bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoantibodies to Sympathetic Ganglia, GAD, or Tyrosine Phosphatase in Long-Term IDDM With and Without ECG-Based Cardiac Autonomic Neuropathy
Authors: Muhr Daniela , Mollenhauer Ulrike , Ziegler Anette-Gabriele , Haslbeck Manfred , Standl Eberhard , Schnell Oliver 
Published: March 2007

OBJECTIVE
To evaluate the association of autoantibodies to complement-fixing sympathetic ganglia (CF-SG), and tyrosine phosphatase (IA-2) with electrocardiogram (ECG)-based cardiac autonomic neuropathy (CAN) in long-term IDDM.

RESEARCH DESIGN AND METHODS
We examined the prevalence of autoantibodies to CF-SG (by complement-fixing indirect immunoflourescence), GAD, and IA-2 (by radioligand assay) and islet cells (by indirect immunofluorescence) in 96 long-term IDDM patients (41 with ECG-based CAN, ≥ 2 of 5 cardiac reflex tests abnormal; 55 without ECG-based CAN). As a control group, 89 healthy nondiabetic subjects were investigated.

RESULTS
CF-SG autoantibodies were observed more frequently in long-term IDDM patients than in the control group (25 vs. 4%, P = 0.0001). Of the IDDM patients, 14 (34%) with CAN and 10 (18%) without CAN presented with CF-SG autoantibodies (P = 0.06). GAD or IA-2 autoantibodies were detected in 14 (34%) and 17 (41%) IDDM patients with CAN, compared with 24 (44%) and 29 (53%) IDDM patients without CAN (P = 0.2, P = 0.2). Islet cell antibodies were observed in 6 (15%) IDDM patients with and in 9 (16%) IDDM patients without CAN (P = 0.5).

CONCLUSIONS
In long-term IDDM, the role of CF-SG autoantibodies, which tend to be more frequent in patients with ECG-based CAN, requires further investigations. The persistence of GAD and IA-2 autoantibodies is not related to ECG-based CAN.
Brain Abnormalities Demonstrated by Magnetic Resonance Imaging in Adult IDDM Patients With and Without a History of Recurrent Severe Hypoglycemia
Authors: Perros Petros , Deary Ian J , Sellar Robin J , Best Jonathan JK , Frier Brian M 
Published: March 2007

OBJECTIVE
Previous studies of a cohort of 100 patients with IDDM have shown that a history of recurrent severe hypoglycemia is associated with a modest impairment of cognitive function. The aim of the present study was to determine whether IDDM patients with and without a history of severe hypoglycemia have lesions in the brain that are identifiable by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) and to investigate the putative relationship of any structural brain abnormalities with cognitive function.

RESEARCH DESIGN AND METHODS
MRI and MRS of the brain were performed in 22 patients from the original cohort. Eleven IDDM patients with no history of severe hypoglycemia (group A) were compared with 11 IDDM patients who had a history of five or more episodes of severe hypoglycemia (group B).

RESULTS
Nine patients (41%) had abnormal scans. Two types of abnormalities were observed: high-intensity rounded lesions, &gt; 3 mm in diameters, distributed in the periventricular white matter (leukoaraiosis) in four patients; and cortical atrophy in five patients. Five patients in group B had cortical atrophy, whereas no patient in group A demonstrated this feature (P &lt; 0.05). MRS of the frontal and parietal lobes showed no differences in the N-acetyl aspartate/creatine or N-acetyl aspartate/choline ratios between groups A and B. Patients with cortical atrophy showed a nonsignificant trend toward reduced performance on Rapid Visual Information Processing.

CONCLUSIONS
Brain abnormalities demonstrated by MRI are common in patients with IDDM of long duration and are suggestive of premature aging of the brain. IDDM per se may be an important pathogenic factor, but a significant association was observed between a history of recurrent severe hypoglycemia and cortical atrophy, which may be related to the modest impairment of cognitive function that has been reported previously.
Comparison of Laboratory Test Frequency and Test Results Between African-Americans and Caucasians With Diabetes: Opportunity for Improvement: Findings from a large urban health maintenance organization
Authors: Wisdom Kimberlydawn , Fryzek Jon P , Havstad Suzanne L , Anderson Robert M , Dreiling Michael C , Tilley Barbara C 
Published: March 2007

OBJECTIVE
To compare African-American and Caucasian patients with preexisting diabetes in a health maintenance organization (HMO) on: 1) frequency with which they received a subset of recommended laboratory tests according to the American Diabetes Association (ADA) consensus guidelines and 2) the results of laboratory test values (glycosylated hemoglobin, cholesterol, and creatinine).

