Journal Cover
Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 459  
 
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ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • The Sensitivity and Specificity of the Glucose Challenge Test in a
           Universal Two-Step Screening Strategy for Gestational Diabetes Mellitus
           Using the 2013 World Health Organization Criteria
    • Authors: Benhalima; K.; Van Crombrugge, P.; Moyson, C.; Verhaeghe, J.; Vandeginste, S.; Verlaenen, H.; Vercammen, C.; Maes, T.; Dufraimont, E.; De Block, C.; Jacquemyn, Y.; Mekahli, F.; De Clippel, K.; Van Den Bruel, A.; Loccufier, A.; Laenen, A.; Devlieger, R.; Mathieu, C.
      Keywords: Pregnancy-Clinical/Epidemiology, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0556
      Issue No: Vol. 41, No. 7 (2018)
       
  • Clinical Inertia in Type 2 Diabetes Management: Evidence From a Large,
           Real-World Data Set
    • Authors: Pantalone; K. M.; Misra-Hebert, A. D.; Hobbs, T. M.; Ji, X.; Kong, S. X.; Milinovich, A.; Weng, W.; Bauman, J.; Ganguly, R.; Burguera, B.; Kattan, M. W.; Zimmerman, R. S.
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0116
      Issue No: Vol. 41, No. 7 (2018)
       
  • State of Behavioral Health Integration in U.S. Diabetes Care: How Close
           Are We to ADA Recommendations'
    • Authors: Barry; S. A.; Harlan, D. M.; Johnson, N. L.; MacGregor, K. L.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0642
      Issue No: Vol. 41, No. 7 (2018)
       
  • Lifetime Prevalence and Prognosis of Prediabetes Without Progression to
           Diabetes
    • Authors: Echouffo-Tcheugui; J. B.; Niiranen, T. J.; McCabe, E. L.; Jain, M.; Vasan, R. S.; Larson, M. G.; Cheng, S.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0524
      Issue No: Vol. 41, No. 7 (2018)
       
  • Diabetes and Prediabetes Prevalence by Race and Ethnicity Among People
           With Severe Mental Illness
    • Authors: Mangurian; C. V.; Schillinger, D.; Newcomer, J. W.; Vittinghoff, E.; Essock, S. M.; Zhu, Z.; Dyer, W. T.; Schmittdiel, J. A.
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0425
      Issue No: Vol. 41, No. 7 (2018)
       
  • Comment on Stiermaier et al. Prevalence and Prognostic Impact of Diabetes
           in Takotsubo Syndrome: Insights From the International, Multicenter GEIST
           Registry. Diabetes Care 2018;41:1084-1088
    • Authors: Del Buono; M. G.; Carbone, S.; Abbate, A.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0442
      Issue No: Vol. 41, No. 7 (2018)
       
  • Response to Comment on Stiermaier et al. Prevalence and Prognostic Impact
           of Diabetes in Takotsubo Syndrome: Insights From the International,
           Multicenter GEIST Registry. Diabetes Care 2018;41:1084-1088
    • Authors: Stiermaier; T.; Santoro, F.; El-Battrawy, I.; Brunetti, N. D.; Akin, I.; Eitel, I.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dci18-0016
      Issue No: Vol. 41, No. 7 (2018)
       
  • Comment on Redondo et al. Racial/Ethnic Minority Youth With Recent-Onset
           Type 1 Diabetes Have Poor Prognostic Factors. Diabetes Care
           2018;41:1017-1024
    • Authors: Nwosu B. U.
      Keywords: Pediatrics-Type 1 Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0483
      Issue No: Vol. 41, No. 7 (2018)
       
  • Response to Comment on Redondo et al. Racial/Ethnic Minority Youth With
           Recent-Onset Type 1 Diabetes Have Poor Prognostic Factors. Diabetes Care
           2018;41:1017-1024
    • Authors: Redondo; M. J.; Libman, I.; Cheng, P.; Kollman, C.; Tosur, M.; Gal, R. L.; Bacha, F.; Klingensmith, G. J.; Clements, M.; for the Pediatric Diabetes Consortium
      Keywords: Pediatrics-Type 1 Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dci18-0017
      Issue No: Vol. 41, No. 7 (2018)
       
  • Comment on Gordin et al. Differential Association of Microvascular
           Attributions With Cardiovascular Disease in Patients With Long Duration of
           Type 1 Diabetes. Diabetes Care 2018;41:815-822
    • Authors: Azar; M.; Coirier, E.; Delyfer, M.-N.; Korobelnik, J.-F.; Mohammedi, K.; Blanco, L.; Alexandre, L.; Monlun, M.; Rigalleau, V.
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0510
      Issue No: Vol. 41, No. 7 (2018)
       
  • Response to Comment on Gordin et al. Differential Association of
           Microvascular Attributions With Cardiovascular Disease in Patients With
           Long Duration of Type 1 Diabetes. Diabetes Care 2018;41:815-822
    • Authors: Gordin; D.; King, G. L.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dci18-0021
      Issue No: Vol. 41, No. 7 (2018)
       
  • In This Issue of Diabetes Care
    • Pages: 1325 - 1326
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc18-ti07
      Issue No: Vol. 41, No. 7 (2018)
       
  • Big Topics for Diabetes Care in 2018: Clinical Guidelines, Costs of
           Diabetes, and Information Technology
    • Authors: Riddle; M. C.; Bakris, G.; Boulton, A. J. M.; Blonde, L.; DAlessio, D.; Greene, E. L.; de Groot, M.; Hood, K.; Hu, F. B.; Kahn, S. E.; Kaul, S.; LeRoith, D.; Moses, R. G.; Rich, S. S.; Rosenstock, J.; Tamborlane, W. V.; Wylie-Rosett, J.; Reynolds, L.
      Pages: 1327 - 1329
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dci18-0035
      Issue No: Vol. 41, No. 7 (2018)
       
  • John Denis McGarry, PhD: A Remembrance of a Master Metabolic Physiologist
    • Authors: Newgard C. B.
      Pages: 1330 - 1336
      Keywords: Integrated Physiology-Other Hormones, Profiles in Progress
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dci18-0022
      Issue No: Vol. 41, No. 7 (2018)
       
  • Gestational Diabetes Mellitus: Is It Time to Reconsider the Diagnostic
           Criteria'
    • Authors: Cheung; N. W.; Moses, R. G.
      Pages: 1337 - 1338
      Keywords: Pregnancy-Clinical/Epidemiology, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dci18-0013
      Issue No: Vol. 41, No. 7 (2018)
       
