bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Care and Outcomes in Type 2 Diabetic Patients
Authors: De Berardis Giorgia , Pellegrini Fabio , Franciosi Monica , Belfiglio Maurizio , Di Nardo Barbara , Greenfield Sheldon , Kaplan Sherrie H. , Rossi Marie C.E. , Sacco Michele , Tognoni Gianni , Valentini Miriam , Nicolucci Antonio ,   on behalf of the QuED Study Group
Published: March 2007

OBJECTIVE—The role of general practice and diabetes clinics in the management of diabetes is still a matter of debate. Methodological flaws in previous studies may have led to inaccurate conclusions when comparing the care provided in these different settings. We compared the care provided to type 2 diabetic patients attending diabetes outpatient clinics (DOCs) or being treated by a general practitioner (GP) using appropriate statistical methods to adjust for patient case mix and physician-level clustering.
RESEARCH DESIGN AND METHODS—We prospectively evaluated the process and intermediate outcome measures over 2 years in a sample of 3,437 patients recruited by 212 physicians with different specialties practicing in 125 DOCs and 103 general practice offices. Process measures included frequency of HbA1c, lipids, microalbuminuria, and serum creatinine measurements and frequency of foot and eye examinations. Outcome measures included HbA1c, blood pressure, and total and LDL cholesterol levels.
RESULTS—Differences for most process measures were statistically significantly in favor of DOCs. The differences were more marked for patients who were always treated by the same physician within a DOC and if that physician had a specialty in diabetology. Less consistent differences in process measures were detected when patients followed by GPs were compared with those followed by physicians with a specialty other than diabetology. As for the outcomes considered, patients attending DOCs attained better total cholesterol levels, whereas no major differences emerged in terms of metabolic control and blood pressure levels between DOCs and GPs. Physicians’ specialties were not independently related to patient outcomes.
CONCLUSIONS—Being followed always by the same physician in a DOC, particularly if the physician had a specialty in diabetes, ensured better quality of care in terms of process measures. In the short term, care provided by DOCs was also associated with better intermediate outcome measures, such as total cholesterol levels.
Depressive Symptoms and the Risk of Type 2 Diabetes
Authors: Golden Sherita Hill , Williams Janice E. , Ford Daniel E. , Yeh Hsin-Chieh , Paton Sanford Catherine , Nieto F. Javier , Brancati Frederick L. 
Published: March 2007

OBJECTIVE—The goal of this study was to determine whether depressive symptoms predict type 2 diabetes.RESEARCH DESIGN AND METHODS—We analyzed data on depressive symptoms (including recent fatigue, sleep disturbance, feelings of hopelessness, loss of libido, and increased irritability) in a longitudinal, biracial cohort study of 11,615 initially nondiabetic adults aged 48–67 years, who were subsequently followed for 6 years for the development of type 2 diabetes.RESULTS—At baseline, depressive symptoms were positively associated with BMI, fasting insulin, systolic blood pressure, caloric intake, physical inactivity, and current smoking (all P &lt; 0.05). In prospective analyses, after adjusting for age, race, sex, and education, individuals in the highest quartile of depressive symptoms had a 63% increased risk of developing diabetes compared with those in the lowest quartile (relative hazard [RH] 1.63, 95% CI 1.31–2.02). This relation persisted after adjustment for stress-associated lifestyle factors (smoking, physical activity, caloric intake, and adiposity) (1.28, 1.02–1.60) and metabolic covariates (fasting insulin and glucose, lipids, blood pressure, and adiposity) (1.38, 1.10–1.73).CONCLUSIONS—In this cohort, depressive symptoms predicted incident type 2 diabetes. This relation is only partially explained by demographic, metabolic, and lifestyle factors. Possible neuroendocrine mediators of the stress-obesity-diabetes relationship require further evaluation in prospective cohort studies that use an established tool to assess depression and incorporate neurohormonal measurements.
Comparison of the [13C]Glucose Breath Test to the Hyperinsulinemic-Euglycemic Clamp When Determining Insulin Resistance
Authors: Lewanczuk Richard Z. , Paty Breay W. , Toth Ellen L. 
Published: March 2007

