bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized trial of insulin aspart with intensified basal NPH insulin supplementation in people with Type 1 diabetes
Authors: DeVries J. H. , Lindholm A. , Jacobsen J. L. , Heine R. J. , Home P. D. ,   The Tri‐Continental Insulin Aspart Study Group
Published: December 2004

AbstractAims Insulin aspart has been shown to improve post‐prandial and overall glycaemic control in people with Type 1 diabetes. We hypothesized that insulin aspart with intensified basal NPH insulin supplementation would result in better overall glycaemic control than human regular insulin with standard basal NPH insulin.Methods The trial was conducted in 43 centres in seven countries. People with Type 1 diabetes were randomized to mealtime insulin aspart with up to four daily NPH doses if meals were > 5 h apart and a 25% increase in bedtime NPH dose (n = 187), or to mealtime human unmodified insulin with once or twice daily basal NPH insulin (n = 181). Efficacy and safety were evaluated at 12 weeks (primary evaluation period) and 64 weeks.Results At 12 and 64 weeks there was no statistically significant difference in HbA1c between the insulin aspart and regular insulin groups: −0.09 (95% confidence interval (CI) −0.23, +0.05)% and −0.14 (−0.32, +0.04)%. Post‐prandial glucose values were lower and the area under the 24‐h self‐monitored blood glucose curve above 7.0 mmol/l was 28% smaller with insulin aspart (35.2 ± 3.2 vs. 48.9 ± 3.1 mmol/l h, P = 0.0015). No significant differences were found in mild or severe hypoglycaemia, or adverse event rate. At 64 weeks treatment satisfaction was higher in the insulin aspart group (difference 1.57 (95% CI 0.49, 2.64) points, P = 0.004), while quality of life was not different.Conclusions Improved post‐prandial glycaemic control and treatment satisfaction with insulin aspart were confirmed. Intensifying basal insulin supplementation resulted in a similar HbA1c decrement as previously found with the use of insulin aspart and standard NPH insulin supplementation. This does not support routinely basal NPH insulin intensification when using rapid‐acting insulin analogues in daily practice.
Maternal ante‐natal parameters as predictors of persistent postnatal glucose intolerance: a comparative study between Afro‐Caribbeans, Asians and Caucasians
Authors: Sinha B. , Brydon P. , Taylor R. S. , Hollins A. , Munro A. , Jenkins D. , Dunne F. 
Published: December 2004

AbstractAims To measure the prevalence of persistent glucose intolerance at 6–12 weeks postpartum in various ethnic groups to assess the value of targeted postpartum screening.Methods A retrospective study was performed using computerized databases from two large maternity units within one UK region. Both units used the same screening strategy for gestational diabetes mellitus (GDM) and the same postpartum follow‐up at 6–12 weeks using a 75‐g oral glucose tolerance test (OGTT). A total of 221 women with a diagnosis of GDM/impaired glucose tolerance (IGT) in the index pregnancy in addition to a completed postpartum 75‐g OGTT were studied. Of these, 91 were Caucasian, 89 were of Indo‐Asian (Asian) origin and 41 were of Afro‐Caribbean origin.Results The study showed that 35% Indo‐Asians had persistent postpartum glucose intolerance compared with 7% Caucasians and 5% Afro‐Caribbeans (P < 0.003). Insulin requirement during pregnancy and a diagnosis of gestational diabetes prior to 20 weeks of pregnancy were predictive for persistent postpartum glucose intolerance amongst Indo‐Asians.Conclusions The frequency of postpartum glucose intolerance among Indo‐Asian women is significantly greater than among age‐matched Caucasian and Afro‐Caribbean women. We suggest that all Indo‐Asian women with gestational diabetes should undergo postpartum screening for persistent glucose intolerance. However, in non‐Asian women selective screening may be more cost effective.Diabet. Med. 20, 382–386 (2003)
A lifecourse study of risk for hyperinsulinaemia, dyslipidaemia and obesity (the central metabolic syndrome) at age 49–51 years
Authors: Parker L. , Lamont D. W. , Unwin N. , Pearce M. S. , Bennett S. M. A. , Dickinson H. O. , White M. , Mathers J. C. , Alberti K. G. M. M. , Craft A. W. 
Published: December 2004