  • Gestational Diabetes Mellitus: Does One Size Fit All' A Challenge to
           Uniform Worldwide Diagnostic Thresholds
    • Authors: McIntyre; H. D.; Jensen, D. M.; Jensen, R. C.; Kyhl, H. B.; Jensen, T. K.; Glintborg, D.; Andersen, M.
      Pages: 1339 - 1342
      Abstract: OBJECTIVETo define the prevalence and pregnancy outcomes related to elevated fasting venous plasma glucose (FVPG) in a Danish pregnancy cohort.RESEARCH DESIGN AND METHODSThis was an observational cohort study including 1,516 women without gestational diabetes mellitus (GDM) by Danish criteria. FVPG measured at 28 weeks’ gestation was related to pregnancy outcomes.RESULTSWith use of the World Health Organization (WHO) 2013 threshold of FVPG ≥5.1 mmol/L, 40.1% of the cohort qualified as having GDM. There was no evidence of excess fetal growth, hypertension in pregnancy, or cesarean delivery in women with FVPG
      Keywords: Pregnancy-Clinical/Epidemiology, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2393
      Issue No: Vol. 41, No. 7 (2018)
       
  • Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward
    • Authors: Hernandez; T. L.; Brand-Miller, J. C.
      Pages: 1343 - 1345
      Keywords: Nutrition-Clinical, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dci18-0014
      Issue No: Vol. 41, No. 7 (2018)
       
  • Gestational Diabetes Mellitus and Diet: A Systematic Review and
           Meta-analysis of Randomized Controlled Trials Examining the Impact of
           Modified Dietary Interventions on Maternal Glucose Control and Neonatal
           Birth Weight
    • Authors: Yamamoto; J. M.; Kellett, J. E.; Balsells, M.; Garcia-Patterson, A.; Hadar, E.; Sola, I.; Gich, I.; van der Beek, E. M.; Castaneda-Gutierrez, E.; Heinonen, S.; Hod, M.; Laitinen, K.; Olsen, S. F.; Poston, L.; Rueda, R.; Rust, P.; van Lieshout, L.; Schelkle, B.; Murphy, H. R.; Corcoy, R.
      Pages: 1346 - 1361
      Abstract: OBJECTIVEMedical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions.RESEARCH DESIGN AND METHODSData from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms.RESULTSFrom 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (–4.07 mg/dL [95% CI –7.58, –0.57]; P = 0.02 and –7.78 mg/dL [95% CI –12.27, –3.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (–170.62 g [95% CI –333.64, –7.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison.CONCLUSIONSModified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM.
      Keywords: Nutrition-Clinical, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc18-0102
      Issue No: Vol. 41, No. 7 (2018)
       
  • The Human Placenta in Diabetes and Obesity: Friend or Foe' The 2017
           Norbert Freinkel Award Lecture
    • Authors: Desoye G.
      Pages: 1362 - 1369
      Abstract: The placenta plays a key role in sustaining fetal growth and development. Due to its position between mother and fetus, it is exposed to changes in the intrauterine environment in both circulations. The relative influence of changes in those circulations depends on the period of gestation. Early in pregnancy, maternal influences prevail and may affect the complex biological processes characteristic for this pregnancy period, such as placentation, early cell differentiation, and spiral artery remodeling. It is still unclear whether the placenta early in pregnancy is a friend or foe for the fetus. Later in pregnancy, when the fetal circulation is gradually establishing, fetal signals gain importance in regulating placental structure and function. Many of the placental alterations seen at term of pregnancy are the result of fetoplacental interactions often driven by fetal signals associated with maternal diabetes or obesity. These alterations, such as hypervascularization or enhanced cholesterol removal from placental endothelial cells, can be regarded as adaptations to maintain homeostasis at the fetoplacental interface and, thus, to protect the fetus. However, extreme conditions such as poorly controlled diabetes or pronounced obesity may exceed placental homeostatic capacity, with potentially adverse consequences for the fetus. Thus, in late pregnancy, the placenta acts mostly as a friend as long as the environmental perturbations do not exceed placental capacity for mounting adaptive responses.
      Keywords: Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dci17-0045
      Issue No: Vol. 41, No. 7 (2018)
       
  • A Tailored Letter Based on Electronic Health Record Data Improves
           Gestational Weight Gain Among Women With Gestational Diabetes Mellitus:
           The Gestational Diabetes Effects on Moms (GEM) Cluster-Randomized
           Controlled Trial
    • Authors: Hedderson; M. M.; Brown, S. D.; Ehrlich, S. F.; Tsai, A.-L.; Zhu, Y.; Quesenberry, C. P.; Crites, Y.; Ferrara, A.
      Pages: 1370 - 1377
      Abstract: OBJECTIVEEvaluate whether a tailored letter improved gestational weight gain (GWG) and whether GWG mediated a multicomponent intervention’s effect on postpartum weight retention among women with gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSA cluster-randomized controlled trial of 44 medical facilities (n = 2,014 women) randomized to usual care or a multicomponent lifestyle intervention delivered during pregnancy (tailored letter) and postpartum (13 telephone sessions) to reduce postpartum weight retention. The tailored letter, using electronic health record (EHR) data, recommended an end-of-pregnancy weight goal tailored to prepregnancy BMI and GWG trajectory at GDM diagnosis: total GWG at the lower limit of the IOM range if BMI ≥18.5 kg/m2 or the midpoint if
      Keywords: Pregnancy-Clinical/Epidemiology, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-1133
      Issue No: Vol. 41, No. 7 (2018)
       
