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Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 520  
  Full-text available via subscription Subscription journal
ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • Post-ACA Racial Disparity of Eye Examinations Among the U.S.
           Noninstitutionalized Population With Diabetes: 2014-2015
    • Authors: Monnette; A. M.; Wharton, M. K.; Zhao, Y.; Fonseca, V. A.; Shi, L.
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-1991
      Issue No: Vol. 42, No. 5 (2019)
  • Sex Differences in Treatment With ACE Inhibitors and Angiotensin Receptor
           Blockers in Patients With Type 1 Diabetes
    • Authors: Möllsten; A.; Toppe, C.; Eeg-Olofsson, K.; Lind, T.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-2542
      Issue No: Vol. 42, No. 5 (2019)
  • Underuse of Medications and Lifestyle Counseling to Prevent Cardiovascular
           Disease in Patients With Diabetes
    • Authors: Newman; J. D.; Berger, J. S.; Ladapo, J. A.
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-1554
      Issue No: Vol. 42, No. 5 (2019)
  • Comment on Wright et al. Increased Reporting of Immune Checkpoint
           Inhibitor-Associated Diabetes. Diabetes Care 2018;41:e150-e151
    • Authors: Jorgensen; L. B.; Yderstraede, K.
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-2595
      Issue No: Vol. 42, No. 5 (2019)
  • Comment on Johnson et al. Cost-effectiveness Analysis of Routine Screening
           Using Massively Parallel Sequencing for Maturity-Onset Diabetes of the
           Young in a Pediatric Diabetes Cohort: Reduced Health System Costs and
           Improved Patient Quality of Life. Diabetes Care 2019;42:69-76
    • Authors: Estrella; J. F. G. L.; Simmons, D.
      Keywords: Health Care Delivery-Economics
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc19-0043
      Issue No: Vol. 42, No. 5 (2019)
  • Response to Comment on Johnson et al. Cost-effectiveness Analysis of
           Routine Screening Using Massively Parallel Sequencing for Maturity-Onset
           Diabetes of the Young in a Pediatric Diabetes Cohort: Reduced Health
           System Costs and Improved Patient Quality of Life. Diabetes Care
    • Authors: Johnson; S. R.; Carter, H. E.; Leo, P.; Hollingworth, S. A.; Davis, E. A.; Jones, T. W.; Conwell, L. S.; Harris, M.; Brown, M. A.; Graves, N.; Duncan, E. L.
      Keywords: Health Care Delivery-Economics
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dci19-0010
      Issue No: Vol. 42, No. 5 (2019)
  • Comment on Mulukutla et al. Autoantibodies to the IA-2 Extracellular
           Domain Refine the Definition of "A+" Subtypes of Ketosis-Prone Diabetes.
           Diabetes Care 2018;41:2637-2640
    • Authors: Heneberg P.
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc19-0022
      Issue No: Vol. 42, No. 5 (2019)
  • Response to Comment on Mulukutla et al. Autoantibodies to the IA-2
           Extracellular Domain Refine the Definition of "A+" Subtypes of
           Ketosis-Prone Diabetes. Diabetes Care 2018;41:2637-2640
    • Authors: Mulukutla; S. N.; Acevedo-Calado, M.; Hampe, C. S.; Pietropaolo, M.; Balasubramanyam, A.
      Keywords: Immunology
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dci19-0007
      Issue No: Vol. 42, No. 5 (2019)
  • Comment on Sims et al. Proinsulin Secretion Is a Persistent Feature of
           Type 1 Diabetes. Diabetes Care 2019;42:258-264
    • Authors: Steenkamp; D. W.; Cacicedo, J. M.; Sullivan, C. A.
      Keywords: Islet Biology-Beta Cell-Stimulus-Secretion Coupling and Metabolism
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc19-0158
      Issue No: Vol. 42, No. 5 (2019)
  • Response to Comment on Sims et al. Proinsulin Secretion Is a Persistent
           Feature of Type 1 Diabetes. Diabetes Care 2019;42:258-264
    • Authors: Sims; E. K.; Bahnson, H. T.; Nyalwidhe, J.; Haataja, L.; Davis, A. K.; Speake, C.; DiMeglio, L. A.; Blum, J.; Morris, M. A.; Mirmira, R. G.; Nadler, J.; Mastracci, T. L.; Marcovina, S.; Qian, W.-J.; Yi, L.; Swensen, A. C.; Yip-Schneider, M.; Schmidt, C. M.; Considine, R. V.; Arvan, P.; Greenbaum, C. J.; Evans-Molina, C.
      Keywords: Islet Biology-Beta Cell-Stimulus-Secretion Coupling and Metabolism
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dci19-0012
      Issue No: Vol. 42, No. 5 (2019)
  • In This Issue of Diabetes Care
    • Pages: 703 - 704
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc19-ti05
      Issue No: Vol. 42, No. 5 (2019)
  • Promises and Perils of Group Clinics for Young People Living With
           Diabetes: A Realist Review
    • Authors: Papoutsi; C.; Colligan, G.; Hagell, A.; Hargreaves, D.; Marshall, M.; Vijayaraghavan, S.; Greenhalgh, T.; Finer, S.
      Pages: 705 - 712
      Abstract: Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following Realist And Meta-narrative Evidence Synthesis–Evolving Standards (RAMESES) quality standards, we conducted a systematic search across 10 databases. A total of 131 articles met inclusion criteria and were analyzed to develop theoretically informed explanations of how and why group clinics could work (or not) for young people with diabetes. Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four overarching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics: 1) emphasizing self-management as practical knowledge; 2) developing a sense of affinity between patients; 3) providing safe, developmentally appropriate care; and 4) balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care. Group clinics for young people with diabetes offer the potential to complement individualized care but are not a panacea and may generate as well as solve problems.
      Keywords: Health Care Delivery-Economics
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2005
      Issue No: Vol. 42, No. 5 (2019)
  • The Diabetes Story: A Call to Action: 2018 Presidential Address
    • Authors: Reusch; J. E. B.
      Pages: 713 - 717
      Keywords: Health Care Delivery-Economics
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dci18-0050
      Issue No: Vol. 42, No. 5 (2019)
  • Metabolic Culprits in Obese Pregnancies and Gestational Diabetes Mellitus:
           Big Babies, Big Twists, Big Picture: The 2018 Norbert Freinkel Award
    • Authors: Barbour L. A.
      Pages: 718 - 726
      Abstract: Pregnancy has been equated to a "stress test" in which placental hormones and growth factors expose a mother’s predisposition toward metabolic disease, unleashing her previously occult insulin resistance (IR), mild β-cell dysfunction, and glucose and lipid surplus due to the formidable forces of pregnancy-induced IR. Although pregnancy-induced IR is intended to assure adequate nutrition to the fetus and placenta, in mothers with obesity, metabolic syndrome, or those who develop gestational diabetes mellitus, this overnutrition to the fetus carries a lifetime risk for increased metabolic disease. Norbert Freinkel, nearly 40 years ago, coined this excess intrauterine nutrient exposure and subsequent offspring developmental risk "fuel-mediated teratogenesis," not limited to only excess maternal glucose. Our attempts to better elucidate the causes and mechanisms behind this double-edged IR of pregnancy, to metabolically characterize the intrauterine environment that results in changes in newborn body composition and later childhood obesity risk, and to examine potential therapeutic approaches that might target maternal metabolism are the focus of this article. Rapidly advancing technologies in genomics, proteomics, and metabolomics offer us innovative approaches to interrogate these metabolic processes in the mother, her microbiome, the placenta, and her offspring that contribute to a phenotype at risk for future metabolic disease. If we are successful in our efforts, the researcher, endocrinologist, obstetrician, and health care provider fortunate enough to care for pregnant women have the unique opportunity to positively impact health outcomes not only in the short term but in the long run, not just in one life but in two—and possibly, for the next generation.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dci18-0048
      Issue No: Vol. 42, No. 5 (2019)
  • Nutritional Strategies for Prevention and Management of Diabetes:
           Consensus and Uncertainties
    • Authors: Wylie-Rosett; J.; Hu, F. B.
