bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Postprandial Metabolic Control After Subcutaneous Injection of a Short-Acting Insulin Analog in IDDM of Short Duration With Residual Pancreatic β-Cell Function
Authors: Pampanelli Simone , Torlone Elisabetta , Ialli Carlo , Sindaco Paola Del , Ciofetta Marco , Lepore Mauro , Bartocci Linda , Brunetti Paolo , Bolli Geremia B 
Published: March 2007

OBJECTIVE
To compare postprandial metabolic control after subcutaneous injection of a short-acting insulin analog [Lys(B289),Pro(B29)] (Lispro) or human regular insulin (Humulin R U-100 [Hum-R]) in insulin-dependent diabetes mellitus (IDDM) of short duration with residual β-cell function.

RESEARCH DESIGN AND METHODS
Six IDDM patients (age 25 ± 2 years, diabetes duration 14 ± 2 months, HbA1c 6.4 ± 0.5%) with residual pancreatic β-cell function (fasting plasma C-peptide 0.19 ± 0.02 nmol/l) were studied on three different occasions. Postbreakfast plasma glucose was maintained at ∼ 7.1 mmol/l by means of intravenous insulin until either 1200 when 0.1 U/kg Hum-R was injected or until 1225 when 0.1 U/kg of either Hum-R or Lispro was injected subcutaneously. Lunch (mixed meal, 692 Kcal) was served at 1230 (0 min). Six nondiabetic control subjects were also studied.

RESULTS
After Lispro administration, the 120-min plasma glucose decreased more (6.1 ± 0.3 mmol/l) than after injection of Hum-R at −30 min (7.7 ± 0.3 mmol/l) or −5 min (9.9 ± 0.2 mmol/l). By the end of the study, plasma glucose was still lower after Lispro was injected (6.7 ± 0.3 mmol/l) than after Hum-R was injected at −30 min (7.6 ± 0.3 mmol/l) or −5 min (7.3 ± 0.2 mmol/l) (P &lt; 0.05). Two IDDM patients required glucose to prevent hypoglycemia after being injected with Lispro, but four required glucose after being injected with Hum-R at −5 min (Lispro ∼ 27 mmol glucose infused between 90 and 240 min; Hum-R ∼ 80 mmol between 240 and 390 min). After Lispro, plasma insulin peaked earlier (at 30 min, 342 ± 29 pmol/l) than after Hum-R injection at −30 min (at 90 min, 198 ± 28 pmol/l) and was superimposable on that of nondiabetic subjects. In Hum-R injected at −5 min, plasma insulin peaked later (at 120 min) and subsequently remained &gt; in the two other studies.

CONCLUSIONS
Despite the lack of a time interval between injection and meal, Lispro controls postprandial plasma glucose concentration better than Hum-R given 30 min before meals and, to an even greater extent, better than Hum-R given 5 min before meals. In addition, Lispro minimizes the risk of postprandial hypoglycemia, thus closely mimicking the postprandial glucose homeostasis of nondiabetic subjects. IDDM patients with residual pancreatic β-cell function are the ideal candidates for prandial use of Lispro because they can maintain near-normoglycemia longer after subcutaneous analog injection because of residual endogenous insulin secretion.
Steadily High IDDM Incidence Over 4 Years in Sardinia
Authors: Muntoni Sandro , Stabilini Liliana , Stabilini Marco , Mancosu Gabriella , Muntoni Sergio 
Published: March 2007

OBJECTIVE
To verify whether the high incidence of insulin-dependent diabetes mellitus (IDDM) in Sardinia is an epidemic outbreak or a steady phenomenon.

RESEARCH DESIGN AND METHODS
All newly diagnosed cases of IDDM with onset in patients 0–29 years of age between 1 January 1989 and 31 December 1992 among residents in Sardinia were obtained from the Sardinian IDDM Incidence Registry. The local IDDM patient association (Associazione Diabete Infantile Giovanile) served as the secondary and independent source.

RESULTS
The completeness of ascertainment was 91%. The age-standardized mean annual incidence of IDDM (per 100,000) was 34.4 in the 0- to 14-year-old age-group and 26.2 in the entire 0- to 29-year-old range, respectively. Men-to-women ratios were 1.38 and 1.55, respectively. Seasonal variation in incidence was observed, with a peak in fall and winter and a nadir in summer.

