bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burden of Infection and Insulin Resistance in Healthy Middle-Aged Men
Authors: Fernández-Real José-Manuel , López-Bermejo Abel , Vendrell Joan , Ferri Maria-José , Recasens Mónica , Ricart Wifredo 
Published: May 2006

OBJECTIVE—We hypothesized that burden of infection could be associated with chronic low-grade inflammation, resulting in insulin resistance. We aimed to study the effect of exposure to four infections on insulin sensitivity in apparently healthy middle-aged men (n = 124).
RESEARCH DESIGN AND METHODS—By inclusion criteria, all subjects were hepatitis C virus antibody seronegative. Each study subject’s serum was tested for specific IgG class antibodies against herpes simplex virus (HSV)-1, HSV-2, enteroviruses, and Chlamydia pneumoniae through the use of quantitative in vitro enzyme-linked immunosorbent assays. Insulin sensitivity was evaluated using minimal model analysis.
RESULTS—The HSV-2 titer was negatively associated with insulin sensitivity even after controlling for BMI, age, and C-reactive protein (CRP). The associations were stronger when considering the infection burden. In particular, in those subjects who were seropositive for C. pneumoniae, the relationship between the quantitative seropositivity index (a measure of the exposure to various pathogens) and insulin sensitivity was strengthened (r = −0.50, P &lt; 0.0001). We also observed decreasing mean insulin sensitivity index with increasing seropositivity score in subjects positive for enteroviruses. In the latter, the relationship between insulin sensitivity and seropositivity was especially significant (r = −0.71, P &lt; 0.0001). In a multivariate regression analysis, both BMI and quantitative seropositivity index (7%) independently predicted insulin sensitivity variance in subjects with C. pneumoniae seropositivity. When controlling for CRP, this association was no longer significant.
CONCLUSIONS—Pathogen burden showed the strongest association with insulin resistance, especially with enteroviruses and C. pneumoniae seropositivity. We hypothesize that exposure to multiple pathogens could cause a chronic low-grade inflammation, resulting in insulin resistance.
Monitoring Kidney Function in Type 2 Diabetic Patients With Incipient and Overt Diabetic Nephropathy
Authors: Rossing Peter , Rossing Kasper , Gæde Peter , Pedersen Oluf , Parving Hans-Henrik 
Published: May 2006

OBJECTIVE—The purpose of this study was to assess agreement between glomerular filtration rate (GFR) and the decline in GFR estimated with the Modification of Diet in Renal Disease (MDRD) Study Group equation or the Cockcroft-Gault formula and measured by the plasma clearance of 51Cr-EDTA.
RESEARCH DESIGN AND METHODS—We followed a cohort of 156 microalbuminuric type 2 diabetic patients for 8 years with four measurements of GFR and another cohort of 227 type 2 diabetic patients with overt diabetic nephropathy for 6.5 (range 3–17) years with seven (3–22) measurements of GFR.
RESULTS—For patients with microalbuminuria, mean ± SD baseline GFR was 117 ± 24 measured, 92 ± 20 estimated (MDRD equation), or 103 ± 24 ml · min−1 per 1.73 m2 estimated (Cockcroft-Gault formula) (both P &lt; 0.001); 95% limits of agreement were −66.1 to 20.3 (MDRD equation) and −58.7 to 30.7 (Cockcroft-Gault formula). The rate of decline in GFR was 4.1 ± 4.2 measured, 2.9 ± 2.8 estimated (MDRD equation), or 3.4 ± 3.2 ml · min−1 per 1.73 m2 estimated (Cockcroft-Gault formula) (both P &lt; 0.001). For patients with overt nephropathy, baseline GFR was 84 ± 30 measured, 73 ± 24 estimated (MDRD equation), or 81 ± 28 ml · min−1 per 1.73 m2 estimated (Cockcroft-Gault formula) (both P &lt; 0.001) with 95% limits of agreement −47 to 25 (MDRD equation) and −39 to 33 (Cockcroft-Gault formula). The rate of decline in GFR was 5.2 ± 4.1 measured, 4.2 ± 3.8 estimated (MDRD equation), and 4.6 ± 4.1 ml · min−1 per 1.73 m2 estimated (Cockcroft-Gault formula) (both P &lt; 0.001).
CONCLUSIONS—Particularly in microalbuminuric (hyperfiltering) patients, GFR is significantly underestimated with wide limits of agreement by the MDRD equation as well as by the Cockcroft-Gault formula. The rate of decline in GFR is also significantly underestimated with both equations. This makes GFR estimations based upon these equations unacceptable for monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy.
Antihypertensive Medications and the Risk of Incident Type 2 Diabetes
Authors: Taylor Eric N. , Hu Frank B. , Curhan Gary C. 
Published: May 2006

