bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health, Life, and Automobile Insurance Characteristics in Adults With IDDM
Authors: Songer Thomas J , LaPorte Ronald E , Dorman Janice S , Orchard Trevor J , Becker Dorothy J , Drash Allan L 
Published: March 2007

Objective
To determine whether people with insulindependent diabetes mellitus (IDDM) were compromised in their access to insurance.

Research Design and Methods
A case-control study of 158 people with IDDM and 158 nondiabetic siblings matched for age and sex was conducted to evaluate the health, life, and automobile insurance characteristics and history of people with IDDM.

Results
Health insurance coverage (yes/no) among the IDDM and sibling control subjects was similar. More than 90% of the IDDM and control respondents had insurance through a private third-party source, and this insurance did not differ by type of plan, coverage, or premium. However, Medicare coverage was more common among the IDDM subjects and was associated with the presence of severe diabetic complications. IDDM subjects were also more likely to have been denied a health insurance policy by an insurer than were the control subjects (23 vs. 1%, P &lt; 0.001). Similarly, there was no difference between the IDDM and sibling control subjects in the number who had a life or automobile insurance policy. However, life and automobile insurance refusal was much more frequent among the IDDM respondents, more so for life (55 vs. 0%, P &lt; 0.001) than for automobile (12 vs. 4%, P &lt; 0.05) insurance.

Conclusions
These results suggest that access to insurance is severely compromised for people with IDDM. Although most of those with IDDM are able to find some form of insurance, it is evident that on average they must go to extra lengths to find it. These data and a changing insurance environmentemphasize the need to reexamine, as a society, the importance of insurance for people with chronic disease, particularly IDDM.
Effects of α-Glucosidase Inhibition on Meal Glucose Tolerance and Timing of Insulin Administration in Patients With Type I Diabetes Mellitus
Authors: Dimitriadis George , Hatziagellaki Eryfilli , Alexopoulos Evangelos , Kordonouri Olga , Komesidou Vasiliki , Ganotakis Manolis , Raptis Sotirios 
Published: March 2007

Objective
Miglitol, an α-glucosidase inhibitor, delays absorption of carbohydrates. This study was undertaken to determine the potential of this agent as an adjunct to insulin in the treatment of diabetes.

Research Design And Methods
Twelve nonobese patients with insulin-dependent (type I) diabetes mellitus were randomly selected from the outpatient diabetes clinic. The patients were made euglycemic with the Biostator, and postprandial hyperglycemia was determined under the following conditions: protocol 1, subcutaneous injection of insulin (13 ± 1 U) given 60 min before the meal, with insulin dosages determined by the Biostator; protocols 2 and 3 same as protocol 1 but with insulin given at the time of meal ingestion; protocols 4 and 5 same as protocol 1 but with insulin given 30 min before the meal. Miglitol (100 mg) was administered in protocols 2 and 4 and placebo in protocols 3 and 5.

Results
When insulin was given 30 min before the meal with miglitol (protocol 4) or placebo (protocol 5), plasma glucose increased from 4.94 ± 0.16 to 5.94 ± 0.55 mM and from 5.11 ± 0.22 to 8.22 ± 0.72 mM, respectively (P &lt; 0.01). When insulin was given at the time of the meal with miglitol (protocol 2) or placebo (protocol 3), plasma glucose increased from 5.44 ± 0.27 to 7.77 ± 0.5 mM and from 5.72 ± 0.22 to 10.83 ± 0.77 mM, respectively (P &lt; 0.01). When insulin was given 60 min before the meal (protocol 1), plasma glucose initially decreased from 5.61 ± 0.38 to 4.33 ± 0.33 mM and then increased to 6.94 ± 0.66 mM after the meal.(ABSTRACT TRUNCATED AT 250 WORDS)
Short-term Effects Of Alterations in Dietary Fat on Metabolic Control in IDDM
Authors: Ireland Paul , O'Dea Kerin , Nankervis Alison 
Published: March 2007

OBJECTIVE
Two experimental diets were evaluated to investigate the hypothesis that dietary fat has an independent influence on metabolic control in IDDM.

RESEARCH DESIGN AND METHODS
The diets had similar CHO contents (26 and 22% of energy intake) but differed markedly in fat (53 vs. 16% energy) and protein (20 vs. 62% energy). We had 10 subjects follow the low-CHO, high-fat diet, and 8 subjects follow the low-CHO, low-fat, high-protein diet. In each case, markers of glycemic and lipid control obtained after adherence to the experimental diet for 2 wk were compared with corresponding data from a preceding control period during which subjects had followed their usual diet (protein 18–19%, CHO 41–46%, fat 33–37%).

