bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Perception for Developing Diabetes
Authors: Walker Elizabeth A. , Mertz C.K. , Kalten Maria R. , Flynn James 
Published: March 2007

OBJECTIVE—To assess personal risk perceptions for developing diabetes among practicing physicians.
RESEARCH DESIGN AND METHODS—Little is known about comparative risk perceptions concerning diabetes among medical experts. We administered the new Risk Perception Survey for Developing Diabetes to 535 nondiabetic physicians. The participants were 86% male, had a mean age of 49 years, and were 66% white and 24% Asian. Almost 37% were considered at higher risk for developing diabetes based on self-reported risk factors. Over 91% of respondents were either internal medicine or family medicine physicians.
RESULTS—Of the four subscales, Comparative Disease Risk and Environmental Risk indicated moderate risk perceptions, whereas Personal Control scores indicated a robust sense of control over developing diabetes. Optimistic Bias scores showed a tendency toward participants’ being optimistic that they were less likely to develop diabetes. Based on self-reported risk factor categories, a comparison of scores between physicians at higher risk (n = 196) and those at lower risk (n = 313) for developing diabetes showed greater comparative disease risk perception among the higher risk physicians (P &lt; 0.01), as well as greater perception of diabetes risk (P &lt; 0.001). Nearly 50% of higher risk physicians, however, reported an optimistic bias that they were less likely to develop diabetes than other people of their same age and sex. Women (n = 75) reported greater perception of environmental risks than men (P &lt; 0.001). Asian respondents (n = 126) reported greater perception of environmental risk (P &lt; 0.001) and greater worry about developing diabetes (P &lt; 0.0001) than white respondents (n = 355). Regression analyses showed that scores for nondiabetes comparative disease risks (0.39) and level of optimistic bias (0.31) were predictive of diabetes risk perception (P &lt; 0.0001).
CONCLUSIONS—The data gathered on physicians’ perception of their personal risk for developing diabetes and other comparative risk judgments provided an expert comparison for future analyses of at-risk or lay individuals’ perceptions of diabetes risk. Effective communication of diabetes risk among physicians, patients, and the general public relies on knowledge of and sensitivity to group differences in these perceptions.
Effect of Dalteparin on Healing of Chronic Foot Ulcers in Diabetic Patients With Peripheral Arterial Occlusive Disease
Authors: Kalani Majid , Apelqvist Jan , Blombäck Margareta , Brismar Kerstin , Eliasson Björn , Eriksson Jan W. , Fagrell Bengt , Hamsten Anders , Torffvit Ole , Jörneskog Gun 
Published: March 2007

OBJECTIVE—Chronic foot ulcers are a common, severe, and expensive complication threatening life and limb in patients with diabetes. The aim of the present study was to investigate the effect of dalteparin on ulcer outcome in patients with diabetes, peripheral arterial occlusive disease, and chronic foot ulcers.RESEARCH DESIGN AND METHODS—A total of 87 patients were investigated in a prospective, randomized, double-blind, placebo-controlled trial. Participants were randomized to treatment with subcutaneous injection of 5,000 units dalteparin (Fragmin, Pharmacia Corporation; n = 44) or an equivalent volume of physiological saline (n = 43) once daily until ulcer healing or for a maximum of 6 months. Ulcer outcome was investigated by evaluating the number of patients 1) who healed with intact skin; 2) in whom the study ulcer was improved, unchanged, or impaired; or 3) who were amputated above or below the ankle level, as compared with control subjects.RESULTS—Two patients, one on dalteparin and one on placebo, dropped out of the study. Ulcer outcome was significantly better (P = 0.042, two-sided χ2 test for trend) in the dalteparin group (n = 43) compared with the placebo group (n = 42). A total of 29 patients healed with intact skin (n = 14) or decreased the ulcer area ≥50% (n = 15) in the dalteparin group compared with 20 (n = 9 and 11, respectively) in the placebo group. Five patients in each group showed impaired ulcer healing, i.e., the ulcer area increased ≥50%. Two patients in the dalteparin group were amputated compared with eight in the placebo group. Time to healing with intact skin was 17 ± 8 weeks in the dalteparin group compared with 16 ± 7 weeks in placebo group (NS).CONCLUSIONS—The results of the present study indicate that dalteparin improves the outcome of chronic foot ulcers in diabetic patients with peripheral arterial occlusive disease.
Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Therapy Are Equally Effective in Type 2 Diabetes
Authors: Raskin Philip , Bode Bruce W. , Marks Jennifer B. , Hirsch Irl B. , Weinstein Richard L. , McGill Janet B. , Peterson Gregory E. , Mudaliar Sunder R. , Reinhardt Rickey R. 
Published: March 2007

