bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Soya and Cellulose Fibers on Postprandial Glycemic Response in Type II Diabetic Patients
Authors: Librenti Maria C , Cocchi Massimo , Orsi Emanuela , Pozza Guido , Micossi Piero 
Published: March 2007

Objective
We studied the effect on serum glucose and insulin of a preprandial ingestion of 7 g of soya fibers or of an equal amount of purified cellulose on eight non-insulin-dependent (type II) diabetic patients.

Research Design and Methods
Four tests were conducted in each patient in random order. In the first study, soya or cellulose was ingested before a standard breakfast, and postprandial glucose and insulin curves were determined. In the second study, intestinal absorption was investigated by means of a standard D-xylose absorption excretion test after the ingestion of soya or cellulose.

Results
Insulin profiles did not differ between the two treatments. The glycemic profiles after soya ingestion were lower than those after cellulose ingestion. The area under the glucose curve and glucose peaks were significantly higher after cellulose ingestion (area under the curve 20.2 ± 3.88 vs. 15.57 ± 4.42 mM × min, P = .05; glucose peaks 4.97 ± 0.76 vs. 3.77 ± 0.77 mM, P &lt; 0.02). The xylose tests were in the normal range, indicating that there was no interference with exose absorption, and no statistical difference was found between cellulose and soya treatment.

Conclusions
It is concluded that soya fiber compared with purified cellulose has a favorable effect on the rise of postprandial glycemia in type II diabetic patients; moreover, the use of soya fibers did not carry any untoward side effect.
Parental and Professional Estimates of Self-Care Independence of Children and Adolescents With IDDM
Authors: Wysocki Tim , Meinhold Patrical A , Abrams Keith C , Barnard Martha U , Clarke William L , Bellando B Jayne , Bourgeois Michael J 
Published: March 2007

Objective
–To report the results of a survey of 490 parents of children with insulin-dependent diabetes mellitus (IDDM) regarding the children's mastery of 38 diabetes-care skills. Parental responses are contrasted with those of a previous survey in which 229 diabetes professionals estimated ages at which typical children with IDDM master the same skills.

Research Design and Methods
–Parents were recruited at five pediatric endocrinology clinics with a response rate of 88.9%.

Results
–For 33 of 38 skills, professionals' median mastery age estimates exceeded, by ≥1 yr, the median ages that parents reported skill mastery by their estimates, children. Despite the parent-professional disagreement about mastery-age their survey responses yielded substantial agreement about the order of mastery of specific skills. The data also revealed two profiles of comparative results. For many items, parents reported earlier skill mastery, but parental and professional estimates eventually converged during adolescence. These skills consisted of rote, motoric acts, or more complex tasks for which errors yield relatively certain aversive consequences. For other skills, more professional estimated skill mastery among adolescents than did parents. These skills required substantial organization and self-regulation by the adolescent, involved treatment components for which the aversive consequences of errors are deferred and uncertain, or they were skills infrequently required of most patients with IDDM.

Conclusions
–The parent-professional discordance revealed by this survey illustrates the importance of clear specification of treatment responsibilities, careful monitoring of self-care competence, and periodic reeducation of children with IDDM.
Natural Course of Remission in IDDM During 1st yr After Diagnosis
Authors: Martin Stephen , Pawlowski Brigette , Greulich Burkard , Ziegler Anette G , Mandrup-Poulsen Thomas , Mahon Jeffrey 
Published: March 2007

Objective
–To describe the natural course of clinical remission in insulin-dependent diabetes mellitus (IDDM) when insulin dose is minimized without loss of target glycemia and to identify factors that predict clinical remission.

Research Design and Methods
–Ninety-five patients, who were placebo-treated control subjects in the Canadian-European multicenter randomized trial of cyclosporin A in recent-onset IDDM, were studied.

