bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Benefits of Metformin Therapy During Continuous Subcutaneous Insulin Infusion Treatment of Type 1 Diabetic Patients
Authors: Meyer Laurent , Bohme Philip , Delbachian Irene , Lehert Philippe , Cugnardey Nathalie , Drouin Pierre , Guerci Bruno 
Published: March 2007

OBJECTIVE—This study was designed to assess the insulin-sparing effect of oral administration of metformin along with a continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetic patients.
RESEARCH DESIGN AND METHODS—A total of 62 patients (25 women and 37 men) were studied in a monocenter, randomized, double-blind placebo-controlled study, comparing metformin (850 mg b.i.d.) with placebo in association with CSII during a 6-month period.
RESULTS—Treatment with metformin was associated with a reduction in daily insulin requirements between V0 and V6 of −4.3 ± 9.9 units (−7.8 ± 18%) compared with an increase with placebo treatment of 1.7 ± 8.3 units (2.8 ± 12.7%) (P = 0.0043). A decrease in basal requirement of insulin was also observed in patients treated with metformin of −2.6 ± 3.2 units (−7.9 ± 23.8%) compared with an increase with placebo treatment of 1.9 ± 5.7 units (8.8 ± 27.1%) (P = 0.023). HbA1c remained unchanged in treatment with metformin and placebo between V0 and V6. The number of hypoglycemic events (&lt;60 mg/dl) was similar in both groups. Significant reductions of total cholesterol (P = 0.04) and LDL cholesterol (P = 0.05) were observed in patients treated with metformin. Gastrointestinal events, including diarrhea and abdominal pain, were reported in three patients in the metformin group who discontinued the trial. Mild or moderate gastrointestinal side effects were also reported in eight patients treated with metformin and two patients treated with placebo (P = 0.069).
CONCLUSIONS—Metformin was found to be a safe insulin-sparing agent, when used in combination with CSII for the treatment of type 1 diabetes.
Plasma and Dietary Vitamin E in Relation to Incidence of Type 2 Diabetes
Authors: Mayer-Davis Elizabeth J. , Costacou Tina , King Irena , Zaccaro Daniel J. , Bell Ronny A. 
Published: March 2007

OBJECTIVE—To evaluate the association of vitamin E with incidence of type 2 diabetes and to do so separately among individuals who did and those who did not report regular use of vitamin supplementation.
RESEARCH DESIGN AND METHODS—The Insulin Resistance Atherosclerosis Study (IRAS) included 895 nondiabetic adults at baseline (including 303 with impaired glucose tolerance [IGT]), 148 of whom developed type 2 diabetes according to World Health Organization (WHO) criteria during the 5-year follow-up. At baseline, dietary vitamin E was estimated by a validated food frequency interview, usual supplement use was confirmed by supplement label, and plasma α-tocopherol was measured. Analyses were conducted separately for individuals who did (n = 318) and did not (n = 577) use vitamin E supplements.
RESULTS—Among supplement nonusers, reported mean intake of vitamin E (mg α-tocopherol equivalents [α-TE]) did not differ between those who remained nondiabetic (n = 490) and those who developed diabetes (n = 87) (10.5 ± 5.5 vs. 9.5 ± 4.8 [means ± SD], respectively, NS). After adjustment for demographic variables, obesity, physical activity, and other nutrients, the association remained nonsignificant (odds ratio [OR] 0.80, 95% CI 0.13–5.06) for the highest level of intake (≥20 mg α-TE) compared with the lowest level (1–4 α-TE). However, results for plasma concentration of α-tocopherol showed a significant protective effect both before and after adjustment for potential confounders (adjusted OR 0.12, 95% CI 0.02–0.68, for the highest quintile vs. the lowest quintile; overall test for trend, P &lt; 0.01). Among individuals who reported habitual use of vitamin E supplements (at least once per month in the year before baseline; 259 remained nondiabetic and 59 developed diabetes), no protective effect was observed for either reported intake of vitamin E or plasma concentration of α-tocopherol
CONCLUSIONS—A protective effect of vitamin E may exist within the range of intake available from food. This effect may go undetected within studies of high-dose supplement use, which appears to hold no additional protective benefit.
Usefulness of Home Blood Pressure Measurement in the Morning in Type 2 Diabetic Patients
Authors: Kamoi Kyuzi , Miyakoshi Masashi , Soda Satoshi , Kaneko Susumu , Nakagawa Osamu 
Published: March 2007