OBJECTIVE—With increasing emphasis on the recognition of the metabolic syndrome and early type 2 diabetes, a clinically useful measure of insulin resistance is desirable. The purpose of this study was to evaluate whether an index of glucose metabolism, as measured by 13CO2 generation from ingested [13C]glucose, would correlate with indexes from the hyperinsulinemic-euglycemic clamp.
RESEARCH DESIGN AND METHODS—A total of 26 subjects with varying degrees of insulin sensitivity underwent both the [13C]glucose breath test and the hyperinsulinemic-euglycemic clamp. Results from the [13C]glucose breath test were compared with measures of insulin sensitivity from the glucose clamp as well as with other commonly used indexes of insulin sensitivity.
RESULTS—There was a strong correlation between the [13C]glucose breath test result and the glucose disposal rate (r = 0.69, P &lt; 0.0001) and insulin sensitivity index (r = 0.69, P &lt; 0.0001) from the insulin clamp. The magnitude of these correlations compared favorably with QUICKI and were superior to the homeostasis model assessment.
CONCLUSIONS—The [13C]glucose breath test may provide a useful noninvasive assessment of insulin sensitivity.
Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit
Authors: Goldberg Philip A. , Siegel Mark D. , Sherwin Robert S. , Halickman Joshua I. , Lee Michelle , Bailey Valerie A. , Lee Sandy L. , Dziura James D. , Inzucchi Silvio E. 
Published: March 2007

OBJECTIVE—In a recent randomized controlled trial, lowering blood glucose levels to 80–110 mg/dl improved clinical outcomes in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides detailed insulin dosing instructions and requires minimal physician input.
RESEARCH DESIGN AND METHODS—We collected data from 52 medical intensive care unit (MICU) patients who were placed on the IIP. Blood glucose levels were the primary outcome measurement. Relevant clinical variables and insulin requirements were also recorded. MICU nurses were surveyed regarding their experience with the IIP.
RESULTS—To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median time to reach target blood glucose levels (100–139 mg/dl) was 9 h. Once blood glucose levels fell below 140 mg/dl, 52% of 5,808 subsequent hourly blood glucose values fell within our narrow target range; 66% within a “clinically desirable” range of 80–139 mg/dl; and 93% within a “clinically acceptable” range of 80–199 mg/dl. Only 20 (0.3%) blood glucose values were &lt;60 mg/dl, none of which resulted in clinically significant adverse events. In general, the IIP was readily accepted by our MICU nursing staff, most of whom rated the protocol as both clinically effective and easy to use.
CONCLUSIONS—Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.
Effectiveness of Different Types of Footwear Insoles for the Diabetic Neuropathic Foot
Authors: Viswanathan Vijay , Madhavan Sivagami , Gnanasundaram Saraswathy , Gopalakrishna Gautham , Das Bhabendra Nath , Rajasekar Seena , Ramachandran Ambady 
Published: March 2007

OBJECTIVE—To compare the effectiveness of different types of footwear insoles in the diabetic neuropathic foot.
RESEARCH DESIGN AND METHODS—A sample of 241 consecutive diabetic patients (158 men and 83 women, age 57.5 ± 9.6 years [mean ± SD], and mean duration of diabetes 12.3 ± 7.2 years) attending the foot clinic with previous foot ulceration and those considered at high risk of foot ulceration were included in the study. The study groups consisted of group 1, patients provided with sandals with insoles made with microcellular rubber (n = 100); group 2, with sandals with polyurethane foam (n = 59); group 3, with molded insoles (n = 32); and group 4, with their own footwear containing leather board insoles (n = 50). Neuropathy status was assessed using a biothesiometer. Plantar pressure was measured using the RS Scan inshoe pressure measurement system. Data obtained from the metatarsal heads were used as the peak pressure. The state of the sandals was assessed after 9 months. The patients were considered to have had an ulcer relapse when either a new ulcer appeared at the site of a previous one or a new foot ulcer appeared in a different area.
RESULTS—Patients who were using therapeutic footwear showed lower foot pressure (group 1, 6.9 ± 3.6; group 2, 6.2 ± 3.9; and group 3, 6.8 ± 6.1 kPa; P = 0.0001), while those who used the nontherapeutic footwear showed an increased foot pressure (group 4, 40.7 ± 20.5 kPa; P = 0.008). The occurrence of new lesions was significantly higher in patients in group 4 (33%) when compared with that of all other groups (4%).
CONCLUSION—Therapeutic footwear is useful to reduce new ulceration and consequently the amputation rate in the diabetic population.
In Type 2 Diabetes, Rosiglitazone Therapy for Insulin Resistance Ameliorates Endothelial Dysfunction Independent of Glucose Control
Authors: Pistrosch Frank , Passauer Jens , Fischer Sabine , Fuecker Katja , Hanefeld Markolf , Gross Peter 
Published: March 2007