CONCLUSIONS
Sardinia has a very high and steady IDDM incidence rate, which is up to fivefold that of other Italian regions and Mediterranean countries and approaches the Finnish top rate in the world. Interaction between the genetic peculiarity of Sardinians and still unidentified powerful environmental agents is likely to account for the phenomenon.
Hypomagnesemia in Type II Diabetes: Effect of a 3-Month Replacement Therapy
Authors: Eibl Nicole L , Kopp Hans-Peter , Nowak Helga R , Schnack Christoph J , Hopmeier Pierre G , Schernthaner Guntram 
Published: March 2007

OBJECTIVE
To investigate the effects of long-term high-dose oral magnesium (Mg) therapy (30 mmol/day) in patients with type II diabetes. Low plasma magnesium levels have been reported in type II diabetes and are associated with insulin resistance and diabetic late complications.

RESEARCH DESIGN AND METHODS
Forty patients with type II diabetes and hypomagnesemia were observed in a randomized double-blind placebo-controlled trial for 3 months (body mass index: 28 ± 4 kg/m2; HbA1c: 7.4 ± 0.8%). Plasma and urine magnesium and metabolic control parameters were determined, and side effects were considered, especially with regard to patients' compliance.

RESULTS
A significant increase in plasma magnesium levels was observed after 3 months of treatment (Mg: 0.73 ± 0.8 vs. 0.81 ±0.1 mmol/1), reaching magnesium levels of the control group (0.88 ± 0.8 mmol/1; NS); metabolic control, however, was not altered (HbA1c: 7.2 ± 0.7 vs. 7.4 ± 0.9%). Six months after the end of the trial, plasma magnesium declined to pretreatment levels (Mg: 0.73 ± 0.07 mmol/1). The prevalence of side effects was high at the beginning and was reduced significantly during treatment.

CONCLUSIONS
We conclude that oral magnesium replacement therapy corrects hypomagnesemia after a minimum treatment period of 3 months. These observations might be important for the prevention of diabetic late complications.
The Independent Contributions of Diabetic Neuropathy and Yasculopatny in Foot Ulceration: How great are the risks?
Authors: McNeely Marguerite J , Boyko Edward J , Ahroni Jessie H , Stensel Victoria L , Reiber Gayle E , Smith Douglas G , Pecoraro Roger E 
Published: March 2007

OBJECTIVE
To describe the relative contributions of neurological and vascular abnormalities to the overall risk of diabetic foot ulceration.

RESEARCH DESIGN AND METHODS
A case-control study of diabetic veterans from the Seattle Veterans Affairs Medical Center was conducted using data collected from 46 patients with diabetic foot ulcers and 322 control subjects. Neuropathy was determined by vibratory, monofilament, and tendon reflex testing. Macro-vascular disease was measured by ankle-arm blood pressure index, and cutaneous perfusion was measured by transcutaneous oxygen tension (TcPO2) on the dorsal foot. A multi variate logistic regression model was used to adjust for confounding variables and to calculate the odds ratios (ORs) for each independent risk factor.

RESULTS
Three variables were significant independent predictors of foot ulceration: absence of Achilles tendon reflexes (adjusted OR 6.48, 95% confidence interval [CI] 2.37–18.06), insensate to the 5.07 monofilament (adjusted OR 18.42, 95% CI 3.83–88.47), and TcPO2 &lt;30 mmHg (adjusted OR 57.87, 95% CI 5.08–658.96). Absent vibratory sensation and low ankle-arm blood pressure index were not significant independent risk factors.

CONCLUSIONS
Both neuropathy and vasculopathy are strong independent risk factors for the development of diabetic foot ulcers. In our model, the strongest risk factor is impaired cutaneous oxygenation. However, in the clinical setting, sensory examination with a 5.07 monofilament probably remains the single most practical measure of risk assessment.
Impaired Left Ventricular Diastolic Function and Vascular Postischemic Vasodilation Associated with Microalbuminuria in IDDM Patients
Authors: Guglielmi Maria D , Pierdomenico Sante D , Salvatore Luigi , Romano Ferdinando , Tascione Evandro , Pupillo Mario , Porreca Ettore , Imbastaro Tiziana , Cuccurullo Franco , Mezzetti Andrea 
Published: March 2007

OBJECTIVE
Microalbuminuria is considered an important predictor of cardiovascular events in diabetic patients. In this study, a possible association of microalbuminuria with significant changes in left ventricular (LV) morphology and function and generalized vascular dysfunction was analyzed in insulin-dependent diabetes mellitus (IDDM) patients without hypertension, coronary artery disease, or autonomie dysfunction.

