bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Syndrome in Type 1 Diabetes
Authors: Thorn Lena M. , Forsblom Carol , Fagerudd Johan , Thomas Merlin C. , Pettersson-Fernholm Kim , Saraheimo Markku , Wadén Johan , Rönnback Mats , Rosengård-Bärlund Milla , Björkesten Clas-Göran af , Taskinen Marja-Riitta , Groop Per-Henrik ,   on behalf of the FinnDiane Study Group
Published: March 2007

OBJECTIVE—The aim of this study was to estimate the prevalence of the metabolic syndrome in Finnish type 1 diabetic patients and to assess whether it is associated with diabetic nephropathy or poor glycemic control.
RESEARCH DESIGN AND METHODS—In all, 2,415 type 1 diabetic patients (51% men, mean age 37 years, duration of diabetes 22 years) participating in the nationwide, multicenter Finnish Diabetic Nephropathy (FinnDiane) study were included. Metabolic syndrome was defined according to the National Cholesterol Education Program diagnostic criteria. Patients were classified as having normal albumin excretion rate (AER) (n = 1,261), microalbuminuria (n = 326), macroalbuminuria (n = 383), or end-stage renal disease (ESRD) (n = 164). Glycemic control was classified as good (HbA1c &lt;7.5%), intermediate (7.5–9.0%), or poor (&gt;9.0%). Creatinine clearance was estimated with the Cockcroft-Gault formula.
RESULTS—The overall prevalence of metabolic syndrome was 38% in men and 40% in women. The prevalence was 28% in those with normal AER, 44% in microalbuminuric patients, 62% in macroalbuminuric patients, and 68% in patients with ESRD (P &lt; 0.001). Patients with metabolic syndrome had a 3.75-fold odds ratio for diabetic nephropathy (95% CI 2.89–4.85), and all of the separate components of the syndrome were independently associated with diabetic nephropathy. The prevalence of metabolic syndrome was 31% in patients with good glycemic control, 36% in patients with intermediate glycemic control, and 51% in patients with poor glycemic control (P &lt; 0.001). Similarly, metabolic syndrome increased with worsening creatinine clearance.
CONCLUSIONS—The metabolic syndrome is a frequent finding in type 1 diabetes and increases with advanced diabetic nephropathy and worse glycemic control.
Gestational Weight Gain and Pregnancy Outcomes in 481 Obese Glucose-Tolerant Women
Authors: Jensen Dorte M. , Ovesen Per , Beck-Nielsen Henning , Mølsted-Pedersen Lars , Sørensen Bente , Vinter Christina , Damm Peter 
Published: March 2007

OBJECTIVE—To investigate the effect of gestational weight gain in obese glucose-tolerant women.
RESEARCH DESIGN AND METHODS—We performed a historical cohort study of 481 women with prepregnancy BMI ≥30 kg/m2 and a normal 2-h 75-g oral glucose tolerance test (OGTT) during the third trimester (according to World Health Organization criteria). Data on OGTT results and clinical outcomes were collected from medical records. Four groups were defined according to weight gain: group 1, &lt;5.0 kg (n = 93); group 2, 5.0–9.9 kg (n = 134); group 3, 10.0–14.9 kg (n = 132); and group 4, ≥15.0 kg (n = 122).
RESULTS—Birth weight increased significantly with increasing weight gain (mean grams ± SD): group 1, 3,456 ± 620; group 2, 3,624 ± 675; group 3, 3,757 ± 582; and group 4, 3,784 ± 597 (P &lt; 0.001). The birth weight in group 1 was similar to that of the background population of primarily normal-weight women (3,478 g). In multivariate analyses, increasing weight gain was associated with significantly higher rates of hypertension (OR 4.8 [95% CI for group 4 vs. group 1: 1.7–13.1]), cesarean section (3.5 [1.6–7.8]), induction of labor (3.7 [1.7–8.0]), and large-for-gestational-age infants (4.7 [2.0–11.0]). There was no difference in rates of small-for-gestational-age infants. Significant predictors for birth weight (determined by multiple linear regression) were gestational weight gain, 2-h OGTT result, pregestational BMI, maternal age, gestational age, and smoking.
CONCLUSIONS—Increasing weight gain in obese women is associated with increasing pregnancy complications. Our data suggest that minimal gestational weight gain might normalize birth weight. Prospective studies should be performed to clarify the safety of recommending limited gestational weight gain.
The Burden of Mortality Attributable to Diabetes
Authors: Roglic Gojka , Unwin Nigel , Bennett Peter H. , Mathers Colin , Tuomilehto Jaakko , Nag Satyajit , Connolly Vincent , King Hilary 
Published: March 2007