      Pages: 727 - 730
      Keywords: Nutrition-Clinical
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dci19-0009
      Issue No: Vol. 42, No. 5 (2019)
  • Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus
    • Authors: Evert; A. B.; Dennison, M.; Gardner, C. D.; Garvey, W. T.; Lau, K. H. K.; MacLeod, J.; Mitri, J.; Pereira, R. F.; Rawlings, K.; Robinson, S.; Saslow, L.; Uelmen, S.; Urbanski, P. B.; Yancy, W. S.
      Pages: 731 - 754
      Keywords: Diabetes Education
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dci19-0014
      Issue No: Vol. 42, No. 5 (2019)
  • Should Viscous Fiber Supplements Be Considered in Diabetes Control'
           Results From a Systematic Review and Meta-analysis of Randomized
           Controlled Trials
    • Authors: Jovanovski; E.; Khayyat, R.; Zurbau, A.; Komishon, A.; Mazhar, N.; Sievenpiper, J. L.; Blanco Mejia, S.; Ho, H. V. T.; Li, D.; Jenkins, A. L.; Duvnjak, L.; Vuksan, V.
      Pages: 755 - 766
      Abstract: OBJECTIVEEvidence from randomized controlled trials (RCTs) suggests that viscous dietary fiber may offer beneficial effects on glycemic control and, thus, an improved cardiovascular disease risk profile. Our purpose was to conduct a systematic review and meta-analysis of RCTs to synthesize the therapeutic effect of viscous fiber supplementation on glycemic control in type 2 diabetes.RESEARCH DESIGN AND METHODSMEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through 15 June 2018. We included RCTs ≥3 weeks in duration that assessed the effects of viscous fiber on markers of glycemic control in type 2 diabetes. Two independent reviewers extracted data. Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the overall certainty of the evidence.RESULTSWe identified 28 eligible trial comparisons (n = 1,394). Viscous fiber at a median dose of ~13.1 g/day significantly reduced HbA1c (MD –0.58% [95% CI –0.88, –0.28]; P = 0.0002), fasting blood glucose (MD –0.82 mmol/L [95% CI –1.32, –0.31]; P = 0.001), and HOMA-insulin resistance (IR) (MD –1.89 [95% CI –3.45, –0.33]; P = 0.02) compared with control and in addition to standard of care. The certainty of evidence was graded moderate for HbA1c, fasting glucose, fasting insulin, and HOMA-IR and low for fructosamine.CONCLUSIONSViscous fiber supplements improve conventional markers of glycemic control beyond usual care and should be considered in the management of type 2 diabetes.
      Keywords: Nutrition-Clinical
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1126
      Issue No: Vol. 42, No. 5 (2019)
  • The Effect of Liquid Meal Replacements on Cardiometabolic Risk Factors in
           Overweight/Obese Individuals With Type 2 Diabetes: A Systematic Review and
           Meta-analysis of Randomized Controlled Trials
    • Authors: Noronha; J. C.; Nishi, S. K.; Braunstein, C. R.; Khan, T. A.; Blanco Mejia, S.; Kendall, C. W. C.; Kahleova, H.; Rahelic, D.; Salas-Salvado, J.; Leiter, L. A.; Sievenpiper, J. L.
      Pages: 767 - 776
      Abstract: OBJECTIVEThe evidence for liquid meal replacements in diabetes has not been summarized. Our objective was to synthesize the evidence of the effect of liquid meal replacements on cardiometabolic risk factors in overweight/obese individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSData sources included MEDLINE, EMBASE, and the Cochrane Library through 10 December 2018. We included randomized trials of ≥2 weeks assessing the effect of liquid meal replacements in weight loss diets compared with traditional weight loss diets on cardiometabolic risk factors in overweight/obese subjects with type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. Data were pooled using the inverse variance method. The overall certainty of the evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).RESULTSNine trial comparisons (N = 961 [median follow-up 24 weeks]) met eligibility criteria. Mean differences were for body weight –2.37 kg (95% CI –3.30 to –1.44), BMI –0.87 kg/m2 (–1.31 to –0.42), body fat –1.66% (–2.17 to –1.15), waist circumference –2.24 cm (–3.72 to –0.77), HbA1c –0.43% (–0.66 to –0.19) (–4.7 mmol/mol [–7.2 to –2.1]), fasting glucose –0.63 mmol/L (–0.99 to –0.27), fasting insulin –11.83 pmol/L (–23.11 to –0.54), systolic blood pressure –4.97mmHg (–7.32 to –2.62), and diastolic blood pressure –1.98 mmHg (–3.05 to –0.91). There was no effect on blood lipids. The overall certainty of the evidence was low to moderate owing to imprecision and/or inconsistency.CONCLUSIONSLiquid meal replacements in weight loss diets lead to modest reductions in body weight, BMI, and systolic blood pressure, and reductions of marginal clinical significance in body fat, waist circumference, HbA1c, fasting glucose, fasting insulin, and diastolic blood pressure. More high-quality trials are needed to improve the certainty in our estimates.
      Keywords: Nutrition-Clinical
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2270
      Issue No: Vol. 42, No. 5 (2019)
  • Effect of a Lifestyle Intervention Program With Energy-Restricted
           Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk
           Factors: One-Year Results of the PREDIMED-Plus Trial
    • Authors: Salas-Salvado; J.; Diaz-Lopez, A.; Ruiz-Canela, M.; Basora, J.; Fito, M.; Corella, D.; Serra-Majem, L.; Wärnberg, J.; Romaguera, D.; Estruch, R.; Vidal, J.; Martinez, J. A.; Aros, F.; Vazquez, C.; Ros, E.; Vioque, J.; Lopez-Miranda, J.; Bueno-Cavanillas, A.; Tur, J. A.; Tinahones, F. J.; Martin, V.; Lapetra, J.; Pinto, X.; Daimiel, L.; Delgado-Rodriguez, M.; Matia, P.; Gomez-Gracia, E.; Diez-Espino, J.; Babio, N.; Castaner, O.; Sorli, J. V.; Fiol, M.; Zulet, M. A.; Bullo, M.; Goday, A.; Martinez-Gonzalez, M. A.; for the PREDIMED-Plus investigators
      Pages: 777 - 788
      Abstract: OBJECTIVEThe long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention.RESEARCH DESIGN AND METHODSOverweight/obese adults with metabolic syndrome aged 55–75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively.RESULTSDiet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P < 0.001), a mean difference of –2.5 kg (95% CI –3.1 to –1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P < 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P < 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts.CONCLUSIONSPREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.
