bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary Cadmium, Impaired Fasting Glucose, and Diabetes in the NHANES III
Authors: Schwartz Gary G. , Il’yasova Dora , Ivanova Anastasia 
Published: March 2007

OBJECTIVE—Increasing rates of type 2 diabetes worldwide suggest that diabetes may be caused by environmental toxins. Cadmium is a widespread environmental pollutant that accumulates in the pancreas and exerts diabetogenic effects in animals. To test the hypothesis that exposure to cadmium is associated with impaired fasting glucose and type 2 diabetes, we examined the associations between urinary cadmium and the prevalence of impaired fasting glucose (prediabetes) and diabetes in the Third National Health and Nutrition Examination Survey (NHANES III).
RESEARCH DESIGN AND METHODS—We analyzed data on 8,722 adults ≥40 years of age from the NHANES III (1988–1994), a cross-sectional health survey of a nationally representative sample of the noninstitutionalized civilian U.S. population. We studied urinary levels of cadmium (adjusted for urine creatinine) in relation to the prevalence of impaired fasting glucose and diabetes, using the criteria of the American Diabetes Association.
RESULTS—After adjustment for age, ethnicity, sex, and BMI, the odds of impaired fasting glucose and diabetes increased dose-dependently with elevations in urinary cadmium from 0–0.99 to 1.00–1.99 and ≥2 μg/g creatinine (impaired fasting glucose, odds ratio [OR] 1.48, 95% CI 1.21–1.82 and OR 2.05, 95% CI 1.42–2.95; diabetes, OR 1.24, 95% CI 1.06–1.45 and OR 1.45, 95% CI 1.07–1.97).
CONCLUSIONS—In this large cross-sectional study, urinary cadmium levels are significantly and dose-dependently associated with both impaired fasting glucose and diabetes. These findings, which require confirmation in prospective studies, suggest that cadmium may cause prediabetes and diabetes in humans.
Lifestyle Modification to Improve Blood Pressure Control in Individuals With Diabetes
Authors: Egede Leonard E. 
Published: March 2007

OBJECTIVE—To determine the effectiveness of physician advice on hypertension-related lifestyle modification in individuals with diabetes.
RESEARCH DESIGN AND METHODS—Data on adults with one or more physician visit in the 1998 National Health Interview Survey (NHIS) were analyzed (diabetes, n = 1,609; no diabetes, n = 19,672). The proportion with hypertension who received physician advice to lose weight, increase physical activity, or take antihypertensive medications and the proportion who reported adhering to advice were compared by diabetes status. Logistic regression was used to identify factors associated with receipt of physician advice and adherence to advice by diabetes status controlling for covariates. Then, logistic regression was also used to determine the extent to which patient adherence among people with diabetes differed by age, sex, and race/ethnicity, controlling for other covariates. STATA statistical software was used for all analyses to account for the complex survey design of NHIS.
RESULTS—Controlling for covariates, individuals with diabetes were more likely to receive advice (odds ratio [OR] 1.94 for weight loss, 1.99 for exercise, and 2.16 for medications). Adherence was more likely in individuals with diabetes (OR 1.40 for losing weight and 2.16 for taking medications). Adherence in people with diabetes did not differ by sex or race/ethnicity. Subjects 18–44 years old were least likely to report losing weight (OR 0.15) or taking medications (0.31) compared with subjects ≥65 years old.
CONCLUSIONS—Physician advice appears effective at changing hypertension-related lifestyles in people with diabetes regardless of sex or race/ethnicity. However, advice on increasing physical activity does not seem as effective.
The Effect of Alcohol Intake on Insulin Sensitivity in Men
Authors: Zilkens Renate R. , Burke Valerie , Watts Gerald , Beilin Laurence J. , Puddey Ian B. 
Published: March 2007

