bluuebunny/crossref_metadata_2025_split huggingface dataset:
Growth Patterns of Large-for-Gestational-Age and Appropriate-for-Gestational-Age Infants of Gestational Diabetic Mothers and Control Mothers at Age 1 Year
Authors: Vohr Betty R , McGarvey Stephen T 
Published: March 2007

OBJECTIVE
The purpose of this study was to explore the development of adiposity in macrosomic and normosomic infants of mothers with gestational diabetes mellitus (GDM) and control subjects between birth and age 1 year, and assess its relation to maternal prenatal factors and neonatal factors.

RESEARCH DESIGN AND METHODS
This was a prospective observational study of 192 infants, including 47 large-for-gestational-age (LGA) infants of GDM mothers, 47 appropriate-for-gestational-age (AGA) infants of GDM mothers, 55 LGA control infants, and 44 AGA control infants who were evaluated at birth and age 1 year. Maternal prenatal and pregnancy anthropometric measurements were recorded. Multiple infant anthropometric measurements, including skinfold thicknesses, were obtained at birth and age 1 year. Regression models were run to detect the independent effects of various maternal and infant factors on 1-year child adiposity, adjusting for their effects at birth.

RESULTS
LGA infants of GDM mothers had a higher BMI, waist circumference, and abdominal skinfold at age 1 year compared with all other study groups. Among infants of GDM mothers, the mean 2-h postprandial glucose value for the second and third trimester correlated with waist circumference (r = 0.28, P &lt; 0.04) and subscapular skinfold (r = 0.37, P &lt; 0.007), and correlated marginally with 1-year sum of four skinfolds. Among infants of GDM mothers, a regression of 1-year sum of four skinfolds was significantly related to maternal prepregnancy weight after controlling for sum of skinfolds at birth. For control infants, the maternal glucose screen value was significantly associated with 1-year sum of skinfolds adjusted for the birth sum of skinfolds.

CONCLUSIONS
We concluded that macrosomic infants of GDM mothers have unique patterns of adiposity that are present at birth and persist at age 1 year. Further, we concluded that maternal factors, including adiposity and intrauterine fuel environment, influence the presence and distribution of adiposity for both infants of GDM mothers and control infants.
Strategies Toward Improved Control During Insulin Lispro Therapy in IDDM: Importance of basal insulin
Authors: Ebeling Pertti , Jansson Per-Anders , Smith Ule , Lalli Carlo , Bolli Geremia B , Koivisto Veikko A 
Published: March 2007

OBJECTIVE
To examine whether overall glycemic control can be improved with insulin lispro by adjustment of the basal insulin regimen without an increased risk of hypoglycemia.

RESEARCH DESIGN AND METHODS
A 5-month open study was performed in 66 IDDM patients after they had been transferred from human regular insulin to insulin lispro as a premeal therapy. The premeal and basal insulin regimens were adjusted according to self-monitoring of blood glucose during the visits at 2-week to 1-month intervals. Diurnal glucose profile, hypoglycemic events, HbA1c, and patient satisfaction were evaluated.

RESULTS
The mean daily glucose level decreased from 9.2 ± 0.2 to 8.4 ± 0.2 mmol/l (P = 0.001) and HbA1c decreased from 8.8 ± 0.1 to 8.0 ± 0.1% (P &lt; 0.001) (mean ± SD). The number of daily NPH injections increased from 1.4 ± 0.1 at baseline to 3.1 ± 0.1 at the end of the study. Total daily insulin dose increased by 3 U (7%) because of an 8-U (43%) rise in basal insulin, whereas premeal insulin dose decreased by 5 U (20%). The number of hypoglycemic episodes did not change during the study. Of the patients, 86% considered insulin lispro equal or better than human regular insulin.

