bluuebunny/crossref_metadata_2025_split huggingface dataset:
The efficacy of an abbreviated model of the International Prostate Symptom Score in evaluating benign prostatic hyperplasia
Authors: Cam K. , Senel F. , Akman Y. , Erol A. 
Published: March 2003

OBJECTIVESTo investigate the acceptability to patients in Turkey of the International Prostate Symptom Score (IPSS) for evaluating benign prostatic hyperplasia (BPH), and to devise a possible abbreviated model, saving time when administered by a physician.PATIENTS AND METHODSThe IPSS questionnaire was initially self‐administered in 200 consecutive patients aged> 50 years and with lower urinary tract symptoms. Patients were instructed only to mark questions which they clearly understood. The IPSS was then administered to 500 consecutive patients by the same physician. Subsequently, each of the seven questions was separately correlated with the IPSS and quality‐of‐life (QoL) score. The first five questions with the highest correlation coefficient for both the total IPSS and QoL score were identified, and every possible combination of these questions produced and correlated.RESULTSIn the first group, 29% of the patients did not complete the form and 44% could not mark at least one item; the effect of educational level was significant (P < 0.05). In the second group a combination of the first three items had a Pearson's correlation of 0.90 with the total IPSS; similarly, four questions combined (2, 3, 6 and 7) also correlated well (r = 0.92). Both combinations took significantly less time to administer (P < 0.05).CONCLUSIONThe abbreviated form of the IPSS consisting of three or four items may be used to assess symptoms in patients with BPH, especially in underdeveloped countries.
Renal services for people with diabetes in the UK
Authors: Roderick P. , Armitage A. 
Published: March 2003

AbstractDiabetic nephropathy is a serious complication of diabetes that can lead to endstage renal failure (ESRF). It is now the most common cause of ESRF in patients accepted onto renal replacement therapy (RRT) programmes in the UK. Rates of diabetic ESRF are more common in ethnic minority populations. The risk of developing diabetic ESRF is higher in Type 1 diabetes but in absolute terms more patients with Type 2 diabetes develop ESRF and are treated. There is still unmet need for RRT amongst patients with diabetes who develop ESRF. The shortage of organ donors, especially amongst ethnic minorities, means that dialysis is the mainstay of treatment in patients with diabetes and ESRF. This is now largely hospital haemodialysis with an increasing proportion being delivered in satellite units. Demand for RRT from patients with diabetes will increase due to demographic change and the increasing prevalence of diabetes, particularly Type 2, in the population. To meet this challenge closer liaison between those primarily caring for patients with diabetes (primary care physicians and diabetologists) and nephrologists is required to ensure effective surveillance of renal function, to increase early referral and to agree protocols of subsequent care. Continued expansion of high‐quality RRT is needed that ensures equity of access with particular targeting in areas with large ethnic minority populations. A national priority must be an increase in the kidney transplant rate.
The projected health care burden of Type 2 diabetes in the UK from 2000 to 2060
Authors: Bagust A. , Hopkinson P. K. , Maslove L. , Currie C. J. 
Published: March 2003

AbstractAims/hypothesis To predict the incidence and prevalence of Type 2 diabetes in the UK, the trends in the levels of diabetes‐related complications, and the associated health care costs for the period 2000–60.Methods An established epidemiological and economic model of the long‐term complications and health care costs of Type 2 diabetes was applied to UK population projections from 2000 to 2060. The model was used to calculate the incidence and prevalence of Type 2 diabetes, the caseloads and population burden for diabetes‐related complications, and annual NHS health care costs for Type 2 diabetes over this time period.Results The total UK population will not increase by more than 3% at any time in the next 60 years. However, the population over 30 will increase by a maximum of 11% by 2030. Due to population ageing, in 2036 there will be approximately 20% more cases of Type 2 diabetes than in 2000. Cases of diabetes‐related complications will increase rapidly to peak 20−30% above present levels between 2035 and 2045, before showing a modest decline. The cost of health care for patients with Type 2 diabetes rises by up to 25% during this period, but because of reductions in the economically active age groups, the relative economic burden of the disease can be expected to increase by 40−50%.Conclusion/interpretation In the next 30 years Type 2 diabetes will present a serious clinical and financial challenge to the UK NHS.
Thiazolidinediones: a new class of antidiabetic drugs
Authors: Day C. 
Published: March 2003

