bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Syndrome and Risk of Restenosis in Patients Undergoing Percutaneous Coronary Intervention
Authors: Rana Jamal S. , Monraats Pascalle S. , Zwinderman Aeilko H. , de Maat Moniek P.M. , Kastelein John J.P. , Doevendans Pieter A.F. , de Winter Robbert J. , Tio René A. , Frants Rune R. , van der Laarse Arnoud , van der Wall Ernst E. , Jukema J. Wouter 
Published: March 2007

OBJECTIVE—Patients with metabolic syndrome have increased risk of cardiovascular events. The number of patients with metabolic syndrome is rapidly increasing, and these patients often need revascularization. However, only limited data are available on the effect of metabolic syndrome on restenosis in patients undergoing percutaneous coronary intervention (PCI).
RESEARCH DESIGN AND METHODS—To assess the role of metabolic syndrome in the development of restenosis, we performed an analysis in a population of patients from the GENetic DEterminants of Restenosis (GENDER) study. The GENDER project, a multicenter prospective study, included consecutive patients after successful PCI and was designed to study the predictive value of various genetic and other risk factors for subsequent clinical restenosis, defined as target vessel revascularization (TVR) or combined end point of death, myocardial infarction, and TVR. This subpopulation of GENDER consisted of 901 patients, 448 of whom (49.7%) had metabolic syndrome.
RESULTS—On multivariable Cox regression analysis, controlling for age, sex, previous myocardial infarction, stent length, current smoking, and statin therapy, there was no association between increased risk of TVR (hazard ratio 1.03 [95% CI 0.68–1.57]) or the combined end point (1.05 [0.71–1.55]) and the presence of metabolic syndrome.
CONCLUSIONS—This study demonstrates that metabolic syndrome is not associated with TVR or the combined end point after PCI. Furthermore, accumulating characteristics of metabolic syndrome were neither associated with increased risk of TVR nor with the combined end point. Therefore, PCI has equal beneficial results in patients with or without metabolic syndrome. This is important information in light of the pandemic proportion of metabolic syndrome that the medical community will face.
Reduced Hypoglycemia Risk With Insulin Glargine
Authors: Rosenstock Julio , Dailey George , Massi-Benedetti Massimo , Fritsche Andreas , Lin Zhengning , Salzman Alan 
Published: March 2007

OBJECTIVE—Insulin glargine (LANTUS) is a once-daily basal insulin analog with a smooth 24-h time-action profile that provides effective glycemic control with reduced hypoglycemia risk (particularly nocturnal) compared with NPH insulin in patients with type 2 diabetes. A recent “treat-to-target” study has shown that more patients on insulin glargine reached HbA1c levels ≤7.0% without confirmed nocturnal hypoglycemia compared with NPH insulin. We further assessed the risk for hypoglycemia in a meta-analysis of controlled trials of a similar design for insulin glargine versus once- or twice-daily NPH insulin in adults with type 2 diabetes.
RESEARCH DESIGN AND METHODS—All studies were 24–28 weeks long, except one 52-week study, for which interim 20-week data were used.
RESULTS—Patient demographics were similar between the insulin glargine (n = 1,142) and NPH insulin (n = 1,162) groups. The proportion of patients achieving target HbA1c (≤7.0%) was similar between insulin glargine–and NPH insulin–treated patients (30.8 and 32.1%, respectively). There was a consistent significant reduction of hypoglycemia risk associated with insulin glargine, compared with NPH insulin, in terms of overall symptomatic (11%; P = 0.0006) and nocturnal (26%; P &lt; 0.0001) hypoglycemia. Most notably, the risk of severe hypoglycemia and severe nocturnal hypoglycemia were reduced with insulin glargine by 46% (P = 0.0442) and 59% (P = 0.0231), respectively.
CONCLUSIONS—These results confirmed that insulin glargine given once daily reduces the risk of hypoglycemia compared with NPH insulin, which can facilitate more aggressive insulin treatment to a HbA1c target of ≤7.0% in patients with type 2 diabetes.
Amputation Prevention Initiative in South India
Authors: Viswanathan Vijay , Madhavan Sivagami , Rajasekar Seena , Chamukuttan Snehalatha , Ambady Ramachandran 
Published: March 2007

