bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethnic and Racial Differences in Diabetes Care
Authors: Bonds Denise E. , Zaccaro Daniel J. , Karter Andrew J. , Selby Joe V. , Saad Mohammed , Goff David C. 
Published: March 2007

OBJECTIVE—Diabetes and its complications disproportionately affect African Americans and Hispanics. Complications could be prevented with appropriate medical care. We compared five processes of care and three outcomes of care among African Americans, Hispanics, and non-Hispanic whites.
RESEARCH DESIGN AND METHODS—We used data from the Insulin Resistance Atherosclerosis Study (1993–1998) of participants with known diabetes. African Americans and Hispanics were compared with non-Hispanic whites from the same region. Five process measures (treatment of diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease) and three outcome measures (control of diabetes, hypertension, and hyperlipidemia) were evaluated.
RESULTS—Comparison groups were similar in baseline characteristics. African Americans and Hispanics were equally likely as their non-Hispanic white comparison group to receive treatment for diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease, although treatment rates for hyperlipidemia and albuminuria were poor for all groups. African Americans were more likely to have poorly controlled diabetes (HbA1c &gt;8.0%: OR 2.23, 95% CI 1.26–3.94). Both African American and Hispanics were significantly more likely to have borderline or poorly controlled hypertension than non-Hispanic whites (blood pressure &gt;130–140/85–90 or &gt;140/90 mmHg: African American/non-Hispanic white OR 3.22, 95% CI 1.57–6.59; Hispanic/non-Hispanic white 3.14, 1.35–7.3).
CONCLUSIONS—The rates of treatment for diabetes and associated comorbidities are similar across all three ethnic groups. Few individuals in any ethnic group received treatment for hyperlipidemia and albuminuria. Ethnic disparities exist in control of diabetes and hypertension. Programs should be tested to improve overall quality of care and eliminate these disparities.
Mortality From Site-Specific Malignancies in Type 2 Diabetic Patients From Verona
Authors: Verlato Giuseppe , Zoppini Giacomo , Bonora Enzo , Muggeo Michele 
Published: March 2007

OBJECTIVE— The aim of the present work was to compare mortality from site-specific malignancies in type 2 diabetic patients with those in the general population.
RESEARCH DESIGN AND METHODS— Mortality from site-specific cancers was assessed in a population-based cohort of 7,148 type 2 diabetic patients from Verona (Northern Italy) during a 10-year follow-up (1987–1996) by reviewing death certificates. Standardized mortality ratio (SMR) data were computed using as reference mortality rates in the general population of Verona.
RESULTS— During follow-up, 641 patients (378 men and 263 women) died of malignancies. The most common causes of death among site-specific malignancies were digestive tumors both in men (140 of 378, 37.0%) and women (105 of 263, 39.9%), respiratory tumors in men (103 of 378, 27.2%), and tumors of the reproductive system in women (79 of 263, 30.0%). A slight increase in the overall mortality from malignancies was observed in diabetic patients and achieved statistical significance in women (observed/expected = 1.16, 95% CI 1.02–1.30; P = 0.019) but not in men (observed/expected = 1.07, 0.97–1.19; P = 0.163). Excess mortality from hepatic cancer (SMR = 1.86, 1.44–2.38) was observed in both men and women. In addition, women with diabetes experienced a higher mortality from pancreatic tumors (observed/expected = 1.78, 1.13–2.67) and breast tumors (observed/expected = 1.40, 1.06–1.81). Excess mortality from breast cancer was confined to obese women with diabetes.
CONCLUSIONS— Mortality from site-specific malignancies is different in type 2 diabetic patients than in the general population. Better control of body weight seems necessary to prevent the excess mortality from breast cancer in women.
Utility of HbA1c Levels for Diabetes Case Finding in Hospitalized Patients With Hyperglycemia
Authors: Greci Laura S. , Kailasam Mala , Malkani Samir , Katz David L. , Hulinsky Ilja , Ahmadi Ramin , Nawaz Haq 
Published: March 2007