OBJECTIVE—Recently, repeated home blood pressure (HBP) measurements in the morning for a long period have been shown to have a stronger predictive power for mortality in patients with hypertension than occasional casual/clinic blood pressure (CBP) measurements. We studied whether HBP in the morning in type 2 diabetic patients is useful for prediction of diabetic complications.
RESEARCH DESIGN AND METHODS—The occurrence of diabetic complications (nephropathy, retinopathy, coronary heart disease [CHD], and cerebrovascular disease [CVD]) were examined in relation to morning HBP as well as to CBP in 170 type 2 diabetic patients treated with antidiabetic and antihypertensive drugs. Blood pressure was measured at the clinic during the day and at home after awakening in the morning. Clinic hypertension (CH) and morning hypertension (MH) were defined as systolic blood pressure (SBP) ≥130 mmHg and/or diastolic blood pressure (DBP) ≥85 mmHg. The relation of CH and MH to the prevalence of these events was examined.
RESULTS—There were no significant differences in the prevalence of nephropathy, retinopathy, CHD, and CVD between the two groups with (n = 131) and without CH (n = 39), whereas the prevalences of these events in the patients with MH (n = 97) were significantly higher (P &lt; 0.05) than in those without MH (n = 73). The prevalence of nephropathy was highly associated with systolic MH.
CONCLUSIONS—Elevations of HBP in the morning in diabetic patients are strongly related to microvascular and macrovascular complications, especially nephropathy. It is concluded that the control of MH may prevent vascular complications in type 2 diabetic patients.
Valuing Health-Related Quality of Life in Diabetes
Authors: Coffey J. Todd , Brandle Michael , Zhou Honghong , Marriott Deanna , Burke Ray , Tabaei Bahman P. , Engelgau Michael M. , Kaplan Robert M. , Herman William H. 
Published: March 2007

OBJECTIVE—Cost-utility analyses use information on health utilities to compare medical treatments that have different clinical outcomes and impacts on survival. The purpose of this study was to describe the health utilities associated with diabetes and its treatments, complications, and comorbidities.RESEARCH DESIGN AND METHODS—We studied 2,048 subjects with type 1 and type 2 diabetes recruited from specialty clinics at a university medical center. We administered a questionnaire to each individual to assess demographic characteristics, type and duration of diabetes, treatments, complications, and comorbidities, and we used the Self-Administered Quality of Well Being index (QWB-SA) to calculate a health utility score. We then created regression models to fit the QWB-SA-derived health utility scores to indicator variables for type 1 and type 2 diabetes and each demographic variable, treatment, and complication. The coefficients were arranged in clinically meaningful ways to develop models to describe penalties from the health utility scores for nonobese diabetic men without additional treatments, complications, or comorbidities.RESULTS—The utility scores for nonobese diet-controlled men and women with type 2 diabetes and no microvascular, neuropathic, or cardiovascular complications were 0.69 and 0.65, respectively. The utility scores for men and women with type 1 diabetes and no complications were slightly lower (0.67 and 0.64, respectively). Blindness, dialysis, symptomatic neuropathy, foot ulcers, amputation, debilitating stroke, and congestive heart failure were associated with lower utility scores.CONCLUSIONS—Major diabetes complications are associated with worse health-related quality of life. The health utility scores provided should facilitate studies of the health burden of diabetes and the cost-utility of alternative strategies for the prevention and treatment of diabetes.
Decreased Mortality Associated With the Use of Metformin Compared With Sulfonylurea Monotherapy in Type 2 Diabetes
Authors: Johnson Jeffrey A. , Majumdar Sumit R. , Simpson Scot H. , Toth Ellen L. 
Published: March 2007