Results
–The mean insulin dose decreased during the first months after diagnosis, with a nadir at 3 mo, when 27% of the patients did not require insulin to maintain target glycemia. At 1 yr, 10% of patients still did not need insulin. Patients not receiving insulin who had glycosylated hemoglobin within the normal range were called remitters. Mean basal and glucagon-stimulated C-peptide values were significantly (P &lt; 0.025) higher in remitters than nonremitters at the start of the study. Therefore, all patients were divided into those with values above the mean stimulated C-peptide (0.4 nM) and those with values below the mean at entry. The probability of entering a remission with a stimulated C-peptide &gt; 0.4 nM was 10 times as high (P &lt; 0.05) as for those with a stimulated C-peptide below this level. Surprisingly, the beginning and end of the remission were associated with neither major changes in C-peptide levels nor islet cell antibody and insulin-antibody titer. A more rapid loss of stimulated C-peptide occurred in patients who lacked HLA-DR3 and -DR4 (P &lt; 0.05 at mo 9).

Conclusions
–This study shows a higher spontaneous clinical remission rate than expected during the 1st yr after diagnosis. Preserved beta-cell function at entry predicts a greater chance of entering a remission, and a more rapid loss of beta-cell function was seen in patients without HLA-DR3 and -DR4.
Community-Based Epidemiological Study on Diabetes in Pu-Li, Taiwan
Authors: Chou Pesus , Chen Hsu-Hsi , Hsiao Kwang-Jen 
Published: March 2007

Objective
–To determine the prevalence and possible risk factors associated with diabetes in Pu-Li, Taiwan.

Research Design and Methods
–The project was a community-based cross-sectional study with stratified cluster sampling of residents ≥ 30 yr of age. Medical students conducted home-visit interviews with public health nurses, drew fasting blood samples from 1738 of 2573 registered residents ≥ 30 yr of age in Pu-Li, Taiwan.

Results
–The prevalence of diabetes, including those with a history of diabetes and newly diagnosed cases determined by modified World Health Organization criteria, was 12.4%. With the standard world population of Segi, the age-adjusted prevalences were 6.9% for previous diabetes and 4.4% for new diabetes. The age-specific prevalence of diabetes increased significantly with age for new diabetes cases but not for previously diagnosed cases. To study factors associated with diabetes, we first applied univariate analysis. Stratified analyses by age and sex were used for interaction assessment. A significant interaction effect on diabetes was found between age and sex. Logistic regression was used for multivariate analysis. The final model showed that, after controlling for all other covariates, the significant factors associated with diabetes were family history of diabetes (father and/or mother, yes vs. no, odds ratio [OR] 3.13, 95% confidence interval [CI] 1.17–8.33), obesity (yes vs. no, OR 2.69, 95% CI 1.09–6.63), and age (continuous, OR 1.04, 95% CI 1.00–1.08). Locality and physical activity were not significantly correlated with diabetes.

Conclusions
–The age-adjusted prevalence of diabetes in Pu-Li were 6.9% for previous diabetes and 4.4% for new diabetes. Possible risk factors associated with diabetes with logistic regression were family history of diabetes, obesity, and age. Locality and physical activity were not significantly correlated with diabetes.
Hyperfibrinogenemia: An important risk factor for vascular complications in diabetes
Authors: Ganda Om P , Arkin Charles F 
Published: March 2007

OBJECTIVE
To evaluate the determinants of elevated fibrinogen levels and the impact of hyperfibrinogenemia on vascular complications in diabetes.

RESEARCH DESIGN AND METHODS
Plasma fibrinogen, glucose, HbA1, and lipids were measured in 116 ambulatory type I and type II diabetic patients with (n = 59) or without (n = 57) clinical evidence of micro- or macrovascular complications. In 56 of these patients, factor VII activity and CRP also were measured. Univariate and multivariate data analyses were conducted.