OBJECTIVE—Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy for patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 132 CSII-naive type 2 diabetic patients were randomly assigned (1:1) to CSII (using insulin aspart) or MDI therapy (bolus insulin aspart and basal NPH insulin) in a multicenter, open-label, randomized, parallel-group, 24-week study. Efficacy was assessed with HbA1c and eight-point blood glucose (BG) profiles. Treatment satisfaction was determined with a self-administered questionnaire. Safety assessments included adverse events, hypoglycemic episodes, laboratory values, and physical examination findings.
RESULTS—HbA1c values decreased similarly for both groups from baseline (8.2 ± 1.37% for CSII, 8.0 ± 1.08% for MDI) to end of study (7.6 ± 1.22% for CSII, 7.5 ± 1.22% for MDI). The CSII group showed a trend toward lower eight-point BG values at most time points (only significant 90 min after breakfast; 167 ± 48 vs. 192 ± 65 mg/dl for CSII and MDI, respectively; P = 0.019). A total of 93% of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience, flexibility, ease of use, and overall preference. Safety assessments were comparable for both treatment groups.
CONCLUSIONS—Insulin aspart in CSII therapy provided efficacy and safety comparable to MDI therapy for type 2 diabetes. Patients with type 2 diabetes can be trained as outpatients to use CSII and prefer CSII to injections, indicating that pump therapy should be considered when initiating intensive insulin therapy for type 2 diabetes.
Relationships of Plasma Interleukin-18 Concentrations to Hyperhomocysteinemia and Carotid Intimal-Media Wall Thickness in Patients With Type 2 Diabetes
Authors: Aso Yoshimasa , Okumura Ki-ichi , Takebayashi Kohzo , Wakabayashi Sadao , Inukai Toshihiko 
Published: March 2007

OBJECTIVE—We compared plasma interleukin (IL)-18 concentrations in patients with type 2 diabetes with those in age-matched control subjects and investigated whether plasma IL-18 was associated with plasma total homocysteine (tHcy) concentration or carotid intimal-media wall thickness (IMT), an early marker of atherosclerosis, in these patients.
RESEARCH DESIGN AND METHODS—We measured plasma IL-18 in 103 type 2 diabetic patients and 45 age-matched control subjects. We also measured patients’ plasma tHcy and serum high-sensitivity C-reactive protein (hs-CRP). IMT was evaluated for both common carotid arteries.
RESULTS—Plasma IL-18 was significantly higher in diabetic patients than in control subjects (203 ± 153 vs. 118 ± 37 pg/ml, P &lt; 0.001). High IL-18 was defined as equaling or exceeding the mean + 2 SD of plasma IL-18 in control subjects (192 pg/ml). Patients with high IL-18 showed a greater carotid IMT than those with normal IL-18. Carotid plaques were more numerous in diabetic patients with high IL-18 than in those with normal IL-18. Plasma tHcy concentrations were significantly higher in patients with high IL-18 than in those with normal IL-18. Univariate and multivariate analyses showed a strong independent association between tHcy and IL-18. Plasma IL-18 also correlated positively with serum hs-CRP.
CONCLUSIONS—In patients with type 2 diabetes, plasma IL-18 concentrations are greater than in nondiabetic subjects. Plasma IL-18 is an independent determinant of plasma tHcy, which is linked independently with atherosclerotic carotid wall thickening.
Diabetic Retinopathy
Authors: Brown Jonathan Betz , Pedula Kathryn L. , Summers Kent H. 
Published: March 2007

