bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proinsulin Immunoreactivity in Recent-Onset IDDM: The significance of insulin antibodies and insulin autoantibodies
Authors: Snorgaard Ole , Kjems Lise L , Røder Micheal E , Hartling Svend G , Dinesen Bo , Binder Christian 
Published: March 2007

OBJECTIVE
To study the natural history of fasting proinsulin immunoreactivity (PIM) during the first 30 months of IDDM and its relationship to fasting C-peptide and insulin antibodies.

RESEARCH DESIGN AND METHODS
An incidence cohort of 204 consecutive newly diagnosed IDDM patients were followed prospectively, having blood drawn for measurements at diagnosis and at 1, 3, 6, 9, 12, 18, 24, and 30 months. A sensitive enzyme-linked immunosorbent assay was used for the determination of PIM.

RESULTS
All patients had detectable fasting PIM in plasma at diagnosis, with a median value and interquartile range of 3.5 pmol/l (2.2–6.2). The median PIM level increased during the first months of IDDM to reach a peak at 9–12 months (9.9–10.3 pmol/l). PIM then declined gradually to 5.6 pmol/l (1.9–13.5) at 30 months without reaching baseline. PIM at each time point was widely scattered in a skewed log-normal distribution without signs of bimodality. After the onset of insulin treatment, median insulin antibody level increased and declined in a similar pattern. Both PIM and antibody level were significantly higher in children and adolescents compared with adults. However, stepwise multiple regression analysis showed that age was only of minor importance for the PIM variation during the study period. Insulin antibody level and fasting C-peptide were the major determinants at 3–30 months, accounting for ∼40% of the variation (R2). Blood glucose was of minor importance, and insulin dose, HbA1c, and BMI were of no importance. The correlation between fasting PIM and fasting C-peptide improved (R2 doubled) if the insulin antibody level was accounted for. Further, the slope of the correlation curve between PIM and C-peptide increased threefold when antibody binding was &gt; 4%. At diagnosis, insulin autoantibodies could be detected in 19% of the patients. Their presence predicted higher proinsulin at 1–3 months, a higher insulin dose the 1st year, and higher levels of insulin antibodies later in the study.

CONCLUSIONS
Circulating insulin antibodies may affect the level of PIM in IDDM, probably by adding a pool of IgG-bound PIM thereby increasing half-life and plasma concentration. This may explain why C-peptide and PIM levels do not change in concert during the 1st years of IDDM. Unlike C-peptide, PIM can not therefore quantitate β-cell secretion unless the presence of insulin antibodies is ruled out.
Effects of Troglitazone: A new hypoglycemic agent in patients with NIDDM poorly controlled by diet therapy
Authors: Iwamoto Yasuhiko , Kosaka Kinori , Kuzuya Takeshi , Akanuma Yasuo , Shigeta Yukio , Kaneko Toshio 
Published: March 2007

OBJECTIVE
To investigate the clinical efficacy of troglitazone, a newly developed oral hypoglycemic agent, in patients with NIDDM.

RESEARCH DESIGN AND METHODS
There were 284 NIDDM patients (20–82 years of age) whose glycemic control while on a diet was judged stable but was judged unsatisfactory (fasting plasma glucose [FPG] ≥ 8.3 mmol/l) when entered into a multicenter and double-blind study with parallel groups study. They were randomly allocated into two groups, the troglitazone group (the T group: 400 mg/day p.o.) and the placebo group (the P group), and were treated with test drugs for 12 weeks.

RESULTS
We evaluated efficacy in 136 patients of the T group and 126 patients of the P group. There was no significant difference in any of baseline characteristics between the T and P groups. In the T group, FPG and HbA1c decreased significantly after treatment (before versus after, FPG 10.1 ± 1.6 vs. 8.8 ± 1.9 mmol/l, P &lt; 0.001; HbA1c: 8.6 ± 1.5 vs 8.1 ± 1.7%, P &lt; 0.001). FPG and HbA1c did not change after treatment in the P group (before versus after, FPG 10.1 ± 1.8 vs. 9.9 ± 2.1 mmol/l; HbA1c 8.5 ± 1.5 vs. 8.6 ± 1.6%). Of 136 patients in the T group, 62 (45.6%) were classified as responders. Serum triglyceride level also decreased in the T group but not in the P group. Body weight increased slightly only in the T group. There were no differences in changes in blood pressure between the two groups. No serious adverse events occurred in either group.