OBJECTIVE—Population data suggest that alcohol consumption may influence the risk of diabetes in a biphasic manner, but this has not been tested by any controlled interventions. The object of this study was to determine whether reducing alcohol intake in moderate-to-heavy drinkers (40–110 g/day) results in improvement in insulin sensitivity.
RESEARCH DESIGN AND METHODS—A 4-week run-in period where subjects maintained their usual drinking pattern was followed by randomization to a two-way cross-over intervention study. In each of two 4-week treatment interventions, subjects either substituted their usual alcohol intake with a 0.9% alcohol beer or maintained their usual alcohol intake. At the end of each 4-week period, insulin sensitivity as determined by the low-dose insulin glucose infusion test and the homeostasis model assessment (HOMA) score, and biomarkers of alcohol consumption (γ-glutamyl transpeptidase [γ-GT] and HDL cholesterol) were measured.
RESULTS—A total of 16 healthy men aged 51.0 ± 2.7 (mean ± SEM) years with a BMI of 26.4 ± 0.61 kg/m2 completed the study. There was a large reduction in alcohol intake (72.4 ± 5.0 vs. 7.9 ± 1.6 g/day, P &lt; 0.001) and significant reductions in γ-GT (geometric mean 24.4 units/l [95% CI 19.7–30.2] vs. 18.6 units/l [15.5–22.2], P &lt; 0.01) and HDL cholesterol (1.36 ± 0.07 vs. 1.13 ± 0.07 mmol/l, P &lt; 0.001). There was no effect of alcohol on insulin sensitivity index (ISI), fasting insulin, glucose, or HOMA score.
CONCLUSIONS—A substantial reduction in alcohol intake from 7.2 to 0.8 standard drinks per day in healthy men did not change insulin sensitivity as measured by ISI or HOMA score.
Pramlintide as an Adjunct to Insulin Therapy Improves Long-Term Glycemic and Weight Control in Patients With Type 2 Diabetes
Authors: Hollander Priscilla A. , Levy Philip , Fineman Mark S. , Maggs David G. , Shen Larry Z. , Strobel Susan A. , Weyer Christian , Kolterman Orville G. 
Published: March 2007

OBJECTIVE—Mealtime amylin replacement with the human amylin analog pramlintide, as an adjunct to mealtime insulin replacement, reduces postprandial glucose excursions in patients with type 2 diabetes. The aim of the present study was to assess the long-term efficacy and safety of pramlintide in this patient population.
RESEARCH DESIGN AND METHODS—In a 52-week, double-blind, placebo-controlled, parallel-group, multicenter study, 656 patients with type 2 diabetes (age 57 ± 10 years, diabetes duration 12 ± 7 years, BMI 34.0 ± 7.0 kg/m2, HbA1c 9.1 ± 1.2%, mean ± SD) treated with insulin (alone or in combination with sulfonylureas and/or metformin) were randomized to receive additional preprandial subcutaneous injections of either placebo or pramlintide (60 μg TID, 90 μg BID, or 120 μg BID).
RESULTS—Treatment with pramlintide 120 μg BID led to a sustained reduction from baseline in HbA1c (−0.68 and −0.62% at weeks 26 and 52, respectively), which was significantly greater than that seen with placebo (P &lt; 0.05). The proportion of patients achieving an HbA1c &lt;8% was approximately twofold greater with pramlintide (120 μg BID) than with placebo (46 vs. 28%, P &lt; 0.05). The glycemic improvement with pramlintide 120 μg BID was accompanied by a mean weight loss (−1.4 kg vs. +0.7 kg with placebo at week 52, P &lt; 0.05) and occurred without an overall increase in the severe hypoglycemia event rate. The most common adverse event associated with pramlintide use was transient, mild-to-moderate nausea.
CONCLUSIONS—Mealtime amylin replacement with pramlintide 120 μg BID, as an adjunct to insulin therapy, improves long-term glycemic and weight control in patients with type 2 diabetes.
Serum Lipoproteins in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Cohort
Authors: Jenkins Alicia J. , Lyons Timothy J. , Zheng Deyi , Otvos James D. , Lackland Daniel T. , McGee Daniel , Garvey W. Timothy , Klein Richard L. ,   The DCCT/EDIC Research Group
Published: March 2007

