bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Lisinopril Therapy Reduces Exercise-Induced Albuminuria in Normoalbuminuric Normotensive IDDM Patients
Authors: Tuominen Juha A , Ebeling Pertti , Koivisto Veikko A 
Published: March 2007

OBJECTIVE
To study the effect of lisinopril on the exercise-induced urinary albumin excretion rate.

RESEARCH DESIGN AND METHODS
A total of 26 IDDM patients with normoalbuminuria were randomized into two groups, with one group receiving placebo (n = 13, age 36 ± 3 years, BMI 24.5 ± 1.1 kg/m2) and the other group receiving an average of 15 mg lisinopril daily (n = 13, age 34 ± 2 years, BMI 24.4 ± 0.9 kg/m2). Overnight and exercise-induced urinary albumin excretion rate was measured at baseline and after 1 and 2 years of treatment. Two patients in the placebo group and none in the lisinopril group developed microalbuminuria.

RESULTS
In the lisinopril group, the exercise-induced urinary albumin excretion rate diminished 46% after the 1st year (P = 0.059) and 66% (P &lt; 0.01) after the 2nd year. However, it remained unchanged in the control group. Systolic blood pressure (sBP) and diastolic blood pressure (dBP) were similar at baseline and after 1 year, but at 2 years, sBP was 13 mmHg lower (P = 0.03) and dBP was 9 mmHg lower (P = 0.052) in the lisinopril group as compared with the control group. The dBP decreased significantly at 1 and 2 years in the lisinopril group, while there was no significant change in the sBP. In the whole group at baseline, the overnight albumin excretion rate correlated with HbA1c (r = 0.50, P &lt; 0.01) and the duration of diabetes (r = 0.39, P &lt; 0.05), and sBP correlated with both the overnight (r = 0.42, P &lt; 0.05) and the exercise-induced (r = 0.48, P &lt; 0.05) albumin excretion rate.

CONCLUSIONS
Glycemic control and blood pressure are directly related to the overnight albumin excretion rate also in normotensive normoalbuminuric IDDM patients. Lisinopril treatment reduces the exercise-induced urinary albumin excretion rate in such patients. These data suggest a protective effect of lisinopril against the development of microalbuminuria.
Effects of Changing Diagnostic Criteria on the Risk of Developing Diabetes
Authors: Dinneen Sean F , Maldonado David , Leibson Cynthia L , Klee George G , Li Hongzhe , Melton L Joseph , Rizza Robert A 
Published: March 2007

OBJECTIVE
The American Diabetes Association (ADA) has recommended that the fasting plasma glucose (FPG) level used to diagnose diabetes be changed from 7.8 mmol/l (the level recommended by the National Diabetes Data Group [NDDG] in 1979) to 7.0 mmol/l. We examined the impact of this change on rates of progression to overt diabetes from different levels of FPG.

RESEARCH DESIGN AND METHODS
Using the laboratory database of Mayo Clinic, we assembled a cohort of 8,098 nondiabetic Olmsted County residents 40 years of age or older on 1 July 1983. Subjects were followed for a median of 9 years.

RESULTS
Among 7,567 individuals with follow-up FPG data, 778 (10.3%) progressed to ADA diabetes and 513 (6.8%; P &lt; 0.0001) progressed to NDDG diabetes. The risk of developing ADA diabetes was 7, 19, and 39% for individuals with initial FPG values in the ranges of &lt;5.6, 5.6–6.0, and 6.1–6.9 mmol/l, respectively. For progression to NDDG diabetes, the respective risks were 3, 11, and 25%. A clear gradient of risk was observed within the “normal” range of FPG (&lt;5.6 mmol/l). Among the 793 individuals who developed ADA diabetes, 222 (29%) developed NDDG diabetes simultaneously and 291 (37%) developed NDDG diabetes later. In all FPG subgroups, progression to ADA diabetes occurred ∼7 years sooner than progression to NDDG diabetes.

