bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes and sexual function in older adults: results of an international survey
Authors: Nicolosi Alfredo , Glasser Dale B , Brock Gerald , Laumann Edward , Gingell Clive 
Published: August 2008

The Global Study of Sexual Attitudes and Behaviors (GSSAB) is a contemporaneous survey of attitudes, behaviours, beliefs and satisfaction with relationships among men and women aged 40—80 years. Interviews were conducted with more than 26,000 subjects from 28 countries. Data captured from the survey indicated that the majority of adults are sexually active into their later years and that sex remains an important part of their overall life. This paper will discuss comparisons between diabetic and non-diabetic participants. Overall, approximately 10% of subjects reported that they had diabetes mellitus. Fewer diabetic than non-diabetic subjects reported that they had had sexual intercourse in the last 12 months and among sexually active subjects, diabetic subjects tended to report lower levels of physical and emotional satisfaction in their relationship with their partner. Symptoms of sexual dysfunction were more common among diabetic men than non-diabetic men. However, fewer than 15% of subjects had discussed their sexual problems with a doctor.
Prevalence and management of hyperglycaemia in patients given thrombolysis for acute coronary syndromes
Authors: Baynes Kevin Cr , Mcintosh Colin , Feher Michael D 
Published: August 2008

The prevalence of hyperglycaemia in patients given thrombolysis for suspected acute myocardial infarction has not been clearly established. This is a retrospective case-note study of 69 consecutive patients who received thrombolysis on admission to a coronary care unit over a 15-month period. Admission plasma glucose > 7.8 mmol/L was observed in 46%, whilst a random glucose > 11.0 mmol/L was recorded in 22% of the group. A history of type 2 diabetes was present in 19%; with a glucose > 11.0 mmol/L being recorded in 61% on admission. Intravenous insulin therapy was administered to 43% of those without a history of diabetes, but presentation hyperglycaemia in the diabetic range, whereas 88% of known diabetic patients were treated with insulin. Hyperglycaemia/glucose intolerance, although commonly observed in patients thrombolysed for acute myocardial infarction, is not always managed with insulin therapy. There is a need for clear diabetes management protocols for all teams managing patients in coronary care units.
Are undiagnosed IGT/IFG and type 2 diabetes common in heart disease and hypertension?
Authors: Savage George , Ewing Peter , Kirkwood Helen , Carter Sarah 
Published: August 2008

Diabetes mellitus causes significant morbidity and mortality, and up to 50% of people with diabetes may be as yet undiagnosed. Additionally impaired glucose tolerance (IGT) is known to increase vascular risk and the risk of developing diabetes. The aim of this study was to look for IGT and/or impaired fasting glucose (IFG) and undiagnosed diabetes amongst patients with hypertension and patients with ischaemic heart disease (IHD) as part of an annual structured assessment. In IHD patients the uptake was 83.45% with a yield of 2.47% for undiagnosed diabetes and 12.39% for IGT/IFG. In hypertensive patients the uptake was 75.84% with a yield of 2.01% for undiagnosed diabetes and 18.54% for IGT/IFG. We concluded that looking for undiagnosed type 2 diabetes and patients with IGT/IFG in primary care may be worthwhile amongst patients with hypertension or IHD.
What are the clinical manifestations of cardiovascular disease in diabetes? Ten year analysis from a clinic based population
Authors: Stephens Jeffrey W , Humphries Steve E , Cooper Jacqueline A , Hurel Steven J 
Published: August 2008

Aims Cardiovascular disease may manifest as CHD, PVD and CbVD. Our aim was to explore these interactions and associated risk factors. Methods Patients were identified who attended clinic in 1990—1991 and remained under follow-up in 2000—2001. The latter were categorised by the presence/absence of manifest CHD, PVD and CbVD. Baseline clinic measurements (1990—1991) were studied in relation to CVD manifestations. Results Seven hundred and ninety-eight (CVD:358) patients were identified with follow-up. Of those with CVD: 51% had CHD, 14% PVD, and 9% CbVD exclusively. A further 17% had CHD+PVD, 4% CHD+CbVD, 2% PVD+CbVD, while 3% of patients had all three manifestations together. Increasing age, LDL-cholesterol and glucose were associated with increased risk of CHD, PVD and CbVD. Conclusions The majority of diabetic patients with CVD have $CHD (75%), and only 3% have a combination of CHD, PVD and CbVD.
Predictors of mortality in patients with peripheral vascular disease. A prospective follow-up study
Authors: Missouris Constantinos G , Kalaitzidis Rigas G , Kerry Sally M , Cappuccio Francesco P 
Published: August 2008

