bluuebunny/crossref_metadata_2025_split huggingface dataset:
Admission Plasma Glucose
Authors: Zindrou Dlear , Taylor Kenneth M. , Bagger Jens Peder 
Published: March 2007

OBJECTIVE—To investigate the relationship between admission plasma glucose and 30-day mortality after primary isolated coronary artery bypass grafting (CABG) in nondiabetic patients.
RESEARCH DESIGN AND METHODS—All nondiabetic patients with admission plasma glucose measurement undergoing primary isolated CABG from 1993 to 1997 were included in this study.
RESULTS—In 878 consecutive patients (155 women), overall mortality was 3.4% (95% CI 2.3–4.8). The mortality rate in women (n = 11; 7.1%, 3.6–12.3) was higher than in men (n = 19; 2.6%, 1.6–4.1) (P = 0.01). There was a positive correlation between plasma glucose and 30-day mortality among women only (P = 0.0001). There was a higher mortality rate in the upper two glucose quartiles (11.7%, 5.5–21.0) compared with the lower two quartiles (2.6%, 3.0–8.9) in the female patients (P = 0.03); a plasma glucose of 6.0 mmol/l separated high- and low-mortality groups. Furthermore, women in the upper two glucose quartiles had a fourfold higher mortality rate than men in the similar quartiles (P = 0.002). Among men, there was no difference in mortality rate across glucose quartiles. In a multivariate analysis, admission plasma glucose, history of thyroid disease, left ventricular ejection fraction &lt;0.35, operation bypass time, and perioperative myocardial infarction were independently associated with mortality.
CONCLUSIONS—Women with admission plasma glucose ≤6.0 mmol/l and men across the whole range of glucose values had similar mortality rates after CABG. The surplus female mortality was found only in subjects with plasma glucose &gt;6 mmol/l. Further studies are needed to appraise the possible influence of glucose status on outcome from CABG in nondiabetic subjects.
Evidence of Primary β-Cell Destruction by T-Cells and β-Cell Differentiation From Pancreatic Ductal Cells in Diabetes Associated With Active Autoimmune Chronic Pancreatitis
Authors: Tanaka Shoichiro , Kobayashi Tetsuro , Nakanishi Koji , Okubo Minoru , Murase Toshio , Hashimoto Masaji , Watanabe Goro , Matsushita Hiroshi , Endo Yuzo , Yoshizaki Hideo , Kosuge Tomoo , Sakamoto Michiie , Takeuchi Kazuo 
Published: March 2007

OBJECTIVE—Diabetes associated with autoimmune chronic pancreatitis (ACP) is a subtype of diabetes that is responsive to corticosteroid treatment of progressive endocrine and exocrine dysfunction. However, little is known about pathological changes of islet and exocrine pancreas in ACP.
RESEARCH DESIGN AND METHODS—We examined pancreatic specimens obtained on biopsy from four diabetic men with ACP (mean [range]: age 62 years [48–78], duration of ACP 3 months [1–5], duration of diabetes 1 month [0–3]) morphologically, immunohistochemically, and morphometrically.
RESULTS—The pancreatic specimens in all cases exhibited inflammatory cell infiltration surrounding ductal cells and extensive fibrosis. Some islets were infiltrated with mononuclear cells with disrupted β-cells. The subsets of T-cells infiltrated to the islets were mainly CD8+. Islet β-cell volume was decreased; the mean percentage area of β-cells in the islets in four cases with ACP were 16% (range 13–20) (P = 0.0015 vs. type 2 diabetic patients, 48% [27–73], n = 8; P = 0.0002 vs. nondiabetic control subjects, 58% [39–77], n = 7). Preserved ductal cells were surrounded predominantly by CD8+ or CD4+ T-cells. Some cytokeratin 19–positive ductal cells contained insulin and glucagon, representing upregulated differentiation of islet cells from ductal cells. Insulin promoter factor-1 (IPF-1) was hyperexpressed in insulin-containing ductal cells.
CONCLUSIONS—Diabetes associated with ACP is caused by T-cell–mediated mechanisms primarily involving islet β-cells as well as pancreatic ductal cells. In ACP, ductal islet precursor cells were associated with IPF-1 hyperexpression, suggesting a critical role of IPF-1 on islet cell differentiation and eventual β-cell restoration.
Muscle Fiber Composition and Capillary Density in Turner Syndrome
Authors: Gravholt Claus Højbjerg , Nyholm Birgit , Saltin Bengt , Schmitz Ole , Christiansen Jens Sandahl 
Published: March 2007

