bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pioglitazone reduces atherogenic dense low density lipoprotein (LDL) particles in patients with type 2 diabetes mellitus
Authors: Winkler Karl , Friedrich Isolde , Baumstark Manfred W , Wieland Heinrich , März Winfried 
Published: August 2008

Aim The new oral antidiabetic agent pioglitazone improves insulin sensitivity and glycaemic control, lowers triglycerides and increases high density lipoprotein (HDL) cholesterol in type 2 diabetes. The effect of pioglitazone on low density lipoprotein (LDL) subfractions is investigated, herein.Methods The effect of pioglitazone monotherapy (45 mg o.d. for six months) on LDL subfractions was observed in 30 patients with poorly controlled type 2 diabetes (HbA1C ≥ 7.5% and < 11.5% and triglycerides ≥ 150 mg/dL). The distribution of LDL subfractions was determined by equilibrium density gradient ultracentrifugation before and during treatment.Results HbA1C (9.5% before and 7.4% on treatment, p<0.001), triglycerides (-135 mg/dL [-32.2%], p=0.002) and apo B in LDL-6 (the most dense LDL subfraction) decreased significantly. The mean diameter of LDL particles increased (19.5 nm before and 19.8 nm on treatment, p=0.005), while the mean LDL density decreased significantly (from 1.0394 kg/L to 1.0381 kg/L on treatment; p=0.033). HDL increased from 36.3 mg/dL to 44.2 mg/dL (+ 21.6%, p<0.001). Total cholesterol and LDL-cholesterol did not change significantly.Conclusions The results confirm that pioglitazone improves glycaemic control in patients with type 2 diabetes. In addition, pioglitazone reduced the proportion of atherogenic dense LDL. The effects of pioglitazone on lipoprotein metabolism may translate into a reduced risk for atherosclerotic complications in type 2 diabetes.
Erectile dysfunction in patients with diabetes mellitus — advances in treatment with phosphodiesterase type 5 inhibitors
Authors: Snow Kenneth J 
Published: August 2008

Erectile dysfunction (ED) is a common complication of diabetes mellitus. In four independent, 12-week, randomised, placebo-controlled clinical trials that evaluated the pro-erectile properties of the selective phosphodiesterase type 5 (PDE-5) inhibitors, sildenafil (Viagra) (25—100 mg), tadalafil (10 and 20 mg) and vardenafil (10 and 20 mg) in men with ED secondary to diabetes mellitus, all the active drugs were significantly superior to placebo. In this difficult-to-treat population, the greatest difference from placebo for the overall responder rate of diabetic men reporting improved erections occurred with vardenafil 20 mg (72% vs. 13% for placebo). All the PDE-5 inhibitors were generally well tolerated. There were fewer reports of visual disturbance with vardenafil or tadalafil than with sildenafil, which may be due to their greater selectivity for PDE-5 inhibition and less cross-reactivity with retinal PDE-6 inhibition. The studies suggest there may be significant differences between the three drugs. However, only head-to-head studies will determine true differences in both efficacy and side effect profile.
Increased carotid intimal media thickness precedes albuminuria in South Indian type 2 diabetic subjects
Authors: Viswanathan Vijay , Snehalatha Chamukuttan , Mohan Rangamoorthy Suresh , Mamtha Nair Balakrishnan , Ramachandran Ambady 
Published: August 2008

Introduction Intimal media thickness (IMT) of common carotid artery (CCA) is used as an index of atherosclerosis. IMT is increased in subjects with diabetes and also with diabetic nephropathy. Aim The study was undertaken in South Indian type 2 diabetic patients with different degrees of albuminuria to see whether albuminuria worsened IMT. Material and methods IMT was measured by ultrasonography in 273 diabetic subjects with normoalbuminuria (n=91), microalbuminuria (n=92), clinical proteinuria (Prot) (n=90) and in age-matched non-diabetic subjects (n=99). The diabetic subjects were older than the non-diabetic subjects hence IMT was age-adjusted using a linear regression formula. Results Age-adjusted IMT value in diabetic subjects was significantly higher (0.88±0.3 mm) than in non-diabetic subjects (0.57±0.34 mm) (p<0.001). Mean IMT in normoalbuminuria (0.87±0.26 mm), microalbuminuria (0.90± 0.33 mm) and Prot (0.86±0.39 mm) patients were not significantly different from each other. Male gender, age, diabetes and total cholesterol were independently associated with IMT, while duration of diabetes, hypertension and HbA1C were not. Conclusion Increased carotid IMT occurred in type 2 diabetes prior to the presence of albuminuria. Further deterioration in IMT did not occur with the presence of albuminuria.
Pharmacological management of hyperlipidaemia
Authors: Evans Marc , Roberts Aled , Rees Alan 
Published: August 2008