Background Peripheral vascular disease is associated with increased cardiovascular mortality and reduced life expectancy. The main causes of death are due to concomitant coronary heart and cerebrovascular disease. Objective To assess the long-term survival of patients with PVD and to investigate the impact of the presence of risk factors on mortality. Design Cohort study of patients with intermittent claudication and angiographically established PVD. Baseline investigations were performed in 1990—2; follow-up continued until 1999. Setting St George's Hospital in South London. Patients One hundred and ten consecutive patients (66 men and 44 women) referred electively for PVD and who underwent lower limb digital subtraction angiography. Main outcome measures Survival rates, all-cause mortality. Results Sixty-one patients (55.4%) died during the follow-up period (26 from cardiovascular causes). The overall five-year survival rate was 52% (95% C.I. 42—62). The survival rate was significantly lower in patients older than 70 years (38% [26—51]) compared to those 70 years or younger (69% [54—80])(p<0.05). The risk of all-cause mortality was almost two-fold in the older than younger age group (sex-adjusted hazards ratio 1.89 [1.08—3.10]). The presence of diabetes at the baseline was an important predictor of survival. After adjusting for age and sex diabetic patients had a hazards ratio of 1.79 (0.96—3.37) compared to non-diabetic patients for all-cause mortality. Further adjustment for hypertension, smoking and renal impairment did not attenuate the risk estimate. Hypertension, smoking and the presence of renal artery stenosis were associated with greater risk of all-cause mortality, although none of these estimates reached statistical significance. Conclusions Age and presence of diabetes are important independent prognostic factors for increased mortality in patients with peripheral vascular disease.
Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study
Authors: Sparre Hermann Leif , Nilsson BO , Wettre Staffan 
Published: August 2008

Aim To assess the vitamin B12 status of patients with type 2diabetes who had been receiving metformin treatment for at least one year. Methods Patients with type 2 diabetes attending a diabetes clinic were included in a cross-sectional cohort study. Patients exposed to metformin for more than one year (n=53) were compared with a non-exposed control group (n=31). Serum cobalamin and other variables reflecting vitamin B12 status were measured. Results Patients on metformin had lower cobalamin (289±137 vs. 395±162 pmol/L; p<0.01) and holotranscobalamin (76±49 vs. 97±41 pmol/L; p<0.05), and higher HCy (11.3+3.3 vs. 10.3±2.3 µmol/L; p<0.05); these changes were correlated. Eight metformin patients, but no controls, had holotranscobalamin below the normal range (p<0.05). Methylmalonic acid and folate were similar in both groups. Conclusion Patients exposed to long-term metformin therapy had 26.7% lower cobalamin, 21.6% lower holotranscobalamin and 9.7% higher HCy serum concentrations than control subjects. Such changes indicate a potential risk for development of vitamin B12 deficiency. Our results highlight the necessity of checking B12 status during metformin therapy.
Review: Aspirin and diabetes
Authors: Raghavan Rajeev P , Laight David W , Shaw Kenneth M , Cummings Michael H 
Published: August 2008

Type 2 diabetes accounts for a large proportion of cardiovascular disease within the UK. Inflammation is increasingly seen as a core process (even touted as a causative factor) connecting the metabolic syndrome and cardiovascular disease. Inflammatory markers, adhesion molecules, transcription regulators such as PPAR-gamma and NF-kappa B are being recognised as key elements of the underlying pathological process. In particular the links between oxidative stress, metabolic syndrome components and a pro-inflammatory milieu are becoming increasingly recognised.Salicylates have been used extensively for more than a hundred years but remain the subject of much research and scientific debate. Mechanisms of aspirin action, such as effects on endothelial function, oxidative stress, hyperglycaemia, inflammation, and mechanisms of aspirin resistance are being elucidated. With the advent of COX-2 selective inhibitors, the importance of the cyclo-oxygenase (COX-1 & COX-2 enzymes) pathways and the implications of more selective COX manipulation are being re-evaluated. There is no universal consensus on the use and dose of aspirin in diabetes. This review focuses upon the impact that aspirin may have to ameliorate the pathophysiology of diabetes and CVD.
Effect of candesartan cilexetil on carotid intima-media thickness in hypertensive type 2 diabetic patients. MITEC study: design and baseline characteristics
Authors: Valensi Paul , Baguet Jean-Philippe , Asmar Roland , Nisse-Durgeat Sophie , Mallion Jean-Michel 
Published: August 2008