OBJECTIVE—To assess muscle fiber composition and capillary density in Turner syndrome, a condition linked with insulin resistance and increased frequency of type 2 diabetes, and link these findings with insulin sensitivity and physical fitness.
RESEARCH DESIGN AND METHODS—A total of 10 patients with Turner syndrome who were off hormone replacement therapy (aged 32.7 ± 8.9 years) and a control group of 14 normal women (aged 35.6 ± 9.3 years) were studied. None of the participants had diabetes or any family history of type 2 diabetes. An oral glucose tolerance test was performed, and insulin sensitivity was assessed by homeostasis model assessment (HOMA) and a composite whole-body insulin sensitivity index (ISIcomp). Physical fitness was assessed, and a muscle biopsy was obtained.
RESULTS—Women with Turner syndrome were insulin resistant, as seen by a lower ISIcomp (P = 0.003) and increased glucose (P &lt; 0.0005) and insulin (P = 0.01) levels at 120 min. Impaired glucose tolerance was present in most Turner syndrome patients (6 of 10), but not in the control subjects. Women with Turner syndrome had an increased size of type IIa fibers (P = 0.01), whereas the size of their type I and IIa fibers were comparable with the control group. The groups did not differ in percentage of type I, Iia, or IIx fibers, and there was no difference in the capillary density. Significant correlations were found among ISIcomp, the HOMA index (RHOMA), and the mean area of type IIa fibers (ISIcomp: r = −0.632, P = 0.002; RHOMA: r = 0.570, P = 0.006). Furthermore, capillaries/type IIa fibers correlated significantly with ISIcomp (r = −0.618, P = 0.01). There were no significant correlations between Vo2max and muscle fiber composition.
CONCLUSIONS—Healthy women with Turner syndrome are characterized by impaired glucose tolerance, insulin resistance, low physical capacity, and enlarged type IIa muscle fibers, indicating diminished oxygen and substrate supply for metabolic processes. These findings could be indicative of a prediabetic state.
Productivity and Medical Costs of Diabetes in a Large Employer Population
Authors: Ramsey Scott , Summers Kent H. , Leong Stephanie A. , Birnbaum Howard G. , Kemner Jason E. , Greenberg Paul 
Published: March 2007

OBJECTIVE—The purpose of this study was to assess the economic burden of diabetes from an employer’s perspective. We analyzed the costs of diabetes, using claims data for an employed population and the prevalence of selected comorbid conditions.RESEARCH DESIGN AND METHODS—The data source is a claims database from a national Fortune 100 manufacturer. It includes medical, pharmacy, and disability claims for all beneficiaries (n &gt;100,000). Both medical and work productivity costs of diabetes patients are compared by age with those of matched control subjects from the overall beneficiary population. Out-of-pocket and intangible costs are excluded.RESULTS—In 1998, the employer’s mean annual per capita costs were higher for all diabetes beneficiaries than for control subjects ($7,778 ± 16,176 vs. $3,367 ± 8,783; P &lt; 0.0001), yielding an incremental cost of $4,410 ± 18,407 associated with diabetes. The medical and productivity costs for employees with diabetes were significantly (P &lt; 0.0008) higher than for control subjects. The incremental cost of diabetes among employees ranged from $4,671 (aged 18–35 years) to $4,369 (aged 56–64 years).CONCLUSIONS—Diabetes imposes a significant economic burden on employers, particularly when including productivity costs. Employers should select health plans that provide enriched benefits to diabetes patients, including ready access to medical and pharmacy services as well as aggressive diabetes management programs.
Determinants of Mild Gestational Hyperglycemia and Gestational Diabetes Mellitus in a Large Dutch Multiethnic Cohort
Authors: Weijers Rob N.M. , Bekedam Dick J. , Smulders Yvo M. 
Published: March 2007

