bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of diabetes‐related amputation in South Asians vs. Europeans in the UK
Authors: Chaturvedi N. , Abbott C. A. , Whalley A. , Widdows P. , Leggetter S. Y. , Boulton A. J. M. 
Published: March 2003

AbstractAims To compare the risk of and risk factors for diabetes‐related amputation in South Asians and Europeans.Methods This was a population‐based case control study based in the health districts of Bolton, Oldham and Central Manchester in the UK. Cases with diabetes‐related amputation performed between 1992 and 1997 (n = 172) and controls with diabetes and no amputation (n = 376) were selected from the primary care‐based North‐west Diabetes Foot Study database. Risk factor data were also collected.Results Age at diagnosis adjusted odds ratio (OR) of amputation in South Asians compared with Europeans was 0.26, 95% confidence interval (CI) 0.11–0.65, P = 0.004. In the control population, South Asians were less likely than Europeans to have peripheral vascular disease (PVD) (9% vs. 24%, P = 0.02), neuropathy (30% vs. 54%, P = 0.003), and less likely to have ever been smokers (31% vs. 57%, P = 0.03). When these factors were added to the model, the OR was attenuated to 0.84, 95% CI 0.23–3.08, P = 0.8.Conclusions South Asians with diabetes have about a quarter of the risk of amputation of Europeans. This is mostly explained by low rates of PVD and neuropathy in South Asians, in part associated with low rates of smoking. The reasons for the South Asian protection from both PVD and neuropathy deserve further exploration.Diabet. Med. 19, 99–104 (2002)
Resource consumption and costs in Dutch patients with Type 2 diabetes mellitus. Results from 29 general practices
Authors: Redekop W. K. , Koopmanschap M. A. , Rutten G. E. H. M. , Wolffenbuttel B. H. R. , Stolk R. P. , Niessen L. W. 
Published: March 2003

AbstractAims The aims of this study were to estimate the costs incurred by Dutch patients with Type 2 diabetes, examine which patient and/or treatment characteristics are associated with costs, and estimate the medical and non‐medical costs of patients with Type 2 diabetes in The Netherlands.Methods Twenty‐nine Dutch general practitioners provided information on all Type 2 diabetes patients in their practice (n = 1371), information on demography, clinical characteristics, treatment type, the presence of complications and the type and amount of medical consumption during the previous 6 months. Medical costs were analysed using multivariate linear regression. Estimates of costs seen in The Netherlands were based on these results plus information from other sources regarding costs of end‐stage renal disease, appliances, travel and productivity loss.Results Although only 9% of patients were hospitalized within the previous 6 months, hospitalization costs represented one‐third of the medical costs, drug costs 40% and ambulatory costs 26%. Patients using insulin, patients with macrovascular complications only or in combination with microvascular complications incurred higher medical costs than other patients. Age and hyperlipidaemia were also positively related to medical costs. When these results were combined with other data sources, we estimated that patients with Type 2 diabetes are responsible for £365 500 000 (1 271 000 000 guilders) or 3.4% of the relevant parts of health care costs in 1998. The non‐medical costs (travel costs, productivity costs) are limited: 52 500 000 (183 000 000 guilders).Conclusions Independent determinants of the medical costs of Type 2 diabetes in The Netherlands include age, complications, insulin use and hyperlipidaemia.Diabet. Med. 19, 246–253 (2002)
Role of sibutramine in the treatment of obese Type 2 diabetic patients receiving sulphonylurea therapy
Authors: Serrano‐Rios M. , Melchionda N. , Moreno‐Carretero E. 
Published: March 2003

