bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis of Type 2 Diabetes at an Older Age
Authors: Tan Hwee H. , McAlpine Ritchie R. , James Peter , Thompson Philip , McMurdo Marion E.T. , Morris Andrew D. , Evans Josie M.M. ,   DARTS/MEMO Collaboration
Published: March 2007

OBJECTIVE—To compare the mortality of people who were diagnosed with type 2 diabetes over 65 years of age with that of nondiabetic individuals.
RESEARCH DESIGN AND METHODS—Using a population-based diabetes information system for an observational cohort study in Tayside, Scotland, people who were diagnosed with type 2 diabetes over the age of 65 years between 1993 and 2002 were identified. Nondiabetic comparators, matched for age and sex, were identified from the nondiabetic population. The two cohorts were followed up for mortality and cardiovascular mortality according to death certification records.
RESULTS—There were 3,594 people with type 2 diabetes (48% male) and 7,188 matched comparators identified in the study. Over a mean follow-up period of 4.6 ± 2.9 years for 3,594 people with type 2 diabetes and 7,188 comparators, 909 (25.3%) patients in the diabetic cohort and 1,651 (23.0%) in the nondiabetic cohort died. The adjusted relative risk for mortality in the diabetic cohort compared with the nondiabetic cohort was 1.06 (95% CI 0.94–1.19) for men and 1.29 (1.15–1.45) for women. Cardiovascular deaths accounted for 49.4% of the deaths in people with and 45.2% in those without diabetes (adjusted relative risk 1.01 [0.93–1.10]).
CONCLUSIONS—Men diagnosed with type 2 diabetes over the age of 65 years have no excess mortality compared with their nondiabetic counterparts, a finding that was not replicated for women.
Clinical Outcomes and Adherence to Medications Measured by Claims Data in Patients With Diabetes
Authors: Pladevall Manel , Williams L. Keoki , Potts Lisa Ann , Divine George , Xi Hugo , Elston Lafata Jennifer 
Published: March 2007

OBJECTIVE—Although poor medication adherence may contribute to inadequate diabetes control, ways to feasibly measure adherence in routine clinical practice have yet to be established. The present study was conducted to determine whether pharmacy claims-based measures of medication adherence are associated with clinical outcomes in patients with diabetes.
RESEARCH DESIGN AND METHODS—The study setting was a large, integrated delivery and financial system serving the residents of southeastern Michigan. The study population consisted of 677 randomly selected patients aged ≥18 years with a diagnosis of diabetes, hypercholesterolemia, and hypertension and who filled at least one prescription for either an antidiabetic, lipid-lowering, or antihypertensive drug in each of the 3 study years (1999–2001). The main outcome measures were HbA1c, LDL cholesterol levels, and blood pressure.
RESULTS—Nonadherent patients had both statistically and clinically worse outcomes than adherent patients. Even after adjusting for demographic and clinical characteristics, nonadherence was significantly associated with HbA1c and LDL cholesterol levels. A 10% increase in nonadherence to metformin and statins was associated with an increase of 0.14% in HbA1c and an increase of 4.9 mg/dl in LDL cholesterol levels. Nonadherence to ACE inhibitors was not significantly associated with blood pressure.
CONCLUSIONS—Claims-based measures of medication adherence are associated with clinical outcomes in patients with diabetes and may therefore prove to be useful in clinical practice. More research is needed on methods to introduce claims-based adherence measurements into routine clinical practice and how to use these measurements to effectively improve adherence and health outcomes in chronic care management.
Factors Associated With Preterm Delivery in Women With Type 1 Diabetes
Authors: Lepercq Jacques , Coste Joel , Theau Anne , Dubois-Laforgue Daniele , Timsit Jose 
Published: March 2007

