bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dietary Fat and Meat Intake in Relation to Risk of Type 2 Diabetes in Men
Authors: van Dam Rob M. , Willett Walter C. , Rimm Eric B. , Stampfer Meir J. , Hu Frank B. 
Published: March 2007

OBJECTIVE—To examine dietary fat and meat intake in relation to risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We prospectively followed 42,504 male participants of the Health Professionals Follow-Up Study who were aged 40–75 years and free of diagnosed diabetes, cardiovascular disease, and cancer in 1986. Diet was assessed by a validated food frequency questionnaire and updated in 1990 and 1994. During 12 years of follow-up, we ascertained 1,321 incident cases of type 2 diabetes.
RESULTS—Intakes of total fat (multivariate RR for extreme quintiles 1.27, CI 1.04–1.55, P for trend=0.02) and saturated fat (1.34, 1.09–1.66, P for trend=0.01) were associated with a higher risk of type 2 diabetes. However, these associations disappeared after additional adjustment for BMI (total fat RR 0.97, CI 0.79–1.18; saturated fat 0.97, 0.79–1.20). Intakes of oleic acid, trans-fat, long-chain n-3 fat, and α-linolenic acid were not associated with diabetes risk after multivariate adjustment. Linoleic acid was associated with a lower risk of type 2 diabetes in men &lt;65 years of age (RR 0.74, CI 0.60–0.92, P for trend=0.01) and in men with a BMI &lt;25 kg/m2 (0.53, 0.33–0.85, P for trend=0.006) but not in older and obese men. Frequent consumption of processed meat was associated with a higher risk for type 2 diabetes (RR 1.46, CI 1.14–1.86 for ≥5/week vs. &lt;1/month, P for trend &lt;0.0001).
CONCLUSIONS—Total and saturated fat intake were associated with a higher risk of type 2 diabetes, but these associations were not independent of BMI. Frequent consumption of processed meats may increase risk of type 2 diabetes.
Intensive Lifestyle Changes Are Necessary to Improve Insulin Sensitivity
Authors: McAuley Kirsten A. , Williams Sheila M. , Mann Jim I. , Goulding Ailsa , Chisholm Alex , Wilson Noela , Story Gretchen , McLay Rebecca T. , Harper Michelle J. , Jones Ianthe E. 
Published: March 2007

OBJECTIVE—The extent to which lifestyle must be altered to improve insulin sensitivity has not been established. This study compares the effect on insulin sensitivity of current dietary and exercise recommendations with a more intensive intervention in normoglycemic insulin-resistant individuals.
RESEARCH DESIGN AND METHODS—Seventy-nine normoglycemic insulin-resistant (determined by the euglycemic insulin clamp) men and women were randomized to either a control group or one of two combined dietary and exercise programs. One group (modest level) was based on current recommendations and the other on a more intensive dietary and exercise program. Insulin sensitivity was measured using a euglycemic insulin clamp, body composition was measured using dual-energy X-ray absorptiometry, and anthropometry and aerobic fitness were assessed before and after a 4-month intervention period. Four-day dietary intakes were recorded, and fasting glucose, insulin, and lipids were measured.
RESULTS—Only the intensive group showed a significant improvement in insulin sensitivity (23% increase, P=0.006 vs. 9% in the modest group, P=0.23). This was associated with a significant improvement in aerobic fitness (11% increase in the intensive group, P=0.02 vs. 1% in the modest group, P=0.94) and a greater fiber intake, but no difference in reported total or saturated dietary fat.
CONCLUSIONS—Current clinical dietary and exercise recommendations, even when vigorously implemented, did not significantly improve insulin sensitivity; however, a more intensive program did. Improved aerobic fitness appeared to be the major difference between the two intervention groups, although weight loss and diet composition may have also played an important role in determining insulin sensitivity.
Health-Related Quality of Life and Treatment Satisfaction in Dutch Patients With Type 2 Diabetes
Authors: Redekop W. Ken , Koopmanschap Marc A. , Stolk Ronald P. , Rutten Guy E.H.M. , Wolffenbuttel Bruce H.R. , Niessen Louis W. 
Published: March 2007

