bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Effectiveness of a Quality Improvement Program for Patients With Type 2 Diabetes in General Practice
Authors: Renders Carry M. , Valk Gerlof D. , Franse Lonneke V. , Schellevis François G. , van Eijk Jacques Th.M. , van der Wal Gerrit 
Published: March 2007

OBJECTIVE—To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes.
RESEARCH DESIGN AND METHODS—A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA1c and blood lipid levels. Main patient outcomes were blood pressure and HbA1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices.
RESULTS—Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01–5.82) for the measurement of urine albumin to 12.08 (4.70–31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome.
CONCLUSIONS—The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.
Utilization of Oral Hypoglycemic Agents in a Drug-Insured U.S. Population
Authors: Boccuzzi Stephen J. , Wogen Jenifer , Fox James , Sung Jennifer C.Y. , Shah Amishi B. , Kim Jennifer 
Published: March 2007

OBJECTIVE—Clinical trials provide information regarding the safety and efficacy of medications used to manage type 2 diabetes but do not elucidate drug effectiveness in a typical managed care environment. The aim of this study was to characterize “real-world” drug utilization patterns from both a prescriber and a patient perspective.
RESEARCH DESIGN AND METHODS—We conducted a retrospective analysis of a large administrative pharmacy claims database, using data on continuously pharmacy benefit–eligible members prescribed oral hypoglycemic agents (OHAs).
RESULTS—The 12-month persistence rate for the OHA cohort was low, ranging from 31% for α-glucosidase inhibitors to 60% for metformin; compliance rates varied between 70 and 80%. During the first 12 months of therapy, 36% of the patients remaining on therapy at 12 months had one or more therapy modifications. The mean number of therapy changes increased with the length of patient follow-up, with more than half of all patients experiencing at least one therapy change over the duration of follow-up.
CONCLUSIONS—These findings document the wide variation in utilization patterns associated with pharmacological management of type 2 diabetes, suggesting that opportunity exists to optimize its pharmacological management.
Relations Between ACE Gene and ecNOS Gene Polymorphisms and Resistive Index in Type 2 Diabetic Patients With Nephropathy
Authors: Taniwaki Hiromichi , Ishimura Eiji , Matsumoto Naoki , Emoto Masanori , Inaba Masaaki , Nishizawa Yoshiki 
Published: March 2007

OBJECTIVE—ACE and endothelial cell nitric oxide synthase (ecNOS) genotypes have been reported to be related to the incidence of renal diseases and coronary artery diseases. In order to assess the effect of the gene polymorphism of both ACE and ecNOS on renal hemodynamic abnormality, we examined 155 Japanese patients with type 2 diabetes with various stages of nephropathy.
RESEARCH DESIGN AND METHODS—The patients ranged in age from 40 to 72 years (92 men and 63 women). They were divided into four groups: group 1 consisted of patients with urinary albumin excretion (UAE) &lt;30 mg/day (n = 69), group 2 had 30 ≤ UAE &lt; 300 mg/day (n = 44), group 3 had UAE ≥300 mg/day and serum creatinine &lt;1.5 mg/dl (n = 22), and group 4 had serum creatinine &gt;1.5 mg/dl (n = 20). Intrarenal hemodynamics were studied by duplex Doppler sonography in patients with type 2 diabetes. The ACE and ecNOS gene polymorphisms were examined by polymerase chain reaction.
RESULTS—There were no significant differences in sex, BMI, and blood glucose level, but there were differences in HbA1c and lipoprotein profiles among the four groups. There were no significant differences in the distribution of ACE genotype or in the frequency of the ecNOS 4a allele among the four groups. Resistive index (RI) values of the interlobar arteries of group 4 were significantly higher than those of groups 1, 2, and 3, whereas the RI values were not significantly different among groups 1, 2, and 3. Multiple regression analysis showed that age, duration of diabetes, systolic and diastolic blood pressure, and creatinine clearance were significantly associated with the increased RI values, but that there was no significant association between RI values and the ecNOS genotype (R2 = 0.613, P &lt; 0.0001).
CONCLUSIONS—These results suggest that intrarenal hemodynamic abnormalities are present as a feature of the progression of nephropathy in type 2 diabetes, and that they are associated with age, duration of diabetes, decreased creatinine clearance, and blood pressure, but not with the genetic factors of the ACE and ecNOS gene polymorphism in nephropathy of type 2 diabetes.
Endothelial Perturbation in Children and Adolescents With Type 1 Diabetes
Authors: Romano Mario , Pomilio Mariapina , Vigneri Sergio , Falco Angela , Chiesa Pierluigi Lelli , Chiarelli Francesco , Davì Giovanni 
Published: March 2007