OBJECTIVE—The reported rate of preterm delivery in women with type 1 diabetes ranges from 22 to 45%, but the reasons are unclear. The purpose of this study was to identify factors associated with preterm delivery in these women.
RESEARCH DESIGN AND METHODS—We studied the influence of maternal and diabetes-related factors on the occurrence of preterm delivery in 168 single pregnancies occurring in 127 women with type 1 diabetes. Women with spontaneous or indicated preterm delivery were compared with those who delivered after 37 weeks of gestation using polytomous logistic regression.
RESULTS—The overall rate of preterm delivery was 24%, fivefold higher than the French prematurity rate in single pregnancy. Preterm delivery was spontaneous in 9% and indicated in 15%. HbA1c ≥7% at delivery was associated with spontaneous preterm delivery (odds ratio [OR] 5.3 [95% CI 1.1–26.8]). Nulliparity (12.0 [2.3–64.1]), progression of nephropathy (7.7 [1.3–46.9]), preeclampsia (12.0 [3.1–47.1]), and HbA1c ≥7% (7.5 [1.5–37.9]) at delivery were all associated with indicated preterm delivery. Preterm delivery was associated with significant neonatal morbidity as the risks for neonatal hypoglycemia and respiratory distress syndrome were increased by three- to sixfold compared with the reference group.
CONCLUSIONS—The rate of preterm delivery remains high in women with type 1 diabetes. Different factors were associated with spontaneous and indicated preterm delivery, respectively. Because poor glycemic control was a risk factor for both outcomes, part of preterm delivery might be preventable.
Peripheral Arterial Disease, Diabetes, and Mortality
Authors: Leibson Cynthia L. , Ransom Jeanine E. , Olson Wayne , Zimmerman Bruce R. , O’Fallon W. Michael , Palumbo Pasquale J. 
Published: March 2007

OBJECTIVE—The aims of this study were to provide estimates of 1) the risk of mortality for individuals with both diabetes and peripheral arterial disease (PAD) relative to that for individuals with either condition alone and 2) the association between PAD progression and mortality for individuals with diabetes, PAD, and both conditions.
RESEARCH DESIGN AND METHODS—This longitudinal cohort study was conducted in Rochester, Minnesota. Local residents age 50–70 years with a prior diagnosis of PAD and/or diabetes were identified from the Mayo Clinic diagnostic registry and invited to a baseline examination (1977–1978). Those who met inclusion criteria were assessed for PAD progression at 2 and 4 years and followed for vital status through 31 December 1999.
RESULTS—The numbers who met criteria for PAD, diabetes, and both conditions at baseline were 149, 238, and 186, respectively. Within each group, observed survival was less than expected (P &lt; 0.001). The adjusted risk of death for both conditions was 2.2 times that for PAD alone. Among the 449 who returned at 4 years, the risk of subsequent death was greater for those whose PAD had progressed; among individuals with diabetes alone at baseline, 100% (17 of 17) who met criteria for PAD progression were dead by 31 December 1999 compared with 62% (111 of 178) of those who had not met criteria (adjusted relative hazard 2.29 [95% CI 1.30–4.02], P = 0.004). The increased mortality associated with PAD progression was significant only for individuals with diabetes (alone or with PAD).
CONCLUSIONS—Diabetes is a risk factor for both PAD and PAD-associated mortality, emphasizing the critical need to detect and monitor PAD in diabetic patients.
Family and Disease Management in African-American Patients With Type 2 Diabetes
Authors: Chesla Catherine A. , Fisher Lawrence , Mullan Joseph T. , Skaff Marilyn M. , Gardiner Phillip , Chun Kevin , Kanter Richard 
Published: March 2007