CONCLUSIONS
The baseline level of FPG is a major predictor of an individual's risk of developing diabetes. The proposed change in the diagnostic criteria for diabetes will lead to earlier diagnosis among individuals who are destined to develop the disease.
Two-Step Islet Autoantibody Screening for Risk Assessment of Type 1 Diabetes in Relatives
Authors: Pastore Matteo R , Bazzigaluppi Elena , Bonfanti Riccardo , Dozio Nicoletta , Sergi Alessandro , Balini Annalisa , Belloni Cristina , Meschi Franco , Bonifacio Ezio , Bosi Emanuele 
Published: March 2007

OBJECTIVE
To examine the performance of islet cell antibodies (ICAs) and antibodies to glutamate decarboxylase (GADA), IA-2 (IA-2 antibody [IA-2A]), and insulin (insulin autoantibody [IAA]), alone and in combination, in assessing type 1 diabetes risk within type 1 diabetic families to identify a practical and effective screening strategy for predicting type 1 diabetes in relatives.

RESEARCH DESIGN AND METHODS
ICA, GADA, IA-2A, and IAA were determined in 806 first-degree relatives participating in a prospective type 1 diabetes family study (median follow-up 6.17 years, range 0.6–8.3). The conferred risk of developing type 1 diabetes within 6 years was evaluated by Kaplan-Meier for each antibody marker, used alone or in combination.

RESULTS
ICAs were detected in 3%, GADA in 5.1%, IA-2A in 2.5%, and IAA in 3.7% of relatives; ≥1 antibody markers were detected in 10.7% of relatives and ≥2 were detected in 1.9% of relatives. The risk of type 1 diabetes at 6 years was 1.5% in relatives with only 1 marker and 24.8% in relatives with ≥2 markers. As a practical and effective strategy for type 1 diabetes risk assessment in relatives, this study indicates a first-step screening based on GADA and IA-2A measurement—which identified 6.5% of relatives, including all who developed the disease, with a 6-year type 1 diabetes risk of 9.0%—followed by a second step based on ICA and IAA measurement in relatives with either GADA or IA-2A, which identified a total of 1.9% of all relatives as having ≥2 markers, and a 6-year risk of 24.8%, including 6 of 7 who developed type 1 diabetes.

CONCLUSIONS
A two-step antibody screening, based first on GADA and IA-2A and then on ICA and IAA measurements in identified individuals, is likely to be a practical, sensitive, and effective strategy for predicting type 1 diabetes in first-degree relatives.
Relationship Between Electroneurographic Changes and Serum Ubiquitin Levels in Patients With Type 2 Diabetes
Authors: Akarsu Ersin , Pirim Ibrahim , Çapoğlu Ilyas , Deniz Orhan , Akçay Güngör , Ünüvar Necdet 
Published: March 2007

OBJECTIVE— The aim of the present study was to investigate any relationship between serum ubiquitin levels and electroneurographic changes in peripheral nerves for patients with type 2 diabetes.RESEARCH DESIGN AND METHODS— The study involved 34 patients(19 men, 15 women; mean age 46 ± 13 years) with type 2 diabetes. Serum ubiquitin values were measured by sandwich enzyme-linked immunosorbent assay. Measurement of nerve conduction velocity (NCV) was performed on three motor(median, tibial, and peroneal) and three sensory (median, ulnar, and sural)nerves. The value of motor compound muscle action potential (CMAP) was obtained from the sum of median, tibial, and peroneal motor nerve amplitudes,and sensory compound nerve action potential (CNAP) was computed as the sum of median and ulnar sensory nerve amplitudes.RESULTS— Patients with diabetes were divided into three groups: group 1 (n = 8) had normal electroneurography results, group 2 (n = 8) had slowed NCV, and group 3 (n = 18) had low values of motor CMAP and/or sensory CNAP as well as slowed NCV. Mean ubiquitin level in group 3 (20.4 ± 2.9 ng/dl) was significantly higher than that in group 1 (11.2 ± 1.1 ng/dl, t = 11.5, P &lt;0.0001) and group 2 (13.2 ± 2.7 ng/dl, t = 5.9, P&lt; 0.0001). Serum ubiquitin levels were inversely correlated with motor CMAP(r = -0.68) and sensory CNAP (r = -0.61) values.CONCLUSIONS— The results of this study indicate that there could be a relationship between the diminished amplitudes of axons of the peripheral nerve and the increase in serum ubiquitin levels in patients with type 2 diabetes. Further studies are required to confirm this relationship.
Mealtime Glucose Regulation With Nateglinide in Healthy Volunteers
Authors: Kalbag Jyoti B. , Walter Yulia H. , Nedelman Jerry R. , McLeod James F. 
Published: March 2007