AbstractAims To investigate whether the satiety‐inducing agent sibutramine affected body weight and associated anthropometry in overweight and obese (body mass index (BMI) > 27) Type 2 diabetic patients on sulphonylurea therapy.Methods A randomized, placebo‐controlled trial was undertaken in 134 patients with stable metabolic control on chronic sulphonylurea therapy. Patients were placed on moderate caloric restriction and received treatment with either sibutramine (15 mg/day) or placebo for 6 months.Results Fifty‐three of 69 sibutramine‐treated and 57/65 placebo‐treated patients completed the study. Both groups showed progressive weight loss. At the end of the trial weight loss was two times greater in the sibutramine group (mean ± sem; −4.5 ± 0.5 kg) than placebo (−1.7 ± 0.5 kg, P < 0.001 vs. sibutramine). There was a trend for more patients to lose > 5% of initial body weight in the sibutramine group than placebo. BMI (P < 0.001) and waist circumference (P < 0.001) were also decreased to a greater extent by sibutramine. Mean reductions in HbA1c were commensurate with weight loss in both the sibutramine and placebo (−0.78 ± 0.17% and −0.73 ± 0.23%; P = 0.84). Sibutramine was well tolerated with only two patients withdrawn due to potentially drug‐related serious adverse events (palpitations).Conclusions Sibutramine, in conjunction with moderate caloric restriction, enhances weight loss and reduces waist circumference in overweight and obese Type 2 diabetic patients receiving sulphonylurea therapy. This is associated with additional improvements in glycaemic control in a limited number of patients losing ≥ 10% of their baseline body weight.
Group therapy for binge eating in Type 2 diabetes: a randomized trial
Authors: Kenardy J. , Mensch M. , Bowen K. , Green B. , Walton J. 
Published: March 2003

AbstractAims This preliminary study addresses three related issues. First, there is a need to test the effectiveness of cognitive behavioural therapy (CBT) for binge eating in populations with Type 2 diabetes. Second, the impact of a treatment for binge eating on diabetes management is unknown. Finally, whilst a number of treatment modalities have been shown to improve binge eating, there has not been a comparison between CBT and a non‐specific therapy for binge eating.Methods Group CBT for binge eating was compared with a group non‐prescriptive therapy (NPT), a therapy for which there is no theoretical or empirical support in eating disorders, in a randomized trial which included a post‐treatment assessment and a 3‐month follow‐up.Results There were no differences between CBT and NPT at post‐treatment, with both treatments being associated with significant changes in binge eating, mood and body mass index. However, there was a significant relapse in binge eating at the 3‐month follow‐up in the NPT condition. This was in contrast to the CBT condition, where treatment gains were maintained. Finally, across treatments, reduction in binge eating from pre‐ to post‐treatment was associated with reduction in HbA1c.Conclusions Binge eating in Type 2 diabetes is responsive to psychosocial treatment, and reduction in binge eating appears to improve glycaemic control. However, this is a small study with a short follow‐up period. Future studies will need to extend the follow‐up period to assess for long‐term maintenance of the effects of CBT on binge eating and diabetic control in this population.
eNOS4 polymorphism of the endothelial nitric oxide synthase predicts risk for severe diabetic retinopathy
Authors: Taverna M. J. , Sola A. , Guyot‐Argenton C. , Pacher N. , Bruzzo F. , Chevalier A. , Slama G. , Reach G. , Selam J.‐L. 
Published: March 2003

AbstractBackground Genetic factors may be involved in the development, and particularly in the severity, of diabetic retinopathy (DR), in addition to chronic hyperglycaemia. Increased nitric oxide generation has been suggested to play a significant role in the pathogenesis of DR.Aims and methods To examine whether the eNOS4 is involved in the risk of severe DR, 200 unrelated Caucasian Type 1 diabetic patients of long duration were randomly selected (M/F 103/97, age 44.4 ± 12.4 years, diabetes duration 27.7 ± 10.0 years, body mass index 24.3 ± 3.4 kg/m2, HbA1c 8.6 ± 1.3%). The eNOS4 polymorphism was analysed by polymerase chain reaction, and DR by retinal angiography and classified as presence (n = 101) or absence (n = 99) of severe (proliferative or pre‐proliferative) DR.Results The genotype distribution of eNOS4b/b (wild‐type), eNOS4b/a (heterozygous) and eNOS4a/a (homozygous) was 72%, 24.5% and 3.5%, respectively. Frequency of eNOS4a/a was significantly lower in patients with severe DR (n = 0) when compared with controls (n = 7, odds ratio (OR) = 0 (95% confidence interval (CI) = 0.5–0.74), P = 0.02). eNOS4b/b was more frequent in patients with severe DR (n = 80) when compared with controls (n = 64, OR = 2.1 (95% CI = 1.1–4.12), P = 0.032). Frequency of eNOS4b/a was not different between the study (n = 21) and control groups (n = 28, ns). The allelic frequencies between the study and control groups were different (4b: n = 181 vs. n = 156, respectively, OR = 2.3 (95% CI = 1.27–4.25), P = 0.005; 4a: n = 21 vs. n = 42, respectively, OR = 0.4 (95% CI = 0.24–0.79), P = 0.005).Conclusions We demonstrate in Caucasians with Type 1 diabetes that (i) eNOS4a/a is associated with absent or non‐severe DR, and (ii) eNOS4b/b is associated with severe DR.
Association of British Clinical Diabetologists (ABCD) survey of secondary care services for diabetes in the UK, 2000. 1. Methods and major findings
Authors: Winocour P. H. , Ainsworth A. , Williams R. ,   on behalf of the Association of British Clinical Diabetologists (ABCD)
Published: March 2003

