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Journal Cover Diabetes Care
  [SJR: 5.827]   [H-I: 284]   [447 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
   Published by American Diabetes Association Homepage  [4 journals]
  • Comment on Lovshin et al. Dipeptidyl Peptidase 4 Inhibition Stimulates
           Distal Tubular Natriuresis and Increases in Circulating SDF-1{alpha}1-67
           in Patients With Type 2 Diabetes. Diabetes Care 2017;40:1073-1081
    • Authors: van Baar; M. J. B.; van Raalte, D. H.; Muskiet, M. H. A.
      Keywords: Clinical Therapeutics/New Technology-Pharmacological Treatment of Complications
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1258
      Issue No: Vol. 40, No. 11 (2017)
       
  • Response to Comment on Lovshin et al. Dipeptidyl Peptidase 4 Inhibition
           Stimulates Distal Tubular Natriuresis and Increases in Circulating
           SDF-1{alpha}1-67 in Patients With Type 2 Diabetes. Diabetes Care
           2017;40:1073-1081
    • Authors: Lovshin; J. A.; Lovblom, L. E.; Cherney, D. Z. I.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dci17-0033
      Issue No: Vol. 40, No. 11 (2017)
       
  • Comment on Ely et al. A National Effort to Prevent Type 2 Diabetes:
           Participant-Level Evaluation of CDCs National Diabetes Prevention Program.
           Diabetes Care 2017;40:1331-1341
    • Authors: Ritchie; N. D.; Kaufmann, P.; Sauder, K. A.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1242
      Issue No: Vol. 40, No. 11 (2017)
       
  • Response to Comment on Ely et al. A National Effort to Prevent Type 2
           Diabetes: Participant-Level Evaluation of CDCs National Diabetes
           Prevention Program. Diabetes Care 2017;40:1331-1341
    • Authors: Ely; E. K.; Gruss, S. M.; Luman, E. T.; Albright, A. L.
      Keywords: Epidemiology-Other
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dci17-0036
      Issue No: Vol. 40, No. 11 (2017)
       
  • Comment on Lachin et al. Association of Glycemic Variability in Type 1
           Diabetes With Progression of Microvascular Outcomes in the Diabetes
           Control and Complications Trial. Diabetes Care 2017;40:777-783
    • Authors: Fleischer; J.; Cichosz, S. L.; Hansen, T. K.
      Keywords: Complications-Neuropathy
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1339
      Issue No: Vol. 40, No. 11 (2017)
       
  • Response to Comment on Lachin et al. Association of Glycemic Variability
           in Type 1 Diabetes With Progression of Microvascular Outcomes in the
           Diabetes Control and Complications Trial. Diabetes Care 2017;40:777-783
    • Authors: Lachin; J. M.; Bebu, I.; Bergenstal, R. M.; Pop-Busui, R.; Service, F. J.; Zinman, B.; Nathan, D. M.; for the DCCT/EDIC Research Group
      Keywords: Complications-Retinopathy
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dci17-0038
      Issue No: Vol. 40, No. 11 (2017)
       
  • Comment on Craig et al. Prevalence of Celiac Disease in 52,721 Youth With
           Type 1 Diabetes: International Comparison Across Three Continents.
           Diabetes Care 2017;40:1034-1040
    • Authors: Maltoni; G.; Franceschi, R.; DAnnunzio, G.; Toni, S.; Rabbone, I.; Zucchini, S.
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1348
      Issue No: Vol. 40, No. 11 (2017)
       
  • Response to Comment on Craig et al. Prevalence of Celiac Disease in 52,721
           Youth With Type 1 Diabetes: International Comparison Across Three
           Continents. Diabetes Care 2017;40:1034-1040
    • Authors: Craig; M. E.; Prinz, N.; Boyle, C. T.; Campbell, F. M.; Jones, T. W.; Hofer, S. E.; Simmons, J. H.; Holman, N.; Tham, E.; Fröhlich-Reiterer, E.; DuBose, S.; Thornton, H.; King, B.; Maahs, D. M.; Holl, R. W.; Warner, J. T.; on behalf of the Australasian Diabetes Data Network (ADDN), the T1D Exchange Clinic Network (T1DX), the National Paediatric Diabetes Audit (NPDA) the Prospective Diabetes Follow-up Registry (DPV)
      Keywords: Pediatrics-Type 1 Diabetes
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dci17-0040
      Issue No: Vol. 40, No. 11 (2017)
       
  • In This Issue of Diabetes Care
    • Pages: 1423 - 1424
      PubDate: 2017-10-23T12:00:31-07:00
      DOI: 10.2337/dc17-ti11
      Issue No: Vol. 40, No. 11 (2017)
       
  • Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control
    • Authors: Edelman; S. V.; Polonsky, W. H.
      Pages: 1425 - 1432
      Abstract: Despite U.S. Food and Drug Administration (FDA) approval of over 40 new treatment options for type 2 diabetes since 2005, the latest data from the National Health and Nutrition Examination Survey show that the proportion of patients achieving glycated hemoglobin (HbA1c)
      Keywords: Epidemiology-Other
      PubDate: 2017-10-23T12:00:31-07:00
      DOI: 10.2337/dc16-1974
      Issue No: Vol. 40, No. 11 (2017)
       
  • The Promise and Practice of Genetics on Diabetes Care: The Fog Rises to
           Reveal a Field of Genetic Complexity in HNF1B
    • Authors: Rich S. S.
      Pages: 1433 - 1435
      Keywords: Genetics-Type 1 Diabetes
      PubDate: 2017-10-23T12:00:31-07:00
      DOI: 10.2337/dci17-0014
      Issue No: Vol. 40, No. 11 (2017)
       