OBJECTIVE—To estimate the global number of excess deaths due to diabetes in the year 2000.
RESEARCH DESIGN AND METHODS—We used a computerized generic formal disease model (DisMod II), used by the World Health Organization to assess disease burden through modeling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, age- and sex-specific estimates of diabetes prevalence, and available published estimates of relative risk of death for people with diabetes compared with people without diabetes. The results were validated with population-based observations and independent estimates of relative risk of death.
RESULTS—The excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2% of all deaths. Excess mortality attributable to diabetes accounted for 2–3% of deaths in poorest countries and over 8% in the U.S., Canada, and the Middle East. In people 35–64 years old, 6–27% of deaths were attributable to diabetes.
CONCLUSIONS—These are the first global estimates of mortality attributable to diabetes. Globally, diabetes is likely to be the fifth leading cause of death.
Access to Care for Patients With Insulin-Requiring Diabetes in Developing Countries
Authors: Beran David , Yudkin John S. , de Courten Maximilian 
Published: March 2007

OBJECTIVE—The objective of this study was to assess the barriers to care for patients with insulin-requiring diabetes in Mozambique and Zambia.
RESEARCH DESIGN AND METHODS—We used the Rapid Assessment Protocol for Insulin Access to collect information through interviews, discussions, site visits, and document reviews. Government organizations, health facilities, care givers, and patients were asked about care for people with insulin-requiring diabetes. Between 100 and 200 interviews/discussions per country were undertaken in and around the capital city and the regional capital and in a rural area.
RESULTS—Insulin was present in both countries in sufficient quantities, although the financial burden for health services and patients meant that problems with supply exist. There are problems with quantification of needs and equitable distribution of insulin. Problems with availability of syringes and testing equipment were noted, particularly in Mozambique. This lack of tools and infrastructure for diagnosis and follow-up coupled with low levels of health care worker training and lack of diagnostic reagents resulted in a substantial risk of misdiagnosis or failure to detect diabetes. The estimated prevalence of insulin-requiring diabetes differs more than 10-fold between urban and rural areas in Mozambique and 4-fold between Mozambique and Zambia, suggesting that problems in diagnosis and care result in substantial worsening of prognosis for such patients.
CONCLUSIONS—Insulin is necessary but not sufficient to improve prognosis for diabetic patients. A Rapid Assessment Protocol methodology can be used to define problems in health care delivery for diabetes. Proper care for insulin-requiring diabetes necessitates health systems able to provide trained personnel, medicines in sufficient quantity, and diagnostic and monitoring facilities.
Biofeedback-Assisted Relaxation in Type 2 Diabetes
Authors: McGinnis Ronald A. , McGrady Angele , Cox Stephen A. , Grower-Dowling Kimber A. 
Published: March 2007

