bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Physician Gender Associated With the Quality of Diabetes Care?
Authors: Kim Catherine , McEwen Laura N. , Gerzoff Robert B. , Marrero David G. , Mangione Carol M. , Selby Joseph V. , Herman William H. 
Published: March 2007

OBJECTIVE—This study examines the association between physician gender and diabetes quality of care.
RESEARCH DESIGN AND METHODS—We examined the association between the gender of primary care physicians (n = 1,686) and the quality of diabetes care they provided to their patients participating in the Translating Research Into Action for Diabetes (TRIAD) study. Main outcome measures were diabetes processes of care including receipt of dilated retinal exams, urine microalbumin/protein testing, foot exams, lipid and HbA1c (A1C) testing, recommendation to take aspirin, and influenza vaccination over 1 year. Intermediate outcomes included blood pressure, A1C, LDL levels, and patient satisfaction. Hierarchical regression models accounted for clustering within provider groups and health plans and adjusted for patient age, gender, race, income, education, diabetes treatment and duration, and health status, along with physician age, years of practice, and specialty.
RESULTS—Compared with male physicians (n = 1,213), female physicians (n = 473) were younger, had more recently completed training, and were more often internists. Patients of female physicians (n = 4,585) were more often women and younger than patients of male physicians (n = 1,783). In adjusted analyses, patients of female physicians were slightly more likely to receive lipid measurements (predicted probability 1.09 [95% CI 1.02–1.15]) and A1C measurements (1.02 [1.00–1.05]) and were slightly more likely to have an LDL &lt;130 mg/dl (1.05 [1.00–1.10]).
CONCLUSIONS— Patients of female physicians received similar quality of care compared with patients of male physicians.
Birth Weight and Parental BMI Predict Overweight in Children From Mothers With Gestational Diabetes
Authors: Schaefer-Graf Ute M. , Pawliczak Julia , Passow Doerte , Hartmann Reinhard , Rossi Rainer , Bührer Christoph , Harder Thomas , Plagemann Andreas , Vetter Klaus , Kordonouri Olga 
Published: March 2007

OBJECTIVE—To investigate the growth of children from pregnancies with gestational diabetes mellitus (GDM) and its association with antenatal maternal, fetal, and recent anthropometric parameters of mother and father.
RESEARCH DESIGN AND METHODS—In 324 pregnancies of Caucasian women with GDM, BMI before pregnancy, maternal glycemic values, and measurements of the fetal abdominal circumference were recorded. The weight and height of infants were measured at birth and at follow-up at 5.4 years (range 2.5–8.5). In addition, somatic data from routine examinations at 6, 12, and 24 months and the BMI of parents at follow-up were obtained. BMI standard deviation scores (SDSs) were calculated based on age-correspondent data.
RESULTS—At all time points, BMI was significantly above average (+0.82 SDS at birth; +0.56 at 6, +0.35 at 12, and +0.32 at 24 months; and +0.66 at follow-up; P &lt; 0.001). BMI at birth was related to BMI at follow-up (r = 0.27, P &lt; 0.001). The rate of overweight at follow-up was 37% in children with birth BMI ≥90th percentile and 25% in those with normal BMI at birth (P &lt; 0.05). Abdominal circumference of third trimester and postprandial glucose values were related to BMI at follow-up (r = 0.22 and r = 0.18, P &lt; 0.01). Recent maternal, paternal, and birth BMI were independent predictors of BMI at follow-up (r = 0.42, P &lt; 0.001). Sixty-nine percent of children of parents with BMI ≥30 kg/m2 were overweight at follow-up compared with 20% of those with parental BMI &lt;30 kg/m2 (P &lt; 0.001).
CONCLUSIONS—Children of mothers with GDM have a high rate of overweight that is associated both with intrauterine growth and parental obesity.
Changing the Definition of Impaired Fasting Glucose
Authors: Vaccaro Olga , Riccardi Gabriele 
Published: March 2007