  • Diabetes, Associated Clinical Spectrum, Long-term Prognosis, and
           Genotype/Phenotype Correlations in 201 Adult Patients With Hepatocyte
           Nuclear Factor 1B (HNF1B) Molecular Defects
    • Authors: Dubois-Laforgue; D.; Cornu, E.; Saint-Martin, C.; Coste, J.; Bellanne-Chantelot, C.; Timsit, J.; for the Monogenic Diabetes Study Group of the Societe Francophone du Diabete
      Pages: 1436 - 1443
      Abstract: OBJECTIVEMolecular defects of hepatocyte nuclear factor 1B (HNF1B) are associated with a multiorgan disease, including diabetes (maturity-onset diabetes of the young 5) and kidney abnormalities. The HNF1B syndrome is related to HNF1B mutations or to a 17q12 deletion spanning 15 genes, including HNF1B. Here, we described HNF1B-related diabetes and associated phenotypes and assessed genotype/phenotype correlations at diagnosis and in the long-term.RESEARCH DESIGN AND METHODSThis multicenter retrospective cohort study included 201 patients, aged 18 years or older at follow-up, with HNF1B mutations (n = 101) or deletion (n = 100).RESULTSDiabetes was present in 159 patients. At diagnosis, clinical symptoms of diabetes were present in 67 of 144 patients and HNF1B renal disease in 64 of 102. Although responsiveness to sulfonylureas/repaglinide was observed in 29 of the 51 tested, 111 of 140 patients (79%) were treated with insulin at follow-up. Diabetic retinopathy and/or neuropathy were present in 46 of 114 patients. Renal cysts were present in 122 of 166 patients, chronic kidney disease stages 3–4 (CKD3–4) in 75 of 169 (44%), and end-stage renal disease (ESRD) in 36 of 169 (21%). Compared with the patients with mutations, those with HNF1B deletion less often had CKD3–4/ESRD at diagnosis (11 of 43 vs. 27 of 35, P < 10–4) and in the long term (40 of 78 vs. 71 of 91, P = 0.0003). They were leaner and more frequently treated with insulin.CONCLUSIONSIn patients with HNF1B syndrome, diabetes complications, cardiovascular risk factors, CKD3–4, and ESRD are highly prevalent. At diabetes diagnosis, the presence of morphological and/or functional kidney disease may help etiological diagnosis. Genotype/phenotype correlations may have implications for the care and the prognosis of these patients.
      PubDate: 2017-10-23T12:00:31-07:00
      DOI: 10.2337/dc16-2462
      Issue No: Vol. 40, No. 11 (2017)
       
  • Effect of a Behavioral Intervention Strategy for Adoption and Maintenance
           of a Physically Active Lifestyle: The Italian Diabetes and Exercise Study
           2 (IDES_2): A Randomized Controlled Trial
    • Authors: Balducci; S.; DErrico, V.; Haxhi, J.; Sacchetti, M.; Orlando, G.; Cardelli, P.; Vitale, M.; Bollanti, L.; Conti, F.; Zanuso, S.; Nicolucci, A.; Pugliese, G.; for the Italian Diabetes Exercise Study 2 (IDES{-}_2) Investigators
      Pages: 1444 - 1452
      Abstract: OBJECTIVEAdherence to physical activity (PA) recommendations is hampered by the lack of effective strategies to promote behavior change. The Italian Diabetes and Exercise Study 2 (IDES_2) is a randomized controlled trial evaluating a novel behavioral intervention strategy for increasing PA and decreasing sedentary time (SED-time) in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSThe study randomized 300 physically inactive and sedentary patients with type 2 diabetes 1:1 to receive theoretical and practical counseling once yearly for 3 years (intervention group [INT]) or standard care (control group [CON]). Here, we report the 4-month effects on objectively (accelerometer) measured daily light-intensity PA (LPA), moderate-to-vigorous–intensity PA (MVPA), and SED-time, and cardiovascular risk factors.RESULTSLPA and MVPA both increased, and SED-time decreased in both groups, although changes were significantly more marked in INT participants (approximately twofold for LPA and SED-time and approximately sixfold for MVPA). A significant reduction in HbA1c was observed only in INT subjects. An increase in LPA>0.92 h · day–1 and in MVPA>7.33 min · day–1 and a decrease in SED-time>1.05 h · day–1 were associated with an average decrease in HbA1c of ~1% and also with significant improvements in fasting glucose, body weight, waist circumference, and hs-CRP. Changes in PA and SED-time were independent predictors of improvements in HbA1c.CONCLUSIONSThis behavioral intervention is effective in the short term for increasing LPA and MVPA and reducing SED-time. Significant improvements in cardiometabolic risk profiles were observed in subjects experiencing the most pronounced changes in PA and SED-time, even if below the recommended level.
      Keywords: Exercise
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0594
      Issue No: Vol. 40, No. 11 (2017)
       
  • What End Users and Stakeholders Want From Automated Insulin Delivery
           Systems
    • Authors: Naranjo; D.; Suttiratana, S. C.; Iturralde, E.; Barnard, K. D.; Weissberg-Benchell, J.; Laffel, L.; Hood, K. K.
      Pages: 1453 - 1461
      Abstract: OBJECTIVEThe purpose of this study was to rigorously explore psychosocial factors associated with automated insulin delivery systems among people living with type 1 diabetes.RESEARCH DESIGN AND METHODSAcross four sites in the U.S. and U.K., 284 participants completed structured interviews or focus groups on expectations, desired features, potential benefits, and perceived burdens of automated insulin delivery systems. Recorded audio files were transcribed and analyzed using NVivo.RESULTSThree themes were identified as critical for uptake of automated insulin delivery: considerations of trust and control, system features, and concerns and barriers to adoption. Children and adolescents with type 1 diabetes primarily identified needs specific to their life stage and social contexts (e.g., school). Adults with type 1 diabetes, parents of youth with type 1 diabetes, and partners of adults with type 1 diabetes were most concerned about the accuracy, adaptability, and algorithm quality alongside expectations that systems stabilize glucose levels and reduce risk for long-term complications.CONCLUSIONSIncorporating stakeholder perspectives on use of automated insulin delivery systems will improve the adoption of devices, quality of life, and likelihood of optimal health. Efforts to build trust in systems, optimize user-system interactions, and provide clear guidance about device capabilities and limitations may help potential users achieve optimal glycemic outcomes.
      Keywords: Clinical Therapeutics/New Technology-Insulin Delivery Systems
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0400
      Issue No: Vol. 40, No. 11 (2017)
       