OBJECTIVE—Insulin resistance is an independent risk factor for arteriosclerosis and cardiovascular mortality. However, the mechanism by which insulin resistance contributes to arteriosclerosis is unknown. Conceivably, endothelial dysfunction could be involved. Therefore, we asked whether therapy for insulin resistance ameliorates any endothelial dysfunction.RESEARCH DESIGN AND METHODS—We performed a double-blind cross-over trial of 12 patients with recently diagnosed type 2 diabetes. They received rosiglitazone 4 mg b.i.d. for 12 weeks and nateglinide 60 mg b.i.d. for the same number of weeks in random order. To assess the degree of endothelial dysfunction, we used venous occlusion plethysmography. We studied vasodilation in response to acetylcholine (ACh) with and without exogenous insulin. The agents were infused into the brachial artery. Furthermore, we determined insulin resistance by euglycemic clamp.RESULTS—Glycemic control was comparable under rosiglitazone and nateglinide. Rosiglitazone ameliorated insulin resistance by 60% compared with nateglinide. ACh response was significantly increased after rosiglitazone treatment (maximum forearm blood flow 12.8 ± 1.3 vs. 8.8 ± 1.3 ml/100 ml after rosiglitazone and nateglinide, respectively; P &lt; 0.05) but did not attain the level of healthy control subjects (14.0 ± 0.7 ml/100 ml). Coinfusion of exogenous insulin increased ACh response further in the rosiglitazone group. N-monomethyl-l-arginine-acetate (l-NMMA), an antagonist of nitric oxide synthase, largely prevented the increased vasodilation after rosiglitazone, regardless of the presence or absence of insulin. Insulin sensitivity and blood flow response were found to be correlated (P &lt; 0.01).CONCLUSIONS—Insulin resistance is a major contributor toward endothelial dysfunction in type 2 diabetes. Both endothelial dysfunction and insulin resistance are amenable to treatment by rosiglitazone.
Is Presence of Islet Autoantibodies at Birth Associated With Development of Persistent Islet Autoimmunity?
Authors: Stanley Heather M. , Norris Jill M. , Barriga Katherine , Hoffman Michelle , Yu Liping , Miao Dongmei , Erlich Henry A. , Eisenbarth George S. , Rewers Marian 
Published: March 2007

OBJECTIVE—To determine whether the presence of islet autoantibodies in the umbilical cord blood is predictive of subsequent development of islet autoimmunity.
RESEARCH DESIGN AND METHODS—Cord blood sera from 1,118 subjects from the Diabetes Autoimmunity Study in the Young (DAISY) cohort, as well as their venous blood samples taken at follow-up clinic visits, were tested for GAD65 autoantibodies (GAAs), insulin autoantibodies (IAAs), and IA-2 autoantibodies (IA-2As). Venous blood samples taken from mothers of cord blood autoantibody–positive children were analyzed for the same autoantibodies.
RESULTS—At least one of three islet autoantibodies was present in 42 (3.7%) of the cord blood samples tested. The presence of cord blood autoantibodies did not predict the subsequent development of islet autoimmunity (adjusted hazard ratio = 0.73 [0.09, 5.88]). Discordance between cord blood and corresponding maternal autoantibodies was seen in 3 of 36 infants. A strong correlation between levels of autoantibody in cord blood and maternal circulation was found for GAA (r2 = 0.93, P &lt; 0.001) and IAA (r2 = 0.89, P &lt; 0.001) but not IA-2A (r2 = 0.05, P = 0.19). Cord blood autoantibodies in all but one subject disappeared by 9 months of age.
CONCLUSIONS—The presence of cord blood autoantibodies is not predictive of subsequent development of islet autoimmunity. The majority of cord blood autoantibodies appear to result from maternal transmission.
Lipoprotein(a) Is an Independent Risk Factor for Peripheral Arterial Disease in Chinese Type 2 Diabetic Patients in Taiwan
Authors: Tseng Chin-Hsiao 
Published: March 2007