Coronary heart disease (CHD) is a major cause of morbidity and mortality. Recent evidence supports the benefits of intensive low density lipoprotein-cholesterol (LDL-c) reduc-of intensive low density lipoprotein-cholesterol (LDL-c) reduction on CHD risk with various ongoing end point trials addressing the issue of optimal cholesterol reduction. Statins reduce LDL-c, and have been shown to reduce CHD event rates in both primary and secondary prevention trials. The magnitude of this effect is not fully accounted for by LDL-c reduction alone and may relate to effects on other lipid parameters. Fibrates represent the best treatment for raising high density lipoprotein-cholesterol (HDL-c) and a variety of agents, which specifically target HDL-c, are under development. New therapies being developed to meet the challenge of intensive cholesterol lowering include rosuvastatin, a potent statin, producing reductions in LDL-c of up to 69% and ezetimibe, a selective cholesterol absorption inhibitor, producing reductions in LDL-c of up to 25%. This review summarises the evidence regarding dyslipidaemia and vascular risk and how advances in lipid-lowering therapy may be important in future management of hyperlipidaemia.
Hypertension, diabetes and cardiovascular risk in ethnic minorities in the UK
Authors: Cappuccio Francesco P , Barbato Antonio , Kerry Sally M 
Published: August 2008

Mortality from coronary heart disease (CHD), stroke and end-stage renal failure (ESRF) is high in South Asian (Indo-Asian) migrants in the UK. This is associated with a high prevalence of diabetes and hypertension. Mortality from stroke and ESRF is also high in migrants to the UK of black African origin. However, CHD mortality is low in this group. This pattern of mortality is also associated with a high prevalence of hypertension and diabetes. Conventional risk factors, such as cigarette smoking and hypercholesterolaemia, are less prevalent in ethnic minority populations in the UK and unlikely to explain the differences seen between groups, although each risk factor is likely to contribute to the variation in vascular disease within each group.
Diabetes services in primary care: are we prepared for the diabetes NSF?
Authors: Buckley Martin G , Liversedge Stephen N , Dean John D 
Published: August 2008

Aims To conduct a survey examining issues relating to implementation of the diabetes NSF (National Service Framework) in primary care. Methods Fifty-two general practices were sent a questionnaire (14 questions) to investigate issues relating to implementation of the NSF for diabetes. Results A completed questionnaire was returned by 32 (≥ 60%) of practices. Of these, 30 (93.7%) had a practice register for diabetes, 18 (56.2%) had a screening policy for undiagnosed diabetes and 23 (71.9%) had specific diabetes clinics (SDC). The practice nurse was at the front line of diabetes care, with the general practitioner, podiatrist and dietitian playing an increased role when patients had uncontrolled risk factors, or complications. In SDC lack of funding, specialist personnel and time were the main barriers to implementing the diabetes NSF. In most practices holding SDC, patients with diabetes (65.2%) were not seen in the same clinics as patients with other cardiovascular risk problems, but without diabetes (34.8%). In those general practices not holding SDC, the majority reported they did not wish to develop these clinics (60%), due mainly to time restrictions. Only a minority (24%) of general practices referred patients with psychological problems, related to diabetes, to clinical psychology services. Conclusion Many general practices lack the necessary infrastructure to deliver comprehensive diabetes care and will struggle, without additional resources, to meet standards of care required, following NSF implementation.
Ischaemic outcomes assessment survey: A pilot study in patients with peripheral arterial disease
Authors: Howard James J , Souchek Julianne , Collins Tracie C 
Published: August 2008