  • Gestational Diabetes Mellitus and Renal Function: A Prospective Study With
           9- to 16-Year Follow-up After Pregnancy
    • Authors: Rawal; S.; Olsen, S. F.; Grunnet, L. G.; Ma, R. C.; Hinkle, S. N.; Granström, C.; Wu, J.; Yeung, E.; Mills, J. L.; Zhu, Y.; Bao, W.; Ley, S. H.; Hu, F. B.; Damm, P.; Vaag, A.; Tsai, M. Y.; Zhang, C.
      Pages: 1378 - 1384
      Abstract: OBJECTIVETo examine whether gestational diabetes mellitus (GDM), independent of subsequent diabetes, is an early risk factor for renal impairment long term after the index pregnancy.RESEARCH DESIGN AND METHODSIn the Diabetes & Women’s Health (DWH) study (2012–2016), we examined the independent and joint associations of GDM and subsequent diabetes with long-term renal function among 607 women with and 619 women without GDM in the Danish National Birth Cohort (DNBC) index pregnancy (1996–2002). At median follow-up of 13 years after the index pregnancy, serum creatinine (mg/dL) and urinary albumin (mg/L) and creatinine (mg/dL) were measured, from which estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were derived.RESULTSCompared with women without GDM or subsequent diabetes, women with a GDM history had significantly higher eGFR even if they had not subsequently developed diabetes (adjusted β-coefficient [95% CI] = 3.3 [1.7, 5.0]). Women who had a GDM history and later developed diabetes (n = 183) also had significantly higher UACR [exponent β = 1.3 [95% CI 1.1, 1.6]) and an increased risk of elevated UACR (≥20 mg/g) [adjusted relative risk [95% CI] = 2.3 [1.1, 5.9]) compared with women with neither. After adjusting for potential confounders including prepregnancy BMI and hypertension, GDM without subsequent diabetes was not related to UACR.CONCLUSIONSWomen who develop GDM in pregnancy were more likely to show increased eGFR levels 9–16 years postpartum, which could indicate early stages of glomerular hyperfiltration and renal damage. However, only those who subsequently developed diabetes showed overt renal damage as evidenced by elevated UACR.
      Keywords: Pregnancy-Clinical/Epidemiology, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2629
      Issue No: Vol. 41, No. 7 (2018)
       
  • Neonatal Hypoglycemia Following Diet-Controlled and Insulin-Treated
           Gestational Diabetes Mellitus
    • Authors: Voormolen; D. N.; de Wit, L.; van Rijn, B. B.; DeVries, J. H.; Heringa, M. P.; Franx, A.; Groenendaal, F.; Lamain-de Ruiter, M.
      Pages: 1385 - 1390
      Abstract: OBJECTIVETo assess the risk of neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus (GDM) and how it relates to birth weight.RESEARCH DESIGN AND METHODSProspective cohort study included term neonates born after GDM from January 2013 through December 2015 at the University Medical Center Utrecht (Utrecht, the Netherlands). Routine screening of neonatal blood glucose levels was performed at 1, 3, 6, 12, and 24 h after birth. Main outcome measures were neonatal hypoglycemia defined as blood glucose ≤36 mg/dL (severe) and ≤47 mg/dL (mild).RESULTSA total of 506 neonates were included, born after pregnancies complicated by GDM treated either with insulin (22.5%) or without insulin (77.5%). The incidence of mild and severe hypoglycemia was similar in the insulin-treated and diet-controlled groups (33 vs. 35%, P = 0.66; and 20 vs. 21%, P = 0.79). A birth weight>90th centile was seen in 17.2% of all infants. Although children with a birth weight>90th centile had the highest risk for hypoglycemia, the vast majority of hypoglycemia (78.6%) was detected in those with a birth weight
      Keywords: Pregnancy-Clinical/Epidemiology, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc18-0048
      Issue No: Vol. 41, No. 7 (2018)
       
  • Day-and-Night Closed-Loop Insulin Delivery in a Broad Population of
           Pregnant Women With Type 1 Diabetes: A Randomized Controlled Crossover
           Trial
    • Authors: Stewart; Z. A.; Wilinska, M. E.; Hartnell, S.; ONeil, L. K.; Rayman, G.; Scott, E. M.; Barnard, K.; Farrington, C.; Hovorka, R.; Murphy, H. R.
      Pages: 1391 - 1399
      Abstract: OBJECTIVEDespite advances in technology, optimal glucose control remains elusive and neonatal complications remain ubiquitous in type 1 diabetes (T1D) pregnancy. Our aim was to examine the safety, efficacy, and longer-term feasibility of day-and-night closed-loop insulin delivery.RESEARCH DESIGN AND METHODSWe recruited 16 pregnant women (mean [SD]: age 32.8 [5.0] years, T1D duration 19.4 [10.2] years, HbA1c 8.0% [1.1], and BMI 26.6 [4.4] kg/m2) to an open-label, randomized, crossover trial. Participants completed 28 days of closed-loop and sensor-augmented pump (SAP) insulin delivery separated by a washout period. Afterward, participants could continue to use the closed-loop system up to 6 weeks postpartum. The primary end point was the proportion of time with glucose levels within the target range (63–140 mg/dL).RESULTSThe proportion of time with glucose levels within target was comparable during closed-loop and SAP insulin delivery (62.3 vs. 60.1% [95% CI –4.1 to 8.3]; P = 0.47). Mean glucose and time spent hyperglycemic>140 mg/dL also did not differ (131.4 vs. 131.4 mg/dL [P = 0.85] and 36.6 vs. 36.1% [P = 0.86], respectively). During closed-loop, fewer hypoglycemic episodes occurred (median 8 [range 1–17] vs. 12.5 [1–53] over 28 days; P = 0.04) and less time at
      Keywords: Pregnancy-Basic Science/Translational, Reconsidering Pregnancy with Diabetes
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2534
      Issue No: Vol. 41, No. 7 (2018)
       
  • Decreasing an Offloading Devices Size and Offsetting Its Imposed
           Limb-Length Discrepancy Lead to Improved Comfort and Gait
    • Authors: Crews; R. T.; Candela, J.
      Pages: 1400 - 1405
      Abstract: OBJECTIVEPatient adherence is a challenge in offloading diabetic foot ulcers (DFUs) with removable cast walkers (RCWs). The size and weight of an RCW, changes to gait, and imposed limb-length discrepancies may all discourage adherence. This study sought to determine whether RCW size and provision of a contralateral limb lift affected users’ comfort and gait.RESEARCH DESIGN AND METHODSTwenty-five individuals at risk for DFUs completed several 20-m walking trials under five footwear conditions: bilateral standardized shoes, a knee-high RCW with shoe with or without an external shoe lift contralaterally, and an ankle-high RCW with shoe with or without an external shoe lift contralaterally. Perceived comfort ratings were assessed through the use of visual analog scales. Spatial and temporal parameters of gait were captured by an instrumented walkway, and plantar pressure was measured and recorded using pedobarographic insoles.RESULTSThe bilateral shoes condition was reported to be most comfortable; both RCW conditions without the lift were significantly less comfortable (P < 0.01). In contrast to the ankle-high RCW, the knee-high RCW resulted in significantly slower walking (5.6%; P < 0.01) but greater offloading in multiple forefoot regions of the offloaded foot (6.8–8.1%; P < 0.01). Use of the contralateral shoe lift resulted in significantly less variability in walking velocity (52.8%; P < 0.01) and reduced stance time for the offloaded foot (2.6%; P = 0.01), but it also reduced offloading in multiple forefoot regions of the offloaded foot (3.7–6.0%; P < 0.01).CONCLUSIONSImproved comfort and gait were associated with the ankle-high RCW and contralateral limb lift. Providing this combination to patients with active DFUs may increase offloading adherence and subsequently improve healing.
      Keywords: Foot Care-Lower Extremities
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2584
      Issue No: Vol. 41, No. 7 (2018)
       