AbstractAims Suboptimal maternal nutrition and catch‐up growth in early childhood predispose to insulin resistance and other components of metabolic syndrome in later life. A central metabolic syndrome (CMS) has been identified comprising obesity, dyslipidaemia and insulin resistance. This study was designed to investigate determinants of risk for CMS.Methods Persons born in Newcastle in May and June 1947 (n = 358) were followed to 1996–1998. A lifecourse approach was used to estimate the proportion of variance in a summary measure of CMS at age 49–51 years accounted for by factors operating at different stages of life.Results After adjustment for other early life variables, childhood catch‐up growth in men accounted for significant variation in the CMS score independent of adult lifestyle. In adulthood, exercise level in men and smoking in both genders were independently associated with CMS. Over two‐thirds of explained variation in the CMS score in women, and almost half in men, was accounted for exclusively by factors measured in adulthood.Conclusions While risk for CMS in men is compounded by early life disadvantage, promotion of a healthier adult lifestyle and a reduction in the number of people taking up smoking would appear to be the public health interventions most likely to reduce the prevalence of CMS in middle age.Diabet. Med. 20, 406–415 (2003)
Quality of diabetes management in children and adolescents in Denmark1
Authors: Nordly S. , Jørgensen T. , Andreasen A. H. , Hermann N. , Mortensen H. B. 
Published: December 2004

AbstractAim To describe the management of children and adolescents with Type 1 diabetes mellitus in Denmark.Methods Quality indicators with standards of childhood diabetes management were chosen based on international and national guidelines. Data originated from the nation‐wide Danish Registry for Childhood Diabetes and two questionnaires: one questionnaire was sent to all children with diabetes (response rate 78%, n = 1335) and the other was sent to the 19 centres in Denmark treating these children (response rate 100%). Simultaneously, the children were asked to take a blood sample for central HbA1c‐analysis (normal range 4.3–5.8, mean 5.1%).Results Most children were managed at centres which complied with the standards for the process indicators for good diabetes management, but not with the standards for most structure and outcome indicators. Only one third of the children reached the treatment target for HbA1c. Their mean HbA1c‐level increased gradually from ages 4–14 without significant difference between genders. The youngest children had the lowest HbA1c (mean 8.2%) and the lowest rate of severe hypoglycaemic events (4.6 events per 100 patient years). The subgroup of children without any hypoglycaemic events had the significantly lowest mean HbA1c‐level (8.6%, P = 0.028).Conclusions The Danish Registry for Childhood Diabetes provided useful data for quality improvement, but had to be supplemented with data from questionnaires on the structure and process indicators. Outcome of paediatric diabetes management in Denmark was unsatisfactory. Centres need feedback on ways to improve care to lower the children's risk of developing severe diabetes complications.Diabet. Med. 20, 568–574 (2003)
Factors predictive of nephropathy in DCCT Type 1 diabetic patients with good or poor metabolic control
Authors: Zhang L. , Krzentowski G. , Albert A. , Lefèbvre P. J. 
Published: December 2004

AbstractAims The study aim was to assess the time‐related risk of developing diabetic nephropathy [albumin excretion rate (AER) ≥ 40 mg/24 h] from baseline covariates in Type 1 diabetic patients with either good or poor metabolic control (MC).Methods Based on material from the Diabetes Control and Complications Trial study (n = 1441), patients were considered as under good or poor MC if their HbA1c mean level up to last visit fell in the lowest (≤ 6.9%) or highest (≥ 9.5%) quintile of the overall HbA1c distribution, respectively. Prevalence cases of nephropathy were excluded from the study. Survival analysis and Cox regression were applied to the data.Results Among patients with good MC (n = 277), 15% had developed nephropathy at the end of the study. Conversely, among patients with poor MC (n = 268), the proportion without the complication was 52%. When adjusting for MC, time to diabetic nephropathy was related to age (P < 0.0001), AER (P < 0.001), duration of diabetes (P < 0.005), body mass index (BMI) (P < 0.005), all at baseline, and to gender (P < 0.01). Patients with upper normal range AER levels, longer duration of diabetes and lower BMI were at higher risk, regardless of MC. The adverse effect of younger age on diabetic nephropathy was more marked in good than in poor MC. Although women tended to develop the complication more often under good MC, they appeared to be better protected under poor MC.Conclusions This study confirms occurrence of diabetic nephropathy under good MC and non‐occurrence of the complication despite poor MC. It also demonstrates that some baseline covariates can affect, in a differential manner, time to diabetic nephropathy depending on MC.Diabet. Med. 20, 580–585 (2003)
Performance assessment of the Medtronic‐MiniMed Continuous Glucose Monitoring System and its use for measurement of glycaemic control in Type 1 diabetic subjects
Authors: Sachedina N. , Pickup J. C. 
Published: December 2004