OBJECTIVE—To determine whether intensive treatment and education strategies for type 2 diabetic patients with high-risk diabetic foot disease helps in preventing foot amputations.
RESEARCH DESIGN AND METHODS—Participants included 4,872 consecutive type 2 diabetic patients (male-to-female ratio 3,422:1,450, mean (±SD) age 60.5 ± 8.8 years, mean duration of diabetes 13.7 ± 7.6 years) with high-risk diabetic foot disease. The patients were categorized as high-risk subjects according to the International Consensus on the Diabetic Foot. The three study groups were subjects with diabetes and neuropathy (group 1; n = 2,871), diabetic neuropathy with deformity (group 2; n = 235), and diabetic neuropathy with deformity and foot ulceration or peripheral vascular disease (group 3; n = 1,766). Neuropathy was diagnosed by biothesiometry. Peripheral vascular disease was diagnosed as an ankle brachial index &lt;0.8. All the subjects were educated regarding diabetic foot disease and its complications and prevention. They were also instructed to visit the center if any sign of new lesions appeared.
RESULTS—Among the 1,259 group 3 subjects who came for follow-up, 718 (57%) strictly followed the advice given and 541 (43%) did not. Ulcers present during the recruitment had healed in 585 (82%) subjects who followed the advice, but in only 269 (50%) subjects who did not. A significantly larger proportion of subjects who did not follow the advice developed new problems (26%) and required surgical procedures (14%) compared with those who followed the advice (5 and 3%, respectively).
CONCLUSIONS—Strategies such as intensive management and foot care education are helpful in preventing newer problems and surgery in diabetic foot disease.
Dietary Glycemic Index, Glycemic Load, Cereal Fiber, and Plasma Adiponectin Concentration in Diabetic Men
Authors: Qi Lu , Rimm Eric , Liu Simin , Rifai Nader , Hu Frank B. 
Published: March 2007

OBJECTIVE—Adiponectin may improve insulin sensitivity, reduce inflammation, and ameliorate glycemic control. However, few studies have evaluated dietary predictors of plasma adiponectin levels, especially among subjects with type 2 diabetes.
RESEARCH DESIGN AND METHODS—To examine the associations of dietary glycemic load, glycemic index, and fibers with plasma adiponectin levels, we conducted a cross-sectional analysis in 780 diabetic men from the Health Professionals’ Follow-up Study. Dietary information was obtained in 1986, 1990, and 1994 using semiquantitative food-frequency questionnaires.
RESULTS—After adjustment for age, BMI, smoking, alcohol consumption, physical activity, aspirin use, HbA1c, history of hypertension or hypercholesterolemia, and fiber intake, dietary glycemic index and glycemic load were inversely associated with plasma adiponectin in a dose-dependent fashion (P for trend = 0.005 for glycemic index and 0.004 for glycemic load). Adiponectin levels were 13% lower in the highest quintile of dietary glycemic index than in the lowest quintile. For dietary glycemic load, adiponectin levels were 18% lower in the highest quintile than in the lowest. In contrast, high intake of cereal fiber was associated with increased plasma adiponectin levels, adjusting for lifestyle factors and dietary glycemic load (P for trend = 0.003). Adiponectin levels were 19% higher in the highest quintile than in the lowest quintile. Higher magnesium intake was also associated with increased plasma adiponectin.
CONCLUSIONS—Diets low in glycemic load and high in fiber may increase plasma adiponectin concentrations in diabetic patients.
Time Trends and Geographic Disparities in Acute Complications of Diabetes in Ontario, Canada
Authors: Booth Gillian L. , Hux Janet E. , Fang Jiming , Chan Benjamin T.B. 
Published: March 2007

OBJECTIVE—This study examines whether acute diabetes complication rates have fallen in recent years and whether geographic factors influence these trends.
RESEARCH DESIGN AND METHODS—A population-based time-trend analysis of acute complications of diabetes was conducted using linked administrative and census data from Ontario, Canada. The study population included all adults identified through a province-wide electronic diabetes registry between 1994 and 1999 (n = 577,659). The primary outcome was hospitalizations for hyper- and hypoglycemia and emergency department visits for diabetes.
RESULTS—Between 1994 and 1999, rates of hospitalization for hyper- and hypoglycemic emergencies decreased by 32.5 and 76.9%, respectively; emergency department visits for diabetes fell by 23.9%. On multivariate analysis, fiscal year was an independent predictor of acute diabetes complications, with individuals in our cohort experiencing a decline in risk of ∼6% per year for either being hospitalized with hyper- or hypoglycemia or requiring an emergency department visit for diabetes. After accounting for variation in physician service use, diabetic individuals living in rural areas or Aboriginal communities were nearly twice as likely to have an acute complication, whereas those residing in remote areas of the province were nearly three times as likely to experience an event.
CONCLUSIONS—Although our findings suggest an overall improvement in diabetes care in Ontario, certain subgroups of the population continue to experience higher rates of complications that are potentially preventable through good ambulatory care. Measures to improve access to timely and effective outpatient care may further reduce rates of acute complications among the diabetic population.
Awareness and Treatment of Dyslipidemia in Young Adults With Type 1 Diabetes
Authors: Wadwa R. Paul , Kinney Gregory L. , Maahs David M. , Snell-Bergeon Janet , Hokanson John E. , Garg Satish K. , Eckel Robert H. , Rewers Marian 
Published: March 2007