RESEARCH DESIGN AND METHODS
Thirty-four young long-term IDDM patients, 16 with and 18 without microalbuminuria, and 20 control subjects were studied. LV systolic function and wall thickness were evaluated by M-mode echocardiography. LV diastolic function was studied using a combined echo-Doppler and phonocardiographic technique. The hyperemic response to forearm ischemia was measured by strain-gauge plethysmography. All patients underwent 24-h ambulatory blood pressure monitoring.

RESULTS
LV mass index and wall thickness:radius ratio were significantly higher in microalbuminuric patients. LV relaxation was significantly impaired in both diabetic groups compared with control subjects; moreover, this impairment was significantly greater in microalbuminuric than in normoalbuminuric patients. In microalbuminuric patients, forearm postischemic vasodilation was also significantly lower and mean awake diastolic blood pressure (dBP) was significantly higher than in the other two groups.

CONCLUSIONS
Our data suggest that microalbuminuria is associated with significant changes in LV morphology, a more severe impairment of cardiac diastolic function, altered vascular dilatory capacity, and higher daytime dBP. Therefore, microalbuminuric patients should be considered to have a higher risk of cardiovascular complications and be kept under closer surveillance.
Apolipoprotein E Polymorphism as a Risk Factor for Vascular Disease in Diabetic Patients
Authors: Boemi Massimo , Sirolla Cristina , Amadio Loredana , Fumelli Paolo , Pometta Daniel , James Richard W 
Published: March 2007

OBJECTIVE
To examine the prevalence of cardiovascular disease in diabetic patients as a function of apolipoprotein (apo) E polymorphism.

RESEARCH DESIGN AND METHODS
The apo E phenotypes and plasma lipid, lipoprotein, and apo levels were determined for 517 Italian diabetic patients. The prevalence of cardiovascular disease (defined as ischemic heart disease [IHD] and/or peripheral vascular disease and/or cerebrovascular disease) was assessed as a function of apo E polymorphism at entry and after 4 years.

RESULTS
The occurrence of vascular disease did not differ significantly between diabetic patients in the various categories of apo E phenotype either at entry into the study or after 4 years. When expressed as a percentage of patients with disease, we observed—for E2, E3, and E4 carriers, respectively—at entry: IHD, 20.0% (n = 14), 21.0% (n = 79), and 21.5% (n = 14); and macroangiopathy, 24.3% (n = 17), 29.3% (n = 110), and 24.6% (n = 16). Apo E polymorphism did not make a significant contribution to multiple logistic regression models designed to identify the factors associated with the occurrence of vascular disease in diabetic patients.

CONCLUSION
Apo E polymorphism and, notably, the apo E4 allele cannot be universally considered as a particular risk factor for cardiovascular disease in diabetic patients.
A Multicenter Evaluation of Blood Glucose Awareness Training-II
Authors: Cox Daniel , Gonder-Frederick Linda , Polonsky William , Schlundt David , Julian Diana , Clarke William 
Published: March 2007

OBJECTIVE
Blood glucose awareness training (BGAT) teaches individuals with insulin-dependent diabetes to more accurately estimate/detect their blood glucose (BG) fluctuations. It has not, however, consistently resulted in improved ability to detect low BG. To assess an enhanced version of BGAT (BGAT-II), with more focus on increasing sensitivity to low BG events, a multicenter study was undertaken. Following up on previous findings that BGAT is most effective with individuals who are least accurate in estimating BG, this study explicitly recruited subjects who did and did not report reduced awareness of hypoglycemia.

RESEARCH DESIGN AND METHODS
Seventy-eight subjects from three research sites participated in a repeated baseline design. Subjects' BG estimation accuracy and BG profiles were assessed 6 months before, immediately before, and immediately after BGAT-II.

RESULTS
Post-treatment, BGAT-II led to better overall accuracy in detecting BG fluctuations and better detection of both low and high BG levels. This was achieved while the number of low readings of self-monitoring of blood glucose (SMBG) was reduced. Reduction in the number of low SMBG events was significant only for subjects reporting awareness of hypoglycemia. Detection of low BG was significant only for subjects reporting reduced awareness of hypoglycemia. Both groups demonstrated equivalent improvements in detection of high BG levels.