  • Cut Points for Identifying Clinically Significant Diabetes Distress in
           Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes
           MILES Youth-Australia
    • Authors: Hagger; V.; Hendrieckx, C.; Cameron, F.; Pouwer, F.; Skinner, T. C.; Speight, J.
      Pages: 1462 - 1468
      Abstract: OBJECTIVETo establish cut point(s) for the Problem Areas in Diabetes–teen version (PAID-T) scale to identify adolescents with clinically meaningful, elevated diabetes distress.RESEARCH DESIGN AND METHODSData were available from the Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Youth–Australia Study, a national survey assessing various psychosocial indicators among self-selected National Diabetes Services Scheme registrants. Participants in the current study (n = 537) were (mean ± SD) 16 ± 2 years old, had type 1 diabetes for 6 ± 4 years, and 62% (n = 334) were girls. They completed measures of diabetes distress (PAID-T) and depressive symptoms (Patient Health Questionnaire for Adolescents) and self-reported their most recent HbA1c and frequency of self-monitoring of blood glucose (SMBG). Relationships between the PAID-T and the psychological and clinical variables were examined to identify a clinically meaningful threshold for elevated diabetes distress. ANOVA was used to test whether these variables differed by levels of distress.RESULTSTwo cut points distinguished none-to-mild (90) diabetes distress. Moderate distress was experienced by 18% of adolescents and high distress by 36%. Mean depressive symptoms, self-reported HbA1c, and SMBG differed significantly across the three levels of diabetes distress (all P < 0.001), with moderate-to-large effect sizes.CONCLUSIONSUsing the PAID-T, this study defined two clinically meaningful cut points to distinguish none-to-mild, moderate, and high diabetes distress in adolescents (aged 13–19). Based on these cut points, most respondents experienced at least moderate diabetes distress, which was clinically significant. Establishing thresholds for elevated diabetes distress will aid clinicians and researchers to interpret PAID-T scores, prompt discussion and intervention for those with unmet needs, and enable the effectiveness of interventions to be evaluated.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0441
      Issue No: Vol. 40, No. 11 (2017)
       
  • Understanding the Gap Between Efficacy in Randomized Controlled Trials and
           Effectiveness in Real-World Use of GLP-1 RA and DPP-4 Therapies in
           Patients With Type 2 Diabetes
    • Authors: Carls; G. S.; Tuttle, E.; Tan, R.-D.; Huynh, J.; Yee, J.; Edelman, S. V.; Polonsky, W. H.
      Pages: 1469 - 1478
      Abstract: OBJECTIVEThe objective of this study was to estimate and explain the gap between clinical efficacy and real-world (RW) effectiveness of type 2 diabetes medications.RESEARCH DESIGN AND METHODSThis mixed-methods quasi-experimental study used retrospective claims (Optum/Humedica) to compare the change in HbA1c of RW patients with type 2 diabetes 12 months after starting a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase 4 (DPP-4) inhibitor with published findings from randomized controlled trials (RCTs) evaluating these drugs. Selected RW patients were similar to RCT patients, and regression analysis was used in the RW data to adjust for differences between poorly adherent and adherent patients to explain why RCT and RW findings may differ.RESULTSRW patients initiating a GLP-1 RA (n = 221) or a DPP-4 (n = 652) experienced smaller reductions in HbA1c (GLP-1 RA: –0.52% [–6 mmol/mol], DPP-4: –0.51% [–6 mmol/mol])than reported in RCTs (–1.30% [–14 mmol/mol] from seven GLP-1 RA RCTs, n = 2,600; –0.68% [–8 mmol/mol] from four DPP-4 RCTs, n = 1,889). Baseline HbA1c, additional medications, and adherence were significant explanatory factors in the RW HbA1c change. Modeled estimates of RCT efficacy (–1.04% GLP-1 RA [–12 mmol/mol], –0.69% DPP-4 [–8 mmol/mol]) were within the RCTs’ reported range (GLP-1 RA: –0.84% to –1.60% [–9 to –18 mmol/mol], DPP-4: –0.47% to –0.90% [–5 to –10 mmol/mol]). Poor medication adherence accounted for approximately three-fourths of the gap between RW and expected RCT results (gap = 0.51% [6 mmol/mol] GLP-1 RA; 0.18% [3 mmol/mol] DPP-4).CONCLUSIONSPoor medication adherence is primarily why RW effectiveness is significantly less than RCT efficacy, suggesting an urgent need to effectively address adherence among patients with type 2 diabetes.
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc16-2725
      Issue No: Vol. 40, No. 11 (2017)
       
  • Acute Kidney Injury in Patients on SGLT2 Inhibitors: A Propensity-Matched
           Analysis
    • Authors: Nadkarni; G. N.; Ferrandino, R.; Chang, A.; Surapaneni, A.; Chauhan, K.; Poojary, P.; Saha, A.; Ferket, B.; Grams, M. E.; Coca, S. G.
      Pages: 1479 - 1485
      Abstract: OBJECTIVESodium-glucose cotransporter-2 (SGLT2) inhibitors are new medications that improve cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). However, the Food and Drug Administration has issued alerts regarding increased acute kidney injury (AKI) risk with canagliflozin and dapagliflozin. We aimed to assess the real-world risk of AKI in new SGLT2 inhibitor users in two large health care utilization cohorts of patients with T2D.RESEARCH DESIGN AND METHODSWe used longitudinal data from the Mount Sinai chronic kidney disease registry and the Geisinger Health System cohort. We selected SGLT inhibitor users and nonusers (patients with T2D without SGLT2 inhibitor prescription). We determined AKI by the KDIGO (Kidney Disease: Improving Global Outcomes) definition (AKIKDIGO). We performed 1:1 nearest-neighbor propensity matching and calculated unadjusted hazard ratios (HRs) and adjusted HRs (aHRs; accounting for covariates poorly balanced) for AKI in primary and sensitivity analyses.RESULTSWe identified 377 SGLT2 inhibitor users and 377 nonusers in the Mount Sinai cohort, of whom 3.8 and 9.7%, respectively, had an AKIKDIGO event over a median follow-up time of 14 months. The unadjusted hazards of AKIKDIGO were 60% lower in users (HR 0.4 [95% CI 0.2–0.7]; P = 0.01), which was unchanged (aHR 0.4 [95% CI 0.2–0.7]; P = 0.004) postadjustment. Similarly, we identified 1,207 SGLT2 inhibitor users and 1,207 nonusers in the Geisinger cohort, of whom 2.2 and 4.6% had an AKIKDIGO event. AKIKDIGO unadjusted hazards were lower in users (HR 0.5 [95% CI 0.3–0.8]; P < 0.01) with modest attenuation postadjustment for covariates (aHR 0.6 [95% CI 0.4–1.1]; P = 0.09). These estimates did not qualitatively change across several sensitivity analyses.CONCLUSIONSOur findings do not suggest an increased risk of AKI associated with SGLT2 inhibitor use in patients with T2D in two large health systems.
      Keywords: Epidemiology-Other
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1011
      Issue No: Vol. 40, No. 11 (2017)
       