AbstractObjective To examine the provision, and variations in, secondary care diabetes services in the UK.Methodology and participants A postal survey of all 238 identified secondary care providers of diabetes services in 2000.Results Following two reminders, a 77% response rate was achieved. Major deficiencies in core staffing levels were recorded, with 36% of services provided by only one consultant physician with an interest in diabetes. The provision of diabetes specialist nurses was less than recommended in 87% of responses, whereas podiatry and dietetic support was unavailable in 3% and 27% of responses, respectively. Diabetes registers were not present in 28%, and a co‐ordinated retinopathy screening programme unavailable in 26% of responses. Key biochemical measurements were unavailable in 9% (microalbuminuria) to 18% (HDL‐cholesterol) of responses. A ‘Well‐Resourced Service’ score was devised taking account of levels of personnel, facilities and specialized clinical services. There was a significant geographical variation in this score (P < 0.001), with the lowest score (least well‐resourced services) in the Eastern NHS Region of England, and the highest score in the North‐west NHS Region of England. The ‘Well‐Resourced Service’ score was also significantly lower (P < 0.05) where there were less than two whole‐time consultant physicians providing diabetes services. In contrast to other aspects of service provision, availability of dieticians and a combined diabetes–ophthalmology service had declined since 1990. Of 245 recorded bids for resources and service improvements for diabetes care, the success rate overall was 44%, and lowest where bids were made for dietetic and podiatry support.Conclusions There is presently a major shortfall in provision of secondary care diabetes services throughout the UK, with evidence that there is significant regional variation and less facilities and resources where there are less than two consultants providing specialized diabetes services. On average bids for service improvements were only successful in < 50% of cases, most usually where the service was relatively better provided for. Considerable development and investment are required nationally to ensure equitable access to specialized diabetes services, a vital component in reducing adverse diabetes outcomes.
Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait
Authors: Shaltout A. A. , Moussa M. A. A. , Qabazard M. , Abdella N. , Karvonen M. , Al‐Khawari M. , M. Al‐Arouj  , Al‐Nakhi A. , Tuomilehto J. , El‐Gammal A. ,   Kuwait Diabetes Study Group
Published: March 2003

AbstractAims To provide age–gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged ≤ 14 years.Methods Data were prospectively collected over a period of 6 years (1992–1997) according to the DiaMond Project protocol using the capture–recapture method of ascertainment.Results Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100 000 children 0–14 years (95% confidence interval (CI) 18.0–22.1); age‐standardized incidence rate 20.9 (95% CI 18.8–23.0). The incidence rate among boys, 21.1 per 100 000 (95% CI 18.1–24.1) was slightly higher than that among girls, 19.0 per 100 000 (95% CI 16.1–21.8). The age‐standardized incidence rate was 21.9 (95% CI 18.9–24.8) in boys, and 19.9 (95% CI 17.1–22.8) in girls. Incidence rates increased with age in both sexes (boys χ2 for linear trend = 13.5, P < 0.001; and for girls χ2= 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6‐year period (χ2= 6.210, P = 0.013), and in age group 5–9 (χ2= 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001).Conclusion The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.
Evaluation of a new screening method for detecting peripheral arterial disease in a primary health care population of patients with diabetes mellitus
Authors: Johansson K. E. A. , Marklund B. R. G. , Fowelin J. H. R. 
Published: March 2003