CONCLUSIONS
Troglitazone at 400 mg/day decreased FPG and HbA1c significantly in NIDDM patients who had failed to respond to diet therapy. Troglitazone, developed as a drug to enhance insulin action, can be a useful hypoglycemic agent for the treatment of NIDDM.
Efficacy of Feedback From Quarterly Laboratory Comparison in Maintaining Quality of a Hospital Capillary Blood Glucose Monitoring Program
Authors: Jones Helen E , Cleave Barbara , Zinman Bernard , Szalai John Paul , Nichol Heather L , Hoffman Barry R 
Published: March 2007

OBJECTIVE
A 1-year randomized prospective study was conducted to investigate the efficacy of feedback from split-sample testing as part of a capillary blood glucose quality assurance program.

RESEARCH DESIGN AND METHODS
A total of 124 nurses were randomized to either group A (quarterly comparisons with feedback) or group B (no feedback). The measure of nurse accuracy against the laboratory at 0, 6, and 12 months was determined by an additional five to seven split-sample tests without giving feedback to either group. Mean accuracy was determined in terms of percent absolute deviation from the laboratory result and a clinical consensus limit of ± 20% deviation from the laboratory.

RESULTS
By 12 months, there was a significant effect of feedback on nurse agreement with the laboratory method (P = 0.022 when agreement was scored as the mean percent absolute difference and P = 0.002 when agreement was scored in terms of the ± 20% clinical consensus limit). Nurses in the group who had received no quarterly feedback from split-sample testing produced a 3.5% greater mean percent absolute deviation from the laboratory method and 12% fewer comparisons within the acceptable ± 20% range.

CONCLUSIONS
Feedback received from split-sample testing has a significant effect in maintaining accuracy in capillary blood glucose monitoring.
Attending the Diabetes Center Is Associated With Increased 5-Year Survival Probability of Diabetic Patients: The Verona Diabetes Study
Authors: Verlato Giuseppe , Muggeo Michele , Bonora Enzo , Corbellini Maurizio , Bressan Franco , De Marco Roberto 
Published: March 2007

OBJECTIVE
The aim of the present study is to compare the survival of patients attending diabetes centers with that of patients exclusively consulting family physicians.

RESEARCH DESIGN AND METHODS
The study was carried out in the frame of the Verona Diabetes Study, a population-based survey of known diabetes prevalence with a subsequent 5-year mortality follow-up. A cohort of 7,488 diabetic patients were identified on 31 December 1986 from three diﬀerent sources: a drug consumption database, family physicians, and diabetes centers (one for children and one for adults). As of 31 December 1986, 3,288 patients in the entire cohort exclusively consulted their own family physicians, while 4,200 patients also had periodic examinations at the diabetes centers. The life status of the diabetic cohort was ascertained on 31 December 1991.

RESULTS
Compared with the nondiabetic population, diabetic patients seen only by family physicians had a standardized mortality ratio (SMR) of 1.62 (95% CI 1.51–1.74), while patients attending both family physicians and diabetes centers showed an SMR of 1.44 (1.34–1.54), the difference being statistically significant (P = 0.017). The 5-year survival probability, estimated by the Kaplan-Meier method, was 0.76 (0.75–0.78) in patients seen only by family physicians and 0.81 (0.80–0.82) in patients attending the diabetes centers. Multivariate analysis by Cox regression model showed that attending the diabetes centers was an independent predictor of survival even after adjusting for sex, age, and therapy of diabetes. The relative risk of 5-year all-cause mortality amounted to 0.83 (0.75–0.92) in patients also attending the diabetes centers with respect to patients consulting only family physicians (P &lt; 0.001).