OBJECTIVE—To measure the extent to which modern intensified risk factor control has lessened the duration-specific prevalence of diabetic retinopathy and, therefore, has decreased the risk of blindness in Americans with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Intensified control of blood glucose and blood pressure has prevented diabetic retinopathy in randomized controlled trials. There is as yet no confirmation that subsequent treatment intensification in the community has had the same result. We identified all 6,993 members of a health maintenance organization, Kaiser Permanente Northwest (KPNW), who, in 1997–1998, had dilated retinal examinations and verifiable data of diagnosis of type 2 diabetes. We plotted prevalence by time since diagnosis for background diabetic retinopathy (BDR) and proliferative diabetic retinopathy (PDR) and compared these results to identically derived 1980–1982 results from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). We estimated multivariate predictive models.
RESULTS—Mean (± SD) HbA1c in KPNW was 7.84 ± 1.26% versus 10.37% (standardized) in the WESDR. KPNW blood pressure averaged 138.6 ± 13.8/79.5 ± 7.4 mmHg compared with 147.0/79.0 in the WESDR. BDR was much less prevalent in KPNW, but PDR prevalence appeared unchanged. BDR preceded diagnosis in 20.8% of the WESDR subjects but only 2.0% of KPNW subjects. However, in both populations, the first cases of PDR appeared similarly, soon after diagnosis.
CONCLUSIONS—Earlier diagnosis and more aggressive control of blood glucose and blood pressure decreased the duration-adjusted prevalence of background, but not of sight-threatening proliferative retinopathy. More population-based research is needed to replicate and explain this unexpected finding. Detecting and treating PDR should not be neglected on the assumption that risk-factor control has minimized its prevalence.
Magnesium Intake and Risk of Type 2 Diabetes in Men and Women
Authors: Lopez-Ridaura Ruy , Willett Walter C. , Rimm Eric B. , Liu Simin , Stampfer Meir J. , Manson JoAnn E. , Hu Frank B. 
Published: March 2007

OBJECTIVE—To examine the association between magnesium intake and risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We followed 85,060 women and 42,872 men who had no history of diabetes, cardiovascular disease, or cancer at baseline. Magnesium intake was evaluated using a validated food frequency questionnaire every 2–4 years. After 18 years of follow-up in women and 12 years in men, we documented 4,085 and 1,333 incident cases of type 2 diabetes, respectively.
RESULTS—After adjusting for age, BMI, physical activity, family history of diabetes, smoking, alcohol consumption, and history of hypertension and hypercholesterolemia at baseline, the relative risk (RR) of type 2 diabetes was 0.66 (95% CI 0.60–0.73; P for trend &lt;0.001) in women and 0.67 (0.56–0.80; P for trend &lt;0.001) in men, comparing the highest with the lowest quintile of total magnesium intake. The RRs remained significant after additional adjustment for dietary variables, including glycemic load, polyunsaturated fat, trans fat, cereal fiber, and processed meat in the multivariate models. The inverse association persisted in subgroup analyses according to BMI, physical activity, and family history of diabetes.
CONCLUSIONS—Our findings suggest a significant inverse association between magnesium intake and diabetes risk. This study supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.
Intensive Therapy With Inhaled Insulin via the AERx Insulin Diabetes Management System
Authors: Hermansen Kjeld , Rönnemaa Tapani , Petersen Astrid Heide , Bellaire Shannon , Adamson Ulf 
Published: March 2007

