bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Antibiotics Is Not Associated With Decreased Risk of Myocardial Infarction Among Patients With Diabetes
Authors: Karter Andrew John , Thom David H. , Liu Jennifer , Moffet Howard H. , Ferrara Assiamira , Selby Joe V. 
Published: March 2007

OBJECTIVE—To study the relationship between exposure to antibiotic treatment and risk of subsequent myocardial infarction (MI) in patients with diabetes.
RESEARCH DESIGN AND METHODS—A case-control design was used to assess the effect of previous antibiotic exposure in diabetes patients with acute, nonfatal or fatal MI (case subjects) and individually matched control subjects (four control subjects to one case subject, matched on sex, age, and index date). Subjects were sampled from the Northern California Kaiser Permanente Diabetes Registry, a well-characterized, ethnically diverse diabetic population from Kaiser Permanente Medical Care Program, Northern California Region. MI events were ascertained during a 2-year observation period (1998–1999). Separate conditional logistic regression models were specified to assess antibiotic exposure history (cephalosporins only, penicillins only, macrolides only, quinolones only, sulfonamides only, tetracyclines only, as well as more than one, any, or no antibiotic) for three nested windows before the index date (0–6 months, 0–12 months, 0–24 months), facilitating assessment of whether the potential effect was dependent on the timing of the exposure.
RESULTS—A total of 1,401 MI case subjects were observed. Odds ratios were calculated in models adjusted for age, sex, race, education attainment, time since diabetes diagnosis, diabetes type and treatment, use of diet and exercise, total cholesterol, HDL cholesterol, triglyceride levels, hypertension, elevated urinary albumin excretion, serum creatinine, BMI, and smoking. We found no evidence of a protective effect of any of these therapeutic classes of antibiotics during any of the three time frames.
CONCLUSIONS—Our study does not support the hypothesis that use of antibiotics has a protective effect for prevention of coronary heart disease in diabetic patients.
The Aging of Elastic and Muscular Arteries
Authors: Cameron James D. , Bulpitt Christopher J. , Pinto Elisabete S. , Rajkumar Chakravarthi 
Published: March 2007

OBJECTIVE—To compare age-related changes in the mechanical properties of different arterial segments in normal volunteers and subjects with type 2 diabetes.
RESEARCH DESIGN AND METHODS—In 169 subjects (diabetic n = 57 and nondiabetic n = 112), we assessed the mechanical properties of three arterial segments of differing wall composition. Pulse wave velocity (PWV) was measured noninvasively in a thoraco-abdominal segment (carotid femoral PWV [PWVcf]), in an upper limb muscular artery (carotid radial PWV [PWVcr]), and from the aorta to the finger (PWV from the aorta to the finger [PWVfin]). Central aortic compliance (CAC) was also measured.
RESULTS—Average CAC was lower (0.662 vs. 0.850, P &lt; 0.05) and all measures of PWV tended to be faster in diabetic subjects despite the fact that they were, on average, 10 years younger. However, these measures were not related to age in diabetic subjects. After correcting for blood pressure, only PWVcf was associated with age in nondiabetic subjects (P &lt; 0.001). Expressing results as ratios of nonelastic to elastic arterial segments (i.e., PWVcr-to-PWVcf and PWVfin-to-PWVcf) improved the relationship with age. Both PWVcr-to-PWVcf and PWVfin-to-PWVcf were significantly associated with age in nondiabetic subjects (r = −0.59, P &lt; 0.001; r = −0.57, P &lt; 0.001) but not in diabetic subjects (r = −0.15, P = 0.302; r = −0.24, P = 0.129). Multivariate analysis showed that the ratios were not associated with systolic blood pressure.
CONCLUSIONS—There are significant differences in the rate of age-related decline in vascular stiffness in elastic arteries of nondiabetic compared with diabetic arteries. Diabetic arteries appear to age at an accelerated rate at an earlier age and then reach a functional plateau.
Elevated Blood Interleukin-6 Levels in Hyperketonemic Type 1 Diabetic Patients and Secretion by Acetoacetate-Treated Cultured U937 Monocytes
Authors: Jain Sushil K. , Kannan Krishnaswamy , Lim Gideon , Matthews-Greer Janice , McVie Robert , Bocchini Joseph A. 
Published: March 2007