CONCLUSIONS
Although the study was open, the date suggest that the appropriate combination of insulin lispro and basal insulin can improve postmeal hyperglycemia, HbA1c, and treatment satisfaction without increasing the risk of hypoglycemia.
Diabetic Retinopathy, Promoter (4G/5G) Polymorphism of PAI-1 Gene, and PAI-1 Activity in Pima Indians With Type 2 Diabetes
Authors: Nagi Dinesh K , McCormack Lynn J , Mohamed-Ali Vidya , Yudkin John S , Knowler William C , Grant Peter J 
Published: March 2007

OBJECTIVE
To examine the relationship between plasma plasminogen activator inhibitor 1 (PAI-1) activity and PAI-1 gene (4G/5G) polymorphism and diabetic retinopathy in Pima Indians with type 2 diabetes.

RESEARCH DESIGN AND METHODS
We studied 171 Pima Indians with type 2 diabetes between the ages of 30–70 years in a population-based epidemiological survey. Plasma PAI-1 activity was measured by a spectrophotometric assay and PAI-1 4G/5G promoter genotype by the polymerase chain reaction (PCR) using allele-specific primers. Retinopathy was assessed by ophthalmoscopy after pupillary dilation and classified as any retinopathy or as nonproliferative and proliferative.

RESULTS
Retinopathy was present in 70 (41%) subjects, and 4 (2.3%) subjects had proliferative retinopathy. Plasma PAI-1 activity was not significantly different among subjects with and without retinopathy (17.1 ± vs. 19.7 ± 9.1 arbitrary units (AU)/ml, P = 0.09). PAI-1 activity was negatively correlated with duration of diabetes (rs = −0.18, P = 0.02). In a logistic regression analysis controlled for age, sex, BMI, and duration of diabetes, any retinopathy was significantly associated with fasting plasma glucose concentrations (P &lt; 0.05), 2-h postload glucose (P = 0.02), and HbA1c (P = 0.008), but not with PAI-1 activity (P = 0.48). The prevalence of retinopathy in the three genotype groups differed significantly (4G/4G, 4G/5G, and 5G/5G were 44, 49, and 24%, respectively; chi χ2 = 8.22, df = 2, P = 0.016) and remained significant after controlling for age, sex, BMI, duration of diabetes, glycated hemoglobin, and urine albumin-to-creatine ratio in a logistic regression analysis. The odds ratios for retinopathy in subjects with 4G/4G and 4G/5G, compared with the 5G/5G genotype, were 2.0 and 3.1, respectively.

CONCLUSIONS
Although diabetic retinopathy in Pima Indians with type 2 diabetes is not associated with PAI-1 activity, subjects with the 4G/4G and 4G/5G genotype had a higher prevalence of retinopathy compared with 5G/5G PAI-1genotype. These preliminary findings indicate that in Pima Indians with type 2 diabetes, presence of the 4G allele of the PAI-1 gene was associated with a higher risk of diabetic retinopathy.
Treatment of Diabetic Ketoacidosis Using Normalization of Blood 3-Hydroxybutyrate Concentration as the Endpoint of Emergency Management: A randomized controlled study
Authors: Wiggam M Ivan , O'Kane Maurice J , Harper Roy , Atkinson A Brew , Hadden David R , Trimble Elisabeth R , Bell Patrick M 
Published: March 2007

OBJECTIVE
To compare the efficacy of an extended insulin regimen using correction of hyperketonemia as endpoint with a more conventional regimen in the treatment of diabetic ketoacidosis.

RESEARCH DESIGN AND METHODS
A total of 22 patients admitted to a Belfast teaching hospital with clinical and biochemical features of diabetic ketoacidosis (pH &lt; 7.25 and/or bicarbonate &lt; 16 mmol/l) were randomized to either conventional or extended insulin regimens. In the conventional regimen, insulin was administered at 5 U/h until near-normoglycemia (blood glucose ≤ 10 mmol/l) and then administered at a reduced rate until clinical recovery. In the extended regimen, administration of insulin at 5 U/h was continued beyond attainment of normoglycemia, until resolution of hyperketonemia (3-hydroxybutyrate &lt; 0.5 mmol/l). Main outcome measures were 3-hydroxybutyrate and bicarbonate levels during the 24 h after attainment of near-normoglycemia.