OBJECTIVE—To compare the glycemic control of inhaled insulin via the AERx insulin diabetes management system (iDMS) with that of subcutaneous (SC) insulin, both combined with NPH insulin at bedtime, in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—The AERx iDMS uses a liquid insulin formulation to achieve flexible precise mealtime dosing (with increments corresponding to 1 IU administered subcutaneously) and ensures insulin delivery only when the breathing technique is optimal. This trial in patients with type 2 diabetes compared the glycemic control (HbA1c) achieved by inhaled insulin administered via AERx iDMS with that using SC insulin. This was a randomized, 12-week, open-label, parallel, multicenter, multinational trial in 107 nonsmoking patients with type 2 diabetes (mean age 59 years, mean duration of diabetes 11.9 years). Patients were randomized to receive either inhaled fast-acting human insulin via AERx iDMS immediately before meals or SC fast-acting human insulin administered 30 min before meals, both in combination with evening NPH insulin.
RESULTS—Baseline and demographic characteristics were similar between the two groups. There was no statistically significant difference in HbA1c between the AERx and SC groups after 12 weeks of treatment (7.84 ± 0.77 vs. 7.76 ± 0.77%, P = 0.60). Fasting serum glucose was significantly lower in the AERx group compared with the SC group by the end of the trial (8.9 ± 3.8 vs. 10.8 ± 3.7 mmol/l, P = 0.01) with a similar NPH dose in the two groups (0.23 vs. 0.23 IU/kg, P = 0.93). There were no statistically significant differences between the two groups in the intra-subject variability of fasting or prandial blood glucose increment. Adverse events were similar in the two groups. No major safety concerns were raised during the trial.
CONCLUSIONS—In patients with type 2 diabetes, preprandial inhaled insulin via AERx iDMS is as effective as preprandial SC insulin injection in achieving glycemic control with similar tolerability.
Effect of Weight Loss on Cardiac Synchronization and Proinflammatory Cytokines in Premenopausal Obese Women
Authors: Marfella Raffaele , Esposito Katherine , Siniscalchi Mario , Cacciapuoti Federico , Giugliano Francesco , Labriola Domenico , Ciotola Myriam , Di Palo Carmen , Misso Lucio , Giugliano Dario 
Published: March 2007

OBJECTIVE—Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss.
RESEARCH DESIGN AND METHODS—Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women.
RESULTS—Compared with nonobese women, obese women had increased concentrations of CRP (P &lt; 0.01), TNF-α (P &lt; 0.01), IL-6 (P &lt; 0.01), and IL-18 (P &lt; 0.01). Moreover, obese women had a higher myocardial performance index (P &lt; 0.02) and lower transmitral Doppler flow (P &lt; 0.05), pulmonary venous flow analysis (P &lt; 0.02), and ejection fraction (P &lt; 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-α, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P &lt; 0.01) and CRP (P &lt; 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity.
CONCLUSIONS—In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women.
Opportunistic Screening for Diabetes in Routine Clinical Practice
Authors: Ealovega Mark W. , Tabaei Bahman P. , Brandle Michael , Burke Ray , Herman William H. 
Published: March 2007

OBJECTIVE—Since 1997, the American Diabetes Association has recommended that nondiabetic individuals ≥45 years of age be screened for diabetes at least every 3 years. We sought to characterize the frequency, methods, and results of diabetes screening in routine clinical practice.
RESEARCH DESIGN AND METHODS—We studied opportunistic screening in nondiabetic members of a health maintenance organization ≥45 years of age who were assigned to a large, integrated, academic health care delivery system. Screening was defined as the first glucose, HbA1c, or oral glucose tolerance test (OGTT) performed between 1 January 1998 and 31 December 2000. Chart review was performed to determine the prevalence of diabetes risk factors and to describe follow-up.
RESULTS—Of 8,286 nondiabetic patients ≥45 years of age, 69% (n = 5,752) were screened. The frequency of screening was greater in patients with one or more primary care visits and increased with age. Women were more likely to be screened than men, and patients with at least one diabetes risk factor were more likely to be screened than those without risk factors. Random plasma glucose was the most common screening test (95%). Four percent (n = 202) of those screened had abnormal results. Only 38% (n = 77) of those with abnormal results received appropriate follow-up, and 17% (n = 35) were diagnosed with diabetes within 6 months of screening. The yield of screening was very low (0.6%, 35 of 5,752).
CONCLUSIONS—Despite frequent screening and appropriate targeting of high-risk patients, follow-up of patients with abnormal results is uncommon and the yield of screening is low. Interventions are needed to help physicians recognize and provide appropriate follow-up for patients with potentially abnormal random glucose levels.
Closing the Gap: Effect of Diabetes Case Management on Glycemic Control Among Low-Income Ethnic Minority Populations
Authors:   The California Medi-Cal Type 2 Diabetes Study Group
Published: March 2007