      Keywords: Nutrition-Clinical
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-0836
      Issue No: Vol. 42, No. 5 (2019)
  • Gluten Intake and Risk of Islet Autoimmunity and Progression to Type 1
           Diabetes in Children at Increased Risk of the Disease: The Diabetes
           Autoimmunity Study in the Young (DAISY)
    • Authors: Lund-Blix; N. A.; Dong, F.; Marild, K.; Seifert, J.; Baron, A. E.; Waugh, K. C.; Joner, G.; Stordal, K.; Tapia, G.; Stene, L. C.; Johnson, R. K.; Rewers, M. J.; Norris, J. M.
      Pages: 789 - 796
      Abstract: OBJECTIVETo study the association of gluten intake with development of islet autoimmunity and progression to type 1 diabetes.RESEARCH DESIGN AND METHODSThe Diabetes Autoimmunity Study in the Young (DAISY) follows children with an increased risk of type 1 diabetes. Blood samples were collected at 9, 15, and 24 months of age, and annually thereafter. Islet autoimmunity was defined by the appearance of at least one autoantibody against insulin, IA2, GAD, or ZnT8 (zinc transporter 8) in at least two consecutive blood samples. Using food frequency questionnaires, we estimated the gluten intake (in grams per day) annually from 1 year of age. Cox regression modeling early gluten intake, and joint modeling of the cumulative gluten intake during follow-up, were used to estimate hazard ratios adjusted for confounders (aHR).RESULTSBy August 2017, 1,916 subjects were included (median age at end of follow-up 13.5 years), islet autoimmunity had developed in 178 participants, and 56 of these progressed to type 1 diabetes. We found no association between islet autoimmunity and gluten intake at 1–2 years of age or during follow-up (aHR per 4 g/day increase in gluten intake 1.00, 95% CI 0.85–1.17 and 1.01, 0.99–1.02, respectively). We found similar null results for progression from islet autoimmunity to type 1 diabetes. Introduction of gluten at
      Keywords: Epidemiology-Nutrition
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2315
      Issue No: Vol. 42, No. 5 (2019)
  • Diabetes Distress, Intentional Hyperglycemia at Work, and Glycemic Control
           Among Workers With Type 1 Diabetes
    • Authors: Hansen; U. M.; Skinner, T.; Olesen, K.; Willaing, I.
      Pages: 797 - 803
      Abstract: OBJECTIVEThe aim was to explore relationships between work-related factors, work-related diabetes distress (WRDD), diabetes distress (measured by Problem Areas in Diabetes [PAID]-5 scale), intentional hyperglycemia at work (IHW), and glycemic control.RESEARCH DESIGN AND METHODSA cross-sectional survey was conducted with 1,030 working adults with type 1 diabetes and linked with electronic health record data from a specialist diabetes clinic in Denmark. With use of structural equation modeling, two alternative models were compared, based on fit indices, statistical significance, and theoretical meaningfulness.RESULTSA combined model provided the best fit to the data. WRDD was more strongly affected by work ability, opportunity to self-manage at work, being treated differently, and job demands. PAID-5 was more strongly affected by identity concern and blame and judgment. Both PAID-5 and WRDD were associated with more frequent IHW, which was associated in turn with worse glycemic control.CONCLUSIONSWork-related factors are associated with WRDD and PAID-5. Distress increases the frequency of IHW, which is, in turn, associated with worse glycemic control. Future studies should investigate ways to balance diabetes management and work life without compromising diabetes care.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1426
      Issue No: Vol. 42, No. 5 (2019)
  • Effect of a Behavioral Weight Loss Intervention in People With Serious
           Mental Illness and Diabetes
    • Authors: Tseng; E.; Dalcin, A. T.; Jerome, G. J.; Gennusa, J. V.; Goldsholl, S.; Cook, C.; Appel, L. J.; Maruthur, N. M.; Daumit, G. L.; Wang, N.-Y.
      Pages: 804 - 809
      Abstract: OBJECTIVEGiven the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes.RESEARCH DESIGN AND METHODSUsing data from ACHIEVE, a randomized controlled trial to evaluate the effects of a behavioral weight loss intervention among overweight/obese people with SMI, we assessed and compared weight change from baseline to 18 months in participants with and without diabetes using a longitudinal mixed-effects model.RESULTSOf the 291 trial participants, 82 (28.2%) participants had diabetes (34 and 48 in intervention and control groups, respectively) at baseline. Participants with diabetes were more likely to be taking antipsychotics (31.7% vs. 18.7%, P = 0.02). At 18 months, participants in the control group with diabetes lost 1.2 lb (0.6%) of body weight compared with 0.8 lb (0.7%) among those without diabetes. In the intervention group, participants with diabetes lost 13.7 lb (6.6%) of their initial body weight compared with 5.4 lb (2.9%) for those without diabetes. Corresponding net effects (intervention minus control) were 4.6 lb (2.2%) and 12.5 lb (6.0%) net weight reduction over 18 months in the no diabetes and the diabetes subgroups, respectively. However, the between-group difference in intervention effects was statistically nonsignificant (absolute weight change: P-interaction = 0.08; % weight change: P-interaction = 0.10).CONCLUSIONSA behavioral weight loss intervention is effective among overweight and obese individuals with SMI regardless of their diabetes status.
      Keywords: Obesity-Human
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2201
      Issue No: Vol. 42, No. 5 (2019)
  • Suboptimal Nocturnal Glucose Control Is Associated With Large for
           Gestational Age in Treated Gestational Diabetes Mellitus
    • Authors: Law; G. R.; Alnaji, A.; Alrefaii, L.; Endersby, D.; Cartland, S. J.; Gilbey, S. G.; Jennings, P. E.; Murphy, H. R.; Scott, E. M.
      Pages: 810 - 815
      Abstract: OBJECTIVEContinuous glucose monitoring (CGM) provides far greater detail about fetal exposure to maternal glucose across the 24-h day. Our aim was to examine the role of temporal glucose variation on the development of large for gestational age (LGA) infants in women with treated gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSWe performed a prospective observational study of 162 pregnant women with GDM in specialist multidisciplinary antenatal diabetes clinics. Participants undertook 7-day masked CGM at 30–32 weeks’ gestation. Standard summary indices and glycemic variability measures of CGM were calculated. Functional data analysis was applied to determine differences in temporal glucose profiles. LGA was defined as birth weight ≥90th percentile adjusted for infant sex, gestational age, maternal BMI, ethnicity, and parity.RESULTSMean glucose was significantly higher in women who delivered an LGA infant (6.2 vs. 5.8 mmol/L, P = 0.025, or 111.6 mg/dL vs. 104.4 mg/dL). There were no significant differences in percentage time in, above, or below the target glucose range or in glucose variability measures (all P> 0.05). Functional data analysis revealed that the higher mean glucose was driven by a significantly higher glucose for 6 h overnight (0030–0630 h) in mothers of LGA infants (6.0 ± 1.0 mmol/L vs. 5.5 ± 0.8 mmol/L, P = 0.005, and 108.0 ± 18.0 mg/dL vs. 99.0 ± 14.4 mg/dL).CONCLUSIONSMothers of LGA infants run significantly higher glucose overnight compared with mothers without LGA infants. Detecting and addressing nocturnal glucose control may help to further reduce rates of LGA in women with GDM.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2212
      Issue No: Vol. 42, No. 5 (2019)
  • Seasonal Variations in the Achievement of Guideline Targets for HbA1c,
           Blood Pressure, and Cholesterol Among Patients With Type 2 Diabetes: A
           Nationwide Population-Based Study (ABC Study: JDDM49)
    • Authors: Sakamoto; M.; Matsutani, D.; Minato, S.; Tsujimoto, Y.; Kayama, Y.; Takeda, N.; Ichikawa, S.; Horiuchi, R.; Utsunomiya, K.; Nishikawa, M.