OBJECTIVE—This study evaluates the impact of lowering the diagnostic threshold for impaired fasting glucose (IFG) from 6.1 to 5.6 mmol/l as proposed by the American Diabetes Association (ADA) on the prevalence of the condition, classification of individuals, and risk definition.
RESEARCH DESIGN AND METHODS—A total of 1,285 employees of the Italian Telephone Company aged 35–59 years without known diabetes underwent an oral glucose tolerance test (OGTT). BMI, serum cholesterol, triglycerides, and blood pressure were measured. Medication use was recorded.
RESULTS—With the new ADA criterion, the proportion of people diagnosed with IFG increased from 3.2 to 9.7%. The newly proposed IFG category identified 41% of all subjects with impaired glucose tolerance (IGT) compared with 16.2% identified with the use of the World Health Organization criterion for IFG; the improvement in accuracy has been achieved at the cost of classifying more previously “normal” subjects as having IFG (from 2.3 to 7.3%). Both IFG and IGT were associated with an unfavorable risk profile for diabetes and cardiovascular disease, with a higher estimated risk for IGT than IFG.
CONCLUSIONS—Even with the revised diagnostic criterion, IFG and IGT identify distinct groups that have a different background risk. The cost/benefit of preventive measures tested in people with IGT may not apply to the new IFG category.
Insulin Resistance and Preeclampsia in Gestational Diabetes Mellitus
Authors: Montoro Martin N. , Kjos Siri L. , Chandler Mary , Peters Ruth K. , Xiang Anny H. , Buchanan Thomas A. 
Published: March 2007

OBJECTIVE—To compare the degree of insulin resistance in women with gestational diabetes mellitus (GDM) who do and do not develop preeclampsia.
RESEARCH DESIGN AND METHODS—We conducted a prospective cohort study of initially normotensive women with GDM who underwent oral glucose tolerance tests (OGTTs), intravenous glucose tolerance tests (IVGTTs), and glucose clamp studies in the early third trimester (n = 150) and 15 months postpartum (n = 89). After delivery, the women were categorized as nonpreeclamptic or preeclamptic (systolic blood pressure [SBP] ≥140 mmHg, diastolic blood pressure [DBP] ≥90 mmHg, and at least &gt;1+ proteinuria or &gt;300 mg/24 h). Metabolic parameters between the groups were compared by χ2 or Fisher’s exact tests and ANOVA with P &lt; 0.05 as significant.
RESULTS—A total of 29 women (19%) developed preeclampsia, which was mild in 21 and severe in 8 women. At entry, there were no differences in age, weight indexes, and glycemic measures between the nonpreeclamptic and preeclamptic groups. Those with preeclampsia were significantly taller (61.5 ± 2.4 vs. 60.1 ± 2.3 in, P = 0.003), were more often nulliparous (38 vs. 16%, P = 0.01), and had higher entry SBP (112 ± 10 vs. 103 ± 6.9 mmHg, P &lt; 0.0001) and DBP (64 ± 9 vs. 59 ± 5 mmHg, P = 0.002). No significant differences between the groups were found in any measures of the OGTT glucose levels, insulin sensitivity index, glucose effectiveness, acute response to glucose, or disposition index, nor were there any differences found in the euglycemic clamp measures of basal or steady-state levels of glucose, insulin, free fatty acid, hepatic glucose output, peripheral glucose clearance, C-peptide, or glucagon. At 15 months postpartum, blood pressure levels remained significantly higher in the preeclamptic group (n = 19) compared with the nonpreeclamptic group (n = 70). No differences in any glycemic or insulin resistance measures were found.
CONCLUSIONS—Women with GDM were uniformly insulin resistant. Those who developed preeclampsia, when compared with those who remained nonpreeclamptic, were not more insulin resistant in either the third trimester or 15 months postpartum. However, women who developed preeclampsia had blood pressure levels that were significantly higher, although still in the normal range, than those of women who remained nonpreeclamptic.
Identifying Individuals at High Risk for Diabetes
Authors: Schmidt Maria Inês , Duncan Bruce B. , Bang Heejung , Pankow James S. , Ballantyne Christie M. , Golden Sherita H. , Folsom Aaron R. , Chambless Lloyd E. ,   for the Atherosclerosis Risk in Communities Investigators
Published: March 2007

OBJECTIVE—To develop and evaluate clinical rules to predict risk for diabetes in middle-aged adults.
RESEARCH DESIGN AND METHODS—The Atherosclerosis Risk in Communities is a cohort study conducted from 1987–1989 to 1996–1998. We studied 7,915 participants 45–64 years of age, free of diabetes at baseline, and ascertained 1,292 incident cases of diabetes by clinical diagnosis or oral glucose tolerance testing.
RESULTS—We derived risk functions to predict diabetes using logistic regression in a random half of the sample. Rules based on these risk functions were evaluated in the other half. A risk function based on waist, height, hypertension, blood pressure, family history of diabetes, ethnicity, and age was performed similarly to one based on fasting glucose (area under the receiver-operating characteristic curve [AUC] 0.71 and 0.74, respectively; P = 0.2). Risk functions composed of the clinical variables plus fasting glucose (AUC 0.78) and additionally including triglycerides and HDL cholesterol (AUC 0.80) performed better (P &lt; 0.001). Evaluation of scores based on the metabolic syndrome as defined by the National Cholesterol Education Program or with slight variations showed AUCs of 0.75 and 0.78, respectively. Rules based on all these approaches, while identifying 20–56% of the sample as screen positive, achieved sensitivities of 40–87% and specificities of 50–86%.
CONCLUSIONS—Rules derived from clinical information, alone or combined with simple laboratory measures, can characterize degrees of diabetes risk in middle-aged adults, permitting preventive actions of appropriate intensity. Rules based on the metabolic syndrome are reasonable alternatives to rules derived from risk functions.
Influence of Glycemic Index/Load on Glycemic Response, Appetite, and Food Intake in Healthy Humans
Authors: Alfenas Rita C.G. , Mattes Richard D. 
Published: March 2007