OBJECTIVE—Disparities exist in the diabetes health status of ethnic minority and/or low-income populations relative to other groups. A primary objective of diabetes management is to improve glycemic control. The feasibility of implementing intensive diabetes case management in disparate populations remains largely untested.
RESEARCH DESIGN AND METHODS—Clinical sites in three southern California counties serving low-income, ethnic minority populations participated in our study. We randomized 362 Medicaid (called Medi-Cal in California) recipients with type 2 diabetes for at least 1 year to intervention (diabetes case management) or control (traditional primary care treatment) groups. Fifty-five percent of participants were minorities. Participants with HbA1c levels less than 7.5%, serious diabetes-related complications, or other serious medical conditions were excluded. We assessed the effect of the intervention (ongoing diabetes case management added to primary care) on glycemic control using serial HbA1c measurements over several years.
RESULTS—The mean duration of follow-up was 25.3 months. HbA1c decreased substantially in both groups from an average of 9.54–7.66% (a reduction of 1.88%) in the intervention group and from an average of 9.66–8.53% (a reduction of 1.13%) in the control group. This improvement was sustained throughout the study. The reduction in HbA1c was consistently greater in the intervention group at each time point (P &lt; 0.001), ranging between 0.65 at 6 months and 0.87 at study end.
CONCLUSIONS—Diabetes case management, added to primary care, substantially improved glycemic control compared with the control group. Diabetes case management can help reduce disparities in diabetes health status among low-income ethnic populations.
The Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children With Type 1 Diabetes
Authors: Bulsara Max K. , Holman C. D’Arcy J. , Davis Elizabeth A. , Jones Timothy W. 
Published: March 2007

OBJECTIVE—To determine the impact of changes to treatment on the incidence of severe hypoglycemia and its risk factors in a large population-based cohort of children with type 1 diabetes.
RESEARCH DESIGN AND METHODS—The cohort consisted of 1,335 children (age at entry 9.5 ± 4.3 years [mean ± SD], range 0–18), yielding 6,928 patient-years of data. The mean follow-up period was 4.7 ± 3.1 years (range 0–10.7). Prospective assessment of severe hypoglycemia (an event leading to loss of consciousness or seizure) and associated clinical factors and outcomes was made between 1992 and 2002. Patients were reviewed every 3 months. Data were analyzed using the negative binomial regression model.
RESULTS—A total of 944 severe events were recorded. The incidence of severe hypoglycemia increased significantly by 29% per year for the first 5 years but appeared to plateau over the last 5 years. The overall average HbA1c significantly decreased (by 0.2% per year) over the whole follow-up period. An increased risk of severe hypoglycemia was associated with lower HbA1c, younger age, higher insulin dose, male sex, and lower parental socioeconomic status. Of insulin therapies, only pump treatment was associated with reduced rates of severe hypoglycemia.
CONCLUSIONS—Severe hypoglycemia remains a major problem for children and adolescents with type 1 diabetes. Recent approaches to therapy may be allowing a degree of improved control without the expected increased risk of severe hypoglycemia but further monitoring will be important.