bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes and Impaired Fasting Glycemia in a Rural Population of Bangladesh
Authors: Sayeed M. Abu , Mahtab Hajera , Khanam Parvin Akter , Latif Zafar Abdul , Ali S. M. Keramat , Banu Akhter , Ahren Bo , Azad Khan A.K. 
Published: March 2007

OBJECTIVE—To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a rural population of Bangladesh.
RESEARCH DESIGN AND METHODS—A cluster sampling of 4,923 subjects ≥20 years old in a rural community were investigated. Fasting plasma glucose, blood pressure, height, weight, and girth of waist and hip were measured. BMI and waist-to-hip ratio (WHR) were calculated. Total cholesterol, triglycerides, and HDL cholesterol were also estimated. We used the 1997 American Diabetes Association diagnostic criteria.
RESULTS—The crude prevalence of type 2 diabetes was 4.3% and IFG was 12.4%. The age-standardized prevalence of type 2 diabetes (95% CI) was 3.8% (3.12–4.49) and IFG was 13.0% (11.76–14.16). The subjects with higher family income had significantly higher prevalence of type 2 diabetes (5.9 vs. 3.5%, P &lt; 0.001) and IFG (15.6 vs. 10.8%, P &lt; 0.001) than those with lower income. Employing logistic regression in different models, we found that wealthy class, family history of diabetes, reduced physical exercise, and increased age, BMI, and WHR were the important predictors of diabetes. Total cholesterol, triglycerides, and HDL cholesterol showed no association with diabetes and IFG.
CONCLUSIONS—The prevalence of diabetes and IFG in the rural population was found to be on the increase compared with the previous reports of Bangladesh and other Asian studies. Older age, higher obesity, higher income, family history of diabetes, and reduced physical activity were proved significant risk factors for diabetes and IFG, whereas plasma lipids showed no association with diabetes and IFG. Further study may address whether diabetes is causally associated with insulin deficiency or insulin resistance.
Absence of Adverse Effects of Severe Hypoglycemia on Cognitive Function in School-Aged Children With Diabetes Over 18 Months
Authors: Wysocki Tim , Harris Michael A. , Mauras Nelly , Fox Larry , Taylor Alexandra , Jackson S. Craig , White Neil H. 
Published: March 2007

OBJECTIVE—Some children with type 1 diabetes may be at risk of cognitive impairments, but mechanisms of this effect have not been confirmed. The objective of this study was to determine whether severe hypoglycemia (SH) in children with type 1 diabetes is associated with cognitive decline over 18 months.
RESEARCH DESIGN AND METHODS—A sample of 142 6- to 15-year-old children with type 1 diabetes (mean age 11.6 ± 2.7 years) enrolled in a trial of intensive therapy (IT) or usual care (UC) were tested with the Das-Naglieri Cognitive Assessment System at baseline and after 9 and 18 months. Episodes of SH were recorded by parents and reported promptly for verification by study nurses. HbA1c was measured quarterly.
RESULTS—Over 18 months, 58 of 142 patients (41%) experienced 111 SH episodes, with a RR of SH of 1.12 for IT over UC. Neither occurrence nor frequency of SH was associated with decline in full-scale intelligence quotient (IQ), standard scores for planning, attention, simultaneous processing, or successive processing, or scaled scores on any of eight subtests. The same findings emerged when only patients who had experienced hypoglycemic seizures or coma were included in the SH group for analyses. These effects persisted when the child’s age, sex, type 1 diabetes duration, and age at diagnosis were controlled statistically. HbA1c during the trial was not associated with cognitive changes.
CONCLUSIONS—SH did not induce adverse changes in the measures of cognitive function administered to 6- to 15-year-old children with type 1 diabetes in this study. Although SH should be avoided in all children with diabetes, these episodes did not have adverse effects on cognition in this age-group over 18 months.
Accuracy of an Electrochemical Sensor for Measuring Capillary Blood Ketones by Fingerstick Samples During Metabolic Deterioration After Continuous Subcutaneous Insulin Infusion Interruption in Type 1 Diabetic Patients
Authors: Guerci Bruno , Benichou Muriel , Floriot Michèle , Bohme Philip , Fougnot Sebastien , Franck Patricia , Drouin Pierre 
Published: March 2007