OBJECTIVE—We evaluated the role of a single measurement of HbA1c in a diabetes case finding in hospitalized patients with random hyperglycemia at admission.
RESEARCH DESIGN AND METHODS—From 20 March to 31 July 2000, 508 patients admitted through the emergency department of one hospital were tested for random hyperglycemia (plasma glucose [PG] &gt;125 mg/dl). Consenting patients with hyperglycemia (without preexisting diabetes or on corticosteroids) underwent testing for HbA1c levels, two fasting PG levels, and an outpatient oral glucose tolerance test (OGTT) if necessary.
RESULTS—Of the patients, 50 (9.8%) met the inclusion criteria. Of these, 70% (n = 35) completed the study, and 60% (n = 21) were diagnosed with diabetes. Patients with diabetes had higher HbA1c levels than subjects without diabetes (6.8 ± 0.4 vs. 5.3 ± 0.1%, P = 0.002). An HbA1c level &gt;6.0% was 100% specific (14/14) and 57% sensitive (12/21) for the diagnosis of diabetes. When a lower cutoff value of HbA1c at 5.2% was used, specificity was 50% (10/21) and sensitivity was 100% (7/14).
CONCLUSIONS—In acutely ill patients with random hyperglycemia at hospital admission, an HbA1c &gt;6.0% reliably diagnoses diabetes, and an HbA1c level &lt;5.2% reliably excludes it (paralleling the operating characteristics of the standard fasting glucose measurements); however, the rapidity of the HbA1c level can be useful for diabetes case finding and treatment initiation early in the hospital course.
Effects of Postmenopausal Hormone Replacement Therapy on HbA1c Levels
Authors: Okada Mayumi , Nomura Seiji , Ikoma Yoko , Yamamoto Eiko , Ito Tomomi , Mitsui Takashi , Tamakoshi Koji , Mizutani Shigehiko 
Published: March 2007

OBJECTIVE—Estrogen seems to contribute to glucose homeostasis in women. The objective of this study was to examine the effects of hormone replacement therapy (HRT) on HbA1c levels in Japanese postmenopausal women and to determine whether the effects varied with age.
RESEARCH DESIGN AND METHODS—We studied 99 postmenopausal women taking HRT (mean ± SD age 56.5 ± 6.9 years, BMI 21.5 ± 2.3 kg/m2) and 101 postmenopausal women not on HRT (51.4 ± 6.1 years, 21.3 ± 2.4 kg/m2). HRT consisted of continuous conjugated equine estrogen (CEE; 0.625 mg/day) and medroxyprogesterone acetate (MPA; 2.5 mg/day) for &gt;2 years.
RESULTS—HbA1c levels are positively associated with age and BMI in women who use HRT as well as in those who do not use HRT. After adjusting for age and BMI, HRT showed no effects on HbA1c levels. However, HbA1c levels were significantly lower in postmenopausal women aged 40–49 years who were taking HRT than in women of similar age who were not taking HRT (mean ± SE 4.776 ± 0.092 vs. 5.096 ± 0.078%, P &lt; 0.05). No differences in HbA1c levels between women who did and did not use HRT were observed in those older than 50 years.
CONCLUSIONS—Oral HRT involving CEE combined with MPA may decrease HbA1c levels in women aged 40–49 years and is likely to have no adverse effects on HbA1c levels in women older than 50 years.
Do Impotent Men With Diabetes Have More Severe Erectile Dysfunction and Worse Quality of Life Than the General Population of Impotent Patients?
Authors: Penson David F. , Latini David M. , Lubeck Deborah P. , Wallace Katrine L. , Henning James M. , Lue Tom F. 
Published: March 2007

OBJECTIVE—Little is known regarding how diabetic men with erectile dysfunction (ED) differ from the general population of impotent men. The primary objective of this study was to compare disease-specific health-related quality of life (HRQOL) and severity of ED in impotent men with and without diabetes.RESEARCH DESIGN AND METHODS—Validated functional and HRQOL questionnaires (including the International Index of Erectile Function, the Sexual Self-Efficacy Scale, and the Psychological Impact of Erectile Dysfunction scales) were administered to patients in an ED disease registry. Men with ED and a history of diabetes (n = 20) were compared with men with ED and no history of diabetes (n = 90) at baseline and at the 12-month follow-up.RESULTS—Diabetic impotent men reported worse erectile function and intercourse satisfaction at baseline, and ED had a greater impact on their emotional life. Diabetic men with ED had significantly different trends over time in the Erectile Function (P &lt; 0.001), Intercourse Satisfaction (P &lt; 0.013), Sexual Desire (P &lt; 0.016), Overall Satisfaction (P &lt; 0.023), and the Sexual Experience-Psychological Impact domains (P &lt; 0.002). In addition, there was a trend toward a difference over time in the Emotional Life-Psychological Impact domain (P &lt; 0.067).CONCLUSIONS—Impotent men with diabetes present with worse ED than nondiabetic men with ED, resulting in worse disease-specific HRQOL in the diabetic men. Although diabetic patients initially respond well to ED treatment, responses do not appear to be durable over time. Therefore, clinicians must provide longer-term follow-up when treating ED in diabetic patients.
The Impact of Severe Hypoglycemia and Impaired Awareness of Hypoglycemia on Relatives of Patients With Type 1 Diabetes
Authors: Jørgensen Hanne V. , Pedersen-Bjergaard Ulrik , Rasmussen Åse K. , Borch-Johnsen Knut 
Published: March 2007