AbstractAims  To assess the accuracy, reliability and measurement of glycaemic control associated with the Medtronic‐MiniMed Continuous Glucose Monitoring System (CGMS) in comparison with blood glucose self‐monitoring (BGSM) in Type 1 diabetic patients.Methods  Type 1 diabetic patients (n = 18) underwent glucose monitoring by the CGMS for up to 3 days, when control was also assessed by BGSM performed eight times daily.Results  Ninety‐five per cent of paired non calibration samples were in the clinically acceptable zones of the Clarke error grid, and 97% in a consensus grid. The median bias was 0.1 mmol/l and relative bias 15%. The failure rate of sensors was 28% of those initially inserted. The CGMS detected significantly more hypoglycaemia and post‐prandial hyperglycaemia, but total duration of hyperglycaemia, blood glucose oscillations and day‐to‐day variability were similarly assessed by CGMS and BGSM.Conclusions  The CGMS has acceptable clinical accuracy. Detection by the CGMS of more hypoglycaemia and post‐prandial hyperglycaemia than BGSM promises a valuable tool for control assessment and optimization of treatment.
The concentrations of short‐chain fatty acids and other microflora‐associated characteristics in faeces from children with newly diagnosed Type 1 diabetes and control children and their family members
Authors: Samuelsson U. , Ludvigsson J. 
Published: December 2004

AbstractAims  The gut flora is quantitatively the most important source of microbial stimulation and may provide a primary signal in the maturation of the immune system. We compared the microflora‐associated characteristics (MACs) in 22 children with newly diagnosed diabetes, 27 healthy controls, and their family members to see if there were differences between the children and if there was a familial pattern.Methods  The MACs were assessed by determining the concentrations of eight short‐chain fatty acids (SCFA), mucin, urobilin, b‐aspartylglycine, coprastanol and faecal tryptic activity (FTA).Results  There were no statistically significant differences between the concentrations of SCFA in the diabetes and control children. Members of families with a diabetic child had a higher concentration of acetic acid (P < 0.02) and lower concentrations of several other SCFAs than control families (P < 0.05–0.02). The other MACs showed no differences between the children or between the two family groups.Conclusion  In this pilot study we saw no differences in the MACs between children with diabetes and their controls. There were, however, some differences between the family members of diabetic children and controls that may indicate a familial pattern regarding the production of SCFAs by the gut flora. The role of the gut flora in relation to the risk of developing Type 1 diabetes needs to be analysed in larger and/or prospective studies.
Gestational diabetes affects platelet behaviour through modified oxidative radical metabolism
Authors: Mazzanti L. , Nanetti L. , Vignini A. , Rabini R. A. , Grechi G. , Cester N. , Curzi C. M. , Tranquilli A. L. 
Published: December 2004

AbstractAims  Patients with Type 1 and Type 2 diabetes mellitus show altered platelet function including decreased nitric oxide synthase (NOS) activity and increased peroxynitrite production. Gestational diabetes mellitus (GDM) is a clinical condition which is ideal for evaluating short‐term effects of impaired glucose metabolism, ruling out the possibility that the platelet abnormalities are a consequence of diabetic complications. The aim of the present work was to study NO metabolism in platelets from pregnant women with GDM. The production of peroxides was also studied as it is strongly involved in peroxynitrite formation.Methods  Platelet NOS activity and peroxynitrite production, levels of hydroperoxides and thiobarbituric acid reactive substances (TBARS) in platelet membranes in the basal state and after in vitro peroxidative stress with phenylhydrazine were determined in 40 pregnant women with GDM, 40 healthy pregnant women (pregnant controls) of comparable age and gestational age, and 15 healthy non‐pregnant women (controls).Results  NOS activity was significantly increased in both groups of pregnant women compared with non‐pregnant ones, and in GDM women compared with pregnant controls. Production of peroxynitrite was higher in GDM women than in pregnant controls, who also had significantly reduced production compared with non‐pregnant women. Basal levels of peroxidation of the platelet membranes evaluated either by hydroperoxide content and TBARS levels or the susceptibility to peroxidation were increased in GDM patients in comparison with both control groups.Conclusions  We have shown a modification in platelet NO and peroxynitrite production and an increase in platelet indicators of oxidative stress in GDM women compared with healthy pregnant women which might be at the basis of a cellular dysfunction.
Comparison of a high‐carbohydrate and a high‐monounsaturated fat, olive oil‐rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus
Authors: Rodríguez‐Villar C. , Pérez‐Heras A. , Mercadé I. , Casals E. , Ros E. 
Published: December 2004

