bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathogenetic Mechanisms of Impaired Glucose Tolerance and Type II Diabetes in African-Americans: The significance of insulin secretion, insulin sensitivity, and glucose effectiveness
Authors: Osei Kwame , Gaillard Trudy , Schuster Dara P 
Published: March 2007

OBJECTIVE
To examine the significance of alterations in insulin sensitivity index (S1), glucose effectiveness (Sg), and β-cell function in the pathogenesis of type II diabetes in African-Americans with varying degrees of glucose intolerance.

RESEARCH DESIGN AND METHODS
A total of 154 African-Americans residing in Franklin County, Ohio, were studied. There were 101 subjects with normal glucose tolerance (NGT), 36 with impaired glucose tolerance (IGT), and 17 with type II diabetes. An oral glucose tolerance test (OGTT) was performed on each subject. S1 and Sg were measured by insulin-modified, frequently sampled intravenous glucose tolerance test (FSIGT).

RESULTS
The mean fasting and postprandial serum glucose levels were significantly greater in the diabetic groups when compared with the IGT and NGT groups. In contrast, while fasting serum insulin and C-peptide levels tended to be greater in the type II diabetic and IGT groups, the postprandial responses were blunted at 30 min in the IGT and type II diabetic groups when compared with the NGT group. The mean acute first-phase insulin release after intravenous glucose was blunted also in the IGT and type II diabetic groups when compared with the NGT group. The S1 was significantly lower in the IGT (1.51 ± 0.19) and type II diabetic (0.61 ± 0.15) groups when compared with the NGT group (2.94 ± 0.20 × 10−4 · min−1 · μU−1 · ml−1). The Sg was not significantly different in the NGT (2.90 ± 0.20), IGT (2.47 ± 0.19), and the type II diabetic (2.35 ± 0.15 × 10−2/min) groups. The glucose effectiveness at theoretical zero insulin concentration (GEZI) followed similar patterns as the Sg. Furthermore, the basal insulin effect (BIE) was significantly lower in the IGT and type II diabetic groups compared with the NGT group. In addition, the glucose decay constant (Kg) was significantly lower (P &lt; 0.001) in the IGT (1.21 ± 0.13) and the type II diabetic (1.07 ± 0.12) groups when compared with the NGT group (2.03 ± 0.10% per minute).

CONCLUSIONS
Our present study demonstrates that African-American patients with IGT and mild type II diabetes have significant reduction in β-cell function, insulin sensitivity, and BEI but have normal and intact Sg and GEZI when compared with NGT subjects. We conclude the following: 1) a reduction in Sg does not appear to play a significant role in the pathogenetic mechanism of IGT and type II diabetes in African-American patients, and 2) the intact Sg in the IGT and type II diabetic groups could serve as a compensatory mechanism for hyperglycemia in African-Americans.
Personal-Model Beliefs and Social-Environmental Barriers Related to Diabetes Self-Management
Authors: Glasgow Russell E , Hampson Sarah E , Strycker Lisa A , Ruggiero Laurie 
Published: March 2007

OBJECTIVE
The specific aims of the present study were to report on the level of personal beliefs and social and environmental barriers across different regimen areas and patient subgroups and on the relationship of personal models and perceived barriers to the level of self-management.

RESEARCH DESIGN AND METHODS
This study focused on several issues related to personal models (representations of illness) and perceived barriers to diabetes self-management among a large heterogeneous survey sample of 2,056 adults throughout the U.S.

RESULTS
Respondents felt that diabetes was a serious disease and that their self-management activities will control their diabetes and reduce the likelihood of long-term complications. Most frequently reported barriers were related to dietary adherence, followed by exercise and glucose testing barriers. Both personal models and barriers significantly predicted level of self-management in all three regimen areas studied (diet, exercise, and glucose testing) after controlling for the influence of demographic and medical history factors. Regimen-specific models and barriers proved to be stronger predictors than more global measures. Differences on personal models and barriers were observed among different patient groups (e.g., age, health insurance, and insulin-taking status). Possible reasons for these differences and implications for intervention and future research are discussed.