Background Patients with peripheral arterial disease (PAD) are at increased risk for stroke, myocardial infarction (MI) and cardiovascular death. Prior studies have focused on the prevalence of PAD, but the rate of ischaemic outcomes among a diverse group of patients with PAD has received less attention. In addition, the assessment of ischaemic outcomes with the use of a survey in place of casenote review, to our knowledge, has not been defined. The purpose of this pilot study was to develop an ischaemic outcomes survey that could be used in place of the labour-intensive casenote review, for data collection as part of a large epidemiological study. Methods A data abstraction form was used as a guide in blinded casenote reviews to compare the patient's reported medical history to casenote documented ischaemic events. The proportion agreement and Cohen's kappa were used to measure the agreement and the statistical significance of this agreement between the questionnaire and casenote review items. Fifty-one patients with a history of PAD were consented and interviewed using a 23-item questionnaire that focused on the ischaemic events of unstable angina, MI, cerebral vascular accident, transient ischaemic attacks, lower extremity revascularisation, or lower extremity amputation. Results Of the 23 patient survey items, proportion agreement was ≥ 70% on more than half of the items with kappa statistics that were fair-to-moderate. For ischaemic outcomes such as lower extremity bypass surgery, there were no yes responses from the patient or within the medical record, which reflects the low prevalence of this outcome. Conclusions Overall, the ischaemic outcomes questionnaire was a valid research tool. It yielded statistically significant kappa values on several items. Although additional work is needed, the present survey provides a good framework on which to develop the final questionnaire, which will be used in a large prospective cohort study to capture ischaemic events in patients with PAD.
Real gains but practical limitations to glycaemic control with insulin in type 2 diabetes
Authors: Gardner Stephen , Dunachie Susanna J , Levy Jonathan C 
Published: August 2008

Background Insulin is increasingly used for type 2 diabetes when oral therapy is inadequate. We have examined the results in unselected patients in a UK hospital diabetes clinic. Methods Clinical database records from 1994 to 2002 were analysed for anthropomorphic data, blood pressure, HbA1C and plasma cholesterol in type 2 diabetic patients starting insulin therapy. Results In 335 patients, HbA 1C at four years correlated positively with HbA1C before starting insulin (r=0.31, p<0.01) and negatively correlated with age at the time of starting insulin (r=-0.19, p<0.01). In two cohorts changed to insulin therapy before and after publication of the results of the UKPDS (1998), HbA1C improved in the first year, with little subsequent change over four years, while weight continued to rise. The later cohort had a significantly greater reduction in HbA1C (p=0.001). Even in this group, only 21.6% of patients achieved HbA1C < 7.5%. Conclusions In a UK diabetes clinic, insulin therapy for type 2 diabetes improved glycaemic control in the first year, but not thereafter, while weight gain continued in subsequent years. Tighter targets may have promoted improved results.
Gabapentin for the treatment of painful diabetic neuropathy: dosing to achieve optimal clinical response
Authors: Gómez-Pérez Francisco J , Perez-Monteverde Armando , Nascimento Osvaldo , Aschner Pablo , Tagle Marino , Fichtner Klaus , Subbiah Ponni , Mutisya Elizabeth M ,   For The Latin American Diabetic Neuropathy Study Group, Parsons Bruce 
Published: August 2008

Objective To determine whether gabapentin titrated to achieve clinical effect (≥ 50% reduction in pain; 900—3,600 mg/day) provides superior efficacy to a commonly prescribed fixed-dose (900 mg/day) in subjects with PDN. Methods In Latin America, an open-label trial randomised 339 subjects with PDN to gabapentin, 900 mg/day, for seven weeks (n=170), or to 900—3,600 mg/day titrated over four weeks to achieve clinical effect, followed by three weeks at stable dose (n=169). Results Gabapentin produced a significantly greater reduction in final weekly mean pain scores from baseline when titrated to clinical effect than when administered as a fixed-dose regimen (53.6% vs. 43.3%; p=0.009). Responder rate was significantly increased (64.5% vs. 47.5%; p=0.002), mean VAS scores significantly decreased, final weekly sleep interference scores significantly decreased (57% C vs. 37.2%; p=0.013), and trends favouring improvement in global functioning and QOL were seen in the titration to clinical effect group (p<0.001). Both regimens were well-tolerated. Conclusions Titration to clinical effect offered superior efficacy in treating PDN compared to a low fixed-dose treatment. Br J Diabetes Vasc Dis 2004;4:173—8
Socioeconomic status, cardiovascular risk factors and the incidence of microvascular and macrovascular disease in type 1 diabetes
Authors: Swaminathan Krishnan , Lewis Susan , Morris Andrew D ,   The Royal College of Physicians of Edinburgh Diabetic Registry Group
Published: August 2008