AbstractAims  To compare the effects of a high‐carbohydrate (CHO) diet and a high‐monounsaturated fatty acid (MUFA) diet on LDL oxidative resistance in free‐living individuals with Type 2 diabetes mellitus.Methods  Twenty‐two men and women out‐patients with Type 2 diabetes, with mean age 61 years and in fair metabolic control (HbA1c < 8.0%), were enrolled at a university hospital lipid clinic in a randomized, crossover feeding trial comparing two isocaloric diets for 6 weeks each: CHO (fat, 28% energy) and MUFA (fat, 40% energy) based on virgin olive oil. Outcome measurements were changes in LDL susceptibility to oxidation, body weight, glycaemic control, and lipoprotein profiles.Results  Planned and observed diets were well matched. Participants preferred the MUFA diet over the CHO diet. The lag time of conjugated diene formation during Cu2+‐induced LDL oxidation was similar after the CHO and MUFA diets (36.4 ± 12.2 min and 36.0 ± 13.7 min, respectively). Body weight, glycaemic control, total triglycerides, and total, LDL‐ and HDL‐cholesterol levels also were similar after the two diets. Compared with the CHO diet, the MUFA diet lowered VLDL‐cholesterol by 35% (P = 0.023) and VLDL triglyceride by 16% (P = 0.016).Conclusions  Natural food‐based high‐CHO and high‐MUFA diets have similar effects on LDL oxidative resistance and metabolic control in subjects with Type 2 diabetes. A MUFA diet is a good alternative to high‐CHO diets for nutrition therapy of diabetes because it also has a beneficial effect on the lipid profile and superior patient acceptance.
Effect of acute carbon monoxide exposure on heart rate variability in patients with coronary artery disease*
Authors: Tarkiainen Tuula H. , Timonen Kirsi L. , Vanninen Esko J. , Alm Sari , Hartikainen Juha E. K. , Pekkanen Juha 
Published: December 2004

SummaryEpidemiological studies have shown that air pollution is associated with increased cardiovascular mortality. Although the pathophysiological mechanisms behind this association have remained largely unknown, it has been suggested that changes in cardiac autonomic function may play a role. In this study, we investigated the association between acute carbon monoxide (CO) exposure and cardiac autonomic function as measured by heart rate variability (HRV) in subjects with stable coronary artery disease. Twenty‐four hour ambulatory electrocardiographic recording with simultaneous continuous personal CO concentration monitoring was performed in six male patients with angiographically verified coronary artery disease three times with 1‐week intervals. Time domain measures of HRV were calculated for 5‐min segments before and during the CO exposure periods. For further analysis CO exposures were divided into low (≤2·7 p.p.m.) and high (>2·7 p.p.m.) CO exposure periods. The mean of maximum CO levels during 61 CO exposure periods was 4·6 p.p.m. (SD 5·0 p.p.m.). High CO exposure was associated with an increase in the square root of the mean of the sum of the squares of differences between adjacent RR intervals (r‐MSSD) (P = 0·034). Heart rate remained unchanged during the CO exposure. In conclusion, acute CO exposure which represented most likely exposure derived from traffic seems to modify cardiac autonomic control in patients with stable coronary artery disease.
The single breath transfer factor (Tl,co) and the transfer coefficient (Kco): a window onto the pulmonary microcirculation
Authors: Hughes J.M.B. 
Published: December 2004