  • Incidence, Demographics, and Clinical Characteristics of Diabetes of the
           Exocrine Pancreas (Type 3c): A Retrospective Cohort Study
    • Authors: Woodmansey; C.; McGovern, A. P.; McCullough, K. A.; Whyte, M. B.; Munro, N. M.; Correa, A. C.; Gatenby, P. A. C.; Jones, S. A.; de Lusignan, S.
      Pages: 1486 - 1493
      Abstract: OBJECTIVEThis study was conducted to describe the incidence of diabetes following pancreatic disease, assess how these patients are classified by clinicians, and compare clinical characteristics with type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODSPrimary care records in England (n = 2,360,631) were searched for incident cases of adult-onset diabetes between 1 January 2005 and 31 March 2016. We examined demographics, diabetes classification, glycemic control, and insulin use in those with and without pancreatic disease (subcategorized into acute pancreatitis or chronic pancreatic disease) before diabetes diagnosis. Regression analysis was used to control for baseline potential risk factors for poor glycemic control (HbA1c ≥7% [53 mmol/mol]) and insulin requirement.RESULTSWe identified 31,789 new diagnoses of adult-onset diabetes. Diabetes following pancreatic disease (2.59 [95% CI 2.38–2.81] per 100,000 person-years) was more common than type 1 diabetes (1.64 [1.47–1.82]; P < 0.001). The 559 cases of diabetes following pancreatic disease were mostly classified by clinicians as type 2 diabetes (87.8%) and uncommonly as diabetes of the exocrine pancreas (2.7%). Diabetes following pancreatic disease was diagnosed at a median age of 59 years and BMI of 29.2 kg/m2. Diabetes following pancreatic disease was associated with poor glycemic control (adjusted odds ratio, 1.7 [1.3–2.2]; P < 0.001) compared with type 2 diabetes. Insulin use within 5 years was 4.1% (3.8–4.4) with type 2 diabetes, 20.9% (14.6–28.9) with diabetes following acute pancreatitis, and 45.8% (34.2–57.9) with diabetes following chronic pancreatic disease.CONCLUSIONSDiabetes of the exocrine pancreas is frequently labeled type 2 diabetes but has worse glycemic control and a markedly greater requirement for insulin.
      Keywords: Epidemiology-Clinical-Diagnosis and Screening
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0542
      Issue No: Vol. 40, No. 11 (2017)
       
  • Dysglycemia and Index60 as Prediagnostic End Points for Type 1 Diabetes
           Prevention Trials
    • Authors: Nathan; B. M.; Boulware, D.; Geyer, S.; Atkinson, M. A.; Colman, P.; Goland, R.; Russell, W.; Wentworth, J. M.; Wilson, D. M.; Evans-Molina, C.; Wherrett, D.; Skyler, J. S.; Moran, A.; Sosenko, J. M.; the Type 1 Diabetes TrialNet Diabetes Prevention Trial-Type 1 Study Groups
      Pages: 1494 - 1499
      Abstract: OBJECTIVEWe assessed dysglycemia and a T1D Diagnostic Index60 (Index60) ≥1.00 (on the basis of fasting C-peptide, 60-min glucose, and 60-min C-peptide levels) as prediagnostic end points for type 1 diabetes among Type 1 Diabetes TrialNet Pathway to Prevention Study participants.RESEARCH DESIGN AND METHODSTwo cohorts were analyzed: 1) baseline normoglycemic oral glucose tolerance tests (OGTTs) with an incident dysglycemic OGTT and 2) baseline Index60
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0916
      Issue No: Vol. 40, No. 11 (2017)
       
  • Antihyperglycemic Medications: A Claims-Based Estimate of First-line
           Therapy Use Prior to Initialization of Second-line Medications
    • Authors: Tseng; Y.-J.; Steinberg, G.; Fox, K. P.; Armstrong, J.; Mandl, K. D.
      Pages: 1500 - 1505
      Abstract: OBJECTIVEThe American Diabetes Association recommends metformin as first-line therapy for type 2 diabetes. However, nonadherence to antihyperglycemic medication is common, and a clinician could confuse nonadherence with pharmacologic failure, potentially leading to premature prescribing of second-line therapies. We measured metformin use prior to second-line therapy initialization.RESEARCH DESIGN AND METHODSThis retrospective cross-sectional study used unidentifiable member claims data from individuals covered from 2010 to 2015 by Aetna, a U.S. health benefits company. Beneficiaries with two physician claims or one hospitalization with a type 2 diabetes diagnosis were included. Recommended use of metformin was measured by the proportion of days covered over 60 days. Through sensitivity analysis, we varied estimates of the percentage of beneficiaries who used low-cost generic prescription medication programs.RESULTSA total of 52,544 individuals with type 2 diabetes were eligible. Of 22,956 patients given second-line treatment, only 1,875 (8.2%) had evidence of recommended use of metformin in the prior 60 days, and 6,441 (28.0%) had no prior claims evidence of having taken metformin. At the top range of sensitivity, only 49.5% patients could have had recommended use. Patients were more likely to be given an additional second-line antihyperglycemic medication or insulin if they were given their initial second-line medication without evidence of recommended use of metformin (P < 0.001).CONCLUSIONSDespite published guidelines, second-line therapy often is initiated without evidence of recommended use of first-line therapy. Apparent treatment failures, which may in fact be attributable to nonadherence to guidelines, are common. Point-of-care and population-level processes are needed to monitor and improve guideline adherence.
      Keywords: Epidemiology-Other
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0213
      Issue No: Vol. 40, No. 11 (2017)
       