RESULTS
After near-normoglycemia, correction of hyperketonemia was achieved earlier with the extended treatment (5.9 ± 0.8 vs. 21.8 ± 3.4 h, P = 0.0004 [mean ± SD]). The area under the curve of 3-hydroxybutyrate against time for 24 h after near-normoglycemia was reduced with the extended treatment (24.9 ± 3.8 vs. 55.9 ± 6.7 mmol·l−1·h−1 P = 0.001). These differences remained statistically significant after adjustment for higher baseline levels of 3-hydroxybutyrate at near-normoglycemia in the extended treatment group. Bicarbonate levels at 6 and 12 h after near-normoglycemia were not significantly different between groups.

CONCLUSIONS
The extended insulin regimen, which was easy to implement at ward level, produced a more rapid resolution of ketosis than the conventional regimen.
Maternal Serum Ferritin and Gestational Impaired Glucose Tolerance
Authors: Lao Terence T , Tam Kar-Fai F 
Published: March 2007

OBJECTIVE
To determine if the reported features of decreased iron store in the infant of diabetic mother are related to underlying maternal iron deficiency, a prospective case-control study was performed on a group of low-risk antenatal patients without preexisting anemia or thalassemia trait and before the diagnosis of gestational diabetes mellitus (GDM) in the last trimester.

RESEARCH DESIGN AND METHODS
At the time of routine screening for anemia and GDM at 28–30 weeks of gestation, an additional blood sample was collected for the assay of serum ferritin, iron, and total iron binding capacity (TIBC). Patients with elevated random sugar underwent a 75-g oral glucose tolerance test (OGTT), interpreted by the World Health Organization criteria. For each person diagnosed with GDM, a control subject matched in maternal age and parity was identified, and their iron status and hematological indexes were compared.

RESULTS
There were 60 patients with gestational impaired glucose tolerance (GIGT), and none had frank GDM. There was no difference in the hematological indexes or serum iron and TIBC values, but serum ferritin level was significantly increased in the GIGT group, when compared with control subjects.

CONCLUSIONS
The findings indicate that there was no evidence of preexisting iron deficiency in the third trimester before the diagnosis of GIGT, while serum ferritin was even increased in the GIGT patients, a phenomenon that could have reflected the glucose intolerance. Serum ferritin is probably an unreliable index for maternal iron therapy in these patients, and the role of iron therapy in GIGT patients remains to be established.
Effects of a Behavioral Intervention on Treatment Adherence and Stress Management in Adolescents With IDDM
Authors: Méndez Francisco J , Beléndez Marina 
Published: March 2007

OBJECTIVE
To evaluate the effects of a behavioral program to increase treatment adherence and to improve stress management in adolescents with IDDM.

RESEARCH DESIGN AND METHODS
A quasi-experimental pretest-posttest design with a nonequivalent control group was used. Eighteen subjects were assigned to the experimental group, which received the program, while nineteen subjects made up the control group, which received routine medical care. During the 12 intervention sessions with diabetic adolescents, different procedures were applied: instruction, blood glucose discrimination training, role-playing, relaxation exercises, self-instructions, problem-solving strategies, and homework, among others.

RESULTS
The results show significant changes in the experimental group in variables related to diabetes information (patients and their parents), adherence, daily hassles, uneasiness and likelihood of response in social interactions, skills and frequency of glycemic analyses, blood glucose estimate errors, and negative family support (parents). The program had no effect on either dietary and physical exercise or glycemic control. The improvements, which were maintained at a follow-up carried out 13 months after finishing the program, were: patients' information about physiopathology (P = 0.000), diet (P = 0.000), physical exercise (P = 0.048), glucose testing (P = 0.030), and insulin (P = 0.000), barriers to adherence frequency (P = 0.000), severity of daily hassles (P = 0.006), and degree of uneasiness in social interaction (P = 0.000).