AbstractAims To compare the ability to detect peripheral arterial disease between the traditional ankle Doppler technique for measuring ankle blood pressure and a new pulse oximetric method for measuring systolic toe pressure, in an unselected primary health care population with diabetes mellitus.Methods The total population with the diagnosis diabetes mellitus in two primary health care districts was studied. The population was investigated by means of pulse palpation, ankle Doppler pressure, systolic toe pressure using a pulse oximetric method, arm blood pressures, neuropathy screening and laboratory tests.Results A total of 126 patients were included in the study. In these patients, 250 extremities were investigated. Systolic ankle Doppler pressure and ankle/arm pressure indices were found to be significantly higher than the pressures and indices achieved with the pulse oximetric method (158 ± 44 vs. 117 ± 33 mmHg, P < 0.0001, and 1.02 ± 0.24 vs. 0.76 ± 0.22, P < 0.0001). Thirty‐one extremities with a systolic toe pressure < 80 mmHg were found. Twenty‐one of these lacked a palpable pulse in the dorsal pedial or posterior tibial artery. The pulse oximetric method gave significantly more pathological indices (Doppler index ≤ 0.8, pulse oximeter index ≤ 0.6) (Doppler 36/250, pulse oximeter 58/250, P = 0.003). However, the Doppler method gave significantly more indices above 1.3 compared with the pulse oximetric method (33/250 vs. 2/250, P = 0.003).Conclusion This study demonstrates that ankle Doppler pressure measurements overestimate peripheral arterial pressure in a typical primary health care population. In the screening situation, this new pulse oximetric toe pressure method seems to be valuable since it can be performed in out‐patient clinics and handle large numbers of patients in a short time and avoid the problem of media sclerosis.Diabet. Med. 19, 307–310 (2002)
Combination of insulin and thiazolidinedione therapy in massively obese patients with Type 2 diabetes
Authors: Buch H. N. , Baskar V. , Barton D. M. , Kamalakannan D. , Akarca C. , Singh B. M. 
Published: March 2003

AbstractAims To evaluate the influence of addition of rosiglitazone to insulin therapy over a 24‐week period in massively obese patients with poorly controlled Type 2 diabetes taking large doses of insulin.Methods Eight massively obese patients (median body mass index (BMI) 42 kg/m2) with Type 2 diabetes who were on large doses of insulin (median daily dose of 204 U) and/or had poor glycaemic control (median HbA1c of 8.1% (upper limit for normal 5.5%)) were treated over a 24‐week period with the combination of insulin and maximum doses of rosiglitazone. Outcomes monitored were changes in weight, BMI, HbA1c, dose of insulin and development of side‐effects.Results At the end of 24 weeks there was a median weight gain of 3 kg (P < 0.01), a fall in median HbA1c from 8.1% to 6.7% (16% reduction from baseline) (P < 0.01) and a reduction in median insulin dose from 204 U/day to 159 U/day (P < 0.01) (23% reduction from baseline). Peripheral oedema was the only significant side‐effect and was seen in five patients.Conclusions Combination of insulin and rosiglitazone is effective in massively obese patients with Type 2 diabetes, though there is a high incidence of peripheral oedema.
Family conflict, adherence, and glycaemic control in youth with short duration Type 1 diabetes
Authors: Anderson B. J. , Vangsness L. , Connell A. , Butler D. , Goebel‐Fabbri A. , Laffel L. M. B. 
Published: March 2003

AbstractAims Behavioural support around diabetes management tasks is linked to glycaemic outcomes. In this study we investigated the relationship between diabetes‐related parental behaviours (conflict around and involvement in treatment tasks), adherence to blood glucose monitoring (BGM), and glycaemic control in youth with short duration Type 1 diabetes mellitus (DM).Methods In a cross‐sectional study, 104 youth (aged 8–17 years, duration of Type 1 DM 0.5–6 years) along with a parent, completed the Diabetes Conflict Scale. Parental involvement in management tasks was assessed with structured interviews and the Diabetes Family Responsibility Questionnaire. Adherence to BGM was evaluated by family report and by independent clinician rating. Glycaemic control was assessed with glycosylated haemoglobin (HbA1c) (ref. range, 4–6%).Results Children (8–12 years; n = 69) and adolescents (13–17 years; n = 35), respectively, had similar durations of diabetes (x ± sd; 2.7 ± 1.69, 2.4 ± 1.32 years) and similar glycaemic control (8.3 ± 1.1%, 8.4 ± 1.1%). In both age groups, parental involvement was a significant predictor of adherence to BGM (P = 0.01). Multivariate analyses, controlling for age, sex, disease duration, and BGM adherence, revealed that higher diabetes conflict significantly related to poorer glycaemic control (HbA1c) (R2 = 0.17; P < 0.01).Conclusions These findings indicate that in this cohort, early in the course of diabetes, diabetes‐specific conflict and adherence to BGM became strongly linked to the child's glycaemic control. This suggests that to insure optimal control, it may be beneficial to introduce targeted interventions to build positive family involvement and interaction around diabetes tasks early in the disease course, before negative behaviours become established.Diabet. Med. 19, 635–642 (2002)
European comparison of costs and quality in the prevention of secondary complications in Type 2 diabetes mellitus (2000–2001)
Authors: Gandjour A. , Kleinschmit F. , Lauterbach K. W. ,   the INTERCARE International Investigators
Published: March 2003

