bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glycemic Control Is Related to the Electrophysiologic Severity of Diabetic Peripheral Sensorimotor Polyneuropathy
Authors: Tkac Ivan , Bril Vera 
Published: March 2007

OBJECTIVE
The aim of the present study was to examine risk factors for the electrophysiologic severity of diabetic peripheral sensorimotor polyneuropathy (DSP).

RESEARCH DESIGN AND METHODS
A total of 97 patients with type 1 diabetes (25 patients) or type 2 diabetes (72 patients) were included in this cross-sectional study. Nerve conduction studies (NCS) were performed on median motor and sensory nerves, peroneal motor nerve, and both sural nerves. The severity of DSP was expressed as the sum of nerve conduction velocities (SNCV) and the score of distal amplitudes (SAMP) of the above-mentioned nerves. General linear models were used to assess the relationship between overall severity of DSP, as well as the severity of lower extremity, upper extremity, motor nerve, or sensory nerve involvement and various risk factors.

RESULTS
GHb was significantly related to both SNCV and SAMP in univariate and multivariate regression analyses. This relationship was present in models where GHb was handled either as a continuous variable or as a categorical variable with highest significance level, with a GHb cutoff level of 9%. The difference in NCV for individual nerves in patients with good-to-moderate glycemic control (GHb ≤9%) and those with poor glycemic control (GHb ≥9%) ranged from 1.8 to 3.6 m/s. SAMP was also significantly lower in patients with poor control. SNCV was also significantly related in multivariate analysis to duration of diabetes and height, while SAMP was related to duration of diabetes, age, and male sex.

CONCLUSIONS
The severity of DSP expressed by electrophysiologic criteria was significantly related to glycemic control in a study including patients with type 1 or type 2 diabetes. Based on the results of the present study, it might be predicted that better diabetic control would decrease the severity of DSP
Prescription Drug Use and Costs Among Diabetic Patients in Primary Health Care Practices in Germany
Authors: Rathmann Wolfgang , Haastert Burkhard , Roseman Jeffrey M , Gries F Arnold , Giani Guido 
Published: March 2007

OBJECTIVE
To evaluate drug prescriptions and costs among diabetic patients in primary care practices in Germany.

RESEARCH DESIGN AND METHODS
Computerized data on prescriptions and costs (drug company sales prices) were analyzed in 30,604 diabetic and 17,723 (5% random sample) nondiabetic patients from 362 primary care practices during 1994. Relative use ratios for drug groups were obtained from logistic regression models (odds ratio [OR] for diabetes) controlling for age, sex, and other covariates. Relative costs (diabetic:nondiabetic) were estimated by direct age and sex standardization.

RESULTS
Diabetic patients had an increased prescription use for most drugs. A substantial increased use (OR ≥ 1.4) was found for cardiovascular drugs, fibrates, gout medication, laxatives, and wound care products. Diabetic subjects (7.9% of all patients) accounted for 21% of total annual prescription costs in the practices. Total costs (U.S. dollars) per patient-year were threefold higher (diabetic patients $384; control subjects $123). After excluding antidiabetic agents and age- and sex-standardization, relative costs were still 1.5 times higher (P &lt; 0.05). Diabetes treatment accounted for 24% of total costs in diabetic patients (insulin 12%; oral antidiabetics 6%). The most important cost factor was cardiovascular drugs (CVDs) (39%). Three CVD groups accounted for about 50% of total CVD costs in diabetic patients (ACE inhibitors 25%; Ca-antagonists 16%; nitrates 10%).

CONCLUSIONS
Prescription use among diabetic patients in primary health care practices was predominantly increased for cardiovascular drugs and for treatment of diabetes-associated disorders. Diabetic patients accounted for over one-fifth of the total pharmacy costs in primary practices, indicating that diabetes is a major economic factor in drug use.
Gastric Emptying Delay and Gastric Electrical Derangement in IDDM
Authors: Cucchiara Salvatore , Franzese Adriana , Salvia Gennaro , Alfonsi Lucia , Iula Vita D , Montisci Antonella , Moreira Flavio L 
Published: March 2007

OBJECTIVE
Patients with diabetes can develop gastrointestinal motor complications; however, prevalence of gut dysmotility in children with diabetes is poorly understood. We measured gastric emptying time and gastric electrical activity in children with IDDM; presence of dyspeptic symptoms was also assessed.