OBJECTIVE—The aim of this project is to specify features of family life that are associated with disease management in African Americans with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 159 African-American patients with type 2 diabetes were assessed on three domains of family life (structure/organization, world view, and emotion management) and three key dimensions of disease management (morale, management behaviors, and glucose regulation). Analyses assessed the associations of family factors with disease management.
RESULTS—Multivariate tests for the main effects of three family variables were significantly related to the block of disease management variables for morale (F = 3.82; df = 12,363; P &lt; 0.0001) and behavior (2.12; 9,329; P &lt; 0.03). Structural togetherness in families was positively related to diabetes quality of life (DQOL)–Satisfaction (P &lt; 0.01). High family coherence, a world view that life is meaningful and manageable, was positively associated with general health (P &lt; 0.05) and DQOL-Impact (P &lt; 0.05) and negatively associated with depressive symptoms (P &lt; 0.001). Emotion management, marked by unresolved family conflict about diabetes, was related to more depressive symptoms (P &lt; 0.001), lower DQOL-Satisfaction (P &lt; 0.01), and lower DQOL-Impact (P &lt; 0.001). No family measures were related to HbA1c levels.
CONCLUSIONS—The family domain of emotion management demonstrates the strongest associations with diabetes management in African-American patients, followed by family beliefs. Patient morale is the aspect of disease management that seems most related to family context.
The Impact of the Micro-Lightguide O2C for the Quantification of Tissue Ischemia in Diabetic Foot Ulcers
Authors: Beckert Stefan , Witte Maria B. , Königsrainer Alfred , Coerper Stephan 
Published: March 2007

OBJECTIVE—Tissue oxygen supply is crucial for wound healing. Especially in diabetic foot lesions, the chances for healing are mainly dependent on the presence or absence of ischemia. This study investigates the impact of the tissue O2 analysis system “O2C” for noninvasive quantification of tissue oxygenation in diabetic foot ulcer patients.
RESEARCH DESIGN AND METHODS—O2C assessed relative blood flow (flow), flow velocity (velo), and hemoglobin concentration (rHb) and hemoglobin oxygenation (SO2) at 2 and 6 mm depth (means ± SE). 1) Measurements were performed on intact skin of the forefoot and forearm of 20 healthy volunteers on 2 consecutive days. 2) Parameters were assessed on intact skin of the forefoot of diabetic foot ulcer patients (n = 14). 3) Measurements were performed directly at the wound site in diabetic patients (n = 14).
RESULTS—1) Flow, velo, rHb, and SO2 at 2 and 6 mm depth were not significantly different when measured at 2 consecutive days. 2) There were no significant differences between diabetic subjects and healthy volunteers. Only flow in 6 mm depth was significantly higher in diabetic subjects (75 ± 13 vs. 51 ± 0.4 arbitrary units [AU], P &lt; 0.05). When diabetic foot ulcer patients were split into healers and nonhealers, initial readings of SO2 at 2 mm (32 ± 6 vs. 44 ± 3%, P &lt; 0.05) and flow in 6 mm (28 ± 1 vs. 51 ± 0.6 AU, P &lt; 0.05) were significantly reduced in nonhealers compared with control subjects, whereas in healers flow in 6 mm (70 ± 0.6 vs. 51 ± 0.6 AU, P &lt; 0.05) was significantly higher than that in control subjects. 3) Initial SO2, rHb, flow, and velo were significantly lower in nonhealing compared with healing wounds.
CONCLUSIONS—O2C is a new reliable and valid method for noninvasive measurement of tissue oxygenation and microvascular blood flow in patients with diabetic foot ulcers.
Continuous Glucose Monitoring and the Reality of Metabolic Control in Preschool Children With Type 1 Diabetes
Authors: Jeha George S. , Karaviti Lefkothea P. , Anderson Barbara , O’Brian Smith E. , Donaldson Susan , McGirk Toniean S. , Haymond Morey W. 
Published: March 2007