OBJECTIVE— To estimate the health-related quality of life (HRQOL) and treatment satisfaction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associated with quality of life and treatment satisfaction.
RESEARCH DESIGN AND METHODS—For a sample of 1,348 type 2 diabetes patients, recruited by 29 general practitioners, we collected data regarding HRQOL. This study was performed as part of a larger European study (Cost of Diabetes in Europe - Type 2 [CODE-2]). We used a generic instrument (Euroqol 5D) to measure HRQOL. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire.
RESULTS—Patients without complications had an HRQOL (0.74) only slightly lower than similarly aged persons in the general population. Insulin therapy, obesity, and complications were associated with a lower HRQOL, independent of age and sex. Although higher fasting blood glucose and HbA1c levels were negatively associated with HRQOL, these factors were not significant after adjustment for other factors using multivariate analysis. Overall treatment satisfaction was very high. Younger patients, patients using insulin, and patients with higher HbA1c levels were less satisfied with the treatment than other patients.
CONCLUSIONS—Obesity and the presence of complications are important determinants of HRQOL in patients with type 2 diabetes.
Diabetes-Related Morbidity and Mortality in a National Sample of U.S. Elders
Authors: Bertoni Alain G. , Krop Julie S. , Anderson Gerard F. , Brancati Frederick L. 
Published: March 2007

OBJECTIVE—Although the number of elders with diabetes has increased dramatically, there are few data on rates of mortality and serious complications in older populations with diabetes. To determine such rates, we conducted a population-based, nonconcurrent cohort study using claims data from the 1994–1996 Medicare 5% Standard Analytical File.
RESEARCH DESIGN AND METHODS—Codes from the ICD-9 were used to identify diabetes and the following complications: amputation, lower extremity infection, gangrene, blindness, acute myocardial infarction, ischemic heart disease, stroke, and metabolic disorders. Using these codes, we assembled a cohort of 148,562 Medicare Part A and B beneficiaries who were ≥65 years of age, who were alive on 1 January 1995, who were not in managed care in 1994, and who had a diabetes-related claim in 1994. Age-specific rates of death and complications were then calculated.
RESULTS—During 24 months of follow-up, 22,044 (14.8%) elders with diabetes died. Death rates in men and women increased significantly with age. Compared with their counterparts in the general U.S. population, elders with diabetes suffered excess mortality at every age group, corresponding to an overall standardized mortality ratio of 1.41 (95% CI 1.39,1.43). The incidence of ischemic heart disease and stroke was 181.5 and 126.2 per 1,000 person-years, respectively, which was higher than the incidence of all other diabetes-related complications.
CONCLUSIONS—In every age group, elders with diabetes have significantly higher all-cause mortality rates than the general population. Medicare data may be useful in monitoring trends in diabetes-related morbidity and total mortality in U.S. elders with diabetes.
Lifetime Costs of Complications Resulting From Type 2 Diabetes in the U.S.
Authors: Caro J. Jaime , Ward Alexandra J. , O’Brien Judith A. 
Published: March 2007

OBJECTIVE—To model the lifetime costs associated with complications of type 2 diabetes.
RESEARCH DESIGN AND METHODS—A cohort of 10,000 patients with diabetes was simulated using a model based on existing epidemiological studies. Complication rates were estimated for various stages of macrovascular disease, nephropathy, retinopathy, neuropathy, and hypoglycemia. At the beginning of the simulation, patients were assumed to have been treated for 5 years and have a mean HbA1c of 8.4. From the U.K. Prospective Diabetes Study, it was estimated that on current therapies, the HbA1c would drift upward on average 0.15% per year. Direct medical costs of managing each complication were estimated (in 2000 U.S. dollars) from all-payor databases, surveys, and literature.
RESULTS—Macrovascular disease was estimated to be the largest cost component, accounting for 85% of cumulative costs of complications over the first 5 years. The costs of complications were estimated to be $47,240 per patient over 30 years, on average. The management of macrovascular disease is estimated to be the largest cost component, accounting for 52% of the costs; nephropathy accounts for 21%, neuropathy accounts for 17%, and retinopathy accounts for 10% of the costs of complications.
CONCLUSIONS—The complications of diabetes account for substantial costs, with management of macrovascular disease being the largest and earliest. If improving glycemic control prevents complications, it will reduce these costs.
The Effect of Estrogen Use on Levels of Glucose and Insulin and the Risk of Type 2 Diabetes in American Indian Postmenopausal Women
Authors: Zhang Ying , Howard Barbara V. , Cowan Linda D. , Yeh Jeunliang , Schaefer Carl F. , Wild Robert A. , Wang Wenyu , Lee Elisa T. 
Published: March 2007