RESULTS
Despite the low CHO content of the high-fat diet, insulin requirements were unchanged relative to the control diet. Moreover, the glycemic response to a standard breakfast was elevated significantly (P &lt; 0.001), suggesting that insulin resistance had either been induced or exacerbated. The small rise in total cholesterol concentration in response to the high-fat diet was accounted for by a rise in HDL cholesterol. Glycemic control and lipid metabolism were unchanged after the low-CHO, low-fat diet, although insulin requirements fell by an average of 6 U/day (P &lt; 0.05) relative to those recorded during the 2-wk control period.

CONCLUSIONS
Diets high in fat are deleterious to glycemic control in IDDM, but general applicability is limited by the small sample size and short duration of this study.
Microalbuminuria Associated With Diabetic Neuropathy
Authors: Bell David SH , Ketchum Catherine H , Robinson C Andrew , Wagenknecht Lynne E , Williams Burson T 
Published: March 2007

Objective
To test the hypothesis that microalbuminuria may show an independent statistical association with diabetic neuropathy.

Research Design and Methods
An observational study of a prospectively identified cohort was conducted at the University Medical Center. The cohort consisted of 78 consecutive diabetic patients who fulfilled the criteria of having diabetes for &gt;10 yr, a normal serum creatinine, urine negative for macroalbuminuria by a commonly used dipstick method, a blood glucose &lt;13.8 mM (&lt;250 mg/dl), and an HbA1 &lt;11% (normal range 5.5–8.5%). Medical record review established the presence of chronic complications of diabetes. Urine albumin level was measured by radioimmunoassay. Albumin concn ≥15 mg/L was used as a cutoff value for microalbuminuria.

RESULTS
Twenty-five of 78 patients (32%) showed microalbuminuria. Of these, 51% had neuropathy, 39% had retinopathy, 35% arterial hypertension, 17% peripheral vascular disease, and 15% ischemic heart disease. After adjusting for age, sex, and type and duration of diabetes, diabetic neuropathy and hypertension showed a significant association with microalbuminuria. After adjusting for other diabetic complications, diabetic neuropathy showed a significant association with microalbuminuria.

Conclusions
Microalbuminuria is independently associated with diabetic neuropathy. This association lends support to the theory of a vascular etiology for diabetic distal symmetrical neuropathy.
Comparison of Combined Therapies in Treatment of Secondary Failure to Glyburide
Authors: Trischitta Vincenzo , Italia Salvatore , Mazzarino Salvatore , Buscema Massimo , Rabuazzo Agata Maria , Sangiorgio Lidia , Squatrito Sebastiano , Vigneri Riccardo 
Published: March 2007

Objective
To compare the effectiveness of alternative combined treatments in patients with non-insulin-dependent diabetes mellitus (NIDDM) with secondary failure to sulfonylureas.

Research Design and Methods
A crossover study was carried out by randomly assigning 16 NIDDM patients to a combined treatment with the addition of either a single low-dose bedtime injection of 0.2 U/kg body wt NPH insulin or an oral three times a day administration of 1.5 g/day metformin to the previously ineffective glyburide treatment.

Results
Both combined therapies significantly (P &lt;0.01) reduced fasting plasma glucose (FPG), postprandial plasma glucose (PPPG) and percentage of HbA1. The addition of metformin was more effective than the addition of insulin (P &lt;0.01) in improving PPPG in the 8 patients with higher post-glucagon C-peptide levels. In contrast, the efficacy of neither combined therapy was related to patient age, age of diabetes onset, duration of the disease, percentage of ideal body weight, and FPG. The addition of insulin but not metformin caused a significant (P &lt;0.01) increase of mean body weight. Neither combined treatment caused changes in serum cholesterol and triglyceride levels. No symptomatic hypoglycemic episode was reported in any of the 16 patients.

CONCLUSIONS
The addition of bedtime NPH insulin or metformin was effective in improving the glycemic control in most NIDDM patients with secondary failure to glyburide. The combination of metformin and sulfonylurea was more effective in reducing PPPG and did not induce any increase of body weight.
Relationship Between Plasma Insulin and Blood Pressure in South African Black Women in Johannesburg
Authors: Joffe Barry I , Panz Vanessa R , Wing Jefrey R , Raal Frederick J , Seftel Harold C 
Published: March 2007

Objectives
To examine the relationship between fasting plasma insulin and blood pressure (BP) in 40 urbanized normotensive South African black women aged 24–60 yr, and to assess the effects of body mass index (BMI) and fasting plasma glucose on BP.