OBJECTIVE—This study was designed to test the accuracy of capillary ketonemia for diagnosis of ketosis after interruption of insulin infusion.
RESEARCH DESIGN AND METHODS—A total of 18 patients with type 1 diabetes treated by external pump were studied during pump stop for 5 h. Plasma and capillary ketonemia and ketonuria were determined every hour from 7:00 a.m. (time 0 min = T0) to 12:00 p.m. (time 300 min = T300). Plasma β-hydroxybutyrate (β-OHB) levels were measured by an enzymatic end point spectrophotometric method, and capillary β-OHB levels were measured by an electrochemical method (MediSense Optium meter). Ketonuria was measured by a semiquantitative test (Ketodiastix). Positive ketosis was defined by a value of ≥0.5 mmol/l for ketonemia and ≥4 mmol/l (moderate) for ketonuria.
RESULTS—After stopping the pump, concentrations of β-OHB in both plasma and capillary blood increased significantly at time 60 min (T60) compared with T0 (P &lt; 0.001), reaching maximum levels at T300 (1.30 ± 0.49 and 1.23 ± 0.78 mmol/l, respectively). Plasma and capillary β-OHB values were highly correlated (r = 0.94, P &lt; 0.0001). For diagnosis of ketosis, capillary ketonemia has a higher sensitivity and negative predictive value (80.4 and 82.5%, respectively) than ketonuria (63 and 71.8%, respectively). For plasma glucose levels ≥250 mg/dl, plasma and capillary ketonemia were found to be more frequently positive (85 and 78%, respectively) than ketonuria (59%) (P = 0.017). The time delay to diagnosis of ketosis was significantly higher for ketonuria than for plasma ketonemia (212 ± 67 vs. 140 ± 54 min, P = 0.0023), whereas no difference was noted between plasma and capillary ketonemia.
CONCLUSIONS—The frequency of screening for ketosis and the efficiency of detection of ketosis definitely may be improved by the use of capillary blood ketone determination in clinical practice.
The Continuous Glucose Monitoring System Is Useful for Detecting Unrecognized Hypoglycemias in Patients With Type 1 and Type 2 Diabetes but Is Not Better Than Frequent Capillary Glucose Measurements for Improving Metabolic Control
Authors: Chico Ana , Vidal-Ríos Pablo , Subirà Montserrat , Novials Anna 
Published: March 2007

OBJECTIVE—To evaluate whether the continuous glucose monitoring system (CGMS; MiniMed, Sylmar, CA) is useful for investigating the incidence of unrecognized hypoglycemias in type 1 and type 2 diabetic patients and for improving metabolic control in type 1 diabetic patients.
RESEARCH DESIGN AND METHODS—A total of 70 diabetic subjects (40 type 1 and 30 type 2 subjects) were monitored using the CGMS. The number of unrecognized hypoglycemias was registered. Furthermore, the 40 type 1 diabetic patients whose treatment was modified in accordance with the information obtained from the CGMS were compared with a control group of 35 different type 1 diabetic patients using intensive capillary glucose measurements. HbA1c levels were measured before the monitoring period and 3 months later.
RESULTS—The CGMS detected unrecognized hypoglycemias in 62.5% of the type 1 diabetic patients and in 46.6% of the type 2 diabetic patients. We found that 73.7% of all events occurred at night. HbA1c concentrations decreased significantly in both the group of type 1 diabetic subjects monitored with the CGMS (from 8.3 ± 1.6 to 7.5 ± 1.2%, P &lt; 0.01) and the control group (from 8.0 ± 1.4 to 7.5 ± 0.8%, P &lt; 0.01). The greatest reduction was observed in the subgroup of patients who started continuous subcutaneous insulin infusion therapy, both in the CGMS-monitored and control groups (from 9.4 ± 2 to 7.2 ± 1.4% and from 8.1 ± 1.8 to 7.1 ± 0.6%, respectively).
CONCLUSIONS—The CGMS is useful for detecting unrecognized hypoglycemias in type 1 and type 2 diabetic subjects; however, it is not better than standard capillary glucose measurements for improving metabolic control of type 1 diabetic subjects, regardless of the therapeutic regimen.
Serum Extracellular Superoxide Dismutase in Patients With Type 2 Diabetes
Authors: Kimura Fumiaki , Hasegawa Goji , Obayashi Hiroshi , Adachi Tetsuo , Hara Hirokazu , Ohta Mitsuhiro , Fukui Michiaki , Kitagawa Yoshihiro , Park Hyohun , Nakamura Naoto , Nakano Koji , Yoshikawa Toshikazu 
Published: March 2007