CONCLUSIONS
BGAT may be an eﬀective behavioral strategy for reversing hypoglycemic unawareness and an adjunct to intensive insulin therapy to reduce the occurrence of severe hypoglycemia.
Hypoglycemm Increases the Gastric Emptying Rate in Healthy Subjects
Authors: Schvarcz Erik , Palmér Mats , Åman Jan , Berne Christian 
Published: March 2007

OBJECTIVES
To compare the gastric emptying rate during normoglycemia with that during insulin-induced hypoglycemia in healthy subjects.

RESEARCH DESIGN AND METHODS
In eight healthy subjects, the rate of gastric emptying of an isotope-labeled meal was assessed by a scintigraphic technique during normoglycemia and hypoglycemia, both controlled by an insulin-glucose clamp.

RESULTS
The mean time taken to empty 50% of the test meal from the stomach (Tg0) for the solid phase was 43.0 ± 20.0 min during normoglycemia, compared with 16.3 ± 6.6 min during hypoglycemia, P &lt; 0.001. The mean T50 for the liquid phase was 38.0 ± 21.2 and 15.4 ± 10.6 min, respectively, P &lt; 0.001.

CONCLUSIONS
Insulin-induced hypoglycemia increases the gastric emptying rate in healthy subjects.
Earlier Appearance of Impaired Insulin Secretion Than of Visceral Adiposity in the Pathogenesis of NIDDM: 5-Year Follow-up of Initially Nondiabetic Japanese-American Men
Authors: Chen Kwang-Wen , Boyko Edward J , Bergstrom Richard W , Leonetti Donna L , Newell-Morris Laura , Wahl Patricia W , Fujimoto Wilfred Y 
Published: March 2007

OBJECTIVE
To identify risk factors for development of non-insulin-dependent diabetes mellitus (NIDDM) during a 5-year longitudinal follow-up of second-generation Japanese-American (Nisei) men.

RESEARCH DESIGN AND METHODS
For 5 years, 137 initially nondiabetic Nisei men were followed with 75-g oral glucose tolerance tests at the initial visit and at 2.5- and 5-year follow-up visits. Body fat distribution was assessed by computed tomography (CT) and body mass index (BMI) calculated at each visit. Fasting insulin and C-peptide, the increment of insulin and C-peptide at 30 min after the oral glucose load, intra-abdominal and total subcutaneous fat by CT, and BMI were compared between those who remained nondiabetic (non-DM) and those who had developed NIDDM at 2.5 years (DM-A) and 5 years (DM-B).

RESULTS
At baseline, the DM-A group had significantly increased intra-abdominal fat, elevated fasting plasma C-peptide, and lower C-peptide response at 30 min after oral glucose. At the 2.5-year follow-up, this group had markedly increased fasting plasma insulin and decreased 30-min insulin and C-peptide response to oral glucose. The DM-B group also had significantly lower insulin response at 30 min after oral glucose at baseline but no significant difference in intra-abdominal fat or fasting plasma insulin and C-peptide levels. When this group developed NIDDM by 5-year follow-up, however, an increase of intra-abdominal fat was found superimposed on the pre-existing lower insulin response. Fasting plasma insulin and C-peptide remained low.

CONCLUSION
In DM-A, lower 30-min insulin response to oral glucose (an indicator of β-cell lesion) and increased intra-abdominal fat and fasting C-peptide (indicators of insulin resistance) were the risk factors related to the development of NIDDM. DM-B subjects had a lower 30-min insulin response to oral glucose at baseline and increased intra-abdominal fat at 5-years, when they were found to have NIDDM. Thus, both insulin resistance and impaired β-cell function contribute to the development of NIDDM in Japanese-Americans, and impaired β-cell function may be present earlier than visceral adiposity in some who subsequently develop NIDDM.
The Relationship Between Smoking and Microvascular Complications in the EURODIAB IDDM Complications Study
Authors: Chaturvedi Nishi , Stephenson Judith M , Fuller John H ,   The EURODIAB IDDM Complications Study Group
Published: March 2007

OBJECTIVE
To examine the relationship between smoking and both glycemic control and microvascular complications in patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
This was a prevalence survey of 3,250 men and women aged 15–60 years with IDDM from 31 diabetes centers in 16 European countries. Participants completed a questionnaire, had retinal photographs taken, and performed a 24-h urine collection. HbA1c, frequency of hypoglycemic and ketoacidotic episodes, urinary albumin excretion rates, and retinopathy were compared by smoking category.