OBJECTIVE—Severe hypoglycemia is a major problem for patients with type 1 diabetes and their relatives. The aim of this study was to compare patients’ and relatives’ assessments of rates of severe hypoglycemia and state of awareness and to explore the influence on involvement and concern of relatives.
RESEARCH DESIGN AND METHODS—A cross-sectional paired questionnaire survey on hypoglycemia and the state of awareness was used in our study comprising 284 unselected adult patients with type 1 diabetes and their closest cohabitant. The cohabitant questionnaires also addressed involvement and concern.
RESULTS—The agreement between assessments of rates of severe hypoglycemia and state of awareness made by patients and cohabitants was weak (κ 0.404 and 0.442, respectively; P &lt; 0.001). Cohabitants recalled more episodes of severe hypoglycemia than patients (2.7 vs. 1.6 episodes/patient-year; P &lt; 0.001). Degree of involvement was positively related to the rate of severe hypoglycemia (P = 0.002) and negatively related to the state of awareness (P = 0.007) but not to level of HbA1c, duration of diabetes, or presence of late complications, except for peripheral neuropathy (P = 0.01).
CONCLUSIONS—Cohabitants of patients with type 1 diabetes recall significantly more episodes of severe hypoglycemia than the patients. The rate of severe hypoglycemia and state of hypoglycemic awareness are the principal determinants of degree of cohabitants’ involvement in their partners’ disease.
Blood Pressure in Young Adulthood and the Risk of Type 2 Diabetes in Middle Age
Authors: Golden Sherita Hill , Wang Nae-Yuh , Klag Michael J. , Meoni Lucy A. , Brancati Frederick L. 
Published: March 2007

OBJECTIVE—Hypertension is known to accompany type 2 diabetes in middle age, but it is unknown how early in life blood pressure (BP) begins to rise among individuals who later develop diabetes. The objective of this study was to evaluate elevated BP as a long-term predictor of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a prospective cohort study of 1,152 white male medical students in The Johns Hopkins Precursors Study to longitudinally assess systolic BP (SBP) and diastolic BP (DBP) from young adulthood through middle age in men who went on to develop diabetes. Incident diabetes was identified by self-report through mailed questionnaires verified by medical record review.
RESULTS—During a median follow-up of 38 years, 77 cases of incident diabetes occurred. The mean age of diabetes diagnosis was 58 years. As early as age 30 years, mean SBP and DBP were significantly higher in men who developed diabetes during follow-up than in those who remained nondiabetic (SBP 122 vs. 119 mmHg, P = 0.009; DBP 78 vs. 75 mmHg, P = 0.0005). The rate of increase in SBP and DBP over time in men who developed diabetes was greater than the rate of increase in men who did not develop diabetes (SBP 0.49 vs. 0.27 mmHg/year, P &lt; 0.00003; DBP 0.24 vs. 0.17 mmHg/year; P = 0.09). After adjustment for BMI and other risk factors for diabetes, SBP and DBP at age 30 years remained significantly higher in individuals who developed diabetes than in their nondiabetic counterparts; however, the difference in the rate of increase in SBP was no longer significant following multivariate adjustment.
CONCLUSIONS—BP elevations precede the development of type 2 diabetes in middle age by 20–25 years. Higher BP in the prediabetic state might contribute to the presence of vascular disease at the time of diagnosis of type 2 diabetes.
Thyroid Dysfunction in Patients With Type 1 Diabetes
Authors: Umpierrez Guillermo E. , Latif Kashif A. , Murphy Mary Beth , Lambeth Helen C. , Stentz Frankie , Bush Andrew , Kitabchi Abbas E. 
Published: March 2007