OBJECTIVE—Diabetic patients have elevated blood levels of interleukin-6 (IL-6), which is known to increase inflammation and the development of vascular disease and atherosclerosis. This study examined the hypothesis that ketosis increases the circulating levels of IL-6 in type 1 diabetic patients as well as the secretion of IL-6 in vitro in a cell culture model using U937 monocytes.
RESEARCH DESIGN AND METHODS—Fasting blood was obtained from type 1 diabetic patients and healthy siblings. To examine the effect of ketosis, U937 monocytes were cultured with ketone bodies (acetoacetate [AA], β-hydroxybutyrate [BHB]) in the presence or absence of high glucose levels in the medium at 37°C for 24 h. IL-6 was determined by the sandwich enzyme-linked immunosorbent assay method, and intracellular reactive oxygen species (ROS) generation was detected using dihydroethidium dye.
RESULTS—The blood level of IL-6 was higher in hyperketonemic (HK) diabetic patients than in normoketonemic (NK) diabetic patients (P &lt; 0.05) and normal control subjects (P &lt; 0.05). There was a significant correlation between ketosis and IL-6 levels (r = 0.36, P &lt; 0.04, n = 34) in the blood of diabetic patients. Cell culture studies found that exogenous addition of the ketone body AA, but not BHB, increases IL-6 secretion and ROS generation in U937 cells. N-acetylcysteine (NAC) prevented the IL-6 secretion in acetoacetate-treated U937 monocytes.
CONCLUSIONS—This study demonstrates that hyperketonemia increases IL-6 levels in the blood of type 1 diabetic patients and that NAC can inhibit IL-6 secretion by U937 monocytic cells cultured in a ketotic medium.
Cardiorespiratory Fitness and Vigorous Leisure-Time Physical Activity Modify the Association of Small Size at Birth With the Metabolic Syndrome
Authors: Laaksonen David E. , Lakka Hanna-Maaria , Lynch John , Lakka Timo A. , Niskanen Leo , Rauramaa Rainer , Salonen Jukka T. , Kauhanen Jussi 
Published: March 2007

OBJECTIVE—Small size at birth has been associated with components of the metabolic syndrome, but little is known about the association with the metabolic syndrome itself or whether leisure-time physical activity (LTPA) and cardiorespiratory fitness modify that association. We studied the association of size at birth with the metabolic syndrome.
RESEARCH DESIGN AND METHODS—Birth weight and length, the metabolic syndrome (World Health Organization criteria), LTPA over the previous 12 months, and Vo2max were assessed in 462 nondiabetic middle-aged Finnish men who were part of a population-based cohort study.
RESULTS—Men with a ponderal index (kg/m3) at birth in the lower third had higher fasting insulin and glucose levels than men in the upper third in age-adjusted analyses and were at least twofold more likely to have the metabolic syndrome, even in men without cardiovascular disease. Adjustment for childhood or adult socioeconomic status or adult BMI did not attenuate the association. Thinness at birth was even more clearly associated with hyperinsulinemia and the metabolic syndrome in men engaging in &lt;25 min/wk of vigorous LTPA and in men with a Vo2max &lt;28.6 ml · kg−1 · min−1 or &lt;2.44 l/min. In active and fit men, however, the association was absent.
CONCLUSIONS—Small size at birth was associated with the metabolic syndrome in middle-aged men already before development of diabetes or cardiovascular disease. Thinness at birth may carry with it lifelong metabolic consequences, but regular strenuous physical activity and maintenance of cardiorespiratory fitness may alleviate or eliminate those consequences.
Specialist Nurse-Led Intervention to Treat and Control Hypertension and Hyperlipidemia in Diabetes (SPLINT)
Authors: New John P. , Mason James M. , Freemantle Nick , Teasdale Sue , Wong Louise M. , Bruce Nick J. , Burns John A. , Gibson John M. 
Published: March 2007