OBJECTIVE—The purpose of this study was to identify independent determinants of mild gestational hyperglycemia (MGH) and gestational diabetes mellitus (GDM) and to assess the correlation between fasting glucose and C-peptide levels among control, MGH, and GDM women.
RESEARCH DESIGN AND METHODS—A total of 1,022 consecutive women were evaluated with a 1-h 50-g glucose challenge test (GCT) at between 16 and 33 weeks of gestation. Women with a capillary whole-blood glucose ≥7.8 mmol/l in the GCT underwent a 3-h 100-g oral glucose tolerance test (OGTT). On the basis of a positive GCT, the women with a positive OGTT were classified as GDM, whereas the women with a negative OGTT were classified as MGH. The following data were collected for all women: age, prepregnancy BMI, ethnicity, clinical and obstetric history, pregnancy outcome, and C-peptide level.
RESULTS—A total of 813 women (79.6%) were normal, 138 (13.5%) had MGH, and 71 (6.9%) had GDM. There was a stepwise significant increase in mean fasting glucose (3.6 ± 0.4, 3.9 ± 0.4, and 4.7 ± 0.7 mmol/l, respectively) and C-peptide level (0.60 [0.1–2.4], 0.86 [0.3–2.0], and 1.00 [0.5–1.6] nmol/l, respectively) among the three diagnostic groups. Maternal age, non-Caucasian ethnicity, and prepregnancy BMI were associated with GDM, whereas only maternal age and prepregnancy BMI were associated with MGH. A positive correlation between levels of fasting glucose and C-peptide was found in control women (r = 0.39 [95% CI 0.31–0.46]). A similar result was seen in MGH women (r = 0.38 [95% CI 0.23–0.52]), whereas the correlation between fasting glucose and C-peptide was nearly lost in GDM women (r = 0.14 [CI −0.09 to 0.36]). The fasting C-peptide–to–glucose ratio was reduced by 60% in GDM patients versus control subjects and MGH patients (0.41 ± 0.25 vs. 0.70 ± 0.20 and 0.73 ± 0.23, P &lt; 0.001).
CONCLUSIONS—Of the well-known independent determinants of GDM, only maternal age and prepregnancy BMI were associated with MGH. It appears that additional factors promoting loss of β-cell function distinguish MGH from GDM. One of these factors appears to be ethnicity.
Older Women With Diabetes Have a Higher Risk of Falls
Authors: Schwartz Ann V. , Hillier Teresa A. , Sellmeyer Deborah E. , Resnick Helaine E. , Gregg Edward , Ensrud Kristine E. , Schreiner Pamela J. , Margolis Karen L. , Cauley Jane A. , Nevitt Michael C. , Black Dennis M. , Cummings Steven R. ,   For the Study of Osteoporotic Fractures Research Group
Published: March 2007

