bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum Insulin, Obesity, and the Incidence of Type 2 Diabetes in Black and White Adults
Authors: Carnethon Mercedes R. , Palaniappan Latha P. , Burchfiel Cecil M. , Brancati Frederick L. , Fortmann Stephen P. 
Published: March 2007

OBJECTIVE—In this study, we tested the hypothesis that fasting serum insulin is higher in nonobese black adults than in white adults and that high fasting insulin predicts type 2 diabetes equally well in both groups.
RESEARCH DESIGN AND METHODS—At the baseline examination (1987–1989) of the Atherosclerosis Risk in Communities Study, fasting insulin and BMI were measured in 13,416 black and white men and women without diabetes. Participants were examined at years 3, 6, and 9 for incident diabetes based on fasting glucose and American Diabetes Association criteria.
RESULTS—Fasting insulin was 19.7 pmol/l higher among nonobese (BMI &lt;30 kg/m2) black women compared with white women (race and obesity interaction term, P &lt; 0.01). There were no differences among men. Among nonobese women, the relative risk for developing diabetes was similar between racial groups: 1.4 (95% CI 1.2–1.5) and 1.3 (1.2–1.4) per 60 pmol/l increase in insulin (P &lt; 0.01) for black and white women, respectively (interaction term, P = 0.6). Findings were similar among men. Adjusting for established risk factors did not attenuate this association.
CONCLUSIONS—Nonobese black women have higher fasting insulin levels than nonobese white women, and fasting insulin is an equally strong predictor of diabetes in both groups. These results suggest one mechanism to explain the excess incidence of diabetes in nonobese black women but do not explain the excess among black men. Future research should evaluate additional factors: genetic, environmental, or the combination of both, which might explain higher fasting insulin among black women when compared with white women.
Digital Retinal Images and Teleophthalmology for Detecting and Grading Diabetic Retinopathy
Authors: Gómez-Ulla Francisco , Fernandez Maria I. , Gonzalez Francisco , Rey Pablo , Rodriguez Marta , Rodriguez-Cid Maria J. , Casanueva Felipe F. , Tome Maria A. , Garcia-Tobio Javier , Gude Francisco 
Published: March 2007

OBJECTIVE—Detecting and grading of diabetic retinopathy (DR) by means of digital retinal images sent via the Internet.
RESEARCH DESIGN AND METHODS—Four nonstereoscopic digital retinal images (45° field each) of 126 eye fundus images from 70 diabetic patients were obtained with a nonmydriatic camera at two peripheral units. The images were sent via the Internet using a web-based system to a reference center, where they were diagnosed and graded by one ophthalmologist. These results were compared with those obtained by two other ophthalmologists, one at each peripheral unit, after direct examination of the patients. A modified severity scale of Airlie House was used for grading DR in all cases. Agreement between observers was assessed using unweighted κ for categorical data and the intraclass correlation coefficient (ICC) for continuous data.
RESULTS—Presence of DR was detected in 69 eyes (55%). All eyes with DR (69 of 69, 100%) were correctly identified (κ = 1) by inspecting the digital images. In 118 eyes (118 of 126, 94%), 57 with no DR and 61 with DR, there was an agreement between the gradation made after the direct examination and the gradation made after the inspection of the images (ICC = 0.92). In eight eyes with DR (8 of 126, 6%), there was disagreement in the grading made with both techniques.
CONCLUSIONS—Inspection of digital retinal images sent via the Internet allowed diagnosis and grading of DR. The presence or absence of DR was correctly assessed by inspection of the images in all instances. We also found agreement, in most cases, between retinopathy gradation made from the images and the gradation made by direct examination of the eyes. These findings suggest that this technique is suitable for screening procedures.
Assessment of Asymptomatic Coronary Artery Disease in Apparently Uncomplicated Type 2 Diabetic Patients
Authors: Gazzaruso Carmine , Garzaniti Adriana , Giordanetti Stefano , Falcone Colomba , De Amici Emanuela , Geroldi Diego , Fratino Pietro 
Published: March 2007