OBJECTIVE—The purpose of this study was to examine the association between the use of different classes of antihypertensive medications and the risk of incident type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a prospective study of three cohorts: the Nurses’ Health Study (NHS) I and II and the Health Professionals Follow-up Study (HPFS). Antihypertensive medication use was ascertained by biennial questionnaires. After excluding participants who reported a history of diabetes at baseline, 41,193 older women (NHS I), 14,151 younger women (NHS II), and 19,472 men (HPFS), all with hypertension, were followed for 8, 10, and 16 years, respectively.
RESULTS—We documented 3,589 incident cases of diabetes. After adjustment for age, BMI, physical activity, the use of other antihypertensive medications, and other risk factors, the multivariate relative risk (RR) of incident diabetes in participants taking a thiazide diuretic compared with those not taking a thiazide was 1.20 (95% CI 1.08–1.33) in older women, 1.45 (1.17–1.79) in younger women, and 1.36 (1.17–1.58) in men. The multivariate RR in participants taking a β-blocker compared with those not taking a β-blocker was 1.32 (1.20–1.46) in older women and 1.20 (1.05–1.38) in men. ACE inhibitors and calcium channel blockers were not associated with risk.
CONCLUSIONS—Thiazide diuretic and β-blocker use were independently associated with a higher risk of incident diabetes. Increased surveillance for diabetes in patients treated with these medications may be warranted.
Association of Elevated Serum Ferritin Levels and the Risk of Gestational Diabetes Mellitus in Pregnant Women
Authors: Chen Xinhua , Scholl Theresa O. , Stein T. Peter 
Published: May 2006

OBJECTIVE— We examined the influence of a moderately elevated serum ferritin level at entry to care on the risk of gestational diabetes mellitus (GDM) and a possible mechanism (increased iron stores versus inflammation).
RESEARCH DESIGN AND METHODS— In a prospective observational study with 1,456 healthy pregnant women in Camden, New Jersey, serum ferritin and anthropometric measurements were determined. Serum C-reactive protein (CRP) concentration was measured in a nested case-control study of 172 subjects.
RESULTS— Women who developed GDM had a higher concentration of serum ferritin than women who did not develop GDM (P &lt; 0.001). Elevated serum ferritin level (highest quintile) was significantly and positively correlated with prepregnant BMI and skinfold measurements. Women in the highest quintile of serum ferritin had a twofold increased risk of developing GDM adjusted for several known risk factors (adjusted odds ratio, 2.02 [95% CI 1.04–3.92], P &lt; 0.05). Similar results were obtained with a nested case-control study, in which women in the highest tertile of serum ferritin (2.35 [1.06–5.22], P &lt; 0.05) or CRP (2.67 [1.16–6.17], P &lt; 0.001) had a greater than twofold increased risk of GDM. However, these effects were modified and became nonstatistically significant after additional adjustment for prepregnant BMI.
CONCLUSIONS— Elevated serum ferritin concentrations early in gestation are associated with an increased risk of GDM. The association, at least in part, is mediated by the maternal fat mass and obesity. These data suggest a possible link between elevated serum ferritin and low-grade inflammation.
Coronary Heart Disease Risk Equivalence in Diabetes Depends on Concomitant Risk Factors
Authors: Howard Barbara V. , Best Lyle G. , Galloway James M. , Howard William James , Jones Kristina , Lee Elisa T. , Ratner Robert E. , Resnick Helaine E. , Devereux Richard B. 
Published: May 2006