CONCLUSIONS
Both the personal-model and barriers scales had good internal consistency and predicted variance in each of the self-management variables after controlling for demographic and medical history factors. These brief self-report personal-model scales demonstrated good internal reliability and were as predictive of self-management as the lengthier interview-based measures in previous studies. The assessment of the treatment effectiveness component of personal models may be sufficient for most clinical purposes.
Efficacy, Safety, and Dose-Response Characteristics of Glipizide Gastrointestinal Therapeutic System on Glycemic Control and Insulin Secretion in NIDDM: Results of two multicenter, randomized, placebo-controlled clinical trials
Authors: Simonson Donald C , Kourides Ione A , Feinglos Mark , Shamoon Harry , Fischette Christine T ,   The Glipizide Gastrointestinal Therapeutic System Study Group
Published: March 2007

OBJECTIVE
To investigate the efficacy, safety, and dose-response characteristics of an extended-release preparation of glipizide using the gastrointestinal therapeutic system (GITS) on plasma glucose, glycosylated hemoglobin (HbA1c), and insulin secretion to a liquid-mixed meal in NIDDM patients.

RESEARCH DESIGN AND METHODS
Two prospective, randomized, double-blind, placebo-controlled, multicenter clinical trials were performed in 22 sites and 347 patients with NIDDM (aged 59 ± 0.6 years; BMI, 29 ± 0.3 kg/m2; known diabetes duration, 8 ± 0.4 years) were studied. Each clinical trial had a duration of 16 weeks with a 1-week washout, 3-week single-blind placebo phase, 4-week titration to a fixed dose, and 8-week maintenance phase at the assigned dose. In the first trial, once-daily doses of 5, 20, 40, or 60 mg glipizide GITS were compared with placebo in 143 patients. In the second trial, doses of 5, 10, 15, or 20 mg of glipizide GITS were compared with placebo in 204 patients. HbA1c, fasting plasma glucose (FPG), insulin, C-peptide, and glipizide levels were determined at regular intervals throughout the study. Postprandial plasma glucose (PPG), insulin, and C-peptide also were determined at 1 and 2 h after a mixed meal (Sustacal).

RESULTS
All doses of glipizide GITS in both trials produced significant reductions from placebo in FPG (range −57 to −74 mg/dl) and HbA1c (range −1.50 to −1.82%). Pharmacodynamic analysis indicated a significant relationship between plasma glipizide concentration and reduction in FPG and HbA1c over a dose range of 5–60 mg, with maximal efficacy achieved at a dose of 20 mg for FPG and at 5 mg for HbA1c. PPG levels were significantly lower, and both postprandial insulin and C-peptide levels significantly higher in patients treated with glipizide GITS compared with placebo. The percent reduction in FPG was comparable across patients with diverse demographic and clinical characteristics, including those with entry FPG ≥ 250 mg/dl, resulting in greater absolute decreases in FPG and HbA1c in patients with the most severe hyperglycemia. Despite the forced titration to a randomly assigned dose, only 11 patients in both studies discontinued therapy because of hypoglycemia. Glipizide GITS did not alter lipids levels or produce weight gain.

CONCLUSIONS
The once-daily glipizide GITS 1) lowered HbA1c, FPG, and PPG over a dose range of 5–60 mg, 2) was maximally effective at 5 mg (using HbA1c) or 20 mg (using FPG) based on pharmacokinetic and pharmacodynamic relationships, 3) maintained its effectiveness in poorly controlled patients (those with entry FPG ≥ 250 mg/dl), 4) was safe and well tolerated in a wide variety of patients with NIDDM, and 5) did not produce weight gain or adversely affect lipids.
Utility of Untimed Urinary Albumin Measurements in Assessing Albuminuria in Black NIDDM Subjects
Authors: Chaiken Rochelle L , Khawaja Raheela , Bard Mara , Eckert-Norton Margaret , Banerji Mary Ann , Lebovitz Harold E 
Published: March 2007

OBJECTIVE
To determine the usefulness of an untimed morning urine specimen in screening a black NIDDM population attending an urban diabetes clinic for microalbuminuria.