OBJECTIVE—To examine the associations between estrogen use and levels of insulin and glucose as well as the effect of estrogen use on the risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS—This report is based on 857 women who were both nondiabetic and postmenopausal at the baseline examination (1989–1992) and who completed a second examination (1993–1995) an average of 4 years later. The participants were divided into three groups: never, past, and current users based on their baseline estrogen use status. ANCOVA was used to compare the insulin and glucose levels among estrogen use groups. Logistic regression was used to evaluate the association between estrogen use and the incidence of type 2 diabetes.
RESULTS—Postmenopausal estrogen use was associated with lower fasting glucose (0.2 mmol/l lower) but higher 2-h glucose levels (0.4 mmol/l higher) compared with never users. It was not significantly associated with the risk of type 2 diabetes compared with past and never users, based on American Diabetes Association or World Health Organization definitions of diabetes or on only a 2-h glucose level ≥11.1 mmol/l. However, the risk of type 2 diabetes increased with increasing duration of estrogen use among current users, with an odds ratio of 1.10 per year of use (95% CI: 1.01–1.19).
CONCLUSIONS—The data suggest that estrogen use in American Indian postmenopausal women may relate to deterioration of glucose tolerance. Longer duration of estrogen use among current users may relate to an increased risk of type 2 diabetes.
Successful Prospective Prediction of Type 1 Diabetes in Schoolchildren Through Multiple Defined Autoantibodies
Authors: LaGasse James M. , Brantley Michael S. , Leech Nicola J. , Rowe Rachel E. , Monks Stephanie , Palmer Jerry P. , Nepom Gerald T. , McCulloch David K. , Hagopian William A. 
Published: March 2007

OBJECTIVE—Almost 90% of type 1 diabetes appears in individuals without a close family history. We sought to evaluate the best current predictive strategy, multiple defined autoantibodies, in a long-term prospective study in the general population.RESEARCH DESIGN AND METHODS—Autoantibodies to pancreatic islets (islet cell antibodies [ICAs]) and defined autoantibodies (d-aab) to human GAD, IA2/ICA512, and insulin were tested in 4,505 Washington schoolchildren. Eight years later, 3,000 (67%) subjects were recontacted, including 97% of subjects with any test &gt;99th percentile.RESULTS—Six subjects developed diabetes (median interval 2.8 years), all from among the 12 individuals with multiple d-aab, representing 50% positive predictive value (95% CI 25–75%) and 100% sensitivity (58–100%). Among the others, diabetes occurred in 0 of 6 with one d-aab plus ICA, 0 of 26 with ICA only, 0 of 7 with one d-aab equaling the 99th percentile and another d-aab equaling the 97.5th percentile, 0 of 86 with one d-aab, and 0 of 2,863 with no d-aab or ICA. Adjusted for verification bias, multiple d-aab were 99.9% specific (99.86–99.93%). At this age, new d-aab seldom appeared. Once present, d-aab usually persisted regardless of disease progression, although less so for insulin autoantibodies. Insulin secretion by sequential glucose tolerance testing remained normal in four multiple d-aab subjects not developing diabetes. Of children developing diabetes, five of six (83%) would be included if HLA-DQ genotyping preceded antibody testing, but HLA-DQ did not explain outcomes among high-risk subjects, even when considered along with other genetic markers.CONCLUSIONS—Multiple d-aab were established by age 14 years and prospectively identified all schoolchildren who developed type 1 diabetes within 8 years.
Energy Metabolism in Diabetic and Nondiabetic Heart Transplant Recipients
Authors: Benedini Stefano , Fiocchi Roberto , Battezzati Alberto , Scifo Paola , Sereni Lucia Piceni , Gamba Amando , Mammana Carmelo , Del Maschio Alessandro , Perseghin Gianluca , Luzi Livio 
Published: March 2007