OBJECTIVE—To determine using the MiniMed continuous glucose monitoring system (CGMS) 1) whether twice-daily insulin injection therapy achieves adequate control in preschool children with type 1 diabetes and 2) whether the CGMS is more informative than self-monitoring of blood glucose (SMBG) regarding glucose control and well tolerated by preschool children and their families.
RESEARCH DESIGN AND METHODS—Ten children &lt;6 years of age with type 1 diabetes were monitored twice using the CGMS. The distribution of glucose values was analyzed, particularly the frequency, duration, and distribution of hypoglycemia. We analyzed the accuracy of the CGMS in detecting hypoglycemia as well as the clinical relevance of the difference between CGMS and SMBG values.
RESULTS—Although hypoglycemia was more frequent during the night (0.8 nighttime episodes · subject–1 · 24 h–1 vs. 0.3 daytime episodes · subject–1 · 24 h–1), the difference did not reach statistical significance (P = 0.07). However, nighttime episodes lasted longer than daytime episodes (1.2 vs. 0.2 h · subject–1 · 24 h–1, P = 0.006). Hypoglycemia accounted for 7% and normoglycemia for 24%, while hyperglycemia occurred 64% of the time, with postprandial hyperglycemia being an almost universal feature (94 ± 7% of all postmeal values). The CGMS correlated well with SMBG without significant clinical discrepancy. The CGMS sensitivity to detect hypoglycemia was 70% with a specificity of 99%; however, the CGMS detected twice as many total episodes as SMBG (82 vs. 40).
CONCLUSIONS—Twice-daily insulin injection rarely achieves control in preschool children with type 1 diabetes. The CGMS is well tolerated by patients and has the advantage of revealing daily glucose trends missed by SMBG.
Two-Year Statin Therapy Does Not Alter the Progression of Intima-Media Thickness in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease
Authors: Beishuizen Edith D. , van de Ree Marcel A. , Jukema J. Wouter , Tamsma Jouke T. , van der Vijver J. Carel M. , Meinders A. Edo , Putter Hein , Huisman Menno V. 
Published: March 2007

OBJECTIVE—Cardiovascular disease (CVD) is the most important cause of mortality in patients with type 2 diabetes. We aimed to determine the effect of statin therapy versus placebo on the progression of carotid intima-media thickness (IMT) in type 2 diabetic patients without manifest CVD.
RESEARCH DESIGN AND METHODS—A randomized, placebo-controlled, double-blind clinical trial was performed in 250 patients with type 2 diabetes. Patients were given either 0.4 mg cerivastatin or placebo daily. In August 2001, when cerivastatin was withdrawn from the market, 0.4 mg cerivastatin was replaced by 20 mg simvastatin without deblinding the study. The primary end point was the change of mean common carotid IMT, as measured by B-mode ultrasound, over 2 years.
RESULTS—Common carotid IMT at baseline was 0.780 mm in the placebo group and 0.763 mm in the statin group and did not change significantly after 2 years. There was no significant difference in IMT change in any carotid segment between the groups. LDL cholesterol was reduced by 25% in the statin group and increased by 8% in the placebo group (P &lt; 0.001). Cardiovascular events occurred in 12 patients in the placebo group and two patients in the statin group (P = 0.006).
CONCLUSIONS—There was no effect of 2 years’ statin therapy on carotid IMT in type 2 diabetic subjects. The natural history of IMT in our patients was milder than anticipated. In contrast, we observed a significantly lower cardiovascular event rate on statin therapy. Prognostic tools other than IMT should be explored in this patient group.
Plasma Vascular Endothelial Growth Factor, Angiopoietin-1, and Angiopoietin-2 in Diabetes
Authors: Lim Hoong Sern , Blann Andrew D. , Chong Aun Yeong , Freestone Bethan , Lip Gregory Y.H. 
Published: March 2007