CONCLUSIONS
These data on patients' survival indicate that diabetes centers play a crucial role in diabetes care. As a corollary, an integration between primary-care physicians and diabetes centers is strongly recommended.
Is the Incidence of Diabetes Increasing in All Age-Groups in The Netherlands?: Results of the second study in the Dutch Sentinel Practice Network
Authors: Ruwaard Dirk , Gijsen Ronald , Bartelds Aad I M , Hirasing Remy A , Verkleij Harry , Kromhout Daan 
Published: March 2007

OBJECTIVE
To assess possible changes in the incidence of diabetes in all age-groups in The Netherlands during a 10-year period (1980–1983/1990–1992).

RESEARCH DESIGN AND METHODS
Since 1970, a network of sentinel stations (the Dutch Sentinel Practice Network) consisting of ∼ 1% of the Dutch population has been in operation to gain insight into the morbidity patterns of the Dutch population as recorded by general practitioners. One of the items recorded from 1990 to 1992 was the incidence of diabetes. The first study with a similar design that registered the incidence of diabetes was conducted from 1980 to 1983.

RESULTS
The overall incidence of diabetes increased significantly by 12.1% in the period between the two studies. This overall increase can largely be attributed to a statistically significant increase in the age-group 45–64 years (30.5%). Although not statistically significant, the 36% increase of diabetes in the age-group 0–19 years is in accordance with the increase of type I diabetes based on the first and second nationwide retrospective studies covering the total Dutch population.

CONCLUSIONS
There is a marked increase in the incidence of diabetes in the age-group 45–64 years. This selective increase is probably not due to a real rise caused by changes in exposure to risk factors but to an earlier recognition of symptoms and signs of diabetes followed by blood glucose measurements and/or to more intensive case finding in general practice.
A Comparison of Renal Disease Across Two Continents: The Epidemiology of Diabetes Complications Study and the EURODIAB IDDM Complications Study
Authors: Lloyd Cathy E , Stephenson Judith , Fuller John H , Orchard Trevor J 
Published: March 2007

OBJECTIVE
To compare prevalence rates of increased albumin excretion in the Epidemiology of Diabetes Complications Study (EDC) (in the U.S.) to similar rates in the EURODIAB study (in Europe) and determine if any differences relate to hypertension, glycemic control, or smoking status.

RESEARCH DESIGN AND METHODS
The study population is made up of two epidemiological clinic-based IDDM populations with comparable ages (x = 28 years, both studies), sex distribution (50% male, EURODIAB; 49% male, EDC), and duration characteristics. Comparison of two cross-sectional (prevalence) studies was made. Despite different laboratory assays, comparability was established for urinary albumin (r = 0.98) and GHb measures (r = 0.95). Hypertension was measured with an identical protocol. Renal status was determined by 24-h urine albumin excretion (&lt; 20 μg/min normal, 20–200 μg/min microalbuminuria, &gt; 200 μg/min macroalbuminuria) in EURODIAB. Identical cutoffs were used for EDC, though two of three samples (24-h, 4-h clinic, and/or overnight sample) had to be positive in one range. (Main findings are confirmed using only 24-h results from EDC.)

RESULTS
The prevalence of macroalbuminuria was higher in EDC (27%) than in EURODIAB (12%). Rates of microalbuminuria were similar (22 vs. 25%, respectively). These patterns were seen at all durations and ages and in both sexes. Controlling for glycemic control, hypertension, or smoking did not account for the higher rate in EDC, nor did exclusion of subjects with raised serum creatinine.

CONCLUSIONS
Advanced renal disease is more prevalent in IDDM in EDC (Pittsburgh, PA) than in Europe. This is not explained by hypertension, glycemic control, or smoking.
Circulating catecholamines and metabolic effects of captopril in NIDDM patients
Authors: De Mattia Giancarlo , Ferri Claudio , Laurenti Oriana , Cassone-Faldetta Maria , Piccoli Alfonso , Santucci Anna 
Published: March 2007

OBJECTIVE
To evaluate the effects of captopril on circulating catecholamine levels in NIDDM patients and the possible relationship between captopril-related changes in circulating catecholamine levels and insulin sensitivity.

