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Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 498  
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ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • HbA1c, Insulin Resistance, and {beta}-Cell Function in Relation to
           Cognitive Function in Type 2 Diabetes: The CAROLINA Cognition Substudy
    • Authors: Janssen; J.; van den Berg, E.; Zinman, B.; Espeland, M. A.; Geijselaers, S. L. C.; Mattheus, M.; Johansen, O. E.; Biessels, G. J.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/DC18-0914
      Issue No: Vol. 42, No. 1 (2018)
  • CKD273 Enables Efficient Prediction of Diabetic Nephropathy in
           Nonalbuminuric Patients
    • Authors: Zürbig; P.; Mischak, H.; Menne, J.; Haller, H.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1322
      Issue No: Vol. 42, No. 1 (2018)
  • Plasma Glucose Level as a Predictor of In-Hospital Mortality in Patients
           at an Emergency Room: A Retrospective Cohort Study
    • Authors: Yoshinaga; R.; Ishikawa, S.; Ayukawa, K.; Doi, Y.
      Keywords: Epidemiology-Other
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1978
      Issue No: Vol. 42, No. 1 (2018)
  • Comment on Wang et al. Incretin-Based Therapies and Diabetic Retinopathy:
    • Authors: Feldman-Billard S.
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1825
      Issue No: Vol. 42, No. 1 (2018)
  • Comment on Li et al. Visual Inspection of Chromatograms Assists
           Interpretation of HbA1c: A Case Report. Diabetes Care 2018;41:1829-1830
    • Authors: Li; J.; Lei, J.; Xu, A.-p.; Xia, Y.; Ji, L.
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1836
      Issue No: Vol. 42, No. 1 (2018)
  • Response to Comment on Li et al. Visual Inspection of Chromatograms
           Assists Interpretation of HbA1c: A Case Report. Diabetes Care
    • Authors: Li; Q.; Xiao, Y.; Shah, A. D.; Li, S.
      Keywords: Clinical Therapeutics/New Technology-Glucose Monitoring and Sensing
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dci18-0038
      Issue No: Vol. 42, No. 1 (2018)
  • Comment on Cheung and Moses. Gestational Diabetes Mellitus: Is It Time to
           Reconsider the Diagnostic Criteria' Diabetes Care 2018;41:1337-1338
    • Authors: Sacks D. A.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1941
      Issue No: Vol. 42, No. 1 (2018)
  • Response to Comment on Cheung and Moses. Gestational Diabetes Mellitus: Is
           It Time to Reconsider the Diagnostic Criteria' Diabetes Care
    • Authors: Cheung; N. W.; Moses, R. G.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dci18-0045
      Issue No: Vol. 42, No. 1 (2018)
  • Comment on Umpierrez and Klonoff. Diabetes Technology Update: Use of
           Insulin Pumps and Continuous Glucose Monitoring in the Hospital. Diabetes
           Care 2018;41:1579-1589
    • Authors: Delgado-Hurtado; J. J.; Armstrong, A.; Chaidarun, S.
      Keywords: Clinical Therapeutics/New Technology-Insulin Delivery Systems
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1929
      Issue No: Vol. 42, No. 1 (2018)
  • Response to Comment on Umpierrez and Klonoff. Diabetes Technology Update:
           Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital.
           Diabetes Care 2018;41:1579-1589
    • Authors: Umpierrez; G. E.; Klonoff, D. C.
      Keywords: Clinical Therapeutics/New Technology-Glucose Monitoring and Sensing
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dci18-0043
      Issue No: Vol. 42, No. 1 (2018)
  • In This Issue of Diabetes Care
    • Pages: 1 - 2
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc19-ti01
      Issue No: Vol. 42, No. 1 (2018)
  • The Effect of a Smartphone-Based, Patient-Centered Diabetes Care System in
           Patients With Type 2 Diabetes: A Randomized, Controlled Trial for 24 Weeks
    • Authors: Kim; E. K.; Kwak, S. H.; Jung, H. S.; Koo, B. K.; Moon, M. K.; Lim, S.; Jang, H. C.; Park, K. S.; Cho, Y. M.