OBJECTIVE—The progression of diabetic angiopathy is, in most cases, unpredictable. The aim of this study was to investigate early events that could influence the development of diabetic angiopathy.RESEARCH DESIGN AND METHODS—Circulating levels of von Willebrand factor (vWF) and tissue-plasminogen activator (tPA), defining endothelial perturbation, were measured in 40 young patients with type 1 diabetes. Patients were divided into two groups according to the duration of diabetes (group A, &lt;1 year; group B, &gt;1 year) and compared with a control group of age- and sex-matched healthy individuals. Prothrombin fragment 1 and 2 (F1+2), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) levels were also determined as markers of a prothrombotic state and inflammatory response. A total of 16 of the 20 children in group A were re-examined after 12 months.RESULTS—Compared with either normal subjects or patients in group B, children in group A showed increased levels of vWF, tPA, F1+2, TNF-α, and CRP. Significant direct correlations between TNF-α or CRP and either vWF, tPA, or F1+2 were observed. Endothelial perturbation was shown in 70% of group A and 20% of group B. After 1 year, 16 of the 20 patients in group A showed a significant reduction in vWF, tPA, F1+2, TNF-α, and CRP levels, whereas endothelial perturbation was reversed in 5 of these patients.CONCLUSIONS—Endothelial perturbation represents an early and, in some cases, reversible event in the chronology of type 1 diabetes in children. A correlation might exist between the initial inflammatory reaction and the appearance of endothelial perturbation.
C-Reactive Protein in Type 1 Diabetes and Its Relationship to Coronary Artery Calcification
Authors: Colhoun Helen M. , Schalkwijk Casper , Rubens Michael B. , Stehouwer Coen D.A. 
Published: March 2007

OBJECTIVE—In 196 type 1 diabetic subjects and 195 nondiabetic subjects aged 30–55 years, we examined whether C-reactive protein (CRP) is elevated in diabetes and whether CRP is associated with coronary artery calcification (CAC).
RESEARCH DESIGN AND METHODS—CRP was measured with a highly sensitive immunoassay. CAC was measured using electron beam computed tomography.
RESULTS—CRP was elevated in diabetic women compared with nondiabetic women (median 1.62 vs. 0.85 mg/l, P &lt; 0.001) independently of other factors, but was similar in diabetic and nondiabetic men (median 0.82 vs. 0.81 mg/l). Insulin dose per day was positively correlated with CRP in diabetic women (Spearman’s ρ = 0.36, P = 0.0003) but much less so in men (ρ = 0.16, P = 0.09). Being in the top tertile for CRP was associated with CAC in diabetic and nondiabetic men even after adjustment for other risk factors (adjusted odds ratio [OR] = 4.6 and 4.3, respectively, P = 0.02 for both). In nondiabetic women, being in the top tertile for CRP was associated with CAC (OR 3.1, P = 0.04), but not independently of BMI (OR = 1 after adjustment). Among diabetic women the association was not significant even before adjustment for BMI (OR = 2.6, P = 0.07).
CONCLUSIONS—Elevated CRP in diabetic women might reflect a particular sensitivity to insulin levels or might reflect insulin resistance. In general, CRP is an important marker of subclinical atherosclerosis, but the clinical significance of elevated CRP in diabetic women needs to be addressed in prospective studies, since CRP was not clearly associated with CAC in this group.
Gestational Diabetes and the Incidence of Type 2 Diabetes
Authors: Kim Catherine , Newton Katherine M. , Knopp Robert H. 
Published: March 2007