RESEARCH DESIGN AND METHODS
Fourteen nonobese normotensive NIDDM men (aged 44.5 ± 5.1 years) underwent a 2-h euglycemic-hyperinsulinemic clamp (40 mU·m−2 · min−1). Baseline evaluation of insulin sensitivity was followed by the random assignment of each patient to either captopril or placebo treatment, according to a crossover double-blind design. Euglycemic-hyperinsulinemic clamp studies were then repeated for all patients after both placebo and captopril treatments. Plasma norepinephrine (NE) and epinephrine (E) levels were assessed before, during, and after each clamp.

RESULTS
Resulting data showed that plasma catecholamine levels increased during baseline euglycemic-hyperinsulinemic clamp (NE: +23.6% time 0 vs. time 120 min, P &lt; 0.05; E: +24.8% time 0 vs. time 120 min, P &lt; 0.05). Captopril treatment significantly increased total glucose uptake (from 19.0 ± 9.0 to 26.8 ± 10.1 mmol·kg−1 · min−1, P &lt; 0.05) and reduced baseline plasma NE (P &lt; 0.001) and E (P &lt; 0.05) levels. However, the magnitude of the NE (+25.7% time 0 vs. time 120 min, P &lt; 0.001) and E (+27.2% time 0 vs. time 120 min, P &lt; 0.05) increments during euglycemic hyperinsulinemia were not affected by the drug. Percentage changes in the ratio of total body glucose uptake to circulating insulin levels and corresponding decrements of baseline plasma E levels after captopril therapy were negatively correlated (r = −0.57, P &lt; 0.05).

CONCLUSIONS
The reduction of circulating catecholamines could contribute, at least in part, to the captopril-related amelioration of insulin sensitivity.
Continued Insulin Dependence Despite Normal Range Insulin Sensitivity and Insulin Connecting Peptide Levels in a Kidney/Islet Transplant Patient
Authors: Atkison Paul R , Zucker Peter , Hramiak Irene , Paul Terri L , Dupre John , Behme Margaret T , Scharp David W , Lacy Paul E , Olack Barbera J , Stiller Calvin R 
Published: March 2007

OBJECTIVE
The majority of islet transplant recipients remain insulin-requiring, although many have near-normal connecting peptide (CP) levels. Insulin resistance may be one possible cause of the continuing need for exogenous insulin in islet transplant recipients. To assess this, we have studied the insulin sensitivity index (S1) in one patient with near-normal CP levels after islet transplant who remained insulin-requiring.

RESEARCH DESIGN AND METHODS
The islet transplant recipient is a 36-year-old woman with no residual CP who received a kidney transplant, followed 7 days later by an islet transplant. The islets were infused into the liver via the umbilical vein. Induction immunosuppression consisted of OKT3, prednisone, cyclosporin A, and azathioprine, with maintenance on the latter three.

RESULTS
Maximum CP levels after a standardized Sustacal meal were 2.09, 1.18, 0.85, and 0.81 nmol/l at 1,6,18, and 24 months posttransplant, respectively. Insulin requirements at the same times were 0.27, 0.45, 0.49, and 0.62 U·kg−1·d−1, while S1 was 36.3, 53.3, and 13.2 min −1·nmol−1·ml at 6,18, and 24 months, respectively. This compares with S1 values of 43.3 ± 10.0 min−1·nmol−1·ml for normal subjects.

CONCLUSIONS
This patient had near-normal S1 and CP levels, but she was unable to discontinue insulin therapy, suggesting that other factors are critical. Despite this, she maintained normal or near-normal glycated hemoglobins, indicating metabolic benefit from the islet transplant.
Glycemic Control and Prognosis in Type I Diabetic Patients With Microalbuminuria
Authors: Bojestig Mats , Arnqvist Hans J , Karlberg Bengt E , Ludvigsson Johnny 
Published: March 2007

OBJECTIVE
To investigate the course of microalbuminuria during the 1980s in type I diabetes patients.