      Pages: 3 - 9
      Abstract: OBJECTIVEThis study evaluated the efficacy of a smartphone-based, patient-centered diabetes care system (mDiabetes) for type 2 diabetes that contains comprehensive modules for glucose monitoring, diet, physical activity, and a clinical decision support system.RESEARCH DESIGN AND METHODSWe conducted a 24-week, multicenter, randomized controlled trial with adult patients with inadequately controlled type 2 diabetes. The patients were randomly assigned to the mDiabetes group or the paper logbook (pLogbook) group. The primary end point was the difference of the change in HbA1c from baseline between the two groups.RESULTSHbA1c reduction from baseline was greater in the mDiabetes group (–0.40 ± 0.09%, n = 90) than in the pLogbook group (–0.06 ± 0.10%, n = 82). The difference of adjusted mean changes was 0.35% (95% CI 0.14–0.55, P = 0.001). The proportion of patients whose HbA1c fell below 7.0% (53 mmol/mol) was 41.1% for the mDiabetes group and 20.7% for the pLogbook group (odds ratio [OR] 2.01, 95% CI 1.24–3.25, P = 0.003). The percentage of patients who attained HbA1c levels below 7.0% (53 mmol/mol) without hypoglycemia was 31.1% in the mDiabetes group and 17.1% in the pLogbook group (OR 1.82, 95% CI 1.03–3.21, P = 0.024). There was no difference in the event numbers of severe hyperglycemia and hypoglycemia between the two groups.CONCLUSIONSThe implementation of the mDiabetes for patients with inadequately controlled type 2 diabetes resulted in a significant reduction in HbA1c levels, with tolerable safety profiles.
      Keywords: Clinical Therapeutics/New Technology-Glucose Monitoring and Sensing
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc17-2197
      Issue No: Vol. 42, No. 1 (2018)
  • Optimal Insulin Correction Factor in Post-High-Intensity Exercise
           Hyperglycemia in Adults With Type 1 Diabetes: The FIT Study
    • Authors: Aronson; R.; Brown, R. E.; Li, A.; Riddell, M. C.
      Pages: 10 - 16
      Abstract: OBJECTIVEPostexercise hyperglycemia, following high-intensity interval training (HIIT) in patients with type 1 diabetes (T1D), is largely underrecognized by the clinical community and generally undertreated. The aim of this study was to compare four multipliers of an individual’s insulin correction factor (ICF) to treat post-HIIT hyperglycemia.RESEARCH DESIGN AND METHODSThe FIT study had a randomized, crossover design in physically active subjects with T1D (mean ± SD age 34.9 ± 10.1 years, BMI 25.5 ± 2.5 kg/m2, and HbA1c 7.2 ± 0.9%) using multiple daily injections. Following an 8-week optimization period, with 300 units/mL insulin glargine used as the basal insulin, subjects performed four weekly sessions of 25 min of HIIT. If hyperglycemia (>8.0 mmol/L) resulted, subjects received a bolus insulin correction 15 min post-HIIT, based on their own ICF, adjusted by one of four multipliers: 0, 50, 100, or 150%.RESULTSSeventeen subjects completed 71 exercise trials, of which 64 (90%) resulted in hyperglycemia. At 40 min postexercise, plasma glucose (PG) increased from mean ± SD 8.8 ± 1.0 mmol/L at baseline to 12.7 ± 2.4 mmol/L (increase of 3.8 ± 1.5 mmol/L). After correction, adjusted mean ± SE PG was significantly reduced for the 50% (–2.3 ± 0.8 mmol/L, P < 0.01), 100% (–4.7 ± 0.8 mmol/L, P < 0.001), and 150% (–5.3 ± 0.8 mmol/L, P < 0.001) arms but had increased further in the 0% correction arm. Both the 100 and 150% corrections were more effective than the 50% correction (P < 0.01 and P < 0.001, respectively) but were not different from each other. Hypoglycemia was rare.CONCLUSIONSIn post-HIIT hyperglycemia, correction based on a patient’s usual ICF is safe and effective. Optimal PG reduction, with minimal hypoglycemia, occurred in the 100 and 150% correction arms.