RESULTS
The prevalence of smoking was 35% in men and 29% in women. Current smokers had poorer glycemic control and, among men, were more likely to have had a ketoacidotic episode than were those who never smoked. Ex-smokers had equivalent glycemic control and marginally more hypoglycemic episodes did than those who never smoked. Current smokers had a higher prevalence of microalbuminuria and total retinopathy than did those who never smoked. Ex-smokers had a higher prevalence of macroalbuminuria and proliferative retinopathy than did those who never smoked, but both had a similar prevalence of microalbuminuria. Adjustment for either current or long-term glycemic control could not fully account for these differences.

CONCLUSIONS
Smoking is associated with poorer glycemic control and an increased prevalence of microvascular complications compared with not smoking. Ex-smokers can achieve glycemic control equivalent to and have a prevalence of early complications similar to that of those who never smoked. We suggest that poorer glycemic control can account for some of the increased risk of complications in smokers, and that quitting smoking would be effective in reducing the incidence of complications. Urgent action is required to reduce the high smoking rates in people with IDDM.
Hormonal Contraception in Women With IDDM: Influence on glycometabolic control and lipoprotein metabolism
Authors: Petersen Kresten R , Skouby Sven O , Vedel Pernille , Haaber Anne B 
Published: March 2007

OBJECTIVE
Safe and effective contraceptive methods are essential for women with insulin-dependent diabetes mellitus (IDDM), but opinions on the use of hormonal oral contraceptives by these women are conflicting. We evaluated the effects on glycometabolic control and lipoprotein metabolism in women with IDDM treated with an oral contraceptive not previously studied in a diabetic population.

RESEARCH DESIGN AND METHODS
A total of 22 women with IDDM received a monophasic combination of ethinyl estradiol and gestodene for 1 year; 20 women of comparable diabetic status using nonhormonal contraception were selected as control subjects. Evaluation was performed before and after 1, 3, 6, and 12 months of hormonal intake using nonparametric statistical methods.

RESULTS
Except for a higher median age of the control group, the baseline values for all clinical and metabolic variables were similar in the two groups, and in neither of the groups were changes in blood pressure, body mass index, or glycemic control observed. In the oral contraceptive group, decreased serum levels of low-density lipoprotein (LDL) cholesterol and increased levels of triglycerides and lipoprotein A were noted, whereas total cholesterol and high-density lipoprotein cholesterol levels were unchanged. In the control group, a decrease of LDL cholesterol was observed. No effect of tobacco smoking on glycometabolic control or lipoprotein metabolism could be demonstrated during hormonal intake.

CONCLUSIONS
No evidence of impaired glycometabolic control or adverse changes in serum levels of lipoproteins known to be associated with atherosclerosis was observed in women with well-controlled IDDM during 1 year of oral contraception with ethinyl estradiol and gestodene.
IDDM in the Province of Pavia, Italy, From a Population-Based Registry: A descriptive study
Authors: Tenconi Meria T , Devoti Gabriele , Albani Ileana , Lorini Renata , Martinetti Miryam , Fratino Pietro , Ferrari Ettore , Ferrero Enrico , Severi Francesca 
Published: March 2007

OBJECTIVE
To report the incidence of insulin-dependent diabetes mellitus (IDDM) in the Province of Pavia, Italy, in the 0- to 29-year-old age-group between 1988 and 1992. Urban versus rural residence, socioeconomic level, and family size of IDDM cases were also investigated.

RESEARCH DESIGN AND METHODS
A prospective register was established in 1988 to collect all newly diagnosed IDDM patients with onset before 30 years of age. The primary data source was based on notification of new cases by hospitals, out-patient clinics, family doctors, and pediatricians. The secondary and independent data source consisted of the registries of prescriptions for insulin syringes in the health districts of the province.

RESULTS
In 5 years (1988–1992), 66 cases of IDDM in the 0- to 29-year-old age-group were identified. The completeness of ascertainment was 100% for the combined sources. Age-adjusted (world-standardized) incidence rates per 100,000 (95% confidence interval) were 9.52 (6.42–13.61), 6.72 (4.68–9.34), and 8.27 (6.42–10.58), respectively, for the age-groups 0–14, 15–29, and 0–29. The rates were higher for residents in urban areas. The number of children in the families of IDDM patients was significantly higher than in the reference population.

CONCLUSIONS
Our data indicate the concordance of IDDM incidence rates with the North-Italian rates and a possible association of the disease with environmental factors. These factors might enhance the susceptibility to IDDM in genetically predisposed individuals.