SummaryThiazolidinediones (TZDs) are a new class of oral antidiabetic agents. They selectively enhance or partially mimic certain actions of insulin, causing a slowly generated antihyperglycaemic effect in Type 2 (noninsulin dependent) diabetic patients. This is often accompanied by a reduction in circulating concentrations of insulin, triglycerides and nonesterified fatty acids. TZDs act additively with other types of oral antidiabetic agents (suphonylureas, metformin and acarbose) and reduce the insulin dosage required in insulin‐treated patients. The glucose‐lowering effect of TZDs is attributed to increased peripheral glucose disposal and decreased hepatic glucose output. This is achieved substantively by the activation of a specific nuclear receptor – the peroxisome proliferator‐activated receptor‐gamma (PPARγ), which increases transcription of certain insulin‐sensitive genes. To date one TZD, troglitazone, has been introduced into clinical use (in Japan, USA and UK in 1997). This was suspended after 2 months in the UK pending further investigation of adverse effects on liver function. TZDs have been shown to improve insulin sensitivity in a range of insulin‐resistant states including obesity, impaired glucose tolerance (IGT) and polycystic ovary syndrome (PCOS). In Type 2 diabetes, the TZDs offer a new type of oral therapy to reduce insulin resistance and assist glycaemic control.Diabet. Med. 16, 179–192 (1999)
Natural course of kidney function in Type 2 diabetic patients with diabetic nephropathy
Authors: Christensen P. K. , Rossing P. , Nielsen F. S. , Parving H. ‐H. 
Published: March 2003

Summary Aims To determine the natural course of kidney function and to evaluate the impact of putative progression promoters in Caucasian Type 2 diabetes mellitus (DM) patients with diabetic nephropathy who had never received any antihypertensive treatment. Methods A long‐term observational study of 13 normotensive to borderline hypertensive Type 2 DM patients with diabetic nephropathy. Glomerular filtration rate (GFR) was measured approximately every year (51Cr‐EDTA plasma clearance technique). Albuminuria, blood pressure (BP) and haemoglobin A1c (HbA1c) was determined 2–4 times per year and serum cholesterol every second year. Results The patients (12 males/one female), age 56 ± 9 (mean ±sd) years, with a known duration of diabetes of 10 ± 6 years, were followed for 55 (24–105) (median (range)) months. GFR decreased from 104 (50–126) to 80 (39–112) ml.min–1.1.73 m–2 (P = 0.002) with a median rate of decline of 4.5 (– 0.4 to 12) ml.min–1.year–1. During follow‐up, albuminuria rose from 494 (301–1868) to 908 (108–2169) mg/24 h (P = 0.25), while BP, HbA1c and serum cholesterol remained essentially unchanged. In univariate analysis the rate of decline in GFR did not correlate significantly with neither baseline nor mean values during follow‐up of BP, albuminuria, HbA1c and serum cholesterol. Conclusions Our study suggests that normotensive to borderline hypertensive Type 2 DM patients with diabetic nephropathy have a rather slow decline in kidney function, but we did not unravel the putative progression promoters responsible for the variation in rate of decline in GFR.Diabet. Med. 16, 388–394 (1999)
The British Diabetic Association Cohort Study, II: cause‐specific mortality in patients with insulin‐treated diabetes mellitus
Authors: Laing S. P. , Swerdlow A. J. , Slater S. D. , Botha J. L. , Burden A. C. , Waugh N. R. , Smith A. W. M. , Hill R. D. , Bingley P. J. , Patterson C. C. , Qiao Z. , Keen H. 
Published: March 2003

