bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autonomic Neuropathy Influences Great Toe Blood Pressure
Authors: Uccioli Luigi , Monticone Giovanna , Durola Laura , Russo Francesco , Mormile Flaminio , Mennuni Gioacchino , Menzinger Guido 
Published: March 2007

OBJECTIVE
To assess the influence of autonomic neuropathy on toe blood pressure (TBP), a parameter used currently as an ischemic index.

RESEARCH DESIGN AND METHODS
The age-matched study subjects included 20 non-insulin-dependent diabetes mellitus (NIDDM) patients with autonomic neuropathy (DN) and 10 NIDDM patients without autonomic neuropathy (D), assessedby standard cardiovascular tests and galvanic skin response, and 8 control subjects (C). None of the subjects had peripheral vascular disease (PVD) (ankle/brachial index 0.9–1.1.

RESULTS
The TBP and toe/brachial index (TBI) were significantly lower in DN than in C and D (P &lt; 0.01). The saturation index (SI), the ratiobetween foot venous and arterial partial pressure of oxygen (PO2), was significantly higher in DN than in C and D (P &lt; 0.05). An inverse relationship was found between TBI and SI (r = 0.554, P = 0.001).

CONCLUSIONS
The autonomic nervous system directly influences peripheral circulation. In diabetic patients without PVD, a failure of sympathetic fibers caused by autonomic neuropathy could lead to a reduction of TBP. Therefore, TBP cannot be used as an ischemic index in diabetic patients.
Increasing Prevalence of NIDDM in the Pacific Island Population of Western Samoa Over a 13-Year Period
Authors: Collins Veronica R , Dowse Gary K , Toelupe Palanitina M , Imo Tofaeono T , Aloaina Faalii L , Spark Raymond A , Zimmet Paul Z 
Published: March 2007

OBJECTIVE
A survey of noncommunicable diseases (NCD) in the Pacific island population of Western Samoa in 1978 (n = 1,206) documented a relatively high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) and obesity. A follow- up survey was performed in 1991 (n = 1,776) to assess changes in NCD prevalence and risk factor distribution over 13 years.

RESEARCH DESIGN AND METHODS
In both surveys, the same representative villages from one urban and two rural areas were studied, and the survey procedure included an oral glucose tolerance test, anthropometric and blood pressure measurements, and physical activity assessment (1991 only).

RESULTS
The age-standardized prevalence of NIDDM in 1991 was 9.5 and 13.4% in Apia (urban) for men and women, respectively. In Poutasi (rural), 5.3% of men and 5.6% of women had NIDDM, and in Tuasivi (rural) the prevalence was 7.0 and 7.5% for men and women, respectively. Age, body mass index (BMI), waist-to-hip circumference ratio, physical inactivity, and family history of diabetes all showed independent association with NIDDM and impaired glucose tolerance. Living in Apia (compared with Poutasi) was also associated with NIDDM. Between 1978 and 1991, the age-standardized prevalence of NIDDM in Apia increased from 8.1 to 9.5% in men and 8.2 to 13.4% in women. In Poutasi, a dramatic increase occurred in prevalence from 0.1 to 5.3% in men, but little change in women was noted (5.4 to 5.6%). In Tuasivi, the increases were 2.3 to 7.0% in men and 4.4 to 7.5% in women. In combined survey areas, increases were observed in the agestandardized prevalence of obesity and mean levels of total cholesterol, fasting triglycerides, and uric acid between surveys as well as a reduction in the prevalence of smoking.

CONCLUSIONS
This is the first study using standardized methods to show a dramatic increase in the prevalence of NIDDM in a developing Pacific island population, and it indicates the importance of maintaining and expanding preventive programs for NIDDM and related lifestyle diseases in these populations.
Incidence of IDDM in the Marche Region, Italy
Authors: Cherubini Valentino , Cantarini Maurizio , Ravaglia Elsa , Bartolotta Edoardo 
Published: March 2007

OBJECTIVE
To provide reliable data concerning the incidence of insulindependent diabetes mellitus (IDDM) in children from the Marche Region in Italy and contribute to a better understanding of its geographical variability throughout Italy and Europe.

RESEARCH DESIGN AND METHODS
All newly diagnosed cases of IDDM in children 0–14 years of age in the Marche Region between 1 January 1990 and 31 December 1992 were recorded. The primary source of ascertainment was clinical records from the 59 hospitals of the region. Secondary and tertiary independent sources included local and national associations for diabetic children and local district centers of the National Health System.