OBJECTIVE—To examine factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM).
RESEARCH DESIGN AND METHODS—We conducted a systematic literature review of articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. We abstracted diagnostic criteria for GDM and type 2 diabetes, cumulative incidence of type 2 diabetes, and factors that predicted incidence of type 2 diabetes.
RESULTS—A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6% to over 70% in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes.
CONCLUSIONS—Conversion of GDM to type 2 diabetes varies with the length of follow-up and cohort retention. Adjustment for these differences reveals rapid increases in the cumulative incidence occurring in the first 5 years after delivery for different racial groups. Targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required.
Diabetes in Employer-Sponsored Health Insurance
Authors: Peele Pamela B. , Lave Judith R. , Songer Thomas J. 
Published: March 2007

OBJECTIVE—To examine medical and mental health care expenditures for large numbers of individuals with diabetes enrolled in employment-sponsored insurance plans.
RESEARCH DESIGN AND METHODS—Health insurance billing data for ∼1.3 million individuals enrolled in health insurance plans sponsored by 862 large self-insured employers nationwide were used to examine employer expenditures and consumer out-of-pocket payments for 20,937 people identified with diabetes. These expenditures were compared with expenditures for individuals with other chronic illnesses. Main outcome measures were covered charges, insurance plan reimbursements, and estimated consumer out-of-pocket payments for both medical and mental health services.
RESULTS—A total of 1.7% of enrollees were identified as having diabetes and ∼11% of those used at least one mental health service during 1996. Health care expenditures were three times higher for those with diabetes compared with all health care consumers in these insurance plans, but when compared with individuals with other chronic illnesses such as heart disease, HIV/AIDS, cancer, and asthma, those with diabetes were not more expensive for employers’ insurance plans. Diabetes accounts for 6.5% of total health plan expenditures.
CONCLUSIONS—Diabetes is not more expensive for either consumers or their employer-sponsored insurance plans than other chronic illnesses.
A Multivariate Logistic Regression Equation to Screen for Diabetes
Authors: Tabaei Bahman P. , Herman William H. 
Published: March 2007

OBJECTIVE—To develop and validate an empirical equation to screen for diabetes.
RESEARCH DESIGN AND METHODS—A predictive equation was developed using multiple logistic regression analysis and data collected from 1,032 Egyptian subjects with no history of diabetes. The equation incorporated age, sex, BMI, postprandial time (self-reported number of hours since last food or drink other than water), and random capillary plasma glucose as independent covariates for prediction of undiagnosed diabetes. These covariates were based on a fasting plasma glucose level ≥126 mg/dl and/or a plasma glucose level 2 h after a 75-g oral glucose load ≥200 mg/dl. The equation was validated using data collected from an independent sample of 1,065 American subjects. Its performance was also compared with that of recommended and proposed static plasma glucose cut points for diabetes screening.
RESULTS—The predictive equation was calculated with the following logistic regression parameters: P = 1/(1 − e−x), where x = −10.0382 + [0.0331 (age in years) + 0.0308 (random plasma glucose in mg/dl) + 0.2500 (postprandial time assessed as 0 to ≥8 h) + 0.5620 (if female) + 0.0346 (BMI)]. The cut point for the prediction of previously undiagnosed diabetes was defined as a probability value ≥0.20. The equation’s sensitivity was 65%, specificity 96%, and positive predictive value (PPV) 67%. When applied to a new sample, the equation’s sensitivity was 62%, specificity 96%, and PPV 63%.
CONCLUSIONS—This multivariate logistic equation improves on currently recommended methods of screening for undiagnosed diabetes and can be easily implemented in a inexpensive handheld programmable calculator to predict previously undiagnosed diabetes.
Proteinuria as a Predictor of Total Plasma Homocysteine Levels in Type 2 Diabetic Nephropathy
Authors: Friedman Allon N. , Hunsicker Lawrence G. , Selhub Jacob , Bostom Andrew G. ,   The Collaborative Study Group
Published: March 2007