RESULTS
Overall mean ± SE fibrinogen levels in patients (339 ± 7.3 mg/dl) were elevated markedly compared with control subjects (248 ± 9.1 mg/dl). Fibrinogen levels were elevated disproportionately in patients with type II diabetes (P &lt; 0.0001), hypertension (P = 0.0001), obesity (P &lt; 0.0001), and vascular complications (P &lt; 0.0001). Fibrinogen was correlated significantly with age (P &lt; 0.001), cholesterol (P = 0.002), CRP (P &lt; 0.001), and factor VII activity (P = 0.032), but not with plasma glucose, triglycerides, HDL cholesterol, or disease duration. Stepwise multiple regression analyses revealed that type II diabetes and presence of vascular complications were major determinants of fibrinogen. For vascular complications, fibrinogen emerged as one of only three independent predictors, the other two being diabetes duration and hypertension.
Prevalence and clinical picture of IDDM in Nigerian Igbo schoolchildren
Authors: Afoke Anthony O , Ejeh Ndubuisi M , Nwonu Eunice N , Okafor Christopher O , Udeh Nnanna J , Ludvigsson Johnny 
Published: March 2007

OBJECTIVE
To evaluate the prevalence and clinical picture of IDDM in Nigerian Igbo schoolchildren born and living in continental Africa.

RESEARCH DESIGN AND METHODS
In three school districts (Ezza, Ishielu, Ohaukwu), 77,862 schoolchildren aged 5–17 yr answered our questionnaires on age, sex, known disease, drugs being taken, family history, and diabetic symptoms like polyuria, polydipsia, polyphagia, and weight loss. Positive respondents were given glucosuric tests, and glucosuric subjects had hyperglycemic tests. Diagnosis of IDDM was established in hyperglycemic patients by referred hospital clinicians based on insulin requirements.

RESULTS
Twelve new cases of IDDM were found in addition to 14 previously diagnosed cases, giving a CPR of 0.33/1000. Ishielu had a CPR of 0.46/1000 compared with 0.25 (P &lt; 0.01) for Ohaukwu. Boys had a CPR of 0.38/1000 compared with 0.25/1000 (P &lt; 0.06) for girls. Boy-to-girl prevalence ratio was ∼ 3:1.

CONCLUSIONS
The relatively high prevalence of IDDM in this poor African population, despite potential deaths caused by minimal medical attention, may be because of long-term protein malnutrition and endemic childhood infections, which have been implicated in the etiology of IDDM in similar malnourished populations.
Insulin Requirements in Insulin-Dependent and Insulin-Requiring GDM Women During Final Month of Pregnancy
Authors: McManus Ruth M , Ryan Edmond A 
Published: March 2007

OBJECTIVE
To determine the significance of falling insulin requirements after the 36th wk of gestation in insulin-requiring pregnant women.

RESEARCH DESIGN AND METHODS
Insulin requirements of women with IDDM and IRGDM were assessed from the 36th wk of pregnancy, with evaluation of maternal characteristics and fetal outcomes.

RESULTS
In 32 pregnancies of women with IDDM, there was a 5 ± 2% decrease in insulin requirements, and in 19 pregnancies of women with IRGDM, there was a 28 ± 10% increase. Of the 62% of women whose insulin requirements declined, the decrement was 12 ± 2% and was associated with longer duration of diabetes (12 ± 2 vs. 6 ± 1 yr, P &lt; 0.05) but not with age, prepregnancy BMI, weight gain, or maternal or fetal complications. Only 3 pregnancies in IRGDM women were associated with a decrease in insulin requirements. Although maternal parameters were no different from those with IDDM, infants born to women with IRGDM were smaller (3531 ± 123 vs. 3874 ± 94 g, P &lt; 0.005).