OBJECTIVE—Cross-sectional studies have reported that the risk of thyroid dysfunction in patients with type 1 diabetes is two- to threefold higher than in the general population. However, longitudinal studies to determine the natural history of thyroid dysfunction in patients with type 1 diabetes are lacking.
RESEARCH DESIGN AND METHODS—We analyzed the incidence of thyroid dysfunction over time in a cohort of 58 patients (26 men and 32 women) enrolled in the Diabetes Control and Complications Trial at the University of Tennessee Health Science Center in 1983 and prospectively followed for 18 years. Patients underwent measurement of thyroid function tests (thyroid-stimulating hormone [TSH], thyroxine, and triiodothyronine) every year and thyroid peroxidase (TPO) antibodies at 4-year intervals.
RESULTS—A total of 18 patients had hypothyroidism, and 1 patient experienced transient hyperthyroidism. Two subjects developed hypothyroidism 7 and 18 years before the development of diabetes and were excluded from the analysis. The mean age of diagnosis was 19 ± 2 years for type 1 diabetes and 29 ± 3 years for hypothyroidism. Hypothyroidism was more common in female (41%) than in male (19%) subjects and in patients with positive TPO antibodies. Patients who were TPO positive were 17.91 times as likely to develop hypothyroidism as patients who were TPO negative (95% CI 3.89–82.54). There were no differences in BMI, lipid profile, and HbA1c between patients with and without thyroid dysfunction.
CONCLUSIONS—This longitudinal study confirms the association between autoimmune thyroid dysfunction and type 1 diabetes. Our results indicate that all subjects with type 1 diabetes should undergo annual screening by serum TSH measurement to detect asymptomatic thyroid dysfunction, particularly those with positive TPO antibodies.
Development of New Peripheral Arterial Occlusive Disease in Patients With Type 2 Diabetes During a Mean Follow-Up of 11 Years
Authors: Kallio Milla , Forsblom Carol , Groop Per-Henrik , Groop Leif , Lepäntalo Mauri 
Published: March 2007

OBJECTIVE— To assess the occurrence and development of new peripheral arterial occlusive disease (PAOD), its risk factors, and the outcome in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS— A total of 130 type 2 diabetic patients (mean age 58 years) were examined at baseline and after a mean follow-up of 11 years (range 7–14). The ankle-brachial index (ABI) and toe-brachial index were used to detect PAOD. Blood and urine samples were taken at baseline, and a history of cardiovascular events was recorded during follow-up.
RESULTS— PAOD was diagnosed in 21 (16%) patients at baseline. During follow-up, 21 of 89 (24%) patients developed new PAOD. There were 29 patients who died, 21 (72%) of them from cardiovascular disease. Patients with PAOD suffered an excess mortality compared with patients without PAOD (58 vs. 16%; P &lt; 0.001). Logistic regression analysis showed that PAOD at baseline was associated with age, duration of diabetes, smoking, and urinary albumin excretion rate. Patients who developed new PAOD during follow-up had higher serum LDL cholesterol concentrations and lower HDL cholesterol concentrations and were older than the patients who remained free of PAOD.
CONCLUSIONS— Objectively measured PAOD is frequent in type 2 diabetic patients. It presents the early clinical signs of atherosclerosis and is strongly associated with cardiovascular death. The risk factor pattern for PAOD was different at baseline and after a mean follow-up of 11 years. We consider routine ABI measurements and modification of risk factors necessary also in patients with asymptomatic PAOD.
Clinical Impact of Prandial State, Exercise, and Site Preparation on the Equivalence of Alternative-Site Blood Glucose Testing
Authors: Bina Dawn M. , Anderson Robyn L. , Johnson Mary L. , Bergenstal Richard M. , Kendall David M. 
Published: March 2007