OBJECTIVE—The objective of this randomized controlled study was to determine the effects of biofeedback and relaxation on blood glucose and HbA1c (A1C) in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Patients with type 2 diabetes were randomized to either 10 sessions of biofeedback (electromyograph and thermal) and relaxation or 3 sessions of education. All sessions were individual. A total of 39 participants were entered, and 30 completed the 3-month protocol. Average blood glucose, A1C, forehead muscle tension, and peripheral skin temperature were assessed, and inventories measuring depression and anxiety were administered prerandomization and after completion of treatment/control.
RESULTS—Biofeedback and relaxation were associated with significant decreases in average blood glucose, A1C, and muscle tension compared with the control group. At 3-month follow-up, the treatment group continued to demonstrate lower blood glucose and A1C. Both groups decreased scores on the depression and anxiety inventories. Patients with depression had higher blood glucose levels and tended to drop out of the study.
CONCLUSIONS—This study supports the use of biofeedback and relaxation in patients with type 2 diabetes for up to 3 months after treatment. Further research is necessary to determine the long-term effects of biofeedback and the effects of mood on patients’ responses to treatment.
Enteral Nutritional Support and Use of Diabetes-Specific Formulas for Patients With Diabetes
Authors: Elia Marinos , Ceriello Antonio , Laube Heiner , Sinclair Alan J. , Engfer Meike , Stratton Rebecca J. 
Published: March 2007

OBJECTIVE—The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes.
RESEARCH DESIGN AND METHODS—Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible.
RESULTS—A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58–1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86–2.32]; two RCTs), and glucose area under curve (by 7.96 mmol · l−1 · min−1 [2.25–13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26–71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas.
CONCLUSIONS—This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.
Preprogrammed Intravenous Insulin Infusion in Diabetic Humans: Metabolic Consequences of Altering Meal Size
Authors: Levy-Marchal Claire , Perlman Kusiel , Zinman Bernard , Albisser A Michael 
Published: March 2007

New implantable, variable-rate, intravenous insulin infusion systems offer the possibility of increased dietary flexibility in the treatment of diabetes mellitus. However, the development of insulin infusion algorithms required to maintain near-normal glycemia inthe presence of a nonconstant diet first requires information concerning the metabolic response to meals of varying size when the insulin dose is fixed. With this goal in mind, we studied five type I diabetics aged 16–40 yr who were treated for 3 wk with a portable intravenous insulin infusion system. Initially, the patient's usual prescribed diabetic diet was provided, and an individual waveform of insulin infusion resulting in diurnalnormoglycemia was defined for each meal. Subsequently, small (12% of total daily calories) and large (36% of total daily calories) versions of the regular breakfast (24% of totaldaily calories) were provided without change in the insulin infusion waveforms, and the resulting metabolic profiles were studied. The overall mean fasting plasma glucose levels before the meals of varying size were not significantly different, but the incremental rises in plasma glucose with the small (31 ± 5 mg/dl), regular (48 ± 7 mg/dl), and large (64 ± 5 mg/dl) breakfasts varied directly with the meal size. The subsequent mean plasma glucose levels before the regular lunch were significantlydifferent (P &lt; .05) after the small (50 ± 4 mg/dl) and large breakfasts (131 ± 9 mg/dl), compared with the regular breakfast (81 ± 7 mg/dl). Despite these differences, the plasma glucose levels before dinner were virtually identical.
We conclude that large variations in meal size produce glycemic changes in keeping with the caloric content of the meal. These changes are associated only with the meal in question and do not result in sustained adverse glycemic consequences. Nevertheless, these results suggest the necessity of developing guidelines for changing mealtime insulin infusion profiles to maintain normoglycemia, despite variations in caloric intake. Only in this way will the unique capabilities of implantable intravenous insulin delivery devices be fully exploited.
Inhaled Insulin: An Overview
Authors: White John R. , Campbell R. Keith 
Published: March 2007

In BriefVarious methods of insulin administration other than injection have been sought since the discovery of insulin. For the past several years, systems that deliver insulin via the pulmonary route have been developed and evaluated. Based on available data, pulmonary insulin appears to be safe, efficacious, and well accepted by patients. This article describes the technology behind several of these pulmonary administration systems and outlines the most recent data from clinical trials evaluating pulmonary insulin.
Preventing Cardiovascular Complications of Type 2 Diabetes: Focus on Lipid Management
Authors: Henry Robert R. 
Published: March 2007