RESULTS
Over the 3-year study period, the overall IDDM incidence rate was 8.1 per 100,000/year. No significant sex-related difference in incidence was noted, with a male:female ratio of 0.9. The completeness of ascertainment was estimated at 100%.

CONCLUSIONS
The Marche Region appears to have a slightly elevated incidence of IDDM among noninsular Italian regions.
A Cost-Benefit Comparison of Intensive Diabetes Management With Implantable Pumps Versus Multiple Subcutaneous Injections in Patients With Type I Diabetes
Authors: Haardt Marie-Joelle , Selam Jean-Louis , Slama Gerard , Bethoux Jean-Pierre , Dorange Catherine , Mace Brigitte , Ramaniche Marie-Lou , Bruzzo Françoise 
Published: March 2007

OBJECTIVE
To investigate if intraperitoneal (IP) insulin infusion via programmable implantable pumps is a potential alternative to subcutaneous (SC) insulin via multiple injections.

RESEARCH DESIGN AND METHODS
We compared the cost-benefits of the two methods using a randomized, prospective, 6-month, crossover design in 10 adult type I diabetic patients.

RESULTS
When judged on the last month of IP versus SC periods in the nine patients who completed the study, metabolic data showed better glycemie control (HbA1c: 7.2 ± 0.2 IP vs. 8.5 ± 0.7% SC, mean ± SE, P = 0.02), reduced glycemie fluctuations (SD of capillary glucose values: 3.4 ± 0.2 IP vs. 4.6 ± 0.2 mM SC, P &gt; 0.01), and fewer mild hypoglycemie events (5.7±2.0 IP vs. 10.0 ± 3.1 events/month SC, P = 0.02). Quality of life, judged by Diabetes Control and Complications Trial questionnaires, was unaffected by pump therapy. Direct costs, including pump acquisition, implantation, and follow-up, were 2.6-fold higher with IP than with SC delivery.

CONCLUSIONS
The implantable pump is more effective in the short term, equally accepted, but more costly than multiple injections and should be limited to patients with unsatisfactory glycemie control despite intensive diabetes management with SC insulin. In addition, longer-term, larger-scale, and comparative evaluation is required.
Subcutaneous Injection of the Incretin Hormone Glucagon-Like Peptide 1 Abolishes Postprandial Glycemia in NIDDM
Authors: Gutniak Mark K , Linde Birgitta , Holst Jens J , Efendić Suad 
Published: March 2007

OBJECTIVE
To investigate the effect of subcutaneously injected glucagon-like peptide 1 (GLP-1) (7–36)amide on postprandial plasma glucose, insulin, and C-peptide levels in patients with non-insulin-dependent diabetes mellitus (NIDDM) and a secondary failure to sulfonylureas.

RESEARCH DESIGN AND METHODS
GLP-1 (25 nmol) was injected subcutaneously into either the abdominal wall or the gluteal region at a standardized depth and speed. The injection device was guided by the ultrasound determination of the depth of the fat layer. The peptide was given 5 min before a standard meal. Plasma concentrations of glucose, C-peptide, insulin, glucagon, and GLP-1 were followed during 240 min after the injection.

RESULTS
In control experiments, a significant hyperglycemia was attained after the meal. GLP-1 given into the abdominal wall not only virtually abolished the postprandial blood glucose rise but significantly decreased glucose concentrations, with a nadir at ∼25 min after the injection. A rapid rise of C-peptide and insulin levels was observed 10-15 min after the injection of GLP-1. The stimulatory effect of GLP-1 was transient, and, at 45 min after the meal, both insulin and C-peptide levels were almost identical in GLP-1 and control experiments. Significantly lower glucagon concentrations were observed 35-65 min after the peptide injection. GLP-1 concentration in plasma increased from 10 pM to a peak concentration (Cmax) of 70 pM at Tmax 30 min after injection. Then GLP-1 levels rapidly decreased to 25 pM at 95 min and returned to basal at 215 min. The gluteal injection of GLP-1 had similar effects compared with the abdominal administration on plasma levels of glucose, insulin, C-peptide, and glucagon.