Media Intima Thickness Evaluation of Candesartan (MITEC), a multicentre, randomised, double-blind, parallel-group study assessed the effect of candesartan cilexetil (CC) versus amlodipine (AML) administered during three years, on carotid intima-media thickness (IMT) in hypertensive type 2 diabetic patients. The study design, the baseline characteristics, and the determinants of carotid IMT are presented. After a placebo run-in period of four weeks, patients were randomised to CC (n=100) or AML (n=109). The mean blood pressure values were 155.9±11.0 mmHg, 91.3± 8.0 mmHg and 64.6±11.8 mmHg for systolic, diastolic and pulse pressure respectively, and the mean HbA1C was 7.1±1.3%. The mean common carotid IMT was 0.74±0.16 mm. The univariate regression analyses showed a significant correlation between IMT and age (p<0.0001), gender (p=0.013) and creatinine clearance (p=0.03). Only age was significantly correlated with carotid IMT (p<0.0001) in the multivariate analysis. In conclusion, the MITEC population has good metabolic control at baseline where carotid IMT is mainly related with age.
Review: Biomarkers in clinical trials and drug development: measurement of cardiometabolic risk
Authors: Matfin Glenn 
Published: August 2008

Cardiometabolic risk is linked to a cluster of modifiable factors, including established risk factors such as obesity, dyslipidaemia, raised blood pressure, and 'nontraditional' risk factors closely related to central (especially intra-abdominal) adiposity. These 'nontraditional' risk factors include dysfunction of inflammation, coagulation, platelets, fibrinolysis, lipoproteins, endothelium, plaque instability, and miscellaneous biological processes. Both the established ('traditional') and emerging ('nontraditional') cardiometabolic risk factors are components of the metabolic syndrome. In patients with known or suspected cardiometabolic diseases, biomarkers are increasingly being explored as indicators of disease presence, severity or activity, prognosis and therapeutic efficacy. Many biomarkers have been proposed for prediction of the macrovascular (and microvascular) complications of cardiometabolic diseases. This review provides background information on biomarkers, and an assessment of the possible utility of biomarkers in clinical trials and drug development programmes that include measurement of cardiometabolic risk.
Review: Drug treatments for obesity: where are we heading and how do we get there?
Authors: Sonnenberg Gabriele E , Matfin Glenn , Reinhardt Rickey R 
Published: August 2008

Obesity has reached epidemic proportions with an estimated 1.7 billion people worldwide classified as either overweight or obese. Obesity is associated with multiple co-morbidities (often clustered as the metabolic syndrome), and can result in decreased life expectancy, with enormous costs to society. Even modest weight loss has been demonstrated to exhibit beneficial effects on the co-morbidities of obesity. While reduced caloric intake and increased physical activity, combined with behavioural modification, appears to be the most rational approach to weight reduction, it only offers short-lived success. For severely obese individuals, bariatric surgery has become an increasingly preferred option resulting in dramatic and well-maintained weight reductions followed by significant changes in obesity-related diseases. Currently, few anti-obesity drugs are approved by regulatory authorities for long-term use (i.e. orlistat, sibutramine and rimonabant). Anti-obesity drug development is an active and dynamic field focusing on two major approaches: 1) inhibiting energy intake by addressing the input into the hypothalamic feeding centre or, 2) attempting to accelerate energy expenditure. Overcoming the hurdles of developing such medications is a daunting task, but it can be anticipated that several drugs in current development might become available within the next decade, and combination therapy of two or more agents could be the future of pharmacological prevention and treatment of obesity.
Delivering improved management and outcomes in diabetic kidney disease in routine clinical care
Authors: Hardy Kevin J , Furlong Niall J , Hulme Shirley A , O'Brien Sarah V 
Published: August 2008