Research Design and Methods
The women comprised equal numbers of young nonobese nondiabetic subjects, middle-aged nonobese nondiabetic subjects, middle-aged obese nondiabetic subjects, and middle-aged obese newly diagnosed non-insulin-dependent diabetic subjects. Systolic and diastolic BPs were recorded (in duplicate) after 15 min of recumbency, and fasting plasma glucose and insulin levels were determined thereafter. The data were analyzed by simple and multivariate regression.

Results
There was a wide distribution of individual physical and biochemical features. With simple correlations, systolic BP correlated significantly with age, BMI, and fasting glucose but not with insulin. Diastolic BP correlated significantly with all four variables (r = 0.37, P &lt;0.05). When adjusted for age, BMI, and glucose, however, the significant correlation between diastolic BP and insulin diminished (r = −0.04).

Conclusions
As in other nonwhite communities, plasma insulin does not appear to play a major role in regulating the BP of South African black women.
Coronary Heart Disease Incidence in NIDDM Patients In The Helsinki Heart Study
Authors: Koskinen Pekka , Mänttäri Matti , Manninen Vesa , Huttunen Jussi K , Heinonen Olli P , Frick M Heikki 
Published: March 2007

Objective
To determine coronary heart disease (CHD) incidence among dyslipidemic subjects with non-insulin-dependent diabetes mellitus (NIDDM) and to assess the effect of lipid-modifying treatment on serum and lipoprotein lipids and the CHD incidence in these patients.

Research Design and Methods
Of the 4081 men participating in the Helsinki Heart Study, a coronary primary prevention trial with gemfibrozil in middle-aged men with high non-high-density lipoprotein (HDL) cholesterol (&gt; 5.2 mM; 200 mg/dL), 135 had NIDDM at entry. The incidence of definite myocardial infarction and cardiac death and changes in serum and lipoprotein lipids were determined during the 5-yr trial in the NIDDM patients and compared with those observed in nondiabetic trial participants.

Results
Compared with nondiabetic subjects, NIDDM patients had lower HDL cholesterol (P &lt; 0.001), higher triglyceride concentration (P &lt; 0.0001), and greater body mass index (P &lt; 0.001), there were more hypertensive patients (P &lt; 0.001) among them. The incidence of myocardial infarction and cardiac death was significantly higher among diabetic than nondiabetic participants (7.4 vs. 3.3%, respectively, P &lt; 0.02). CHD incidence in the gemfibrozil-treated diabetic men (n = 59) was 3.4% compared with 10.5% in the placebo group (NS). In multivariate analysis, diabetes (P &lt; 0.05), age (P &lt; 0.0001), smoking (P &lt; 0.0001), low HDL cholesterol (P &lt; 0.05), and high low-density lipoprotein cholesterol (P &lt; 0.005) were independently related to CHD incidence. Gemfibrozil-induced serum and lipoprotein lipid changes in diabetic patients were similar to those observed in nondiabetic subjects.

Conclusions
Compared with similarly dyslipidemic nondiabetic subjects, patients with NIDDM are at markedly increased risk of CHD. This elevated risk can be somewhat reduced by gemfibrozil.
Effect of Glycemic Control on Growth Velocity in Children With IDDM
Authors: Wise Joyce E , Kolb Elsie L , Sauder Sue E 
Published: March 2007

Objective
To determine the effect of glycemic control on growth velocity in children with insulin-dependent diabetes mellitus.

Research Design and Methods
One hundred twenty-two children with insulin-dependent diabetes mellitus were studied over a 5-yr period. Every 4 mo, glycemic control was assessed by measuring total glycosylated hemoglobin (GHb), pubertal status was determined by physical examination, and height was measured with a stadiometer. Height measurements were normalized for age and sex by converting them to Ζ scores (the number of SD above or below the mean for age and sex). Alterations in growth velocity were determined by the change in Ζ scores (ΔΖ) between visits (i.e., no change in tau score = normal growth velocity; decrease in Ζ score = growth deceleration; and increase in Ζ score = growth acceleration).