SummaryThe transfer factor, Tl,co (with the transfer coefficient, Kco, also known as the transfer factor per unit alveolar volume, [Tl/Va]), is one of the most useful clinical tests of pulmonary function, the only one which specifically focuses on pulmonary microcirculation. It was originally devised in 1909 as a physiological tool to assess the diffusive capacity of the lung as a gas exchanger. It was subsequently developed as a clinical tool, but cumbersome analytical techniques delayed its introduction into clinical medicine until 1950s. The physiology of the carbon monoxide transfer factor (also called the diffusing capacity Dl,co) is based on the Roughton–Forster equation which partitions Dl,co, a conductance, into membrane (Dm) and red cell (θVc) diffusion conductances. Recent work (1987–2001) suggests that 70–80% of the resistance to CO (and O2) diffusion may reside in the red cell fraction. The clinical implication is that Tl,co and Kco are ‘windows’ onto the pulmonary microcirculation. As regards reference values for clinical use, Tl,co depends on age, height and gender. Kco, which is actually a rate constant, is independent of gender, and is affected principally by age. A schema is presented for the clinical interpretation of Tl,co. As Tl,co is derived from the product of Kco and the accessible alveolar volume (Va), examination of these two components (Kco and Va) will usually suggest a specific pathophysiological mechanism as the explanation for a reduction in Tl,co.
Relationship between exercise performance and water distribution measured by new bioelectrical impedance analysis in patients with chronic obstructive pulmonary disease
Authors: Mamoto Takashi , Fujiwara Hiroshi , Toyama Yoshiki , Hirata Kazuto , Yoshikawa Junichi , Fujimoto Shigeo 
Published: December 2004

SummaryBody composition analysis is useful for objective evaluation of malnutrition in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the influence of body composition on exercise performance by patients with COPD using a new method of bioelectrical impedance analysis. Twenty patients with COPD performed incremental exercise ramp tests to the symptom‐limited maximum and constant work rate tests for 10 min. Their body compositions were measured by bioelectrical impedance analysis with eight electrodes and four frequencies, which could estimate the amount of intra‐ and extracellular water (ICW, ECW) and water distribution of the extremities separately. Some pulmonary function parameters of airflow limitation or hyperinflation and body composition parameters were significantly correlated with . Stepwise multiple regression analysis revealed that independent predictors of included ECW/ICW ratio, lower extremity water and FEV1·0 (P<0·0001, R = 0·892), which explained 27, 31 and 21% of , respectively. Furthermore, there was a significant correlation between ECW/ICW ratio and time constant of oxygen consumption in constant work rate tests. These findings indicate that increased ECW/ICW ratio and lower extremity water correlated with exercise intolerance independent of pulmonary function, and that changes in cellular hydration state might affect oxygen utilization of skeletal muscle in patients with COPD. In conclusion, the BIA used in our study, which can easily and simultaneously evaluate the water distribution of the extremities and cellular hydration state, is useful for the evaluation of exercise performance in COPD patients.
Developmental Assessment‐Based Surgical Intervention for Intractable Epilepsies in Infants and Young Children
Authors: Matsuzaka Tetsuo , Baba Hiroshi , Matsuo Atsuko , Tsuru Akira , Moriuchi Hiroyuki , Tanaka Shigeki , Kawasaki Chisato 
Published: December 2004

Summary:  Purpose: To define the most appropriate time for surgery for medically intractable epilepsies in infants and young children.Methods: First we examined retrospectively the changes in developmental quotients (DQs) during the clinical course and the clinical factors affecting the DQ in 39 consecutive patients younger than 15 years, who underwent surgical treatment for intractable epilepsy. Second, we examined prospectively five new patients for early detection of developmental arrest or regression by periodic developmental assessments and whether this could lead to early surgical intervention, eventually resulting in minimal developmental defects.Results: Retrospective studies revealed that the DQ progressively decreased with age and that the reduction of DQ was related to continuing frequent seizures in many patients. The prospective studies demonstrated that periodic developmental assessments could detect the reduction of DQ at 5 months or later after onset of frequent seizures in three patients. In two other patients, operations were performed before reduction of DQs, and their postoperative DQ levels were normal. The postoperative recovery of DQ was complete in one patient whose operation was performed 3 months after reduction of DQ, whereas it was incomplete in two others whose operations were carried out at 12 and 14 months after reduction, respectively. Furthermore, three patients with normal developmental outcome had shorter periods between the onset of frequent seizures and the operation (≤7 months) than those of two patients with developmental delay (≥17 months).Conclusions: To minimize the developmental defects, periodic developmental assessments should be initiated when frequent seizures have occurred, and surgery should be considered as soon as possible when DQ reduction is recognized.