OBJECTIVE—The aim of this study was to determine the distribution of serum extracellular superoxide dismutase (EC-SOD) concentrations in patients with type 2 diabetes and to assess whether increased EC-SOD concentration is associated with the development of diabetic vascular complications.
RESEARCH DESIGN AND METHODs—Serum EC-SOD concentrations were determined in 222 patients with type 2 diabetes and 75 healthy control subjects by an enzyme-linked immunosorbent assay. All subjects had the EC-SOD domain genotyped.
RESULTS—The serum EC-SOD concentrations showed a distinct bimodal distribution in both patients with diabetes and control subjects. All subjects with the high-level phenotype carried the Arg213Gly mutation. The frequency of this variant was similar in the diabetes and control groups. Within the group of subjects with the common EC-SOD phenotype, the serum EC-SOD concentration (mean ± SE) was significantly higher in patients with type 2 diabetes (99.3 ± 1.3 ng/ml) compared with the control subjects (68.4 ± 2.3 ng/ml, P &lt; 0.01). Stepwise multiple regression analysis of the data from the diabetic common phenotype group showed a significant relationship between serum EC-SOD concentration and duration of diabetes (F = 5.31), carotid artery intimal-media thickness (F = 8.24), and severity of nephropathy (F = 16.05) and retinopathy (F = 4.43).
CONCLUSIONS—We observed a strong relationship between the serum concentration of EC-SOD and the severity of both micro- and macrovascular diabetic complications. These findings suggest that serum EC-SOD concentration levels may be a marker of vascular injury, possibly reflecting hyperglycemia-induced oxidative injury to the vascular endothelium and decreased binding of EC-SOD to the vascular wall.
Decreasing Incidence of Severe Diabetic Microangiopathy in Type 1 Diabetes
Authors: Hovind Peter , Tarnow Lise , Rossing Kasper , Rossing Peter , Eising Stefanie , Larsen Nicolai , Binder Christian , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—Conflicting evidence of a decline in incidence of microvascular complications in type 1 diabetes during the last decades has been reported. To assess recent trends in the cumulative incidence of diabetic microangiopathy in type 1 diabetes, we analyzed data from long-term prospective observational studies lasting ≥20 years.
RESEARCH DESIGN AND METHODS—A total of 600 Caucasian patients with onset of type 1 diabetes between 1965 and 1984 were followed until death or until the year 2000. Patients were divided into four groups based on the year of diabetes onset: group A, 1965–1969 (n = 113); group B, 1970–1974 (n = 130); group C, 1975–1979 (n = 113); and group D, 1979–1984 (n = 244). Group A, B, and C are prevalence cohorts identified in 1984; group D is an inception cohort.
RESULTS—In patients followed for ≥20 years, the cumulative incidence (95% CI) of diabetic nephropathy after 20 years of diabetes (urinary albumin excretion &gt;300 mg/24 h) was reduced in patients with more recent diabetes onset (groups A–D): 31.1% (22.5–39.7) vs. 28.4% (19.8–37.0) vs. 18.9% (10.9–26.9) vs. 13.7% (6.2–21.2) (P = 0.015). Similarly, the cumulative incidence of proliferative retinopathy was as follows: 31.2% (22.2–39.8) vs. 30.3% (22.2–38.4) vs. 19.3% (11.2–27.4) vs. 12.5% (5.2–19.8) (P &lt; 0.01). In the latter groups, antihypertensive treatment was started earlier, blood pressure and HbA1c were lower, and fewer patients smoked.
CONCLUSIONS—Our study demonstrates a decrease in the cumulative incidence of diabetic microangiopathy in type 1 diabetes over the past 35 years. Improved glycemic control, lower blood pressure (in part due to early aggressive antihypertensive treatment), and reduced prevalence of smoking rates were associated with the improved prognosis.
Trends in Lipid Management Among Patients With Coronary Artery Disease
Authors: Massing Mark W. , Foley Kathleen A. , Sueta Carla A. , Chowdhury Mridul , Biggs David P. , Alexander Charles M. , Simpson Ross J. 
Published: March 2007

