bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Activity and Proliferative Retinopathy in People Diagnosed With Diabetes Before Age 30 Yr
Authors: Cruickshanks Karen J , Moss Scot E , Klein Ronald , Klein Barbara E 
Published: March 2007

OBJECTIVE
To examine the relationships of past and current physical activity to the prevalence of PDR.

RESEARCH DESIGN AND METHODS
Individuals diagnosed with diabetes &lt; 30 yr of age (n = 818), who were participants in the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy, were examined during 1984–1986. Stereoscopic fundus photographs were graded for presence of PDR. Physical activity was assessed by an interviewer-administered standardized questionnaire.

RESULTS
Women diagnosed with diabetes &lt; 14 yr of age who reported a history of participation in team sports in high school or college were less likely to have PDR at examination (OR 0.46, 95% CI 0.23, 0.93). Those women who reported current strenuous activity levels were less likely to have PDR (OR 0.34, 95% CI 0.13, 0.87). There were no significant associations between past or current physical activity and PDR in men. Current levels of energy expenditure were not related to PDR in either sex.

CONCLUSIONS
Higher levels of physical activity may be associated with a reduced risk of having PDR in women. However, the lack of similar findings in men suggests that physical activity may be a relatively unimportant factor in the etiology of PDR.
Insulin Action in Black Americans With NIDDM
Authors: Banerji Mary Ann , Lebovitz Harold E 
Published: March 2007

OBJECTIVE
To assess the influences that obesity and hyperglycemia have on insulin action in black NIDDM patients.

RESEARCH DESIGN AND METHODS
Thirty-nine subjects were studied who had normal GHb levels and/or FPG &lt;6.4 mM and who had not taken pharmacological agents for 2–91 mo before the study. Insulin action was studied using the euglycemic insulin clamp with a d-[3-3H] glucose infusion. Degree of obesity was assessed with BMI. During carefully monitored follow-up, 9 patients relapsed into a hyperglycemic state, and insulin action was restudied after acute reregulation of their plasma glucose.

RESULTS
Insulin action was related to the degree of obesity at the extremes of BMI: 7 of 8 patients (87.5%) with a BMI &lt;24.0 kg/m2 were insulin sensitive, and 8 of 9 patients (88.9%) with a BMI &gt;28.5 kg/m2 were insulin resistant. In the midrange BMI (24.0–28.5 kg/m2), patients were equally likely to be insulin resistant or insulin sensitive. A plot of frequency versus glucose disposal in those patients was compatible with a bimodal distribution (P &lt; 0.025): 12 of 22 patients were normally insulin sensitive (glucose disposal 6.1–9.4 mg.kg−1 · min−1), and 10 were insulin resistant (glucose disposal 2.4–4.8 mg.kg−1 · min−1). Analysis of this midrange BMI group showed that in the insulin-sensitive group, an inverse relationship existed between BMI and glucose disposal (r = −0.64, P &lt; 0.05), whereas no such relationship was found in the insulin-resistant group. The clinical characteristics of the midrange BMI group indicated that fasting plasma insulin, total cholesterol, and triglycerides were higher; whereas BMI, age, and FPG were not different in the insulin-resistant compared with the insulin-sensitive group. With the development of hyperglycemia, insulin action in the insulin-sensitive group. With the development of hyperglycemia, insulin action in the insulin-sensitive group was decreased, independent of obesity, whereas it was unchanged in the insulin-resistant group.

CONCLUSIONS
Insulin resistance exists in only ∼ 50% of black NIDDM patients. The relationship between obesity and insulin resistance is not a simple one. The data can be explained by one of two hypotheses: 1) insulin resistance in black NIDDM patients is an acquired defect related to the development of obesity and is modulated by hyperglycemia, or 2) NIDDM exists as two variants, one with primary insulin resistance and one with normal insulin sensitivity, and that insulin resistance causes central and/or generalized obesity.
Prevalence of Glucose Intolerance in Asian Indians: Urban-rural difference and significance of upper body adiposity
Authors: Ramachandran Ambady , Snehalatha Chamukuttan , Dharmaraj Daisy , Viswanathan Moopil 
Published: March 2007

OBJECTIVE
To evaluate the prevalence of NIDDM and IGT in the urban and rural areas in southern India.

RESEARCH DESIGN AND METHODS
Two populations of the same ethnic background, but different socioeconomic background were chosen for this study. Nine-hundred urban people and 1038 rural subjects were studied. Fasting and 2-h post-glucose capillary blood samples after a 75 g oral glucose load (WHO criteria) were obtained in these randomly selected adults (≥ 20 yr of age).