RESEARCH DESIGN AND METHODS
A cross-sectional study of 2,312 HMO members with diabetes continuously enrolled during 1991 was conducted using computerized medical record and billing data. Receipt of the ADA recommended tests for glycosylated hemoglobin, cholesterol, and creatinine was compared between African-Americans and Caucasians, stratified by insulin requirements. In addition, group comparisons were made based on the laboratory test results.

RESULTS
Less than 20 percent of all subjects received the recommended number of ADA tests. This did not differ by race except for creatinine and cholesterol testing in insulin users only, where African-Americans had more tests. On average, after adjusting for covariates, African-Americans had significantly higher glycosylated hemoglobin and creatinine laboratory values. Both groups had elevated cholesterol values.

CONCLUSIONS
The opportunity exists to improve the process of care for both African-Americans and Caucasians with diabetes in an HMO setting. The need to improve glycosylated hemoglobin results and subsequently limit complications is especially pressing among the African-American population.
Age and Sex Effects on HbA1c: A study in a healthy Chinese population
Authors: Yang Yi-Ching , Lu Feng-Hwa , Wu Jin-Shang , Chang Chih-Jen 
Published: March 2007

OBJECTIVE
To evaluate whether glycohemoglobin levels increase with age in both sexes and to determine the effect of BMI on this increment.

RESEARCH DESIGN AND METHODS
A cross-sectional survey of 4,580 healthy Chinese men and women, aged 20–85 years, was performed. All subjects who did not have identifiable diseases and who were not on medication known to influence glucose tolerance were recruited from participants at the preventive services of the National Cheng-Kung University Hospital. As an indicator of plasma glucose levels, glycohemoglobin was measured. The subjects were classified according to their age and BMI for both men and women, and any relationships with glycohemoglobin levels were evaluated.

RESULTS
In all the BMI groups divided into quartiles, glycohemoglobin levels increased with age. The largest elevation of glycohemoglobin was observed in the 45- to 54-year-old age-group, except in men with a BMI between the lowest and highest quartiles. The group with a BMI above the highest quartile had a higher glycohemoglobin than the group with a BMI below the lowest quartile in men aged &lt; 54 years and women aged 35–64 years. Men had higher average glycohemoglobin levels than women &lt; 55 years of age.

CONCLUSIONS
The age factor itself may cause an elevation in glycohemoglobin independent of other age-related factors in Chinese men and women, and there is a sex difference with a lower average glycohemoglobin level in women before menopause. Furthermore, BMI, but not a family predisposition to diabetes or leisure-time physical activity, affects this age-dependent increase in glycohemoglobin levels.
Stability of Insulin Lispro in Insulin Infusion Systems
Authors: Lougheed William D , Zinman Bernard , Strack Thomas R , Janis Linda J , Weymouth Alexandra B , Bernstein Elyse A , Korbas Annette M , Frank Bruce H 
Published: March 2007

OBJECTIVE
To test stability of insulin lispro in two insulin infusion systems over 48 h.

RESEARCH DESIGN AND METHODS
We used reverse-phase and size-exclusion high-performance liquid chromatography (HPLC) to determine the purity, potency, and degree of polymerization of U100 insulin lispro (Humalog) after 24- and 48-h pump cycles conducted at 37°C in five Disetronic H-TRON V100 and five MiniMed 504 pumps. Pumps were set to deliver a basal rate of 0.5 U/h and 6-U boluses at t = 0, 4, 8, 24, 24.5, 28.5, 32.5, and 48 h during each cycle. The effluent was collected into 1-ml vials, pooled at 24 or 48 h, and stored at 4°C until assay. After each 48-h run period of insulin delivery, assays for potency, polymer, and purity were performed on the pooled samples from each individual cycle. m-cresol content and the pooled reservoir content were assayed in the 48-h pooled samples.