OBJECTIVE—In patients with uncomplicated diabetes, there is low probability of finding significant coronary artery disease (CAD) by noninvasive tests. Therefore, screening for its presence is not justified, and it is important to find reliable predictors of silent CAD to identify patients with uncomplicated diabetes for further screening. The relationship between lipoprotein(a) [Lp(a)], apolipoprotein(a) [apo(a)] polymorphism, and silent CAD has never been studied. We investigated the association of Lp(a) and apo(a) polymorphism with angiographically documented asymptomatic CAD in type 2 diabetic patients without evident complications.
RESEARCH DESIGN AND METHODS—A total of 1,323 diabetic patients without any clinical and electrocardiographic evidence of CAD were evaluated. Of 121 patients with highly positive results of exercise electrocardiography (ECG) (n = 30) or positive results on exercise thallium scintigraphy (n = 91), 103 subjects showed angiographically documented CAD (CAD group). Of 1,106 patients with negative results on exercise ECG, 103 subjects without CAD (NO CAD group) were selected and matched by age, gender, and duration of diabetes to patients in the CAD group. In patients in the NO CAD group, results of exercise ECG, 48-h ambulatory ECG, and stress echocardiography were negative for CAD.
RESULTS—The CAD group had higher Lp(a) levels (21.7 ± 17.7 vs. 15.2 ± 19.0 mg/dl; P = 0.0093) than the NO CAD group, and a percentage of subjects had at least one small apo(a) isoform (68.9 vs. 29.1%; P = 0.0000) higher than the NO CAD group. Logistic regression analysis showed that apo(a) phenotypes (odds ratio [OR] 8.13, 95% CI 3.65–21.23), microalbuminuria (5.38, 2.44–11.88), smoking (2.72, 1.31–5.64), and Lp(a) levels (2.41, 1.15–5.03) were predictors of asymptomatic CAD.
CONCLUSIONS—Our investigation reports the first evidence of an independent association of Lp(a) and apo(a) polymorphism with asymptomatic CAD. This suggests that Lp(a) levels and apo(a) phenotypes could be used together with other risk factors as markers of asymptomatic CAD in patients with diabetes.
Population-Based Study of Diabetes and Risk Characteristics in Turkey
Authors: Satman Ilhan , Yilmaz Temel , Sengül Ahmet , Salman Serpil , Salman Fatih , Uygur Sevil , Bastar Irfan , Tütüncü Yildiz , Sargin Mehmet , Dinççag Nevin , Karsidag Kubilay , Kalaça Sibel , Özcan Cihangir , King Hilary ,   The TURDEP Group
Published: March 2007

OBJECTIVES—To investigate for the first time the prevalence of diabetes and impaired glucose tolerance (IGT) nationwide in Turkey; to assess regional variations and relationships between glucose intolerance and lifestyle and physical risk factors.
RESEARCH DESIGN AND METHODS—The Turkish Diabetes Epidemiology Study (TURDEP) is a cross-sectional, population-based survey that included 24,788 subjects (age ≥20 years, women 55%, response 85%). Glucose tolerance was classified according to World Health Organization recommendations on the basis of 2-h blood glucose values.
RESULTS—Crude prevalence of diabetes was 7.2% (previously undiagnosed, 2.3%) and of IGT, 6.7% (age-standardized to world and European populations, 7.9 and 7.0%). Both were more frequent in women than men (P &lt; 0.0001) and in those living in urban rather than rural communities (P &lt; 0.001). Prevalence rates of hypertension and obesity were 29 and 22%, respectively. Both were more common among women than men (P &lt; 0.0001). Prevalence of diabetes and IGT increased with rising BMI, waist-to-hip ratio (WHR), and waist girth (P &lt; 0.0001). Multiple logistic regression analysis revealed that age, BMI, WHR, familial diabetes, and hypertension were independently associated with diabetes, age, BMI, WHR, familial diabetes, and hypertension with IGT (except for familial diabetes in women with IGT). Education was related to diabetes in men but was protective for diabetes and IGT in women. Socioeconomic status appeared to decrease the risk of IGT in men while it increased the risk in women. Smoking had a protective effect for IGT in both sexes.
CONCLUSIONS—Diabetes and IGT are moderately common in Turkey by international standards. Associations with obesity and hypertension have been confirmed. Other lifestyle factors had a variable relationship with glucose tolerance.
Women With Impaired Glucose Tolerance During Pregnancy Have Significantly Poor Pregnancy Outcomes
Authors: Yang Xilin , Hsu-Hage Bridget , Zhang Hong , Zhang Cuiping , Zhang Yanni , Zhang Changjun 
Published: March 2007