  • Pharmacologic Differences of Sulfonylureas and the Risk of Adverse
           Cardiovascular and Hypoglycemic Events
    • Authors: Douros; A.; Yin, H.; Yu, O. H. Y.; Filion, K. B.; Azoulay, L.; Suissa, S.
      Pages: 1506 - 1513
      Abstract: OBJECTIVESulfonylureas have been associated with an increased risk of cardiovascular adverse events and hypoglycemia, but it is unclear if these risks vary with different agents. We assessed whether the risks of acute myocardial infarction, ischemic stroke, cardiovascular death, all-cause mortality, and severe hypoglycemia differ between sulfonylureas grouped according to pancreas specificity and duration of action.RESEARCH DESIGN AND METHODSUsing the U.K. Clinical Practice Research Datalink, linked with the Hospital Episodes Statistics and the Office for National Statistics databases, we conducted a cohort study among patients with type 2 diabetes initiating monotherapy with sulfonylureas between 1998 and 2013. Adjusted hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models, comparing use of pancreas-nonspecific, long-acting sulfonylureas (glyburide/glimepiride) to pancreas-specific, short-acting sulfonylureas (gliclazide/glipizide/tolbutamide).RESULTSThe cohort included 17,604 sulfonylurea initiators (mean [SD] follow-up 1.2 [1.5] years). Compared with specific, short-acting sulfonylureas (15,741 initiators), nonspecific, long-acting sulfonylureas (1,863 initiators) were not associated with an increased risk of acute myocardial infarction (HR 0.86; CI 0.55–1.34), ischemic stroke (HR 0.92; CI 0.59–1.45), cardiovascular death (HR 1.01; CI 0.72–1.40), or all-cause mortality (HR 0.81; CI 0.66–1.003), but with an increased risk of severe hypoglycemia (HR 2.83; CI 1.64–4.88).CONCLUSIONSThe nonspecific, long-acting sulfonylureas glyburide and glimepiride do not have an increased risk of cardiovascular adverse events compared with the specific, short-acting sulfonylureas gliclazide, glipizide, and tolbutamide. However, nonspecific, long-acting sulfonylureas glyburide and glimepiride have an increased risk of severe hypoglycemia.
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0595
      Issue No: Vol. 40, No. 11 (2017)
       
  • Diabetes, Prediabetes, and Brain Volumes and Subclinical Cerebrovascular
           Disease on MRI: The Atherosclerosis Risk in Communities Neurocognitive
           Study (ARIC-NCS)
    • Authors: Schneider; A. L. C.; Selvin, E.; Sharrett, A. R.; Griswold, M.; Coresh, J.; Jack, C. R.; Knopman, D.; Mosley, T.; Gottesman, R. F.
      Pages: 1514 - 1521
      Abstract: OBJECTIVETo examine the associations of prediabetes, diabetes, and diabetes severity (as assessed by HbA1c and diabetes duration) with brain volumes and vascular pathology on brain MRI and to assess whether the associations of diabetes with brain volumes are mediated by brain vascular pathology.RESEARCH DESIGN AND METHODSCross-sectional study of 1,713 participants in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) (mean age 75 years, 60% female, 27% black, 30% prediabetes, and 35% diabetes) who underwent 3T brain MRI scans in 2011–2013. Participants were categorized by diabetes-HbA1c status as without diabetes (
      Keywords: Epidemiology-Aging
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1185
      Issue No: Vol. 40, No. 11 (2017)
       
  • Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of
           Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues
    • Authors: ten Kulve; J. S.; Veltman, D. J.; Gerdes, V. E. A.; van Bloemendaal, L.; Barkhof, F.; Deacon, C. F.; Holst, J. J.; Drent, M. L.; Diamant, M.; IJzerman, R. G.
      Pages: 1522 - 1529
      Abstract: OBJECTIVEIt has been suggested that weight reduction and improvements in satiety after Roux-en-Y gastric bypass (RYGB) are partly mediated via postoperative neuroendocrine changes. Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted after food ingestion and is associated with appetite and weight reduction, mediated via effects on the central nervous system (CNS). Secretion of GLP-1 is greatly enhanced after RYGB. We hypothesized that postoperative elevated GLP-1 levels contribute to the improved satiety regulation after RYGB via effects on the CNS.RESEARCH DESIGN AND METHODSEffects of the GLP-1 receptor antagonist exendin 9-39 (Ex9-39) and placebo were assessed in 10 women before and after RYGB. We used functional MRI to investigate CNS activation in response to visual food cues (pictures) and gustatory food cues (consumption of chocolate milk), comparing results with Ex9-39 versus placebo before and after RYGB.RESULTSAfter RYGB, CNS activation was reduced in the rolandic operculum and caudate nucleus in response to viewing food pictures (P = 0.03) and in the insula in response to consumption of palatable food (P = 0.003). GLP-1 levels were significantly elevated postoperatively (P < 0.001). After RYGB, GLP-1 receptor blockade resulted in a larger increase in activation in the caudate nucleus in response to food pictures (P = 0.02) and in the insula in response to palatable food consumption (P = 0.002).CONCLUSIONSWe conclude that the effects of RYGB on CNS activation in response to visual and gustatory food cues may be mediated by central effects of GLP-1. Our findings provide further insights into the mechanisms underlying the weight-lowering effects of RYGB.
      Keywords: Integrated Physiology-Central Nervous System Regulation of Metabolism
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc16-2113
      Issue No: Vol. 40, No. 11 (2017)
       
  • Pioglitazone Improves Left Ventricular Diastolic Function in Subjects With
           Diabetes
    • Authors: Clarke; G. D.; Solis-Herrera, C.; Molina-Wilkins, M.; Martinez, S.; Merovci, A.; Cersosimo, E.; Chilton, R. J.; Iozzo, P.; Gastaldelli, A.; Abdul-Ghani, M.; DeFronzo, R. A.
      Pages: 1530 - 1536
      Abstract: OBJECTIVETo examine the effect of pioglitazone on myocardial insulin sensitivity and left ventricular (LV) function in patients with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSTwelve subjects with T2D and 12 with normal glucose tolerance received a euglycemic insulin clamp. Myocardial glucose uptake (MGU) and myocardial perfusion were measured with [18F]fluoro-2-deoxy-d-glucose and [15O]H2O positron emission tomography before and after 24 weeks of pioglitazone treatment. Myocardial function and transmitral early diastolic relation/atrial contraction (E/A) flow ratio were measured with magnetic resonance imaging.RESULTSPioglitazone reduced HbA1c by 0.9%; decreased systolic and diastolic blood pressure by 7 ± 2 and 7 ± 2 mmHg, respectively (P < 0.05); and increased whole-body insulin-stimulated glucose uptake by 71% (3.4 ± 1.3 to 5.8 ± 2.1 mg/kg · min; P < 0.01) in subjects with T2D. Pioglitazone enhanced MGU by 75% (0.24 ± 0.14 to 0.42 ± 0.13 μmol/min · g; P < 0.01) and myocardial perfusion by 16% (0.95 ± 0.16 to 1.10 ± 0.25 mL/min · g; P < 0.05). Measures of diastolic function, E/A ratio (1.04 ± 0.3 to 1.25 ± 0.4) and peak LV filling rate (349 ± 107 to 433 ± 99 mL/min), both increased (P < 0.01). End-systolic volume, end-diastolic volume, peak LV ejection rate, and cardiac output trended to increase (P not significant), whereas the ejection fraction (61 ± 6 to 66 ± 7%) and stroke volume increased significantly (71 ± 20 to 80 ± 20 L/min; both P < 0.05).CONCLUSIONSPioglitazone improves whole-body and myocardial insulin sensitivity, LV diastolic function, and systolic function in T2D. Improved myocardial insulin sensitivity and diastolic function are strongly correlated.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0078
      Issue No: Vol. 40, No. 11 (2017)
       