RESULTS
Insulin lispro retained full HPLC potency (Δ ≤ 4%) at 48 h, with no degradation of insulin lispro to des-amidoinsulin forms (24 or 48 h). No increase in pumped insulin polymer concentration was observed following 24 h of pump flow. Nonsignificant increases of ≤0.09% (Disetronic) and ≤0.15% (MiniMed) from initial concentrations of 0.18% (polymer divided by total insulin) were detected in three of five pump cycles at 48 h when compared with 37°C paired controls. Nonsignificant decreases (&lt;5 and 10%, Disetronic and MiniMed, respectively) of m-cresol content occurred in both systems following 48 h storage in each device, but sterility was not compromised by this decrease (initial m-cresol concentration, 3.15 mg/ml). Pump performance was without mechanical or electrical fault throughout the study Basal and bolus insulin delivery was evaluated three times daily and remained as expected. Occlusion of catheters by insulin precipitation did not occur, and no change in pH was observed following delivery.

CONCLUSIONS
We conclude that insulin lispro is suitable for prolonged infusion in these two medical devices when syringes and catheters are replaced at 48-h intervals.
The Homeostasis Model in the San Antonio Heart Study
Authors: Haffner Steven M , Miettinen Heikki , Stern Michael P 
Published: March 2007

OBJECTIVE
Both insulin resistance and decreased insulin secretion have been shown to predict the development of NIDDM. However, methods to assess insulin sensitivity and secretion are complicated and expensive to apply in epidemiological studies. The homeostasis model assessment (HOMA) has been suggested as a method to assess insulin resistance and secretion from the fasting glucose and insulin concentrations. However, this method has not been extensively evaluated, particularly in different ethnic groups.

RESEARCH DESIGN AND METHODS
We applied the HOMA model to cross-sectional analyses of the San Antonio Heart Study (n = 2,465).

RESULTS
HOMA insulin resistance (IR) was very strongly correlated with fasting insulin (r = 0.98) and HOMA β-cell function (β-cell) was moderately correlated with the 30-min increment in insulin concentration over the 30-min increment in glucose concentration (Δ I30/Δ G30) in an oral glucose tolerance test (OGTT) (r = 0.44). NIDDM was characterized by both high HOMA IR and low HOMA β-cell function. In Mexican-Americans, HOMA IR in NIDDM subjects was 9.5 compared with 2.7 in normal glucose tolerance (NGT) subjects. In contrast, HOMA β-cell function showed only small differences in Mexican-Americans (176 NIDDM; 257 NGT). However, the ΔI30/ΔG30 (pmol/mmol) showed much larger differences (75 NIDDM; 268 NGT). When modeled separately, impaired glucose tolerance (IGT) was characterized by high HOMA IR and high HOMA β-cell function. However, when analyzed in the same regression model, high HOMA IR and low HOMA β-cell function characterized subjects with IGT. These results were similar in both ethnic groups. Mexican-Americans had increased insulin resistance (as judged by both HOMA IR and fasting insulin) and insulin secretion (by HOMA β-cell and ΔI30/ΔG30) relative to non-Hispanic whites.

CONCLUSIONS
We conclude that HOMA provides a useful model to assess insulin resistance and β-cell function in epidemiological studies in which only fasting samples are available and that, further, it is critical to take into account the degree of insulin resistance in assessing insulin secretion by the HOMA model.
Dexfenfluramine in Obese Chinese NIDDM Patients: A placebo-controlled investigation of the effects on body weight, glycemic control, and cardiovascular risk factors
Authors: Chow Chun-Chung , Ko Gary TC , Tsang Lynn WW , Yeung Vincent TF , Chan Juliana CN , Cockram Clive S 
Published: March 2007

OBJECTIVE
To investigate the safety, efficacy, and metabolic effects of dexfenfluramine in obese Chinese NIDDM patients.

RESEARCH DESIGN AND METHODS
Thirty-two patients, mean (± SD) body weight 76.2 ± 8.5 kg with corresponding BMI 31.1 ± 2.1 kg/m2, were randomized into a two-phase study, after a 2-week single-blind run-in period on placebo. Phase 1 was a randomized 3-month double-blind placebo-controlled trial during which either dexfenfluramine or placebo was added to the existing treatment regimens of diet plus or minus sulfonylureas without metformin. Phase 2 was a further 3-month single-blind trial during which the placebo group was given dexfenfluramine without patients' knowledge of changing to active medication, while the active group continued with dexfenfluramine. Body weight, glycemic control, blood pressure, lipids, and quality of life were assessed before and at 3 and 6 months after randomization. A total of 27 patients were also followed for an additional period of 6–12 months (215 ± 53 days) after dexfenfluramine treatment was withdrawn.