OBJECTIVE—Dyslipidemia is a preventable major risk factor for coronary heart disease (CHD). Despite an increased risk of CHD in type 1 diabetes, little is known concerning awareness and adequacy of dyslipidemia treatment in this population. In this report, we describe the prevalence of dyslipidemia and adequacy of pharmacological treatment in patients with type 1 diabetes and comparable nondiabetic subjects.
RESEARCH DESIGN AND METHODS—From 2000 to 2002, the Coronary Artery Calcification in Type 1 Diabetes study obtained fasting lipid profiles in 1,416 individuals aged 19–56 years with no history of CHD: 652 type 1 diabetic patients (46% men, mean age 37 ± 9 years) and 764 nondiabetic control subjects (50% men, mean age 39 ± 9 years). These data combined with patient questionnaire results were used to determine prevalence of dyslipidemia and adequacy of pharmacological treatment. For all subjects, dyslipidemia was defined using National Cholesterol Education Program Adult Treatment Panel III criteria.
RESULTS—Type 1 diabetic subjects had significantly less dyslipidemia than nondiabetic control subjects (47 vs. 58%, P &lt; 0.001), and a higher percentage of those with abnormal lipids were aware of (52 vs. 34%, P &lt; 0.0001), on medication for (36 vs. 9%, P &lt; 0.0001), and in control of their lipid levels (15 vs. 1.4%, P &lt; 0.001). Of those on treatment, control was achieved in 41% of type 1 diabetic subjects and 15% of nondiabetic participants (P &lt; 0.01).
CONCLUSIONS—Dyslipidemia, a major risk factor for CHD, remains largely undiagnosed and undertreated in high-risk populations, such as patients with type 1 diabetes.
Physical Activity Energy Expenditure Predicts Progression Toward the Metabolic Syndrome Independently of Aerobic Fitness in Middle-Aged Healthy Caucasians
Authors: Ekelund Ulf , Brage Søren , Franks Paul W. , Hennings Susie , Emms Sue , Wareham Nicholas J. 
Published: March 2007

OBJECTIVE—To examine over a period of 5.6 years the prospective associations between physical activity energy expenditure (PAEE), aerobic fitness (Vo2max), obesity, and the progression toward the metabolic syndrome in a population-based cohort of middle-aged men and women (n = 605) who were free of the metabolic syndrome at baseline.
RESEARCH DESIGN AND METHODS—PAEE was measured objectively by individually calibrated heart rate against energy expenditure. Vo2max was predicted from a submaximal exercise stress test. Fat mass and fat-free mass were assessed by bio-impedance. A metabolic syndrome score was computed by summing the standardized values for obesity, hypertension, hyperglycemia, insulin resistance, hypertriglyceridemia, and the inverse level of HDL cholesterol and expressed as a continuously distributed outcome. Generalized linear models were used to examine the independent prospective associations between PAEE and Vo2max and the metabolic syndrome score after adjusting for sex, baseline age, smoking, socioeconomic status, follow-up time, and baseline phenotypes.
RESULTS—PAEE predicted progression toward the metabolic syndrome, independent of baseline metabolic syndrome, body fat, Vo2max, and other confounding factors (standardized β = −0.00085, P = 0.046). This association was stronger when excluding the adiposity component from the metabolic syndrome (standardized β = −0.0011, P = 0.035). Vo2max was not an independent predictor of the metabolic syndrome after adjusting for physical activity (standardized β = 0.00011, P = 0.93).
CONCLUSIONS—PAEE predicts progression toward the metabolic syndrome independent of aerobic fitness, obesity, and other confounding factors. This finding underscores the importance of physical activity for metabolic disease prevention even when an improvement in aerobic fitness is absent.
Improvement of Glycemic Control in Subjects With Poorly Controlled Type 2 Diabetes
Authors: Davies Melanie , Storms Fred , Shutler Simon , Bianchi-Biscay Monique , Gomis Ramon ,   for the AT.LANTUS Study Group
Published: March 2007