OBJECTIVE—To determine whether older women with diabetes have an increased risk of falls and whether known risk factors for falls account for any increased risk.
RESEARCH DESIGN AND METHODS—This prospective cohort study included 9,249 women ≥67 years of age enrolled in the Study of Osteoporotic Fractures. Diabetes was determined by questionnaire at baseline. Physical performance was measured at the second examination. Subsequently, falls were ascertained every 4 months by postcard.
RESULTS—A total of 629 (6.8%) women had diabetes, including 99 who used insulin. During an average of 7.2 years, 1,640 women (18%) fell more than once a year. Diabetes, stratified by insulin use, was associated with an increased risk of falling more than once a year (age-adjusted odds ratio [OR] 1.68 [95% CI 1.37–2.07] for non–insulin-treated diabetes; age-adjusted OR 2.78 [1.82–4.24] for insulin-treated diabetes). In the first 2 years of follow-up, women with diabetes were not more likely to fall than women without diabetes (44 vs. 42%; P = 0.26), but they had more falls (3.1 vs. 2.4; P &lt; 0.01). Women with diabetes were more likely to have other risk factors for falls, which appeared to account for the increased risk of falls associated with non–insulin-treated diabetes (adjusted OR 1.18 [0.87–1.60]) but not insulin-treated diabetes (adjusted OR 2.76 [1.52–5.01]).
CONCLUSIONS—Older women with diabetes have an increased risk of falling, partly because of the increased rates of known fall risk factors, and may benefit from interventions to prevent falls. Further research is needed to determine whether diabetes treatment reduces fall risk.
Exercise Training Improves Vascular Endothelial Function in Patients with Type 1 Diabetes
Authors: Fuchsjäger-Mayrl Gabriele , Pleiner Johannes , Wiesinger Günther F. , Sieder Anna E. , Quittan Michael , Nuhr Martin J. , Francesconi Claudia , Seit Hans-Peter , Francesconi Mario , Schmetterer Leopold , Wolzt Michael 
Published: March 2007

OBJECTIVE—Impaired endothelial function of resistance and conduit arteries can be detected in patients with type 1 diabetes. We studied whether a persistent improvement of endothelial function can be achieved by regular physical training.
RESEARCH DESIGN AND METHODS—The study included 26 patients with type 1 diabetes of 20 ± 10 years’ duration and no overt angiopathy; 18 patients (42 ± 10 years old) participated in a bicycle exercise training program, and 8 patients with type 1 diabetes (33 ± 11 years old) served as control subjects. Vascular function of conduit arteries was assessed by flow-mediated and endothelium-independent dilation of the brachial artery and of resistance vessels by the response of ocular fundus pulsation amplitudes to intravenous NG-monomethyl-l-arginine (l-NMMA) at baseline, after 2 and 4 months of training, and 8 months after cessation of regular exercise.
RESULTS—Training increased peak oxygen uptake (Vo2max) by 13% after 2 months and by 27% after 4 months (P = 0.04). Flow-mediated dilation (FMD) of the brachial artery increased from 6.5 ± 1.1 to 9.8 ± 1.1% (P = 0.04) by training. l-NMMA administration decreased fundus pulsation amplitude (FPA) by 9.1 ± 0.9% before training and by 13.4 ± 1.5% after 4 months of training (P = 0.02). Vo2max, FMD, and FPA were unchanged in the control group. Vascular effects from training were abrogated 8 months after cessation of exercise.
CONCLUSIONS—Our study demonstrates that aerobic exercise training can improve endothelial function in different vascular beds in patients with long-standing type 1 diabetes, who are at considerable risk for diabetic angiopathy. However, the beneficial effect on vascular function is not maintained in the absence of exercise.
Insulin Improves Alveolar-Capillary Membrane Gas Conductance in Type 2 Diabetes
Authors: Guazzi Marco , Oreglia Iacopo , Guazzi Maurizio D. 
Published: March 2007

OBJECTIVE—In type 1 diabetes, lung diffusing capacity for carbon monoxide (DLCO) may be impaired, and insulin has been shown to be beneficial in cases in which near-normal metabolic control is achieved. An influence of insulin, per se, on the alveolar-capillary membrane conductance is unexplored. We aimed at testing this possibility.
RESEARCH DESIGN AND METHODS—We studied 19 life-long nonsmoking, asymptomatic patients with type 2 diabetes and normal cardiac function, whose GHb averaged 6.2 ± 0.3% with diet and hypoglycemic drugs. DLCO and its subcomponents (alveolar capillary membrane conductance [DM] and pulmonary capillary blood volume available for gas exchange [Vc]), vital capacity (VC), forced expiratory volume 1 s (FEV1), cardiac output (CO), ejection fraction (EF), pulmonary wedge pressure (WPP), and pulmonary arteriolar resistance (PAR) were determined before and within 60 min after infusion of 50 ml saline + 10 IU of regular insulin or after saline alone on 2 consecutive days (random block design). Glycemia was kept at baseline levels during experiments by dextrose infusion.
RESULTS—Percent of normal predicted DLCO averaged 84.2 ± 7.9% and in 14 patients was &lt;100%. Insulin infusion, not saline alone, improved (P &lt; 0.01) DLCO (12%) and DM (14%) and raised DLCO to 98% of the normal predicted value. There were no variations in VC, FEV1, CO, EF, WPP, or PAR, suggesting that the influences of the hormone on gas transfer were not mediated by changes in spirometry, volumes, and hemodynamics of the lung.
CONCLUSIONS—Several cases of type 2 diabetes present with increased impedance to gas transfer across the alveolar-capillary membrane, and hypoglycemic drugs do not prevent this inconvenience. Insulin, independently of the metabolic effects, acutely improves gas exchange, possibly through a facilitation of the alveolar-capillary interface conductance.
The Glucose Area Under the Profiles Obtained With Continuous Glucose Monitoring System Relationships With HbAlc in Pediatric Type 1 Diabetic Patients
Authors: Salardi Silvana , Zucchini Stefano , Santoni Roberta , Ragni Luca , Gualandi Stefano , Cicognani Alessandro , Cacciari Emanuele 
Published: March 2007

OBJECTIVE—The purpose of this study was to determine whether the continuous glucose monitoring system (CGMS) (MiniMed, Sylmar, CA) 1) is sufficiently representative of the overall metabolic control as assessed by HbA1c, 2) could be used to identify a particular blood glucose threshold value affecting hemoglobin glycation; and 3) is able to show any relationship between particular glycemic profiles and HbA1c levels.
RESEARCH DESIGN AND METHODS—Of 44 pediatric patients with type 1 diabetes who wore CGMS devices, 28 subjects were selected for the study. Criteria for inclusion were high levels of HbA1c (≥8%) for more than 1 year or a history of frequent hypoglycemic episodes and a complete CGMS registration for 72 h. Age of the subjects ranged from 5.7 to 24.8 years, the mean duration of disease was 7.63 ± 4.75 years, and the mean HbA1c value was 8.7 ± 1.3%. CGMS data were downloaded and glucose profiles were analyzed. The area under each glucose profile was calculated by means of a professional digital planimeter.
RESULTS—The glucose profiles showed a high frequency of prolonged hyperglycemic periods (80% of subjects) and a low frequency of postmeal glycemic peaks (29% of subjects). Postlunch values were significantly correlated with HbA1c levels, but the correlation disappeared when controlling for glucose area values. Glucose area values significantly correlated with HbA1c levels both when considered as a whole (40–400 mg/dl; r = 0.53, P = 0.002) and when considered fractioned (40–150, 40–200, 40–250, 40–300 mg/dl), apart from the 40–90 mg/dl partial area. HbA1c levels were significantly decreased 3 and 6 months after use of CGMS (P = 0.05 and 0.03, respectively, paired Student’s t test) .
CONCLUSIONS—HbA1c levels may be decreased by using the information obtained with the CGMS. Three-day glucose profiles are representative of the overall glucose control, because glucose area values correlate with HbA1c levels. The only glucose threshold below which there seems to be no correlation with HbA1c is 90 mg/dl. Only glucose area, and not postprandial glucose values, are directly and independently correlated with HbA1c. Therefore, to improve metabolic control, it is necessary to lower the whole mean 24-h glycemia and not just the postprandial glucose values.
Attributing Inpatient Medicare Costs to Diabetes Among the Texas Elderly
Authors: McCandless Roy R. 
Published: March 2007

OBJECTIVE—This study compares alternative methods for attributing hospital utilization and costs to diabetes. Findings from five “numerator” methods, found in the literature and based on presence of certain diagnoses or combinations of diagnoses in the billing records, were compared to benchmark findings derived from attributable risk calculations.
RESEARCH DESIGN AND METHODS—Estimates of non-HMO, short-term, nonspecialized hospital stays, hospital days, and costs attributable to diabetes in Texas were derived from the 1995 Medicare inpatient database (MEDPAR) for persons aged at least 65 years at the end of 1994. Attributable risk calculations applied age-, sex-, and ethnicity-specific estimates of diabetes prevalence, based on the combined 1987–1994 National Health Interview Surveys, to 1995 Medicare non-HMO, Part A (hospital insurance) enrollment among the Texas elderly. Alternative prevalence estimates were based on the 1994–1996 Texas Behavioral Risk Factor Surveillance System.
RESULTS—The five numerator methods yielded cost estimates that were 10, 10, 75, 144, and 172% of the benchmark estimate.
CONCLUSIONS—This study documents great variation in diabetes cost estimates that might result from alternative methods for selecting diagnoses or combinations of diagnoses as criteria for attributing costs to diabetes. Whereas no method that ignores population prevalence yielded an accurate cost estimate, I suggest that further empirical study may be helpful in selecting those combinations of diagnoses that might, on average, reasonably estimate diabetes costs in situations where population denominators are unavailable or prevalence is unknown.
Neighborhood Characteristics and Components of the Insulin Resistance Syndrome in Young Adults
Authors: Diez Roux Ana V. , Jacobs David R. , Kiefe Catarina I. 
Published: March 2007

OBJECTIVE—To examine associations of neighborhood characteristics with six components of the insulin resistance syndrome (IRS) in young adults.
RESEARCH DESIGN AND METHODS—Cross-sectional data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study were used to examine associations of neighborhood characteristics with the IRS in 3,093 nondiabetic adults aged 28–40 years. Measures of BMI, fasting HDL cholesterol, triglycerides, insulin, glucose, and systolic blood pressure were combined into an IRS score. U.S. Census-derived neighborhood characteristics were summarized into a neighborhood socioeconomic score, with an increasing score signifying increasing socioeconomic advantage.
RESULTS—Among white men and women, the IRS score was inversely related to neighborhood socioeconomic score. Neighborhood characteristics remained associated with the IRS score after controlling for personal income and education (adjusted mean differences for 95th vs. 5th percentile of neighborhood score: −0.24 standard deviation units [SE = 0.12] in men and −0.56 standard deviation units [SE = 0.10] in women). Among black participants, neighborhood score was inversely associated with IRS score in persons of high income and education (mean differences 95th vs. 5th percentile −0.54 [SE 0.26] in men and −0.52 [SE 0.26] in women) but positively associated or not associated with IRS score in persons of low income and education (mean differences 0.60 [SE 0.21] in men and 0.00 [SE 0.16] in women).
CONCLUSIONS—The IRS score is associated with neighborhood characteristics as early as young adulthood. Features of residential environments may be related to the development of insulin resistance.
Personal Control and Disordered Eating in Female Adolescents With Type 1 Diabetes
Authors: Schwartz Stefanie A. , Weissberg-Benchell Jill , Perlmuter Lawrence C. 
Published: March 2007

OBJECTIVE—The onset and subsequent management of diabetes can challenge one’s sense of control. Sense of control can also be affected by the biological changes accompanying normal pubertal development. The negative impact on one’s sense of control may be further exacerbated when both events (i.e., diabetes and puberty) occur in relatively close temporal proximity.
RESEARCH DESIGN AND METHODS—This study examined the relationship between sense of control and disordered eating and glycemic control in 45 female adolescents with type 1 diabetes.
RESULTS—A lower sense of overall control and a lower sense of bodily control were both directly related to more severe eating-disordered symptoms. However, a lower sense of overall control and lower bodily control were related to poorer metabolic control primarily when the diagnosis of diabetes occurred closer to the onset of puberty.
CONCLUSIONS—Clinicians should assess and monitor perceptions of control and also consider the temporal proximity of disease onset and onset of puberty when managing type 1 diabetes in female adolescents.