  • Hemoglobin A1c Accurately Predicts Continuous Glucose Monitoring-Derived
           Average Glucose in Youth and Young Adults With Cystic Fibrosis
    • Authors: Chan; C. L.; Hope, E.; Thurston, J.; Vigers, T.; Pyle, L.; Zeitler, P. S.; Nadeau, K. J.
      Pages: 1406 - 1413
      Abstract: OBJECTIVEIn cystic fibrosis (CF), hemoglobin A1c (HbA1c) is thought to underestimate glycemia. However, few studies have directly assessed the relationship between HbA1c and average glucose in CF. We determined the relationships among glycemic markers—HbA1c, fructosamine (FA), glycated albumin (%GA), and 1,5-anhydroglucitol (1,5-AG)—and continuous glucose monitoring (CGM) in CF, hypothesizing that alternate markers would better predict average sensor glucose (ASG) than HbA1c.RESEARCH DESIGN AND METHODSCF participants and a group of healthy control subjects (HCs), ages 6–25 years, wore CGM for up to 7 days. Pearson correlations assessed the relationships between CGM variables and HbA1c, FA, %GA, and 1,5-AG. The regression line between HbA1c and ASG was compared in CF versus HC. Linear regressions determined whether alternate markers predicted ASG after adjustment for HbA1c.RESULTSCF (n = 93) and HC (n = 29) groups wore CGM for 5.2 ± 1 days. CF participants were 14 ± 3 years of age and 47% were male, with a BMI z score –0.1 ± 0.8 and no different from HCs in age, sex, or BMI. Mean HbA1c in CF was 5.7 ± 0.8% (39 ± 9 mmol/mol) vs. HC 5.1 ± 0.2% (32 ± 2 mmol/mol) (P < 0.0001). All glycemic markers correlated with ASG (P ≤ 0.01): HbA1c (r = 0.86), FA (r = 0.69), %GA (r = 0.83), and 1,5-AG (r = –0.26). The regression line between ASG and HbA1c did not differ in CF versus HC (P = 0.44). After adjustment for HbA1c, %GA continued to predict ASG (P = 0.0009) in CF.CONCLUSIONSHbA1c does not underestimate ASG in CF as previously assumed. No alternate glycemic marker correlated more strongly with ASG than HbA1c. %GA shows strong correlation with ASG and added to the prediction of ASG beyond HbA1c. However, we are not advocating use of HbA1c for diabetes screening in CF based on these results. Further study will determine whether glycemic measures other than ASG differ among different types of diabetes for a given HbA1c.
      Keywords: Epidemiology-Clinical-Diagnosis and Screening
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2419
      Issue No: Vol. 41, No. 7 (2018)
       
  • Outcomes at 18 Months From a Community Health Worker and Peer Leader
           Diabetes Self-Management Program for Latino Adults
    • Authors: Spencer; M. S.; Kieffer, E. C.; Sinco, B.; Piatt, G.; Palmisano, G.; Hawkins, J.; Lebron, A.; Espitia, N.; Tang, T.; Funnell, M.; Heisler, M.
      Pages: 1414 - 1422
      Abstract: OBJECTIVEThis study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months.RESEARCH DESIGN AND METHODSThe study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months.RESULTSParticipants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (–0.45% [95% CI –0.87, –0.03]; P < 0.05) and in diabetes distress (–0.3 points [95% CI –0.6, –0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (–2.2 points [95% CI –4.1, –0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months.CONCLUSIONSThis study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes.
      Keywords: Diabetes Education
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-0978
      Issue No: Vol. 41, No. 7 (2018)
       
  • Health Care Spending on Diabetes in the U.S., 1996-2013
    • Authors: Squires; E.; Duber, H.; Campbell, M.; Cao, J.; Chapin, A.; Horst, C.; Li, Z.; Matyasz, T.; Reynolds, A.; Hirsch, I. B.; Dieleman, J. L.
      Pages: 1423 - 1431
      Abstract: OBJECTIVEHealth care spending on diabetes in the U.S. has increased dramatically over the past several decades. This research describes health care spending on diabetes to quantify how that spending has changed from 1996 to 2013 and to determine what drivers are increasing spending.RESEARCH DESIGN AND METHODSSpending estimates were extracted from the Institute for Health Metrics and Evaluation’s Disease Expenditure 2013 database. Estimates were produced for each year from 1996 to 2013 for each of 38 age and sex groups and six types of care. Data on disease burden were extracted from the Global Burden of Disease 2016 study. We analyzed the drivers of spending by measuring the impact of population growth and aging and changes in diabetes prevalence, service utilization, and spending per encounter.RESULTSSpending on diabetes in the U.S. increased from $37 billion (95% uncertainty interval $32–$42 billion) in 1996 to $101 billion ($97–$107 billion) in 2013. The greatest amount of health care spending on diabetes in 2013 occurred in prescribed retail pharmaceuticals (57.6% [53.8–62.1%] of spending growth) followed by ambulatory care (23.5% [21.7–25.7%]). Between 1996 and 2013, pharmaceutical spending increased by 327.0% (222.9–456.6%). This increase can be attributed to changes in demography, increased disease prevalence, increased service utilization, and, especially, increases in spending per encounter, which increased pharmaceutical spending by 144.0% (87.3–197.3%) between 1996 and 2013.CONCLUSIONSHealth care spending on diabetes in the U.S. has increased, and spending per encounter has been the biggest driver. This information can help policy makers who are attempting to control future spending on diabetes.
      Keywords: Health Care Delivery-Economics
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-1376
      Issue No: Vol. 41, No. 7 (2018)
       