OBJECTIVE—Large prospective studies have demonstrated that optimum glycemic control is not routinely achieved in clinical practice. Barriers to optimal insulin therapy include hypoglycemia, weight gain, and suboptimal initiation and dose titration. This study compared two treatment algorithms for insulin glargine initiation and titration: algorithm 1 (investigator led) versus algorithm 2 (performed by study subjects).
RESEARCH DESIGN AND METHODS—A prospective, multicenter (n = 611), multinational (n = 59), open-label, 24-week randomized trial in 4,961 (algorithm 1, n = 2,493; algorithm 2, n = 2,468) suboptimally controlled type 2 diabetic subjects.
RESULTS—At baseline, mean diabetes duration was 12.3 ± 7.2 years, and 72% of subjects were pretreated with insulin. At end point, there was no significant difference in the incidence of severe hypoglycemia between algorithms 1 and 2 (0.9 vs. 1.1%). There was a significant reduction in HbA1c from 8.9 ± 1.3 to 7.8 ± 1.2%, with a greater decrease (P &lt; 0.001) with algorithm 2 (−1.22%) versus algorithm 1 (−1.08%). Fasting blood glucose decreased from 170 to 110 mg/dl, with a greater decrease (P &lt; 0.001) with algorithm 2 (−62 mg/dl) versus algorithm 1 (−57 mg/dl). Mean basal insulin dose increased from 22.9 ± 15.5 to 43.0 ± 25.5 IU, with a significant difference (P &lt; 0.003) between algorithm 2 (21.6 IU) and algorithm 1 (18.7 IU).
CONCLUSIONS—Glargine is safe and effective in improving glycemic control in a large, diverse population with longstanding type 2 diabetes. A simple subject-administered titration algorithm conferred significantly improved glycemic control with a low incidence of severe hypoglycemia compared with physician-managed titration.
The Decline in Blood Glucose Levels Is Less With Intermittent High-Intensity Compared With Moderate Exercise in Individuals With Type 1 Diabetes
Authors: Guelfi Kym J. , Jones Timothy W. , Fournier Paul A. 
Published: March 2007

OBJECTIVE—To compare the response of blood glucose levels to intermittent high-intensity exercise (IHE) and moderate-intensity exercise (MOD) in individuals with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Seven healthy individuals with type 1 diabetes were tested on two separate occasions, during which either a 30-min MOD or IHE protocol was performed. MOD consisted of continuous exercise at 40% Vo2peak, while the IHE protocol involved a combination of continuous exercise at 40% Vo2peak interspersed with 4-s sprints performed every 2 min to simulate the activity patterns of team sports.
RESULTS—Both exercise protocols resulted in a decline in blood glucose levels. However, the decline was greater with MOD (−4.4 ± 1.2 mmol/l) compared with IHE (−2.9 ± 0.8 mmol/l; P &lt; 0.05), despite the performance of a greater amount of total work with IHE (P &lt; 0.05). During 60 min of recovery from exercise, glucose levels remained higher in IHE compared with MOD (P &lt; 0.05). Furthermore, glucose levels remained stable during recovery from IHE, while they continued to decrease after MOD (P &lt; 0.05). The stabilization of blood glucose levels with IHE was associated with elevated levels of lactate, catecholamines, and growth hormone during early recovery from exercise (P &lt; 0.05). There were no differences in free insulin, glucagon, cortisol, or free fatty acids between MOD and IHE.
CONCLUSIONS—The decline in blood glucose levels is less with IHE compared with MOD during both exercise and recovery in individuals with type 1 diabetes.
Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients
Authors: Fiorina Paolo , Gremizzi Chiara , Maffi Paola , Caldara Rossana , Tavano Davide , Monti Lucilla , Socci Carlo , Folli Franco , Fazio Ferruccio , Astorri Ettore , Del Maschio Alessandro , Secchi Antonio 
Published: March 2007