      Keywords: Exercise
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1475
      Issue No: Vol. 42, No. 1 (2018)
  • Plasma Fucosylated Glycans and C-Reactive Protein as Biomarkers of
           HNF1A-MODY in Young Adult-Onset Nonautoimmune Diabetes
    • Authors: Juszczak; A.; Pavic, T.; Vuckovic, F.; Bennett, A. J.; Shah, N.; Pape Medvidovic, E.; Groves, C. J.; Sekerija, M.; Chandler, K.; Burrows, C.; Rojnic Putarek, N.; Vucic Lovrencic, M.; Cuca Knezevic, J.; James, T. J.; Gloyn, A. L.; Lauc, G.; McCarthy, M. I.; Owen, K. R.; Gornik, O.
      Pages: 17 - 26
      Abstract: OBJECTIVEMaturity-onset diabetes of the young (MODY) due to variants in HNF1A is the most common type of monogenic diabetes. Frequent misdiagnosis results in missed opportunity to use sulfonylureas as first-line treatment. A nongenetic biomarker could improve selection of subjects for genetic testing and increase diagnosis rates. We previously reported that plasma levels of antennary fucosylated N-glycans and high-sensitivity C-reactive protein (hs-CRP) are reduced in individuals with HNF1A-MODY. In this study, we examined the potential use of N-glycans and hs-CRP in discriminating individuals with damaging HNF1A alleles from those without HNF1A variants in an unselected population of young adults with nonautoimmune diabetes.RESEARCH DESIGN AND METHODSWe analyzed the plasma N-glycan profile, measured hs-CRP, and sequenced HNF1A in 989 individuals with diabetes diagnosed when younger than age 45, persistent endogenous insulin production, and absence of pancreatic autoimmunity. Systematic assessment of rare HNF1A variants was performed.RESULTSWe identified 29 individuals harboring 25 rare HNF1A alleles, of which 3 were novel, and 12 (in 16 probands) were considered pathogenic. Antennary fucosylated N-glycans and hs-CRP were able to differentiate subjects with damaging HNF1A alleles from those without rare HNF1A alleles. Glycan GP30 had a receiver operating characteristic curve area under the curve (AUC) of 0.90 (88% sensitivity, 80% specificity, cutoff 0.70%), whereas hs-CRP had an AUC of 0.83 (88% sensitivity, 69% specificity, cutoff 0.81 mg/L).CONCLUSIONSHalf of rare HNF1A sequence variants do not cause MODY. N-glycan profile and hs-CRP could both be used as tools, alone or as adjuncts to existing pathways, for identifying individuals at high risk of carrying a damaging HNF1A allele.