  • Type 2 Diabetes in Relation to the Risk of Renal Cell Carcinoma Among Men
           and Women in Two Large Prospective Cohort Studies
    • Authors: Graff; R. E.; Sanchez, A.; Tobias, D. K.; Rodriguez, D.; Barrisford, G. W.; Blute, M. L.; Li, Y.; Sun, Q.; Preston, M. A.; Wilson, K. M.; Cho, E.
      Pages: 1432 - 1437
      Abstract: OBJECTIVEWe assessed whether type 2 diabetes is associated with renal cell carcinoma (RCC), independent of key potential confounders, in two large prospective cohorts with biennially updated covariate data.RESEARCH DESIGN AND METHODSA total of 117,570 women from the Nurses’ Health Study (NHS) and 48,866 men from the Health Professionals Follow-Up Study (HPFS) were followed from 1976 and 1986, respectively, through 2014. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs for associations between type 2 diabetes and pathology-confirmed RCC, overall and by stage, grade, and histologic subtype.RESULTSDuring 38 years of follow-up in the NHS, we confirmed 418 RCC case subjects, including 120 fatal cases. Over 28 years in the HPFS, we confirmed 302 RCC case subjects, including 87 fatal cases. Women with type 2 diabetes had a significantly increased risk of RCC compared with women without type 2 diabetes (multivariable HR 1.53; 95% CI 1.14–2.04), with some evidence that the association was stronger for ≤5 (HR 2.15; 95% CI 1.44–3.23) than>5 (HR 1.22; 95% CI 0.84–1.78) years’ duration of type 2 diabetes (Pdifference 0.03). Among men, type 2 diabetes was not associated with total RCC (HR 0.89; 95% CI 0.56–1.41) or with RCC defined by stage, grade, or subtype. Sample sizes for analyses by stage, grade, and subtype were limited.CONCLUSIONSWe found that type 2 diabetes was independently associated with a greater risk of RCC in women but not in men.
      Keywords: Epidemiology-Other
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2518
      Issue No: Vol. 41, No. 7 (2018)
       
  • Using Indirect Measures to Identify Geographic Hot Spots of Poor Glycemic
           Control: Cross-sectional Comparisons With an A1C Registry
    • Authors: Lee; D. C.; Jiang, Q.; Tabaei, B. P.; Elbel, B.; Koziatek, C. A.; Konty, K. J.; Wu, W. Y.
      Pages: 1438 - 1447
      Abstract: OBJECTIVEFocusing health interventions in places with suboptimal glycemic control can help direct resources to neighborhoods with poor diabetes-related outcomes, but finding these areas can be difficult. Our objective was to use indirect measures versus a gold standard, population-based A1C registry to identify areas of poor glycemic control.RESEARCH DESIGN AND METHODSCensus tracts in New York City (NYC) were characterized by race, ethnicity, income, poverty, education, diabetes-related emergency visits, inpatient hospitalizations, and proportion of adults with diabetes having poor glycemic control, based on A1C>9.0% (75 mmol/mol). Hot spot analyses were then performed, using the Getis-Ord Gi* statistic for all measures. We then calculated the sensitivity, specificity, positive and negative predictive values, and accuracy of using the indirect measures to identify hot spots of poor glycemic control found using the NYC A1C Registry data.RESULTSUsing A1C Registry data, we identified hot spots in 42.8% of 2,085 NYC census tracts analyzed. Hot spots of diabetes-specific inpatient hospitalizations, diabetes-specific emergency visits, and age-adjusted diabetes prevalence estimated from emergency department data, respectively, had 88.9%, 89.6%, and 89.5% accuracy for identifying the same hot spots of poor glycemic control found using A1C Registry data. No other indirect measure tested had accuracy>80% except for the proportion of minority residents, which had 86.2% accuracy.CONCLUSIONSCompared with demographic and socioeconomic factors, health care utilization measures more accurately identified hot spots of poor glycemic control. In places without a population-based A1C registry, mapping diabetes-specific health care utilization may provide actionable evidence for targeting health interventions in areas with the highest burden of uncontrolled diabetes.
      Keywords: Epidemiology-Other
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc18-0181
      Issue No: Vol. 41, No. 7 (2018)
       
  • Risk of Type 2 Diabetes Among Lesbian, Bisexual, and Heterosexual Women:
           Findings From the Nurses Health Study II
    • Authors: Corliss; H. L.; VanKim, N. A.; Jun, H.-J.; Austin, S. B.; Hong, B.; Wang, M.; Hu, F. B.
      Pages: 1448 - 1454
      Abstract: OBJECTIVELesbian and bisexual (LB) women are more likely than heterosexual women to exhibit risk factors for type 2 diabetes, but studies estimating the burden of type 2 diabetes among LB women are uncommon and limited to cross-sectional designs. This study investigated incidence of type 2 diabetes in LB women and heterosexual women in a large, longitudinal U.S. cohort.RESEARCH DESIGN AND METHODSWomen participating in the Nurses’ Health Study II (NHS II) ages 24–44 years in 1989 were prospectively followed through 2013. Self-reported clinician diagnosis of type 2 diabetes was assessed every other year to identify incidence. Of the participants, 1,267 identified as lesbian or bisexual and 92,983 identified as heterosexual. Cox proportional hazards regression was used to model incidence of type 2 diabetes.RESULTSLB women had a 27% higher risk of developing type 2 diabetes than heterosexual women (adjusted incidence rate ratio [IRR] 1.27, 95% CI 1.05, 1.54). Differences between LB women and heterosexual women in risk of type 2 diabetes were greater during younger ages (sexual orientation–by-age interaction, P < 0.001). BMI mediated the relationship between sexual orientation and type 2 diabetes; the IRR was completely attenuated when BMI was added to the model (IRR 0.85, 95% CI 0.70, 1.03).CONCLUSIONSFindings indicate that LB women develop type 2 diabetes at younger ages than heterosexual women. Higher BMI in LB women is an important contributor to this disparity. Public health and clinical efforts to prevent, detect, and manage obesity and type 2 diabetes among LB women are warranted.
      Keywords: Epidemiology-Other
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2656
      Issue No: Vol. 41, No. 7 (2018)
       