OBJECTIVE—High glycemic index (GI)/load (GL) diets reportedly enhance appetite and promote positive energy balance. Support for this hypothesis stems largely from acute feeding trials and longer-term studies lacking control over the macronutrient composition and palatability of test foods. This study evaluated the effects of consuming high- and low-GI/GL meals, matched on macronutrient composition and palatability, plasma glucose and insulin, appetite, and food intake.
RESEARCH DESIGN AND METHODS—Thirty-nine healthy adults consumed only low- or only high-GI foods ad libitum in the laboratory for 8 days in either high (three foods per meal)- or low (one food per meal)-variety conditions. Glucose and insulin concentrations as well as appetitive sensations were determined before and for 2 h following breakfast and lunch on days 1 and 8. Energy intake was monitored daily.
RESULTS—There were no significant differences in plasma glucose or insulin responses, appetitive ratings, or food intake between treatments.
CONCLUSIONS—These data indicate that the differential glycemic response of foods tested in isolation under fixed time are not preserved under conditions of chronic ad libitum consumption of mixed meals.
Diabetes Is Associated With Dramatically Decreased Survival in Female but Not Male Subjects With Cystic Fibrosis
Authors: Milla Carlos E. , Billings Joanne , Moran Antoinette 
Published: March 2007

OBJECTIVE—Survival analysis was performed on a prospectively followed cohort of patients with cystic fibrosis (CF) to determine the impact of the development of diabetes on survival.
RESEARCH DESIGN AND METHODS—Clinical data were retrieved for patients diagnosed with CF-related diabetes (CFRD) at the Minnesota CF Center in 1987–2002. Kaplan-Meier survival analysis was performed to estimate median survival. Data were analyzed by Cox regression to evaluate the influence of clinical characteristics at the time of CFRD diagnosis on mortality.
RESULTS—Clinical information was reviewed from 1,081 CF patients. A total of 123 patients with CFRD with fasting hyperglycemia were identified (58 males). Median survival was 49.5 years for male subjects without diabetes, 47.4 years for male subjects with diabetes, 47.0 years for female subjects without diabetes, and 30.7 years for female subjects with diabetes. Only female sex and forced expiratory volume in 1 s at the time of CFRD diagnosis were significant predictors of the subsequent risk of death (P &lt; 0.001). This strong association was not confounded by CFTR genotype, BMI, steroid use, respiratory pathogens, HbA1c, or pregnancy.
CONCLUSIONS—Female subjects with CFRD have a remarkably poorer prognosis compared with all male subjects with CF and female subjects with CF but without diabetes. The etiology of this sex difference is not clear. We speculate it might involve the interaction of female hormones and diabetes on promotion of a proinflammatory state or that androgens might protect male subjects from the catabolic effects of insulin deficiency. Alternatively, the appearance of frank diabetes in female subjects with CF may simply be a marker for some other biological difference that is not immediately apparent.
Autologous Transplantation of Granulocyte Colony–Stimulating Factor–Mobilized Peripheral Blood Mononuclear Cells Improves Critical Limb Ischemia in Diabetes
Authors: Huang Pingping , Li Shangzhu , Han Mingzhe , Xiao Zhijian , Yang Renchi , Han Zhong Chao 
Published: March 2007