CONCLUSIONS
This research introduces the novelty of integrating several behavioral procedures within a wide-ranging package that affects aspects implied in diabetes control such as treatment adherence and stress management. The testing of similar programs on samples of subjects with glycemic control difficulties would be useful.
Excess Costs of Medical Care for Patients With Diabetes in a Managed Care Population
Authors: Selby Joe V , Ray G Thomas , Zhang Danya , Colby Chris J 
Published: March 2007

OBJECTIVE
To estimate the excess costs of medical care for patients with diabetes in a managed care population and to determine the proportion of costs spent on treating the complications of diabetes.

RESEARCH DESIGN AND METHODS
A comparison of 1-year (1994) costs of medical care in the 85,209 members of the diabetes registry of Kaiser Permanente, Northern California, and in 85,209 age- and sex-matched nondiabetic control subjects. Costs were obtained from automated program databases. Costs specifically related to treating acute and long-term complications of diabetes were identified, and the excess costs attributable to each complication in individuals with diabetes were calculated.

RESULTS
Excess expenditures in individuals with diabetes totaled $282.7 million, or $3,494 per person. Per person expenditures for members with diabetes were 2.4 times those for matched control subjects. The largest proportion of total excess costs was for hospitalizations within the health maintenance organization (38.5%). Nearly 38% of the total excess was spent treating the long-term complications of diabetes, predominantly coronary heart disease and end-stage renal disease.

CONCLUSIONS
Diabetes is a costly condition by virtue of its high prevalence and high per person costs. A large proportion of these costs are related to treating complications of diabetes. Available evidence indicates that several measures can reduce complication rates. Thus, effective disease management programs that aim to prevent complications could potentially lead to cost savings in managed care settings.
Evaluation of ICA512As in Combination With Other Islet Cell Autoantibodies at the Onset of IDDM
Authors: Feeney Sandra J , Myers Mark A , Mackay Ian R , Zimmet Paul Z , Howard Neville , Verge Charles F , Rowley Merrill J 
Published: March 2007

OBJECTIVE
The ICA512 pancreatic islet autoantigen is a putative tyrosine phosphatase that is co-identified with the earlier described 40-kDa autoantigen. We report the frequency of autoantibodies to islet cell antigen 512 (ICA512As) in recent-onset IDDM and compare this with other islet cell autoantibodies, including those to GAD (GADAs), insulin (IAAs), and islet cell cytoplasm (ICAs) identified by immunofluorescence.

RESEARCH DESIGN AND METHODS
Sera from 232 children aged between 9 months and 14.9 years collected within 14 days of diagnosis were tested for ICA512As by a radioimmunoprecipitation assay. The results were compared with previously reported data for GADAs (n = 232), IAAs (n = 167), and ICAs (n = 230).

RESULTS
The frequency of a positive result for ICA512As in children with newly diagnosed IDDM was 60%. The frequency was greater for children with an age of onset between 5 and 10 years (69%) than for children aged &lt; 5 years (49%) and aged between 10 and 15 years (56%). The frequencies for other autoantibody reactivities were 69% for GADAs, 65% for IAAs, and 70% for ICAs. A combination of positive results for ICA512As, GADAs, and IAAs gave a sensitivity for the diagnosis of childhood IDDM of 95%, which was not significantly increased by a positive result for ICAs (96%).