Aim To examine the impact of service re-design on management and outcomes in type 2 diabetic patients with microalbuminuria and diabetic nephropathy. Methods The impact of implementation of evidence-based processes of care (blood pressure [BP] control, glycaemic control, renin-angiotensin-aldosterone system blockade, aspirin and cholesterol-lowering therapy, and smoking cessation) on progression to nephropathy in 338 microalbuminuria patients; and on death, doubling of serum creatinine, new end-stage renal failure (ESRF) and cardiovascular events in 127 nephropathy patients is described. Results Effective implementation of evidence-based processes of care improved surrogate outcomes (BP, HbA 1C and low density lipoprotein-cholesterol), was associated with little progression of microalbuminuria to nephropathy (6.1 per 100-patient-years), and in diabetic nephropathy patients were associated with rates of doubling of serum creatinine (1.4 per 100-patient-years), progression to ESRF (1.1 per 100-patient-years), cardiovascular events (3.2 per 100-patient-years) and mortality (2.2 per 100-patient-years) that compares favourably with landmark trials. Conclusion Service re-design in the management of type 2 diabetic kidney disease can deliver improved care and outcomes comparable with landmark trials in a routine clinical care setting.
Review: Challenges in developing therapies for the metabolic syndrome
Authors: Matfin Glenn 
Published: August 2008

Metabolic syndrome refers to a clustering of cardiovascular (CV) risk factors within a single individual. The established risk factor such as obesity, type 2 diabetes, dyslipidaemia, hypertension, and other emerging risk factors are closely related to intra-abdominal adiposity. Insulin resistance is also considered to be an important factor in the aetiology of this syndrome. The emerging risk factors include dysfunction of inflammation, coagulation, platelets, fibrinolysis, lipoproteins, endothelium, and other biological processes. Despite the potential utility of having all the CV risk factors under one umbrella term, debate continues about the very existence of the metabolic syndrome and its diagnostic criteria. Nevertheless, the component risk factors include some of the most common and serious public health challenges facing the developed and developing world today. By treating component risk factors, many existing therapies and new drugs in development target several aspects of metabolic syndrome. However, no drug is currently approved specifically for treatment of the metabolic syndrome. The essential features of the metabolic syndrome, and some of the challenges in developing treatment options are discussed herein.
Quantifying changes in retinal anatomy after interventions for diabetic maculopathy
Authors: Soomro Hibba , Burnett Lesley , Davies Nigel 
Published: August 2008

Introduction Diabetic maculopathy remains the major cause of loss of vision in diabetes. There is evidence to show that control of lipid levels reduces the amount of exudate in diabetic maculopathy, but to date there is no information on the effect of lipid reduction on diabetic macular oedema. Purpose The purpose of this case series was to compare retinal thickness using optical coherence tomography (OCT) of patients with exudative diabetic maculopathy whose only change in management was starting statins or increasing the current dose. MethodsV" Four patients with exudative diabetic maculopathy had serial OCT measurements to assess retinal thickness M before and after commencing or increasing their statin dose. Results Analysis showed a reduction of macula thickness in all cases. Visual acuity also improved during the time course of the measurements. Conclusion Statins may aid management of diabetic maculopathy by reducing macular oedema. This case series gives the first quantified evidence of the effect of statins on reduction of diabetic macular oedema.
Review: Aldosterone antagonism in type 2 diabetes mellitus — a new therapeutic approach to diabetic macrovascular disease?
Authors: Swaminathan Krishnan , Davies Justine , Struthers Allan 
Published: August 2008