OBJECTIVE—This article tests the hypothesis that women with impaired glucose tolerance (IGT) have the same pregnancy outcomes as those of their counterparts with normal glucose tolerance.
RESEARCH DESIGN AND METHODS—From December 1998 to December 1999, 84 of 90 antenatal care base units (ACBUs) under the Tianjin Antenatal Care Network in China participated in the first screening program for gestational diabetes mellitus (GDM). A total of 9,471 pregnant women under the care of participating ACBUs were screened. Of the women screened, 154 were positive for IGT. Of the 154 women, 102 opted for conventional obstetric care. The comparison group was 302 women of normal glucose tolerance (NGT). The initial screening consisted of a 50-g 1-h glucose test, and was carried out at 26–30 gestational weeks. Women with a serum glucose ≥7.8 mmol/l were followed up with a 75-g 2-h oral glucose tolerance test. The World Health Organization’s diagnostic criteria for GDM were used.
RESULTS—Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90–34.93); preterm birth (6.42; 1.46–28.34); breech presentation (3.47; 1.11–10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07–5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors.
CONCLUSIONS—The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.
Prevalence of Gestational Diabetes Mellitus Detected by the National Diabetes Data Group or the Carpenter and Coustan Plasma Glucose Thresholds
Authors: Ferrara Assiamira , Hedderson Monique M. , Quesenberry Charles P. , Selby Joseph V. 
Published: March 2007

OBJECTIVE—In 2000, the American Diabetes Association proposed the adoption of the Carpenter and Coustan criteria for diagnosis of gestational diabetes mellitus (GDM). The Carpenter and Coustan cutoffs are lower than the previously recommended National Diabetes Data Group (NDDG) values and would result in higher prevalence of GDM. Our aim is to estimate the magnitude of change in prevalence of GDM using the Carpenter and Coustan thresholds as compared with the NDDG thresholds by age and ethnicity.
RESEARCH DESIGN AND METHODS—Cross-sectional study of 28,330 women aged 14–49 years who gave birth in 1996 and were members of the Northern California Kaiser Permanente Medical Care Program. Age, ethnicity, screening, and diagnostic test results were assessed from computerized hospitalization and laboratory systems.
RESULTS—A total of 26,481 (94%) women were screened using a 50-g, 1-h oral glucose tolerance test, and 4,190 women underwent a diagnostic 100-g, 3-h oral glucose tolerance test after an abnormal screening. Overall, the GDM prevalence among screened women was 3.2% (95% CI 3.0–3.4) by NDDG and 4.8% (95% CI 4.5–5.1) by Carpenter and Coustan criteria, and based on either threshold, it increased with age (P &lt; 0.001). The age-adjusted GDM prevalence by NDDG and Carpenter and Coustan criteria, respectively, was 5.0 and 7.4% in Asians, 3.9 and 5.6% in Hispanics, 3.0 and 4.0% in African-Americans, and 2.4 and 3.8% in whites. Proportional increments were larger in women aged &lt;25 years (70%) and in whites (58%).
CONCLUSIONS—The prevalence of GDM increased, on average, by 50% with use of the Carpenter and Coustan thresholds. Relative increments were greater in low-risk age and ethnic groups. This information would be useful for clinical settings in predicting cost of GDM based on demographic characteristics of the population.
Factors Associated With Academic Achievement in Children With Type 1 Diabetes
Authors: McCarthy Ann Marie , Lindgren Scott , Mengeling Michelle A. , Tsalikian Eva , Engvall Janet 
Published: March 2007