RESULTS
During the run-in period, both groups were comparable for all parameters measured. At 3 months, mean changes in BMI were −1.2 ± 1.0 kg/m2 (dexfenfluramine) vs. −0.1 ± 0.5 kg/m2 (placebo) (P &lt; 0.001). The mean changes in fasting plasma glucose were −1.14 ± 0.99 vs. 0.51 ± 1.34 mmol/l (dexfenfluramine vs. placebo, P = 0.004). HbA1c also significantly improved in the dexfenfluramine group (−0.80 ± 0.53 vs. 0.25 ± 0.64%, P &lt; 0.001). During the 3-month single-blind dexfenfluramine treatment in the ex-placebo group, there were similar improvements in body weight and glycemic indexes. After cessation of dexfenfluramine therapy at 6 months, significant increases in body weight and glycemic indexes, almost back to the baseline, were observed for both groups.

CONCLUSIONS
Dexfenfluramine aids weight loss and improves glycemic control in obese Chinese NIDDM patients over a 3- to 6-month period. These effects are emphasized after withdrawal of treatment and further support the longer-term use of dexfenfluramine for chronic complicated obesity.
Effect of Race on Outcome After Kidney and Kidney-Pancreas Transplantation in Type 1 Diabetic Patients
Authors: Douzdjian Viken , Bhaskar S Shanmuga , Baliga Prabakar K , Gugliuzza Kristene K , Rajagopalan P R 
Published: March 2007

OBJECTIVE
The racial impact on graft outcome is not well defined in diabetic recipients. The purpose of this study is to analyze our experience with kidney-alone (KA) and kidney-pancreas (KP) transplantation in type 1 diabetic recipients and evaluate the impact of racial disparity on outcome.

RESEARCH DESIGN AND METHODS
The records of 217 kidney transplants (118 KA, 99 KP) performed on type 1 diabetic patients between 1985 and 1995 at the Medical University of South Carolina and the University of Texas Medical Branch were reviewed.

RESULTS
A total of 53 (31%) white patients and 15 (33%) black patients experienced at least one episode of biopsy-proven acute rejection of the renal graft (NS). Patient survival at 1, 2, and 5 years was similar in white (92, 87, 69%) and black (91, 91, 69%) patients (NS). Kidney graft survival at 1, 2, and 5 years in the KA group was 72, 62, and 42% in blacks, compared with 79, 76, and 53% in whites (NS). Kidney graft survival at 1, 2, and 5 years in the KP group was 92, 92, and 74% in blacks, compared with 83, 77, and 58% in whites (NS). Pancreas graft survival at 1, 2, and 5 years was 81, 81, and 81% in blacks, compared with 81, 75, and 62% in whites (NS). Cox regression analysis revealed that donor age ≥ 40 years increased the risk of renal graft failure 6.2-fold (P = 0.0001), whereas the addition of a pancreas transplant to a kidney and a living-related transplant decreased the risk of failure of the kidney graft 0.2 (P = 0.005) and 0.1 times (P = 0.005).

CONCLUSIONS
Our results suggest that when compared with whites, there may be a trend toward an improved kidney and pancreas graft outcome in blacks undergoing KP transplants. These findings suggest that diabetes may override the risk factors that account for the pronounced disparity in outcome observed between nondiabetic white and black recipients.
The Insulin Resistance Syndrome in Native Hawaiians
Authors: Mau Marjorie K , Grandinetti Andrew , Arakaki Richard F , Chang Healani K , Kinney Everett K , Curb J David ,   Native Hawaiian Health Research (NHHR) Project
Published: March 2007

OBJECTIVE
To investigate whether fasting hyperinsulinemia is associated with a clustering of cardiovascular disease (CVD) risk factors, manifesting as the insulin resistance syndrome (IRS), in a population of native Hawaiians.

RESEARCH DESIGN AND METHODS
A total of 574 native Hawaiians ≥ 30 years of age were examined for blood pressure, waist-to-hip ratio (WHR), BMI, oral glucose tolerance, and fasting lipid, insulin, and C-peptide concentrations. All statistical analyses (n = 384) excluded 190 individuals who had NIDDM or who were taking hypertension medication. Using logistic regression analysis, fasting insulin and C-peptide levels were compared with CVD risk factors (glucose intolerance, hypertension, central adiposity, elevated triglyceride levels, and low HDL cholesterol levels) after adjusting for age and obesity.