OBJECTIVE—To examine lipid management trends for coronary artery disease (CAD) patients with and without diabetes in order to determine whether those with diabetes are beginning to receive aggressive lipid management consistent with their elevated risk.
RESEARCH DESIGN AND METHODS—We used outpatient medical record data from 47,813 CAD patients seen at 295 medical practices participating in the Quality Assurance Program II between 1996 and 1998. Lipid testing rates, lipid treatment rates, and serum lipid concentrations are described for CAD patients with and without diabetes within strata of office visit date.
RESULTS—Lipid testing and treatment rates increased and mean lipid levels decreased markedly over time. Those with diabetes were 26% less likely to have a lipid profile and 17% less likely to receive a lipid-lowering medication than their nondiabetic counterparts, and this disparity did not diminish over time. Among treated patients, mean non-HDL cholesterol (non-HDL-C) and LDL cholesterol (LDL-C) declined less rapidly over time for patients with than without diabetes.
CONCLUSIONS—Although impressive progress was made in the outpatient lipid management of CAD patients, lipid management for CAD patients with diabetes improved no more rapidly, and in some cases less rapidly, than for nondiabetic patients. Given their higher risk, more effort is needed to ensure that CAD patients with diabetes receive aggressive lipid management.
Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes
Authors: Niefeld Marlene R. , Braunstein Joel B. , Wu Albert W. , Saudek Christopher D. , Weller Wendy E. , Anderson Gerard F. 
Published: March 2007

OBJECTIVE—To examine the impact of comorbid conditions on preventable hospitalizations among Medicare beneficiaries aged ≥65 years with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Data were drawn from the 1999 Medicare Standard Analytic Files, a 5% nationally representative random sample of Medicare beneficiaries. The analysis sample included 193,556 Medicare beneficiaries aged ≥65 years with type 2 diabetes (ICD-9-CM codes 250.xx) who were enrolled in fee-for-service Medicare. Preventable hospitalization was assessed by measuring ambulatory care-sensitive conditions, an accepted measure of hospitalizations that could have been prevented with appropriate outpatient care. Multivariable analyses controlled for demographics; mortality; renal, ophthalmic, or neurological manifestations of diabetes; type of physician providing the outpatient care; and per capita community-level indicators of income and hospital beds.
RESULTS—Ninety-six percent of beneficiaries in the sample had a comorbidity, and 46% had five or more comorbidities. Among beneficiaries with type 2 diabetes, cardiovascular-related comorbidities were common and accounted for increased odds of preventable hospitalization, controlling for other factors. The likelihood of a preventable hospitalization increased in the presence of a claim for comorbid congestive heart failure, cardiomyopathy, coronary atherosclerosis, hypertension, or cardiac dysrythmias. Noncardiovascular comorbidities associated with a greater likelihood of preventable hospitalization included chronic obstructive pulmonary disease, asthma and lower respiratory disorders, Alzheimer’s disease/dementia, personality/anxiety disorders, depression, and osteoporosis. Our data suggest that nearly 7% of all hospitalizations could be avoided.
CONCLUSIONS—These findings support the need for improved outpatient care strategies to reduce the impact of comorbidity on unnecessary hospitalization in patients aged ≥65 years with type 2 diabetes.
Cutoff Values for Normal Anthropometric Variables in Asian Indian Adults
Authors: Snehalatha Chamukuttan , Viswanathan Vijay , Ramachandran Ambady 
Published: March 2007