Summary Aims To measure cause‐specific mortality, by age, in patients with insulin‐treated diabetes incident at a young age. Methods A cohort of 23 752 patients with insulin‐treated diabetes diagnosed under the age of 30 years, from throughout the United Kingdom, was identified during 1972–93 and followed to February 1997. Death certificates have been obtained for deaths during the follow‐up period and cause‐specific mortality rates and standardized mortality ratios by age and sex are reported. Results During the follow‐up period 949 deaths occurred and at all ages mortality rates were considerably higher than in the general population. Acute metabolic complications of diabetes were the greatest single cause of excess death under the age of 30 years. Cardiovascular disease was responsible for the greatest proportion of the deaths from the age of 30 years onwards. Conclusions Deaths in patients with diabetes diagnosed under the age of 30 have been reported and comparisons drawn with mortality in the general population. To reduce these deaths attention must be paid both to the prevention of acute metabolic deaths and the early detection and treatment of cardiovascular disease and associated risk factors.
Pakistani moslems with Type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self‐monitoring management and glycaemic control
Authors: Hawthorne K. , Tomlinson S. 
Published: March 2003

Summary Aims To study factors such as sex, educational status and place of care, which might influence knowledge and self‐management of diabetes, and glycaemic control in a Pakistani moslem diabetic population attending primary care general practices (GP) and secondary care clinics at the Manchester Diabetes Centre (MDC). Methods Patients with Type 2 diabetes mellitus took part in a one‐to‐one semi‐structured interview and gave blood for haemoglobin A1c levels. Results Two hundred and one patients entered the study. Knowledge about diabetic diets was good (average scores 72%), and patients claimed to perform regular glucose measurements (66%), but they were not good at applying their knowledge to problems in daily life. Only 24% knew how to manage persistent hyperglycaemia. Women were worse than men at this (19 vs. 31% (χ2 = 3.8, P = 0.05)), were less likely to understand why glucose levels should be monitored, and had poorer glycaemic control overall (HbA1c 8.8 vs. 8.1%, P = 0.04). Fifty‐four patients were completely illiterate. They had similar knowledge scores to readers but were less able to handle problem scenarios. Forty‐five of these patients were women, and multiple regression analysis showed they were more likely to have the poorest glycaemic control. No major differences were found between general practioner and hospital attenders, or between patients with and without known complications, except that hospital attenders were more likely to have complications and poorer control. Conclusions Women who cannot read in this population are likely to have poorer glycaemic control and may be finding it more difficult to learn how to apply their knowledge to daily life. This subgroup may need more intensive, culturally appropriate, health education and support.
Oral candidal carriage and infection in insulin‐treated diabetic patients
Authors: Willis A. M. , Coulter W. A. , Fulton C. R. , Hayes J. R. , Bell P. M. , Lamey P. ‐J. 
Published: March 2003

Summary Aim To evaluate candidal load and carriage of candidal species in 414 insulin‐treated diabetes mellitus patients with and without clinical signs of infection. Host factors that could influence candidal load in diabetic patients with oral candidosis were also investigated. Methods Candidal species were recovered from 414 insulin‐treated diabetes mellitus patients attending two hospital diabetic clinics, using an oral rinse technique. Results Seventy‐seven per cent of diabetic patients carried Candida species in their oral cavity, with C. albicans being the species most frequently isolated. C. dubliniensis was found for the first time in this patient group. Forty per cent of patients colonized with candidal species had no clinical signs of oral candidosis. Where oral candidosis was present, erythematous candidosis was the most common clinical presentation. Candidal load was not associated with age, sex or glycaemic control. However, it was significantly increased in those patients who were tobacco smokers, and non‐significantly increased in those patients who wore dentures, or who had clinical signs of oral candidosis. Conclusion The epidemiology of oral candidal carriage and infections in diabetic patients is complex and includes species which have not been previously reported in this group of patients. The development of oral candidosis in insulin‐treated diabetes mellitus patients is not the result of a single entity, but rather, a combination of risk factors.
Poorly controlled elderly Type 2 diabetic patients: the effects of increasing sulphonylurea dosages or adding metformin
Authors: Gregorio F. , Ambrosi F. , Manfrini S. , Velussi M. , Carle F. , Testa R. , Merante D. , Filipponi P. 
Published: March 2003