IN BRIEF
Because type 2 diabetes can be considered a cardiovascular disease in its own right, current American Diabetes Association and National Cholesterol Education Program guidelines recommend aggressive treatment of dyslipidemia in people with diabetes, particularly for elevated LDL cholesterol levels. Use of appropriate treatment as determined by the pattern of lipid abnormalities can substantially reduce the risk of macrovascular disease. Institution of tight glycemic control will be beneficial to most patients, but the majority of people with diabetes will also require diet therapy, weight reduction when necessary, and intensive lipid-lowering therapy, which commonly involves one of the statins or fibric acid derivatives.
Is Postprandial Glucose Control Important? Is It Practical In Primary Care Settings?
Authors: Parkin Christopher Grainger , Brooks Neil 
Published: March 2007

In Brief
Large interventional studies have shown that achieving and maintaining near-normal glycemic levels reduces the risk for microvascular and macrovascular complications in type 2 diabetes. The impact of postprandial glucose on glycemic control has become a topic of much discussion among clinicians. This article examines the literature related to the role of postprandial glucose in type 2 diabetes, both as a contributor to overall glycemia and as an independent risk factor for diabetes complications, and discusses the practicality of managing postprandial hyperglycemia in primary care settings.
Polycystic Ovary Syndrome and the Metabolic Syndrome
Authors: Sharpless Julie L. 
Published: March 2007

In Brief
Many patients with polycystic ovary syndrome (PCOS) also have features of the metabolic syndrome, including insulin resistance, obesity, and dyslipidemia, suggesting an increased risk for cardiovascular disease. Increased awareness of this overlap advocates therapies that improve insulin resistance and often ameliorate PCOS symptoms.
Advances in Obesity Treatment: Clinical Highlights from the NAASO 2003 Annual Meeting
Authors: Marks Jennifer B. 
Published: March 2007

In Brief
This article offers highlights from the 2003 annual meeting of the North American Association for the Study of Obesity, which was co-sponsored by the American Diabetes Association. Topics include recent research into various diets for weight loss, the relationship between obesity and polycystic ovarian syndrome, and future treatments of obesity.
Elevated Liver Function Tests in Type 2 Diabetes
Authors: Harris Elizabeth H. 
Published: March 2007

IN BRIEF
Individuals with type 2 diabetes have a higher incidence of liver function test abnormalities than individuals who do not have diabetes. Mild chronic elevations of transaminases often reflect underlying insulin resistance. Elevation of transaminases within three times the upper limits of normal is not a contraindication for starting oral antidiabetic or lipid-modifying therapy. In contrast, antidiabetic agents have generally been shown to decrease alanine aminotransferase levels as tighter blood glucose levels are achieved.
Influence of general anaesthesia on the pharmacokinetics of intravenous fentanyl and its primary metabolite in horses
Authors: THOMASY S. M. , MAMA K. R. , WHITLEY K. , STEFFEY E. P. , STANLEY S. D. 
Published: March 2007

SummaryReasons for performing study: In order to evaluate its potential as an adjunct to inhalant anaesthesia in horses, the pharmacokinetics of fentanyl must first be determined.Objectives: To describe the pharmacokinetics of fentanyl and its metabolite, N‐[1‐(2‐phenethyl‐4‐piperidinyl)maloanilinic acid (PMA), after i.v. administration of a single dose to horses that were awake inTreatment 1and anaesthetised with isoflurane inTreatment 2.Methods: A balanced crossover design was used (n = 4/group). DuringTreatment 1, horses received a single dose of fentanyl (4 μg/kg bwt, i.v.) and duringTreatment 2, they were anaesthetised with isoflurane and maintained at 1.2 × minimum alveolar anaesthetic concentration. After a 30 min equilibration period, a single dose of fentanyl (4 μg/kg bwt, i.v.) was administered to each horse. Plasma fentanyl and PMA concentrations were measured at various time points using liquid chromatography‐mass spectrometry.Results: Anaesthesia with isoflurane significantly decreased mean fentanyl clearance (P < 0.05). The fentanyl elimination half‐life, in awake and anaesthetised horses, was 1 h and volume of distribution at steady state was 0.37 and 0.26 l/kg bwt, respectively. Anaesthesia with isoflurane also significantly decreased PMA apparent clearance and volume of distribution. The elimination half‐life of PMA was 2 and 1.5 h in awake and anaesthetised horses, respectively.Conclusions and potential relevance: Pharmacokinetics of fentanyl and PMA in horses were substantially altered in horses anaesthetised with isoflurane. These pharmacokinetic parameters provide information necessary for determination of suitable fentanyl loading and infusion doses in awake and isoflurane‐anaesthetised horses.
Lamellar pro‐inflammatory cytokine expression patterns in laminitis at the developmental stage and at the onset of lameness: innate vs. adaptive immune response
Authors: BELKNAP J. K. , GIGUÈRE S. , PETTIGREW A. , COCHRAN A. M. , VAN EPS A. W. , POLLITT C. C. 
Published: March 2007