      Keywords: Epidemiology-Clinical-Diagnosis and Screening
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-0422
      Issue No: Vol. 42, No. 1 (2018)
  • Decreasing Cumulative Incidence of End-Stage Renal Disease in Young
           Patients With Type 1 Diabetes in Sweden: A 38-Year Prospective Nationwide
    • Authors: Toppe; C.; Möllsten, A.; Waernbaum, I.; Schön, S.; Gudbjörnsdottir, S.; Landin-Olsson, M.; Dahlquist, G.; for the Swedish Childhood Diabetes Study Group the Swedish Renal Register; Swedish Childhood Diabetes Study Group
      Pages: 27 - 31
      Abstract: OBJECTIVEDiabetic nephropathy is a serious complication of type 1 diabetes. Recent studies indicate that end-stage renal disease (ESRD) incidence has decreased or that the onset of ESRD has been postponed; therefore, we wanted to analyze the incidence and time trends of ESRD in Sweden.RESEARCH DESIGN AND METHODSIn this study, patients with duration of type 1 diabetes>14 years and age at onset of diabetes 0–34 years were included. Three national diabetes registers were used: the Swedish Childhood Diabetes Register, the Diabetes Incidence Study in Sweden, and the National Diabetes Register. The Swedish Renal Registry, a national register on renal replacement therapy, was used to identify patients who developed ESRD.RESULTSWe found that the cumulative incidence of ESRD in Sweden was low after up to 38 years of diabetes duration (5.6%). The incidence of ESRD was lower in patients with type 1 diabetes onset in 1991–2001 compared with onset in 1977–1984 and 1985–1990, independent of diabetes duration.CONCLUSIONSThe risk of developing ESRD in Sweden in this population is still low and also seems to decrease with time.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1276
      Issue No: Vol. 42, No. 1 (2018)
  • Late-Onset T1DM and Older Age Predict Risk of Additional Autoimmune
    • Authors: Hughes; J. W.; Bao, Y. K.; Salam, M.; Joshi, P.; Kilpatrick, C. R.; Juneja, K.; Nieves, D.; Bouhairie, V.; Jordan, O. J.; Blustein, E. C.; Tobin, G. S.; McGill, J. B.
      Pages: 32 - 38
      Abstract: OBJECTIVEType 1 diabetes (T1DM) is associated with other autoimmune diseases (AIDs), which may have serious health consequences. The epidemiology of AIDs in T1DM is not well defined in adults with T1DM. In this cross-sectional cohort study, we sought to characterize the incident ages and prevalence of AIDs in adults with T1DM across a wide age spectrum.RESEARCH DESIGN AND METHODSA total of 1,212 adults seen at the Washington University Diabetes Center from 2011 to 2018 provided informed consent for the collection of their age, sex, race, and disease onset data. We performed paired association analyses based on age at onset of T1DM. Multivariate logistic regression was used to evaluate the independent effects of sex, race, T1DM age of onset, and T1DM duration on the prevalence of an additional AID.RESULTSMean ± SD age of T1DM onset was 21.2 ± 14.4 years. AID incidence and prevalence increased with age. Female sex strongly predicted AID risk. The most prevalent T1DM-associated AIDs were thyroid disease, collagen vascular diseases, and pernicious anemia. T1DM age of onset and T1DM duration predicted AID risk. Patients with late-onset T1DM after 30 years of age had higher risks of developing additional AIDs compared with patients with younger T1DM onset.CONCLUSIONSThe prevalence of AIDs in patients with T1DM increases with age and female sex. Later onset of T1DM is an independent and significant risk factor for developing additional AIDs. Individuals who are diagnosed with T1DM at older ages, particularly women, should be monitored for other autoimmune conditions.
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1157
      Issue No: Vol. 42, No. 1 (2018)
  • Real-World Database Examining the Association Between Avascular Necrosis
           of the Femoral Head and Diabetes in Taiwan
    • Authors: Lai; S.-W.; Lin, C.-L.; Liao, K.-F.
      Pages: 39 - 43
      Abstract: OBJECTIVENo study has been conducted to evaluate the association between avascular necrosis of the femoral head and diabetes. This study’s aim was to assess this issue in Taiwan.RESEARCH DESIGN AND METHODSA population-based cohort study was performed to analyze the database of Taiwan’s National Health Insurance Program. There were 27,869 subjects aged 20–84 years with newly diagnosed diabetes from 2000 to 2012 as the group with diabetes. The group without diabetes included 111,476 sex- and age-matched subjects without diabetes. The incidence of avascular necrosis of the femoral head at the end of 2013 was measured. A multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% CI for avascular necrosis of the femoral head associated with diabetes.RESULTSThe overall incidence of avascular necrosis of the femoral head was 1.37-fold higher in the group with diabetes than in the group without diabetes (6.53 vs. 4.76 per 1,000 person-years [95% CI 1.31–1.43]). After adjusting for confounders, the HR of avascular necrosis of the femoral head was 1.16 (95% CI 1.11–1.21) for the subjects with diabetes compared with the subjects without diabetes.CONCLUSIONSPatients with diabetes have a 1.16-fold increased risk for developing avascular necrosis of the femoral head.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1258
      Issue No: Vol. 42, No. 1 (2018)
  • Postpregnancy BMI in the Progression From Hypertensive Disorders of
           Pregnancy to Type 2 Diabetes
    • Authors: Timpka; S.; Stuart, J. J.; Tanz, L. J.; Hu, F. B.; Franks, P. W.; Rich-Edwards, J. W.