RESEARCH DESIGN AND METHODS
Untimed morning specimens were provided by 218 black NIDDM subjects. Of the 218 subjects, 123 also provided 24-h urine specimens. The 24-h specimens were assayed for albumin excretion rate (AER) in milligrams per 24 h, and the albumin-to-creatinine ratio (A-to-C) in micrograms per milligram was determined on the untimed morning urine specimen.

RESULTS
Correlation between the A-to-C ratio and the 24-h AER was 0.96 (P = 0.0001). In the range of clinical proteinuria, r was 0.92 (P = 0.003, n = 7). In the range of microalbuminuria, r was 0.55 (P = 0.005, n = 26), and in the normal range, r was 0.59 (P ≤ 0.0001, n = 90). Analysis of the untimed urine specimens from 218 black NIDDM subjects showed that 171 had A-to-C &lt; 30 μg/mg, 38 had A-to-C 30–300 μg/mg, and 9 had A-to-C &gt; 300 μg/mg. Data were grouped according to duration of NIDDM and the presence or absence of hypertension. None of the newly diagnosed NIDDM patients (&lt; 1 year) (n = 40) had microalbuminuria. The frequency of microalbuminuria and clinical proteinuria increased with 1) duration of NIDDM 5–10 years (odds ratio [OR], 3.39; 95% CI 1.17–9.82),2) duration of NIDDM &gt; 10 years (OR, 11.03; 95% CI 4.16–29.25), and 3) presence of hypertension (OR, 2.59; 95% CI I.20–5.61).

CONCLUSIONS
The A-to-C ratio obtained from an untimed morning urine specimen correlates with the AER from a 24-h collection. In black subjects with newly diagnosed NIDDM, microalbuminuria is not present to a significant degree. Duration of NIDDM &gt; 5 years is associated with increased prevalence of microalbuminuria, and hypertension is associated with microalbuminuria and clinical proteinuria in this population.
Gastric Myoelectrical Activity in Patients With Diabetes: Role of glucose control and autonomic nerve function
Authors: Kawagishi Takahiko , Nishizawa Yoshiki , Emoto Masanori , Maekawa Kiyoshi , Okuno Yasuhisa , Taniwaki Hiromichi , Inaba Masaaki , Ishimura Eiji , Morii Hirotoshi 
Published: March 2007

OBJECTIVE
Gastric myoelectrical activity was studied in diabetic patients using electrogastrography (EGG) to elucidate the relationship between glucose control, diabetic autonomic neuropathy (AN), and gastrointestinal motility.

RESEARCH DESIGN AND METHODS
Cutaneous EGG was recorded during 1 h of fasting and 1 h after the ingestion of a standard meal in 57 diabetic patients and 10 healthy subjects. EGG was measured in 12 diabetic patients after glycemic control for 4 weeks. Diabetic patients were also studied with respect to the presence of gastrointestinal symptoms and AN.

RESULTS
The percentage of dominant electrical frequency (DF) in normal range (the percentage ratio between the power at 2.4–3.6 cycles/min [cpm] and at 1–10 cpm) was significantly lower in patients with AN than in either the control subjects or the patients without AN (P &lt; 0.01). The dominant frequency instability coefficient (DFIC) was significantly higher in patients with and without AN than in the control subjects (P &lt; 0.01). The postprandial-to-fasting power ratio (PR) was the lowest in patients with AN (P &lt; 0.01). Multiple regression analysis revealed that HbA1c levels were independently associated with the DFIC (R2 = 0.099, P = 0.0170) and that AN and HbA1c levels were independently associated with the PR (R2 = 0.378, P &lt; 0.0001) in diabetic patients. The percentage of normal DF increased and the DFIC decreased significantly after glycemic control in 12 diabetic patients (P = 0.0409; P = 0.0096, respectively).