OBJECTIVE—This study examined the metabolic effects of heart transplantation in patients in end-stage cardiac failure.
RESEARCH DESIGN AND METHODS—A total of 18 patients after heart transplantation for end-stage heart disease (age 47± 3 years; transplant age 5.5± 1.5 years; BMI 25.8± 0.8 kg/m2; cyclosporin A 4.2 ±0.6 mg/[kg·day]; azathioprine 0.87± 0.31 mg/[kg·day]), 12 patients with type 2 diabetes (D-Tx), and 6 patients without type 2 diabetes (Tx) were studied by means of 1) an oral glucose tolerance test (OGTT) to assess the β-cell secretory response, 2) a euglycemic-hyperinsulinemic (1 mU/[kg·min]) clamp combined with indirect calorimetry and a primed continuous infusion of [6,6-2H2]glucose and [1-13C]leucine to measure postabsorptive and insulin-stimulated carbohydrate and protein metabolism, and 3) 1H-NMR spectroscopy of the calf muscles to measure intramyocellular triglyceride (IMCL) content. The patients were selected from 480 transplant patients in whom there was a 6% prevalence of type 2 diabetes. Five healthy subjects matched for anthropometric parameters served as control subjects (CON).
RESULTS—Tx had postabsorptive and insulin-stimulated glucose, leucine, and free fatty acid metabolism, as well as IMCL content, similar to that of CON. D-Tx were characterized by a reduced secretory response during the OGTT and peripheral insulin resistance with respect to glucose metabolism, which was paralleled by increased plasma free fatty acid concentrations and IMCL content. A defective insulin-dependent suppression of the endogenous leucine flux (index of proteolysis) was also evident during the clamp in D-Tx.
CONCLUSIONS—Heart transplantation, notwithstanding the immunosuppressive therapy, was characterized by a normal postabsorptive and insulin-stimulated glucose, leucine, and free fatty acid metabolism in Tx. In contrast, insulin resistance with respect to glucose, free fatty acids, and protein metabolism was present in D-Tx regardless of whether diabetes was preexisting or consequent to heart transplantation.
Abnormal Carbohydrate Metabolism During Pregnancy
Authors: Paradisi Giancarlo , Biaggi Arabella , Ferrazzani Sergio , De Carolis Sara , Caruso Alessandro 
Published: March 2007

OBJECTIVE—To evaluate whether abnormal endothelial function, a common finding in premenopausal women with type 2 diabetes, is present in early states of diabetes during pregnancy, such as impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM).
RESEARCH DESIGN AND METHODS—Brachial artery flow-mediated dilatation (FMD) (endothelium-dependent) and nitrate-induced dilatation (NID) (endothelium-independent) were measured in 23 pregnant subjects with carbohydrate abnormalities (10 IGT, 13 GDM) and in 15 pregnant control subjects during the third trimester of gestation. High-resolution vascular ultrasonography was used to perform these investigations. A fasting lipid panel was obtained, and glucose and insulin values in response to a 100-g oral glucose load were also measured.
RESULTS—FMD was significantly reduced in both groups of women with abnormal carbohydrate metabolism compared with control subjects (7.6 ±1.1% in the IGT group and 4.1 ±0.9% in the GDM group vs. 10.9 ±1.1% in control subjects, P &lt; 0.04 and P &lt; 0.0001, respectively). Significant difference in FMD was also observed between IGT and GDM groups (P &lt; 0.04). NID was comparable in the three groups. Among all subjects, FMD showed a strong independent negative correlation with glycemic area (r=−0.60, P &lt; 0.0001).
CONCLUSIONS—Endothelial dysfunction, an early marker of macrovascular disease, is present in pregnancies complicated by IGT and GDM. This alteration, which seems to be directly related to glycemic levels, could explain, at least in part, the increased risk for concurrent hypertensive disorders during pregnancy in these women.
Effect of Diabetes on Renal Medullary Oxygenation During Water Diuresis
Authors: Epstein Franklin H. , Veves Aristidis , Prasad Pottumarthi V. 
Published: March 2007

OBJECTIVES—To study the effect of water diuresis on renal medullary and cortical oxygenation in patients with diabetes using blood oxygenation level–dependent magnetic resonance imaging (BOLD MRI).
RESEARCH DESIGN AND METHODS—Nine mild diabetic subjects (48 ±2.7 years of age, six women) and nine nondiabetic subjects of similar age and sex, all without known vascular or renal disease, were studied noninvasively by MRI before and during water diuresis.
RESULTS—Water diuresis induced an increase in medullary oxygenation in control subjects, producing a decrease in R2* (apparent spin-spin relaxation time) of 1.89 ±0.27 (P &lt; 0.01), but no significant change in the group of diabetic subjects.
CONCLUSIONS—These findings in middle-aged diabetic subjects, which resembled those previously described in elderly subjects &gt;65 years of age, suggest early impairment of adaptive vasodilatation within the renal medulla in diabetes.
Hypertriglyceridemic HyperapoB in Type 2 Diabetes
Authors: Sniderman Allan D. , Lamarche Benoit , Tilley Jessica , Seccombe David , Frohlich Jiri 
Published: March 2007