OBJECTIVE—The aim of this study was to examine the relationship between use of metformin and sulfonylurea and mortality in new users of these agents.
RESEARCH DESIGN AND METHODS—Saskatchewan Health databases were used to examine population-based mortality rates for new users of oral antidiabetic agents. Individuals with prescriptions for sulfonylurea or metformin in 1991–1996 and no use in the year prior were identified as new users. Prescription records were prospectively followed for 1–9 years; subjects with any insulin use were excluded. Causes of death were identified based on ICD-9 codes in an electronic vital statistics database. Multivariate logistic regression and survival analyses were used to assess the differences in mortality between drug cohorts, after adjusting for potential confounding variables.
RESULTS—The total study sample comprised 12,272 new users of oral antidiabetic agents; the average length of follow-up was 5.1 (SD 2.2) years. In subjects with at least 1 year of drug exposure and no insulin use, mortality rates were 750/3,033 (24.7%) for those receiving sulfonylurea monotherapy, 159/1,150 (13.8%) for those receiving metformin monotherapy, and 635/4,683 (13.6%) for those receiving combination therapy over an average 5.1 (SD 2.2) years of follow-up. The adjusted odds ratio (OR) for all-cause mortality for metformin monotherapy was 0.60 (95% CI 0.49–0.74) compared with sulfonylurea monotherapy. Sulfonylurea plus metformin combination therapy was also associated with reduced all-cause mortality (OR 0.66, 95% CI 0.58–0.75). Reduced cardiovascular-related mortality rates were also observed in metformin users compared with sulfonylurea monotherapy users.
CONCLUSIONS—Metformin therapy, alone or in combination with sulfonylurea, was associated with reduced all-cause and cardiovascular mortality compared with sulfonylurea monotherapy among new users of these agents.
A Novel Noninvasive Blood Glucose Monitor
Authors: Malchoff Carl D. , Shoukri Kamal , Landau Julian I. , Buchert Janusz M. 
Published: March 2007

OBJECTIVE—To evaluate the precision and accuracy of a new advanced prototype of a noninvasive blood glucose monitor across a wide range of serum glucose concentrations.
RESEARCH DESIGN AND METHODS—An advanced handheld noninvasive glucose monitor prototype was calibrated and tested using patients recruited by the General Research Center of the University of Connecticut Health Center. The monitor, developed by Infratec, uses principles of thermal emission spectroscopy. The noninvasive measurement of tympanic membrane glucose concentration was calibrated to the serum glucose concentration using 432 paired measurements from 20 subjects with insulin-requiring diabetes. This calibration was subsequently tested (results of power analyses) in a blind fashion with 126 paired measurements from six diabetic subjects who require insulin.
RESULTS—In vivo measurements demonstrated the reproducibility of the methodology of the noninvasive glucose monitor. Based on the calibration model, predicted glucose concentrations for six subjects were as follows (for 126 data points): SD = 32 mg/dl, mean absolute relative error (%MARE) = 11.6, with a correlation coefficient of r = 0.87. Noninvasive glucose results were also compared with laboratory reference measurements using an error-in-variables method. Clark error grid analysis showed that 100% of the measurements fell within zones A and B (90% in zone A and 10% in zone B). The SD for all noninvasive measured concentrations was 27 mg/dl, %MARE was 8.6, and the correlation coefficient was r = 0.94.
CONCLUSIONS—This first independent clinical study of an advanced noninvasive blood glucose prototype based on thermal emission in the mid-infrared spectral region has demonstrated glucose measurements with clinically acceptable accuracy but without the necessity of individual daily calibration.
Association of HLA-DQ Genotype in Autoantibody-Negative and Rapid-Onset Type 1 Diabetes
Authors: Tanaka Shoichiro , Kobayashi Tetsuro , Nakanishi Koji , Koyama Rikako , Okubo Minoru , Murase Toshio , Odawara Masato , Inoko Hidetoshi 
Published: March 2007

OBJECTIVE—Some type 1 diabetic patients have a distinct phenotype characterized by the absence of pancreatic autoantibodies and fulminant clinical symptoms at onset, including marked hyperglycemia, severe diabetic ketoacidosis, and normal to near-normal HbA1c levels with complete destruction of β-cells. However, little is known about genetic factors of this distinct subtype of diabetes (fulminant autoantibody-negative type 1 diabetes).
RESEARCH DESIGN AND METHODS—We analyzed HLA-DQ genotypes in fulminant autoantibody-negative type 1 diabetes (n = 22) and autoantibody-positive type 1 diabetes (immune-mediated type 1 diabetes, n = 78) recruited from a cohort between 1980 and 2000.
RESULTS—Fulminant autoantibody-negative type 1 diabetes had a significantly high prevalence of the HLA-DQA1*0303-DQB1*0401 haplotype in a homozygous manner (RR 39) or in a heterozygous manner with the HLA-DQA1*0302-DQB1*0303 haplotype (RR 13). In contrast, autoantibody-positive type 1 diabetic patients had a high prevalence of the HLA-DQA1*0302-DQB1*0303 haplotype in a homozygous manner (RR 10) or in a heterozygous manner with the HLA-DQA1*0303-DQB1*0401 haplotype (RR 12).
CONCLUSIONS—Pathogenic roles of genotypic combinations of specific HLA-DQ haplotypes in a homozygous manner are suggested as causative mechanisms of aggressive β-cell damage in a subtype of autoantibody-negative type 1 diabetes with fulminant clinical features.
A Randomized Controlled Trial of Resistance Exercise Training to Improve Glycemic Control in Older Adults With Type 2 Diabetes
Authors: Castaneda Carmen , Layne Jennifer E. , Munoz-Orians Leda , Gordon Patricia L. , Walsmith Joseph , Foldvari Mona , Roubenoff Ronenn , Tucker Katherine L. , Nelson Miriam E. 
Published: March 2007