      Pages: 816 - 823
      Abstract: OBJECTIVEPrecise monthly achievement rates for reaching guideline targets for HbA1c, blood pressure (BP), and lipid levels remain unknown. We evaluated achievement rates on a monthly basis in persons with type 2 diabetes mellitus (T2DM) and explored related factors.RESEARCH DESIGN AND METHODSThis retrospective study initially analyzed data on 104,601 persons with T2DM throughout Japan. Patients whose HbA1c, BP, and LDL cholesterol were measured ≥12 times during a 24-month period were included. We evaluated monthly achievement rates. Achieved targets were defined as HbA1c
      Keywords: Epidemiology-Clinical-Diagnosis and Screening
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1953
      Issue No: Vol. 42, No. 5 (2019)
  • Improved Open-Loop Glucose Control With Basal Insulin Reduction 90 Minutes
           Before Aerobic Exercise in Patients With Type 1 Diabetes on Continuous
           Subcutaneous Insulin Infusion
    • Authors: Zaharieva; D. P.; McGaugh, S.; Pooni, R.; Vienneau, T.; Ly, T.; Riddell, M. C.
      Pages: 824 - 831
      Abstract: OBJECTIVETo reduce exercise-associated hypoglycemia, individuals with type 1 diabetes on continuous subcutaneous insulin infusion typically perform basal rate reductions (BRRs) and/or carbohydrate feeding, although the timing and amount of BRRs necessary to prevent hypoglycemia are unclear. The goal of this study was to determine if BRRs set 90 min pre-exercise better attenuate hypoglycemia versus pump suspension (PS) at exercise onset.RESEARCH DESIGN AND METHODSSeventeen individuals completed three 60-min treadmill exercise (~50% of VO2peak) visits in a randomized crossover design. The insulin strategies included 1) PS at exercise onset, 2) 80% BRR set 90 min pre-exercise, and 3) 50% BRR set 90 min pre-exercise.RESULTSBlood glucose level at exercise onset was higher with 50% BRR (191 ± 49 mg/dL) vs. 80% BRR (164 ± 41 mg/dL; P < 0.001) and PS (164 ± 45 mg/dL; P < 0.001). By exercise end, 80% BRR showed the smallest drop (–31 ± 58 mg/dL) vs. 50% BRR (–47 ± 50 mg/dL; P = 0.04) and PS (–67 ± 41 mg/dL; P < 0.001). With PS, 7 out of 17 participants developed hypoglycemia versus 1 out of 17 in both BRR conditions (P < 0.05). Following a standardized meal postexercise, glucose rose with PS and 50% BRR (both P < 0.05), but failed to rise with 80% BRR (P = 0.16). Based on interstitial glucose, overnight mean percent time in range was 83%, 83%, and 78%, and time in hypoglycemia was 2%, 1%, and 5% with 80% BRR, 50% BRR, and PS, respectively (all P> 0.05).CONCLUSIONSOverall, a 50–80% BRR set 90 min pre-exercise improves glucose control and decreases hypoglycemia risk during exercise better than PS at exercise onset, while not compromising the postexercise meal glucose control.
      Keywords: Exercise
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2204
      Issue No: Vol. 42, No. 5 (2019)
  • Early Intervention for Diabetes in Medical and Surgical Inpatients
           Decreases Hyperglycemia and Hospital-Acquired Infections: A Cluster
           Randomized Trial
    • Authors: Kyi; M.; Colman, P. G.; Wraight, P. R.; Reid, J.; Gorelik, A.; Galligan, A.; Kumar, S.; Rowan, L. M.; Marley, K. A.; Nankervis, A. J.; Russell, D. M.; Fourlanos, S.
      Pages: 832 - 840
      Abstract: OBJECTIVETo investigate if early electronic identification and bedside management of inpatients with diabetes improves glycemic control in noncritical care.RESEARCH DESIGN AND METHODSWe investigated a proactive or early intervention model of care (whereby an inpatient diabetes team electronically identified individuals with diabetes and aimed to provide bedside management within 24 h of admission) compared with usual care (a referral-based consultation service). We conducted a cluster randomized trial on eight wards, consisting of a 10-week baseline period (all clusters received usual care) followed by a 12-week active period (clusters randomized to early intervention or usual care). Outcomes were adverse glycemic days (AGDs) (patient-days with glucose 15 mmol/L [270 mg/dL]) and adverse patient outcomes.RESULTSWe included 1,002 consecutive adult inpatients with diabetes or new hyperglycemia. More patients received specialist diabetes management (92% vs. 15%, P < 0.001) and new insulin treatment (57% vs. 34%, P = 0.001) with early intervention. At the cluster level, incidence of AGDs decreased by 24% from 243 to 186 per 1,000 patient-days in the intervention arm (P < 0.001), with no change in the control arm. At the individual level, adjusted number of AGDs per person decreased from a mean 1.4 (SD 1.6) to 1.0 (0.9) days (–28% change [95% CI –45 to –11], P = 0.001) in the intervention arm but did not change in the control arm (1.8 [2.0] to 1.5 [1.8], –9% change [–25 to 6], P = 0.23). Early intervention reduced overt hyperglycemia (55% decrease in patient-days with mean glucose>15 mmol/L, P < 0.001) and hospital-acquired infections (odds ratio 0.20 [95% CI 0.07–0.58], P = 0.003).CONCLUSIONSEarly identification and management of inpatients with diabetes decreased hyperglycemia and hospital-acquired infections.
      Keywords: Health Care Delivery-Economics
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2342
      Issue No: Vol. 42, No. 5 (2019)
  • Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2
           Diabetes With Comorbid Depressive and/or Regimen-Related Distress
           Symptoms: 12-Month Outcomes From COMRADE
    • Authors: Cummings; D. M.; Lutes, L. D.; Littlewood, K.; Solar, C.; Carraway, M.; Kirian, K.; Patil, S.; Adams, A.; Ciszewski, S.; Edwards, S.; Gatlin, P.; Hambidge, B.