RESEARCH DESIGN AND METHODS
Gastric emptying time and gastric electrical activity were measured by ultrasonography and electrogastrography (EGG), respectively, in 40 consecutive IDDM children (median age: 9 years [6–14]) without autonomic neuropathy; 15 healthy children (median age: 7 years [4–15]) served as control subjects. The EGG variables studied were percent of electrical dysrhythmias (bradygastria or 0.5−2.0 cpm, tachygastria or 4.0–9.0 cpm; normal rhythm is 2.0–4.0 cpm) and fed-to-fasting ratio of the dominant EGG power. Blood glucose level in the fasting state and 180 min after feeding and HbA1C concentration were also measured. Data are given as median (ranges) and means ± SD. Statistical analysis was performed using the parametric t test and the nonparametric signed-rank tests, with P &lt; 0.05 considered significant.

RESULTS
Gastric emptying time was delayed in 26 patients (group A), whereas in 14 patients (group B), it was in the same range as control values; group A patients significantly differed from group B for increased prevalence of gastric electrical dysrhythmias (P &lt; 0.01) and for a lower fed-to-fasting ratio of the dominant EGG power (P &lt; 0.01). Group B patients did not differ from control subjects for the EGG variables measured. Diabetic children with gastroparesis had significantly higher levels of both HbA1C and blood glucose measured 180 min after feeding than those with normal gastric emptying time (P &lt; 0.05); there was a significant correlation between levels of HbA1C and degree of gastric emptying delay, whereas a significant inverse correlation between gastric emptying time and fed-to-fasting ratio of the dominant EGG power was found both in patients and control subjects.

CONCLUSIONS
Delay of gastric emptying time and gastric electrical abnormalities are found in a high proportion of children with diabetes and can contribute to poor glycemic control, most likely by causing a mismatch between the onset of insulin action and the delivery of nutrients into the small intestine. Diabetic children with unexplained poor glycemic control should be investigated for abnormalities in gastric motility.
Beginning Insulin Treatment of Obese Patients With Evening 70/30 Insulin Plus Glimepiride Versus Insulin Alone
Authors: Riddle Matthew C , Schneider Jill ,   The Glimepiride Combination Group
Published: March 2007

OBJECTIVE
This study tested a simple algorithm for beginning insulin for obese patients with type 2 diabetes after sulfonylurea failure, comparing suppertime 70/30 insulin plus continued glimepiride with insulin alone.

RESEARCH DESIGN AND METHODS
This was a multicenter ambulatory randomized double-masked parallel comparison. There were 208 subjects with secondary failure to sulfonylureas who took glimepiride titrated to 8 mg b.i.d. for 8 weeks; 145 subjects with fasting plasma glucose (FPG) 180–300 mg/dl (10–16.7 mmol/1) on this treatment were randomized to placebo plus insulin (PI) or glimepiride plus insulin (GI) for 24 weeks. A dosage of 70/30 insulin before supper was titrated, seeking fasting capillary blood glucose (FBG) 120 mg/dl (6.7 mmol/1), equivalent to FPG 140 mg/dl (7.8 mmol/1). Outcome measures included FPG, HbA1c, insulin dosage, weight, serum insulin and lipids, and adverse events.

RESULTS
FPG and HbA1c were equivalent at baseline: 261 vs. 250 mg/dl (14.5 vs. 13.9 mmol/1), and 9.9 vs. 9.7%. At 24 weeks, the FPG target was achieved in both groups (136 vs. 138 mg/dl, 7.6 vs. 7.6 mmol/1), and HbA1c values were equal (7.7 vs. 7.6%). However, with GI, control improved faster and fewer subjects dropped out (3 vs. 15%, P &lt; 0.01), and less insulin was needed (49 vs. 78 U/d, P &lt; 0.001). The outcomes were alike in other respects. No subject had severe hypoglycemia.

CONCLUSIONS
Injection of 70/30 insulin before supper safely restored glycemic control of type 2 diabetes not controlled by glimepiride alone. Control was restored more rapidly and with less injected insulin when glimepiride was continued.
Postmenopausal Estrogens and Risk of Myocardial Infarction in Diabetic Women
Authors: Kaplan Robert C , Heckbert Susan R , Weiss Noel S , Wahl Patricia W , Smith Nicholas L , Newton Katherine M , Psaty Bruce M 
Published: March 2007

OBJECTIVE
The effect of hormone replacement therapy on the risk of myocardial infarction in diabetic women has not been well studied. We conducted a case-control study of postmenopausal estrogen use and risk of incident myocardial infarction (MI) in pharmacologically treated diabetic women enrolled at Group Health Cooperative of Puget Sound, a large health maintenance organization in the state of Washington.