OBJECTIVE—Vascular endothelial growth factor (VEGF) and angiopoietin (Ang)-1 and Ang-2 are mediators of angiogenesis. More recent data suggest that the balance between these growth factors may affect vascular endothelial integrity. Because diabetes is closely associated with endothelial perturbation, we studied plasma levels of these angiogenic growth factors in patients with diabetes; their relationship with glycemia, inflammation, and endothelial damage/dysfunction; and the effect of intensified cardiovascular risk management.
RESEARCH DESIGN AND METHODS—We measured plasma VEGF, Ang-1, and Ang-2 alongside plasma von Willebrand factor (vWf) and urine albumin–to–creatinine ratio (marking endothelial damage/dysfunction) and interleukin (IL)-6 in 94 patients (38 with overt cardiovascular disease [CVD]) with diabetes and 34 normal control subjects.
RESULTS—Plasma vWf (P = 0.009), IL-6 (P &lt; 0.001), VEGF (P = 0.001), and Ang-2 (P = 0.001), but not Ang-1 (P = 0.635), were higher in diabetic patients with and without CVD than in control subjects. On multivariate analysis, HbA1c was an independent predictor of plasma VEGF (P = 0.032) and Ang-2 (P = 0.015). Of the 94 patients, a subgroup of 33 patients with and 31 patients without CVD participated in a year of intensified cardiovascular risk management. HbA1c and LDL cholesterol reduced significantly with treatment, along with associated reductions in plasma vWf and VEGF in both groups (P &lt; 0.001). Ang-2 decreased (P &lt; 0.001) only in patients without CVD. There were no significant changes in plasma IL-6 levels in both groups.
CONCLUSIONS—Plasma Ang-2 (but not Ang-1), like VEGF levels, are selectively elevated in patients with diabetes and are associated with indexes of endothelial damage/dysfunction, regardless of vascular disease. Intensive multifactorial intervention is associated with reductions in plasma VEGF, vWf, and (in patients without CVD) Ang-2 levels, possibly reflecting an improved vascular profile with treatment.
Autonomic Symptoms and Diabetic Neuropathy
Authors: Low Phillip A. , Benrud-Larson Lisa M. , Sletten David M. , Opfer-Gehrking Tonette L. , Weigand Stephen D. , O’Brien Peter C. , Suarez Guillermo A. , Dyck Peter J. 
Published: March 2007

OBJECTIVE—The prevalence of autonomic symptoms and deficits in certain systems is known, but a comprehensive autonomic symptom profile in diabetes is not available. We aimed to estimate this using a laboratory evaluation of autonomic function and a validated self-report measure of autonomic symptoms in patients and matched control subjects from the population-based Rochester Diabetic Neuropathy Study.
RESEARCH DESIGN AND METHODS—Participants included 231 patients with diabetes (type 1, n = 83; type 2, n = 148) and 245 healthy age-matched control subjects. We assessed symptoms using a validated self-report instrument (Autonomic Symptom Profile) and evaluated the severity and distribution of autonomic deficits (cardiovagal, sudomotor, adrenergic) with the objective, laboratory-based Composite Autonomic Severity Score (CASS).
RESULTS—Autonomic symptoms were present more commonly in type 1 than in type 2 diabetes, with symptoms of orthostatic intolerance, secretomotor, urinary control, diarrhea, and sleep disturbance and pupillomotor, vasomotor, and erectile dysfunction significantly increased over healthy control subjects in type 2 diabetic patients. The prevalence of autonomic impairment was 54% in type 1 and 73% in type 2 diabetic patients. Severity of autonomic failure was mild overall (mean CASS 2.3; maximum 10), with orthostatic hypotension occurring in 8.4 and 7.4% of type 1 and 2 diabetic patients, respectively. Fourteen percent of patients had a CASS ≥5, indicating moderate to severe generalized autonomic failure. The correlation of symptoms with autonomic deficits (CASS) was better in type 1 than type 2 diabetic subjects and was weak overall.
CONCLUSIONS—These findings indicate that autonomic symptoms and deficits are common in diabetes, but mild in severity, and that the correlation between symptom scores and deficits is overall weak in mild diabetic neuropathy, emphasizing the need to separately evaluate autonomic symptoms.
Sex-Related Differences Between Adiponectin and Insulin Resistance in Schoolchildren
Authors: Tsou Pei-Ling , Jiang Yi-Der , Chang Ching-Chung , Wei Jung-Nan , Sung Fung-Chang , Lin Chau-Ching , Chiang Chuan-Chi , Tai Tong-Yuan , Chuang Lee-Ming 
Published: March 2007

