bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome
Authors: Suri Rita S. , Clark William F. , Barrowman Nick , Mahon Jeffrey L. , Thiessen-Philbrook Heather R. , Rosas-Arellano M. Patricia , Zarnke Kelly , Garland Jocelyn S. , Garg Amit X. 
Published: March 2007

OBJECTIVE—To quantify the incidence of diabetes during the acute phase of diarrhea-associated hemolytic uremic syndrome (D+HUS) and to identify features associated with its development.
RESEARCH DESIGN AND METHODS—A systematic review and meta-analysis of articles assessing diabetes during D+HUS was conducted. Relevant citations were identified from Medline, Embase, and Institute for Scientific Information Citation Index databases. Bibliographies of relevant articles were hand searched. All articles were independently reviewed for inclusion and data abstraction by two authors.
RESULTS—Twenty-one studies from six countries were included. Only 2 studies reported a standard definition of diabetes; 14 defined diabetes as hyperglycemia requiring insulin. The incidence of diabetes during the acute phase of D+HUS could be quantified in a subset of 1,139 children from 13 studies (1966–1998, age 0.2–16 years) and ranged from 0 to 15%, with a pooled incidence of 3.2% (95% CI 1.3–5.1, random-effects model, significant heterogeneity among studies, P = 0.007). Children who developed diabetes were more likely to have severe disease (e.g., presence of coma or seizures, need for dialysis) and had higher mortality than those without diabetes. Twenty-three percent of those who developed diabetes acutely died, and 38% of survivors required long-term insulin (median follow-up 12 months). Recurrence of diabetes was possible up to 60 months after initial recovery.
CONCLUSIONS—Children with D+HUS should be observed for diabetes during their acute illness. Consideration should be given to long-term screening of D+HUS survivors for diabetes.
The Relation of Fasting and 2-h Postchallenge Plasma Glucose Concentrations to Mortality
Authors: Sorkin John D. , Muller Denis C. , Fleg Jerome L. , Andres Reubin 
Published: March 2007

OBJECTIVE—Under the auspices of the National Institutes of Health, American Diabetes Association, and World Health Organization, expert committees lowered the fasting plasma glucose (FPG) concentration diagnostic for diabetes from 7.8 to 7.0 mmol/l and defined 6.1–6.9 mmol/l as impaired fasting glucose (IFG) and &lt;6.1 mmol/l as normal fasting glucose. In 2003, IFG was lowered to 5.6–6.9 mmol/l and normal fasting glucose to &lt;5.6 mmol/l. Reports of the relationship between glucose concentration and all-cause mortality have been inconsistent. It is not known if the 2-h plasma glucose (2hPG) concentration from an oral glucose tolerance test (OGTT) adds to the predictive power of FPG.
RESEARCH DESIGN AND METHODS—We followed 1,236 men for an average of 13.4 years to determine the relationship between both FPG and 2hPG and all-cause mortality.
RESULTS—Risk for mortality did not increase until the FPG exceeded 6.1 mmol/l. Risk increased by ∼40% in the 6.1–6.9 mmol/l range and doubled when FPG ranged from 7.0 to 7.7 mmol/l. A combination of the 2hPG and FPG allowed better estimation of risk than the FPG alone. Within any category of FPG, risk generally increased as the 2hPG increased, and within any category of 2hPG, risk generally increased as the FPG increased.
CONCLUSIONS—These data support the decision to lower the FPG diagnostic for diabetes from 7.8 to 7.0 mmol/l, show that both IFG and impaired glucose tolerance have risks between the normal and diabetic ranges, and show that the OGTT adds predictive power to that of FPG alone and should not be abandoned. The lowering of IFG to 5.6 mmol/l from 6.1 mmol/l, at least for mortality, is, however, not supported by our results.
Does Diabetes Care Compete With the Provision of Women’s Preventive Care Services?
Authors: Tabaei Bahman P. , Herman William H. , Jabarin Annissa F. , Kim Catherine 
Published: March 2007