RESEARCH DESIGN AND METHODS
Case subjects (n = 212) were all postmenopausal women with treated diabetes who sustained an incident fatal or nonfatal MI between July 1986 and December 1994. Control subjects (n = 122) were treated diabetic women drawn from a stratified random sample of postmenopausal women without prior MI. Computerized pharmacy data and medical records were used to measure use of estrogens. Cardiovascular risk factors recorded from medical records, computerized pharmacy and laboratory data, and telephone interviews were used as adjustment variables.

RESULTS
In this study, 8.5% of case and 13.9% of control subjects were current users of estrogens. The relative risk (RR) of MI for current estrogen users was 0.51 (95% CI 0.22–1.15) relative to never users, adjusted for age, study year, weight, angina, and duration of treated diabetes. Among current estrogen users, risk of MI tended to decline with each additional year of estrogen use (adjusted RR – 0.78, 95% CI 0.56–1.08). Of those studied, 45.3% of case and 37.7% of control subjects were past users of estrogens (adjusted RR = 1.22,95% CI 0.71–2.09).

CONCLUSIONS
This study suggests that use of postmenopausal estrogens does not increase risk of MI in diabetic women and that sustained use may be of benefit.
Acarbose in NIDDM Patients With Poor Control on Conventional Oral Agents: A 24-week placebo-controlled study
Authors: Lam Karen SL , Tiu SC , Tsang MW , Ip TP , Tam Sidney CF 
Published: March 2007

OBJECTIVE
To determine the efficacy of acarbose, compared with placebo, on the metabolic control of NIDDM patients inadequately controlled on maximal doses of conventional oral agents.

RESEARCH DESIGN AND METHODS
In this three-center double-blind study, 90 Chinese NIDDM patients with persistent poor glycemic control despite maximal doses of sulfonylurea and metformin were randomly assigned to receive additional treatment with acarbose 100 mg thrice daily or placebo for 24 weeks, after 6 weeks of dietary reinforcement. Efficacy was assessed by changes in HbA1c, fasting and 1-h postprandial plasma glucose and insulin levels, and fasting lipid levels.

RESULTS
Acarbose treatment was associated with significantly greater reductions in HbA1c (−0.5 ± 0.2% vs. placebo 0.1 ± 0.2% [means ± SEM], P = 0.038), 1-h postprandial glucose (−2.3 ± 0.4 mmol/1 vs. placebo 0.7 ± 0.4 mmol/1, P &lt; 0.001) and body weight (−0.54 ± 0.32 kg vs. placebo 0.42 ± 0.29 kg, P &lt; 0.05). There was no significant difference between the two groups regarding changes in fasting plasma glucose and lipids or fasting and postprandial insulin levels. Flatulence was the most common side effect (acarbose vs. placebo: 28/45 vs. 11/44, P &lt; 0.05). One patient on acarbose had asymptomatic elevations in serum transaminases that normalized in 4 weeks after acarbose withdrawal. Another patient on acarbose developed severe hypoglycemia; glycemic control was subsequently maintained on half the baseline dosage of sulfonylurea.

CONCLUSIONS
In NIDDM patients inadequately controlled on conventional oral agents, acarbose in moderate doses resulted in beneficial effects on glycemic control, especially postprandial glycemia, and mean body weight. Additional use of acarbose can be considered as a useful alternative in such patients if they are reluctant to accept insulin therapy.
The Third Version of the Diabetes Attitude Scale
Authors: Anderson Robert M , Fitzgerald James T , Funnell Martha M , Gruppen Larry D 
Published: March 2007

OBJECTIVE
The objective of this study was to develop a third version of the Diabetes Attitude Scale (DAS-3) that is congruent with current scientific knowledge about diabetes, has improved subscale internal reliability scores, and is shorter than the earlier versions of this instrument.

RESEARCH DESIGN AND METHODS
The second DAS was revised and rewritten by a panel of diabetes experts, including patients, associated with the University of Michigan Diabetes Research and Training Center. The revised version of the instrument was sent to physicians, nurses, dietitians, and patients with diabetes. Completed and usable questionnaires were obtained from 384 patients with diabetes, 321 physicians, 540 nurses, and 569 dietitians. The total number of surveys used for these analyses was 1,814.

RESULTS
The study resulted in a revised DAS with 33 items and five discrete subscales. The subscales were attitudes toward the following: 1) need for special training to provide diabetes care, 2) seriousness of type 2 diabetes, 3) value of tight glucose control, 4) pyschosocial impact of diabetes, and 5) attitude toward patient autonomy. Overall, the subscale reliabilities of the DAS-3 were superior to the earlier versions of the scale.