OBJECTIVE—To relate the nuclear magnetic resonance (NMR)-determined lipoprotein profile, conventional lipid and apolipoprotein measures, and in vitro oxidizibility of LDL with gender and glycemia in type 1 diabetes.
RESEARCH DESIGN AND METHODS—In the 1997–1999 Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications (DCCT/EDIC) cohort, serum from 428 women and 540 men were characterized by conventional lipids, NMR, apolipoprotein levels, and LDL susceptibility to in vitro oxidation. Simple and partial correlation coefficients were calculated for each lipoprotein-related parameter versus gender, with and without covariates (age, diabetes duration, concurrent HbA1c, DCCT randomization, hypertension, BMI, waist-to-hip ratio, and albuminuria). For concurrent HbA1c, data were analyzed as above, exchanging gender for HbA1c. Associations were significant if P &lt; 0.05.
RESULTS—Although men and women had similar total and LDL cholesterol and triglycerides, men exhibited the following significant percent differences in NMR profiles versus women: small VLDL 41; IDL −30; medium LDL 39; small LDL 21; large HDL −32; small HDL 35; LDL particle concentration 4; VLDL and HDL diameters −8 and −4, respectively. Small VLDL, small HDL, medium LDL (women only), small LDL (men only), and LDL particle concentration were positively correlated, and HDL size was inversely correlated, with concurrent HbA1c. NMR profile was unrelated to prior DCCT randomization. Susceptibility of LDL to oxidation was unrelated to gender and glycemia.
CONCLUSIONS—Male gender and poor glycemia are associated with a potentially more atherogenic NMR lipoprotein profile. Neither gender nor glycemia influence LDL oxidation in vitro.
Safety and Efficacy of Repaglinide in Type 2 Diabetic Patients With and Without Impaired Renal Function
Authors: Hasslacher Christoph ,   for the Multinational Repaglinide Renal Study Group
Published: March 2007

OBJECTIVE—To evaluate the influence of renal impairment on the safety and efficacy of repaglinide in type 2 diabetic patients.RESEARCH DESIGN AND METHODS—This multinational, open-label study comprised a 6-week run-in period, continuing prestudy antidiabetic medication, followed by a titration period (1–4 weeks) and a 3-month maintenance period. Patients with normal renal function (n = 151) and various degrees of renal impairment (n = 130) were treated with repaglinide (maximal dose of 4 mg, three times daily). Safety and efficacy assessments were performed at baseline (end of run-in) and at the end of study treatment.RESULTS—The type and severity of adverse events during repaglinide treatment were similar to the run-in period. The number of patients with adverse events was not significantly related to renal function during run-in or repaglinide treatment. Percentage of patients with hypoglycemic episodes increased significantly (P = 0.007) with increasing severity of renal impairment during run-in but not during repaglinide treatment (P = 0.074). Metabolic control (HbA1c and fasting blood glucose) with repaglinide was unchanged from that on previous antidiabetic medication. Final repaglinide dose tended to be lower for patients with severe and extreme renal impairment than for patients with less severe renal impairment or normal renal function (P = 0.032).CONCLUSIONS—Repaglinide has a good safety and efficacy profile in type 2 diabetic patients complicated by renal impairment and is an appropriate treatment choice, even for individuals with more severe degrees of renal impairment.
RANTES Promoter Genotype Is Associated With Diabetic Nephropathy in Type 2 Diabetic Subjects
Authors: Nakajima Kunihiro , Tanaka Yasushi , Nomiyama Takashi , Ogihara Takeshi , Ikeda Fuki , Kanno Rei , Iwashita Noseki , Sakai Ken , Watada Hirotaka , Onuma Tomio , Kawamori Ryuzo 
Published: March 2007

OBJECTIVE—To evaluate the effect of RANTES gene promoter polymorphism and RANTES receptor (CCR5 gene) promoter polymorphism on diabetic nephropathy in Japanese type 2 diabetic subjects.RESEARCH DESIGN AND METHODS—A total 616 Japanese subjects with type 2 diabetes were recruited. Polymorphisms of −28 C/G and −403 G/A in the RANTES gene promoter region, and of 59029 G/A in the CCR5 gene promoter region were detected by PCR-RFLP (restriction fragment length polymorphism). The association of these genotypes with nephropathy was analyzed.RESULTS—While the RANTES −403 genotype showed no association with nephropathy, the frequency of the −28G allele was significantly higher in the DN2 group (urinary albuminuria-to-creatinine ratio [ACR] ≧300 mg/g creatinine, serum creatinine &lt;2.0 mg/dl) than in the DN0 (ACR &lt;30 mg/g creatinine) and DN1 (ACR ≥30 mg/g creatinine and &lt;300 mg/g creatinine) groups. The frequency of a RANTES −28G-positive genotype (C/G or G/G) was higher in the DN2 group than in the DN0 and DN1 groups (34% vs. 25 and 20%, P = 0.0268, χ2 = 4.905), and the frequency of a CCR5 59029 A-positive genotype (G/A or A/A) was higher in the DN1 and DN2 groups than in the DN0 group (84 and 85% vs. 76%, P = 0.0123, χ2 = 6.269). Discriminant analysis showed that the RANTES −28G-positive genotype and CCR5 59029A-positive genotype were independently associated with nephropathy. The percentage of macroalbuminuria was twofold higher in the subjects having −28G or 59029A and threefold higher in the subjects having −28G and 59029A than in the subjects without −28G and 59029A.CONCLUSIONS—The RANTES promoter −28G genotype and CCR5 promoter 59029A genotype may be independent risk factors for diabetic nephropathy in patients with type 2 diabetes and may have an additive effect on nephropathy.
Frequency of Severe Hypoglycemia Requiring Emergency Treatment in Type 1 and Type 2 Diabetes
Authors: Leese Graham P. , Wang Jixian , Broomhall Janice , Kelly Paul , Marsden Andrew , Morrison William , Frier Brian M. , Morris Andrew D. ,   For the DARTS/MEMO Collaboration
Published: March 2007