OBJECTIVE—Care for chronic diseases may compete with preventive health care. To test this hypothesis, we examined the association between diabetes-related processes of care and preventive care in women.
RESEARCH DESIGN AND METHODS—Using data from a prospective cohort study of diabetes care in managed care settings, we reviewed the care 540 diabetic women received from 355 primary care providers within 14 provider groups from one health plan. Of the 540 women, 278 were eligible to receive mammograms and 314 were eligible to receive Pap smears. Mammography performance was measured as at least one mammogram over a 2-year period and Pap performance was measured as at least one Pap smear over a 3-year period. To assess the association between diabetes-related processes of care and preventive services, we used hierarchical logistic regression models, accounted for clustering within provider groups, and adjusted for patient age, race, income and education level, diabetes treatment and duration, and health status, as well as physician age, sex, years of practice, and specialty. Diabetes-related processes of care were defined as dilated retinal examinations, urine microalbumin/protein testing, foot examinations, lipid and HbA1c testing, recommendations to take aspirin, and influenza vaccinations received over a 1-year period.
RESULTS—In this cohort, 73% of eligible women received mammograms and 56% received Pap smears. After adjustment of models, better diabetes-related processes of care, better health status, and non-Medicaid insurance were associated with mammography performance. Better diabetes-related processes of care, younger patient age, and any visit to a gynecologist were associated with Pap performance.
CONCLUSIONS—Better processes of diabetes care were associated with better women’s preventive health care. Diabetes management did not compete with sex-specific screening.
Postpartum Physical Activity and Related Psychosocial Factors Among Women With Recent Gestational Diabetes Mellitus
Authors: Smith Ben J. , Cheung N. Wah , Bauman Adrian E. , Zehle Katharina , McLean Mark 
Published: March 2007

OBJECTIVE—In this study, we examined patterns of postpartum physical activity among women with recent gestational diabetes mellitus (GDM) and psychosocial factors related to this behavior that could be addressed in diabetes prevention interventions.
RESEARCH DESIGN AND METHODS—A random sample of women who had attended diabetes clinics in Sydney, Australia, in the past 6–24 months for treatment of GDM were surveyed by telephone. Variables measured included physical activity behaviors, self-efficacy, social support, and barriers to participation.
RESULTS—Of 226 women who completed the survey (mean age 33.4 years), 26.5% were classified as sedentary, and only 33.6% reported sufficient physical activity as recommended by health authorities. Walking was the most popular physical activity, and most women reported no other moderate- or vigorous-intensity activity. Lack of assistance with child care (49.1%) and insufficient time (37.6%) were the most common barriers to physical activity. The type of social support most often reported was verbal encouragement (39.1%), with more than half of the women never receiving assistance with housework or others exercising with them. Self-efficacy for physical activity was lowest when women were under time pressure or tired. Multivariate analyses showed that sufficient physical activity was associated with high social support (odds ratio 2.5 [95% CI 1.21–3.79]) and high self-efficacy (2.09 [1.06–3.20]).
CONCLUSIONS—The prevalence of sufficient physical activity was found to be low and strongly related to social support and self-efficacy. This is an important group to whom diabetes prevention strategies can be targeted.
Resistance to Insulin Therapy Among Patients and Providers
Authors: Peyrot Mark , Rubin Richard R. , Lauritzen Torsten , Skovlund Soren E. , Snoek Frank J. , Matthews David R. , Landgraf Rüdiger , Kleinebreil Line ,   on behalf of the International DAWN Advisory Panel
Published: March 2007

OBJECTIVE—To examine the correlates of patient and provider attitudes toward insulin therapy.
RESEARCH DESIGN AND METHODS—Data are from surveys of patients with type 2 diabetes not taking insulin (n = 2,061) and diabetes care providers (nurses = 1,109; physicians = 2,681) in 13 countries in Asia, Australia, Europe, and North America. Multiple regression analysis is used to identify correlates of attitudes toward insulin therapy among patients, physicians, and nurses.
RESULTS—Patient and provider attitudes differ significantly across countries, controlling for individual characteristics. Patients rate the clinical efficacy of insulin as low and would blame themselves if they had to start insulin therapy. Self-blame is significantly lower among those who have better diet and exercise adherence and less diabetes-related distress. Patients who are not managing their diabetes well (poor perceived control, more complications, and diabetes-related distress) are significantly more likely to see insulin therapy as potentially beneficial. Most nurses and general practitioners (50–55%) delay insulin therapy until absolutely necessary, but specialists and opinion leaders are less likely to do so. Delay of insulin therapy is significantly less likely when physicians and nurses see their patients as more adherent to medication or appointment regimens, view insulin as more efficacious, and when they are less likely to delay oral diabetes medications.
CONCLUSIONS—Patient and provider resistance to insulin therapy is substantial, and for providers it is part of a larger pattern of reluctance to prescribe blood glucose–lowering medication. Interventions to facilitate timely initiation of insulin therapy will need to address factors associated with this resistance.
Comparison of a Needle-Type and a Microdialysis Continuous Glucose Monitor in Type 1 Diabetic Patients
Authors: Wentholt Iris M. , Vollebregt Marit A. , Hart Augustus A. , Hoekstra Joost B. , DeVries J. Hans 
Published: March 2007