RESEARCH DESIGN AND METHODS
This was a 10-year follow-up of 109 patients in whom type I diabetes was diagnosed between 1961 and 1980 before 15 years of age and who were initially investigated between 1977 and 1983 after a diabetes duration of ≥ 3 years. Microalbuminuria was defined as an albumin excretion rate (AER) of 20-200 μg/min in two of three consecutive urine samples.

RESULTS
At the initial investigation, 81 patients had normal AER, 27 had microalbuminuria, and 1 had macroalbuminuria. Between 1989 and 1992, 99 (91%) patients were reinvestigated. Only 5 (19%) of the initially microalbuminuric patients developed macroproteinuria during the 10-year follow-up period, and in 15 (58%) patients, AER decreased to normal. Three (4%) of the normoalbuminuric patients developed microalbuminuria but none macroproteinuria. The initially microalbuminuric patients, in whom AER normalized, improved their glycemic control from 1980-1983 to 1989-1991 (mean ± SE HbA1c 7.5 ± 0.2 to 6.6 ± 0.3%; P = 0.01).

CONCLUSIONS
In the majority of patients with microalbuminuria in whom it is possible to obtain good glycemic control, microalbuminuria will disappear and the risk of developing nephropathy will be markedly reduced.
Effect of Exercise Intensity on Glucose and Insulin Metabolism in Obese Individuals and Obese NIDDM Patients
Authors: Kang Jie , Robertson Robert J , Hagberg James M , Kelley David E , Goss Fredric L , Dasilva Sergio G , Suminski Richard R , Utter Alan C 
Published: March 2007

OBJECTIVE
The primary purpose of this study was to evaluate the acute effect of exercise of differing intensity on plasma glucose and insulin responses to an oral glucose challenge.

RESEARCH DESIGN AND METHODS
Six obese men and six obese men with NIDDM of similar age, weight, percentage body fat, and Vo2peak participated in the study. Each subject underwent two 7-day exercise programs in a counterbalanced order at 2-week intervals. During each 7-day exercise period, the subjects cycled every day at a power output corresponding to 50% Vo2peak for 70 min or 70% Vo2peak for 50 min. Muscle glycogen utilization was estimated during exercise on day 7 using a [3H]glucose infusion technique in conjunction with indirect calorimetry. During the day before and after each 7-day exercise period, a 3-h oral glucose tolerance test (OGTT) was administered after a 12-h overnight fast.

RESULTS
The average caloric expenditure did not differ between exercise at 50 and 70% Vo2peak in both obese and obese NIDDM subjects. However, the carbohydrate oxidation was higher (P &lt; 0.05) during exercise at 70 than 50% Vo2peak in obese subjects (77 ± 5 vs. 68 ± 6 g) and obese NIDDM subjects (70 ± 4 vs. 58 ± 6 g). Muscle glycogen utilization was also higher (P &lt; 0.05) during exercise at 70 than 50% Vo2peak in obese subjects (59 ± 9 vs. 30 ± 7 g) and in obese NIDDM subjects (48 ± 5 vs. 24 ± 5 g). In obese subjects, plasma glucose response area during the OGTT did not change after 7 days of exercise at either 50 or 70% Vo2peak. Plasma insulin response area during the OGTT also did not change after 7 days of exercise at 50% Vo2peak. However, plasma insulin response area was reduced (P &lt; 0.05) after 7 days of exercise at 70% Vo2peak (9,644 ± 1,783 vs. 7,538 ± 1,522 μ· ml"1 · 180 min"1). In obese NIDDM subjects, both plasma glucose and insulin response areas during the OGTT did not decrease after 7 days of exercise at either 50 or 70% Vo2peak.