CONCLUSIONS
Insulin requirements from the 36th wk of gestation commonly decreased in women with IDDM, associated with longer duration of diabetes but did not carry any adverse prognostic indication for the infants. Women with IRGDM experienced a continual increase in insulin requirements over the final weeks of pregnancy.
Cost-Effectiveness of Alternative Methods for Diabetic Retinopathy Screening
Authors: Lairson David R , Pugh Jacqueline A , Kapadia Asha S , Lorimor Ronald J , Jacobson James , Velez Ramon 
Published: March 2007

OBJECTIVE
To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degrees retinal camera compared to the standard ophthalmologist's exam and an ophthalmic exam by a physician's assistant or nurse practitioner technician, for detecting nonproliferative and proliferative diabetic retinopathy.

RESEARCH DESIGN AND METHODS
Comparison of 45-degrees fundus photographs with and without pharmacological pupil dilation taken by technicians and interpreted by experts, direct and indirect ophthalmoscopy by ophthalmologists, and direct ophthalmoscopy by technicians with seven-field stereoscopic fundus photography (reference standard). Costs were estimated from market prices and actual resource use. The study included 352 patients attending outpatient diabetes and general-medicine clinics at VA and DOD facilities.

RESULTS
Medical system costs per true positive were: 45-degrees photos with dilation, $295; 45-degrees photos without dilation, $378; ophthalmologist, $390; and technician, $794. Patient costs per true positive were: 45-degrees photos with dilation, $139; 45-degrees photos without dilation, $171; ophthalmologist, $306; and technician, $1009. Cost-effectiveness is sensitive to program size due to high fixed cost of the camera methods but not to prevalence. Cost-effectiveness of the technician exam is strongly affected by its sensitivity.

CONCLUSIONS
Primary-care screening with retinal photographs through pharmacologically dilated pupils for diabetic retinopathy is an appropriate and cost-effective alternative to screening by an ophthalmologist in this setting. Ophthalmologists are scarce, primary-care physicians are extremely busy, and large clinics allow fixed equipment costs to be spread across many patients.
Growth of Children Before Onset of Diabetes
Authors: Price David E , Burden Andrew C 
Published: March 2007

OBJECTIVE
To examine the growth of children before the onset of diabetes.

RESEARCH DESIGN AND METHODS
Heights before diagnosis, expressed as SDS, of each diabetic child identified from the diabetes register and of two age- and sex-matched control subjects were obtained from records of routine examinations performed at 3.5, 6, 11, and 13 yr. The heights of their siblings, with control subjects, also were obtained.

RESULTS
Diabetic children were considerably taller than control subjects before diagnosis (0–1 yr before diagnosis SDS 0.82 ± 0.26 vs. 0.16 ± 0.14, P &lt; 0.05, n = 24; 1–2 yr before diagnosis SDS 1.02 ± 0.17 vs. 0.16 ± 0.14, P &lt; 0.001, n = 30; 2–3 yr before diagnosis SDS 0.97 ± 0.23 vs. 0.04 ± 0.20, P &lt; 0.005, n = 16). At more than 3 yr before diagnosis, the diabetic children were not significantly taller than control subjects (SDS 0.8 ± 0.2 vs. 0.27 ± 0.13, respectively; n = 33). The siblings of the diabetic children were no taller than control subjects.

CONCLUSIONS
Diabetic children, but not their siblings, were taller than control subjects before diagnosis, suggesting growth-inducing metabolic changes may precede the onset of clinical diabetes by at least 3 yr.
Relationship Between Absorption of Radiolabeled Soluble Insulin, Subcutaneous Blood Flow, and Anthropometry
Authors: Vora Jiten P , Burch Anna , Peters John R , Owens David R 
Published: March 2007

OBJECTIVE
To evaluate the interrelationships between the rate of absorption of soluble insulin, SCBF, and anthropometry in normal subjects.