OBJECTIVE—We examined the reliability of two continuous glucose sensors in type 1 diabetic patients at night and during rapid glucose excursions and verified the hypothesized nocturnal hypoglycemic drift of the needle-type sensor (CGMSgold) and delay of the microdialysis sensor (GlucoDay).
RESEARCH DESIGN AND METHODS—Blood was sampled overnight twice per hour in 13 patients. Rapid-acting insulin was given subcutaneously 30 min after breakfast. Sampling once per minute started 45 min after breakfast and 75 min after insulin injection for 30 min, with the aim of determining peak and nadir glucose values. Mean absolute differences (MADs) between sensor and blood glucose values were calculated. Sensor curves were modeled for all patients using linear regression. Horizontal and vertical shifts of sensor curves from the blood glucose curves were assessed. A vertical shift indicates sensor drift and a horizontal shift sensor delay.
RESULTS—Drift was minimal in the needle-type and microdialysis sensors (−0.02 and −0.04 mmol/l). Mean ± SD delay was 7.1 ± 5.5 min for the microdialysis sensor (P &lt; 0.001). MAD was 15.0% for the needle-type sensor and 13.6% for the microdialysis sensor (P = 0.013). After correction for the 7-min delay, the microdialysis MAD improved to 11.7% (P &lt; 0.0001).
CONCLUSIONS—The microdialysis sensor was more accurate than the needle-type sensor, with or without correction for a 7-min delay. In contrast to the previous version, the current needle-type sensor did not exhibit nocturnal hypoglycemic drift. Continuous subcutaneous glucose sensors are valuable adjunctive tools for glucose trend analyses. However, considering the large MADs, individual sensor values should be interpreted with caution.
Serum Interleukin-18 Levels Are Associated With Nephropathy and Atherosclerosis in Japanese Patients With Type 2 Diabetes
Authors: Nakamura Akihiko , Shikata Kenichi , Hiramatsu Makoto , Nakatou Tatsuaki , Kitamura Takuya , Wada Jun , Itoshima Tatsuya , Makino Hirofumi 
Published: March 2007

OBJECTIVE—Interleukin (IL)-18 is a proinflammatory cytokine secreted from mononuclear cells. Serum concentration of IL-18 is a strong predictor of death in patients with cardiovascular diseases. Recent studies have shown that microinflammation is involved in the pathogenesis of diabetic nephropathy as well as of cardiovascular diseases. This study aimed to test the hypothesis that the serum level of IL-18 is a common predictor of nephropathy and atherosclerosis in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Eighty-two Japanese patients with type 2 diabetes and 55 age- and sex-matched healthy control subjects were enrolled. Patients with renal dysfunction (creatinine clearance &lt;1 ml/s) were excluded. We assessed clinical parameters and measured serum and urinary IL-18 levels, serum IL-6 levels, carotid intima-media thickness (IMT), and brachial-ankle pulse wave velocity (baPWV) in all patients. Further, we evaluated changes of urinary albumin excretion rate (AER) after 6 months in 76 diabetic patients.
RESULTS—Serum and urinary IL-18 levels were significantly elevated in patients with type 2 diabetes as compared with control subjects (serum IL-18 179 ± 62 vs. 121 ± 55 pg/ml, P &lt; 0.001; urinary IL-18 97 ± 159 vs. 47 ± 54 pg/ml, P = 0.035). Univariate linear regression analysis showed significant positive correlations between serum IL-18 and AER (r [correlation coefficient] = 0.525, P &lt; 0.001), HbA1c (r = 0.242, P = 0.029), high-sensitivity C-reactive protein (hs-CRP) (r = 0.240, P = 0.031), and urinary β-2 microglobulin (r = 0.235, P = 0.036). Serum IL-18 levels also correlated positively with carotid IMT (r = 0.225, P = 0.042) and baPWV (r = 0.232, P = 0.040). We also found a significant correlation between urinary IL-18 and AER (r = 0.309, P = 0.005). Multivariate linear regression analysis showed that AER (standard correlation coefficients [B] = 0.405, P &lt; 0.001) and hs-CRP (B = 0.207, P = 0.033) were independently associated with serum IL-18 levels. AER was also independently associated with urinary IL-18 levels (B = 0.295, P = 0.005). Moreover, serum and urinary IL-18 levels correlated positively with AER after 6 months (r = 0.489, P &lt; 0.001 and r = 0.320, P = 0.005) and changes in AER during the follow-up period (r = 0.268, P = 0.018 and r = 0.234, P = 0.042).
CONCLUSIONS—Serum levels of IL-18 might be a predictor of progression of diabetic nephropathy as well as cardiovascular diseases.
Total Contact Casting of the Diabetic Foot in Daily Practice
Authors: Nabuurs-Franssen Marrigje H. , Sleegers Ron , Huijberts Maya SP , Wijnen Wiel , Sanders Antal P. , Walenkamp Geert , Schaper Nicolaas C. 
Published: March 2007

OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P &lt; 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P &lt; 0.05). Median duration of cast treatment was 34 days. New ulcers, all superfical, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days.CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
Initiating Insulin Therapy in Type 2 Diabetes
Authors: Raskin Philip , Allen Elsie , Hollander Priscilla , Lewin Andrew , Gabbay Robert A. , Hu Peter , Bode Bruce , Garber Alan ,   for the INITIATE Study Group
Published: March 2007

OBJECTIVE—Safety and efficacy of biphasic insulin aspart 70/30 (BIAsp 70/30, prebreakfast and presupper) were compared with once-daily insulin glargine in type 2 diabetic subjects inadequately controlled on oral antidiabetic drugs (OADs).
RESEARCH DESIGN AND METHODS—This 28-week parallel-group study randomized 233 insulin-naive patients with HbA1c values ≥8.0% on &gt;1,000 mg/day metformin alone or in combination with other OADs. Metformin was adjusted up to 2,550 mg/day before insulin therapy was initiated with 5–6 units BIAsp 70/30 twice daily or 10–12 units glargine at bedtime and titrated to target blood glucose (80–110 mg/dl) by algorithm-directed titration.
RESULTS—A total of 209 subjects completed the study. At study end, the mean HbA1c value was lower in the BIAsp 70/30 group than in the glargine group (6.91 ± 1.17 vs. 7.41 ± 1.24%, P &lt; 0.01). The HbA1c reduction was greater in the BIAsp 70/30 group than in the glargine group (−2.79 ± 0.11 vs. −2.36 ± 0.11%, respectively; P &lt; 0.01), especially for subjects with baseline HbA1c &gt;8.5% (−3.13 ± 1.63 vs. −2.60 ± 1.50%, respectively; P &lt; 0.05). More BIAsp 70/30–treated subjects reached target HbA1c values than glargine-treated subjects (HbA1c ≤6.5%: 42 vs. 28%, P &lt; 0.05; HbA1c &lt;7.0%: 66 vs. 40%, P &lt; 0.001). Minor hypoglycemia (episodes/year) was greater in the BIAsp 70/30 group than in the glargine group (3.4 ± 6.6 and 0.7 ± 2.0, respectively; P &lt; 0.05). Weight gain and daily insulin dose at study end were greater for BIAsp 70/30–treated subjects than for glargine-treated subjects (weight gain: 5.4 ± 4.8 vs. 3.5 ± 4.5 kg, P &lt; 0.01; insulin dose: 78.5 ± 39.5 and 51.3 ± 26.7 units/day, respectively).
CONCLUSIONS—In subjects with type 2 diabetes poorly controlled on OADs, initiating insulin therapy with twice-daily BIAsp 70/30 was more effective in achieving HbA1c targets than once-daily glargine, especially in subjects with HbA1c &gt;8.5%.
Prognostic Effect of Insertion/Deletion Polymorphism of the ACE Gene on Renal and Cardiovascular Clinical Outcomes in Chinese Patients With Type 2 Diabetes
Authors: Wang Ying , Ng Maggie C.Y. , So Wing Yee , Tong Peter C.Y. , Ma Ronald C.W. , Chow Chun Chung , Cockram Clive S. , Chan Juliana C.N. 
Published: March 2007