CONCLUSIONS
There appears to be an association between improvement in gastric myoelectrical activity and autonomic nerve function. Abnormalities of gastric myoelectrical activity may be partly ameliorated via the improvement of autonomic nerve function, which accompanies glycemic control.
White Coat Hypertension in NIDDM Patients With and Without Incipient and Overt Diabetic Nephropathy
Authors: Nielsen Flemming S , Gæde Pernille , Vedel Pernille , Pedersen Oluf , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE
Early data have suggested a high prevalence of white coat hypertension (∼ 50%) in NIDDM patients. To study this phenomenon further, we determined the prevalence of white coat hypertension in NIDDM patients with normo- or microalbuminuria or with diabetic nephropathy.

RESEARCH DESIGN AND METHODS
Three groups of hypertensive NIDDM patients (repeated clinic blood pressure &gt; 140/90 mmHg or antihypertensive treatment) attending the Steno Diabetes Center were investigated in a cross-sectional study. Group 1 had normoalbuminuria (a urinary albumin excretion [UAE] rate &lt; 30 mg/24 h, n = 30, age 61 ± 7 [mean ± SD] years, 20 men), group 2 had microalbuminuria (UAE rate 30–300 mg/24 h, n = 51, age 55 ± 7 years, 35 men), and group 3 had diabetic nephropathy (UAE rate &gt; 300 mg/24h, n = 47, 62 ± 7 years, 36 men). If given, all previous antihypertensive medication was withdrawn at least 2 weeks before the study (48%). The prevalence of white coat hypertension (clinic hypertension with normal blood pressure values at home) was determined by comparison of clinic blood pressure (Hawksley Random sphygmomanometer) and the ambulatory daytime (7:00 A.M. to 11:00 P.M.) blood pressure (A&D TM2420). By applying established criteria, white coat hypertension was confirmed if daytime blood pressure was &lt; 135/85 mmHg.

RESULTS
The clinic blood pressure was 155/86 (SE 3/2) mmHg, 156/89 (2/1) mmHg, and 171/90 (3/2) mmHg in group 1, 2, and 3, respectively (P &lt; 0.05 comparing group 3 with groups 1 and 2). The prevalence of white coat hypertension was significantly higher in group 1 as compared with groups 2 and 3, 23% (95% CI 10–42) vs. 8% (2–19) and 9% (2–20) (P &lt; 0.05), with no difference between the latter two groups.

CONCLUSIONS
The prevalence of white coat hypertension in normoalbuminuric NIDDM patients resembles that observed in nondiabetic subjects with essential hypertension, whereas the prevalence is significantly lower in NIDDM patients with incipient or overt diabetic nephropathy, suggesting a difference between primary and secondary hypertension.
Deficient Counterregulation: A Possible Risk Factor for Excessive Fetal Growth in IDDM Pregnancies
Authors: Rosenn Barak M , Miodovnik Menachem , Khoury Jane C , Siddiqi Tariq A 
Published: March 2007

OBJECTIVE
The rate of macrosomia in infants born to women with IDDM remains high despite intensive insulin therapy and good glycemic control. We hypothesized that one of the factors contributing to this high rate of macrosomia is deficient counterregulatory hormonal responses to hypoglycemia.

RESEARCH DESIGN AND METHODS
Hypoglycemia was induced in 17 women with IDDM and 10 normal control subjects at 24–28 and at 32–34 weeks' gestation, using the hypoglycemic clamp technique. Plasma glucose concentrations were decreased to 3.3 mmol/l and maintained at this level for 1 h. Blood samples were drawn every 15 min for measurement of counterregulatory hormone concentrations.