RESEARCH DESIGN AND METHODS
In 12 normal men (age range 23–30 yr, BMI 18.2–41.3 kg/m2), simultaneous assessment of the absorption of 125I-labeled soluble insulin and SCBF (99mTc clearance) was performed, on separate study days, for the anterior abdominal wall, anterior midthigh, and the upper arm sites. Each site was examined in a randomized order on two separate occasions. Absorption of 125I-soluble insulin was determined by external monitoring of residual radioactivity levels at the injection site for 6 h postinjection. Residual radioactivity level-time curves, including the characteristic early phase of slow absorption of soluble insulin (the lag phase), were described using two- and three-parameter biexponential models. Anthropometric measurements included BMI, ultrasonic measurement of the subcutaneous adipose tissue layer, and caliper skin fold thickness at the anterior abdominal wall, biceps, triceps, anterior midthigh, and subscapular sites.

RESULTS
A highly significant positive relationship was observed between the rate of absorption of 125I-soluble insulin and SCBF (rS =0.44–0.52; P &lt; 0.01–0.001). The duration of the lag phase was inversely correlated with SCBF (rS = −0.34 – −0.51; P &lt; 0.01–0.001). Inverse relationships also were observed for the subjects' degree of adiposity with the rate of soluble insulin absorption (rs = −0.43–−0.71; P &lt; 0.001) and SCBF (rS = −0.27–−0.62; P &lt; 0.05–0.001). Significantly shorter lag phase was observed for the abdominal site compared with thigh and arm injection sites (P &lt; 0.05–0.01).

CONCLUSIONS
The rate of absorption of soluble insulin, including during the lag phase, is positively correlated with SCBF. Increasing adiposity prolongs the duration of the early lag phase and reduces the rate of absorption of soluble insulin and SCBF.
Analysis of Early-Phase Insulin Responses in Nonobese Subjects With Mild Glucose Intolerance
Authors: Yoneda Hiroko , Ikegami Hiroshi , Yamamoto Yoshihiro , Yamato Eiji , Cha Tepyon , Kawaguchi Yoshihiko , Tahara Yasuhiro , Ogihara Toshio 
Published: March 2007

OBJECTIVE
To study the possible contribution of a B-cell defect in the development of glucose intolerance in nonobese subjects.

RESEARCH DESIGN AND METHODS
There were 41 normal, nondiabetic subjects; 18 subjects with IGT; and 21 patients with NIDDM. All subjects were nonobese (BMI &lt; 27 kg/m2). Insulin secretory responses to an OGTT, IVGTT, and GST were studied.

RESULTS
Early-phase insulin responses to OGTT and IVGTT were decreased in subjects with IGT to levels comparable with those in NIDDM patients, whereas the response to GST was preserved in the subjects with IGT compared with NIDDM patients. The insulinogenic index of OGTT correlated well (r = 0.78) with early-phase insulin response to IVGTT, suggesting that the insulinogenic index in OGTT is related to the early-phase insulin response to IVGTT in nonobese subjects.

CONCLUSIONS
Impaired early-phase insulin response to glucose was associated with mild glucose intolerance, suggesting the importance of impaired insulin secretion in the development of glucose intolerance in nonobese subjects.
Early Disturbances of Ambulatory Blood Pressure Load in Normotensive Type I Diabetic Patients With Microalbuminuria
Authors: Benhamou Pierre Y , Halimi Serge , Gaudemaris Régis De , Boizel Robert , Pitiot Muriel , Siche Jean P , Bachelot Ivan , Mallion Jean M 
Published: March 2007

OBJECTIVE
To compare 24-h ABP in normotensive type 1 diabetic patients with and without microalbuminuria.

RESEARCH DESIGN AND METHODS
The study was a retrospective comparison of cases and matched control subjects. The first phase included 35 type 1 diabetic patients, normotensive by OMS criteria. The 23 patients with normoalbuminuria (&lt; 15 μg/min) were compared with 12 patients with microalbuminuria (≥ 15 μg/min). In the second phase, the 12 microalbuminuric patients were paired by sex- and age-matched with 12 normoalbuminuric patients and 12 nondiabetic healthy control subjects. We measured casual systolic and diastolic BP and HR, 24-h ABP and AHR (recorded with a Spacelabs automatic recorder), and microalbuminuria.