OBJECTIVE—Patients with diabetes who manifest proteinuria are at increased risk for cardiovascular events. Some studies suggest that proteinuria exerts its cardiovascular effects at least partly through a positive association with total plasma homocysteine (tHcy). Modestly sized but better designed contrary studies find no such link through a limited range of serum creatinine and proteinuria. We tested the hypothesis that proteinuria independently predicts tHcy levels in a larger cohort of type 2 diabetic patients with nephropathy throughout a much broader range of kidney disease and proteinuria.
RESEARCH DESIGN AND METHODS—Baseline data for the cross-sectional study were obtained from 717 patients enrolled in the multicenter Irbesartan Diabetic Nephropathy Trial. All subjects had type 2 diabetes, hypertension, and proteinuria and were between 29 and 78 years of age. Data included age, sex, BMI, serum creatinine and albumin, LDL and HDL cholesterol, triglyceride, proteinuria and albuminuria, plasma folate, B12, and pyridoxal 5′-phosphate (PLP) (the active form of B6), HbA1c, and tHcy levels. Unadjusted and multivariable models were used in the analysis.
RESULTS—Crude analyses revealed significant associations between tHcy and age (r = 0.074; P = 0.008), creatinine (r = 0.414; P &lt; 0.001), PLP (r = −0.105; P = 0.021), B12 (r = −0.216; P &lt; 0.001), folate (r = −0.241; P &lt; 0.001), and HbA1c (r = −0.119; P = 0.003), with serum albumin approaching significance (r = 0.055; P = 0.072). Only serum creatinine, plasma folate, B12, serum albumin, sex, HbA1c, and age were independent predictors of tHcy after controlling for all other variables.
CONCLUSIONS—By finding no independent correlation between proteinuria (or albuminuria) and tHcy levels, this study improves the external validity of previous negative findings. Therefore, it is unlikely that the observed positive association between proteinuria and cardiovascular disease is directly related to hyperhomocysteinemia.
Increased Risk of Childhood Type 1 Diabetes in Children Born After 1985
Authors: Svensson Jannet , Carstensen Bendix , Mølbak AnneGrete , Christau Bjørn , Mortensen Henrik B. , Nerup Jørn , Borch-Johnsen Knut ,   the Danish Study Group of Diabetes in Childhood (DSBD)
Published: March 2007

OBJECTIVE—The incidence rate of childhood type 1 diabetes is thought to be increasing; however, Danish studies have not confirmed this. Using a national diabetes register initiated in 1996 and two previous regional incidence studies, we studied the age-specific incidence of type 1 diabetes over 30 years. Here, we describe the incidence rates of type 1 diabetes in Danish children from 1996 to 2000 and evaluate trends in age-specific incidence rates from 1970 to 2000.
RESEARCH DESIGN AND METHODS—A nationwide registration of all newly diagnosed cases of type 1 diabetes among children under the age of 15 years was established in Denmark in 1996. Incidence rates of type 1 diabetes in Denmark were obtained from this register. Age-specific incidence rates were compared with data collected from 1970 to 1976 and from 1980 to 1984, both population-based studies using existing national routine registration of hospitalizations within the survey areas. Population data were obtained from Statistics Denmark.
RESULTS—During the study period, 1,421 Danish children developed type 1 diabetes before the age of 15 years. The incidence rates by age-groups were: 12.7, 19.4, and 26.3 for the 0–4, 5–9, and 10–14 years age-groups, respectively, and 19.5 for the 0–14 years age-group per 100,000 in the period 1996–2000. An age-period-cohort analysis showed a modest drift effect (yearly increase) of 1.2% (0.7–1.8) from 1970 to 2000, and a significant birth cohort effect with an increased risk for children born after 1985 was observed.
CONCLUSIONS—The incidence rate of type 1 diabetes is rising in children living in Denmark. The steep increase in the youngest age-group was explained by the increased risk for cohorts born at the beginning of the 1980s.
The Prevalence of the HNF-1α G319S Mutation in Canadian Aboriginal Youth With Type 2 Diabetes
Authors: Sellers Elizabeth A.C. , Triggs-Raine Barbara , Rockman-Greenberg Cheryl , Dean Heather J. 
Published: March 2007