Summary Aims To assess the effects and safety of increasing sulphonylurea dosages or adding metformin in poorly controlled elderly Type 2 diabetic patients.Methods A 18‐month multicentre clinical study was performed on sulphonylurea‐treated diabetic patients over 70 years of age with well‐preserved renal function, steady fasting blood glucose ≥  200 mg/dl and HbA1c≥  9%. Patients were randomly assigned to sulphonylurea increased up to its maximum dosage (1st group) or to addition of metformin (2nd group). Glycaemic control, lipid pattern, haemostatic status and safety were monitored during run‐in, at baseline and at scheduled intervals for 18 months. Results[85 patients in the 1st group and 89 patients in the 2nd with complete data. Results Similar improvements in glycaemic levels were observed with both treatments within the first month and a similar decrease in HbA1c within the third month. No further changes occurred in glycaemic control. In the 1st group, fasting glucose (mmol/l, mean ± se) decreased from 14.21 ± 0.49 to 9.88 ± 0.21, average day‐long glucose from 14.87 ± 0.27 to 10.69 ± 0.19 and HbA1c (%) from 10.32 ± 0.13 to 8.66 ± 0.13. In the 2nd treatment group fasting glucose decreased from 14.59 ± 0.61 to 9.05 ± 37.28, average day‐long glucose from 15.09 ± 0.29 to 10.32 ± 0.21 and HbA1c from 10.33 ± 0.13 to 8.77 ± 0.12 (for all P <  0.0005). In this 2nd group, a decrease in LDL‐cholesterol (P <  0.05) and an increase in HDL‐cholesterol levels (P <  0.02) were also observed. In the 1st group, anthrombin III activity increased significantly (P <  0.01). In the 2nd group, significant reductions in markers of platelet function (FP4 and βTG, P <  0.01), thrombin generation (FPA, F1 +  2 and D‐D, P <  0.01), and fibrinolysis inhibition (PAI‐1 activity, PAI‐1 antigen, P <  0.001) were observed. Increases in some fibrinolytic activation markers (t‐PA activity, and AT‐III activity, P <  0.01) occurred. Fasting lactate concentrations were unchanged in the metformin‐treated group. No serious adverse effects were observed in either group. Conclusions These results suggest that either high sulphonylurea dosages or a therapy combining lower sulphonylurea dosages with metformin are effective and safe in an aged but healthy population. Metformin provides additional benefits counteracting several cardiovascular risk factors but must be administered with caution, bearing in mind the general contra‐indications for the drug but not age alone.
Correlations between insulin sensitivity and bone mineral density in non‐diabetic men
Authors: Abrahamsen B. , Rohold A. , Henriksen J. E. , Beck‐Nielsen H. 
Published: March 2003

Summary Aims To investigate relationships between bone mineral density (BMD), insulin secretion and insulin sensitivity, controlling for body composition, in view of data suggesting that hypoglycaemia leads to decreased osteoblast proliferation and a negative calcium balance and that insulin stimulates osteoblast differentiation and collagen synthesis, with no clear evidence if this response in impaired in insulin resistance. Methods Femur and whole body (WB) BMD was measured in 55 male patients with ischaemic heart disease and 40 healthy men, using a Hologic QDR‐2000 densitometer. Insulin sensitivity (Si) was estimated as the rate of glucose disappearance divided by the area under the insulin curve during an intravenous glucose tolerance test. Results Insulin and C‐peptide levels were not correlated with BMD, but Si was a significant predictor of femur (log, r = 0.35) and WB BMD (log r = 0.29, both P < 0.01), even after controlling for weight and age. Fat mass (FM) was a predictor of BMD (femur: r = 0.33 P < 0.01, WB: r = 0.43 P < 0.001). In the femur the association with FM disappeared when log(Si) was entered in the regression. Lean body mass (LBM) contributed significantly to BMD (r = 0.50 and r = 0.66, both P < 0.001). Conclusions These results are compatible with a direct influence of lean body mass on bone, while the impact of fat mass may consist of insulin resistance with increased insulin exposure of bone. It is hypothesized that patients with insulin resistance in the metabolic pathway do not exhibit resistance to the skeletal actions of insulin.
Relation between insulin resistance and carotid intima‐media thickness and stenosis in non‐diabetic subjects. Results from a cross‐sectional study in Malmö, Sweden
Authors: Hedblad B. , Nilsson P. , Janzon L. , Berglund G. 
Published: March 2003