  • The Role of Hyperglycemia, Insulin Resistance, and Blood Pressure in
           Diabetes-Associated Differences in Cognitive Performance--The Maastricht
           Study
    • Authors: Geijselaers; S. L. C.; Sep, S. J. S.; Claessens, D.; Schram, M. T.; van Boxtel, M. P. J.; Henry, R. M. A.; Verhey, F. R. J.; Kroon, A. A.; Dagnelie, P. C.; Schalkwijk, C. G.; van der Kallen, C. J. H.; Biessels, G. J.; Stehouwer, C. D. A.
      Pages: 1537 - 1547
      Abstract: OBJECTIVETo study to what extent differences in cognitive performance between individuals with different glucose metabolism status are potentially attributable to hyperglycemia, insulin resistance, and blood pressure–related variables.RESEARCH DESIGN AND METHODSWe used cross-sectional data from 2,531 participants from the Maastricht Study (mean age ± SD, 60 ± 8 years; 52% men; n = 666 with type 2 diabetes), all of whom completed a neuropsychological test battery. Hyperglycemia was assessed by a composite index of fasting glucose, postload glucose, glycated hemoglobin (HbA1c), and tissue advanced glycation end products; insulin resistance by the HOMA of insulin resistance index; and blood pressure–related variables included 24-h ambulatory pressures, their weighted SDs, and the use of antihypertensive medication. Linear regression analyses were used to estimate mediating effects.RESULTSAfter adjustment for age, sex, and education, individuals with type 2 diabetes, compared with those with normal glucose metabolism, performed worse in all cognitive domains (mean differences in composite z scores for memory –0.087, processing speed –0.196, executive function and attention –0.182; P values
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0330
      Issue No: Vol. 40, No. 11 (2017)
       
  • Identification of Novel Circulating Biomarkers Predicting Rapid Decline in
           Renal Function in Type 2 Diabetes: The Fremantle Diabetes Study Phase II
    • Authors: Peters; K. E.; Davis, W. A.; Ito, J.; Winfield, K.; Stoll, T.; Bringans, S. D.; Lipscombe, R. J.; Davis, T. M. E.
      Pages: 1548 - 1555
      Abstract: OBJECTIVETo assess the ability of plasma apolipoprotein (apo) A-IV (apoA4), apo C-III, CD5 antigen-like (CD5L), complement C1q subcomponent subunit B (C1QB), complement factor H–related protein 2, and insulin-like growth factor binding protein 3 (IBP3) to predict rapid decline in estimated glomerular filtration rate (eGFR) in type 2 diabetes.RESEARCH DESIGN AND METHODSMass spectrometry was used to measure baseline biomarkers in 345 community-based patients (mean age 67.0 years, 51.9% males) from the Fremantle Diabetes Study Phase II (FDS2). Multiple logistic regression was used to determine clinical predictors of rapid eGFR decline trajectory defined by semiparametric group-based modeling over a 4-year follow-up period. The incremental benefit of each biomarker was then assessed. Similar analyses were performed for a ≥30% eGFR fall, incident chronic kidney disease (eGFR
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0911
      Issue No: Vol. 40, No. 11 (2017)
       
  • Effects of Liraglutide on Weight Loss, Fat Distribution, and {beta}-Cell
           Function in Obese Subjects With Prediabetes or Early Type 2 Diabetes
    • Authors: Santilli; F.; Simeone, P. G.; Guagnano, M. T.; Leo, M.; Maccarone, M. T.; Di Castelnuovo, A.; Sborgia, C.; Bonadonna, R. C.; Angelucci, E.; Federico, V.; Cianfarani, S.; Manzoli, L.; Davi, G.; Tartaro, A.; Consoli, A.
      Pages: 1556 - 1564
      Abstract: OBJECTIVEObesity is associated with an increased risk of type 2 diabetes and cardiovascular complications. The risk depends significantly on adipose tissue distribution. Liraglutide, a glucagon-like peptide 1 analog, is associated with weight loss, improved glycemic control, and reduced cardiovascular risk. We determined whether an equal degree of weight loss by liraglutide or lifestyle changes has a different impact on subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in obese subjects with prediabetes or early type 2 diabetes.RESEARCH DESIGN AND METHODSSixty-two metformin-treated obese subjects with prediabetes or newly diagnosed type 2 diabetes, were randomized to liraglutide (1.8 mg/day) or lifestyle counseling. Changes in SAT and VAT levels (determined by abdominal MRI), insulin sensitivity (according to the Matsuda index), and β-cell function (β-index) were assessed during a multiple-sampling oral glucose tolerance test; and circulating levels of IGF-I and IGF-II were assessed before and after a comparable weight loss (7% of initial body weight).RESULTSAfter comparable weight loss, achieved by 20 patients per arm, and superimposable glycemic control, as reflected by HbA1c level (P = 0.60), reduction in VAT was significantly higher in the liraglutide arm than in the lifestyle arm (P = 0.028), in parallel with a greater improvement in β-index (P = 0.021). No differences were observed in SAT reduction (P = 0.64). IGF-II serum levels were significantly increased (P = 0.024) only with liraglutide administration, and the increase in IGF-II levels correlated with both a decrease in VAT ( = –0.435, P = 0.056) and an increase in the β-index ( = 0.55, P = 0.012).CONCLUSIONSLiraglutide effects on visceral obesity and β-cell function might provide a rationale for using this molecule in obese subjects in an early phase of glucose metabolism dysregulation natural history.
      Keywords: Clinical Therapeutics/New Technology-Non-Insulin Injectables
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0589
      Issue No: Vol. 40, No. 11 (2017)
       