OBJECTIVE—To examine academic achievement in children with diabetes and to identify predictors of achievement.
RESEARCH DESIGN AND METHODS—Participants were 244 children, ages 8–18 years, with type 1 diabetes. Measures included school-administered standardized achievement tests (Iowa Tests of Basic Skills and Iowa Tests of Educational Development [ITBS/ITED]), grade point averages (GPAs), school absences, behavioral assessment, age at disease onset, hospitalizations, and HbA1c. Statistical differences between subgroups of children were evaluated using t test and ANOVA, statistically controlling for socioeconomic status. Regression analyses were carried out to examine predictors of academic performance.
RESULTS—Reading scores and GPA were lower for children with poor metabolic control than for children with average control. Children with hospitalizations for hyperglycemia had lower overall achievement scores than children with better metabolic control and fewer hospitalizations for hyperglycemia. The small group of children with tight metabolic control and hypoglycemic hospitalizations scored particularly low on the ITBS/ITED. Other variables had less clear relationships with academic achievement. Neither early onset of diabetes nor frequent school absence was associated with lower scores on the ITBS/ITED. Sex comparisons found that boys performed better than girls only in math. Socioeconomic status and parent ratings of behavior problems were significantly correlated with academic achievement, but medical variables added only slightly to predictive precision.
CONCLUSIONS—For most children with diabetes, medical variables are not as strongly associated with academic achievement as are factors such as socioeconomic status and behavioral factors. Poor metabolic control and serious hypoglycemia, however, are a potential concern for a subset of these children.
Autoregulation of Glomerular Filtration Rate in Patients With Type 2 Diabetes During Isradipine Therapy
Authors: Christensen Per K. , Akram Kamran , Kønig Karen B. , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—Calcium-channel blockade impairs renal autoregulation in animals. Impaired renal autoregulation leads to transmission of the systemic blood pressure (BP) into the glomerulus, resulting in capillary hypertension. Information on the impact of calcium antagonist treatment on renal autoregulation in humans is lacking. This study examines the effect of isradipine treatment on the autoregulation of the glomerular filtration rate (GFR).
RESEARCH DESIGN AND METHODS—We performed a randomized double-blind crossover study with 5 mg o.d. isradipine retard and matching placebo in 16 hypertensive patients with type 2 diabetes. Each treatment arm lasted 4 weeks. On the last day of each treatment period, GFR (single-shot 51Cr-EDTA plasma clearance technique for 4 h) was measured twice between 8:00 a.m. and 5:00 p.m., first without clonidine and then after intravenous injection of 75 μg clonidine. BP was measured every 10 min (Takeda TM2420; A&D, Tokyo).
RESULTS—Clonidine reduced mean arterial BP (MABP) by 15 ± 1 vs. 11 ± 1 mmHg (means ± SE) during placebo and isradipine treatment, respectively (P &lt; 0.05). GFR was reduced from 102 ± 4 to 99 ± 4 ml · min−1 · 1.73 m−2 with placebo (P &lt; 0.01) and from 106 ± 5 to 98 ± 5 ml · min−1 · 1.73 m−2 during treatment with isradipine (P &lt; 0.01). Mean difference (95% CI) between changes in GFR with placebo and isradipine was −4.6 ml · min−1 · 1.73 m−2 (−10.0 to 0.6) (P = 0.08). Six patients had a reduction in GFR &gt;13% (exceeding the normal limit of autoregulation) combined with a complete pressure-passive vasculature (defined as ΔMABP% ≤ ΔGFR%) during isradipine treatment versus none during the placebo treatment (P &lt; 0.05).
CONCLUSIONS—Isradipine impairs GFR autoregulation in a sizeable proportion of hypertensive type 2 diabetic patients.
Promoter Polymorphisms −359T/C and −303A/G of the Catalytic Subunit p110β Gene of Human Phosphatidylinositol 3-Kinase Are Not Associated With Insulin Secretion or Insulin Sensitivity in Finnish Subjects
Authors: Kossila Maija , Pihlajamäki Jussi , Kärkkäinen Päivi , Miettinen Raija , Kekäläinen Päivi , Vauhkonen Ilkka , Ylä-Herttuala Seppo , Laakso Markku 
Published: March 2007

OBJECTIVE—Phosphatidylinositol (PI) 3-kinase activity is required for insulin-stimulated translocation of GLUT4 transporters and glucose uptake and utilization. Therefore, genes encoding the subunits of PI 3-kinase are promising candidate genes for insulin resistance and type 2 diabetes. We recently cloned the catalytic subunit p110β gene of human PI 3-kinase and reported two nucleotide polymorphisms, −359T/C and −303A/G, in the promoter region of this gene. In this study, we determined the effects of these polymorphisms on insulin secretion and insulin sensitivity.
RESEARCH DESIGN AND METHODS—We studied two separate groups of Finnish nondiabetic subjects. Insulin secretion was evaluated by intravenous glucose tolerance test and insulin sensitivity by hyperinsulinemic-euglycemic clamp.
RESULTS—Our results showed that the −359T/C and −303A/G polymorphisms did not have a significant effect on fasting plasma insulin levels, insulin secretion, or insulin sensitivity.
CONCLUSIONS—It is unlikely that the promoter polymorphisms −359T/C and −303A/G of the catalytic subunit p110β gene of human PI 3-kinase have a major impact on insulin secretion, insulin sensitivity, or the risk of type 2 diabetes in Finnish subjects.
Excess Physical Limitations Among Adults With Diabetes in the U.S. Population, 1997–1999
Authors: Ryerson Blythe , Tierney Edward F. , Thompson Theodore J. , Engelgau Michael M. , Wang Jing , Gregg Edward W. , Geiss Linda S. 
Published: March 2007