RESULTS
Using the WHO criteria, the prevalence of NIDDM, adjusted to the age of the respective general population, was 8.2% in the urban and 2.4% in the rural populations. The prevalence was 8.4 and 7.9%, respectively, in urban men and women, and 2.6 and 1.6% in rural men and women. The age-adjusted prevalence of IGT was 8.7 and 7.8% in the urban and rural areas, respectively. The prevalence of IGT was 8.8% in urban men and 8.3% in women; the corresponding values for rural men and women were 8.7 and 6.4%. The prevalence of NIDDM increased with age, markedly so in the urban people. The urban-rural difference was significant for NIDDM (X2 = 29.4, P &lt; 0.001) but not for IGT. In the urban population, 65% of the NIDDM patients were known cases, whereas in the rural area, the known cases accounted for only 24%. Bivariate analysis showed an association of BMI, STR, and WHR with prevalence of NIDDM plus IGT. In the multiple logistic regression analysis, age, BMI, STR, and WHR were associated significantly with glucose intolerance in the urban population, whereas only age was significant in the rural population. The best predictors of NIDDM were age, BMI, WHR, and urbanization.

CONCLUSIONS
The study showed a high prevalence of NIDDM in the urban southern Indian population. The prevalence of NIDDM in the same ethnic group in rural areas was significantly lower. The prevalence of IGT was similar in both populations. Upper body adiposity was a significant predictor of NIDDM in this population with low rates of obesity.
Eating disorders in adolescents with IDDM: A controlled study
Authors: Peveler Robert C , Fairburn Christopher G , Boller Irene , Dunger David 
Published: March 2007

OBJECTIVE
To determine the prevalence of clinical eating disorders and lesser degrees of disturbed eating in adolescents with IDDM and a matched sample of nondiabetic control subjects.

RESEARCH DESIGN AND METHODS
A cross-sectional survey of eating habits and attitudes conducted in 76 adolescents with IDDM, and age- and sex-matched nondiabetic control subjects. Eating disorder features were assessed by standardized research interview adapted for use with patients with diabetes (EDE). Glycemic control was assessed by GHb assay.

RESULTS
Adolescent girls with IDDM were heavier than nondiabetic female control subjects and were dieting more intensively to control their shape and weight. However, clinical eating disorders were no more common among adolescent girls with IDDM than among nondiabetic control subjects. Nine percent of the IDDM girls met diagnostic criteria for an operational version of “Eating disorder not otherwise specified.” Fifteen percent had omitted or reduced their dose of insulin to influence their shape and weight. Eating disorder features and insulin misuse for shape and weight control were not found in IDDM or nondiabetic boys, and these two groups did not differ in their body weight.

CONCLUSIONS
Adolescent girls with IDDM are heavier than their nondiabetic counterparts and diet more intensively to control their shape and weight. Disordered eating habits and weight control behavior are common, but no more so in IDDM than in nondiabetic subjects. Insulin misuse for the purpose of shape and weight control is not restricted to subjects with a clinical eating disorder. Disordered eating is associated with impaired glycemic control.
Diabetes Is Not Caused by Cassava Toxicity: A study in a Tanzanian community
Authors: Swai A B M , Mclarty D G , Mtinangi B L , Tatala S , Kitange H M , Mlingi N , Rosling H , Howlett W P , Brubaker G R , Alberti K G M M 
Published: March 2007

OBJECTIVE
To test the hypothesis that consumption of cassava with liberation of cyanide causes diabetes in malnourished individuals.

RESEARCH DESIGN AND METHODS
Glucose tolerance was assessed in two rural communities in Tanzania; in one (Nyambori), the main source of calories was cassava; and in the other (Uswaa), cassava was rarely eaten. Undernutrition was prevalent in both communities. The people of Nyambori were known to have high dietary cyanide exposure for many years from consumption of insufficiently processed cassava. Of the 1435 people in Nyambori ≥ 15 yr old, 1067 (74%) were surveyed, and 1429 of 1472 (97%) eligible subjects in Uswaa were surveyed. All had 75-g oral glucose tolerance tests and measurement of BMI. Plasma and urine thiocyanate and blood cyanide also were measured in some subjects.