      Pages: 841 - 848
      Abstract: OBJECTIVEThis study evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on hemoglobin A1c (HbA1c) in rural adult patients with type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms.RESEARCH DESIGN AND METHODSThis study was a randomized controlled trial of a 16-session severity-tailored CBT plus lifestyle counseling intervention compared with usual care. Outcomes included changes in HbA1c, RRD, depressive symptoms, self-care behaviors, and medication adherence across 12 months.RESULTSPatients included 139 diverse, rural adults (mean age 52.6 ± 9.5 years; 72% black; BMI 37.0 ± 9.0 kg/m2) with T2D (mean HbA1c 9.6% [81 mmol/mol] ± 2.0%) and comorbid depressive or distress symptoms. Using intent-to-treat analyses, patients in the intervention experienced marginally significant improvements in HbA1c (–0.92 ± 1.81 vs. –0.31 ± 2.04; P = 0.06) compared with usual care. However, intervention patients experienced significantly greater improvements in RRD (–1.12 ± 1.05 vs. –0.31 ± 1.22; P = 0.001), depressive symptoms (–3.39 ± 5.00 vs. –0.90 ± 6.17; P = 0.01), self-care behaviors (1.10 ± 1.30 vs. 0.58 ± 1.45; P = 0.03), and medication adherence (1.00 ± 2.0 vs. 0.17 ± 1.0; P = 0.02) versus usual care. Improvement in HbA1c correlated with improvement in RRD (r = 0.3; P = 0.0001) and adherence (r = –0.23; P = 0.007).CONCLUSIONSTailored CBT with lifestyle counseling improves behavioral outcomes and may improve HbA1c in rural patients with T2D and comorbid depressive and/or RRD symptoms.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1841
      Issue No: Vol. 42, No. 5 (2019)
  • Comparative Effectiveness and Maintenance of Diabetes Self-Management
           Education Interventions for Marshallese Patients With Type 2 Diabetes: A
           Randomized Controlled Trial
    • Authors: McElfish; P. A.; Long, C. R.; Kohler, P. O.; Yeary, K. H. K.; Bursac, Z.; Narcisse, M.-R.; Felix, H. C.; Rowland, B.; Hudson, J. S.; Goulden, P. A.
      Pages: 849 - 858
      Abstract: OBJECTIVEMarshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c).RESEARCH DESIGN AND METHODSA two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models.RESULTSParticipants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (–0.61% [95% CI –1.19, –0.03]; P = 0.038) and 12 months (–0.77% [95% CI –1.38, –0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (–1.18% [95% CI –1.55, –0.81]), to 6 months (–0.67% [95% CI –1.06, –0.28]), and to 12 months (–0.87% [95% CI –1.28, –0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (–0.55% [95% CI –0.93, –0.17]; P = 0.005).CONCLUSIONSParticipants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants’ family members.
      Keywords: Diabetes Education
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1985
      Issue No: Vol. 42, No. 5 (2019)
  • Disordered Eating Behaviors in Youth and Young Adults With Type 1 or Type
           2 Diabetes Receiving Insulin Therapy: The SEARCH for Diabetes in Youth
    • Authors: Nip; A. S. Y.; Reboussin, B. A.; Dabelea, D.; Bellatorre, A.; Mayer-Davis, E. J.; Kahkoska, A. R.; Lawrence, J. M.; Peterson, C. M.; Dolan, L.; Pihoker, C.
      Pages: 859 - 866
      Abstract: OBJECTIVEThis study examines the prevalence of disordered eating behaviors (DEB) and its associations with glycemic control, insulin sensitivity (IS), and psychosocial functioning in a large, diverse cohort of youth and young adults with type 1 or type 2 diabetes.RESEARCH DESIGN AND METHODSIn the SEARCH for Diabetes in Youth study, 2,156 youth and young adults with type 1 diabetes (mean ± SD age 17.7 ± 4.3 years; 50.0% female) and 149 youth and young adults with type 2 diabetes (age 21.8 years ± 3.5; 64.4% female) who were receiving insulin therapy completed the Diabetes Eating Problem Survey–Revised (DEPS-R), a self-reported measure for identifying disordered eating. DEB were defined as a DEPS-R score ≥20. Demographic characteristics, clinical measures, and health behaviors of participants with DEB and those without DEB were compared by using t tests.RESULTSDEB were observed in 21.2% of participants with type 1 diabetes and 50.3% of participants with type 2 diabetes. Participants encountered challenges in maintaining a healthy weight while controlling their diabetes. For both types of diabetes, individuals with DEB had a significantly higher BMI z score, lower insulin sensitivity, more depressive symptoms, and poorer quality of life than those without DEB. Diabetic ketoacidosis episodes occurred more frequently in youth with type 1 diabetes with DEB compared to those without DEB.CONCLUSIONSThese findings highlight that DEB are prevalent among youth and young adults with type 1 and type 2 diabetes and who are receiving insulin therapy, and DEB are associated with poorer clinical outcomes and psychosocial well-being. Heightened awareness and early interventions are needed to address DEB for this at-risk population, as are longitudinal studies evaluating the course of DEB and diabetes outcomes.
      Keywords: Nutrition-Clinical
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2420
      Issue No: Vol. 42, No. 5 (2019)
  • Heart Rate, Autonomic Function, and Future Changes in Glucose Metabolism
           in Individuals Without Diabetes: The Whitehall II Cohort Study
    • Authors: Hansen; C. S.; Faerch, K.; Jorgensen, M. E.; Malik, M.; Witte, D. R.; Brunner, E. J.; Tabak, A. G.; Kivimäki, M.; Vistisen, D.
      Pages: 867 - 874
      Abstract: OBJECTIVEAutonomic nervous system dysfunction is associated with impaired glucose metabolism, but the temporality of this association remains unclear in individuals without diabetes. We investigated the association of autonomic function with 5-year changes in glucose metabolism in individuals without diabetes.RESEARCH DESIGN AND METHODSAnalyses were based on 9,000 person-examinations for 3,631 participants without diabetes in the Whitehall II cohort. Measures of autonomic function included 5-min resting heart rate and six heart rate variability (HRV) indices. Associations between baseline autonomic function measures and 5-year changes in fasting and 2-h plasma glucose, serum insulin concentrations, insulin sensitivity (insulin sensitivity index [ISI0–120] and HOMA of insulin sensitivity), and β-cell function (HOMA of β-cell function) were estimated in models adjusting for age, sex, ethnicity, metabolic factors, and medication.RESULTSA 10-bpm higher resting heart rate was associated with 5-year changes in fasting and 2-h insulin and ISI0–120 of 3.3% change (95% CI 1.8; 4.8), P < 0.001; 3.3% change (1.3; 5.3), P = 0.001; and –1.4% change (–2.4; –0.3), P = 0.009, respectively. In models adjusted for age, sex, and ethnicity, higher baseline values of several HRV indices were associated with a 5-year decrease in fasting and 2-h insulin and ISI0–120. However, significance was lost by full adjustment. A majority of HRV indices exhibited a trend toward higher values being associated with lower insulin levels and higher insulin sensitivity.CONCLUSIONSHigher resting heart rate in individuals without diabetes is associated with future unfavorable changes in insulin levels and insulin sensitivity. Associations may be mediated via autonomic function; however, results are inconclusive. Resting heart rate may be a risk marker for future pathophysiological changes in glucose metabolism.