CONCLUSIONS
Our results further establish that positivity in a combination of tests is more valuable for the prediction of IDDM than a result for any single autoantibody and that the age of the patient should be considered when selecting the combination of tests to use.
Evidence That Plasma Leptin and Insulin Levels are Associated With Body Adiposity Via Different Mechanisms
Authors: Schwartz Michael W , Prigeon Ronald L , Kahn Steven E , Nicolson Marjery , Moore Jason , Morawiecki Andrew , Boyko Edward J , Porte Daniel 
Published: March 2007

OBJECTIVE
Like insulin, the adipocyte hormone, leptin, circulates at levels proportionate to body adiposity. Because insulin may regulate leptin secretion, we sought to determine if plasma leptin levels are coupled to body adiposity via changes in circulating insulin levels or insulin sensitivity and whether leptin secretion from adipocytes is impaired in subjects with NIDDM.

RESEARCH DESIGN AND METHODS
We used multiple linear regression to analyze relationships between BMI (a measure of body adiposity) and fasting plasma levels of leptin and insulin in 98 nondiabetic human subjects (68 men/30 women) and 38 subjects with NIDDM (27 men/11 women). The insulin sensitivity index (S1) was also determined in a subset of nondiabetic subjects (n = 38).

RESULTS
Fasting plasma leptin concentrations were correlated to both BMI (r = 0.66, P = 0.0001) and fasting plasma insulin levels (r = 0.65, P = 0.0001) in nondiabetic men and women (r = 0.58, P = 0.0009 for BMI; r = 0.47, P = 0.01 for insulin). While the plasma leptin level was also inversely related to S1 (r = −0.35; P = 0.03), this association was dependent on BMI, whereas the association between insulin and S1 was not. Conversely, the relationship between plasma leptin and BMI was independent of S1, whereas that between insulin and BMI was dependent on S1. The relationship between plasma leptin levels and BMI did not differ significantly among NIDDM subjects from that observedin nondiabetic subjects.

CONCLUSIONS
We conclude that 1) body adiposity, sex, and the fasting insulin level are independently associated with plasma leptin level; 2) because NIDDM doesnot influence leptin levels, obesity associated with NIDDM is unlikely to result from impaired leptin secretion; and 3) insulin sensitivity contributes to the association between body adiposity and plasma levels of insulin, but not leptin. The mechanisms underlying the association between body adiposity and circulating levels of these two hormones, therefore, appear to bedifferent.
The Efficacy of Self-Monitoring of Blood Glucose in NIDDM subjects: A criteria-based literature review
Authors: Faas A , Schellevis F G , Eijk J T M Van 
Published: March 2007

OBJECTIVE
To determine the efficacy of self-monitoring of blood glucose (SMBG) in NIDDM patients from studies published during the years 1976–1996.

RESEARCH DESIGN AND METHODS
A systematic literature search was conducted. The selected studies were assessed for their methodological quality and reviewed on the reported efficacy and on the following topics: characteristics of the study population, follow-up duration, nature of the efficacy measures, use of a therapy decision scheme, nature of the intervention, nature of the SMBG device, patient instruction, type of SMBG regime, assessment of the frequency of self-measurement, and whether feedback was given on the measured glucose levels. Studies with positive conclusions on the efficacy of SMBG were compared with studies with negative conclusions on the basis of the these characteristics to determine which factors could have contributed to the results.

RESULTS
Of the 11 studies identified, only 4 met all quality criteria. Six of the studies were randomized controlled trials, of which only one showed positive conclusions regarding the efficacy of SMBG. Although the studies differed on most topics, no factor could be identified as responsible for the results of the studies.

CONCLUSIONS
The efficacy of SMBG in NIDDM patients is still questionable and should be tested in a rigorous high-quality randomized controlled trial, for which some recommendations are given.
Association of Symptoms of Type 2 Diabetic Patients With Severity of Disease, Obesity, and Blood Pressure
Authors: Bulpitt Christopher J , Palmer Alison J , Battersby Clare , Fletcher Astrid E 
Published: March 2007

OBJECTIVE
The symptoms of 430 type 2 diabetic patients were determined by a self-administered questionnaire before entry into the U.K. Prospective Diabetes Study.