RESULTS
Mean ± SD plasma and urine thiocyanate levels in Nyambori were 296 ± 190 and 497 ± 457 μM (n = 204), respectively, compared with 30 ± 37 and 9 ± 13 μM, respectively, in Uswaa (n = 92) (P &lt; 0.001 for all differences). The mean blood cyanide level in Nyambori was elevated (1.4 [range 0.1–30.2] μM; n = 91). The prevalence of diabetes in the cassava village (Nyambori) was 0.5% compared with 0.9% in Uswaa (NS). The prevalence of IGT was similar in the two villages in the 15- to 34- and the 34- to 54-yr-old age-groups; but in those ≥ 55 yr old, IGT was higher in Nyambori (17.4 vs 7.2%, P = 0.029). Mean fasting and 2-h blood glucose levels were slightly higher in Nyambori village after adjusting for age, sex, and BMI (4.5 vs. 4.2 and 5.0 vs. 4.4 mM, respectively).

CONCLUSIONS
High dietary cyanide exposure was not found to have had a significant effect on the prevalence of diabetes in an undernourished population in Tanzania. Cassava consumption is thus highly unlikely to be a major etiological factor in so-called MRDM, at least in East Africa.
Identifying Diabetic Patients at High Risk for Lower-Extremity Amputation in a Primary Health Care Setting: A prospective evaluation of simple screening criteria
Authors: Rith-Najarian Stephen J , Stolusky Thomas , Gohdes Dorothy M 
Published: March 2007

OBJECTIVE
To evaluate prospectively a risk categorization scheme for lower-extremity problems that incorporates the Semmes-Weinstein 5.07 monofilament and a simple exam to stratify patients who were followed in a primary-care setting into risk groups for plantar ulceration and lower-extremity amputation.

RESEARCH DESIGN AND METHODS
Patients with diabetes in a well-defined American-Indian population were stratified into four risk categories based on sensation status to the 5.07 monofilament, the presence of foot deformity, and a history of lower-extremity events (amputation or ulceration): category 0, sensate; category 1, insensate; category 2, insensate with deformity; and category 3, history of lower extremity events. Patients were followed prospectively for lower extremity events and changes in sensation status.

RESULTS
We gave screening exams to 358 (88%) of 406 individuals with diabetes in the community. The distribution of patients for risk categories 0, 1, 2, and 3 was 74.3, 8.4, 4.5, and 13%, respectively. Over a 32-mo follow-up period, 41 patients developed ulcerations, and incidence rates correlated positively with increasing risk category (P &lt; 0.00001). All 14 amputations occurred in risk groups 2 and 3.

CONCLUSIONS
These data suggest that the risk categorization described here may have a role in identifying patients at risk for lower extremity events who are followed in a primary-care setting.
Hemophilus Influenza Infection of an Implantable Insulin-Pump Pocket
Authors: Levy Richard P , Borchelt Mark D , Kremer Richard M , Francis Stephen J , O'Connor Carol A 
Published: March 2007

OBJECTIVE
To increase awareness of adverse events associated with the use of implantable insulin pumps.

RESEARCH DESIGN AND METHODS
A descriptive case report of a pump implant infection.

RESULTS
This is a case report of one implanted insulin pump-pocket infection among a series of 15 patients. After exposure to a child with a respiratory infection on PID 30, V.L.C. (the patient) developed a fulminant pump-pocket infection. H. influenza was recovered from it. Despite aggressive antibiotic therapy, the infection could not be controlled. Insulin delivery ceased, and the pump was explanted. The pump-pocket infection rapidly resolved with pump removal, permitting later reimplantation.

CONCLUSIONS
We have adopted the American Heart Association indications and antimicrobial prophylaxis regimens recommended for prevention of endocarditis in patients with prosthetic values for patients with implanted insulin pumps.
Epidemiology of Insulin-Using Commercial Motor Vehicle Drivers: Major variability of state licensing requirements in the U.S.
Authors: Gower Idamae F , Songer Thomas J , Hylton Harold , Thomas Neill L , Ekoe Jean-Marie , Lave Lester B , LaPorte Ronald E 
Published: March 2007

OBJECTIVE
Licensing agencies in many areas, including the U.S., prohibit insulin-using individuals from driving CMVs or large trucks. This study examined the debate over the risks of licensing insulin-using individuals to drive CMVs as an occupation, and the variations in regulations of different states.

RESEARCH DESIGN AND METHODS
As part of an ongoing review of the regulations governing interstate commerce in the U.S., we surveyed all 50 states and Washington, D.C. to determine the regulations concerning intrastate driving. We received responses from 48 states and D.C., representing 95% of the U.S. population.

RESULTS
Only 9 states reported preventing insulin users from acquiring a CMV license, whereas 39 states and D.C. permitted licensing within state boundaries. Of the states allowing insulin users to drive, 26 placed special requirements on CMV licensing.