This study was undertaken to explore the associations between socioeconomic deprivation, prevalent cardiovascular risk factors and the development of microvascular and macrovascular complications in a cohort of subjects with type 1 diabetes mellitus in Scotland. We identified 2,314 people with type 1 diabetes from clinic records in six Scottish regions from 1989 to 1996. Postcode sectors were used to determine the Carstairs Index as a proxy for socioeconomic status. Clinic records and linkage to Scottish morbidity records allowed the association of socioeconomic status with the development of microvascular and macrovascular disease and the prevalence of cardiovascular risk factors to be evaluated. There was no overall association between prevalence of disease and socioeconomic status. There was a significant univariate relationship between smoking and deprivation (trend test p<0.0 D 0001; 47% of the most deprived were current smokers compared to 25% of the least deprived). Multivariate analysis showed that raised blood pressure, increasing age, smoking, high glycated haemoglobin and albuminuria were all independently associated with the development of macrovascular disease. Raised blood pressure, increasing duration of diabetes and high glycated haemoglobin were independently associated with microvascular disease. No associations were observed between either medical problem and socioeconomic status either before or after adjustment for other factors. Our study concluded that social deprivation is associated with an increased risk of smoking. Our results did not confirm a tendency to poor glycaemic or blood pressure control in people who are deprived and there was no association between deprivation and incident microvascular or macrovascular disease.
Assessment of postprandial glucose: relationship between a standardised continental breakfast and the oral glucose tolerance test
Authors: Golay Alain , Guitard Christiane , Hoyer Monique , Logan John O , Brunel Patrick C 
Published: August 2008

Background To determine the relationship between postprandial glucose(PPG) and insulin values after an oral glucose tolerance test (OGTT) and a standardised continental breakfast. Methods An open, single-centre, randomised, crossover study in 32 fasted patients with type 2 diabetes and 10 healthy volunteers. Plasma glucose and insulin concentrations following a standardised breakfast challenge and a 75 g OGTT were measured over two hours. Results In both groups, the standardised breakfast induced similar plasma glucose and insulin profiles to the OGTT. Mean PPG excursions at each time-point were 1—2 mmol/L greater following the OGTT than the breakfast. Two-hour OGTT glucose levels correlated highly (r ≥ 0.80) with those following the breakfast at all time-points between 0.5—2 hours. Conclusion Plasma glucose levels measured 0.5—2 hours following a standardised breakfast are useful for assessing postprandial hyperglycaemia for diagnostic or post-treatment evaluations.
The Alphabet Strategy and standards of care in young adults with type 1 diabetes
Authors: Gholap Nitin , Pillai Meera , Virmani Sumit , Lee James D , James Diane , Morrissey John , Datta Vipan , Patel Vinod 
Published: August 2008

The Alphabet Strategy is a mnemonic-based approach to assist commitment to important aspects of diabetes care: Advice; Blood pressure lowering; Cholesterol and creatinine control; Diabetes control; Eye examination; Foot examination; and use of Guardian drugs. This strategy reported high standards of care of patients with type 2 diabetes. This study assesses the impact of the Alphabet Strategy on diabetes management in young adults with type 1 diabetes and compared data with those of a recently published multicentre study. Results were analysed using the chi-square test and Student's t-test. Data were collected retrospectively from 68 patients with type 1 diabetes aged 16—25 years attending the George Eliot Hospital (GEH) adolescent diabetes clinic and who were being managed as per The Alphabet Strategy. Standards of diabetes care in the GEH clinic were better than those reported in the multicentre study. GEH versus multicentre study: clinic non-attendance 12% vs. 24.6%: mean HbA1C% 8.4 vs. 9.5, p<0.001: screening rates; hypertension 100% vs. 88%, p<0.05; nephropathy 80% vs. 56%, p<0.01; retinopathy 98% in GEH clinic: prevalence of complications; nephropathy 5% vs. 21%, p<0.02; retinopathy 24% vs. 28%, not significant. In conclusion, we found regular clinic visits and separate adolescent clinics improve glycaemic control. The Alphabet Strategy may be considered an effective approach in monitoring/screening and attaining targets in young adults with type 1 diabetes.
Assessment of arterio-ventricular coupling by tissue Doppler and wave intensity in type 2 diabetes
Authors: Avgeropoulou Catherine , Illmann Alexander , Schumm-Draeger Petra-Maria , Kallikazaros Jannis , Von Bibra Helene 
Published: August 2008