CONCLUSIONS
GLP-1 is promptly absorbed from the subcutaneous tissue. It exerts a significant blood glucose lowering effect when administered before meals in overweight patients with NIDDM.
Independent Correlation Between Plasma Lipoprotein(a) and Angiographie Coronary Artery Disease in NIDDM
Authors: Watts Gerald F , Gwilym Rhiannon M Ap , Mazurkiewicz Janina , Coltart John 
Published: March 2007

OBJECTIVE
To examine the correlation between angiographie coronary artery disease (CAD) and plasma lipoprotein(a) [Lp(a)] concentration in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
In this cross-sectional study of 36 patients with NIDDM who underwent coronary angiography, CAD was assessed visually using a coronary artery score (CAS), and plasma Lp(a) was measured immunotur-bidimetrically.

RESULTS
Lp(a) concentration was significantly higher in patients in the middle and upper tenues of CASs (&gt;4) compared with those in the lower tenue (≤4); geometric mean 0.30 g/l(95% confidence interval [CI] 0.22–0.40) vs. 0.12 g/l (0.08–0.17, P = 0.002). Lp(a) was significantly and positively correlated with the CAS (R2 23%, P = 0.006), independent of other cardiovascular risk factors, including lipoprotein related variables and glycated hemoglobin.

CONCLUSIONS
Plasma Lp(a) is a strong and independent correlate of the extent of angiographie CAD in symptomatic patients with NIDDM.
Relationship Between Habitual Physical Activity and Insulin Area Among Individuals With Impaired Glucose Tolerance: The San Luis Valley Diabetes Study
Authors: Regensteiner Judith G , Shetterly Susan M , Mayer Elizabeth J , Eckel Robert H , Haskell William L , Baxter Judith , Hamman Richard F 
Published: March 2007

OBJECTIVE
To determine whether higher levels of physical activity are associated with lower fasting insulin levels and lower insulin areas under the oral glucose tolerance curve in individuals with impaired glucose tolerance (IGT) in a community setting.

RESEARCH DESIGN AND METHODS
Data from a cross-sectional study of a population consisting of 219 Hispanic and non-Hispanic white men and women with IGT (by World Health Organization criteria) in two rural Colorado counties were analyzed. Total physical activity was assessed by a 7-day physical activity recall, from which metabolic equivalents (METs) were estimated (expressed as MET h/week). Relationships of MET h/week with fasting insulin levels and insulin areas were assessed while considering obesity, age, and other risk factors known to influence fasting insulin level and insulin area.

RESULTS
Among all subjects, univariate analyses showed that higher physical activity levels were associated with lower mean insulin areas and fasting insulin levels (both P ≤ 0.05). Multiple linear regression showed that higher levels of physical activity were significantly associated with lower values of of the insulin area (P &lt; 0.001) but not with fasting insulin levels. The relationship between insulin area and habitual physical activity was independent of obesity, fat distribution, and age.

CONCLUSIONS
On the basis of cross-sectional data, we conclude that higher levels of habitual physical activity are associated with lower insulin areas in a population of individuals with IGT. Understanding the impact of physical activity on markers of insulin action in individuals with IGT is important because of the greatly enhanced risk of non-insulin-dependent diabetes mellitus and, hence, cardiovascular disease in this population.
A Longitudinal Study of Plasma Insulin and Glucagon in Women With Previous Gestational Diabetes
Authors: Damm Peter , Kühl Claus , Hornnes Peter , Mølsted-Pedersen Lars 
Published: March 2007

OBJECTIVE
To investigate whether plasma insulin or glucagon predicts later development of diabetes in women with gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS
The subjects studied were 91 women with diet-treated GDM and 33 healthy women. Plasma insulin and glucagon during a 50-g oral glucose tolerance test (OGTT) were measured during pregnancy, postpartum, and at follow-up 5-11 years later. At follow-up, the women were also examined with a 75-g OGTT or an intravenous glucagon test.

RESULTS
Twenty-seven (30%) of the women with previous GDM had abnormal glucose tolerance at follow-up (2 had insulin-dependent diabetes mellitus, 13 had non-insulin-dependent diabetes mellitus, and 12 had impaired glucose tolerance). Compared with the control subjects, women with previous GDM had relatively impaired insulin secretion (decreased insulinogenic index and delayed peak insulin response) at all time points investigated; this was also found when only nonobese glucose-tolerant women were examined. Low insulin secretion during pregnancy together with a high fasting plasma glucose level at the diagnostic OGTT in pregnancy and hyperglycemia during the postpartum OGTT were predictive for subsequent development of overt diabetes (logistic regression analysis).