OBJECTIVES—Much less attention has been paid to LDL in type 2 diabetes than to VLDL or HDL. In particular, there are few data on apoB levels in these patients. Moreover, most reports have focused on mean lipoprotein levels and consequently there is little information on the frequencies of the various dyslipidemic phenotypes.
RESEARCH DESIGN AND METHODS—Plasma and lipoprotein lipids, apoB and apoA1 were measured by standardized methods. LDL particle size was determined by PAGE. The total cohort was divided into phenotypes by two different methods. The first was based on triglycerides (≥ or &lt;1.5 mmol/l) and LDL cholesterol (≥ or &lt;4 mmol/l), whereas the second was based on triglycerides (≥ or &lt;1.5 mmol/l) and apoB (≥ or &lt;120 mg/dl).
RESULTS—For the overall cohort, plasma triglycerides were elevated (2.13 ±1.6 mmol/l), total and LDL cholesterol were normal (5.34 ±1.1 and 3.28 ±0.88 mmol/l, respectively), and peak LDL size was reduced (252.9 ±5.8 Å). HDL cholesterol was between the 25th and 50th percentiles of the general population (1.12 ±0.36 mmol/l). The average level of apoB was 114 ±29 mg/dl, a value that is between the 50th and 75th percentiles of the general population and is higher than that for LDL cholesterol, which was between the 25th and the 50th percentiles of the population. The results of the phenotyping analysis were as follows. Using the conventional approach, only 23% has abnormal LDL, i.e., an elevated LDL cholesterol level. Using the new approach, almost 40% has an elevated apoB and therefore an elevated LDL particle number. Only 12.8% has combined hyperlipidemia based on the conventional approach, whereas almost one-third had the equivalent, hypertriglyceridemic hyperapoB-based on the new algorithm. The severity of the dyslipoproteinemia in this group was noteworthy. Although the average LDL cholesterol was 3.91 mmol/l, a value just below the 75th percentile of the general population, the average apoB was 145 mg/dl, a value that approximates the 95th percentile of the population.
CONCLUSIONS—The dyslipidemic profile of patients with type 2 diabetes is not uniform. A substantial group have normal lipids and normal LDL particle number and size whereas others have markedly abnormal profiles. Diagnosis based on triglycerides and apoB rather than triglycerides and LDL cholesterol revealed that more than one in five had hypertriglyceridemic hyperapoB, which is characterized by hypertriglyceridemia, marked elevation of LDL particle number, small dense LDL, and low HDL, a constellation of abnormalities that is associated with markedly accelerated atherogenesis and therefore justifies intensive medical therapy.
A Randomized Study and Open-Label Extension Evaluating the Long-Term Efficacy of Pramlintide as an Adjunct to Insulin Therapy in Type 1 Diabetes
Authors: Whitehouse Fred , Kruger Davida F. , Fineman Mark , Shen Larry , Ruggles James A. , Maggs David G. , Weyer Christian , Kolterman Orville G. 
Published: March 2007

OBJECTIVE—To assess the effect of mealtime amylin replacement with pramlintide on long-term glycemic and weight control in patients with type 1 diabetes.
RESEARCH DESIGN AND METHODS—In a 52-week, double-blind, placebo-controlled, multicenter study, 480 patients with type 1 diabetes were randomized to receive preprandial injections of placebo or 30 μg pramlintide q.i.d., in addition to existing insulin regimens. At week 20, pramlintide-treated patients were re-randomized to 30 or 60 μg pramlintide q.i.d. if decreases from baseline in HbA1c were &lt;1% at week 13. Of the 342 patients who completed the 52-week study, 236 individuals (∼70%) elected to participate in a 1-year open-label extension in which all patients received 30 or 60 μg pramlintide q.i.d..
RESULTS—Treatment with pramlintide led to a mean reduction in HbA1c of 0.67% from baseline to week 13 that was significantly (P &lt; 0.0001) greater than the placebo reduction (0.16%), and a significant placebo-corrected treatment difference was sustained through week 52 (P = 0.0071). The greater HbA1c reduction was associated with an average weight loss, rather than weight gain, and was not accompanied by an increased overall event rate of severe hypoglycemia. In the open-label extension, mean HbA1c levels decreased rapidly in patients receiving pramlintide for the first time and remained at reduced levels in patients who continued pramlintide treatment. The most common adverse events reported by the pramlintide group were mild nausea and anorexia, which both occurred during the initial weeks of treatment and dissipated over time.
CONCLUSIONS—Mealtime pramlintide treatment as an adjunct to insulin improved long-term glycemic control without inducing weight gain or increasing the overall risk of severe hypoglycemia in patients with type 1 diabetes.