The renin-angiotensin-aldosterone system has long been a target of pharmacological approaches for the control of blood pressure and increasingly for heart failure, myocardial infarction, nephropathy and diabetes. Clinical trials involving the renin-angiotensin-aldosterone axis have traditionally focused on angiotensin-converting enzyme (ACE) inhibitors or angiotensin (Ang) II receptor blockers, thereby laying the emphasis on inhibiting Ang II. It is now acknowledged that aldosterone is also an important culprit in addition to Ang II. Recently, major intervention trials in heart failure have demonstrated the marked cardiovascular beneficial effect of aldosterone antagonism over and above ACE-inhibitor therapy, underscoring the harmful effects of aldosterone in cardiovascular disease. Diabetes is now increasingly recognised as not only a metabolic disorder but a vascular disease as well. Therefore, the prospect arises that aldosterone antagonism may translate in reduced cardiovascular risk in a high-risk disorder like diabetes mellitus. If so, aldosterone antagonists may offer a new therapy in diabetes mellitus for the primary prevention of cardiovascular disease. Br J Diabetes Vasc Dis 2008;8:16-19
Long-term costs and clinical outcomes associated with metformin-glibenclamide combination tablets (Glucovance®) in patients with type 2 diabetes sub-optimally controlled by metformin: a modelling study in the French setting
Authors: Ray Joshua A , Huet Dominique , Valentine William J , Palmer Andrew J , Cugnardey Nathalie , Renaudin Corinne 
Published: August 2008

Objectives Most patients eventually become hyperglycaemic on metformin monotherapy. We modelled clinical and economic consequences for such patients of switching to a single-tablet metformin-glibenclamide combination (Glucovance®) or glibenclamide, or increasing metformin dosage. Methods A validated computer simulation model of diabetes projected long-term clinical and cost outcomes for the French setting, using data from a 16-week randomised controlled trial. Results Compared with metformin, Glucovance® 500/2.5 mg or 500/5 mg was associated with increased quality-adjusted life expectancy (0.45 and 0.27 quality-adjusted life-years [QALYs] respectively; base case analysis), reduced direct medical costs (by 3,331 and 2,026) and fewer diabetes-related complications. Compared with glibenclamide, Glucovance® 500/5 mg increased quality-adjusted life expectancy by 0.28 QALYs and reduced direct medical costs by 1,793. Conclusions From a third-party healthcare payer perspective in France, Glucovance® represents a dominant treatment option versus metformin or glibenclamide for patients sub-optimally controlled on metformin monotherapy.
Age at diagnosis of diabetes in a secondary care population: 1992—2005
Authors: Sharp Patrick S , Brown Beata , Qureshi Asjid 
Published: August 2008

To assess the change in age at diagnosis of diabetes over time in a secondary care diabetes clinic, clinical characteristics of patients attending were compared in 1992 and 2005. Those of European and South Asian origins were analysed separately. Results In 1992, 28.4% of patients of European and 7.5% of patients of South Asian origins had type 1 diabetes. These proportions were similar in 2005. Mean age at diagnosis of type 1 diabetes remained unchanged from 1992 to 2005: Europeans: 20.6 versus 20.2 years (p=0.63) and in South Asians: 23.7 versus 21.3 years (p=0.21). By contrast the age at diagnosis of type 2 diabetes was younger in both groups in 2005 compared with 1992: Europeans: 54.0 versus 57.1 years (p<0.001). South Asians: 47.5 versus 49.0 years (p=0.003). Conclusions These data suggest an earlier age at diagnosis of type 2 diabetes in those of both, European and South Asian origin over 13 years of study.
Is non-dipping of nocturnal blood pressure in type 2 diabetes associated with increased incidence of microalbuminuria?
Authors: Heggie Alison J , Adamson Karen A , Marioni Riccardo E , Padfield Paul L , Strachan Mark Wj 
Published: August 2008

icroalbuminuria has been associated with Mnon-dipping of nocturnal blood pressure (BP) in people with type 2 diabetes, but the mechanism of this association is unclear. We aimed to identify the development of microalbuminuria in patients with nocturnal non-dipping of BP and type 2 diabetes. Data were examined from 150 people with type 2 diabetes who had undergone ambulatory BP monitoring, non-dippers were defined as those with a systolic nocturnal BP dip less than 10% of the daytime BP. The development of microalbuminuria, over five years of follow-up, in dippers and non-dippers was not significantly different. Non-dippers who were microalbuminuric at baseline were more likely to have a higher body mass index (p=0.01) and to be male (p<0.01). This lack of a difference may be due to the initial exclusion of microalbuminuric patients, who may be genetically predetermined to develop microalbuminuria. Further prospective trials are required to investigate this relationship.