RESULTS
All 17 women with IDDM had diminished epinephrine responses to hypoglycemia, compared with control subjects. Eight of the women with IDDM (nonresponders) had minimal or no responses (&lt; 165 pmol/l above baseline) and nine women (responders) had a moderate response (244–764 pmol/l). Of the eight nonresponders, seven had large infants (birth weight in the upper quartile), while only three of the nine responders had large infants (P &lt; 0.05).

CONCLUSIONS
Severely impaired counterregulatory epinephrine responses to hypoglycemia in pregnant women with IDDM may be a factor contributing to excessive fetal growth. We speculate that in these women, recurrent episodes of hypoglycemia may result in frequent bouts of increased caloric intake, with repeated episodes of transient hyperglycemia leading to fetal hyperinsulinism and excessive fetal growth.
Erythromycin Derivative Improves Gastric Emptying and Insulin Requirement in Diabetic Patients With Gastroparesis
Authors: Ishii Masataka , Nakamura Teruo , Kasai Fukio , Baba Tsuneharu , Takebe Kazuo 
Published: March 2007

OBJECTIVE
To evaluate the effect of the erythromycin derivative EM523L on gastric emptying and postprandial insulin requirement in insulin-dependent diabetic patients with severe gastroparesis.

RESEARCH DESIGN AND METHODS
In six IDDM patients with severe gastroparesis (two men and four women, mean age 44.5 years [range 36–53]), the insulin infusion pattern during feedback control with an artificial endocrine pancreas device (Biostator) after intake of a test meal, the retention rate of residual isotope (99mTc-labelled Sn-colloid) in the stomach, and the time-concentration curve of plasma acetaminophen as the marker for liquid emptying were studied with EM523L or a control placebo

RESULTS
Time courses of insulin infusion rates peaked within 120 min after intake of the test meal in the EM523L phase, whereas no apparent peak rates were observed in the control phase. The total amount of insulin required in the first 90 min postprandial was significantly greater in the EM523L phase than in the control phase. EM523L significantly decreased the residual isotope ratio in the stomach at ≥50 min postprandial and increased the plasma acetaminophen concentrations at 30–120 min postprandial, compared with respective values in the control phase.

CONCLUSIONS
Preliminary results obtained from a small number of patients suggest that EM523L or erythromycin analogs, which have agonistic activity to motilin receptors as well as no antibacterial effect, may be useful to accelerate gastric emptying and improve insulin requirement patterns, thereby establishing more stable glycemic control.
Long-Term Hyperglycemia Is Related to Peripheral Nerve Changes at a Diabetes Duration of 4 years
Authors: Allen Catherine , Shen Guanghong , Palta Mari , Lotz Barend , Jacobson Richard , D'Alessio Donn ,   For the Wisconsin Diabetes Registry
Published: March 2007

OBJECTIVE
To examine longitudinal hyperglycemia and peripheral nerve responses in a population-based incident cohort.

RESEARCH DESIGN AND METHODS
A sample from an incident cohort of young people was comprehensively followed from diagnosis of IDDM. Participants were invited to submit blood samples three times per year for central testing of GHb. During their 4th year of diabetes, nerve conduction studies were performed on the median sensory and motor, peroneal motor, and sural sensory nerves. Relationships between mean GHb and nerve latencies, velocities, and amplitudes were explored.

RESULTS
GHb was positively related to all nerve latencies and negatively related to all nerve velocities. The relationships between mean GHb and nerve conduction latencies and velocities differed by sex for the peroneal nerve latency (β = 0.17 male subjects, β = −0.01 female subjects; P &lt; 0.001). Pubertal participants had lower velocities and longer latencies than prepubertal participants (β = 0.37; P = 0.05 peroneal latency), after adjustment for GHb, height, and extremity temperature. Sensory and motor nerve amplitudes were related to GHb, and these relationships did not differ by sex.