OBJECTIVE— This study was designed to compare the pharmacodynamic effects of single doses of nateglinide (A-4166), repaglinide,and placebo on mealtime insulin secretion and glycemic control in healthy subjects.RESEARCH DESIGN AND METHODS— Fifteen healthy volunteers participated in this open-label five-period crossover study. They received single 10-min preprandial doses of 120 mg nateglinide, 0.5 or 2 mg repaglinide, or placebo or 1 min preprandially of 2 mg repaglinide. Subjects received each dose only once, 48 h apart. Pharmacodynamic and pharmacokinetic assessments were performed from 0 to 12 h postdose.RESULTS— Nateglinide induced insulin secretion more rapidly than 2 and 0.5 mg repaglinide and placebo (10 min preprandial), with mean rates of insulin rise of 2.3, 1.3, 1.15, and 0.8 μU ·ml-1 · min-1, respectively, over the 0- to 30-min postmeal interval. After peaking, insulin concentrations decreased rapidly in the nateglinide-treated group and were similar to placebo within 2 h postdose. After 2 mg repaglinide, peak insulin concentrations were delayed and returned to baseline more slowly than with nateglinide treatment. Nateglinide treatment produced lower average plasma glucose concentrations in the 0- to 2-h postdose interval than either dose of repaglinide and placebo (P &lt; 0.05 vs. 0.5 mg repaglinide and placebo). Plasma glucose concentrations returned more rapidly to predose levels with nateglinide treatment than with either dose of repaglinide. Treatment with repaglinide produced a sustained hypoglycemic effect up to 6 h postdose.CONCLUSIONS— In this single-dose study in nondiabetic volunteers, nateglinide provided a more rapid and shorter-lived stimulation of insulin secretion than repaglinide, resulting in lower meal-related glucose excursions. If similar results are observed in diabetes, nateglinide may produce a more physiological insulin secretory response with the potential for a reduced risk of postabsorptive hypoglycemia.
A Comparison of Two Diabetic Foot Ulcer Classification Systems
Authors: Oyibo Samson O. , Jude Edward B. , Tarawneh Ibrahim , Nguyen Hienvu C. , Harkless Lawrence B. , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE— In this study, the following two ulcer classification systems were applied to new foot ulcers to compare them as predictors of outcome: the Wagner (grade) and the University of Texas (UT)(grade and stage) wound classification systems.RESEARCH DESIGN AND METHODS— Ulcer size, appearance, clinical evidence of infection, ischemia, and neuropathy at presentation were recorded,and patients were followed up until healing or for 6 months.RESULTS— Of 194 patients with new foot ulcers, 67.0% were neuropathic, 26.3% were neuroischemic, 1.0% were ischemic, and 5.7% had no identified underlying factors. Median (interquartile range [IQR]) ulcer size at presentation was 1.5 cm2 (0.6-4.0). Lower-limb amputations were performed for 15% of ulcers, whereas 65% healed [median (IQR) healing time 5(3-10) weeks] and 16% were not healed at study termination; 4% of patients died. Wagner grade (P &lt; 0.0001), and UT grade (P &lt;0.0001) and stage (P &lt; 0.001) showed positive trends with increased number of amputations. For UT stage, the risk of amputation increased with infection both alone (odds ratio [OR] = 11.1, P &lt;0.0001) and in combination with ischemia (OR = 14.7, P &lt; 0.0001),but not significantly with ischemia alone (OR = 4.6, P = 0.09). Healing times were not significantly different for each grade of the Wagner(P = 0.1) or the UT system (P = 0.07), but there was a significant stepwise increase in healing time with each stage of the UT system(P &lt; 0.05), and stage predicted healing (P &lt;0.05).CONCLUSIONS— Increasing stage, regardless of grade, is associated with increased risk of amputation and prolonged ulcer healing time. The UT system's inclusion of stage makes it a better predictor of outcome.
Evidence-Based Guidelines Meet the Real World
Authors: Larme Anne C. , Pugh Jacqueline A. 
Published: March 2007