Aim To evaluate ventricular-arterial coupling in preclinical cardiovascular disease, we used a new wave intensity approach and tissue Doppler in patients with and without type 2 diabetes mellitus (DM). Methods Sixty-five type 2 diabetes patients and 57 control individuals with normal systolic left ventricular function and without overt coronary or peripheral artery disease were assessed by tissue Doppler for myocardial velocities and by a combined Doppler and echo-tracking system (Aloka SSD-5500, Tokyo) for local arterial stiffness (epsilon, pulse wave velocity) and the characteristic peaks W1 and W2 of pulse wave intensity. Results Diabetes patients had significantly higher systolic blood pressure and pressure derivates (p<0.002). Diastolic myocardial velocity (Ve) was decreased (p<0.001). Epsilon and pulse wave velocity (p<0.001) were higher and so was W1 (11785±7491 vs. 9191±4299, p<0.04) but not W2. In the pooled data, independent predictors for Ve were age, septal wall thickness, Vs and HbA1C (R2 duration of diabetes (R2 0.479). 0.426) and for W1 systolic blood pressure, Vs, W2 and duration of diabetes (R2 0.479). Conclusion In type 2 diabetes pump function is preserved and maintained against increased arterial stiffness and impedance at the expense of increased myocardial oxygen requirements. Tissue Doppler and wave intensity measurements may be useful for therapeutic monitoring.
PET scan before CABG in diabetes
Authors: Hegazy Hesham , Refaei Ayman , Assedique Azza , Alsaif Shukri , Taha Mayada , Refaei Mostafa , Elkum Nasser , Alomran Hamed , Al-Halees Zohair 
Published: August 2008

Background and objectives Since the role of positron emission tomography (PET) scanning in diabetes is not clear, this study sought to assess the usefulness of PET scanning for viability in this patient group. Methods Forty-four per cent insulin-treated, and 56% non-insulin-treated diabetic patients with severely impaired left ventricular function (LVEF 29± 9%) underwent first coronary artery bypass grafting (CABG). Pre-operative viability was assessed by PET scan. Results Eighty-two per cent of patients received ≥3 grafts. Twenty-seven patients were discharged home and followed for a mean 3.5±1.6 years. Postoperative LVEF improved to 40±9 (p<0.0001). Multiple regression analysis indicated that the only variable that predicted improvement in global LV function was presence of hibernating segments at PET scan. The single variable that predicted deterioration of LVEF was the number of segments with reduced perfusion and metabolism at PET scan. Conclusion PET scan is an accurate tool for prediction of global left ventricular function recovery following CABG in people with diabetes.
Vasodilator prostanoids compensate for attenuated nitric oxide mediated vasodilation in type 1 diabetes
Authors: Browne Duncan L , Meeking Darryl R , Allard Sharon , Munday Linda J , Shaw Kenneth M , Cummings Michael H 
Published: August 2008

Background Previous research examining endothelial function and the biochemical pathways mediating vasodilation in type 1 diabetes has been conflicting. Both impaired and preserved nitric oxide (NO) mediated vasodilation have been reported whilst some authors have suggested enhanced vasodilator prostanoid (P) activity. The aim of this study was to determine the relative contributions of NO and P to endothelial function in a homogenous group of type 1 diabetic patients free of other confounding factors that may influence vascular behaviour.^f ^ Methods and results Endothelial function was assessed using forearm venous plethysmography in 16 patients with uncomplicated type 1 (duration of diabetes 16.8±2.5 years (mean±SEM), HbA1C 7.53±0.21% ) and 15 non-diabetic age and sex matched healthy control subjects. Forearm responses to the endothelium-dependent vasodilator, acetylcholine (ACh) (7.5, 15 and 30 µg/min), were recorded at baseline and after intra-arterial infusion of L-NMMA (a NO synthase inhibitor). Responses to ACh were re-examined following co-infusion of L-NMMA and indomethacin (a cyclo-oxygenase inhibitor). Responses to ACh were calculated as areas under the curve (AUC). At baseline vasodilator responses to ACh were similar (p=0.3) in diabetic and non-diabetic subjects. However, L-NMMA reduced ACh mediated responses to a lesser extent in diabetic subjects than control subjects (3±6% versus 18±3%; p<0.03 respectively). Co-infusion with indomethacin further reduced blood flow, but the relative decrease in AUC was greater in the diabetic group (28±3% vs. 14±3%; p<0.001). The contribution of biochemical pathways other than NO and P were similar in both diabetic and control groups (69±7% vs. 68±4%; p=0.45). Conclusions Vasodilator responses to ACh were unchanged in type 1 diabetes but this was reliant up on enhanced P mediated activity compensating for attenuated NO activity. Furthermore, vasoactive substances in addition to NO and P contribute significantly to vascular tone in both diabetic and non-diabetic subjects.