RESULTS
No correlation between microalbuminuria and casual BP was observed. Microalbuminuria was correlated significantly with diastolic 24-h APR and nocturnal systolic and diastolic ABP (r = 0.35, 0.38, and 0.33, respectively; P &lt; 0.05) and with AHR during all time periods (24-h, r = 0.46; day, r = 0.39; night, r = 0.39; P &lt; 0.05). Normo- and microalbuminuric patients did not differ in casual BP and HR. However, microalbuminuric patients had a significant increase in systolic 24-h ABP (119.1 ± 8.2 vs. 113.1 ± 8.1, P = 0.05), diastolic 24-h ABP (74.9 ± 7.5 vs. 70.2 ± 5.7, P = 0.04), nocturnal systolic ABP (112.8 ± 7.1 vs. 105.8 ± 7.9, P = 0.01), and AHR during all time periods. The same results were observed when patients were paired by age and sex.

CONCLUSIONS
Normotensive microalbuminuric type 1 patients, although strictly comparable with normoalbuminuric patients for casual BP and HR, have an increased ABP and HR, especially during the night. This difference might reflect dysautonomia. Ambulatory measurement of BP and HR is more appropriate than casual measurements in hemodynamic studies of incipient diabetic nephropathies and could be proposed as an interesting tool for an early prediction of diabetic nephropathy.
Use of Premixed Insulin Among the Elderly: Reduction of errors in patient preparation of mixtures
Authors: Coscelli C , Calabrese G , Fedele D , Pisu E , Calderini C , Bistoni S , Lapolla A , Mauri M G , Rossi A , Zappella A 
Published: March 2007

OBJECTIVE
To evaluate the accuracy of elderly patients in their mixing of regular and intermediate insulins, to assess the safety and efficacy of premixed insulins compared with extemporarily mixed insulins, and to determine patients' preferences.

RESEARCH DESIGN AND METHODS
We conducted a crossover multicenter study of 5 mo duration. Premixed insulins and patient-mixed, human biosynthetic (rDNA) insulins were used among 64 insulin-treated patients with NIDDM. After a 4-wk run-in period, eligible patients were randomly assigned to treatment 1 (extemporarily mixed insulins) or treatment 2 (premixed insulins) for 8 wk. After that period, the two treatments were crossed for an additional 8-wk period. A blood glucose profile was recorded monthly and HbA1c was measured at the beginning and at the end of each treatment period. An in vitro skills test was performed to assess the accuracy and reproducibility of the patient preparation of insulin doses, and a questionnaire was used to determine their personal preferences for premixed versus extemporarily mixed insulin.

RESULTS
In our study, the quality of the metabolic control was the same whether patients used self-mixed or premixed insulin. The differences in blood glucose profiles and HbA1c were negligible between type and periods of treatment. The overall number of hypoglycemic episodes increased during the trial in both groups, but the difference between treatments was not significant.
The in vitro skills test, however, indicated that the accuracy in the preparation of insulin doses was significantly higher when patients aspirated from one vial compared with preparation from two vials (P &lt; 0.001). The CVs were 3.7% when drawing up a single dose and 5.0% when preparing a mixture, but the ranges were rather elevated (0.1–20.7 and 0.6–35.8%, respectively). Forty-two patients described the preparation of their daily insulin dose as very easy and 21 described it as easy when using premixed insulins versus 11 and 43, respectively, when using extemporarily mixed insulins (P &lt; 0.001).

CONCLUSIONS
While the quality of the metabolic control was the same whether patients used self-mixed or premixed insulin, the in vitro skills test indicated that insulin preparation by elderly patients is highly inaccurate. In some patients, a modification of the contents of the insulin is likely to occur in a few days. The use of premixed insulins should lessen the errors that occur in mixing insulins and from the contamination of the second insulin vial. Draw-up errors could partially account for the lack of improvement of glucose control during the period when patients received premixed insulins. A longer observation period probably is needed to assess appreciable changes in the quality of diabetes control.