OBJECTIVE—To investigate the prevalence of the unique HNF-1α G319S mutation in a population of aboriginal youth with type 2 diabetes and to describe the relationship between clinical and historical characteristics and the presence or absence of the HNF-1α G319S mutation.
RESEARCH DESIGN AND METHODS—Participating youth were genotyped for the G319S mutation of the HNF-1α gene. Clinical, laboratory, and historical data were collected via chart review (blinded to genotype results). Comparison data were derived from another study involving young nondiabetic pregnant aboriginal women.
RESULTS—A total of 51 youth seen sequentially in a type 2 diabetes clinic participated in this study. Of these, 21 (41.2%) had at least one copy of the mutant allele. The allele frequency in the study population was 0.29 (95% CI 0.20–0.38), which was significantly different from the allele frequency of 0.13 in the comparison population (χ2 = 6.78, P = 0.009). The frequency of the homozygous mutation (S319/S319) was 0.18. Mean BMI was significantly lower (P = 0.002), mean HbA1c was significantly higher (P = 0.02), and acanthosis nigricans was significantly less frequent (P = 0.004) in those with the mutation compared with the wild type. Mean insulin levels were lower and insulin sensitivity (assessed by homeostasis model assessment [HOMA]) was greater in the homozygote group compared with the wild-type group (P = 0.002 and P = 0.0007, respectively). A dose-dependent gradient was observed for these characteristics.
CONCLUSIONS—These data support the association between the HNF-1α G319S mutation and early-onset type 2 diabetes in this population. Those with the mutation lacked clinical characteristics of insulin resistance (e.g., obesity and acanthosis nigricans) and had lower insulin levels, suggesting that an insulin-secretory and/or -production defect plays an important role in the development of diabetes in this group. Further investigation of the pathophysiology of the S319 homo- and heterozygote is needed because it may impact treatment and/or prevention of this disease.
Comparison of Insulin Aspart With Buffered Regular Insulin and Insulin Lispro in Continuous Subcutaneous Insulin Infusion
Authors: Bode Bruce , Weinstein Richard , Bell David , McGill Janet , Nadeau Daniel , Raskin Philip , Davidson Jaime , Henry Robert , Huang Won-Chin , Reinhardt Rickey R. 
Published: March 2007

OBJECTIVE—To compare the safety and efficacy of insulin aspart (IAsp), buffered regular insulin (BR), and insulin lispro administered by continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes.
RESEARCH DESIGN AND METHODS—After completing a 4-week run-in period with BR, 146 adult patients with type 1 diabetes (with pretrial CSII experience) were randomly assigned (2:2:1) to CSII treatment with IAsp, BR, or lispro for 16 weeks in a multicenter, open-label, randomized, parallel-group study. Bolus insulin doses were administered 30 min before meals (BR) or immediately before meals (IAsp or lispro).
RESULTS—Treatment groups had similar baseline HbA1c (7.3% ±0.7 for IAsp, 7.5% ±0.8 for BR, and 7.3% ±0.7 for lispro). After 16 weeks of treatment, HbA1c values were relatively unchanged from baseline, and the mean changes in baseline HbA1c values were not significantly different between the three groups (0.00 ±0.51, 0.15 ±0.63, and 0.18 ±0.84 for the IAsp, BR, and lispro groups, respectively). The rates of hypoglycemic episodes (blood glucose &lt;50 mg/dl) per patient per month were similar (3.7, 4.8, and 4.4 for the IAsp, BR, and lispro groups, respectively). Clogs/blockages in pumps or infusion sets were infrequent; most subjects (76, 83, and 75% in the IAsp, BR, and lispro groups, respectively) had ≤1 clog or blockage per 4 weeks during the trial.
CONCLUSIONS—Insulin aspart in CSII was as efficacious and well tolerated as BR and lispro and is a suitable insulin for continuous subcutaneous insulin infusion using external pumps.