SummaryReasons for performing study: Recent research has indicated that inflammation plays a role in the early stages of laminitis and that, similar to organ failure in human sepsis, early inflammatory mechanisms may lead to downstream events resulting in lamellar failure. Characterisation of the type of immune response (i.e. innate vs. adaptive) is essential in order to develop therapeutic strategies to counteract these deleterious events.Objectives: To quantitate gene expression of pro‐inflammatory cytokines known to be important in the innate and adaptive immune response during the early stages of laminitis, using both the black walnut extract (BWE) and oligofructose (OF) models of laminitis.Methods: Real‐time qPCR was used to assess lamellar mRNA expression of interleukins‐1β, 2, 4, 6, 8, 10, 12 and 18, and tumour necrosis factor alpha and interferon gamma at the developmental stage and at the onset of lameness.Results: Significantly increased lamellar mRNA expression of cytokines important in the innate immune response were present at the developmental stage of the BWE model, and at the onset of acute lameness in both the BWE model and OF model. Of the cytokines characteristic of the Th1 and Th2 arms of the adaptive immune response, a mixed response was noted at the onset of acute lameness in the BWE model, whereas the response was skewed towards a Th1 response at the onset of lameness in the OF model.Conclusions: Lamellar inflammation is characterised by strong innate immune response in the developmental stages of laminitis; and a mixture of innate and adaptive immune responses at the onset of lameness.Potential relevance: These results indicate that anti‐inflammatory treatment of early stage laminitis (and the horse at risk of laminitis) should include not only therapeutic drugs that address prostanoid activity, but should also address the marked increases in lamellar cytokine expression.
Oral and intravenous administration of nimesulide in the horse: rational dosage regimen from pharmacokinetic and pharmacodynamic data
Authors: VILLA R. , CAGNARDI P. , BELLOLI C. , ZONCA A. , ZIZZADORO C. , FERRO E. , CARLI S. 
Published: March 2007

SummaryReasons for performing study: The selective COX‐2‐inhibitor nimesulide is used extra‐label in equine veterinary practice as an anti‐inflammatory agent. However, there are no data on which to base the rational use of the drug in this species.Objectives: To determine the effective COX selectivity of nimesulide in the horse, and suggest a suitable dosing schedule.Methods: The pharmacokinetics of nimesulide in the horse after oral administration (1 mg/kg bwt), and oral and i.v. administration (1.5 mg/kg bwt) were investigated, effects of feeding status on bioavailability determined, and plasma protein binding of the drug and its principal metabolites measured. Compartmental and noncompartmental pharmacokinetic analyses were performed. The plasma concentration‐time profile was used, together within vitroliterature data on nimesulide inhibition of COX isoforms, to determine the effective COX selectivity of nimesulide in the horse, and suggest a suitable dosing schedule.Results and conclusions: The findings suggest that 1.5 mg/kg bwt may produce adequate clinical effects, and the dosing interval should be 12–24 h depending on condition severity. However, at that dose, the concentration in the animal exceeds thein vitroIC50for both isoforms, so that COX‐1/COX‐2 selectivity is lost and side‐effects due to COX‐1 inhibition are a possibility. Nimesulide should therefore be used with caution in equine clinical practice.