutic option in these patients in view of their greater risk for microvascular complications and the accumulating body of evidence that better glucose control reduces the risk of these complications.
Treatment of a Unique Anemia in Patients With IDDM With Epoetin Alfa
Authors: Rarick Mark U , Espina Byron M , Colley Daniel T , Chrusoskie Aaron , Gandara Shannan , Feinstein Donald I 
Published: March 2007

OBJECTIVE
To identify and treat a unique form of anemia in patients with long-term IDDM.

RESEARCH DESIGN AND METHODS
Patients with IDDM, unexplained symptomatic anemia, and serum creatinine levels of &lt; 177 μmol/l (2.0 mg/dl) were treated with epoetin alfa (Procrit, Ortho Biotech, Raritan, NJ), 50 U/kg three times weekly, subcutaneously, to reach a target hematocrit of 38–40%. Baseline serum erythropoietin titers were measured before drug therapy.

RESULTS
Six patients were treated with epoetin alfa. Median age of the group was 74 years, with IDDM being diagnosed for a median of &gt; 20 years. All patients had symptoms of anemia with a median hematocrit of 28.9% (range 27–31). Compared with iron deficiency control patients, the group had a limited erythropoietin (EPO) response to the degree of anemia. All patients showed increases in hematocrit, median peak of 40.9%, with median time-to-peak response of 12 weeks. Baseline symptoms of anemia resolved in all patients. No adverse effects were noted during the treatment period.

CONCLUSIONS
There is a unique form of anemia in patients with long-term IDDM and clinically normal renal function who respond to low-dose epoetin alfa therapy. The rapid response to therapy and depressed baseline erythropoietin titers suggest the anemia is due to a lack of endogenous EPO release.
Treatment of Hypercholesterolemia and Combined Hyperlipidemia With Simvastatin and Gemfibrozil in Patients With NIPPM: A multicenter comparison study
Authors: Tikkanen Matti J , Laakso Markku , Ilmonen Marja , Helve Eero , Kaarsalo Esko , Kilkki Esa , Saltevo Juha ,   The Study Group
Published: March 2007

OBJECTIVE
To compare the lipid-lowering efficacies of simvastatin and gemfibrozil in NIDDM patients with combined (mixed) hyperlipidemia (CHL) or isolated hypercholesterolemia (IHC).

RESEARCH DESIGN AND METHODS
Patients with primary dyslipidemia and NIDDM were recruited for this double-blind, double-dummy comparison study from 10 Finnish centers. After a 4-week placebo run-in period, they were randomly assigned to simvastatin or gemfibrozil. The simvastatin group (n = 47) received 10 mg once nightly for 8 weeks, 20 mg for the next 8 weeks, and 40 mg for the third 8-week period. The gemfibrozil group (n = 49) received 600 mg twice daily throughout the 24 weeks. The lipid-lowering efficacies of both drugs were compared in all patients as well as separately in patients with CHL and IHC.

RESULTS
In all patients, simvastatin reduced LDL and total cholesterol and the LDL-to-HDL cholesterol ratio more effectively, whereas gemfibrozil was more effective in elevating HDL cholesterol and decreasing triglyceride levels. The drug effects differed according to lipid phenotype at baseline. Simvastatin decreased LDL cholesterol levels by 30–40% in both phenotypes. Gemfibrozil caused a 15% reduction in LDL cholesterol in IHC but no change in CHL patients. Simvastatin produced 15–30% reductions in triglyceride levels in CHL but no change in IHC patients. Gemfibrozil caused reductions in triglycerides in CHL (50% and more) and in IHC (40%) patients, with 12–18% increases in HDL cholesterol in these groups.