CONCLUSIONS
Women who develop GDM have a relative insulin secretion deficiency, the severity of which is predictive for later development of diabetes. Furthermore, our data indicate that their relatively reduced β-cell function may be a significant pathogenic factor in relation to the high incidence of subsequent diabetes in women with GDM. This could be important in the design of follow-up programs for women with previous GDM.
Physician and Patient Prevention Practices in NIDDM in a Large Urban Managed-Care Organization
Authors: Martin Toni L , Selby Joe V , Zhang Danya 
Published: March 2007

OBJECTIVE
To examine physician and patient adherence to prevention guidelines in non-insulin-dependent diabetes mellitus (NIDDM) with attention to possible differences in adherence by patient race or ethnicity.

RESEARCH DESIGN AND METHODS
We performed a cross-sectional chart review study of prevention practices, complications, and risk factors in 378 NIDDM patients (at least 5 years known duration) who were Permanente Medical Care Program, Oakland, CA. There were 232 blacks, 81 whites, 29 Hispanics, and 36 members of other races/ethnicities.

RESULTS
Age- and duration-adjusted prevalence of 14 complications was low and, with the exception of diabetic retinopathy, did not differ significantly by race. An eight-point prevention score that reflected recommended use of glucose, HbA1c, high-density lipoprotein/total cholesterol, blood pressure and proteinuria testing, ophthalmology a and foot examinations, and diabetes education during a 2-year period did not differ by race/ethnicity (P = 0.36). The mean score (4.9 ± 1.6) indicated that on average, five of eight guidelines were performed appropriately. Compliance was poorest for annual proteinuria checks (32.2%). No differences were noted by race/ethnicity in referrals to ophthalmology, weight reduction, or smoking cessation or in missed appointments or failure to keep referral visits.

CONCLUSIONS
The absence of racial differences in either prevention practices or complication rates in this insured prepaid setting suggests that improved access to preventive services may be effective in reducing such differences nationally. However, adherence to several guidelines was ≤ 50%, indicating that physicians are not sufficiently convinced of the necessity for these prevention measures.
Effects of Alprazolam on Glucose Regulation in Diabetes: Results of double-blind, placebo-controlled trial
Authors: Lustman Patrick J , Griffith Linda S , Clouse Ray E , Freedland Kenneth E , Eisen Seth A , Rubin Eugene H , Carney Robert M , McGill Janet B 
Published: March 2007

OBJECTIVE
To determine the effects of alprazolam on glucose regulation in anxious and nonanxious patients with poor glycemic control and establish whether regulatory benefits are related to anxiolytic effects of the medication.

RESEARCH DESIGN AND METHODS
Fifty-eight patients with poor glycemic control, 16 (27.6%) of whom had a symptomatic generalized anxiety disorder, were entered into a randomized, double-blind, placebo-controlled, 8-week trial using alprazolam (up to 2 mg/day) as the active agent. Generalized anxiety disorder was determined in accordance with Diagnostic and Statistical Manual of Mental Disorders criteria, and anxiety symptoms were measured using the Hopkins Symptom Checklist. Glycated hemoglobin levels were used to determine glucose regulation. Compliance behavior was assessed using glucometers and medication monitors equipped with electronic memory.

RESULTS
A statistically significant reduction in glycated hemoglobin level was observed in patients treated with alprazolam compared with those receiving placebo (−1.1 vs. −0.3%, P = 0.04). This treatment effect was not a function of differences in compliance behaviors. Anxiety symptoms decreased in both alprazolam- and placebo-treated patients with generalized anxiety disorder, but reduction in glycated hemoglobin level was not dependent on alleviation of anxiety.

CONCLUSIONS
A short course of alprazolam improved glucose regulation in patients with a history of poor diabetes control. This effect was not directly related to concomitant changes in anxiety. Alprazolam treatment of anxious patients with poorly controlled diabetes may result in decreased anxiety and improved glucose regulation through independent mechanisms.
Reproducibility of the First-Phase Insulin Response to Intravenous Glucose Is Not Improved by Retrograde Cannulation and Arterialization or the Use of a Lower Glucose Dose
Authors: McNair Peter D , Colman Peter G , Alford Frank P , Harrison Leonard C 
Published: March 2007

OBJECTIVE
To determine whether the reproducibility of the first-phase insulin response (FPIR) measured during an intravenous glucose tolerance test is improved by the use of a lower glucose dose or retrograde sampling from an arterialized hand vein.