OBJECTIVE—To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care.
RESEARCH DESIGN AND METHODS—This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure (≥140/80 mmHg), raised total cholesterol (≥5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4–6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention.
RESULTS—Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11–1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia (OR 1.69 [1.25–2.29], P = 0.0007) than for hypertension (OR 1.14 [0.86–1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32–0.92], P = 0.02).
CONCLUSIONS—This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.
Management of Uncontrolled Hypertension in a Nurse-Led Clinic Compared With Conventional Care for Patients with Type 2 Diabetes
Authors: Denver Elizabeth A. , Barnard Maria , Woolfson Robin G. , Earle Kenneth A. 
Published: March 2007

OBJECTIVE—To compare the effectiveness of a nurse-led hypertension clinic with conventional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We studied 120 men and women outpatient attendees (61% non-Caucasian) with type 2 diabetes and a seated blood pressure (BP) ≥140/80 mmHg. All patients were being treated for hypertension, and 71% had increased urinary albumin excretion (UAE). Patients were allocated to either a nurse-led hypertension clinic or conventional primary care. The primary outcome measure was a change in systolic BP. Secondary outcome measures were total cholesterol, HDL cholesterol, total triglycerides, HbA1c, UAE, serum creatinine, and changes in absolute stroke and coronary heart disease (CHD) risk scores.
RESULTS—The mean (95% CI) difference in the decrement of systolic BP was 12.6 mmHg (5.9–19.3) (P = 0.000) in favor of the nurse-led group, whose patients were three times more likely to a reach target systolic BP &lt;140 mmHg compared with conventional care (P = 0.003). A significant fall in 10-year CHD (P = 0.004) and stroke risk (P = 0.000) scores occurred only in the nurse-led group. There were no significant differences in the reduction of diastolic BP or any of the other secondary outcome measures at 6 months.
CONCLUSIONS—Compared with conventional care, a nurse-led hypertension clinic is a more effective intervention for patients with type 2 diabetes and uncontrolled hypertension. A target systolic BP &lt;140 mmHg is more readily achieved and may be associated with significant reductions in 10-year cardiovascular disease risk scores.
Impact of Population Management With Direct Physician Feedback on Care of Patients With Type 2 Diabetes
Authors: Grant Richard W. , Hamrick Hope E. , Sullivan Christine M. , Dubey Anil K. , Chueh Henry C. , Cagliero Enrico , Meigs James B. 
Published: March 2007

OBJECTIVE—Population-level strategies may improve primary care for diabetes. We designed a controlled study to assess the impact of population management versus usual care on metabolic risk factor testing and management in patients with type 2 diabetes. We also identified potential patient-related barriers to effective diabetes management.
RESEARCH DESIGN AND METHODS—We used novel clinical software to rank 910 patients in a diabetes registry at a single primary care clinic and thereby identify the 149 patients with the highest HbA1c and cholesterol levels. After review of the medical records of these 149 patients, evidence-based guideline recommendations regarding metabolic testing and management were sent via e-mail to each intervention patient’s primary care provider (PCP). Over a 3-month follow-up period, we assessed changes in the evidence-based management of intervention patients compared with a matched cohort of control patients receiving usual care at a second primary care clinic affiliated with the same academic medical center.
RESULTS—In the intervention cohort, PCPs followed testing recommendations more often (78%) than therapeutic change recommendations (36%, P = 0.001). Compared with the usual care control cohort, population management resulted in a greater overall proportion of evidence-based guideline practices being followed (59 vs. 45%, P = 0.02). Most intervention patients (62%) had potential barriers to effective care, including depression (35%), substance abuse (26%), and prior nonadherence to care plans (18%).
CONCLUSIONS—Population management with clinical recommendations sent to PCPs had a modest but statistically significant impact on the evidence-based management of diabetes compared with usual care. Depression and substance abuse are prevalent patient-level adherence barriers in patients with poor metabolic control.
Predicted Costs and Outcomes From Reduced Vibration Detection in People With Diabetes in the U.S.
Authors: Shearer Arran , Scuffham Paul , Gordois Adam , Oglesby Alan 
Published: March 2007