  • Diabetes-Attributable Nursing Home Costs for Each U.S. State
    • Authors: Neuwahl; S. J.; Honeycutt, A. A.; Poehler, D. C.; Shrestha, S. S.; Zhang, P.; Hoerger, T. J.
      Pages: 1455 - 1461
      Abstract: OBJECTIVETo estimate the diabetes-attributable nursing home costs for each state.RESEARCH DESIGN AND METHODSWe used a diabetes-attributable fraction (AF) approach to estimate nursing home costs attributable to diabetes (in 2013 dollars) in aggregate and per person with diabetes in each state. We calculated the AFs as the difference in diabetes prevalence between nursing homes and the community. We used the Centers for Medicare & Medicaid Services 2013–2015 Minimum Data Set to estimate the prevalence of diabetes in nursing homes and to adjust for the intensity of care among people with diabetes in nursing homes. Community prevalence was estimated using the Behavioral Risk Factor Surveillance System (BRFSS). State nursing home expenditures were from the 2013 State Health Expenditure Accounts.RESULTSThe fraction of total nursing home expenditures attributable to diabetes ranged from 12.3% (Illinois) to 22.5% (Washington, DC; median AF of 15.6%, New Jersey). The median AF was highest in the 19–64 years age-group and lowest in the 85 years or older age-group. Nationally, diabetes-attributable nursing home costs were $18.6 billion. State-level diabetes-attributable costs ranged from $21 million in Alaska to $2.0 billion in California. Diabetes-attributable nursing home costs per person ranged from $374 in New Mexico to $1,610 in Washington, DC (median of $799 in Maine).CONCLUSIONSOur estimates provide state policymakers with an improved understanding of the economic burden of diabetes in each state’s nursing homes. These estimates could serve as critical inputs for planning and evaluating diabetes prevention and management interventions that can keep people healthier and living longer in their communities.
      Keywords: Health Care Delivery-Economics
      PubDate: 2018-06-22T12:05:02-07:00
      DOI: 10.2337/dc17-2028
      Issue No: Vol. 41, No. 7 (2018)
       
  • Long-term Outcomes of Lifestyle Intervention to Prevent Diabetes in
           American Indian and Alaska Native Communities: The Special Diabetes
           Program for Indians Diabetes Prevention Program
    • Authors: Jiang; L.; Johnson, A.; Pratte, K.; Beals, J.; Bullock, A.; Manson, S. M.; the Special Diabetes Program for Indians Diabetes Prevention Program
      Pages: 1462 - 1470
      Abstract: OBJECTIVEEvidence for long-term translational effectiveness of lifestyle interventions in minority populations is scarce. This article reports long-term outcomes, for up to 10 years, of such an intervention to prevent diabetes in American Indian and Alaska Native (AI/AN) communities.RESEARCH DESIGN AND METHODSFrom January 2006 to July 2016, the Special Diabetes Program for Indians Diabetes Prevention Program implemented the Diabetes Prevention Program lifestyle intervention among 46 AI/AN health care programs. Enrolled participants underwent a thorough clinical assessment at baseline, after completing the Lifestyle Balance Curriculum (postcurriculum assessment), and annually thereafter. Proportional hazards regression was used to estimate the association between diabetes incidence and postcurriculum weight loss status.RESULTSOf 8,652 enrolled participants, 65% finished the postcurriculum assessment. The assessment completion rate diminished over time to 13% in year 10. Among those with postcurriculum weight measurements, 2,028 (36%) lost>5% of their initial weight, 978 (17%) lost 3–5%, whereas 2,604 (47%) had
      Keywords: Epidemiology-Other
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-2685
      Issue No: Vol. 41, No. 7 (2018)
       
  • Randomized Outpatient Trial of Single- and Dual-Hormone Closed-Loop
           Systems That Adapt to Exercise Using Wearable Sensors
    • Authors: Castle; J. R.; El Youssef, J.; Wilson, L. M.; Reddy, R.; Resalat, N.; Branigan, D.; Ramsey, K.; Leitschuh, J.; Rajhbeharrysingh, U.; Senf, B.; Sugerman, S. M.; Gabo, V.; Jacobs, P. G.
      Pages: 1471 - 1477
      Abstract: OBJECTIVEAutomated insulin delivery is the new standard for type 1 diabetes, but exercise-related hypoglycemia remains a challenge. Our aim was to determine whether a dual-hormone closed-loop system using wearable sensors to detect exercise and adjust dosing to reduce exercise-related hypoglycemia would outperform other forms of closed-loop and open-loop therapy.RESEARCH DESIGN AND METHODSParticipants underwent four arms in randomized order: dual-hormone, single-hormone, predictive low glucose suspend, and continuation of current care over 4 outpatient days. Each arm included three moderate-intensity aerobic exercise sessions. The two primary outcomes were percentage of time in hypoglycemia (
      Keywords: Clinical Therapeutics/New Technology-Insulin Delivery Systems
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0228
      Issue No: Vol. 41, No. 7 (2018)
       
  • Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers
    • Authors: Fesseha; B. K.; Abularrage, C. J.; Hines, K. F.; Sherman, R.; Frost, P.; Langan, S.; Canner, J.; Likes, K. C.; Hosseini, S. M.; Jack, G.; Hicks, C. W.; Yalamanchi, S.; Mathioudakis, N.
      Pages: 1478 - 1485
      Abstract: OBJECTIVEThis study evaluated the association between hemoglobin A1c (A1C) and wound outcomes in patients with diabetic foot ulcers (DFUs).RESEARCH DESIGN AND METHODSWe conducted a retrospective analysis of an ongoing prospective, clinic-based study of patients with DFUs treated at an academic institution during a 4.7-year period. Data from 270 participants and 584 wounds were included in the analysis. Cox proportional hazards regression was used to assess the incidence of wound healing at any follow-up time in relation to categories of baseline A1C and the incidence of long-term (≥90 days) wound healing in relation to tertiles of nadir A1C change and mean A1C change from baseline, adjusted for potential confounders.RESULTSBaseline A1C was not associated with wound healing in univariate or fully adjusted models. Compared with a nadir A1C change from baseline of –0.29 to 0.0 (tertile 2), a nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing in the subset of participants with baseline A1C
      Keywords: Foot Care-Lower Extremities
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-1683
      Issue No: Vol. 41, No. 7 (2018)
       