OBJECTIVE—To examine the association between lipoprotein(a) [Lp(a)] and peripheral arterial disease (PAD) and determine the optimal cutoff in Chinese type 2 diabetic patients in Taiwan.
RESEARCH DESIGN AND METHODS—Serum Lp(a) was determined in 557 type 2 diabetic patients (243 men and 314 women) recruited consecutively from a diabetes clinic at the National Taiwan University Hospital. Ankle-brachial index (ABI) &lt;0.9 was diagnosed as PAD (n = 45) and &lt;0.8 as severe PAD (n = 20). Potential confounders included age, sex, BMI, waist-to-hip ratio (WHR), diabetes duration, insulin usage, smoking, hypertension, systolic and diastolic blood pressure, fasting plasma glucose (FPG), total cholesterol, triglycerides, and HDL and LDL cholesterol.
RESULTS—The distribution of Lp(a) was right skewed and no significant differences for sex, WHR, insulin usage, smoking, hypertension, and systolic and diastolic blood pressure were observed. In men, log[Lp(a)] was correlated positively with age, duration, and total and LDL cholesterol (borderline significant, P &lt; 0.1) and negatively with BMI, triglycerides, and FPG (P &lt; 0.1). In women, log[Lp(a)] was correlated positively with total and LDL cholesterol and negatively with triglycerides and BMI (P &lt; 0.1). ABI was significantly correlated with log[Lp(a)], especially in men or in patients with PAD. The optimal cutoff determined by discriminant analysis was 13.3 mg/dl. Patients with Lp(a) above this value had a 2.7-fold higher risk of PAD after multivariate adjustment. Lp(a) also significantly increased from no PAD to mild and severe PAD (17.1 ± 14.4, 23.7 ± 20.3, and 36.9 ± 22.8 mg/dl, respectively, P &lt; 0.001).
CONCLUSIONS—Lp(a) is an independent risk factor for PAD in type 2 diabetic patients in Taiwan. The optimal cutoff is 13.3 mg/dl.
Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort
Authors: McKeown Nicola M. , Meigs James B. , Liu Simin , Saltzman Edward , Wilson Peter W.F. , Jacques Paul F. 
Published: March 2007

OBJECTIVE—The aim of this study was to examine the relation between carbohydrate-related dietary factors, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort.
RESEARCH DESIGN AND METHODS—We examined cross-sectional associations between carbohydrate-related dietary factors, insulin resistance, and the prevalence of the metabolic syndrome in 2,834 subjects at the fifth examination (1991–1995) of the Framingham Offspring Study. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated using the following formula (fasting plasma insulin × plasma glucose)/22.5. The metabolic syndrome was defined using the National Cholesterol Education Program criteria.
RESULTS—After adjustment for potential confounding variables, intakes of total dietary fiber, cereal fiber, fruit fiber, and whole grains were inversely associated, whereas glycemic index and glycemic load were positively associated with HOMA-IR. The prevalence of the metabolic syndrome was significantly lower among those in the highest quintile of cereal fiber (odds ratio [OR] 0.62; 95% CI 0.45–0.86) and whole-grain (0.67; 0.48–0.91) intakes relative to those in the lowest quintile category after adjustment for confounding lifestyle and dietary factors. Conversely, the prevalence of the metabolic syndrome was significantly higher among individuals in the highest relative to the lowest quintile category of glycemic index (1.41; 1.04–1.91). Total carbohydrate, dietary fiber, fruit fiber, vegetable fiber, legume fiber, glycemic load, and refined grain intakes were not associated with prevalence of the metabolic syndrome.
CONCLUSIONS—Whole-grain intake, largely attributed to the cereal fiber, is inversely associated with HOMA-IR and a lower prevalence of the metabolic syndrome. Dietary glycemic index is positively associated with HOMA-IR and prevalence of the metabolic syndrome. Given that both a high cereal fiber content and lower glycemic index are attributes of whole-grain foods, recommendation to increase whole-grain intake may reduce the risk of developing the metabolic syndrome.
Trying to Lose Weight, Losing Weight, and 9-Year Mortality in Overweight U.S. Adults With Diabetes
Authors: Gregg Edward W. , Gerzoff Robert B. , Thompson Theodore J. , Williamson David F. 
Published: March 2007