CONCLUSIONS
The DAS-3 is a valid and reliable general measure of diabetes-related attitudes and is most suitable for comparisons across different groups of health care professionals and/or patients. The DAS-3 is also suitable for the evaluation of patient and/or professional education programs if those programs focus on the specific topic areas measured by the five DAS-3 subscales.
Microdialysis of Glucose in Subcutaneous Adipose Tissue up to 3 Weeks in Healthy Volunteers
Authors: Wientjes Klaas J , Vonk Pieter , Vonk-van Klei Yvonne , Schoonen Adelbert JM , Kossen Nico W 
Published: March 2007

OBJECTIVE
To measure possible changes in dialysate glucose concentrations over time, to validate the diffusional model for glucose transport from tissue to the probe, and to evaluate the actual glucose concentration in adipose tissue.

RESEARCH DESIGN AND METHODS
Glucose concentrations in the subcutaneous adipose tissue of five healthy subjects (age 25 ± 2.7 years, BMI 23.2 ± 2.3 kg/m2 [mean ± SD]) were measured by the microdialysis technique and compared with blood glucose. We applied microdialysis probes with hollow fibers of various membrane length (10–35 mm), used eight perfusion flow rates (0.5–20 μl/min), and perfused four glucose solutions (0.0, 2.8, 8.3, 11.1 mmol/l).

RESULTS
After implantation, a substantial decrease in glucose recovery to the lowest value of 26 ± 10% of the final plateau value was noted during the first few hours (n = 4). Recovery increased and stabilized after 5–9 days at 84.0 ± 7.4% of capillary blood glucose when a flow rate of 0.5 μ/min was applied. According to the zero net-flux method, the glucose concentration in equilibrium, Cequi, with the surrounding tissue can be obtained. This concentration also decreases; however, 1 h after recovery, Cequi increases again over 1 or 2 days to a stable value that is not significantly different from the measured capillary blood glucose (P &lt; 0.05). Using various perfusion flow rates and probes (membrane length 10–35 mm), it is shown that diffusion is the rate-limiting process for glucose transport through tissue.

CONCLUSIONS
Insertion of the microdialysis probes causes damage to the adipose cells and the vascular bed around the probe. Glucose recovery decreases because of a lower blood supply. In 5–9 days, glucose recovery increases; apparently, this time is needed to repair the microstructure of tissue around the probe. After stabilization of the recovery, no loss of probe permeability, which is due to biocompatibility problems, was seen. The change during the 2 days in equilibrium concentration is probably caused by an inflammation reaction that consumes glucose around the probe. The individual increase in recovery during the 1st days after probe insertion until a stable plateau value is reached (flow rate &gt;0 μ/min) is complicated for short-term clinical glucose measurements in adipose tissue. After stabilization, the mean equilibrium concentration of all subjects was equal to the mean capillary blood glucose concentration. Therefore, we conclude that capillary blood glucose concentration probably is the driving force for diffusion through the capillary wall into the probe and is not some interstitial concentration.
Insulin and Glucose Excursion Following Premeal Insulin Lispro or Repaglinide in Cystic Fibrosis–Related Diabetes
Authors: Moran Antoinette , Phillips James , Milla Carlos 
Published: March 2007

OBJECTIVE—Insulin and glucose levels in response to premeal insulin lispro or repaglinide were evaluated in adult patients with cystic fibrosis–related diabetes (CFRD) without fasting hyperglycemia.
RESEARCH DESIGN AND METHODS—Seven patients with CFRD were fed 1,000-kcal liquid mixed meals. Three study conditions were administered in random order on separate mornings: 1) no premeal diabetes medication, 2) insulin lispro, 0.1 unit/kg body wt premeal and 3) repaglinide 1 mg premeal. Glucose and insulin levels were measured every 20 min for 5 h.
RESULTS—Fasting insulin and glucose levels were normal in patients with CFRD, but the peak glucose level was elevated. Insulin lispro significantly decreased the peak glucose level (P = 0.0004) and the 2-h (P = 0.001) and 5-h (P &lt; 0.0001) glucose area under the curve (AUC). Repaglinide significantly decreased the 5-h glucose AUC (P = 0.03). Neither drug completely normalized cystic fibrosis glucose excursion at the doses used for this study. Insulin lispro significantly increased the 5-h insulin AUC (P = 0.04).
CONCLUSIONS—In response to subcutaneous insulin lispro, postprandial glucose excursion was significantly diminished and insulin secretion was enhanced compared with a control meal in which no medication was given to patients with CFRD. The oral agent repaglinide resulted in lesser corrections in these parameters. Neither drug completely normalized glucose or insulin levels, suggesting that the doses chosen for this study were suboptimal. Placebo-controlled longitudinal studies comparing the effectiveness of repaglinide and insulin on glucose metabolic control as well as overall nutrition and body weight are needed to help determine optimal medical treatment of CFRD.
The Relationship Among Homocysteine, Creatinine Clearance, and Albuminuria in Patients With Type 2 Diabetes
Authors: Davies Linda , Wilmshurst Errol G. , McElduff Aidan , Gunton Jenny , Clifton-Bligh Phillip , Fulcher Gregory R. 
Published: March 2007