  • C-Peptide Decline in Type 1 Diabetes Has Two Phases: An Initial
           Exponential Fall and a Subsequent Stable Phase
    • Authors: Shields; B. M.; McDonald, T. J.; Oram, R.; Hill, A.; Hudson, M.; Leete, P.; Pearson, E. R.; Richardson, S. J.; Morgan, N. G.; Hattersley, A. T.; on behalf of the TIGI Consortium
      Pages: 1486 - 1492
      Abstract: OBJECTIVEThe decline in C-peptide in the 5 years after diagnosis of type 1 diabetes has been well studied, but little is known about the longer-term trajectory. We aimed to examine the association between log-transformed C-peptide levels and the duration of diabetes up to 40 years after diagnosis.RESEARCH DESIGN AND METHODSWe assessed the pattern of association between urinary C-peptide/creatinine ratio (UCPCR) and duration of diabetes in cross-sectional data from 1,549 individuals with type 1 diabetes using nonlinear regression approaches. Findings were replicated in longitudinal follow-up data for both UCPCR (n = 161 individuals, 326 observations) and plasma C-peptide (n = 93 individuals, 473 observations).RESULTSWe identified two clear phases of C-peptide decline: an initial exponential fall over 7 years (47% decrease/year [95% CI –51, –43]) followed by a stable period thereafter (+0.07%/year [–1.3, +1.5]). The two phases had similar durations and slopes in patients above and below the median age at diagnosis (10.8 years), although levels were lower in the younger patients irrespective of duration. Patterns were consistent in both longitudinal UCPCR (n = 162; ≤7 years duration: –48%/year [–55, –38];>7 years duration –0.1% [–4.1, +3.9]) and plasma C-peptide (n = 93;>7 years duration only: –2.6% [–6.7, +1.5]).CONCLUSIONSThese data support two clear phases of C-peptide decline: an initial exponential fall over a 7-year period, followed by a prolonged stabilization where C-peptide levels no longer decline. Understanding the pathophysiological and immunological differences between these two phases will give crucial insights into understanding β-cell survival.
      Keywords: Integrated Physiology-Insulin Secretion In Vivo
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0465
      Issue No: Vol. 41, No. 7 (2018)
       
  • Higher Collagen VI Formation Is Associated With All-Cause Mortality in
           Patients With Type 2 Diabetes and Microalbuminuria
    • Authors: Rasmussen; D. G. K.; Hansen, T. W.; von Scholten, B. J.; Nielsen, S. H.; Reinhard, H.; Parving, H.-H.; Tepel, M.; Karsdal, M. A.; Jacobsen, P. K.; Genovese, F.; Rossing, P.
      Pages: 1493 - 1500
      Abstract: OBJECTIVEType 2 diabetes is a common risk factor for the development of chronic kidney disease (CKD). Enhanced de novo collagen type VI (COL VI) formation has been associated with renal fibrosis and CKD. We investigated the hypothesis that PRO-C6, a product specifically generated during COL VI formation, is prognostic for adverse outcomes in patients with type 2 diabetes and microalbuminuria.RESEARCH DESIGN AND METHODSIn a prospective, observational study, we measured PRO-C6 in the serum (S-PRO-C6) and urine (U-PRO-C6) of 198 patients with type 2 diabetes and microalbuminuria without symptoms of coronary artery disease. Patients were followed for a median of 6.5 years, and end points were a composite of cardiovascular events (n = 38), all-cause mortality (n = 26), and reduction of estimated glomerular filtration rate (eGFR) of>30% (disease progression [n = 42]). Cox models were unadjusted and adjusted for the conventional risk factors of sex, age, BMI, systolic blood pressure, LDL cholesterol, smoking, HbA1c, plasma creatinine, and urinary albumin excretion rate.RESULTSDoubling of S-PRO-C6 increased hazards for cardiovascular events (hazard ratio 3.06 [95% CI 1.31–7.14]), all-cause mortality (6.91 [2.96–16.11]), and disease progression (4.81 [1.92–12.01]). Addition of S-PRO-C6 to a model containing conventional risk factors improved relative integrated discrimination by 22.5% for cardiovascular events (P = 0.02), 76.8% for all-cause mortality (P = 0.002), and 53.3% for disease progression (P = 0.004). U-PRO-C6 was not significantly associated with any of the outcomes.CONCLUSIONSS-PRO-C6 generated during COL VI formation predicts cardiovascular events, all-cause mortality, and disease progression in patients with type 2 diabetes and microalbuminuria.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-2392
      Issue No: Vol. 41, No. 7 (2018)
       
  • Metabolic Syndrome and Neurocognition Among Diverse Middle-Aged and Older
           Hispanics/Latinos: HCHS/SOL Results
    • Authors: Gonzalez; H. M.; Tarraf, W.; Vasquez, P.; Sanderlin, A. H.; Rosenberg, N. I.; Davis, S.; Rodriguez, C. J.; Gallo, L. C.; Thyagarajan, B.; Daviglus, M.; Khambaty, T.; Cai, J.; Schneiderman, N.
      Pages: 1501 - 1509
      Abstract: OBJECTIVEHispanics/Latinos have the highest risks for metabolic syndrome (MetS) in the U.S. and are also at increased risk for Alzheimer disease. In this study, we examined associations among neurocognitive function, MetS, and inflammation among diverse middle-aged and older Hispanics/Latinos.RESEARCH DESIGN AND METHODSCross-sectional data (2008–2011) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analyzed to examine associations between neurocognition and MetS among diverse Hispanics/Latinos (N = 9,136; aged 45–74 years).RESULTSMetS status was associated with lower global neurocognition, mental status, verbal learning and memory, verbal fluency, and executive function. Age significantly modified the associations between MetS and learning and memory measures. Significant associations between MetS and neurocognition were observed among middle-aged Hispanics/Latinos, and all associations remained robust to additional covariates adjustment.CONCLUSIONSWe found that MetS was associated with lower neurocognitive function, particularly in midlife. Our findings support and extend current hypotheses that midlife may be a particularly vulnerable developmental period for unhealthy neurocognitive aging.
      Keywords: Epidemiology-Aging
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-1896
      Issue No: Vol. 41, No. 7 (2018)
       