OBJECTIVE—To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes.
RESEARCH DESIGN AND METHODS—Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, ambulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated.
RESULTS—A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients treated with insulin, respectively. Age, duration, and socioeconomic status were identified as risk factors for severe hypoglycemia. One in three cases were treated solely by the ambulance service with no other contact from health care professionals. The total estimated cost of emergency treatment of severe hypoglycemia was ≤£92,078 in one year.
CONCLUSIONS—Hypoglycemia requiring emergency assistance from health service personnel is as common in people with type 2 diabetes treated with insulin as in people with type 1 diabetes. It is associated with considerable NHS resource use that has a significant economic and personal cost.
Increasing Physical Activity in People With Type 2 Diabetes
Authors: Kirk Alison , Mutrie Nanette , MacIntyre Paul , Fisher Miles 
Published: March 2007

OBJECTIVE—To evaluate effect of exercise consultation on physical activity and resultant physiological and biochemical variables at 6 months in people with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n = 35) or not (n = 35). Exercise consultation, based on the transtheoretical model, combines motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Changes from baseline to 6 months were assessed in 1) physical activity (7-day recall, accelerometer, cardiorespiratory fitness, stage, and processes of change), 2) physiological variables (blood pressure and BMI), and 3) biochemical variables (HbA1c, lipid profile, and fibrinogen).
RESULTS—Between-group differences were recorded for the change in minutes of moderate activity (P &lt; 0.001) and activity counts (P &lt; 0.001) per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week (P &lt; 0.001). The control group recorded no significant changes. More experimental participants increased stage of change (χ2 = 22.6, P &lt; 0.001). Between-group differences were recorded for the change in total exercise duration and peak gradient (P &lt; 0.005), HbA1c (P = 0.02), systolic BP (P = 0.02), and fibrinogen (P = 0.03).
CONCLUSIONS—Exercise consultation increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes.
Do All Prepubertal Years of Diabetes Duration Contribute Equally to Diabetes Complications?
Authors: Donaghue Kim C. , Fairchild Jan M. , Craig Maria E. , Chan Albert K. , Hing Stephen , Cutler Lucy R. , Howard Neville J. , Silink Martin 
Published: March 2007

OBJECTIVE—This study was designed to explore the timeline of protection against complications in prepubertal children with diabetes, in particular the effects of diabetes duration before age 5 years.
RESEARCH DESIGN AND METHODS—In this study, 193 adolescents with prepubertal diabetes onset were followed longitudinally for retinopathy (early background and clinical) and microalbuminuria (albumin excretion rate &gt;7.5 μg/min and &gt;20 μg/min). Multiple logistic regression analysis was used to compare the effect of pre- and postpubertal diabetes duration on the risk of each complication in 90 subjects reassessed as young adults. For the entire cohort, Kaplan-Meier estimates were used to determine time free of each complication, and survival was compared in those diagnosed before and after age 5 years. Accelerated failure time modeling was used to estimate the effect of covariates, including diabetes duration before puberty, on the risk of complications.
RESULTS—Prepubertal duration improved the prediction for retinopathy over postpubertal duration alone in the young adults. The survival-free period of retinopathy and microalbuminuria was significantly longer (2–4 years) for those diagnosed before age 5 years compared with those diagnosed after age 5 years. Time to onset of all complications increased progressively with longer diabetes duration before gonadarche. Higher HbA1c during adolescence had an independent effect on the risk of retinopathy and microalbuminuria.
CONCLUSIONS—Prepubertal diabetes duration remains a significant predictor of retinopathy in young adults. The effect of time on the risk of retinopathy and microalbuminuria is nonuniform, with an increasing delay in the onset of complications in those with longer prepubertal duration. These findings are of major clinical importance when setting targets of glycemic control in young children who are at greatest risk of hypoglycemia.
Insulin Resistance, Inflammation, and Serum Fatty Acid Composition
Authors: Fernández-Real José-Manuel , Broch Montserrat , Vendrell Joan , Ricart Wifredo 
Published: March 2007