OBJECTIVE—Although it is accepted that elevated plasma homocysteine (tHcy) levels occur in end-stage renal disease and type 2 diabetes, the changes with milder renal dysfunction (e.g., microalbuminuria) are less clearly established. This study explores the relationship among tHcy, creatinine clearance (Ccr), and albumin excretion rate (AER) in a population with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 260 patients with type 2 diabetes were screened in our outpatient clinic during 10 months. Fasting blood samples were collected, and AER was calculated from an overnight timed urine sample. Ccr was calculated using the Cockroft-Gault formula.
RESULTS—A total of 198 subjects (76%) had normoalbuminuria (&lt;20 μg/min), 50 subjects (19%) had microalbuminuria (20–200 μg/min), and 12 subjects (5%) had macroalbuminuria (≥200 μg/min). Those with microalbuminuria had higher levels of tHcy than those with normoalbuminuria (13.2 ± 7.8 vs. 11.3 ± 4.6 μmol/l, P &lt; 0.05). Patients were then subdivided based on low Ccr (&lt;80 ml · min−1 · 1.73 m−2) and normal Ccr (≥80 · min −1 · 1.73 m−2). None of the patients with macroalbuminuria had normal Ccr. In those with normoalbuminuria, tHcy levels were higher than in those with low Ccr than in those with normal Ccr (12.0 ± 4.6 vs. 10.0 ± 4.4 μmol/l, P &lt; 0.01). The same was found for those with microalbuminuria (low Ccr versus normal Ccr: 14.6 ± 9.0 vs. 10.2 ± 2.8 μmol/l, P &lt; 0.02). For normal Ccr, tHcy was similar irrespective of AER (normoalbuminuria versus microalbuminuria: 10.0 ± 4.4 vs. 10.2 ± 2.8 μmol/l, NS). For low Ccr, tHcy was higher in those with microalbuminuria versus normoalbuminuria (14.6 ± 9.0 vs. 12.0 ± 4.6 μmol/l, P = 0.01). Using multivariate regression, Ccr, but neither AER nor the presence of albuminuria, was an independent predictor of tHcy.
CONCLUSIONS—These data strongly suggest that in patients with type 2 diabetes, the relationship between plasma tHcy and AER is largely due to associated changes in renal function, as defined by Ccr.
Changes in BMI and Weight Before and After the Development of Type 2 Diabetes
Authors: Looker Helen C. , Knowler William C. , Hanson Robert L. 
Published: March 2007

OBJECTIVE—To examine weight changes occurring before and after the diagnosis of diabetes and the association of these changes with treatment and microvascular complications.
RESEARCH DESIGN AND METHODS—We undertook an analysis of serial examinations conducted between 1965 and 2000 in residents of the Gila River Community in Central Arizona. Data were taken from 4,226 examinations of 816 individuals in whom diabetes developed over the course of a longitudinal study and who had undergone a nondiabetic examination within 4 years preceding diagnosis. We measured changes in BMI between examinations.
RESULTS—Before diagnosis of diabetes, there were steady gains in weight: mean BMI climbed between 0.43 and 0.71 kg/m2 per year. After diagnosis, the weight gain declined, and weight loss was generally seen; the mean rate of change of BMI ranged between −0.61 and +0.22 kg/m2 per year. When current treatment was considered, there was greater weight stability in individuals taking insulin compared with those not taking hypoglycemic medication. Medication was a statistically significant factor for change in weight for most of the time intervals analyzed. There was no statistically significant association with retinopathy or nephropathy.
CONCLUSIONS—Before development of diabetes, there was a progressive rise in weight, and after diagnosis, there was a tendency toward weight loss. Weight-loss interventions in individuals with diabetes will need to account for this tendency if they are to successfully modify the course of the disease.