CONCLUSIONS
Simvastatin is useful in both CHL and IHC patients, whereas gemfibrozil can be used in patients with high triglyceride and low or normal LDL cholesterol levels.
Fish Oil and Glycemic Control in Diabetes: A meta-analysis
Authors: Friedberg Cylla E , Janssen Martien J F M , Heine Robert J , Grobbee Diederick E 
Published: March 2007

OBJECTIVE
Hypertriglyceridemia is associated with cardiovascular disease in diabetes. Fibrates effectively lower, but do not always normalize, serum triglyceride levels. Fish oil supplements may then be added to lower serum triglyceride levels. Doubt remains whether the net effect of fish oil intake on glycemic control is beneficial in diabetes. We therefore performed a meta-analysis from published clinical trials.

RESEARCH DESIGN AND METHODS
Data sources were Medline (Cologne, Germany), Excerpta Medica, Current Contents, review articles, and published reference lists. Publications of 26 trials were selected, and all trials included more than five diabetes (IDDM and NIDDM) patients and addressed the effects offish oil (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) on serum lipids and glucose tolerance. We (C.E.F, M.J.F.M.J.) extracted data independently based on predetermined criteria. Studies were classified according to design.

RESULTS
All studies combined showed a decrease in mean triglyceride concentrations in association with fish oil: −0.60 mmol/1 (95% CI, −0.84 to −0.33, P &lt; 0.01) and a slight but significant increase in serum LDL cholesterol: 0.18 mmol/1 (95% CI, 0.04−0.32, P = 0.01), with both findings most prominent in NIDDM. No significant changes in HbA1c percentages occurred in diabetic subjects treated with fish oil. Fasting blood glucose levels were increased with borderline significance in NIDDM subjects (0.43 mmol/1 [95% CI, 0.00–0.87], P = 0.06) and were significantly lower in IDDM subjects (−1.86 mmol/1 [95% CI, −3.1 to −0.61], P &lt; 0.05). Significant dose-response effects of EPA (g/day) on HbA1c and triglycerides and of DHA (g/day) on fasting blood glucose levels, HbA1c, and triglycerides were demonstrated only in NIDDM subjects.

CONCLUSIONS
The use of fish oil has no adverse affects on HbA1c in diabetic subjects and lowers triglyceride levels effectively by almost 30%. However, this may be accompanied by a slight increase in LDL cholesterol concentration. Fish oil may be useful in treating dyslipidemia in diabetes.
Childhood Diabetes in China: Enormous variation by place and ethnic group
Authors: Yang Ze , Wang Kean , Li Tianlin , Sun Wei , Li Yurui , Chang Yue-Fang , Dorman Janice S , LaPorte Ronald E 
Published: March 2007

OBJECTIVE
To investigate the incidence rate of IDDM in China.

RESEARCH DESIGN AND METHODS
The Chinese IDDM registry was established in 1991 as part of the World Health Organization's Multinational Project for Childhood Diabetes (DiaMond) project. Twenty-two centers were developed to monitor the incidence of IDDM in children &lt;15 years of age. The population under investigation includes &gt;20 million individuals, representing ∼7% of the children in China. Capture-recapture methods were used to estimate the ascertainment.

RESULTS
The overall ascertainment-corrected IDDM incidence rate in China was 0.51 per 100,000, the lowest rate ever reported. There was a 12-fold geographic variation (0.13–1.61 per 100,000). In general, the incidence rate was higher in the north and the east. There was a sixfold difference among ethnic groups (highest: Mongol group, 1.82 per 100,000; lowest: Zhuang group, 0.32 per 100,000).

CONCLUSIONS
China has an extremely low overall IDDM incidence rate. China also has the greatest geographic and ethnic variation seen for any country.
Validation of Home Blood Glucose Meters With Respect to Clinical and Analytical Approaches
Authors: Brunner Gernot A , Ellmerer Martin , Sendlhofer Gerald , Wutte Andrea , Trajanoski Zlatko , Schaupp Lukas , Quehenberger Franz , Wach Paul , Krejs Guenter J , Pieber Thomas R 
Published: March 2007

OBJECTIVE
To evaluate the clinical and analytical accuracy of home blood glucose meters.