OBJECTIVE—Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients.
RESEARCH DESIGN AND METHODS—We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardiovascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population (n = 4,549) with a high prevalence of diabetes.
RESULTS—In both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4% for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was &gt;40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed similar patterns, as did separate analyses by sex.
CONCLUSIONS—Our results and comparisons with other available data show wide variation in the rate of CHD in diabetes, depending on the population and existing risk factors. Most individuals had a 10-year cumulative incidence &gt;20%, but only those with multiple risk factors had a 10-year cumulative incidence that was equivalent to that of patients with CHD. Until more data are available, it may be prudent to consider targets based on the entire risk factor profile rather than just the presence of diabetes.
Coffee, Caffeine, and Risk of Type 2 Diabetes
Authors: van Dam Rob M. , Willett Walter C. , Manson JoAnn E. , Hu Frank B. 
Published: May 2006

OBJECTIVE—High habitual coffee consumption has been associated with a lower risk of type 2 diabetes, but data on lower levels of consumption and on different types of coffee are sparse.
RESEARCH DESIGN AND METHODS—This is a prospective cohort study including 88,259 U.S. women of the Nurses’ Health Study II aged 26–46 years without history of diabetes at baseline. Consumption of coffee and other caffeine-containing foods and drinks was assessed in 1991, 1995, and 1999. We documented 1,263 incident cases of confirmed type 2 diabetes between 1991 and 2001.
RESULTS—After adjustment for potential confounders, the relative risk of type 2 diabetes was 0.87 (95% CI 0.73–1.03) for one cup per day, 0.58 (0.49–0.68) for two to three cups per day, and 0.53 (0.41–0.68) for four or more cups per day compared with nondrinkers (P for trend &lt;0.0001). Associations were similar for caffeinated (0.87 [0.83–0.91] for a one-cup increment per day) and decaffeinated (0.81 [0.73–0.90]) coffee and for filtered (0.86 [0.82–0.90]) and instant (0.83 [0.74–0.93]) coffee. Tea consumption was not substantially associated with risk of type 2 diabetes (0.88 [0.64–1.23] for four or more versus no cups per day; P for trend = 0.81).
CONCLUSIONS—These results suggest that moderate consumption of both caffeinated and decaffeinated coffee may lower risk of type 2 diabetes in younger and middle-aged women. Coffee constituents other than caffeine may affect the development of type 2 diabetes.
Gestational Diabetes Identifies Women at Risk for Permanent Type 1 and Type 2 Diabetes in Fertile Age
Authors: Järvelä Ilkka Y. , Juutinen Jaana , Koskela Pentti , Hartikainen Anna-Liisa , Kulmala Petri , Knip Mikael , Tapanainen Juha S. 
Published: May 2006

OBJECTIVE—Our aim was to evaluate the predictive value of gestational diabetes mellitus (GDM), diabetes-associated autoantibodies, and other factors for development of clinical diabetes later in life.
RESEARCH DESIGN AND METHODS—In this case-control study the presence of autoantibodies was studied in 435 women with GDM and in healthy matched control subjects. The need for exogenous insulin during GDM was recorded. In the GDM group, the mean follow-up period was 5.7 years and in the control group 6.1 years.
RESULTS—Among the subjects with GDM, 20 (4.6%) developed type 1 diabetes and 23 (5.3%) developed type 2 diabetes, whereas none of the control subjects became diabetic. Two-thirds of those who developed type 1 diabetes tested positive initially for islet cell antibodies (ICAs), whereas 56% of them had autoantibodies to GAD (GADAs) and 38% to the protein tyrosine phosphatase–related IA-2 molecule. Only 2 of the 23 women who presented later with type 2 diabetes tested positive for autoantibodies. According to multivariate analysis, initial age ≤30 years, the need for insulin treatment for GDM, and antibody positivity for ICAs and GADAs were associated with increased risk for clinical type 1 diabetes.
CONCLUSIONS—Pregnancy seems to identify women who are at risk of developing diabetes later in life. About 10% of Finnish women with GDM will develop diabetes over the next 6 years; nearly half of them develop type 1 diabetes and the other half type 2 diabetes. Age ≤30 years, the need for insulin treatment during pregnancy, and positivity for ICAs and GADAs confer a high risk of subsequent progression to type 1 diabetes in women affected by GDM.
Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?
Authors: Sarkar Urmimala , Fisher Lawrence , Schillinger Dean 
Published: May 2006