CONCLUSIONS
The results indicate that, despite a standardized U.S. federal law for driving across states, enormous variability exists in the policies for driving within states, ranging from no restrictions to a complete ban on CMV driving for insulin users.
Leukocyte Scanning With 111In Is Superior to Magnetic Resonance Imaging in Diagnosis of Clinically Unsuspected Osteomyelitis in Diabetic Foot Ulcers
Authors: Newman Lisa G , Waller John , Palestro Christopher J , Hermann George , Klein Michael J , Schwartz Myron , Harrington Elizabeth , Harrington Martin , Roman Sheila H , Stagnaro-Green Alex 
Published: March 2007

OBJECTIVE
To compare the accuracies of MRI and leukocyte scanning in diagnosing clinically unsuspected osteomyelitis in diabetic foot ulcers.

RESEARCH DESIGN AND METHODS
A prospective study of 16 diabetic foot ulcers in 12 patients, including both ambulatory and hospitalized patients, was performed at a university medical center. Pedal images were obtained by leukocyte scanning with [111In]oxyquinoline and MRI. Definitive diagnosis of osteomyelitis then was determined by bone biopsy for culture and histology.

RESULTS
Biopsy-proven osteomyelitis was present in 7 (44%) of the 16 foot ulcers. The diagnosis was suspected clinically in 0%. Leukocyte scanning was 100% sensitive, whereas MRI was only 29% sensitive in diagnosing osteomyelitis in diabetic foot ulcers. Specificities were 67 and 78%, respectively. The positive and negative predictive values (70 and 100%, respectively) for the leukocyte scan also were &gt; those of MRI (50 and 58%, respectively).

CONCLUSIONS
Leukocyte scanning is superior to MRI in detecting clinically unsuspected osteomyelitis in diabetic foot ulcers.
Chronic Sulfonylurea Therapy Augments Basal and Meal-Stimulated Insulin Secretion While Attenuating Insulin Responses to Sulfonylurea Per Se
Authors: McIntyre H David , Ma Alan , Bird Dominique M , Patterson Carol A , Cameron Donald P 
Published: March 2007

OBJECTIVE
To examine changes in glycemia and insulin secretion in response to SU per se and in response to a standard diet plus OD or TD SU therapy during chronic GP and GB therapy.

RESEARCH DESIGN AND METHODS
Randomized (between agents and in order of dosing regimens), prospective, open, crossover study among 14 NIDDM patients to compare glucose, insulin, and C-peptide responses to a standard diet and to 10 mg of oral GP or GB taken without food 1) after 2 wk without therapy, 2) after 4 wk of either GP (n = 7) or GB (n = 7) treatment OD, and 3) after 4 wk of TD therapy with the same agent. Each patient received the same drug for maintenance therapy and for assessment of the response to the drug alone.

RESULTS
We observed a comparable reduction in overall glycemia with both agents, with more marked postprandial effects for GP. Similar glucose, insulin, and C-peptide profiles for both agents during OD and TD therapy. Augmented insulin secretion in response to meals contrasting with reduced insulinotropic effects of the drugs per se with chronic therapy.

CONCLUSIONS
Therapeutic equivalence of OD and TD dosing with GP and GB during chronic therapy. In view of the improved insulin secretion in response to nutrient stimuli, the attenuation of responses to SU per se during chronic therapy does not imply impairment of β-cell secretory capacity or represent a therapeutic disadvantage.
Impact of NIDDM on Mortality and Causes of Death in Pima Indians
Authors: Sievers Maurice L , Nelson Robert G , Knowler William C , Bennett Peter H 
Published: March 2007

OBJECTIVE
To compare overall and cause-specific death rates for diabetic and nondiabetic Pima Indians.

RESEARCH DESIGN AND METHODS
This community-based study determined overall and cause-specific death rates in persons with and without NIDDM in the Pima population. Underlying causes of death for the 10-yr period from 1975 to 1984 were derived from review of death certificates and medical records. Diabetes diagnoses were based on an ongoing diabetes study initiated by the National Institutes of Health in 1965.

RESULTS
Of the 512 deaths, 241 were in Pima Indians with NIDDM; 203 (84%) of the deaths in diabetic subjects were attributed to natural causes (46 diabetic nephropathy, 35 IHD, 29 infections, 20 malignant neoplasms, 20 alcoholic liver disease, 18 stroke, 35 other causes). For natural causes, the overall age-sex-adjusted death rate in diabetic subjects was 1.7 times (95% CI 1.4–2.2) that in nondiabetic subjects. Longer duration of diabetes was significantly related to mortality, an association that was stronger in women than in men. Rates of death from diabetic nephropathy, IHD, and infections (but not stroke) were each significantly related to longer diabetes duration. Together, diabetic nephropathy and IHD accounted for 90% of the excess death rate among diabetic, compared with nondiabetic, Pimas.