OBJECTIVE—Asian Indians have a high risk of developing glucose intolerance with small increments in their BMI. They generally have high upper-body adiposity, despite having a lean BMI. Therefore, this analysis was performed to find out the normal cutoff values for BMI and upper-body adiposity (waist circumference [WC] or waist-to-hip ratio [WHR]) by computing their risk associations with diabetes.
RESEARCH DESIGN AND METHODS—The risk of diabetes with stratified BMI, WC, or WHR was computed in 10,025 adults aged ≥20 years without a history of diabetes, and they were tested by oral glucose tolerance tests, using World Health Organization criteria. The calculations were performed separately in men and women using diabetes as the dependent variable versus normoglycemia (normal glucose tolerance) in multiple logistic regression analyses. Age-adjusted and stratified BMI, WC, or WHR were used as the independent variables, using the first stratum as the reference category. The upper limit of the stratum above which the risk association became statistically significant (P &lt; 0.05) was considered to be the cutoff for normal values.
RESULTS—Normal cutoff values for BMI was 23 kg/m2 for both sexes. Cutoff values for WC were 85 and 80 cm for men and women, respectively; the corresponding WHRs were 0.88 and 0.81, respectively. Optimum sensitivity and specificity obtained from the receiver operator characteristic curve corresponded to these cutoff values.
CONCLUSIONS—The cutoff value for normal BMI for men and women was 23 kg/m2. The cutoff values for WC and WHR were lower in women than in men. The values were significantly lower compared with the corresponding values in white populations.
Importance of Obtaining Independent Measures of Insulin Secretion and Insulin Sensitivity During the Same Test
Authors: Tripathy Devjit , Wessman Ylva , Gullström Monica , Tuomi Tiinamaija , Groop Leif 
Published: March 2007

OBJECTIVE—To validate and apply a method for independent assessment of insulin secretion and insulin sensitivity (SI) during the same test; that is, an intravenous glucose tolerance test followed by a euglycemic-hyperinsulinemic clamp, also called the Botnia clamp. This test was then applied to nondiabetic subjects with (FH+) and without (FH−) a first-degree family history of diabetes.
RESEARCH DESIGN AND METHODS—The Botnia clamp measures the first-phase insulin response (FPIR) to 0.3g/kg glucose i.v. and insulin sensitivity (M-value) from a 2-h euglycemic clamp begun 60 min after the glucose bolus. The M-value obtained during the Botnia clamp was compared with M-values obtained during a regular euglycemic clamp without prior glucose bolus. Repeated tests were performed in random order in subjects with normal and abnormal glucose tolerance. Finally, the test was applied to subjects with and without a family history of type 2 diabetes.
RESULTS—SI and insulin secretion from this test showed a high degree of reproducibility, and the M-value obtained with the Botnia clamp correlated strongly with the M-value from a euglycemic clamp without prior glucose bolus (r = 0.953, P &lt; 0.005). FH+ subjects showed decreased SI (P = 0.02), but similar FPIR, compared with FH− subjects. However, insulin secretion adjusted for the degree of insulin resistance was significantly impaired (P = 0.04).
CONCLUSIONS—In conclusion, the Botnia clamp provides reliable and independent measures of SI and β-cell function during the same test. As illustrated above, knowledge of the degree of SI is mandatory when presenting data on insulin secretion.
Differences in LDL Oxidizability by Glycemic Status
Authors: Schwenke Dawn C. , D’Agostino Ralph B. , Goff David. C. , Karter Andrew J. , Rewers Marian J. , Wagenknecht Lynne E. 
Published: March 2007