RESEARCH DESIGN AND METHODS
Six blood glucose meters—Reflolux S (Boehringer Mannheim, Mannheim, Germany), One Touch II (LifeScan, Milpitas, CA), Glucocard Memory (Menarini, Florence, Italy), Precision QID (Medisense, Cambridge, U.K.), HaemoCue (HaemoCue, Ängelholm, Sweden), and Accutrend a (Boehringer Mannheim, Mannheim, Germany)—were compared with a reference method (Beckman Glucose Analyzer II) under controlled conditions (glucose clamp technique). Validation of the blood glucose meters was accomplished by clinically oriented approaches (error grid analysis), statistical approaches (variance components analysis), and by the criteria of the American Diabetes Association (ADA), which recommend a target variability of &lt;5%.

RESULTS
A total of 1,794 blood glucose monitor readings and 299 reference values ranging from 2.2 to 18.2 mmol/1 were analyzed (705 readings &lt;3.89 mmol/1, 839 readings between 3.89 and 9.99 mmol/1, and 250 readings &gt;9.99 mmol/1). According to error grid analysis, only Reflolux S and Glucocard M had 100% of estimations within the clinically acceptable zones A and B. Assessment of analytical accuracy revealed substantial differences between the glucose meters after separation of the data into defined glycemic ranges. None of the devices met the ADA criteria.

CONCLUSIONS
To evaluate accuracy of blood glucose meters, error grid analysis, as well as statistical models, are helpful means and should be performed together. Analytical performance of currently available home blood glucose meters differs substantially within defined glycemic ranges.
Muscular Endurance in Long-Term IDDM Patients
Authors: Andersen Henning 
Published: March 2007

OBJECTIVE
To determine the short-term muscular endurance and working capacity of leg muscles in long-term IDDM patients in relation to neuropathic complications, muscle strength, and metabolic control.

RESEARCH DESIGN AND METHODS
The muscular endurance of extensors and flexors at the ankle and knee was assessed in 44 IDDM patients and in 44 matched control subjects during 30 maximal isokinetic movements. The endurance index was the work performance of the last 5 movements relative to the first 5 movements. Total work was the summated work of all movements. All patients underwent a neurological evaluation, nerve conduction studies, and quantitative sensory tests.

RESULTS
The combined endurance index of the ankle extensors and flexors was 70% (51–88) (median [range]) in the diabetic group and 65% (55–82) in the control group (P &lt; 0.01). For knee extensors and flexors the combined endurance index was 65% (55–103) for the diabetic patients and 63% (48–75) in the control subjects (P &lt; 0.01). The endurance index related neither to the severity of neuropathy nor to the metabolic control (blood glucose and HbA1c) for any of the muscle groups. Diabetic patients had reduced strength of all muscle groups (14–24%, P &lt; 0.02) and impaired total work performance (15–20%, P &lt; 0.01) for ankle movements.

CONCLUSIONS
Long-term IDDM patients have increased endurance but reduced strength and work performance of leg muscles. The combined effect of the motor abnormalities is suggested to give rise to functional impairment, including an increased risk of falls and injuries.
Angiographic Evaluation of Peripheral Arterial Occlusive Disease and Its Role as a Prognostic Determinant for Major Amputation in Diabetic Subjects With Foot Ulcers
Authors: Faglia Ezio , Favales Fabrizio , Quarantiello Antonella , Calia Patrizia , Clelia Paratore , Brambilla Giorgio , Rampoldi Antonio , Morabito Alberto 
Published: March 2007

OBJECTIVE
To evaluate in diabetic patients with foot ulcers the angiographic findings of peripheral occlusive arterial disease and their role as a prognostic determinant for major amputation.

RESEARCH DESIGN AND METHODS
From 1993 to 1995, 104 diabetic inpatients with foot ulcers underwent arteriography on the ulcerated limb. Stenoses in the iliac trunk, the superficial femoral artery, the profunda femoral artery, the popliteal artery, the anterior tibial artery, the posterior tibial artery, and the peroneal artery were scored on the basis of vessel lumen reduction: 0 if stenoses involved a reduction in the vessel lumen of &lt;50%, 1 if stenoses involved 50 to &lt;75% reduction, 2 if stenoses involved 75 to &lt;100% reduction, and 3 if total occlusion was present. The sum of the points assigned to each of these arteries was called the angiographic score.