OBJECTIVE—Although prior research demonstrated that improving diabetes self-efficacy can improve self-management behavior, little is known about the applicability of this research across race/ethnicity and health literacy levels. We examined the relationship between diabetes self-efficacy and self-management behavior in an urban, diverse, low-income population with a high prevalence of limited health literacy.
RESEARCH DESIGN AND METHODS—We administered an oral questionnaire in Spanish and English to patients with type 2 diabetes at two primary care clinics at a public hospital. We measured self-efficacy, health literacy, and self-management behaviors using established instruments. We performed multivariate regressions to explore the associations between self-efficacy and self-management, adjusting for clinical and demographic factors. We tested for interactions between self-efficacy, race/ethnicity, and health literacy on self-management.
RESULTS—The study participants were ethnically diverse (18% Asian/Pacific Islander, 25% African American, 42% Latino/a, and 15% white), and 52% had limited health literacy (short version of the Test of Functional Health Literacy in Adults score &lt;23). Diabetes self-efficacy was associated with four of the five self-management domains (P &lt; 0.01). After adjustment, with each 10% increase in self-efficacy score, patients were more likely to report optimal diet (0.14 day more per week), exercise (0.09 day more per week), self-monitoring of blood glucose (odds ratio 1.16), and foot care (1.22), but not medication adherence (1.10, P = 0.40). The associations between self-efficacy and self-management were consistent across race/ethnicity and health literacy levels.
CONCLUSIONS—Self-efficacy was associated with self-management behaviors in this vulnerable population, across both race/ethnicity and health literacy levels. However, the magnitude of the associations suggests that, among diverse populations, further study of the determinants of and barriers to self-management is warranted. Policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the spectrum of health literacy.
Choice of Antibody Immunotherapy Influences Cytomegalovirus Viremia in Simultaneous Pancreas-Kidney Transplant Recipients
Authors: Huurman Volkert A.L. , Kalpoe Jayant S. , van de Linde Pieter , Vaessen Norbert , Ringers Jan , Kroes Aloys C.M. , Roep Bart O. , De Fijter Johan W. 
Published: May 2006

OBJECTIVE—Simultaneous pancreas-kidney (SPK) transplantation in type 1 diabetic patients requires immunotherapy against allo- and autoreactive T-cells. Cytomegalovirus (CMV) infection is a major cause for morbidity after transplantation and is possibly related to recurrent autoimmunity. In this study, we assessed the pattern of CMV viremia in SPK transplant recipients receiving either antithymocyte globulin (ATG) or anti-CD25 (daclizumab) immunosuppressive induction therapy.
RESEARCH DESIGN AND METHODS—We evaluated 36 SPK transplant recipients from a randomized cohort that received either ATG or daclizumab as induction therapy. Patients at risk for CMV infection received oral prophylactic ganciclovir therapy. The CMV DNA level in plasma was measured for at least 180 days using a quantitative real-time PCR. Recipient peripheral blood mononuclear cells were cross-sectionally HLA tetramer-stained for CMV-specific CD8+ T-cells.
RESULTS—Positive CMV serostatus in donors was correlated with a higher incidence of CMV viremia than negative serostatus. In patients at risk, daclizumab induction therapy significantly prolonged CMV-free survival. CMV viremia occurred earlier and was more severe in patients with rejection episodes than in patients without rejection episodes. CMV-specific CD8+ T-cell counts were significantly lower in patients developing CMV viremia than in those who did not.
CONCLUSIONS—Despite their comparable immunosuppressive potential, daclizumab is safer than ATG regarding CMV infection risk in SPK transplantation. ATG-treated rejection episodes are associated with earlier and more severe infection. Furthermore, high CMV-specific tetramer counts reflect antiviral immunity rather than concurrent viremia because they imply low viremic activity. These findings may prove valuable in the discussion on both safety of induction therapy and recurrent autoimmunity in SPK and islet transplantation.
Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments
Authors: Schober Tilmann , Wong Kimberly , DeLisle Gaëlle , Caya Chelsea , Brendish Nathan J. , Clark Tristan W. , Dendukuri Nandini , Doan Quynh , Fontela Patricia S. , Gore Genevieve C. , Li Patricia , McGeer Allison J. , Noël Kim Chloe , Robinson Joan L. , Suarthana Eva , Papenburg Jesse 
Published: March 2024

ImportanceRapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear.ObjectiveTo determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment.Data SourcesOvid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022.Study SelectionRandomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing.Data Extraction and SynthesisPreferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.Main Outcomes and MeasuresAntibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs.ResultsOf 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, −0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding.Conclusions and RelevanceThe results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.
Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD
Authors: Hu Jia-Chian , Shao Shih-Chieh , Tsai Daniel Hsiang-Te , Chuang Albert Tzu-Ming , Liu Kuan-Hung , Lai Edward Chia-Cheng 
Published: March 2024

ImportanceSodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with lower anemia risk, based on findings from post hoc analyses of the CREDENCE and DAPA-CKD trials; however, the effectiveness of SGLT2 inhibitors in a more generalizable type 2 diabetes (T2D) and chronic kidney disease (CKD) population, with active comparisons pertinent to current practice, is unknown.ObjectiveTo evaluate and compare anemia incidence between SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among patients with T2D and CKD stages 1 to 3.Design, Setting, and ParticipantsThis retrospective cohort study used target trial emulation of an expanded CREDENCE and DAPA-CKD study framework. The study was conducted among adults with T2D and CKD initiating SGLT2 inhibitors or GLP-1 RAs between January 1, 2016, and December 31, 2021, with follow-up until December 31, 2022. The study was conducted at the Chang Gung Medical Foundation, the largest multi-institutional hospital system in Taiwan.ExposuresInitiation of SGLT2 inhibitors or GLP-1 RAs.Main Outcomes and MeasuresThe primary outcome was a composite of anemia outcomes, including anemia event occurrence (hemoglobin level &amp;lt;12-13 g/dL or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes) or anemia treatment initiation. Changes in hematological parameters, including hemoglobin level, hematocrit level, and red blood cell count, were evaluated during the follow-up period for as long as 3 years.ResultsThe cohort included a total of 13 799 patients with T2D and CKD, initiating SGLT2 inhibitors (12 331 patients; mean [SD] age, 62.4 [12.3] years; 7548 [61.2%] male) or GLP-1 RAs (1468 patients; mean [SD] age, 61.5 [13.3] years; 900 [61.3%] male). After the median follow-up period of 2.5 years, patients receiving SGLT2 inhibitors had lower incidence of composite anemia outcomes (hazard ratio [HR], 0.81; 95% CI, 0.73-0.90) compared with those receiving GLP-1 RAs. SGLT2 inhibitors were associated with a lower incidence of anemia events (HR, 0.79; 95% CI, 0.71-0.87) but not with a lower rate of anemia treatment initiation (HR, 0.99; 95% CI, 0.83-1.19). Changes in hematological parameters for SGLT2 inhibitors and GLP-1 RAs throughout the 3-year follow-up period supported the primary analyses.Conclusions and RelevanceIn this multi-institutional cohort study with target trial emulation, SGLT2 inhibitors were associated with a decreased risk of composite anemia outcomes, especially anemia event occurrences. SGLT2 inhibitors may be considered as an adjunct therapy to reduce anemia incidence in patients with T2D and CKD.