OBJECTIVE—To study the effect of body composition and adiponectin on insulin resistance and β-cell function in schoolchildren during puberty.
RESEARCH DESIGN AND METHODS—Plasma adiponectin level and its relationships with insulin sensitivity and β-cell function were analyzed in 500 randomly recruited nondiabetic Taiwanese schoolchildren (245 boys and 255 girls) aged 6–18 years in a national survey program for diabetes in 1999. Insulin resistance and β-cell function were evaluated by homeostasis model assessment (HOMA). Plasma adiponectin concentrations were determined with radioimmunoassay.
RESULTS—Plasma glucose levels remained stable, whereas insulin resistance increased with a compensatory rise in β-cell function during this period. A transient drop of adiponectin level with a trough at 10–12 years was found in boys but not in girls. This pubertal drop of adiponectin levels in boys coincides with the sharp rise in testosterone concentration. A negative correlation between testosterone levels and adiponectin concentration was also noted in boys (r = −0.142, P = 0.032). Plasma adiponectin levels correlated inversely with relative body weight, fasting insulin concentrations, and insulin resistance index by HOMA in boys aged 15–18 years and in girls aged 11–14 years. No association was observed between adiponectin levels and β-cell function by HOMA.
CONCLUSIONS—There is a transient drop in the level of adiponectin during male puberty, correlated with the increase in testosterone level in boys. Plasma adiponectin levels were inversely correlated with obesity and insulin resistance in boys and girls during the pubertal period.
Low Cardiorespiratory Fitness Is Associated With Elevated C-Reactive Protein Levels in Women With Type 2 Diabetes
Authors: McGavock Jonathan M. , Mandic Sandra , Vonder Muhll Isabelle , Lewanczuk Richard Z. , Quinney H. Arthur , Taylor Dylan A. , Welsh Robert C. , Haykowsky Mark 
Published: March 2007

OBJECTIVE—The purpose of this study was to examine differences in novel markers of cardiovascular disease (CVD) in women with type 2 diabetes stratified according to cardiorespiratory fitness.
RESEARCH DESIGN AND METHODS—A total of 28 women (mean age 57 ± 6 years) with type 2 diabetes who were free from overt CVD were placed into low cardiorespiratory fitness (LCF) or average cardiorespiratory fitness (ACF) groups based on a graded exercise test to exhaustion. A group of eight women without type 2 diabetes were also examined and served as healthy control subjects. The median V˙o2peak value was used as a cutoff for group determination. We assessed both conventional CVD risk factors, including blood pressure, BMI, and lipid profile, as well as novel CVD risk factors, such as left ventricular filling dynamics, arterial stiffness, fasting insulin, and C-reactive protein (CRP).
RESULTS—V˙o2peak values were 69 ± 14 and 91 ± 24% of predicted values for sedentary age-matched healthy individuals in the LCF and ACF groups, respectively. BMI was significantly greater in the LCF group (P &lt; 0.05); however, no differences were observed in age, lipid profile, or resting hemodynamics. CRP was 3.3-fold higher in the LCF group (6.3 ± 41. vs. 1.9 ± 1.7 mg/l, P &lt; 0.05), whereas other novel markers of CVD were not significantly different between the groups. Significant negative relationships were observed between V˙o2peak and both CRP (r = −0.49) and the homeostasis model assessment index (r = −0.48) (P &lt; 0.05).
CONCLUSIONS—The novel finding of this investigation is that low cardiorespiratory fitness is associated with elevated CRP and reduced fasting glucose control in women with type 2 diabetes.