RESULTS
Sixty-six percent of native Hawaiians were overweight or obese, and 70% were found to have central adiposity. Fasting insulin concentrations were correlated with BMI, WHR, blood pressure, and triglyceride, HDL cholesterol, and glucose concentrations. Fasting insulin was also significantly associated with an increasing number of CVD risk factors in each participant (P &lt; 0.001). Fasting insulin and C-peptide concentrations were independently associated with glucose intolerance, high triglyceride levels, and low HDL cholesterol levels. However, only fasting C-peptide concentrations were independently associated with hypertension and central adiposity. Apparent differences in the correlates of fasting insulin and C-peptide may be related to multiple factors and warrant further evaluation.

CONCLUSIONS
This study provides cross-sectional data confirming the existence of the IRS in native Hawaiians. However, further longitudinal studies are needed to examine the relationship of insulin resistance and/or surrogate markers to increased rates of NIDDM and CVD mortality in native Hawaiians.
The Epidemiology of Diabetes in Pregnant Native Canadians: A risk profile
Authors: Harris Stewart B , Caulfield Laura E , Sugamori Mark E , Whalen Elaine A , Henning Beth 
Published: March 2007

OBJECTIVE
The purpose of this study was to determine the prevalence of diabetes in pregnancy (gestational diabetes mellitus [GDM] and NIDDM) and to identify risk factors in the development of GDM in a native population in northwestern Ontario, Canada.

RESEARCH DESIGN AND METHODS
A retrospective analysis of 1,305 singleton deliveries among Ojibwa-Cree women from northwestern Ontario, Canada, was conducted from 1990 to 1993 inclusive. GDM was diagnosed using a 3-h oral glucose tolerance test (OGTT) and defined according to standard guidelines.

RESULTS
The overall prevalence of diabetes in pregnancy (NIDDM and GDM) was 11.6% (152 of 1,305) with a GDM prevalence of 8.4% (110 of 1,305). Among 741 women with complete data, prevalence rates increased with age, peaking at 46.9% in the age-group ≥ 35 years. Significant risk factors for GDM included older maternal age, multiparity, prepregnancy obesity, a family history of diabetes, and a history of GDM in previous pregnancies.

CONCLUSIONS
Diabetes in pregnancy among Ojibwa-Cree reported here represent the highest rates reported to date in a Canadian population. The high rates of maternal obesity and relative young age of this population further highlight the urgent need for diabetes screening and prevention in this population.
The Use of Biothesiometry to Detect Neuropathy in Children and Adolescents With IDDM
Authors: Davis E A , Jones T W , Walsh P , Byrne G C 
Published: March 2007

OBJECTIVE
To develop clinically useful reference ranges for vibration perception thresholds (VPTs), using biothesiometry in children and adolescents and to assess the reliability of the technique to identify subclinical neuropathy in subjects with IDDM at this age and to examine a large population-based sample of pediatric patients.

RESEARCH DESIGN AND METHODS
VPTs were measured using a handheld biothesiometer at the medial malleolus and hallux in 232 nondiabetic children and adolescents aged 7–18 years (12.9 ± 4.2 years) and a population-based sample of 307 young IDDM patients (13.3 ± 4.6 years of age). The mean of three readings at each site was correlated with height, pubertal status, and age for all subjects and, in addition for the IDDM sample, with the duration of IDDM, ambient blood glucose, and mean HbA1c from diagnosis. Those IDDM subjects found to have elevated VPTs (&gt; 97th percentile), and a control group of patients with IDDM underwent nerve conduction studies to determine the sensitivity and specificity of biothesiometry to detect abnormal neural function in children. Interoperator reliability was assessed in a separate trial in which two operators measured VPTs independently in the same 11 children.

RESULTS
In the nondiabetic control subjects, height demonstrated the best correlation with VPT measures, and a reference range was thus established with percentile charts, using mean VPT and height. VPTs were higher in the diabetic sample, compared with the nondiabetic sample (P &lt; 0.05). Of the children, 28 (9.1%) had VPT values &gt; 97th percentile developed from studies of the nondiabetic subjects; of these, 11 were younger than 11 years and 8 were prepubertal. Nerve conduction studies confirmed reduced conduction velocity and prolonged distal latencies in those with abnormal VPTs, compared with normal control subjects and IDDM patients with normal VPTs. Sensitivity of biothesiometry to reflect abnormal nerve function was estimated as 82% and specificity as 75% at this age. Interoperator variation was small (7.25% of total variance).

CONCLUSIONS
Biothesiometry is a useful noninvasive tool for the detection of subclinical neuropathy in children and adolescents. The use of height-related reference ranges may make screening for neuropathy more feasible in younger patients and allow large-scale longitudiral analysis of its development.