OBJECTIVE—Improving diabetes care in the U.S. is critical because diabetes rates are increasing dramatically, particularly among minority and low-income populations. Although evidence-based practice guidelines for diabetes have been widely disseminated, many physicians fail to implement them. The objective of this study was to explore what happens to diabetes practice guidelines in real-world clinical settings.
RESEARCH DESIGN AND METHODS—A qualitative research design was used. Open-ended semistructured interviews lasting 1–2 h were conducted with 32 key informants (physicians, certified diabetes educators, researchers, and agency personnel) selected for their knowledge of diabetes care in South Texas, an area with a high diabetes prevalence and a large proportion of minority and low-income patients.
RESULTS—Health professionals stress that contextual factors are more important barriers to optimal diabetes care than physician knowledge and attitudes. Barriers exist at multiple levels and are interrelated in a complex manner. Examples include the following: time constraints and practice economics in the private practice setting; the need to maintain referral relationships and maldistribution of professionals in the practice community; low awareness and low socioeconomic status among patients; and lack of access for low-income patients, low reimbursement, and insufficient focus on prevention in the U.S. health care system.
CONCLUSIONS—Contextual barriers must be addressed in order for diabetes practice guidelines to be implemented in real-world clinical practice. Suggested changes include an increased focus on prevention, improvements in health care delivery for chronic diseases, and increased attention to the special needs of minority and low-income populations.
Acute Hypoglycemia in Humans Causes Attentional Dysfunction While Nonverbal Intelligence Is Preserved
Authors: McAulay Vincent , Deary Ian J. , Ferguson Stewart C. , Frier Brian M. 
Published: March 2007

OBJECTIVE—Experimentally induced hypoglycemia in humans causes progressive but reversible cognitive dysfunction, but it is not known to what extent neuropsychological tests index abilities of cognitive functioning that are important in everyday life. This study examines the effects of acute insulin-induced hypoglycemia on attention and intelligence in nondiabetic humans.
RESEARCH DESIGN AND METHODS—A hyperinsulinemic glucose clamp was used to achieve controlled euglycemia (4.50 [0.22] mmol/l) and hypoglycemia (blood glucose 2.59 [0.19] mmol/l) in 20 healthy volunteers. Subjects were studied on two occasions in a counterbalanced order. During each study condition, subjects completed parallel tests of cognitive function. Cognitive function was assessed by the Test of Everyday Attention and Raven’s Progressive Matrices.
RESULTS—Hypoglycemia induced a significant deterioration in tests sensitive to both visual and auditory selective attention. During hypoglycemia, attentional flexibility deteriorated and speed of information processing was delayed. Sustained attention was preserved and intelligence scores did not deteriorate during hypoglycemia.
CONCLUSIONS—During hypoglycemia, a significant deterioration occurs in attentional abilities, whereas fluid intelligence is preserved. On the basis of these results, it can be surmised that many complex attention tasks relevant to everyday life are impaired during moderate hypoglycemia.
Do Different Dimensions of the Metabolic Syndrome Change Together Over Time?
Authors: Maison Patrick , Byrne Christopher D. , Hales C. Nicholas , Day Nicholas E. , Wareham Nicholas J. 
Published: March 2007

OBJECTIVE—The metabolic syndrome is a loosely defined cluster of cardiovascular risk factors including low HDL cholesterol, hypertriglyceridemia, glucose intolerance, and hypertension. Evidence for inclusion of these features in the syndrome has mostly come from cross-sectional studies, and a few studies have examined how the various factors change together over time.
RESEARCH DESIGN AND METHODS—We conducted a prospective population-based cohort study of 937 individuals aged 40–65 years who underwent oral glucose tolerance testing on two occasions at 4.5-year intervals. Changes in the components of the metabolic syndrome were analyzed by principal component analysis in the entire population and in a subgroup of 471 individuals who did not receive pharmaceutical therapy for hypertension and dyslipidemia.
RESULTS—Principal component analysis identified three independent factors in men: a blood pressure factor (systolic and diastolic blood pressure and BMI), a glucose factor (fasting and 120-min postload glucose, BMI, waist-to-hip ratio [WHR], and fasting insulin level), and a lipid factor (triglycerides and HDL cholesterol, BMI, WHR, and fasting insulin level). In women, an additional factor was identified, which included BMI, WHR, fasting insulin, and triglycerides. Analysis of the contribution of these variables to the different subdimensions indicated that BMI was the central feature of the syndrome in both sexes.
CONCLUSIONS—This analysis of change in the features of the metabolic syndrome over time provides evidence of the fundamental importance of obesity in the origin of this disorder.
Orthostatic Hypertension in Patients With Type 2 Diabetes
Authors: Yoshinari Mototaka , Wakisaka Masanori , Nakamura Udai , Yoshioka Maki , Uchizono Yuji , Iwase Masanori 
Published: March 2007