OBJECTIVE— To assess the application of autologous transplantation of granulocyte colony–stimulating factor (G-CSF)–mobilized peripheral blood mononuclear cells (PBMNCs) in the treatment of critical limb ischemia (CLI) of diabetic patients and to evaluate the safety, efficacy, and feasibility of this novel therapeutic approach.
RESEARCH DESIGN AND METHODS—Twenty-eight diabetic patients with CLI were enrolled and randomized to either the transplant group or the control group. In the transplant group, the patients received subcutaneous injections of recombinant human G-CSF (600 μg/day) for 5 days to mobilize stem/progenitor cells, and their PBMNCs were collected and transplanted by multiple intramuscular injections into ischemic limbs. All of the patients were followed up after at least 3 months.
RESULTS—At the end of the 3-month follow-up, the main manifestations, including lower limb pain and ulcers, were significantly improved in the patients of the transplant group. Their laser Doppler blood perfusion of lower limbs increased from 0.44 ± 0.11 to 0.57 ± 0.14 perfusion units (P &lt; 0.001). Mean ankle-brachial pressure index increased from 0.50 ± 0.21 to 0.63 ± 0.25 (P &lt; 0.001). A total of 14 of 18 limb ulcers (77.8%) of transplanted patients were completely healed after cell transplantation, whereas only 38.9% of limb ulcers (7 of 18) were healed in the control patients (P = 0.016 vs. the transplant group). No adverse effects specifically due to cell transplantation were observed, and no lower limb amputation occurred in the transplanted patients. In contrast, five control patients had to receive a lower limb amputation (P = 0.007, transplant vs. control group). Angiographic scores were significantly improved in the transplant group when compared with the control group (P = 0.003).
CONCLUSIONS—These results provide pilot evidence indicating that the autologous transplantation of G-CSF–mobilized PBMNCs represents a simple, safe, effective, and novel therapeutic approach for diabetic CLI.
The Role of Autoimmunity at Diagnosis of Type 1 Diabetes in the Development of Thyroid and Celiac Disease and Microvascular Complications
Authors: Glastras Sarah J. , Craig Maria E. , Verge Charles F. , Chan Albert K. , Cusumano Janine M. , Donaghue Kim C. 
Published: March 2007

OBJECTIVE—The purpose of this study was to explore whether the presence of thyroid and endomysial autoantibodies at diagnosis of type 1 diabetes in children predicts development of thyroid and celiac disease, respectively, and whether diabetes-associated autoantibodies at diagnosis predict development of microvascular complications up to 13 years later.
RESEARCH DESIGN AND METHODS—Autoantibodies were measured at diagnosis of type 1 diabetes in 173 children aged 0–15 years and included thyroperoxidase antibody (TPOA), endomysial antibody (EMA), islet cell autoantibody, GAD antibody (GADA), and insulin autoantibody. Thyroid disease was defined as thyroid stimulating hormone level ≥5 μU/ml. Celiac disease was confirmed by small-bowel biopsy. Assessment of microvascular complications included stereoscopic fundal photography, pupillometry, thermal threshold, and albumin excretion rate (AER).
RESULTS—The incidence rates for thyroid and celiac disease were 0.9 and 0.7 per 100 patient-years, respectively. Within 13 years, 6 of 13 children with positive TPOA tests at diagnosis developed thyroid disease compared with 5 of 139 children with negative TPOA tests (P &lt; 0.001). All four patients with positive EMA titers at diagnosis had biopsy-proven celiac disease. Five of 11 patients who developed thyroid disease and 4 of 8 who developed celiac disease had negative TPOA and EMA tests at diagnosis, respectively. Retinopathy was detected in 39% and elevated AER in 36%. The presence of diabetes-associated autoantibodies at diagnosis did not predict microvascular complications though GADA titer levels predicted pupillary abnormality.
CONCLUSIONS—Elevated TPOA and EMA levels at diagnosis of type 1 diabetes predict the development of thyroid and celiac disease, respectively. In children with negative antibody titers at diagnosis, screening at 2-year intervals is recommended.
Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!
Authors: Meijer Jan-Willem G. , Smit Andries J. , Lefrandt Joop D. , van der Hoeven Johannes H. , Hoogenberg Klaas , Links Thera P. 
Published: March 2007