RESEARCH DESIGN AND METHODS
Entry into the trial followed 2 months of dietary treatment for newly diagnosed patients with type 2 diabetes. Forty symptoms with five levels of severity were included in the questionnaire. A complaint rate was computed as the sum of symptom scores divided by the number of symptom questions answered.

RESULTS
The complaint rate was independently and positively related to BMI, fasting plasma glucose (FPG), and being a woman. Three symptoms—presence of dry mouth (P &lt; 0.001), thirst (P &lt; 0.01), and stomach pain (P = 0.02)—were related to FPG independent of sex, age, BMI, or blood pressure. Only dry mouth was related to HbA1c (P = 0.05). Complaints of shortness of breath, swollen ankles, headaches, heartburn, sweating, wheezing, nocturia, thirst, and diarrhea increased with BMI independently of other variables. A complaint of cold extremities decreased with BMI. Heartburn, weakness of limbs, and hot flushes were positively related to blood pressure, and unsteadiness was negatively related.

CONCLUSIONS
The symptoms reported by patients with type 2 diabetes increased with FPG and markedly with BMI. The symptoms associated with obesity have been underestimated in the past.
Intact Proinsulin, des 31,32 Proinsulin, and Specific Insulin Concentrations Among Nondiabetic and Diabetic Subjects in Populations at Varying Risk of Type 2 Diabetes
Authors: Nagi Dinesh K , Knowler William C , Mohamed-Ali Vidya , Bennett Peter H , Yudkin John S 
Published: March 2007

OBJECTIVE
To examine hyperinsulinemia, insulin secretion, and β-cell function in Pima Indians, South Asians, and whites, populations at varying risk of diabetes.

RESEARCH DESIGN AND METHODS
We investigated 136 Pima Indian, 98 Asian, and 80 white nondiabetic and 172 Pima Indian, 40 Asian, and 49 white diabetic subjects. Highly specific assays for insulin, intact proinsulin, and des 31,32 proinsulin were used. Insulin secretion was assessed using ratio of increment (0 to 30 min) in insulin to glucose concentrations during an oral glucose tolerance test (OGTT).

RESULTS
Nondiabetic Pima Indians were significantly more obese than Asians and whites. Pima Indian subjects had significantly higher (P &lt; 0.01) fasting insulin concentrations (median 109 pmol/l, range 40−250) than Asian (37 pmol/l, range 17−91) and white (30 pmol/l, range 10−82) subjects. These differences remained significant when controlled for obesity. Nondiabetic Pima Indians also had higher fasting C-peptide concentrations and higher early insulin secretion during an OGTT. Fasting concentrations of intact proinsulin and des 31,32 proinsulin were also significantly higher in Pima Indians (P &lt; 0.01). However, the proportion of proinsulin-like molecules was significantly lower (P &lt; 0.01) in Pima Indians (median 7.9% vs. 12.7% for South Asians and 12.2% for whites). Subjects with diabetes from the three ethnic groups showed significantly higher fasting insulin concentrations but lower 30-min insulin and lower ratios of increment (0−30 min) in insulin to glucose concentrations than did nondiabetic subjects. The proportion of proinsulin-like molecules was not significantly different in diabetic subjects from the three ethnic groups.

CONCLUSIONS
These specific assays for insulin indicate that after adjusting for obesity nondiabetic Pima Indians are truly hyperinsulinemic, which is consistent with their insulin resistance as measured by other methods. Hyperinsulinemia in this population with a high risk of diabetes is likely to be due to enhanced insulin secretion. Furthermore, in Pima Indians, the predominant β-cell secretory product is insulin and not its precursors. We conclude that the differences in the risk of diabetes among these three groups are not due to differences in insulin secretion or insulin processing. Subjects with type 2 diabetes have defective early insulin secretion during OGTTs but show fasting hyperinsulinemia even when specific assays for insulin are used.