OBJECTIVE—To determine whether clinically significant differences exist in fasting blood glucose (BG) at the forearm, palm, and thigh relative to the fingertip; to assess the impact of prandial status by comparing BG between alternative sites and the fingertip at several time intervals after carbohydrate intake; to assess the effects of moderate brief exercise on site-to-site differences in BG; to evaluate the impact of site preparation by local rubbing on alternative-site testing (AST) equivalence; and to determine levels of perceived pain and satisfaction associated with AST.
RESEARCH DESIGN AND METHODS—Fasting BG was measured using the One Touch Ultra (LifeScan, Milpitas, CA) at the fingertip, palm, thigh, and each forearm (with local rubbing) in 86 patients with type 2 diabetes. A 40-g carbohydrate meal was consumed and BG was again measured from each site at 60, 90, and 120 min postmeal, with an additional forearm test at 90 min without local rubbing. Patients then exercised for 15 min with repeat BG at each site. Differences in BG between sites were assessed using repeated-measures ANOVA and regression analyses.
RESULTS—Significant differences in BG at alternative sites were found 60 min postmeal (P = 0.0003) and postexercise (P = 0.037). Specifically, clinically significant differences (expressed as percent difference from the fingertip) at 60 min include −8.8 ± 10.8% at the forearm and −13.7 ± 10.7% at the thigh, and postexercise +19.1 ± 19.1% at the forearm and +15.6 ± 22.6% at the thigh. However, no significant differences were observed between sites in either the fasting state or at 90 and 120 min postmeal. The dynamic results suggest a time lag in equilibration of forearm and thigh BG during periods of rapid glucose change. Palm and fingertip BG test results were similar at all time points.
CONCLUSIONS—AST results are consistent with fingertip BG results in both the fasting state and 2 h postmeal; no benefit from site preparation by local rubbing was noted. However, testing at sites other than the hand cannot be recommended 1 h postmeal or immediately after exercise. AST is equivalent and appropriate for use at testing times commonly used in clinical practice.
Nurse-Based Management in Patients With Gestational Diabetes
Authors: García-Patterson Apolonia , Martín Esther , Ubeda Justa , María Miguel A. , Adelantado Juan M. , Ginovart Gemma , de Leiva Alberto , Corcoy Rosa 
Published: March 2007

OBJECTIVE—To compare the rate of insulin treatment and perinatal outcome in women with gestational diabetes mellitus (GDM) under endocrinologist-based versus diabetes nurse-based metabolic management.
RESEARCH DESIGN AND METHODS—In a retrospective analysis, maternal characteristics, rate of insulin treatment, and perinatal outcome of patients with GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receiving endocrinologist-based care were compared with those delivering between 1 July 1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. The diabetes nurse’s role was similar to that of an advanced practice nurse in the U.S. There were no changes in the metabolic goals and instruments or in obstetric and neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher’s exact test.
RESULTS—Maternal characteristics (age, BMI, family history of diabetes, prior glucose intolerance, gestational age, and blood glucose at diagnosis of GDM) did not differ between groups treated during the two periods. Rates of insulin treatment and perinatal outcome (hypertension, preterm delivery, cesarean section, low Apgar score, macrosomia, small- and large-for-gestational-age newborns, obstetric trauma, major malformations, hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory distress, and mortality) were also similar in both groups.
CONCLUSIONS—Comparison of periods of endocrinologist-based and diabetes nurse-based metabolic management of women with GDM showed no differences in the rate of insulin treatment and perinatal outcome. This supports a more active role of nurses in the management of women with GDM.
The Significance of Impaired Fasting Glucose Versus Impaired Glucose Tolerance
Authors: Carnevale Schianca Gian Piero , Rossi Antonello , Sainaghi Pier Paolo , Maduli Elisabetta , Bartoli Ettore 
Published: March 2007

OBJECTIVE—The American Diabetes Association recommended substituting 2hBS (glycemia at the second hour of an oral glucose tolerance test [OGTT]) for fasting blood glucose (FBS) in screening for glucose intolerance. It is debated whether these tests measure the same abnormality and relate to defective insulin secretion or resistance. This study examines the diagnostic effectiveness of FBS versus 2hBS and their relationship with insulin secretion and resistance.
RESEARCH DESIGN AND METHODS—Based on history or physical findings suggesting glucose intolerance, we enrolled 398 unselected subjects admitted to a general Internal Medicine ward. After 5 days of a weight-maintaining diet, FBS, 2hBS, and insulin were measured during OGTT. The homeostatic model assessment was used to assess β-cell function and insulin resistance.
RESULTS—Excluding 19 patients with diabetes (5%), we identified 284 subjects with normal glucose tolerance (NGT), 22 with isolated impaired fasting glucose (IFG), 59 with isolated impaired glucose tolerance (IGT), and 14 with associated IFG/IGT. The sensitivity of FBS in predicting 2hBS was 19%, specificity 93%. Positive and negative predictive values were 39% and 83%, respectively. Insulin resistance was absent in NGT and IFG and markedly elevated in IGT and IFG/IGT, whereas defective insulin release was significant only in isolated IFG.
CONCLUSIONS—In unselected patients, elevated FBS depends primarily on defective insulin secretion, and impaired 2hBS on insulin resistance. Because these tests measure different alterations, they are useful in combination.