OBJECTIVE—Several national and international scoring systems are used to diagnose diabetic polyneuropathy (PNP). The variety in these scores and the lack of data on validity and predictive value has led to a comparison and validation of the scores with clinical standards for PNP to determine the most powerful measurement for screening.
RESEARCH DESIGN AND METHODS—Three matched groups were selected: 24 diabetic patients with neuropathic foot ulcers, 24 diabetic patients without PNP or ulcers, and 21 control subjects without diabetes. In all participants the scores from the International Consensus on the Diabetic Foot (ICDF) and the Dutch Nederlandse Diabetes Federatie-Centraal Beleids Orgaan (NDF/CBO) were tested. The Diabetic Neuropathy Symptom score, the Diabetic Neuropathy Examination score, Heart Rate Variability, the Nerve Conduction Sum score, and a San Antonio Consensus sum score were obtained as clinical standards. Reproducibility was tested in a separate study (13 patients).
RESULTS—The construct validity and discriminative power of the ICDF and NDF/CBO scores were comparable, although monofilaments (NDF/CBO) scored lower. The predictive value was good for all scores, with the best results being obtained for the tuning fork (NDF/CBO). Reproducibility of the NDF/CBO scores (monofilaments and tuning fork) was high.
CONCLUSIONS—The characteristics of the scores of tests recommended by ICDF and NDF/CBO are comparable. The single use of the 128-Hz tuning fork produces results similar to the extended scores of the ICDF and much better than those of monofilaments on validation and for predictive value. For screening we therefore advise the use of the tuning fork alone.
Normalization of Plasma Insulin Profiles in Diabetic Subjects with Programmed Insulin Delivery
Authors: Schade David S , Eaton R Philip , Spencer William 
Published: March 2007

Normalization of plasma glucose concentration with subcutaneous injections of insulin has been difficult. With intravenous insulin delivery, normalization of plasma glucose concentration in adult-onset diabetic patients has been achieved when their plasma insulin concentration was normalized. In juvenile-onset diabetic subjects totally lacking endogenous insulin, the effect of normalization of the plasma insulin concentration has not yet been reported.
In the present studies, the plasma insulin profile was normalized in four brittle, insulin-dependent diabetic subjects throughout three meals (breakfast, lunch, and supper). Plasma free insulin concentration was assayed after precipitation of endogenous insulin antibodies with polyethylene glycol. Acute meal-related increases in plasma free insulin concentration were achieved with a programmable intravenous insulin delivery system.
When plasma insulin profiles were normalized in insulin-dependent diabetic subjects lacking endogenous insulin secretion, an improvement in meal-related glucose excursions was observed. However, complete normalization of plasma glucose concentration was not achieved, suggesting that factors other than plasma insulin concentration modulate carbohydrate homeostasis in brittle diabetes. These factors may include portal vein hypoinsulinemia during peripheral vein insulin infusion, stress hormone concentrations, and tissue insulin resistance.
Obstructive Sleep Apnea: Its Relevance in the Care of Diabetic Patients
Authors: Boyer Suzanne , Kapur Vishesh 
Published: March 2007

In Brief
Obstructive sleep apnea (OSA) is a common and frequently unrecognized disorder. It is often found in patients with obesity, diabetes, and cardiovascular disease, and there is growing evidence that sleep apnea is independently associated with increased cardiovascular morbidity. This article reviews the presentation, diagnosis, and treatment of OSA and its related health risks. It also discusses the proposed associations between OSA and diabetes and insulin resistance.
Clarifying the Role of Insulin in Type 2 Diabetes Management
Authors: White John R. , Davis Stephen N. , Cooppan Ramachandiran , Davidson Mayer B. , Mulcahy Kathryn , Manko Gary A. , Nelinson Donald ,   the Diabetes Consortium Medical Advisory Board
Published: March 2007

In Brief
The prevalence of type 2 diabetes has been increasing rapidly and with it has been resultant morbidity and mortality. Strict glycemic control reduces the progression of diabetic microvascular disease; however, most patients treated with sulfonylureas require additional insulin therapy. This article addresses common clinician concerns about prescribing insulin early in type 2 diabetes. It presents strategies for incorporating basal insulin therapy with glargine (Lantus) into a regimen that promotes compliance.
Management of Diabetic Peripheral Neuropathy
Authors: Boulton Andrew J.M. 
Published: March 2007

IN BRIEFDiabetic peripheral neuropathy affects up to 50% of older type 2 diabetic patients. Whereas some patients may have extremely painful symptoms, others with a more marked neuropathic deficit may be asymptomatic. Diagnosis requires careful examination of the lower limbs. Management involves establishing that the neuropathy is caused by diabetes instead of more sinister causes and aiming for optimal glycemic control. Medications, usually tricyclic drugs or anticonvulsant agents, may be required. Patients with peripheral neuropathy must be considered at risk of insensate foot ulceration and must receive preventive education and podiatric care.
Erectile Dysfunction
Authors: Thethi Tina K. , Asafu-Adjaye Nana O. , Fonseca Vivian A. 
Published: March 2007

IN BRIEFErectile dysfunction affects ∼ 30 million men in the United States to some extent. It may indicate the presence of a serious underlying medical condition, such as cardiovascular disease, diabetes, or depression. It compromises multiple aspects of a patient's life, including overall quality of life and interpersonal relationships.