OBJECTIVE—The aim of this study was to examine the relationships between intention to lose weight, actual weight loss, and all-cause mortality among overweight individuals with diabetes.
RESEARCH DESIGN AND METHODS— We performed a prospective analysis among 1,401 overweight diabetic adults aged ≥35 years sampled in the National Health Interview Survey. The previous year intention to lose weight and weight change were assessed by self-report. Nine-year mortality rates were examined according to intent to lose weight and weight loss, which were adjusted for age, sex, education, ethnicity, smoking, initial body weight, and diabetes complications.
RESULTS—Individuals trying to lose weight had a 23% lower mortality rate (hazard rate ratio [HRR] 0.77, 95% CI 0.61–0.99) than those who reported not trying to lose weight. This association was as strong for those who failed to lose weight (0.72, 0.55–0.96) as for those who succeeded in losing weight (0.83, 0.63–1.08). Trying to lose weight was beneficial for overweight (BMI 25–30 kg/m2) individuals (0.62, 0.46–0.83) but not for obese (BMI &gt;30) individuals (1.17, 0.72–1.92). Overall weight loss, without regard to intent, was associated with an increase of 22% (1.22, 0.99–1.50) in the mortality rate. This increase was largely explained by unintentional weight loss, which was associated with a 58% (1.58, 1.08–2.31) higher mortality rate.
CONCLUSIONS—Overweight diabetic adults trying to lose weight have a reduced risk of all-cause mortality, independent of whether they lose weight. Actual weight loss is associated with increased mortality only if the weight loss is unintentional.
Accuracy of the GlucoWatch G2 Biographer and the Continuous Glucose Monitoring System During Hypoglycemia
Authors:   *The Diabetes Research in Children Network (DirecNet) Study Group
Published: March 2007

OBJECTIVE—The goal of this study was to assess the accuracy of the GlucoWatch G2 Biographer (GW2B) and the continuous glucose monitoring system (CGMS) during hypoglycemia in children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—During a 24-h clinical research center stay, 91 children and adolescents with type 1 diabetes (aged 3.5–17.7 years) wore one or two CGMSs, and 89 of these subjects wore one or two GW2Bs. Frequent serum glucose determinations were made during the day, overnight, and during insulin-induced hypoglycemia resulting in 192 GW2B reference pairs and 401 CGMS reference pairs during hypoglycemia (reference glucose ≤60 mg/dl).
RESULTS—During hypoglycemia, the median absolute difference between the 192 GW2B reference glucose pairs was 26 mg/dl and between the 401 CGMS reference glucose pairs was 19 mg/dl with 31 and 42%, respectively, of the sensor values within 15 mg/dl of the reference glucose. Sensitivity to detect hypoglycemia when the GW2B alarm level was set to 60 mg/dl was 23% with a false-alarm rate of 51%. Analyses suggested that modified CGMS sensors that became available in November 2002 might be more accurate than the original CGMS sensors (median absolute difference 15 vs. 20 mg/dl).
CONCLUSIONS—These data show that the GW2B and the CGMS do not reliably detect hypoglycemia. Both of these devices perform better at higher glucose levels, suggesting they may be more useful in reducing HbA1c levels than in detecting hypoglycemia.
Improved Glucose Excursions Using an Implantable Real-Time Continuous Glucose Sensor in Adults With Type 1 Diabetes
Authors: Garg Satish K. , Schwartz Sherwyn , Edelman Steven V. 
Published: March 2007

OBJECTIVE—The capability of emerging glucose sensor technology to continuously monitor glucose levels may provide ways to achieve glycemic targets while reducing hypoglycemia.
RESEARCH DESIGN AND METHODS—A first-generation, long-term continuous glucose sensor (DexCom, San Diego, CA) was implanted subcutaneously in 15 patients with type 1 diabetes. Safety, efficacy, and potential benefits were evaluated during a blinded control period and in a study period during which patients had real-time access to the glucose data.
RESULTS—The bias differences between self-monitored blood glucose (SMBG) and sensor data were &lt;15% at 2.8, 4.4, 5.6, 8.3, and 11.1 mmol/l. No procedure or device-related adverse events were observed. Of 15 patients, 13 (87%) had functional sensors during the 12-h simulated home use study with 96% of points in the A and B regions of the Clarke error grid, an R value of 0.88, and a mean absolute relative difference of 16% when retrospectively compared with SMBG. In actual home use, during the blinded control period (50 ± 16 days) data were not displayed to the patient, whereas during the unblinded study period (44 ± 17 days) the data were presented to the patient, and alerts were set at 3.1, 5.6, and 11.1 mmol/l. Patients spent a median of 47% less time below 3.1 mmol/l (P &lt; 0.05) and 25% less time above 13.3 mmol/l (P &lt; 0.05) during the nonblinded study period compared with the blinded control period.
CONCLUSIONS—The availability of real-time continuous glucose values may help patients reduce their hyperglycemic excursions and lower the risk of hypoglycemia.