CONCLUSIONS
It is concluded that the exercise-induced improvement in insulin sensitivity is influenced by exercise intensity in obese individuals. The improved insulin sensitivity after 7 days of exercise at 70% Vo2peak in obese individuals may be related to greater muscle glycogen utilization during exercise. The lack of improvement in glucose tolerance and insulin sensitivity after 7 days of exercise at either 50 or 70% Vo2peak in obese NIDDM patients may be due to the fact that the NIDDM patients selected in the present study were relatively hypoinsulinemic.
Postural Rearrangement in IDDM Patients With Peripheral Neuropathy
Authors: Giacomini Pier Giorgio , Bruno Ernesto , Monticone Glovanna , Di Girolamo Stefano , Magrini Antonio , Parisi Leoluca , Menzinger Guido , Uccioli Luigi 
Published: March 2007

OBJECTIVE
To evaluate the influence of diabetic peripheral neuropathy on postural strategy.

RESEARCH DESIGN AND METHODS
Static posturography and nerve conduction velocity were performed in the following age-matched subjects: 10 IDDM patients with peripheral neuropathy, 23 IDDM patients without peripheral neuropathy, and 21 control subjects. All subjects with signs or symptoms of postural instability were excluded from the study. The following posturographic parameters were drawn: 1) velocity of body sway, expressed as mean velocity and average of the SDs, 2) VFY, the parameter derived from the velocity variance and the anteroposterior mean position of the body (this parameter monitors the postural strategy pursued by the subject), and 3) fast Fourier transformation on the x (FFTX) and y (FFTY) planes, spectral analysis of the frequencies of body oscillation on frontal (x) and anteroposterior (y) planes.

RESULTS
Mean velocity and its SD were higher in IDDM patients with peripheral neuropathy than in control subjects and IDDM patients without peripheral neuropathy (P &lt; 0.001). VFY was increased in IDDM patients with peripheral neuropathy versus control subjects and IDDM patients without peripheral neuropathy (P &lt; 0.01). A direct relationship was found between parameters of posturography and some parameters of nerve conduction tests.

CONCLUSIONS
Diabetic patients with peripheral neuropathy demonstrate a shift from physiological ankle control to hip postural control as monitored by specific posturography analysis.
The Relationship Between Socioeconomic Status and Diabetes Control and Complications in the EURODIAB IDDM Complications Study
Authors: Chaturvedi Nishi , Stephenson Judith M , Fuller John H ,   The EURODIAB IDDM Complications
Published: March 2007

OBJECTIVE
To determine whether there are socioeconomic differences in diabetes control and complications in people with IDDM.

RESEARCH DESIGN AND METHODS
We conducted a prevalence survey of 1,217 men and 1,170 women with IDDM age 25–60 years from European clinics. Age at completion of education defined socioeconomic status: ≤ 14 years defined those with primary education; 15–18 years, as secondary education; and &gt; 19 years, as college education. Glycemic control, lipids, diet, retinopathy, neuropathy, and heart disease were assessed centrally.

RESULTS
People with a primary education were older and had diabetes for longer than those with a college education. The mean percentage of HbA1c was worst in the primary-educated men (6.6 vs. 6.1%, P = 0.0007 for trend) and women (6.5 vs. 6.0%, P = 0.0007). Total cholesterol level was higher in primary-educated than in college-educated men (5.6 vs 5.3 mmol/l, P = 0.002), as was triglyceride level (1.23 vs. 1.02 mmol/l, P = 0.0001). College-educated people were the least likely to be current smokers (P &lt; 0.0001), and were most likely to partake in vigorous exercise (P &lt; 0.001). Surprisingly, There was little difference in the prevalence of heart disease by educational status in men, while it was highest in the least educated women, but proliferative retinopathy was more common in primary- than in college-educated men (16 vs 10%, P = 0.04) as was macroalbuminuria (15 vs 9%, P = 0.03). Glycemic control could not fully account for these differences.

CONCLUSIONS
Healthy lifestyles are more prevalent in better educated men and women with IDDM, but these are not reflected in heart disease prevalence in men. The lower prevalence of severe microvascular complications in better educated men, unaccounted for by better glycemic control, requires further investigation.