OBJECTIVE—To investigate differences in LDL oxidizability by glycemic status within the Insulin Resistance Atherosclerosis Study cohort.
RESEARCH DESIGN AND METHODS—LDL oxidizability (lag time and oxidation rate) after exposure to copper was compared among 352 subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), newly diagnosed type 2 diabetes, and known type 2 diabetes.
RESULTS—After adjustment for age, clinic, ethnicity, sex, and smoking status, LDL oxidation rates differed by glycemic status (P = 0.001), with a strong trend (P = 0.0001) for reduced LDL oxidation rate with increasing extent and duration of glucose intolerance (2,378 ± 54, 2,208 ± 65, 2,145 ± 71, and 2,115 ± 48 arbitrary units [mean ± SE] for NGT, IGT, newly diagnosed type 2 diabetes, and known type 2 diabetes, respectively). Differences in LDL oxidation rate among groups were relatively unaltered by adjustment for lipids and lipoproteins, hypertension, BMI, and waist-to-hip ratio (WHR) and remained significant even after further adjustment for dietary antioxidants and fatty acids, as well as medications. LDL lag times differed marginally by glycemic status (P = 0.058), with similar values for NGT, IGT, and newly diagnosed type 2 diabetes (57–60 min) but higher values for known type 2 diabetes (65 ± 2). These differences were eliminated by further adjustment for lipids and lipoproteins, hypertension, BMI, and WHR.
CONCLUSIONS—We found that glycemic status influenced LDL oxidizability, with a paradoxical reduction in LDL oxidizability, as indicated by a lower LDL oxidation rate with increased extent and duration of glucose intolerance. This difference was only slightly attenuated by adjustment for relevant demographic, metabolic, dietary, and pharmacological factors that potentially influence LDL oxidation.
Effect of Acute Psychotic Stress in Nondiabetic Subjects on β-Cell Function and Insulin Sensitivity
Authors: Shiloah Eli , Witz Shula , Abramovitch Yehuda , Cohen Ohad , Buchs Andreas , Ramot Yoram , Weiss Mordechai , Unger Abraham , Rapoport Micha J. 
Published: March 2007

OBJECTIVE—To determine the effect of acute psychotic stress on glucose homeostasis in nondiabetic subjects.
RESEARCH DESIGN AND METHODS—β-Cell function and insulin sensitivity were determined by the homeostasis model assessment in 39 nondiabetic patients with acute psychotic stress reaction admitted to a psychiatric ward. The clinical global impression (CGI) score was used to evaluate the level of psychological stress. Patients were assessed on admission, after 2 weeks, before discharge, and 6 months after discharge.
RESULTS—The mean CGI score decreased significantly with time: 5.3 ± 0.8 and 1.6 ± 0.7 on admission and predischarge, respectively (P &lt; 0.001). This was associated with a significant reciprocal increase of mean β-cell function from 96.8 ± 33.2 to 134.4 ± 60% at admission and postdischarge, respectively (P &lt; 0.003), and a decrease of mean insulin sensitivity from 101.7 ± 36 to 77.1 ± 34.8% (P &lt; 0.001). In contrast, mean glucose and HbA1c levels did not change significantly. Subgroup analysis demonstrated that patients with the highest stress score on admission (≥6) had significantly higher glucose (P = 0.01) and insulin levels (P = 0.04) than patients with lower score (&lt;6). Furthermore, insulin sensitivity and CGI score on admission were inversely correlated (r = −0.38, P &lt; 0.02). In these patients, no correlation was found between β-cell function or insulin sensitivity and BMI.
CONCLUSIONS—These data indicate that β-cell function and insulin sensitivity are inversely correlated with acute psychotic stress.