RESULTS
Stenoses causing a vessel lumen reduction ≥50% were detected in 103 patients (99%). Stenoses were also detected in subjects with palpable foot pulses, ankle-brachial indexes ≥1, or transcutaneous oxygen tension ≥50 mmHg. The risk of major amputation was increased significantly when total occlusion was present in the popliteal and infrapopliteal arteries (x2 for trend = 50.57, P &lt; 0.001). No major amputation was carried out in patients with angiographic scores &lt;10; major amputation was carried out in all the patients with scores &gt;14. Multivariate analysis indicated a high angiographic score as an independent risk factor for major amputation (odds ratio 2.32, P = 0.001, CI 1.40–3.84).

CONCLUSIONS
Angiography permits an exact detection of occlusive arterial disease in subjects with normal results for noninvasive vascular procedures. A score that has a relevant prognostic value for major amputation can be obtained from the evaluation of the extent and diffusion of the stenoses.
The Effect of Magnesium Supplementation in Increasing Doses on the Control of Type 2 Diabetes
Authors: de Lourdes Lima Maria , Cruz Thomaz , Pousada Judith Carreiro , Rodrigues Luiz Erlon , Barbosa Karyne , Canguçu Valquiria 
Published: March 2007

OBJECTIVE
Hypomagnesemia occurs in 25–38% of patients with type 2 diabetes. Several studies have suggested an association between magnesium (Mg) depletion and insulin resistance and/or reduction of insulin secretion in these cases. Our purpose was to evaluate if Mg supplementation (as magnesium oxide [MgO]) would improve metabolic control in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
We studied 128 patients with type 2 diabetes (32 men, 96 women, aged 30–69 years), treated by diet or diet plus oral antidiabetic drugs, in the Bahia Federal University Hospital, Brazil. Patients at risk for hypomagnesemia or with reduced renal function were excluded. This study was a clinical randomized double-blind placebo-controlled trial. Patients received either placebo, 20.7 mmol MgO, or 41.4 mmol MgO daily(elementary Mg) for 30 days. Mg concentrations were measured in plasma, in mononuclear cells, and in 24-h urine samples. Fasting blood glucose, HbA1, and fructosamine were used as parameters of metabolic control.

RESULTS
Of the patients, 47.7% had low plasma Mg, and 31.1% had low intramononuclear Mg levels. Intracellular Mg in patients with diabetes was significantly lower than in the normal population (62 blood donors; 1.4 ± 0.6 vs. 1.7 ± 0.6 μg/mg of total proteins). No correlation was found between plasma and intracellular Mg concentrations (r = −0.179; P = 0.15) or between Mg concentrations and glycemic control (r = −0.165; P = 0.12). Intracellular Mg levels were lower in patients with peripheral neuropathy than in those without (1.2 ± 0.5 vs. 1.5 ± 0.6 μg/mg). Similar findings were observed in patients with coronary disease (1.0 ± 0.5 vs. 1.5 ± 0.6 μg/mg). In the placebo and in the 20.7 mmol Mg groups, neither a change in plasma and intracellular levels nor an improvement in glycemic control were observed. Replacement with 41.4 mmol Mg tended to increase plasma, cellular, and urine Mg and caused a significant fall (4.1 ± 0.8 to 3.8 ± 0.7 mmol/1) in fructosamine (normal, 1.87–2.87 mmol/1).

CONCLUSIONS
Mg depletion is common in poorly controlled patientswith type 2 diabetes, especially in those with neuropathy or coronary disease. More prolonged use of Mg in doses that are higher than usual is needed toestablish its routine or selective administration in patients with type 2 diabetes to improve control or prevent chronic complications.