  • Serial Measurement of Natriuretic Peptides and Cardiovascular Outcomes in
           Patients With Type 2 Diabetes in the EXAMINE Trial
    • Authors: Jarolim; P.; White, W. B.; Cannon, C. P.; Gao, Q.; Morrow, D. A.
      Pages: 1510 - 1515
      Abstract: OBJECTIVEPatients with type 2 diabetes are at increased risk of developing heart failure (HF). Enhanced recognition of patients at risk for HF would help guide therapeutic decisions.RESEARCH DESIGN AND METHODSWe investigated the prognostic implications of changes in N-terminal B-type natriuretic peptide (NT-proBNP) concentration in patients with type 2 diabetes and ischemic heart disease who were enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial, a phase 3b trial of alogliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor. Patients with type 2 diabetes and a recent acute coronary syndrome event were eligible. NT-proBNP was measured at baseline and 6 months. Cardiovascular (CV) death or hospitalization for HF was the end point of principal interest for this analysis.RESULTSWe observed a strong graded relationship between increasing baseline and 6-month NT-proBNP concentration and the incidence of major CV events (P < 0.001). After adjusting for potential confounders, NT-proBNP at baseline was independently associated with the development of major CV events, in particular hospitalization for HF. Patients who had persistently high NT-proBNP (P < 0.001) or developed high NT-proBNP at 6 months (P < 0.001) were at a significantly higher risk for CV death/HF than those in whom NT-proBNP remained low at both time points or who had a high NT-proBNP value at baseline that subsequently declined to the low category. Absolute changes in NT-proBNP by 6 months were also strongly associated with subsequent outcomes. Treatment with a DPP-4 inhibitor did not meaningfully alter NT-proBNP concentrations (P = 0.20).CONCLUSIONSSerial monitoring of NT-proBNP in patients with type 2 diabetes and ischemic heart disease may be useful for identifying patients at highest risk for HF.
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-0109
      Issue No: Vol. 41, No. 7 (2018)
       
  • Hypogonadotropic Hypogonadism in Men With Diabesity
    • Authors: Dhindsa; S.; Ghanim, H.; Batra, M.; Dandona, P.
      Pages: 1516 - 1525
      Abstract: One-third of men with obesity or type 2 diabetes have subnormal free testosterone concentrations. The lower free testosterone concentrations are observed in obese men at all ages, including adolescents at completion of puberty. The gonadotropin concentrations in these males are inappropriately normal; thus, these patients have hypogonadotropic hypogonadism (HH). The causative mechanism of diabesity-induced HH is yet to be defined but is likely multifactorial. Decreased insulin and leptin signaling in the central nervous system are probably significant contributors. Contrary to popular belief, estrogen concentrations are lower in men with HH. Men with diabesity and HH have more fat mass and are more insulin resistant than eugonadal men. In addition, they have a high prevalence of anemia and higher mortality rates than eugonadal men. Testosterone replacement therapy results in a loss of fat mass, gain in lean mass, and increase in insulin sensitivity in men with diabesity and HH. This is accompanied by an increase in insulin-signaling genes in adipose tissue and a reduction in inflammatory mediators that interfere with insulin signaling. There is also an improvement in sexual symptoms, anemia, LDL cholesterol, and lipoprotein (a). However, testosterone therapy does not consistently affect HbA1c in men with diabetes. The effect of testosterone replacement on cardiovascular events or mortality in men with diabesity is not known and remains to be studied in prospective trials.
      Keywords: Obesity-Human
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-2510
      Issue No: Vol. 41, No. 7 (2018)
       
  • Global Diabetes Prevention Interventions: A Systematic Review and Network
           Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose
    • Authors: Galaviz; K. I.; Weber, M. B.; Straus, A.; Haw, J. S.; Narayan, K. M. V.; Ali, M. K.
      Pages: 1526 - 1534
      Abstract: OBJECTIVEUnderstanding the real-world impacts of lifestyle modification (LSM) for diabetes prevention is imperative to inform resource allocation. The purpose of this study was to synthetize global evidence on the impact of LSM strategies on diabetes incidence and risk factors in one parsimonious model.RESEARCH DESIGN AND METHODSPubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for studies published between January 1990 and April 2015. Effectiveness/translation studies of any design testing LSM strategies, targeting high-risk populations (with prediabetes or diabetes risk factors), and reporting diabetes incidence, weight, or glucose outcomes were included. We extracted number of diabetes cases/incidence rates and mean changes in weight (kg), fasting blood glucose (FBG, mmol/L), 2-h postload glucose (mmol/L), and hemoglobin A1c (%). Pairwise random-effects and frequentist random-effects network meta-analyses were used to obtain pooled effects.RESULTSSixty-three studies were pooled in the meta-analysis (n = 17,272, mean age 49.7 years, 28.8% male, 60.8% white/European). In analyses restricted to controlled studies (n = 7), diabetes cumulative incidence was 9% among intervention participants and 12% among control participants (absolute risk reduction 3%; relative risk 0.71 [95% CI 0.58, 0.88]). In analyses combining controlled and uncontrolled studies (n = 14), participants receiving group education by health care professionals had 33% lower diabetes odds than control participants (odds ratio 0.67 [0.49, 0.92]). Intervention participants lost 1.5 kg more weight [–2.2, –0.8] and achieved a 0.09 mmol/L greater FBG decrease [–0.15, –0.03] than control participants. Every additional kilogram lost by participants was associated with 43% lower diabetes odds (β = 0.57 [0.41, 0.78]).CONCLUSIONSReal-world LSM strategies can reduce diabetes risk, even with small weight reductions.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-2222
      Issue No: Vol. 41, No. 7 (2018)
       
  • Large Changes in Brain Volume Observed in an Asymptomatic Young Child With
           Type 1 Diabetes
    • Authors: Mazaika; P. K.; Aye, T.; Reiss, A. L.; Buckingham, B. A.
      Pages: 1535 - 1537
      Keywords: Pediatrics-Type 1 Diabetes
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc17-2503
      Issue No: Vol. 41, No. 7 (2018)
       
  • Erratum. Impact of Liraglutide on Amylase, Lipase, and Acute Pancreatitis
           in Participants With Overweight/Obesity and Normoglycemia, Prediabetes, or
           Type 2 Diabetes: Secondary Analyses of Pooled Data From the SCALE Clinical
           Development Program. Diabetes Care 2017;40:839-848
    • Authors: Steinberg; W. M.; Rosenstock, J.; Wadden, T. A.; Donsmark, M.; Jensen, C. B.; DeVries, J. H.
      Pages: 1538 - 1538
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-er07
      Issue No: Vol. 41, No. 7 (2018)
       
  • Issues and Events
    • Pages: 1539 - 1539
      PubDate: 2018-06-22T12:05:03-07:00
      DOI: 10.2337/dc18-ie07
      Issue No: Vol. 41, No. 7 (2018)
       
 
 
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