  • Longitudinal Change in Fasting Blood Glucose and Myocardial Infarction
           Risk in a Population Without Diabetes
    • Authors: Jin; C.; Chen, S.; Vaidya, A.; Wu, Y.; Wu, Z.; Hu, F. B.; Kris-Etherton, P.; Wu, S.; Gao, X.
      Pages: 1565 - 1572
      Abstract: OBJECTIVETo examine the change in fasting blood glucose (FBG) during repeated assessments over time and its potential impact on the risk of developing myocardial infarction (MI).RESEARCH DESIGN AND METHODSThis prospective cohort study included 68,297 participants without diabetes (mean age 49 years) who were free of MI, stroke, and cancer prior to or in 2010 (baseline of the current analysis). FBG concentrations were measured in 2006, 2008, and 2010. The FBG trajectories during 2006–2010, the primary exposure of the current study, were identified by latent mixture modeling. Incident MI cases were confirmed via review of medical records by cardiologists.RESULTSWe identified five discrete FBG trajectories according to FBG range and changing pattern over time: elevated-stable (n = 3,877), elevated-decreasing (n = 7,060), moderate-increasing (n = 10,298), moderate-stable (n = 40,352), and low-stable (n = 6,710). During 4 years of follow-up, we documented 283 incident MI cases. Relative to the moderate-stable pattern (FBG ranged from 4.9 to 5.1 mmol/L), adjusted hazard ratios (HRs) were 1.53 (95% CI 1.04, 2.26) for the elevated-stable pattern (FBG ranged from 6.1 to 6.3 mmol/L) and HR 0.61 (95% CI 0.38, 0.98) for the elevated-decreasing pattern (FBG decreased from 6.0 to 5.4 mmol/L), after adjustment for potential confounders such as age, sex, lifestyle factors, obesity, medical history, blood pressure, blood lipids, and C-reactive protein. Consistently, cumulative average and increasing rate of FBG during 2006–2010, but not a single baseline FBG, predicted future risk of MI.CONCLUSIONSWe found that discrete FBG trajectories were significantly associated with subsequent risk of MI in individuals without diabetes. These observations suggest that long-term trajectories of FBG may be important for risk prediction of MI and possibly other macrovascular diseases.
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0610
      Issue No: Vol. 40, No. 11 (2017)
       
  • Influences of Breakfast on Clock Gene Expression and Postprandial Glycemia
           in Healthy Individuals and Individuals With Diabetes: A Randomized
           Clinical Trial
    • Authors: Jakubowicz; D.; Wainstein, J.; Landau, Z.; Raz, I.; Ahren, B.; Chapnik, N.; Ganz, T.; Menaged, M.; Barnea, M.; Bar-Dayan, Y.; Froy, O.
      Pages: 1573 - 1579
      Abstract: OBJECTIVEThe circadian clock regulates glucose metabolism by mediating the activity of metabolic enzymes, hormones, and transport systems. Breakfast skipping and night eating have been associated with high HbA1c and postprandial hyperglycemia after lunch and dinner. Our aim was to explore the acute effect of breakfast consumption or omission on glucose homeostasis and clock gene expression in healthy individuals and individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSIn a crossover design, 18 healthy volunteers and 18 volunteers with 14.5 ± 1.5 years diabetes, BMI 30.7 ± 1.1 kg/m2, and HbA1c 7.6 ± 0.1% (59.6 ± 0.8 mmol/mol) were randomly assigned to a test day with breakfast and lunch (YesB) and a test day with only lunch (NoB). Postprandial clock and clock-controlled gene expression, plasma glucose, insulin, intact glucagon-like peptide 1 (iGLP-1), and dipeptidyl peptidase IV (DPP-IV) plasma activity were assessed after breakfast and lunch.RESULTSIn healthy individuals, the expression level of Per1, Cry1, Rorα, and Sirt1 was lower (P < 0.05) but Clock was higher (P < 0.05) after breakfast. In contrast, in individuals with type 2 diabetes, Per1, Per2, and Sirt1 only slightly, but significantly, decreased and Rorα increased (P < 0.05) after breakfast. In healthy individuals, the expression level of Bmal1, Rorα, and Sirt1 was higher (P < 0.05) after lunch on YesB day, whereas the other clock genes remained unchanged. In individuals with type 2 diabetes, Bmal1, Per1, Per2, Rev-erbα, and Ampk increased (P < 0.05) after lunch on the YesB day. Omission of breakfast altered clock and metabolic gene expression in both healthy and individuals with type 2 diabetes.CONCLUSIONSBreakfast consumption acutely affects clock and clock-controlled gene expression leading to normal oscillation. Breakfast skipping adversely affects clock and clock-controlled gene expression and is correlated with increased postprandial glycemic response in both healthy individuals and individuals with diabetes.
      Keywords: Nutrition-Clinical
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc16-2753
      Issue No: Vol. 40, No. 11 (2017)
       
  • Does Cardiorespiratory Fitness Attenuate the Adverse Effects of
           Severe/Morbid Obesity on Cardiometabolic Risk and Insulin Resistance in
           Children' A Pooled Analysis
    • Authors: Nyström; C. D.; Henriksson, P.; Martinez-Vizcaino, V.; Medrano, M.; Cadenas-Sanchez, C.; Arias-Palencia, N. M.; Löf, M.; Ruiz, J. R.; Labayen, I.; Sanchez-Lopez, M.; Ortega, F. B.
      Pages: 1580 - 1587
      Abstract: OBJECTIVETo investigate 1) differences in cardiometabolic risk and HOMA of insulin resistance (HOMA-IR) across BMI categories (underweight to morbid obesity), 2) whether fit children have lower cardiometabolic risk/HOMA-IR than unfit children in each BMI category, and 3) differences in cardiometabolic risk/HOMA-IR in normal-weight unfit children and obese fit children.RESEARCH DESIGN AND METHODSA pooled study including cross-sectional data from three projects (n = 1,247 children aged 8–11 years). Cardiometabolic risk was assessed using the sum of the sex- and age-specific z scores for triglycerides, HDL cholesterol, glucose, and the average of systolic and diastolic blood pressure and HOMA-IR.RESULTSA significant linear association was observed between the risk score and BMI categories (P trend ≤0.001), with every incremental rise in BMI category being associated with a 0.5 SD higher risk score (standardized β = 0.474, P < 0.001). A trend was found showing that as BMI categories rose, cardiorespiratory fitness (CRF) attenuated the risk score, with the biggest differences observed in the most obese children (–0.8 SD); however, this attenuation was significant only in mild obesity (–0.2 SD, P = 0.048). Normal-weight unfit children had a significantly lower risk score than obese fit children (P < 0.001); however, a significant reduction in the risk score was found in obese fit compared with unfit children (–0.4 SD, P = 0.027). Similar results were obtained for HOMA-IR.CONCLUSIONSAs BMI categories rose so did cardiometabolic risk and HOMA-IR, which highlights the need for obesity prevention/treatment programs in childhood. Furthermore, CRF may play an important role in lowering the risk of cardiometabolic diseases in obese children.
      Keywords: Pediatrics-Obesity and Type 2 Diabetes
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-1334
      Issue No: Vol. 40, No. 11 (2017)
       