CONCLUSIONS
In Pima Indians, NIDDM has a significant adverse effect on death rates that is directly related to diabetes duration, especially for deaths from diabetic nephropathy, IHD, or infections. Among the Pima, diabetic nephropathy is the leading cause of death, and IHD ranks second—a variation from other populations (in which IHD ranks first), probably partly attributable to a much younger age of onset of diabetes among the Pima than in the U.S. white population.
Renal Hemodynamics and Albumin Excretion Rate in Patients With Diabetes Secondary to Acquired Pancreatic Disease
Authors: Tiengo Antonio , Briani Giustina , Scaldaferri Ennio , Riva Fausto , Jori Elisabetta , Sgnaolin Elena , Fenato Rita , D'Ambrosio Michele , Fioretto Paola , Nosadini Romano , Crepaldi Gaetano , Trevisan Roberto 
Published: March 2007

OBJECTIVE
To assess kidney function and AER in patients with PD.

RESEARCH DESIGN AND METHODS
Thirty-three patients with PD (age 52 ± 7 yr, duration of disease 11 ± 6 yr, BMI 24 ± 3 kg/m2) and 33 patients with IDDM were matched for sex, BMI, and duration of disease. GFR and RPF were determined by single injection of [51Cr]EDTA and [125I]hippurate. AER was measured by radioimmunoassay in a single timed overnight urine collection.

RESULTS
GFR and RPF were, respectively, 113 ± 35 and 441 ± 145 ml · min−1 · 1.73 m2 in patients with PD and 123 ± 30 and 549 ± 94 (P &lt; 0.001) in IDDM. FF was significantly higher in patients with PD (0.26 ± 0.05 vs. 0.22 ± 0.03; P &lt; 0.001). Prevalence of hyperfiltration (GFR &gt; 135 ml · min−1 · 1.73 m2) was similar in both groups (30% in patients with PD vs. 28% in those with IDDM). Geometric mean of urinary AER was 10.4 μg/min (range 1–186) in patients with PD and 11.2 (1–198) in IDDM patients. Some 30.3% of patients with PD and 18% of those with IDDM were microalbuminuric (AER &gt; 20 μg/min). By multiple regression analysis, AER was significantly related to systolic (P &lt; 0.04) and diastolic blood pressure (P &lt; 0.01) and to BMI (P &lt; 0.03) in patients with PD. Retinopathy was more frequent in microalbuminuric patients with PD than in those without elevated AER.

CONCLUSIONS
We suggest that early renal abnormalities occur similarly in patients with PD and IDDM.
Diabetic Retinopathy in Oklahoma Indians With NIDDM: Incidence and risk factors
Authors: Lee Elisa T , Lee Vivian S , Kingsley Ronald M , Lu Min , Russell Dana , Asal Nabih R , Wilkinson C P , Bradford Reagan H 
Published: March 2007

OBJECTIVE
To determine the incidence rates and risk factors for development of diabetic retinopathy in Oklahoma Indians.

RESEARCH DESIGN AND METHODS
Cohort follow-up study with baseline examination between 1972 and 1980 and follow-up examination between 1987 and 1991. Mean ± SD follow-up time was 12.8 ± 1.7 yr. Eleven Indian Health Service facilities (clinics and hospitals) in Oklahoma participated in the study. Study participants were a quasirandom sample of 1012 American Indians (379 men, 633 women) in Oklahoma with NIDDM, 927 of whom received a detailed eye examination at baseline. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. The average quantum of Indian blood was 92% (77% full blood). At follow-up, 515 (55.6%) were alive, 408 (44.0%) were deceased, and 4 (0.4%) could not be traced. Of the living participants, 380 (73.8%) underwent an ophthalmoscopic examination.

RESULTS
The incidence of retinopathy among the participants who were free of disease at baseline and who survived the follow-up interval was 72.3%. By multivariate analysis, significant independent predictors of retinopathy recorded at baseline were FPG level, therapeutic regimen, systolic blood pressure, and duration of diabetes. FPG levels ≥ 11.1 mM (200 mg/dl) increased the risk of retinopathy 1.7 times that for levels &lt; 7.8 mM (140 mg/dl). Insulin use was associated with a 20% greater incidence. Hypertension was a particularly significant risk factor for those with lower FPG levels.

CONCLUSIONS
Given that NIDDM is reaching epidemic proportions in Oklahoma Indians and that most may be afflicted with retinopathy, frequent ophthalmological examinations are clearly indicated for this high-risk population. The role of intervention, namely glycemic and hypertensive control, deserves further study.