AbstractAims To compare the out‐patient costs and process quality of preventing secondary complications in patients with Type 2 diabetes mellitus in France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the UK.Methods A total of 188 European physician practices assessed annual services for one hypothetical average patient (cost evaluation) and 178 practices reported retrospective data on one or two real patients (quality evaluation) in 2000/2001. In countries with a detailed fee‐for‐service schedule (Germany, Italy, and Switzerland) reimbursement fees were used to approximate costs. These fee‐for‐service schedules were also used to develop index (average) fees for all countries, in order to measure resource utilization. The following process quality indicators were evaluated: control of HbA1c; control of lipids; urine test for (micro)albuminuria; control of blood pressure; foot examination; neurological examination; eye examination; and patient education. For each country an average quality rating was calculated by weighting the response to each quality indicator with the level of scientific evidence.Results Average quality ratings ranged from 0.40 in The Netherlands to 0.62 in the UK (0 = lowest rating; 1 = highest rating). Total annual costs for secondary prevention were higher in Switzerland than in Germany and Italy (EUR475, EUR381, and EUR283, respectively). Resource utilization was highest in Germany and lowest in the UK.Conclusions The overall quality of preventive services documented was found to be poor in the seven European countries studied. The UK rated as both the most effective and the most efficient country in providing secondary prevention in Type 2 diabetes.
Nitric oxide and vascular endothelial growth factor concentrations are increased but not related in vitreous fluid of patients with proliferative diabetic retinopathy
Authors: Hernández C. , Lecube A. , Segura R. M. , Sararols L. , Simó R. 
Published: March 2003

AbstractAims Several reports have implicated nitric oxide (NO) in the angiogenic process. The assessment of NO stable end products, nitrite and nitrate (NOx), is commonly used as a measure of NO production in biological fluids. The aims of the study were to investigate NOx concentrations in the vitreous fluid of patients with proliferative diabetic retinopathy (PDR) and to evaluate the relationship between NOx and vascular endothelial growth factor (VEGF).Patients and methods Serum and vitreous fluid samples were obtained simultaneously at the time of vitreoretinal surgery from 23 patients with PDR, and 17 control non‐diabetic patients with non‐proliferative ocular disease. NOx was determined by using the Griess reaction and VEGF levels were assessed by ELISA.Results The intravitreous concentration of NOx was significantly elevated in patients with PDR in comparison with the control group (31.6 ± 2.96 µmol/l vs. 18 ± 2.46 µmol/l; P = 0.01). However, we did not detect any differences between NOx serum concentrations. We observed a correlation between serum and vitreous levels of NOx in diabetic patients (r = 0.79; P < 0.001), but not in the control group. Intravitreous levels of VEGF in patients with PDR were higher than those obtained in serum (1.42 ng/ml (0.12–7.62) vs. 0.12 ng/ml (0.03–0.42); P < 0.01). Vitreal levels of VEGF were strikingly higher in patients with PDR than in the control subjects (1.42 ng/ml (0.12–7.62) vs. 0.009 ng/ml (0.009–0.04); P < 0.001). No correlation between vitreal concentrations of NOx and VEGF was observed, either in diabetic patients or in the control group.Conclusions NOx and VEGF are increased but not related in the vitreous fluid of diabetic patients with PDR. Our results suggest that serum diffusion could play a significant role in explaining the increase of NOx. By contrast, intraocular production seems to be the main factor responsible for the intravitreous enhancement of VEGF.Diabet. Med. 19, 655–660 (2002)