      Keywords: Epidemiology-Other
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1838
      Issue No: Vol. 42, No. 5 (2019)
  • Risk Factors for Retinopathy in Type 1 Diabetes: The DCCT/EDIC Study
    • Authors: Hainsworth; D. P.; Bebu, I.; Aiello, L. P.; Sivitz, W.; Gubitosi-Klug, R.; Malone, J.; White, N. H.; Danis, R.; Wallia, A.; Gao, X.; Barkmeier, A. J.; Das, A.; Patel, S.; Gardner, T. W.; Lachin, J. M.; on behalf of the Diabetes Control Complications (EDIC) Research Group
      Pages: 875 - 882
      Abstract: OBJECTIVEThe Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy reduced the development and progression of retinopathy in type 1 diabetes (T1D) compared with conventional therapy. The Epidemiology of Diabetes Interventions and Complications (EDIC) study observational follow-up showed persistent benefits. In addition to glycemia, we now examine other potential retinopathy risk factors (modifiable and nonmodifiable) over more than 30 years of follow-up in DCCT/EDIC.RESEARCH DESIGN AND METHODSThe retinopathy outcomes were proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), and ocular surgery. The survival (event-free) probability was estimated using the Kaplan-Meier method. Cox proportional hazards models assessed the association between risk factors and subsequent risk of retinopathy. Both forward- and backward-selection approaches determined the multivariable models.RESULTSRate of ocular events per 1,000 person-years was 12 for PDR, 14.5 for CSME, and 7.6 for ocular surgeries. Approximately 65%, 60%, and 70% of participants remained free of PDR, CSME, and ocular surgery, respectively. The greatest risk factors for PDR in descending order were higher mean HbA1c, longer duration of T1D, elevated albumin excretion rate (AER), and higher mean diastolic blood pressure (DBP). For CSME, risk factors, in descending order, were higher mean HbA1c, longer duration of T1D, and greater age and DBP and, for ocular surgeries, were higher mean HbA1c, older age, and longer duration of T1D.CONCLUSIONSMean HbA1c was the strongest risk factor for the progression of retinopathy. Although glycemic control is important, elevated AER and DBP were other modifiable risk factors associated with the progression of retinopathy.
      Keywords: Complications-Retinopathy
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2308
      Issue No: Vol. 42, No. 5 (2019)
  • Risk Factors for Kidney Disease in Type 1 Diabetes
    • Authors: Perkins; B. A.; Bebu, I.; de Boer, I. H.; Molitch, M.; Tamborlane, W.; Lorenzi, G.; Herman, W.; White, N. H.; Pop-Busui, R.; Paterson, A. D.; Orchard, T.; Cowie, C.; Lachin, J. M.; on behalf of the Diabetes Control Complications (EDIC) Research Group
      Pages: 883 - 890
      Abstract: OBJECTIVEIn type 1 diabetes (T1D), the course of microalbuminuria is unpredictable and timing of glomerular filtration rate (GFR) loss is uncertain. Thus, there is a need to identify the risk factors associated with the development of more advanced stages of kidney disease through large, long-term systematic analysis.RESEARCH DESIGN AND METHODSMultivariable Cox proportional hazards models assessed the association of baseline and time-dependent glycemic and nonglycemic risk factors for incident macroalbuminuria and reduced estimated GFR (eGFR; defined as
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2062
      Issue No: Vol. 42, No. 5 (2019)
  • Nonproteinuric Versus Proteinuric Phenotypes in Diabetic Kidney Disease: A
           Propensity Score-Matched Analysis of a Nationwide, Biopsy-Based Cohort
    • Authors: Yamanouchi; M.; Furuichi, K.; Hoshino, J.; Toyama, T.; Hara, A.; Shimizu, M.; Kinowaki, K.; Fujii, T.; Ohashi, K.; Yuzawa, Y.; Kitamura, H.; Suzuki, Y.; Sato, H.; Uesugi, N.; Hisano, S.; Ueda, Y.; Nishi, S.; Yokoyama, H.; Nishino, T.; Samejima, K.; Kohagura, K.; Shibagaki, Y.; Mise, K.; Makino, H.; Matsuo, S.; Ubara, Y.; Wada, T.; Research Group of Diabetic Nephropathy, the Ministry of Health, Labour Development
      Pages: 891 - 902
      Abstract: OBJECTIVEClinicopathological characteristics, renal prognosis, and mortality in patients with type 2 diabetes and reduced renal function without overt proteinuria are scarce.RESEARCH DESIGN AND METHODSWe retrospectively assessed 526 patients with type 2 diabetes and reduced renal function (estimated glomerular filtration rate [eGFR]
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1320
      Issue No: Vol. 42, No. 5 (2019)
  • Self-Monitoring of Blood Glucose in Youth-Onset Type 2 Diabetes: Results
           From the TODAY Study
    • Authors: Weinstock; R. S.; Braffett, B. H.; McGuigan, P.; Larkin, M. E.; Grover, N. B.; Walders-Abramson, N.; Laffel, L. M.; Chan, C. L.; Chang, N.; Schwartzman, B. E.; Barajas, R. A.; Celona-Jacobs, N.; Haymond, M. W.; for the TODAY Study Group
      Pages: 903 - 909
      Abstract: OBJECTIVETo determine whether self-monitoring of blood glucose (SMBG) is associated with lower HbA1c in youth with type 2 diabetes taking oral medications only or after starting insulin for persistently elevated HbA1c.RESEARCH DESIGN AND METHODSTreatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study participants (n = 699) taking oral medications were asked to perform SMBG twice daily. After reaching primary outcome (PO) (HbA1c ≥8% [64 mmol/mol]) over 6 months or an inability to wean from temporary insulin because of metabolic decompensation), insulin glargine was started. HbA1c and percent of SMBG (SMBG%) (percent days when the meter was used one or more times) before and after PO were analyzed.RESULTSSMBG declined over time and was inversely related to HbA1c (P < 0.0001). Of 298 youth who reached PO and started insulin, 282 had SMBG data. At PO, mean ± SD age was 15.8 ± 2.3 years, BMI 35.5 ± 7.9 kg/m2, and HbA1c 9.6 ± 2.0% (81 ± 21.9 mmol/mol); 65.3% were female. Median SMBG% was 40% at PO, which increased to 49% after 6 months and fell to 41% after 1 year on insulin. At PO, 22% of youth checked ≥80% of days, which increased to 25% and fell to 19% after 6 and 12 months using insulin, respectively. At PO, compared with those who checked
      Keywords: Pediatrics-Obesity and Type 2 Diabetes
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1854
      Issue No: Vol. 42, No. 5 (2019)
  • Long-term Association of Depression Symptoms and Antidepressant Medication
           Use With Incident Cardiovascular Events in the Look AHEAD (Action for
           Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes
    • Authors: Hazuda; H. P.; Gaussoin, S. A.; Wing, R. R.; Yanovski, S. Z.; Johnson, K. C.; Coday, M.; Wadden, T. A.; Horton, E. S.; Van Dorsten, B.; Knowler, W. C.; for The Look AHEAD Research Group
      Pages: 910 - 918
      Abstract: OBJECTIVETo examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSPreplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years. Depression symptoms, assessed with the Beck Depression Inventory (BDI), were analyzed both as a continuous and dichotomized variable (BDI score
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-0575
      Issue No: Vol. 42, No. 5 (2019)
  • Improved Time in Range and Glycemic Variability With Sotagliflozin in
           Combination With Insulin in Adults With Type 1 Diabetes: A Pooled Analysis
           of 24-Week Continuous Glucose Monitoring Data From the inTandem Program
    • Authors: Danne; T.; Cariou, B.; Buse, J. B.; Garg, S. K.; Rosenstock, J.; Banks, P.; Kushner, J. A.; McGuire, D. K.; Peters, A. L.; Sawhney, S.; Strumph, P.