OBJECTIVE— The insertion/deletion (I/D) polymorphism of the ACE gene has been reported to be associated with diabetic microvascular or macrovascular complications. The aim of the present study was to investigate the prognostic effect of I/D polymorphism on renal and cardiovascular clinical outcomes in Chinese patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS— A consecutive cohort of 1,281 Chinese patients with type 2 diabetes were followed for 41.3 ± 21.6 months. Renal end points were defined as renal death and events (need for dialysis, plasma creatinine ≥500 μmol/l, or doubling of plasma creatinine of baseline value ≥150 μmol/l). Cardiovascular end points were defined as cardiovascular death and events, which included ischemic heart disease, heart failure, cerebrovascular accident, and revascularization requiring hospital admission. The I/D polymorphism of the ACE gene was examined by PCR followed by agarose gel electrophoresis.
RESULTS— The frequencies of ACE gene I/D polymorphisms were in Hardy-Weinberg equilibrium. Patients who developed a renal end point (n = 98) had higher frequencies of DD genotype (19.4 vs. 10.8%, P = 0.018) and D allele (41.3 vs. 31.8%, P = 0.006) compared with subjects who did not (n = 1,183). The cumulative rates of renal end points were 10.0, 19.2, and 24.4% in the II (n = 595), DI (n = 539), and DD genotype carriers (n = 147), respectively (log rank P = 0.004). In multiple Cox regression analysis, the occurrence of renal end points remained significantly influenced by I/D polymorphism with a dominant deleterious effect of the DD genotype (DD versus II, adjusted hazard ratio 2.80 [95% CI 1.49–5.29]). There was no prognostic effect of I/D polymorphism on cardiovascular end points.
CONCLUSIONS— The DD genotype of the ACE I/D polymorphism was an independent risk factor for renal but not cardiovascular end points in Chinese patients with type 2 diabetes.
Repaglinide Administration Improves Brachial Reactivity in Type 2 Diabetic Patients
Authors: Manzella Daniela , Grella Rodolfo , Abbatecola Angela Marie , Paolisso Giuseppe 
Published: March 2007

OBJECTIVE—Several studies have demonstrated that endothelial dysfunction plays a central role in diabetic mortality and that the prooxidative effect of postprandial hyperglycemia may actively contribute to atherogenesis. Thus, we investigated the possible effect of short-acting (repaglinide) and long-acting (glibenclamide) insulin secretagogues on endothelial function in type 2 diabetic patients.RESEARCH DESIGN AND METHODS—Sixteen type 2 diabetic patients undergoing diet treatment and with poor glucose control volunteered for the study. The study was designed as a 4-month, randomized, cross-over, parallel-group trial of repaglinide (1 mg twice a day) versus glibenclamide (5 mg twice a day). All patients underwent the following investigations: 1) anthropometrics determinations, 2) blood sampling for routine laboratory analyses and for assessment of oxidative stress indexes, and 3) a brachial reactivity test to evaluate the endothelial function through the study of arterial diameter and flow changes with and without intraarterial infusion of NG-monomethyl-l-arginine, an inhibitor of nitric oxide synthase and tetraethylammonium chloride (TEA), a Ca2+-activated K+ (KCa) channel blocker. All patients were randomly assigned to receive repaglinide or glibenclamide for a period of 4 weeks.RESULTS—Repaglinide administration was associated with a significant reduction in 2-h plasma glucose levels (P &lt; 0.001) and in plasma thiobarbituric acid–reactive substances (TBARS) concentrations (P &lt; 0.001) and with a significant increase in plasma antioxidant power, assessed as Trolox equivalent antioxidant capacity (TEAC) (P &lt; 0.001), effects not observed after glibenclamide administration. With regard to brachial reactivity parameters, repaglinide but not glibenclamide was associated with a significant improvement in brachial reactivity parameters (P &lt; 0.003 for all parameters). In contrast, intra-arterial infusion ofl-NMMA and TEA reduced the beneficial effect of repaglinide.CONCLUSIONS—Repaglinide administration, through good control of postprandial glucose levels, improves brachial reactivity and declines oxidative stress indexes.