OBJECTIVE—To determine the efficacy of high-intensity progressive resistance training (PRT) on glycemic control in older adults with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We performed a 16-week randomized controlled trial in 62 Latino older adults (40 women and 22 men; mean ± SE age 66 ± 8 years) with type 2 diabetes randomly assigned to supervised PRT or a control group. Glycemic control, metabolic syndrome abnormalities, body composition, and muscle glycogen stores were determined before and after the intervention.
RESULTS—Sixteen weeks of PRT (three times per week) resulted in reduced plasma glycosylated hemoglobin levels (from 8.7 ± 0.3 to 7.6 ± 0.2%), increased muscle glycogen stores (from 60.3 ± 3.9 to 79.1 ± 5.0 mmol glucose/kg muscle), and reduced the dose of prescribed diabetes medication in 72% of exercisers compared with the control group, P = 0.004–0.05. Control subjects showed no change in glycosylated hemoglobin, a reduction in muscle glycogen (from 61.4 ± 7.7 to 47.2 ± 6.7 mmol glucose/kg muscle), and a 42% increase in diabetes medications. PRT subjects versus control subjects also increased lean mass (+1.2 ± 0.2 vs. −0.1 ± 0.1 kg), reduced systolic blood pressure (–9.7 ± 1.6 vs. +7.7 ± 1.9 mmHg), and decreased trunk fat mass (−0.7 ± 0.1 vs. +0.8 ± 0.1 kg; P = 0.01–0.05).
CONCLUSIONS—PRT as an adjunct to standard of care is feasible and effective in improving glycemic control and some of the abnormalities associated with the metabolic syndrome among high-risk older adults with type 2 diabetes.
Obesity and Treatment of Diabetes With Glyburide May Both Be Risk Factors for Acute Pancreatitis
Authors: Blomgren Kerstin B. , Sundström Anders , Steineck Gunnar , Wiholm Bengt E. 
Published: March 2007

OBJECTIVE—To evaluate risk factors, notably drugs, for acute pancreatitis.
RESEARCH DESIGN AND METHODS—A population-based case-control study was conducted of 1.4 million inhabitants, aged 20–85 years, of four regions in Sweden between 1 January 1995 and 31 May 1998. A total of 462 case subjects were hospitalized in surgery departments for their first episode of acute pancreatitis without previous gallbladder disease. A total of 1,781 control subjects were randomly selected from a population register. Information was obtained from case records and through telephone interviews.
RESULTS—A total of 27 case subjects (6%) and 55 control subjects (3%) had prevalent diabetes. A total of 53 case subjects (11%) and 130 control subjects (7%) had a BMI &gt;30 kg/m2. Use of glyburide had a crude odds ratio (OR) of 3.2 (95% CI 1.5–5.9), and in a multivariate logistic regression adjusted for covariates, the OR for use of glyburide was 2.5 (1.1–5.9). BMI had a continuous OR of 1.2 (1.1–1.4) per 5 units of BMI. The relative risk for hospitalization longer than 14 days or treatment in an intensive care unit was 2.4 (1.1–5.4) among patients with a BMI &gt;30 kg/m2 when compared with patients with a BMI between 20 and 25 kg/m2.
CONCLUSIONS—Use of glyburide and obesity may both be risk factors for acute pancreatitis. Obesity is associated with an extended hospitalization time in subjects with acute pancreatitis.
Quality of Care for Uninsured Patients With Diabetes in a Rural Area
Authors: Porterfield Deborah S. , Kinsinger Linda 
Published: March 2007