      Pages: 919 - 930
      Abstract: OBJECTIVETo evaluate effects of the dual sodium–glucose cotransporter (SGLT) 1 and SGLT2 inhibitor sotagliflozin in combination with insulin on glucose time in range (TIR) and glucose excursions, postprandial glucose (PPG), and other glycemic metrics in adults with type 1 diabetes using masked continuous glucose monitoring (CGM).RESEARCH DESIGN AND METHODSData sets from the inTandem1 (clinical trial reg. no. NCT02384941) and inTandem2 (clinical trial reg. no. NCT02421510) double-blind randomized trials evaluating sotagliflozin versus placebo in adults with type 1 diabetes treated with optimized insulin were pooled for analyses of masked CGM data from a subset of participants in each trial. The pooled cohort included patients randomized to receive placebo (n = 93), sotagliflozin 200 mg (n = 89), or sotagliflozin 400 mg (n = 96). The primary outcome was change from baseline to week 24 in glucose TIR (3.9–10.0 mmol/L [70–180 mg/dL]). Secondary end points included time below and above the target range and 2-h PPG level assessed after a standardized mixed meal.RESULTSMean percentage of glucose TIR/percentage time spent at
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2149
      Issue No: Vol. 42, No. 5 (2019)
  • The SGLT2 Inhibitor Dapagliflozin Reduces Liver Fat but Does Not Affect
           Tissue Insulin Sensitivity: A Randomized, Double-Blind, Placebo-Controlled
           Study With 8-Week Treatment in Type 2 Diabetes Patients
    • Authors: Latva-Rasku; A.; Honka, M.-J.; Kullberg, J.; Mononen, N.; Lehtimäki, T.; Saltevo, J.; Kirjavainen, A. K.; Saunavaara, V.; Iozzo, P.; Johansson, L.; Oscarsson, J.; Hannukainen, J. C.; Nuutila, P.
      Pages: 931 - 937
      Abstract: OBJECTIVEThe aim of this study was to investigate tissue-specific effects of dapagliflozin on insulin sensitivity and liver and body fat in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSThis randomized, double-blind, parallel group, placebo-controlled study recruited 32 patients with type 2 diabetes. Enrolled patients were to have HbA1c 6.5–10.5% (48–91 mmol/mol) and ≥3 months of stable treatment with metformin, dipeptidyl peptidase 4 inhibitor, or their combination. Patients were randomized 1:1 to receive 10 mg dapagliflozin or placebo daily for 8 weeks. Before and after the intervention, tissue insulin sensitivity was measured using [18F]-fluorodeoxyglucose and positron emission tomography during hyperinsulinemic-euglycemic clamp. Liver proton density fat fraction (PDFF) and adipose tissue volumes were assessed using MRI, and blood biomarkers were analyzed.RESULTSAfter 8 weeks, glycemic control was improved by dapagliflozin (placebo-corrected change in HbA1c –0.39%, P < 0.01), but whole-body glucose uptake was not increased (P = 0.90). Tissue-specific insulin-stimulated glucose uptake did not change in skeletal muscle, liver, myocardium, or white and brown adipose tissue, and endogenous glucose production remained unaffected. However, there were significant placebo-corrected decreases in liver PDFF (–3.74%, P < 0.01), liver volume (–0.10 L, P < 0.05), visceral adipose tissue volume (–0.35 L, P < 0.01), interleukin-6 (–1.87 pg/mL, P < 0.05), and N-terminal prohormone of brain natriuretic peptide (–96 ng/L, P = 0.03).CONCLUSIONSIn this study, 8 weeks of treatment with dapagliflozin reduced liver PDFF and the volume of visceral adipose tissue in obese patients with type 2 diabetes. Although glycemic control was improved, no effect on tissue-level insulin sensitivity was observed.
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1569
      Issue No: Vol. 42, No. 5 (2019)
  • High Prevalence of Diabetes in Patients With Primary Aldosteronism (PA)
           Associated With Subclinical Hypercortisolism and Prediabetes More
           Prevalent in Bilateral Than Unilateral PA: A Large, Multicenter Cohort
           Study in Japan
    • Authors: Akehi; Y.; Yanase, T.; Motonaga, R.; Umakoshi, H.; Tsuiki, M.; Takeda, Y.; Yoneda, T.; Kurihara, I.; Itoh, H.; Katabami, T.; Ichijo, T.; Wada, N.; Shibayama, Y.; Yoshimoto, T.; Ashida, K.; Ogawa, Y.; Kawashima, J.; Sone, M.; Inagaki, N.; Takahashi, K.; Fujita, M.; Watanabe, M.; Matsuda, Y.; Kobayashi, H.; Shibata, H.; Kamemura, K.; Otsuki, M.; Fujii, Y.; Yamamoto, K.; Ogo, A.; Okamura, S.; Miyauchi, S.; Fukuoka, T.; Izawa, S.; Hashimoto, S.; Yamada, M.; Yoshikawa, Y.; Kai, T.; Suzuki, T.; Kawamura, T.; Naruse, M.; on behalf of the Japan Primary Aldosteronism Study Group
      Pages: 938 - 945
      Abstract: OBJECTIVETo investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan.RESEARCH DESIGN AND METHODSThe prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA1c] ≥6.5% [≥48 mmol/mol]; NGSP) and compared with that of the Japanese general population according to age and sex. In 1,386 patients with PA and clear laterality (unilateral or bilateral), the effects of plasma aldosterone concentration (PAC), hypokalemia (
      Keywords: Epidemiology-Other
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1293
      Issue No: Vol. 42, No. 5 (2019)
  • Body Composition and Diabetes Risk in South Asians: Findings From the
           MASALA and MESA Studies
    • Authors: Flowers; E.; Lin, F.; Kandula, N. R.; Allison, M.; Carr, J. J.; Ding, J.; Shah, R.; Liu, K.; Herrington, D.; Kanaya, A. M.
      Pages: 946 - 953
      Abstract: OBJECTIVESouth Asians have a higher prevalence of type 2 diabetes compared with other race/ethnic groups. Body composition is associated with the risk for type 2 diabetes. Differences in body composition between South Asians and other race/ethnic groups are one hypothesized mechanism to explain the disproportionate prevalence of type 2 diabetes in this population.RESEARCH DESIGN AND METHODSThis study used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and the Multi-Ethnic Study of Atherosclerosis (MESA) cohorts to determine whether body composition mediated the elevated prevalence of impaired fasting glucose and type 2 diabetes in South Asians. Participants (n = 2,615) with complete body composition data were included. Ordinal logistic regression models were calculated to determine the odds for glycemic impairment in South Asians compared with the MESA cohort.RESULTSIn multivariate models, South Asians had a significantly higher prevalence of glycemic impairment and type 2 diabetes compared with all four race/ethnic groups included in the MESA (P < 0.001 for all). In unadjusted and multivariate adjusted models, South Asians had higher odds for impaired fasting glucose and type 2 diabetes compared with all other race/ethnic groups (P < 0.001 for all). The addition of body composition measures did not significantly mitigate this relationship.CONCLUSIONSWe did not identify strong evidence that accounting for body composition explains differences in the risk for type 2 diabetes. Future prospective studies of the MESA and MASALA cohorts are needed to understand how adipose tissue impacts the risk for type 2 diabetes and how to best assess this risk.
      Keywords: Epidemiology-Other
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-1510
      Issue No: Vol. 42, No. 5 (2019)
  • Risk of Incident Obstructive Sleep Apnea Among Patients With Type 2
    • Authors: Subramanian; A.; Adderley, N. J.; Tracy, A.; Taverner, T.; Hanif, W.; Toulis, K. A.; Thomas, G. N.; Tahrani, A. A.; Nirantharakumar, K.