OBJECTIVE—The ability to perceive vibration (vibration detection) has been shown to be a good predictor of the long-term complications of diabetic peripheral neuropathy (DPN). We aimed to estimate the predicted complications and costs for the U.S. health care system associated with reduced vibration detection (vibration perception threshold ≥25 V), estimated using a quantitative sensory testing device.RESEARCH DESIGN AND METHODS—A Markov model was constructed for a hypothetical cohort of people with DPN. The model was run over a 10-year period using Monte Carlo simulations to estimate disease progression, predicted costs, and complications according to vibration detection levels.RESULTS—The average individual with reduced vibration detection incurs approximately five times more direct medical costs for foot ulcer and amputations, yields 0.18 fewer quality-adjusted life-years, and lives for ∼2 months less than an average individual with normal vibration detection.CONCLUSIONS—The treatment of foot ulceration and amputation is time-consuming and expensive. If individuals with reduced vibration detection could be identified, then preventative care could be concentrated on those patients, potentially saving valuable resources and improving health outcomes.
A Descriptive and Comparative Study of the Prevalence of Depressive and Anxiety Disorders in Low-Income Adults With Type 2 Diabetes and Other Chronic Illnesses
Authors: Thomas Janet , Jones Glenn , Scarinci Isabel , Brantley Phillip 
Published: March 2007

OBJECTIVE—To determine whether type 2 diabetes contributes to the presence of depressive and anxiety disorder diagnoses in low-income adults with hypertension, asthma, and/or arthritis.
RESEARCH DESIGN AND METHODS—Using a cross-sectional design, this study administered a structured diagnostic interview to low-income primary care patients diagnosed with type 2 diabetes, hypertension, arthritis, and asthma, as well as to those with no chronic illness (n = 326), to determine the 12-month prevalence of depressive and anxiety disorders. A logistic regression (LR) model was used to assess whether a diagnosis of depression and/or anxiety was associated with type 2 diabetes after adjusting for known risk factors.
RESULTS—A high prevalence rate of depressive and/or anxiety disorders was found in the total sample (29%) and in all three illness groups: type 2 diabetes (36%), other chronic illnesses (24%), and no chronic illness (31%). Using LR, a main effect was detected for illness group when age and education were controlled (χ2 = 22.66, df 4, P = 0.000). Specifically, the odds of occurrence of a depressive and/or anxiety disorder in those with comorbid type 2 diabetes were twice that in the nondiabetic, chronically ill comparison group (odds ratio 2.26, 95% CI 1.28–4.01, P = 0.005).
CONCLUSIONS—These results suggest a positive contribution of type 2 diabetes to increased rates of depressive and/or anxiety disorders in patients with hypertension, asthma, and/or arthritis and support prior research that type 2 diabetes may serve as an indicator of depression and anxiety in low-income adults treated in primary care clinics.
Phenotypic Heterogeneity and Associations of Two Aldose Reductase Gene Polymorphisms With Nephropathy and Retinopathy in Type 2 Diabetes
Authors: Wang Ying , Ng Maggie C.Y. , Lee Shao-Chin , So Wing-Yee , Tong Peter C.Y. , Cockram Clive S. , Critchley Julian A.J.H. , Chan Juliana C.N. 
Published: March 2007