OBJECTIVE—Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients.
RESEARCH DESIGN AND METHODS—We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twenty-five patients did not receive a functioning islet transplant (kidney-only group).
RESULTS—GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 ± 3.5% at baseline to 74.9 ± 2.1% at 3 years posttransplantation, P &lt; 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 ± 0.25 to 4.20 ± 0.37 EDV/s, P &lt; 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P &lt; 0.05). The kidney-islet group also showed a reduction of both QT dispersion (53.5 ± 4.9 to 44.6 ± 2.9 ms, P &lt; 0.05) and corrected QT (QTc) dispersion (67.3 ± 8.3 to 57.2 ± 4.6 ms, P &lt; 0.05) with higher erythrocytes Na+-K+-ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness.
CONCLUSIONS—Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft.
Dietary Glycemic Index, Glycemic Load, Fiber, Simple Sugars, and Insulin Resistance
Authors: Lau Cathrine , Færch Kristine , Glümer Charlotte , Tetens Inge , Pedersen Oluf , Carstensen Bendix , Jørgensen Torben , Borch-Johnsen Knut 
Published: March 2007

OBJECTIVE—To examine the relationship between daily glycemic index, daily glycemic load, simple sugars, dietary fiber, and the prevalence of a measure of insulin resistance in 30- to 60-year-old nondiabetic Danish men and women.
RESEARCH DESIGN AND METHODS—The Inter99 study is a nonpharmacological intervention study. We used baseline data and examined cross-sectional associations between carbohydrate-related dietary factors and an estimate of insulin resistance in 5,675 subjects at 30–60 years. The dietary intake was estimated from a self-administered food frequency questionnaire, and insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). Multiple regressions were performed with HOMA-IR as the dependent variable and carbohydrate-related factors as explanatory variables. All models were adjusted for age, sex, smoking, physical activity, total energy intake, BMI, and waist circumference.
RESULTS—Intake of lactose was positively associated with HOMA-IR (P &lt; 0.0001), whereas daily glycemic load and intake of glucose, fructose, dietary fiber, total carbohydrate, fruit, and vegetables were inversely associated with HOMA-IR (P &lt; 0.05). Intake of dietary fiber explained the associations with daily glycemic load and total carbohydrate and attenuated the association with fruit and vegetables. No significant associations were observed for daily glycemic index or sucrose.
CONCLUSIONS—Habitual intake of diets with a high glycemic index and high glycemic load or diets with a high content of total carbohydrate including simple sugars was not associated with the probability of having insulin resistance. Furthermore, intake of dietary fiber was inversely associated with the probability of having insulin resistance.
No Evidence for Genetically Determined Alteration in Insulin Secretion or Sensitivity Predisposing to Type 1 Diabetes
Authors: Hawa Mohammed I. , Bonfanti Riccardo , Valeri Christina , Delli Castelli Michela , Beyan Huriya , Leslie R. David G. 
Published: March 2007

OBJECTIVE— To determine whether inherited changes in insulin secretion or sensitivity could predispose to type 1 diabetes, we studied identical twins of type 1 diabetic patients.
RESEARCH DESIGN AND METHODS— We studied prospectively a consecutive series of 27 identical twins of patients with type 1 diabetes who were initially nondiabetic, as well as 14 control subjects, over a period of 18 years. Of these 27 twins, 15 remain nondiabetic (now estimated at low disease risk) and 12 developed diabetes (pre-diabetic twins). Subjects were tested when not diabetic on at least two occasions with an intravenous glucose tolerance test (IVGTT), and we estimated insulin secretion as first-phase insulin response (FPIR), glucose clearance (Kg), and insulin sensitivity both by homeostasis model assessment of insulin resistance (HOMA-IR) and relative to insulin response by the basal HOMA-IR–to–FPIR ratio.
RESULTS— Twins now at low risk and control subjects had similar fasting blood glucose and insulin levels, FPIR, Kg, HOMA-IR, and HOMA-IR–to–FPIR ratio. In contrast, pre-diabetic twins compared with control twins had higher fasting insulin levels (10.3 ± 6.0 vs. 4.6 ± 4.0 mIU/ml), lower FPIR (245 ± 129 vs. 796 ± 622 mIU · ml−1 · 10 min−1), lower Kg (1.5 ± 0.6 vs. 2.6 ± 0.8% per min), and higher HOMA-IR–to–FPIR ratio (0.007 ± 0.005 vs. 0.001 ± 0.0009) (all P &lt; 0.01).
CONCLUSIONS— These observations in low-risk nondiabetic identical twins failed to identify a familial alteration in either insulin secretion or sensitivity predisposing to type 1 diabetes.