Results
A linear relationship was seen between GHb levels and the change in Ζ scores (r = −0.117, P = 0.001). GHb values &lt; 8% were associated with growth acceleration (ΔΖ = +0.10 ± 0.03), and the greatest growth deceleration occurred when GHb was &gt; 16% (ΔΖ =−-0.07 ± 0.03). The level of GHb at which growth suppression occurred (mean ΔΖ became negative) was dependent on pubertal status: Tanner stage 1 ≤ 10%, Tanner stages 2 and 3 ≤ 8%, Tanner stages 4 and 5 ≤ 16%.

Conclusions
Linear growth velocity in children with insulin-dependent diabetes mellitus is heavily related to metabolic control. Children who are prepubertal or in the early stages of puberty are the most vulnerable to growth suppression. Once puberty is well established, growth suppression does not occur until marked hyperglycemia (GHb &gt; 16%) exists.
Xerostomia in Diabetes Mellitus
Authors: Sreebny Leo M , Yu Albert , Green Andrew , Valdini Anthony 
Published: March 2007

Objective
To determine the prevalence of xerostomia in a group of ambulatory diabetic patients and to compare the following in patients with and without xerostomia: 1) flow rates of saliva and lacrimal fluid, 2) the presence of other symptoms suggestive of oral and extraoral dryness, 3) indexes of glycemic control, and 4) noninvasive measures of cardiovagal autonomic nervous system function.

Research Design and Methods
Forty adult diabetic patients and an equal number of age- and sex-matched healthy nondiabetic control subjects were studied. Subjects who consumed xerogenic drugs or had other significant diseases were excluded from the study. A questionnaire was administered to all patients, and the following tests were performed: resting and stimulated flow rates on whole saliva; Schirmer's test (lacrimal fluid), serum glucose and HbA1, expiration-inspiration ratio, 30:15 ratio, Valsalva ratio, and the systolic blood pressure response to standing.

Results
Forty-three percent of diabetic patients complained of xerostomia, of which 82% were women. The oral dryness was not related to age or the type and duration of diabetes. Symptoms of water loss and oropharyngeal, ocular, and vaginal dryness were much more common in the xerostomic than the nonxerostomic diabetic patients. The salivary flow rates of the diabetic subjects was consistently lower than those of healthy, nondiabetic control subjects. The mean, resting, and whole-saliva flow rate was abnormally low in the diabetic patients who complained of xerostomia; no significant differences were observed for the stimulated salivary and the lacrimal flow rates. Significant inverse relationships were shown between salivary flow and the level of HbA1; none were shown between flow and autonomic function.

Conclusions
Dry mouth is a common complaint among ambulatory diabetic patients. It is strongly associated with objective measurements of poor salivary flow and with other oral and extraoral symptoms of desiccation. The oral dryness is not associated with cardiovagal autonomic system dysfunction but may be due to disturbances in glycemic control.
Plasma Endothelinlike Immunoreactivity Levels in IDDM Patients with Microalbuminuria
Authors: Collier Andrew , Leach John P , McLellan Alistair , Jardine Alan , Morton James J , Small Michael 
Published: March 2007

OBJECTIVE
To determine whether plasma endothelin, a potent vasoconstrictor and growth factor for vascular smooth muscle, is elevated in microalbuminuric insulin-dependent diabetes mellitus patients.

RESEARCH DESIGN AND METHODS
Plasma endothelinlike immunoreactivity was measured by radioimmunoassay in 15 microalbuminuric diabetic patients, 12 normoalbuminuric diabetic patients, and 12 control subjects.

RESULTS
The mean levels of plasma endothelinlike immunoreactivity were raised in the normoalbuminuric patients (8.4 pM [range 4.8–12.7 pM]; P &lt; 0.01) and the microalbuminuric patients (10.2 pM [range 5.6–31.1 pM]; P &lt; 0.001) compared with control subjects (6.1 pM [range 4.5–7.6 pM]). Plasma endothelinlike immunoreactivity was also higher in the microalbuminuric patients compared with the normoalbuminuric patients (P &lt; 0.05).

CONCLUSIONS
The increase in plasma endothelinlike immunoreactivity further confirms endothelial dysfunction in diabetes and this increase in plasma endothelin may contribute to the vascular disease prevalent in diabetes.
Lipoprotein(a) in Diabetic Patients with and Without Chronic Renal Failure
Authors: Guillausseau Pierre Jean , Peynet Jacqueline , Chanson Philippe , Legrand Alian , Altman Jean Jacques , Poupon Joel , N'Guyen Maï , Rousselet François , Lubetzki Jean 
Published: March 2007

OBJECTIVE
To examine the distribution of Lp(a) plasma levels in patients with IDDM and NIDDM, and in nondiabetic and IDDM patients with chronic renal failure.