OBJECTIVE—We investigated the phenotypic features of diabetic microvascular complications and their association with a (CA)n microsatellite and a C/T polymorphism at the 5′ region of the aldose reductase gene (ALR2) in a consecutive cohort of 738 Chinese type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—Of the entire patient cohort, 392 were free of diabetes complications, or uncomplicated, 159 had diabetic nephropathy, 66 had diabetic retinopathy, and 121 had both diabetic nephropathy and retinopathy. Nephropathy was defined as urinary albumin excretion rate (AER) ≥20 μg/min and albumin-to-creatinine ratio ≥3.5 mg/mmol in two urine collections. Retinopathy was defined by the presence of hemorrhages, exudates, laser marks, and fibrous proliferation or by a history of vitrectomy. (CA)n and C/T polymorphisms were examined by PCR followed by capillary electrophoresis and digestion with BfaI, respectively.
RESULTS—In the whole cohort, patients with diabetic retinopathy (n = 187) had higher blood pressure and lower BMI, while those with diabetic nephropathy (n = 280) had higher blood pressure, waist-to-hip ratio, and lipid profile than those without the respective complications. The z+6 carriers of the (CA)n polymorphism were less common in patients with diabetic retinopathy than those without diabetic retinopathy (n = 551) (4.3 vs. 9.3%, P = 0.04). The CT/TT carriers had a higher AER than the CC carriers (30.2 ×/÷ 7.2 vs. 21.9 ×/÷ 6.9 μg/min, P = 0.03). Further subgroup analysis was performed after excluding uncomplicated patients with &lt;5 years disease duration. The group with both diabetic nephropathy and retinopathy had higher frequencies of the z-2 allele (25.7 vs. 16.9%, P = 0.03) and T allele (26.4 vs. 18.5%, P = 0.04) and a lower frequency of the z+6 allele (1.7 vs. 5.5%, P = 0.054) than the uncomplicated group. Multiple logistic regression analysis confirmed that z-2 carrying (odds ratio 2.6, 95% CI 1.20–5.83, P = 0.02) and CT/TT genotypes (OR 2.5, 95% CI 1.19–5.19, P = 0.02) were independent predictors for both diabetic nephropathy and retinopathy.
CONCLUSIONS—Chinese type 2 diabetic patients exhibited phenotypic differences in terms of risk factors for both diabetic nephropathy and diabetic retinopathy. Both the z-2 allele of (CA)n polymorphism and T allele of ALR2 were independently associated with severe diabetic microvascular complications.
Prevalence of Diagnosed Diabetes Among African-American and Non-Hispanic White Youth, 1999
Authors: Oeltmann John E. , Liese Angela D. , Heinze Howard J. , Addy Cheryl L. , Mayer-Davis Elizabeth J. 
Published: March 2007

OBJECTIVE—To document diabetes prevalence among African-American and non-Hispanic white youth in a two-county region in South Carolina.
RESEARCH DESIGN AND METHODS—We conducted a population-based surveillance effort to identify case subjects aged 0–18.9 years with a physician diagnosis of diabetes residing in a two-county region in 1999. Case subjects were ascertained from hospitals, the sole office of pediatric endocrinology, and several smaller sources. Case subjects were classified according to the diagnosis made by a pediatric endocrinologist. As a completeness check, eight randomly selected physicians were queried for eligible case subjects. Capture-recapture provided an additional measure of completeness. Prevalence estimates used U.S. 2000 Census data for the two-county denominator.
RESULTS—Crude total diabetes prevalence was 1.7 cases per 1,000 youth and similar between African-American and non-Hispanic white youth. Among younger youth (0–9.9 years), non-Hispanic white total prevalence was 1.1 per 1,000 and African-American prevalence was 0.6 per 1,000. Among older youth (10.0–18.9 years), non-Hispanic white total prevalence was 2.5 per 1,000 and African-American prevalence was 3.1 per 1,000. Type 2 diabetes was only confirmed among older prevalent cases. Ascertainment completeness was estimated to be 98%.
CONCLUSIONS—Our estimates suggest that total diabetes prevalence among non-Hispanic white youth is similar to rates observed over 20 years ago. Among African-American youth, the difference in prevalence noted between younger and older age-groups was notably greater than that observed among the non-Hispanic white youth, potentially reflecting a more marked increase in diabetes incidence with age.