CONCLUSIONS
Our study indicates that sustained hyperglycemia is related to functional changes, at the minimum, in peripheral sensory and motor nerve conduction at a diabetes duration of 4 years. Our findings are consistent with a dying-back neuropathy, and there is some suggestion that chronic hyperglycemia may be more detrimental to nerves in male subjects than in female subjects.
Clinical Characteristics of Japanese Men With Glucokinase Gene β-cell Promoter Variant
Authors: Yamada Kentaro , Yuan Xiaohong , Ishiyama Satomi , Ichikawa Fumi , Koyama Ken-Ichi , Koyanagi Atsuko , Koyama Wasaku , Nonaka Kyohei 
Published: March 2007

OBJECTIVE
To study the association between a variant at the position of −30 of β-cell-specific promoter of the glucokinase gene and glucose tolerance in the Japanese general population and to assess the clinical characteristics of subjects with the variant.

RESEARCH DESIGN AND METHODS
The genotype of 657 Japanese men aged 51.0 ± 8.8 years (mean ± SD) was analyzed by an allele-specific assay using polymerase chain reaction-restriction fragment length polymorphism.

RESULTS
The variant allele frequency was 0.188 in subjects with normal glucose tolerance, 0.211 in subjects with impaired glucose tolerance, and 0.176 in diabetic subjects. In subjects with fasting plasma glucose levels &lt;140 mg/dl, homozygous subjects for the promoter variant had significantly higher plasma glucose levels 60 min after oral glucose administration when compared with subjects without the variant allele. A cross-sectional analysis showed age-related elevation of basal glucose levels only in subjects without the promoter variant. Individuals heterozygous for the variant had significantly lower levels of HDL cholesterol than normal subjects. HDL cholesterol values were lower in homozygous people than in normal and heterozygous subjects, although the differences were not statistically significant.

CONCLUSIONS
The β-cell promoter variant in homozygous state was associated with impaired glucose tolerance, but not with diabetes, and low HDL cholesterol levels in Japanese men. It is unlikely that the glucose intolerance associated with the promoter variant is progressive with age.
Proinsulin, Intact Insulin, and Fibrinolytic Variables and Fibrinogen in Healthy Subjects: A population study
Authors: Eliasson Mats , Røder Michael E , Dinesen Bo , Evrin Per-Eric , Lindahl Bernt 
Published: March 2007

OBJECTIVE
As high serum insulin predicts impaired fibrinolysis and proinsulin reacts in most conventional insulin assays, we hypothesized that proinsulin could link low fibrinolytic activity and hyperinsulinemic conditions.

RESEARCH DESIGN AND METHODS
We explored the relationship between fibrinolysis and plasma fibrinogen on the one hand and specific insulin and proinsulin on the other, in a healthy population sample of 165 men and women, 25–74 years of age, from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study. Specific insulin and proinsulin were measured by enzyme-linked immunosorbent assay. Partial correlation coefficients, adjusted for age and sex, were calculated.

RESULTS
Plasma fibrinogen levels were related to insulin (r = 0.25, P &lt; 0.01) and proinsulin (r = 0.29, P &lt; 0.001), as was plasminogen activator inhibitor (PAI)-1 activity (r = 0.36 and r = 0.29, respectively; P &lt; 0.001). Tissue Plasminogen activator (tPA) activity correlated inversely to insulin (r = −0.35, P &lt; 0.001) and proinsulin (r = −0.36, P &lt; 0.001). In a multivariate analysis taking also smoking and anthropometric and metabolic measurements into account, fasting proinsulin was a significant predictor of high plasma fibrinogen level. Insulin and proinsulin levels were not related to tPA activity. High levels of postload insulin, triglycerides, and diastolic blood pressure, but not proinsulin, predicted high PAI-l activity.

CONCLUSIONS
In a healthy population, the relationship previously described between high insulin levels and impaired fibrinolysis is not attributable to confounding from proinsulin. Elevated proinsulin levels are associated with high fibrinogen levels.