  • Association Between Adherence to Pharmacotherapy and Outcomes in Type 2
           Diabetes: A Meta-analysis
    • Authors: Khunti; K.; Seidu, S.; Kunutsor, S.; Davies, M.
      Pages: 1588 - 1596
      Abstract: OBJECTIVEA previous study suggests an association between poor medication adherence and excess mortality in chronic disease. The purpose of this study was to assess the association between medication adherence and risk of cardiovascular disease (CVD), all-cause mortality, and hospitalization in type 2 diabetes.RESEARCH DESIGN AND METHODSWe conducted an electronic search on many electronic databases from inception to 27 April 2016. We selected randomized controlled trials and case-control and cohort studies reporting on CVD, all-cause mortality, or hospitalization outcomes by adherence in adults with type 2 diabetes. Two reviewers independently screened for eligible studies and extracted outcome data. Pooled relative risks (RRs) were calculated using a random-effects meta-analysis; risk of bias in each of the included studies was assessed using the GRADE approach.RESULTSEight observational studies were included (n = 318,125). The mean rate of poor adherence was 37.8% (95% CI 37.6–38.0). Adjusted estimates were provided by five studies only. The RRs of good (≥80%) versus poor adherence to medication were 0.72 (95% CI 0.62–0.82, I2 = 0%, three studies) for all-cause mortality and 0.90 (0.87–0.94, I2 = 63%, seven studies) for hospitalization. No evidence of small study bias was observed. Only one study reported CVD outcomes by adherence.CONCLUSIONSWe identified no trials reporting on outcomes by adherence, suggesting a systematic failure to include this information. Pooled estimates from available observational studies suggest that good medication adherence is associated with reduced risk of all-cause mortality and hospitalization in people with type 2 diabetes, although bias cannot be excluded as an explanation for these findings.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc16-1925
      Issue No: Vol. 40, No. 11 (2017)
       
  • Prognostic Impact of Diabetes on Long-term Survival Outcomes in Patients
           With Heart Failure: A Meta-analysis
    • Authors: Dauriz; M.; Mantovani, A.; Bonapace, S.; Verlato, G.; Zoppini, G.; Bonora, E.; Targher, G.
      Pages: 1597 - 1605
      Abstract: OBJECTIVESeveral studies have explored the impact of diabetes on mortality in patients with heart failure (HF). However, the extent to which diabetes may confer risk of mortality and hospitalization in this patient population remains imperfectly known. Here we examine the independent prognostic impact of diabetes on the long-term risk of mortality and hospitalization in patients with HF.RESEARCH DESIGN AND METHODSPubMed, Scopus, and Web of Science from January 1990 to October 2016 were the data sources used. We included large (n ≥1,000) observational registries and randomized controlled trials with a follow-up duration of at least 1 year. Eligible studies were selected according to predefined keywords and clinical outcomes. Data from selected studies were extracted, and meta-analysis was performed using random-effects modeling.RESULTSA total of 31 registries and 12 clinical trials with 381,725 patients with acute and chronic HF and 102,036 all-cause deaths over a median follow-up of 3 years were included in the final analysis. Diabetes was associated with a higher risk of all-cause death (random-effects hazard ratio [HR] 1.28 [95% CI 1.21, 1.35]), cardiovascular death (1.34 [1.20, 1.49]), hospitalization (1.35 [1.20, 1.50]), and the combined end point of all-cause death or hospitalization (1.41 [1.29, 1.53]). The impact of diabetes on mortality and hospitalization was greater in patients with chronic HF than in those with acute HF. Limitations included high heterogeneity and varying degrees of confounder adjustment across individual studies.CONCLUSIONSThis updated meta-analysis shows that the presence of diabetes per se adversely affects long-term survival and risk of hospitalization in patients with acute and chronic HF.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-0697
      Issue No: Vol. 40, No. 11 (2017)
       
  • Erratum. Cardiovascular Disease and Type 2 Diabetes: Has the Dawn of a New
           Era Arrived' Diabetes Care 2017;40:813-820
    • Authors: Abdul-Ghani; M.; DeFronzo, R. A.; Del Prato, S.; Chilton, R.; Singh, R.; Ryder, R. E. J.
      Pages: 1606 - 1606
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-er11
      Issue No: Vol. 40, No. 11 (2017)
       
  • Erratum. Application of Zone Model Predictive Control Artificial Pancreas
           During Extended Use of Infusion Set and Sensor: A Randomized
           Crossover-Controlled Home-Use Trial. Diabetes Care 2017;40:1096-1102
    • Authors: Forlenza; G. P.; Deshpande, S.; Ly, T. T.; Howsmon, D. P.; Cameron, F.; Baysal, N.; Mauritzen, E.; Marcal, T.; Towers, L.; Bequette, B. W.; Huyett, L. M.; Pinsker, J. E.; Gondhalekar, R.; Doyle, F. J.; Maahs, D. M.; Buckingham, B. A.; Dassau, E.
      Pages: 1606 - 1606
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-er11a
      Issue No: Vol. 40, No. 11 (2017)
       
  • Issues and Events
    • Pages: 1607 - 1607
      PubDate: 2017-10-23T12:00:32-07:00
      DOI: 10.2337/dc17-ie11
      Issue No: Vol. 40, No. 11 (2017)
       
 
 
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