OBJECTIVE—The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy.
RESEARCH DESIGN AND METHODS—The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from &lt;90 to ≥90 mmHg and/or an increase in systolic blood pressure (SBP) from &lt;140 to ≥140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms.
RESULTS—The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P &lt; 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 ± 11.4 mmHg in SBP and 9.1 ± 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (−1.0 ± 9.0 and 3.8 ± 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT.
CONCLUSIONS—Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.
Functional Status of Persons With Diabetes-Related Lower-Extremity Amputations
Authors: Peters Edgar J.G. , Childs Michael R. , Wunderlich Robert P. , Harkless Lawrence B. , Armstrong David G. , Lavery Lawrence A. 
Published: March 2007

OBJECTIVE—It is reasonable to predict that diabetes-related lower-extremity amputations have a detrimental impact on quality of life. However, we are unaware of any study in the medical literature describing the functional level of diabetic patients with amputations. The objective of this study was to evaluate amputations among diabetic patients and to determine the functional level of these patients with the Sickness Impact Profile (SIP).
RESEARCH DESIGN AND METHODS—We enrolled 124 patients with diabetes. Case subjects (n = 35) were defined as patients who had undergone amputation of the lower-extremity, and control subjects (n = 89) were defined as patients who had not undergone amputation. Study participants received a standard history and physical examination.
RESULTS—Both the physical dimension scores (33.5 ± 14.9 vs. 22.3 ± 14.7, P &lt; 0.001) and the total SIP scores (27.6 ± 9.9 vs. 22.5 ± 10.3, P = 0.013) were significantly higher for amputees. However, the psychosocial dimension scores were not significantly different between case and control subjects (14.9 ± 8.9 vs. 15.2 ± 10.0, P &gt; 0.05). Post hoc analysis showed that the group of patients who had undergone transtibial amputation had a significantly higher total impairment score than patients who had not undergone amputation (P = 0.039). This is in contrast to patients with toe or midfoot amputations, for whom total impairment scores were not significantly higher than those for the control subjects. Interestingly, bilateral amputees did not have significantly higher scores on either SIP dimension compared with unilateral amputees.
CONCLUSIONS—These findings exemplify the detrimental physical and psychosocial health status of patients with diabetes-related lower-extremity amputation.
Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia
Authors: Rolka Deborah B. , Narayan K. M. Venkat , Thompson Theodore J. , Goldman Dona , Lindenmayer Joann , Alich Kate , Bacall Darcy , Benjamin Evan M. , Lamb Betty , Stuart Dennis O. , Engelgau Michael M. 
Published: March 2007

OBJECTIVE—To evaluate the performance, in settings typical of opportunistic and community screening programs, of screening tests currently recommended by the American Diabetes Association (ADA) for detecting undiagnosed diabetes.
RESEARCH DESIGN AND METHODS—Volunteers aged ≥20 years without previously diagnosed diabetes (n = 1,471) completed a brief questionnaire and underwent recording of postprandial time and measurement of capillary blood glucose (CBG) with a portable sensor. Participants subsequently underwent a 75-g oral glucose tolerance test; fasting serum glucose (FSG) and 2-h postload serum glucose (2-h SG) concentrations were measured. The screening tests we studied included the ADA risk assessment questionnaire, the recommended CBG cut point of 140 mg/dl, and an alternative CBG cut point of 120 mg/dl. Each screening test was evaluated against several diagnostic criteria for diabetes (FSG ≥126 mg/dl, 2-h SG ≥200 mg/dl, or either) and dysglycemia (FSG ≥110 mg/dl, 2-h SG ≥140 mg/dl, or either).
RESULTS—Among all participants, 10.7% had undiagnosed diabetes (FSG ≥126 or 2-h SG ≥200 mg/dl), 52.1% had a positive result on the questionnaire, 9.5% had CBG ≥140 mg/dl, and 18.4% had CBG ≥120 mg/dl. The questionnaire was 72–78% sensitive and 50–51% specific for the three diabetes diagnostic criteria; CBG ≥140 mg/dl was 56–65% sensitive and 95–96% specific, and CBG ≥120 mg/dl was 75–84% sensitive and 86–90% specific. CBG ≥120 mg/dl was 44–62% sensitive and 89–90% specific for dysglycemia.
CONCLUSIONS—Low specificity may limit the usefulness of the ADA questionnaire. Lowering the cut point for a casual CBG test (e.g., to 120 mg/dl) may improve sensitivity and still provide adequate specificity.