OBJECTIVE—Fatty acids (FAs) have been involved in the development of chronic inflammatory conditions such as insulin resistance and obesity. However, the relation among insulin resistance, obesity, inflammatory activity (circulating interleukin [IL]-6) and dietary FAs has been scarcely studied in otherwise healthy subjects.
RESEARCH DESIGN AND METHODS—We aimed to study these interactions in 123 overweight (BMI 26.9 ± 2.4 kg/m2 [means ± SD]) subjects and 109 lean (BMI 21.7 ± 1.7 kg/m2, P &lt; 0.000001) subjects. IL-6 was measured by immunoassay and FA by gas liquid cromatography.
RESULTS—The percentage of saturated FAs (r = 0.30, P = 0.01) and ω-6 FAs (r = −0.32, P = 0.001) were significantly associated with circulating IL-6, whereas the percentage of ω-3 FAs correlated negatively with C-reactive protein in overweight subjects (P = 0.04). Saturated-to-ω-3 and saturated-to-ω-6 FA ratios were significantly and positively associated with C-reactive protein (P &lt; 0.0001) and IL-6 (P &lt; 0.001), respectively. In contrast, none of these associations reached statistical significance in lean subjects. Those subjects in the most insulin-sensitive quintile (homeostasis model assessment value) showed a significantly higher percentage of linoleic acid (C18:2 ϖ6) (P = 0.03) and a significantly lower level of araquidic (C20:0) (P = 0.04), behenic (C22:0) (P = 0.009), lignoceric (C24:0) (P = 0.02), and nervonic (C24:1 ϖ9) (P = 0.001) FAs than the remaining subjects. In parallel, the most insulin-sensitive subjects showed significantly decreased C-reactive protein (P = 0.03). Serum C-reactive protein was significantly associated with percent linoleic acid and eicosapentaenoic acid in nonsmoking men (P = 0.03 and P = 0.04, respectively) and with docosahexaenoic acid in nonsmoking women (r = −0.46, P &lt; 0.0001). We constructed a multivariant regression analysis to predict circulating IL-6. Age, BMI, waist-to-hip ratio (WHR), smoking status, and the relation of saturated to ω-6 or saturated to ω-3 FAs were considered as independent variables separately in men and women. In overweight men, the ratio of saturated to ω-3 FAs (P = 0.01), but not age, sex, BMI, WHR, or smoking status, independently contributed to 17% of IL-6 variance. In lean men, smoking status (P = 0.02), but not the remaining variables, contributed to 8% of IL-6 variance.
CONCLUSIONS—Dietary FAs (as inferred from plasma FA concentration) seem to be linked to inflammatory activity in overweight subjects and in subjects with insulin resistance. Being overweight modulates the relation of FAs to inflammatory markers.
Lipid Testing Among Patients With Diabetes Who Receive Diabetes Care From Primary Care Physicians
Authors: Massing Mark W. , Henley Nancy S. , Carter-Edwards Lori , Schenck Anna P. , Simpson Ross J. 
Published: March 2007

OBJECTIVE—To identify factors related to lipid testing among patients with diabetes who receive diabetes care from primary care physicians.
RESEARCH DESIGN AND METHODS—North Carolina Medicare claims were used to identify individuals with diabetes who received diabetes care from primary care physicians. Lipid testing was related to sociodemographic characteristics, comorbid conditions, physician specialty, and mortality.
RESULTS—Based on Medicare claims from July 1997 through June 1999, 13,660 diabetic North Carolina residents with Medicare, 65–75 years of age, had received HbA1c testing from a single primary care physician during at least three of four consecutive 6-month time intervals. During these 2 years, 31% had no lipid profile and 24% had only one lipid profile. Caucasians were 1.6 times more likely than African Americans to receive lipid profiles. Patients not receiving state Medicare assistance were 1.4 times more likely to have a lipid profile than the presumably lower-income patients receiving assistance. Patients with stroke and heart failure were less likely to receive lipid profiles. Those with no lipid profile were almost twice as likely to die from cardiovascular disease than those with at least two lipid profiles.
CONCLUSIONS—Adherence to lipid testing recommendations by primary care physicians for elderly patients with diabetes has much room for improvement. The most vulnerable patients (African Americans, the economically disadvantaged, and the medically complex) are the least likely to receive lipid testing.