OBJECTIVE—To estimate the prevalence of physical limitations associated with diabetes among U.S. adults ≥18 years of age.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional analysis of the association between diabetes status and physical limitations using the 1997–1999 National Health Interview Survey (NHIS). Physical limitation was defined from self-reported degree of difficulty with nine tasks.
RESULTS—People with diabetes had a higher proportion of any physical limitation than did people without diabetes overall (66 vs. 29%, P &lt; 0.001), for both men (59 vs. 24%, P &lt; 0.001) and women (72 vs. 34%, P &lt; 0.001). Compared with those without diabetes, a higher proportion of people with diabetes had some physical limitation among all age groups, and the difference declined (all P &lt; 0.001) with increasing age (46 vs. 18% for 18–44 years, 63 vs. 35% for 45–64 years, 74 vs. 53% for 65–74 years, and 85 vs. 70% for those 75 years and older). After controlling for demographic characteristics and several other confounders, the odds ratio of physical limitation among adults with diabetes versus those without diabetes was 1.9 (95% CI: 1.8–2.1).
CONCLUSIONS—People with diabetes are much more likely to have a physical limitation than those without diabetes. Interventions are needed in this population to reduce progression from impairment to physical limitation and from physical limitation to disability, especially because the prevalence of diabetes is projected to increase dramatically in the next several decades.
Diabetic Muscle Infarction
Authors: Trujillo-Santos A. J. 
Published: March 2007

OBJECTIVE—To systematically review all the reported cases of diabetic muscle infarction (DMI) and its pathogenesis, clinical features, prognostic implications, and management.
RESEARCH DESIGN AND METHODS—We searched databases (MEDLINE and EMBASE) from their inception to August 2001 and reviewed bibliographies in reports retrieved. Data were extracted in a standardized form.
RESULTS—A total of 47 references were retrieved; 115 patients and 166 episodes were included. DMI was more frequent in women (61.5%, mean age at presentation 42.6 years). Of the cases, 59% had type 1 diabetes; the mean duration of disease was 14.3 years, and multiple diabetic end-organ complications were noted. DMI affects the lower limbs with abrupt onset of pain and local swelling. Diagnosis is made by biopsy, but the characteristic features in magnetic resonance imaging are very typical. Treatment includes bed rest and administration of analgesics, but recurrence is common.
CONCLUSIONS—DMI is a very uncommon complication of long-standing diabetes; presentation is well characterized and management is simple.
Randomized Controlled Community-Based Nutrition and Exercise Intervention Improves Glycemia and Cardiovascular Risk Factors in Type 2 Diabetic Patients in Rural Costa Rica
Authors: Goldhaber-Fiebert Jeremy D. , Goldhaber-Fiebert Sara N. , Tristán Mario L. , Nathan David M. 
Published: March 2007

OBJECTIVE—The prevalence of type 2 diabetes, especially in developing countries, has grown over the past decades. We performed a controlled clinical study to determine whether a community-based, group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica.
RESEARCH DESIGN AND METHODS—A total of 75 adults with type 2 diabetes, mean age 59 years, were randomly assigned to the intervention group or the control group. All participants received basic diabetes education. The subjects in the intervention group participated in 11 weekly nutrition classes (90 min each session). Subjects for whom exercise was deemed safe also participated in triweekly walking groups (60 min each session). Glycosylated hemoglobin, fasting plasma glucose, total cholesterol, triglycerides, HDL and LDL cholesterol, height, weight, BMI, and blood pressure were measured at baseline and the end of the study (after 12 weeks).
RESULTS—The intervention group lost 1.0 ± 2.2 kg compared with a weight gain in the control group of 0.4 ± 2.3 kg (P = 0.028). Fasting plasma glucose decreased 19 ± 55 mg/dl in the intervention group and increased 16 ± 78 mg/dl in the control group (P = 0.048). Glycosylated hemoglobin decreased 1.8 ± 2.3% in the intervention group and 0.4 ± 2.3% in the control group (P = 0.028).
CONCLUSIONS—Glycemic control of type 2 diabetic patients can be improved through community-based, group-centered public health interventions addressing nutrition and exercise. This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes.