bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes Screening in Canada (DIASCAN) Study
Authors: Leiter Lawrence A. , Barr Aiala , Bélanger André , Lubin Stanley , Ross Stuart A. , Tildesley Hugh D. , Fontaine Nathalie 
Published: March 2007

OBJECTIVE—To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals ≥40 years of age who contacted their family physician for routine care.
RESEARCH DESIGN AND METHODS—The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients ≥40 years of age were screened for diabetes. If a casual fingerprick blood glucose was &gt;5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1–6.9 mmol/l, a 2-h 75-g post–glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories.
RESULTS—Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients.
CONCLUSIONS—Routine screening for diabetes by family physicians is justified in patients ≥40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients ≥40 years of age have known diabetes. This has important implications regarding health resources and physician education.
The Association of Heart-Rate Variability With Cardiovascular Risk Factors and Coronary Artery Calcification
Authors: Colhoun Helen M. , Francis Darrel P. , Rubens Michael B. , Underwood S. Richard , Fuller John H. 
Published: March 2007

OBJECTIVE—To examine the association of heart-rate variability with cardiovascular risk factors and coronary calcification in type 1 diabetic and nondiabetic subjects without a history of cardiovascular disease. Reduced heart-rate variability is associated with increased risk of coronary events. Whether it is associated with coronary atherosclerosis is unknown.
RESEARCH DESIGN AND METHODS—Power spectral analysis was used to define heart-rate variability in a cross-sectional study of 160 type 1 diabetic patients and 163 randomly selected nondiabetic adults from the general population aged 30–55 years. Coronary artery calcification was measured using electron beam–computed tomography.
RESULTS—Reduced heart-rate variability was associated with similar risk factors in the diabetic and nondiabetic subjects, namely higher HbA1c, triglycerides, systolic blood pressure, BMI, and albumin excretion rate. Reduced heart-rate variability was significantly associated with coronary artery calcification in all subjects (odds ratio per tertile lower total power = 1.5, P = 0.01). This association was not independent of blood pressure or BMI (odds ratio on adjustment = 1.3, P = 0.1).
CONCLUSIONS—Reduced heart-rate variability clusters with other cardiovascular disease risk factors, especially those that are more common in the insulin resistance syndrome, and is associated with increased coronary calcification in asymptomatic young adults. Whether reduced heart-rate variability leads to other risk factor disturbances or mediates the effects of other risk factors on atherosclerosis deserves further study.
Group Visits Improve Metabolic Control in Type 2 Diabetes
Authors: Trento Marina , Passera Pietro , Tomalino Marco , Bajardi Marina , Pomero Fulvio , Allione Attilio , Vaccari Piero , Molinatti Gian Michele , Porta Massimo 
Published: March 2007

OBJECTIVE—To evaluate whether group visits, delivered as routine diabetes care and structured according to a systemic education approach, are more effective than individual consultations in improving metabolic control in non–insulin-treated type 2 diabetes.
RESEARCH DESIGN AND METHODS—In a randomized controlled clinical trial of 112 patients, 56 patients were allocated to groups of 9 or 10 individuals who participated in group consultations, and 56 patients (considered control subjects) underwent individual visits plus support education. All visits were scheduled every 3 months.
RESULTS—After 2 years, HbA1c levels were lower in patients seen in groups than in control subjects (P &lt; 0.002). Levels of HDL cholesterol had increased in patients seen in groups but had not increased in control subjects (P = 0.045). BMI (P = 0.06) and fasting triglyceride level (P = 0.053) were lower. Patients participating in group visits had improved knowledge of diabetes (P &lt; 0.001) and quality of life (P &lt; 0.001) and experienced more appropriate health behaviors (P &lt; 0.001). Physicians spent less time seeing 9–10 patients as a group rather than individually, but patients had longer interaction with health care providers.
CONCLUSIONS—Group consultations may improve metabolic control in the medium term by inducing more appropriate health behaviors. They are feasible in everyday clinical practice without increasing working hours.
The Effect of Flexible Low Glycemic Index Dietary Advice Versus Measured Carbohydrate Exchange Diets on Glycemic Control in Children With Type 1 Diabetes
Authors: Gilbertson Heather R. , Brand-Miller Jennie C. , Thorburn Anne W. , Evans Sharon , Chondros Patty , Werther George A. 
Published: March 2007

OBJECTIVE—To determine the long-term effect of low glycemic index dietary advice on metabolic control and quality of life in children with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Children with type 1 diabetes (n = 104) were recruited to a prospective, stratified, randomized, parallel study to examine the effects of a measured carbohydrate exchange (CHOx) diet versus a more flexible low–glycemic index (GI) dietary regimen on HbA1c levels, incidence of hypo- and hyperglycemia, insulin dose, dietary intake, and measures of quality of life over 12 months.
RESULTS—At 12 months, children in the low-GI group had significantly better HbA1c levels than those in the CHOx group (8.05 ± 0.95 vs. 8.61 ± 1.37%, P = 0.05). Rates of excessive hyperglycemia (&gt;15 episodes per month) were significantly lower in the low-GI group (35 vs. 66%, P = 0.006). There were no differences in insulin dose, hypoglycemic episodes, or dietary composition. The low-GI dietary regimen was associated with better quality of life for both children and parents.
CONCLUSIONS—Flexible dietary instruction based on the food pyramid with an emphasis of low-GI foods improves HbA1c levels without increasing the risk of hypoglycemia and enhances the quality of life in children with diabetes.
Type 1 and Type 2 Diabetes and Incident Hip Fractures in Postmenopausal Women
Authors: Nicodemus Kristin K. , Folsom Aaron R. 
Published: March 2007

OBJECTIVE—To examine whether postmenopausal women with diabetes experienced a higher incidence of hip fracture than women without diabetes.
RESEARCH DESIGN AND METHODS—A prospective cohort of 32,089 postmenopausal women residing in Iowa were surveyed by mail in 1986 and followed for 11 years. Diabetes status and other potential risk factors were assessed by questionnaires at baseline; incidence of hip fracture was ascertained by follow-up questionnaires.
RESULTS—A total of 490 hip fractures were reported over 306,900 person-years of follow-up. After adjustment for age, smoking status, estrogen use, BMI, and waist-to-hip ratio, women with type 1 diabetes (n = 47) were 12.25 times (95% CI 5.05–29.73) more likely to report an incident hip fracture than women without diabetes. Women with type 2 diabetes had a 1.70-fold higher risk (1.21–2.38) of incident hip fracture than women without diabetes. Longer duration of type 2 diabetes was associated with higher incidence, as was use of insulin or oral diabetes medications in women with type 2 diabetes. Furthermore, women who were initially free of diabetes but in whom diabetes developed had a relative risk of hip fracture of 1.60 (1.14–2.25) compared with women who never had diabetes.
CONCLUSIONS—Postmenopausal women who have diabetes or in whom diabetes develops are at higher risk for hip fracture than nondiabetic postmenopausal women. Strategies to prevent osteoporosis and/or falling may be especially warranted in women with diabetes.
Diabetes and Diabetic Retinopathy in a Mexican-American Population
Authors: West Sheila K. , Klein Ronald , Rodriguez Jorge , Muñoz Beatriz , Broman Aimee T. , Sanchez Rosario , Snyder Robert 
Published: March 2007

OBJECTIVES The prevalence rate of diabetes is probably higher in Hispanics than in Caucasians, although there is controversy about differences in the risk of diabetic retinopathy. The purpose of the study is to determine the prevalence rates of diabetes and diabetic retinopathy in a population-based study of Hispanics aged ≥40 years.
RESEARCH DESIGN AND METHODS—Proyecto VER is a random sample of Hispanic populations aged ≥40 years in Arizona. A total of 4,774 individuals (71.6% of the eligible sample) completed the examinations. Diabetes was defined as self-report of a physician diagnosis or HbA1c value of ≥7.0%. Diabetic retinopathy was assessed on stereo fundus photographs of fields 1, 2, and 4.
RESULTS—The prevalence rate of diabetes in the Hispanic community (individuals ≥40 years of age) was 22%. The prevalence rate of diabetic retinopathy (DR) was 48%; 32% had moderate to severe nonproliferative and proliferative retinopathy. DR increased with increasing duration of diabetes and increasing level of HbA1c. The prevalence rate of DR-like changes in the sample of individuals without diabetic retinopathy was 15% and was not associated with hypertension, systolic blood pressure, or diastolic blood pressure.
CONCLUSIONS—The prevalence rate of diabetes in this population of Hispanics is high, almost twice that of Caucasians. The prevalence rate of DR is high but similar to reports in a Caucasian population. The prevalence rate of 9% moderate to severe retinopathy in the newly diagnosed group suggests that efforts to improve detection and treatment of diabetes in Hispanics may be warranted.
A Randomized Trial of Rosiglitazone Therapy in Patients With Inadequately Controlled Insulin-Treated Type 2 Diabetes
Authors: Raskin Philip , Rendell Marc , Riddle Matthew C. , Dole Jo F. , Freed Martin I. , Rosenstock Julio ,   For the Rosiglitazone Clinical Trials Study Group
Published: March 2007

OBJECTIVE—To determine the efficacy and safety of rosiglitazone (RSG) when added to insulin in the treatment of type 2 diabetic patients who are inadequately controlled on insulin monotherapy.
RESEARCH DESIGN AND METHODS—After 8 weeks of insulin standardization and placebo (PBO) run-in, 319 type 2 diabetic patients with mean baseline HbA1c ≥7.5% (8.9 ± 1.1 to 9.1 ± 1.3) on twice-daily insulin therapy (total daily dose ≥30 U) were randomized to 26 weeks of additional treatment with RSG (4 or 8 mg daily) or PBO. Insulin dose could be down- titrated only for safety reasons. The primary end point was reduction of HbA1c from baseline.
RESULTS—RSG 4 and 8 mg daily significantly improved glycemic control, which was unchanged on PBO. By intent-to-treat analysis, treatment with RSG 8 mg plus insulin resulted in a mean reduction from baseline in HbA1c of 1.2% (P &lt; 0.0001), despite a 12% mean reduction of insulin dosage. Over 50% of subjects treated daily with RSG 8 mg plus insulin had a reduction of HbA1c ≥1.0%. Neither total:HDL cholesterol nor LDL:HDL cholesterol ratios significantly changed with RSG treatment. Serious adverse events did not differ among groups.
CONCLUSIONS—The addition of RSG to insulin treatment results in significant improvement in glycemic control and is generally well tolerated.
Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders
Authors: Barzilay Joshua I. , Spiekerman Charles F. , Kuller Lewis H. , Burke Gregory L. , Bittner Vera , Gottdiener John S. , Brancati Fred L. , Orchard Trevor J. , O’Leary Daniel H. , Savage Peter J. 
Published: March 2007

OBJECTIVE—Clinical cardiovascular disease (CVD) is highly prevalent among people with diabetes. However, there is little information regarding the prevalence of subclinical CVD and its relation to clinical CVD in diabetes and in the glucose disorders that precede diabetes.
RESEARCH DESIGN AND METHODS—Participants in the Cardiovascular Health Study, aged ≥65 years (n = 5,888), underwent vascular and metabolic testing. Individuals with known disease in the coronary, cerebral, or peripheral circulations were considered to have clinical disease. Those without any clinical disease in whom CVD was detected by ultrasonography, electrocardiography, or ankle arm index in any of the three vascular beds were considered to have isolated subclinical disease.
RESULTS—Approximately 30% of the cohort had clinical disease, and ∼60% of the remainder had isolated subclinical disease. In those with normal glucose status, isolated subclinical disease made up most of the total CVD. With increasing glucose severity, the proportion of total CVD that was clinical disease increased; 75% of men and 66% of women with normal fasting glucose status had either clinical or subclinical CVD. Among those with known diabetes, the prevalence was ∼88% (odds ratio [OR] 2.46 for men and 4.22 for women, P &lt; 0.0001). There were intermediate prevalences and ORs for those with impaired fasting glucose status and newly diagnosed diabetes.
CONCLUSIONS—Isolated subclinical CVD is common among older adults. Glucose disorders are associated with an increased prevalence of total CVD and an increased proportion of clinical disease relative to subclinical disease.
Risk of Developing Retinopathy in Diabetes Control and Complications Trial Type 1 Diabetic Patients With Good or Poor Metabolic Control
Authors: Zhang LiYing , Krzentowski Georges , Albert Adelin , Lefebvre Pierre J. 
Published: March 2007

OBJECTIVE—The study goal was to assess and predict the risk of developing retinopathy in type 1 diabetic patients with extreme metabolic control.
RESEARCH DESIGN AND METHODS—Based on material from the Diabetes Control and Complications Trial (DCCT) study (n = 1,441 patients), patients without retinopathy at baseline (DCCT primary cohort) were considered under good or poor metabolic control if the mean HbA1c level (until the last visit) fell in the lower or upper 20% of the overall HbA1c distribution, respectively. Retinopathy was recorded as either absent or present. Logistic regression was used to predict retinopathy from covariates used in the DCCT retinopathy study.
RESULTS—Among the 153 DCCT patients with “good metabolic control” (mean HbA1c ≤6.87%), three-step change retinopathy developed in 15 (9.8%), and 138 (90%) remained free of retinopathy. Conversely, among the 166 patients with “poor metabolic control” (mean HbA1c ≥9.49%), the complication did not develop in 71 (43%) and did develop in 95 (57%). Whereas occurrence of diabetic retinopathy was primarily due to metabolic control (P &lt; 0.0001) and duration of participation in the study (P &lt; 0.0001), two other covariates were found to be significant prognostic factors of the complication: HbA1c at baseline (OR 1.37, P &lt; 0.001) and BMI (OR 1.11, P &lt; 0.05).
CONCLUSIONS—This study confirms that retinopathy develops in ∼10% of patients with type 1 diabetes under good metabolic control, whereas &gt;40% of patients with type 1 diabetes remain free of retinopathy despite poor metabolic control. After adjusting for metabolic control and duration of participation in the study, it was found that previous glycemic exposure (HbA1c) and BMI may provide a possible explanation to such paradoxical clinical situations.
Psychosocial Therapies in Diabetes
Authors: Delamater Alan M. , Jacobson Alan M. , Anderson Barbara , Cox Daniel , Fisher Lawrence , Lustman Patrick , Rubin Richard , Wysocki Timothy 
Published: March 2007

OBJECTIVE—To review key advances in the behavioral science literature related to psychosocial issues and therapies for persons with diabetes, to discuss barriers to research progress, and to make recommendations for future research.
RESEARCH DESIGN AND METHODS—Key findings from the literature on psychosocial research in diabetes are reviewed separately for children and adults. Specific issues covered include psychosocial adjustment and psychiatric disorders, neurocognitive functioning, quality of life, and psychosocial therapies. Barriers that must be addressed to allow research in this area to progress are discussed. Recommendations are then made concerning high-priority areas for advancing research in the field.
CONCLUSIONS—A substantial amount of behavioral science research has demonstrated that psychosocial factors play an integral role in the management of diabetes in both children and adults. Research has also shown the efficacy of a number of psychosocial therapies that can improve regimen adherence, glycemic control, psychosocial functioning, and quality of life. More research in this area is needed to develop psychosocial intervention programs for specific patient populations and to demonstrate the cost-effectiveness of these approaches.
Glucagon-Like Peptide-1 Infusion Must Be Maintained for 24 h/day to Obtain Acceptable Glycemia in Type 2 Diabetic Patients Who Are Poorly Controlled on Sulphonylurea Treatment
Authors: Larsen Jens , Hylleberg Birgitte , Ng Kevin , Damsbo Peter 
Published: March 2007

OBJECTIVE—To assess the efficacy and safety of glucagon-like peptide-1 (GLP-1) on the plasma glucose level when given as a continuous infusion for either 16 or 24 h per day to type 2 diabetic patients who were poorly controlled on sulfonylurea treatment.
RESEARCH DESIGN AND METHODS—This single-center, randomized, parallel, double-blind, placebo-controlled trial was conducted in 40 hospitalized patients who were randomized to receive infusions of either placebo or GLP-1 4 or 8 ng · kg–1 · min–1 for either 16 or 24 h per day for 7 days. At predetermined intervals, 24-h profiles of glucose, glucagon, and insulin were measured. Adverse events and clinical chemistry and hematology were recorded.
RESULTS—For all active treatment groups, the change in average glucose (area under the curve [AUC] for day 7 minus AUC for day 0 divided by 24 h) was statistically significantly different from placebo (P ≤ 0.001). The GLP-1 8 ng · kg–1 · min–1 dose given for 24 h was more efficacious than any of the other doses (P ≤ 0.05). Nocturnal and fasting plasma glucose levels at day 7 were greater in the 16-h groups compared with the 24-h groups (P ≤ 0.05). Insulin AUC did not show any treatment effect for any of the treatment groups when change was assessed from day 0 to day 7. However, for the 16-h groups, the pattern of the insulin profiles changed; the insulin profiles were considerably higher during the initial 3–4 h after restart of the GLP-1 infusion on day 7, although there was a tendency for insulin levels to decrease during the afternoon and evening. Glucagon AUC decreased significantly for all active treatment groups compared with placebo. GLP-1 was generally well tolerated.
CONCLUSIONS—This study demonstrated that GLP-1 should be given continuously to obtain the most optimal glycemic control. Because of the short plasma half-life of native GLP-1, long-acting derivatives should be developed to make GLP-1 treatment clinically relevant.
NeuroD/BETA2 Gene G→A Polymorphism May Affect Onset Pattern of Type 1 Diabetes in Japanese
Authors: Yamada Satoru , Motohashi Yoshiko , Yanagawa Tatsuo , Maruyama Taro , Kasuga Akira , Hirose Hiroshi , Matsubara Koichi , Shimada Akira , Saruta Takao 
Published: March 2007

OBJECTIVE—The majority of type 1 diabetes is considered to be autoimmune with, for the most part, abrupt development. However, type 1 diabetes with slow onset, or the so-called slowly progressive type 1 diabetes or latent autoimmune diabetes in adults, has been recently recognized and is considered to be autoimmune-related. Although some investigators tried to explain the difference in onset pattern by the genetic background, including HLA type, it has not been established thus far. We hypothesized that the difference in onset pattern may relate to regeneration or differentiation of pancreatic β-cells, and we therefore focused on the NeuroD/BETA2 gene, which encodes a transcription factor for the insulin gene and β-cell differentiation.
RESEARCH DESIGN AND METHODS—We examined the NeuroD/BETA2 gene polymorphism in 105 Japanese type 1 diabetic patients and in 122 nondiabetic Japanese subjects in a case-control study, and we stratified the patients according to their onset pattern and islet-associated autoantibody positivity.
RESULTS—Regardless of the existence of islet-associated autoantibody, we found a significant difference in A allele frequency between type 1 diabetic patients with acute-onset type and control subjects. However, no difference was found between type 1 slow-onset diabetic patients and control subjects.
CONCLUSIONS—These results support our hypothesis that NeuroD/BETA2 may affect the ability of regeneration of β-cells, leading to a difference in the onset pattern and clinical course of type 1 diabetes.
Clinical and Psychological Course of Diabetes From Adolescence to Young Adulthood
Authors: Bryden Kathryn S. , Peveler Robert C. , Stein Alan , Neil Andrew , Mayou Richard A. , Dunger David B. 
Published: March 2007

OBJECTIVE—To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood.
RESEARCH DESIGN AND METHODS—A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11–18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20–28 years of age). Longitudinal assessments were made of glycemic control (HbA1c), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory.
RESULTS—Mean HbA1c levels peaked in late adolescence and were worse in female participants (average 11.1% at 18–19 years of age). The proportion of individuals who were overweight (BMI &gt;25.0 kg/m2) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA1c levels than those without complications (difference 1.9%, 95% CI 1.1–2.7, P &lt; 0.0001). Behavioral problems at baseline were related to higher mean HbA1c during the subsequent 8 years (β = 0.15, SEM (β) 0.04, P &lt; 0.001, 95% CI 0.07–0.24).
CONCLUSIONS—The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.