OBJECTIVE—We compared quality of care for uninsured patients with diabetes in private physician offices and community/migrant health centers (C/MHCs).RESEARCH DESIGN AND METHODS—We conducted a cross-sectional medical record review in a convenience sample of eight physician offices and three C/MHC sites in rural North Carolina. Billing systems generated lists of self-pay patients with diabetes. Abstraction of the medical records (n = 142) yielded data on process and intermediate outcome measures of diabetes care, which were derived from the Diabetes Quality Improvement Project.RESULTS—Medical records of patients in C/MHCs demonstrated higher rates on four of six process measures of quality of care, including measurement of HbA1c (98 vs. 75%; P &lt; 0.001), cholesterol (82 vs. 51%; P &lt; 0.001), and urine protein (90 vs. 25%; P &lt; 0.001). Nonsignificant trends in documented eye examinations and the intermediate outcome of blood pressure control were found in medical records of C/MHC patients. No differences were seen in the intermediate outcomes of glucose or lipid control. Notable differences in provider type, time since training, and use of flow sheets were found.CONCLUSIONS—In our sample, uninsured patients with diabetes in C/MHCs had higher quality of care as suggested by higher rates of processes of care. Outcomes were similar in the two settings and well below targets. Further work is required to replicate these findings and to understand which features of C/MHCs may facilitate quality care for the uninsured and are replicable in other settings.
The Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals With Diabetes
Authors: Egede Leonard E. , Ye Xiaobou , Zheng Deyi , Silverstein Marc D. 
Published: March 2007

OBJECTIVE—This study compared the prevalence and pattern of use of complementary and alternative medicine (CAM) in individuals with and without diabetes and identified factors associated with CAM use.
RESEARCH DESIGN AND METHODS—The 1996 Medical Expenditure Panel Survey, a nationally representative sample of the U.S. noninstitutionalized civilian population, was analyzed. Estimates of CAM use in individuals with common chronic conditions were determined, and estimates of CAM use in patients with diabetes were compared with that in individuals with chronic medical conditions. Patterns of use and costs of CAM use in patients with diabetes were compared with those in nondiabetic individuals. Multiple logistic regression was used to determine independent predictors of CAM use in individuals with diabetes, controlling for age, sex, race/ethnicity, household income, educational level, and comorbidity.
RESULTS—Individuals with diabetes were 1.6 times more likely to use CAM than individuals without diabetes (8 vs. 5%, P &lt; 0.0001). In the general population, estimates of CAM use were not significantly different across selected chronic medical conditions, but diabetes was an independent predictor of CAM use. Among individuals with diabetes, older age (≥65 years) and higher educational attainment (high school education or higher) were independently associated with CAM use.
CONCLUSIONS—Diabetes is an independent predictor of CAM use in the general population and in individuals with diabetes. CAM use is more common in individuals aged ≥65 years and those with more than high school education.
Sulfonylurea Inadequacy
Authors: Wright Alex , Burden A.C. Felix , Paisey Richard B. , Cull Carole A. , Holman Rury R. ,   for the U.K. Prospective Diabetes Study Group
Published: March 2007

OBJECTIVE—To evaluate the efficacy of the addition of insulin when maximal sulfonylurea therapy is inadequate in individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Glycemic control, hypoglycemia, and body weight were monitored over 6 years in 826 patients with newly diagnosed type 2 diabetes in 8 of 23 U.K. Prospective Diabetes Study (UKPDS) centers that used a modified protocol. Patients were randomly allocated to a conventional glucose control policy, primarily with diet (n = 242) or an intensive policy with insulin alone (n = 245), as in the main study. However, for patients randomized to an intensive policy with sulfonylurea (n = 339), insulin was added automatically if the fasting plasma glucose remained &gt;108 mg/dl (6.0 mmol/l) despite maximal sulfonylurea doses.
RESULTS—Over 6 years, ∼53% of patients allocated to treatment with sulfonylurea required additional insulin therapy. Median HbA1c in the sulfonylurea ± insulin group was significantly lower (6.6%, interquartile range [IQR] 6.0–7.6) than in the group taking insulin alone (7.1%, IQR 6.2–8.0; P = 0.0066), and significantly more patients in the sulfonylurea ± insulin group had an HbA1c &lt;7% (47 vs. 35%, respectively; P = 0.011). Weight gain was similar in the intensive therapy groups, but major hypoglycemia occurred less frequently over all in the sulfonylurea (± insulin) group compared with the insulin alone group (1.6 vs. 3.2% per annum, respectively; P = 0.017).
CONCLUSIONS—Early addition of insulin when maximal sulfonylurea therapy is inadequate can significantly improve glycemic control without promoting increased hypoglycemia or weight gain.