RESEARCH DESIGN AND METHODS
Previous studies have suggested that the high within-subject variation of FPIR measurement of up to 110% could be reduced by sampling from a retrograde cannulated and arterialized hand vein opposite to the cubital fossa vein through which the glucose was injected or by the use of a lower dose of glucose. Two low-dose (glucose, 5 g/m2 injected over 30 s) and two standard Islet Cell Antibody Registry Users Study (ICARUS) (glucose, 0.5 g/kg injected over 3 min) tests were performed on seven normal subjects at 2-week intervals. Samples were collected simultaneously from the cubital fossa vein, through which the glucose was injected, and from a retrograde cannulated, contralateral hand vein that was arterialized by heating. FPIR was expressed as the sum of the insulin measurements 1 and 3 min after the completion of the glucose injection and as the area under the insulin curve between 0 and 10 min.

RESULTS
Responses to the mean sum of serum insulin concentrations at 1 and 3 min after intravenous glucose were significantly lower for the low-dose test (mean 94 mU/l) than for the high-dose test (mean 184 mU/l) for samples taken from the arm (P &lt; 0.05); mean 0- to 10-min insulin areas were 367 and 596 mU/l for low- and high-dose tests, respectively (P &lt; 0.05). Within-subject coefficients of variation for samples from the hand or the arm ranged from 0.33 to 17.5% and 1.3 to 38% for successive ICARUS and low-dose tests, respectively. Reproducibility, measured by the coefficient of variation between successive tests for each protocol, was not significantly different using samples taken from the arm or the contralateral hand.

CONCLUSIONS
The intravenous glucose tolerance test is reproducible when performed by the same operator over a short time span. Reproducibility is not significantly improved by sampling from an arterialized, retrograde cannulated, contralateral hand vein. There is no case for changing the present ICARUS protocol to incorporate retrograde cannulation or low-dose (5 g/m2) glucose.
Reduction of Postprandial Hyperglycemia in Subjects With IDDM by Intravenous Infusion of AC137, a Human Amylin Analogue
Authors: Kolterman Orville G , Gottlieb Alan , Moyses Chris , Colburn Wayne 
Published: March 2007

OBJECTIVE
To demonstrate that intravenous administration of AC137 (25,28,29 tripro-human amylin), a human amylin analogue, modulates the rate of appearance of glucose derived from a standard oral meal in the peripheral circulation of patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
After the observation that a 2-h infusion of AC137 at a rate of 150 μg/h, in conjunction with the subjects' usual morning insulin dose, decreased postprandial hyperglycemia in 6 subjects with IDDM, a double-blind placebo-controlled two-period crossover design in an additional 18 IDDM patients was undertaken to confirm and extend the observation. Based on reasoning that an effect to modulate the appearance of orally administered glucose would have no impact on the disposition of an intravenous glucose load, nine patients were challenged with an intravenous glucose loads (300 mg/kg), while another nine patients were challenged with a standardized Sustacal meal (350 kcal) during a 5-h infusion of AC137 (50 μg/h). On each occasion, the subjects received their usual morning doses of insulin subcutaneously. The impact of the AC137 infusion on the plasma glucose responses to these different challenges was assessed.

RESULTS
Intravenous infusion of AC137 yielding steady state plasma concentrations of 225 ± 15 pmol/l (mean ± SE) reduced postprandial plasma glucose concentrations after the standardized Sustacal meal challenge. The mean area under the glucose curve, corrected for baseline, was reduced from −1,869 ± 5,562 mg · dl−1 · min during placebo infusion to −28,872 ± 4,812 mg · dl−1 · min during AC137 infusion, P = 0.0015. In contrast, an AC137 infusion producing steady-state concentrations of 234 ± 16 pmol/l had no effect on the plasma glucose profile after administration of an intravenous glucose load.

CONCLUSIONS
AC137 administration, in these patients with IDDM, reduced postprandial hyperglycemia apparently by affecting the delivery rate of glucose from the gastrointestinal tract. AC137 may prove to be a clinically useful addition to insulin regimens to facilitate the achievement of glycemic control.