RESEARCH DESIGN AND METHODS
Cross-sectional study of Lp(a) plasma levels in a population of diabetic patients with stable metabolic control, with simultaneous determination of plasma lipids, fasting plasma glucose, and HbA1. Thirty-six patients with IDDM, 90 with NIDDM, and 41 with chronic renal failure (20 IDDM, 21 nondiabetic) were compared with 78 control subjects.

RESULTS
Lp(a) plasma levels were significantly higher in IDDM and NIDDM patients, as well as in nondiabetic and IDDM patients with chronic renal failure compared with control subjects. No correlation was observed between Lp(a) and lipid plasma levels, fasting plasma glucose, and HbA1.

CONCLUSIONS
Lp(a) may contribute to the increased prevalence of atherosclerotic disease in diabetic patients and patients with chronic renal failure, especially in IDDM patients whose lipoprotein pattern was not different from that of the control group.
Local Skin-Fold Thickness as a Clinical Predictor of Depot Size During Basal Rate Infusion of Insulin
Authors: Hildebrandt Per R , Vaag Allan A 
Published: March 2007

Objective— To determine the influence of local adiposity on insulin depot size during CSII at basal rate.
Research Design and Methods— In 27 diabetic patients, a constant infusion of 125I-labeled Actrapid insulin was given, with U-40 insulin at a rate of 1.12 IU/h in 20 patients, and U-100 at a rate of 1 IU/h in 7 patients. After 16 h of infusion, the steady-state depot size was measured by external counting, and the local skin fold was measured with a Harpenden skin-fold caliper.
Results— U-40 insulin infusion resulted in a steady-state depot size of 5.1 U (2.1–10.9 U), and a corresponding skin-fold thickness of 17.8 mm (5–34 mm). A positive correlation was found between depot size and skin-fold thickness. A similar correlation was observed with U-100 insulin.
Conclusions— During basal rate CSII, large variations in local skin-fold thickness create large variations in the steady-state depot size, which is partly predictable just by lifting the skin fold.
Diabetic Retinopathy
Authors: Ferris Frederick L 
Published: March 2007

OBJECTIVE— To review the natural history and treatment indications for diabetic retinopathy.
RESEARCH DESIGN AND METHODS— Studies of the natural history of diabetic retinopathy and major clinical trials sponsored by the National Eye Institute were reviewed.
RESULTS— Diabetic retinopathy remains a leading cause of vision disability in the U.S. Vision loss results from the consequences of proliferative retinopathy or macular edema. Photocoagulation has been demonstrated to be an effective treatment for these complications of diabetes.
CONCLUSIONS— All people with diabetes should be evaluated regularly to determine whether they would benefit from photocoagulation. As a referral guideline, any person with type I diabetes of &gt;5 yr duration and all people with type II diabetes or any retinopathy should be referred to an ophthalmologist.
Diabetic Kidney Disease in Pima Indians
Authors: Nelson Robert G , Knowler William C , Pettitt David J , Saad Mohammed F , Bennett Peter H 
Published: March 2007

OBJECTIVE— To describe the natural history of kidney disease in Pima Indians with NIDDM.
RESEARCH DESIGN AND METHODS— Review of previous studies describing diabetic kidney disease in this Native-American population and in other populations.
RESULTS— NIDDM is the leading cause of renal failure in Pima Indians, among whom the incidence of ESRD is 23 times that of the general U.S. population. The high incidence of NIDDM and its early onset in the Pima undoubtedly contribute to this difference. The incidence of overt nephropathy and ESRD, as a function of diabetes duration, is at least as high in Pima Indians with NIDDM as that reported in other populations with IDDM. Furthermore, nearly all of the excess mortality associated with NIDDM is found in individuals with overt nephropathy. Mild elevations of UAE, which may be present even shortly after the onset of diabetes, predict the development of overt nephropathy in diabetic Pimas. Additional predictors include high blood pressure, level of glycemia, duration of diabetes, family history of diabetic nephropathy, and type of diabetes treatment.
CONCLUSIONS— Diabetic kidney disease is a major cause of morbidity and mortality in Pima Indians. The natural history of diabetic kidney disease in this population is similar, in many ways, to the natural history described in individuals with IDDM.