Abstract Aims To assess whether there is an association between insulin resistance and carotid intima‐media thickness and stenosis in non‐diabetic subjects free from symptomatic cardiovascular disease. Methods A cross‐sectional population‐based study in Malmö, Sweden, of 4816 (40% men) subjects, born 1926–1945. The prevalence of insulin resistance was established by the homeostasis model assessment (HOMA) and defined as values above the 75th percentile. Criteria issued by the European Group for the Study of Insulin Resistance (EGIR) were used for the definition of the insulin resistance syndrome. Common carotid artery intima‐media thickness (IMT) and carotid stenosis (> 15%) were measured by B‐mode ultrasonography. Results Age and sex‐adjusted common carotid IMT among subjects with the insulin resistance syndrome (12.7%) and controls was 0.812 mm, respectively, 0.778 mm (P < 0.001). The prevalence of stenosis in the two groups was 22.9 and 19.2% (P = 0.040). Insulin resistance per se was after adjustment for age and sex associated with increased IMT (0.780 mm vs. 0.754 mm, P < 0.001). This association disappeared, however, when other factors included in the insulin resistance syndrome were taken into account. Conclusions Fasting serum insulin covaries with a number of factors and conditions known to influence the development of atherosclerosis. It is concluded that the association between insulin resistance, as assessed by the HOMA method in non‐diabetic subjects, and atherosclerosis is explained by its covariance with established risk factors for cardiovascular disease of which hypertension seems to be the most significant.
Altered heel‐pad mechanical properties in patients with Type 2 diabetes mellitus
Authors: Hsu T. ‐C. , Wang C. ‐L. , Shau Y. ‐W. , Tang F. ‐T. , Li K. ‐L. , Chen C. ‐Y. 
Published: March 2003

SUMMARY Aims  To compare the heel‐pad mechanical properties in patients with Type 2 diabetes mellitus with forefoot ulceration, without forefoot ulceration and age‐matched healthy subjects.Methods  Heel‐pad mechanical properties in 40 heels of 20 healthy subjects (group I) age‐matched with the other groups, 42 heels of 21 diabetic patients without forefoot ulceration (group II), and 14 heels of 12 diabetic patients with active forefoot ulceration (group III) were assessed using a self‐constructed loading–unloading device and a 10‐MHz linear‐array ultrasound transducer.Results  There were no differences in the unloaded heel‐pad thickness, compressibility index and elastic modulus between the three groups. When compared with group I subjects (mean ± sd, 27.9 ± 6.1%), a significant increase (P < 0.001) was found in both group II (36.1 ± 8.7%) and group III patients (43.2 ± 6.6%) for the energy dissipation ratio. This ratio was also significantly different (P = 0.003) between groups II and III.Conclusions  The higher impact energy dissipated in the heel‐pad may put patients with Type 2 diabetes at higher risk for developing foot ulceration.
When and how to start insulin treatment in gestational diabetes: a UK perspective
Authors: Hadden D. R. 
Published: March 2003

AbstractGestational diabetes mellitus, however currently defined, is relatively rare in a UK Caucasian population, but is much more common in other ethnic groups. There is likely soon to be better agreement on diagnostic levels of hyperglycaemia in pregnancy, but there is still considerable reluctance to start insulin therapy. There is now good evidence that insulin administered twice daily during the third trimester to mothers who have even a mild degree of hyperglycaemia will reduce fetal size, and in particular fetal adiposity. In relation to recent concepts of the transgenerational passage of Type 2 diabetes and obesity, further epidemiological investigation is required. Insulin treatment in pregnancy may also prove to have a role in prevention of Type 2 diabetes in the next generation.Diabet. Med. 18, 960–964 (2001)
The Utrecht Diabetes Project: telemedicine support improves GP care in Type 2 diabetes
Authors: Rutten G. E. H. M. , Maaijen J. , Valkenburg A. C. H. , Blankestijn J. G. , De Valk H. W. 
Published: March 2003

AbstractIntroduction The Utrecht Diabetes Project (UDP) is a shared‐care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist.Aims To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs' motives for enrolling them.Methods Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs.Results Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out‐patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out‐patient clinics had more patients with diabetes > 10 years or with complications. UDP patients' records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin.Conclusions Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care.Diabet. Med. 18, 459–463 (2001)