      Pages: 954 - 963
      Abstract: OBJECTIVEThis study compared the incidence of obstructive sleep apnea (OSA) in patients with and without type 2 diabetes and investigated risk factors for OSA in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSA retrospective cohort study was performed to compare OSA incidence between adult patients with and without type 2 diabetes matched for age, sex, and BMI. Patients with a prevalent OSA diagnosis were excluded. The study cohort was derived from The Health Improvement Network (THIN), a U.K. primary care database, from 1 January 2005 to 31 December 2017.RESULTSThere were 3,110 (0.88%) and 5,968 (0.46%) incident OSA cases identified in the 360,250 exposed and 1,296,489 unexposed patient cohorts, respectively. Adjusted incidence rate ratio (aIRR) of OSA in patients with type 2 diabetes compared with those without was 1.48 (95% CI 1.42–1.55; P < 0.001). In a multivariate regression analysis of patients with type 2 diabetes, significant predictors of OSA were diabetes-related foot disease (1.23 [1.06–1.42]; P = 0.005), being prescribed insulin in the last 60 days (1.58 [1.42–1.75]; P < 0.001), male sex (2.27 [2.09–2.46]; P < 0.001), being overweight (2.02 [1.54–2.64]; P < 0.001) or obese (8.29 [6.42–10.69]; P < 0.001), heart failure (1.41 [1.18–1.70]; P < 0.001), ischemic heart disease (1.22 [1.11–1.34]; P < 0.001), atrial fibrillation (1.23 [1.04–1.46]; P = 0.015), hypertension (1.32 [1.23–1.43]; P < 0.001), and depression (1.75 [1.61–1.91]; P < 0.001).CONCLUSIONSWhen considered alongside previous evidence, this study indicates that the association between type 2 diabetes and OSA is bidirectional. In addition to known predictors of OSA, diabetes-related foot disease and insulin treatment were identified as risk factors in patients with type 2 diabetes.
      Keywords: Epidemiology-Other
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2004
      Issue No: Vol. 42, No. 5 (2019)
  • Placental 11{beta}-HSD2 and Cardiometabolic Health Indicators in Infancy
    • Authors: Chen; L.; Guilmette, J.; Luo, Z.-C.; Cloutier, A.; Wang, W.-J.; Yang, M.-N.; Fraser, W. D.; Dubois, J.; Nuyt, A. M.
      Pages: 964 - 971
      Abstract: OBJECTIVEFetal excessive exposure to glucocorticoids may program cardiometabolic risk. Placental 11 β-hydroxysteroid dehydrogenase 2 (11β-HSD2) serves as a barrier to prevent fetal overexposure to maternal glucocorticoids. It has not been explored whether placental 11β-HSD2 levels are associated with cardiometabolic health in postnatal life.RESEARCH DESIGN AND METHODSIn a prospective birth cohort study of 246 mother-infant pairs, we measured placental 11β-HSD2 expression and maternal (32–35 weeks of gestation) and cord plasma cortisol concentrations. The primary outcomes were HOMA of insulin resistance (IR) and blood pressure (BP) in infants at age 1 year. Other outcomes included fasting insulin, HOMA β-cell function, carotid intima-media thickness, weight z score, and skinfold thickness (triceps and subscapular) at age 1 year.RESULTSPlacental 11β-HSD2 expression was negatively correlated with HOMA-IR (r = –0.17, P = 0.021) and fasting insulin (r = –0.18, P = 0.017) and marginally negatively correlated with systolic BP (r = –0.16, P = 0.057) but was not correlated with HOMA of β-cell function, diastolic BP, carotid intima-media thickness, and skinfold thickness (all P> 0.1) in infants at age 1 year. Cord plasma cortisol was negatively correlated to skinfold thickness (r = –0.20, P = 0007) but was not correlated with other outcomes at age 1 year. Maternal plasma cortisol was positively correlated with maximal carotid intima-media thickness (r = 0.20, P = 0.03) but was not correlated with other outcomes. Adjusting for maternal and infant characteristics, the associations were similar.CONCLUSIONSThe study is the first to show that higher placental 11β-HSD2 expression is associated with lower IR in infancy. Independent cohort studies are required to confirm this novel finding.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2019-04-22T12:00:34-07:00
      DOI: 10.2337/dc18-2041
      Issue No: Vol. 42, No. 5 (2019)
  • Importance of Treatment Status in Links Between Type 2 Diabetes and
           Alzheimers Disease
    • Authors: McIntosh; E. C.; Nation, D. A.; for the Alzheimers Disease Neuroimaging Initiative
      Pages: 972 - 979
      Abstract: OBJECTIVETo investigate relationships among type 2 diabetes treatment, Alzheimer’s disease(AD) biomarkers, and risk for dementia.RESEARCH DESIGN AND METHODSParticipants were from the Alzheimer's Disease Neuroimaging Initiative (N = 1,289) and were dementia-free at baseline and underwent health assessment, cognitive testing, and MRI. A subset (n = 900) obtained a lumbar puncture to determine cerebrospinal fluid (CSF) phosphorylated tau (p-tau), total tau (t-tau), and β-amyloid 1-42 (Aβ1-42). Participants were grouped by fasting blood glucose and medication history: euglycemia (EU), prediabetes (PD), untreated diabetes (UD), and treated diabetes (TD). Relationships were investigated between treatment status and CSF biomarkers and risk for dementia.RESULTSThe UD group displayed greater p-tau, t-tau, and p-tau/Aβ1-42 levels than the EU, PD, and TD groups (P values
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-1399
      Issue No: Vol. 42, No. 5 (2019)
  • Dysglycemia and the Density of the Coronary Vasa Vasorum
    • Authors: Gerstein; H. C.; Nair, V.; Chaube, R.; Stoute, H.; Werstuck, G.
      Pages: 980 - 982
      Abstract: OBJECTIVEThis study was conducted to determine the relationship between dysglycemia and the coronary artery vasa vasorum density.RESEARCH DESIGN AND METHODSThe left anterior descending coronary artery was removed from 57 deceased individuals during autopsy, and the capillaries in the vessel wall were identified using fluorescent immunohistochemical staining. HbA1c was determined in postmortem whole blood for each individual. The density of the vasa vasorum in the intima-media and the adventitia was manually quantified and recorded by readers unaware of the individual’s other characteristics.RESULTSThe individuals with diabetes had a lower density of the coronary vasa vasorum than those without diabetes. The higher the HbA1c, the lower the density of these vessels in the adventitia and entire vessel wall.CONCLUSIONSDysglycemia-induced damage to the vasa vasorum may promote ischemic heart disease in people with diabetes.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-2483
      Issue No: Vol. 42, No. 5 (2019)
  • Intractable Coronary Artery Disease in a Patient With Type 2 Diabetes
           Presenting With Triglyceride Deposit Cardiomyovasculopathy
    • Authors: Kozawa; J.; Higashi, M.; Shimomura, I.; Hirano, K.-i.
      Pages: 983 - 986
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc18-2365
      Issue No: Vol. 42, No. 5 (2019)
  • Erratum. Genetics coming of age in type 1 diabetes. Diabetes Care
    • Authors: Cerosaletti; K.; Hao, W.; Greenbaum, C. J.
      Pages: 987 - 987
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc19-er05
      Issue No: Vol. 42, No. 5 (2019)
  • Issues and Events
    • Pages: 988 - 988
      PubDate: 2019-04-22T12:00:35-07:00
      DOI: 10.2337/dc19-ie05
      Issue No: Vol. 42, No. 5 (2019)
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