      Pages: 44 - 49
      Abstract: OBJECTIVETo study the extent to which BMI after pregnancy adds to the elevated risk of postpregnancy type 2 diabetes in women with a history of hypertensive disorders of pregnancy (HDP) (preeclampsia or gestational hypertension).RESEARCH DESIGN AND METHODSWe used data from the Nurses’ Health Study II, a prospective cohort study. In women aged 45–54 years without prior gestational diabetes mellitus, we investigated the interaction between BMI and HDP history on the risk of type 2 diabetes. For clinical and public health relevance, we focused on additive interaction. The main outcome measure was the relative excess risk due to interaction calculated from multivariable Cox proportional hazards models using normal weight as the reference group.RESULTSIn total, 6,563 (11.7%) of 56,159 participants had a history of HDP and 1,341 women developed type 2 diabetes during 436,333 person-years. BMI was a strong risk factor for type 2 diabetes regardless of HDP history. However, there was evidence of an additive interaction between BMI and HDP for the risk of type 2 diabetes (P = 0.004). The attributable proportion of risk due to the interaction ranged from 0.12 (95% CI –0.22, 0.46) in women who were overweight to 0.36 (95% CI 0.13, 0.59) in women with obesity class I.CONCLUSIONSMaintaining a healthy weight may be of even greater importance in women with a history of HDP, compared with other women with a history of only normotensive pregnancies, to reduce midlife risk of type 2 diabetes.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1532
      Issue No: Vol. 42, No. 1 (2018)
  • Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in
           the Young and Middle-Aged Adult U.S. Population
    • Authors: Geiss; L. S.; Li, Y.; Hora, I.; Albright, A.; Rolka, D.; Gregg, E. W.
      Pages: 50 - 54
      Abstract: OBJECTIVETo determine whether declining trends in lower-extremity amputations have continued into the current decade.RESEARCH DESIGN AND METHODSWe calculated hospitalization rates for nontraumatic lower-extremity amputation (NLEA) for the years 2000–2015 using nationally representative, serial cross-sectional data from the Nationwide Inpatient Sample on NLEA procedures and from the National Health Interview Survey for estimates of the populations with and without diabetes.RESULTSAge-adjusted NLEA rates per 1,000 adults with diabetes decreased 43% between 2000 (5.38 [95% CI 4.93–5.84]) and 2009 (3.07 [95% CI 2.79–3.34]) (P < 0.001) and then rebounded by 50% between 2009 and 2015 (4.62 [95% CI 4.25–5.00]) (P < 0.001). In contrast, age-adjusted NLEA rates per 1,000 adults without diabetes decreased 22%, from 0.23 per 1,000 (95% CI 0.22–0.25) in 2000 to 0.18 per 1,000 (95% CI 0.17–0.18) in 2015 (P < 0.001). The increase in diabetes-related NLEA rates between 2009 and 2015 was driven by a 62% increase in the rate of minor amputations (from 2.03 [95% CI 1.83–2.22] to 3.29 [95% CI 3.01–3.57], P < 0.001) and a smaller, but also statistically significant, 29% increase in major NLEAs (from 1.04 [95% CI 0.94–1.13] to 1.34 [95% CI 1.22–1.45]). The increases in rates of total, major, and minor amputations were most pronounced in young (age 18–44 years) and middle-aged (age 45–64 years) adults and more pronounced in men than women.CONCLUSIONSAfter a two-decade decline in lower-extremity amputations, the U.S. may now be experiencing a reversal in the progress, particularly in young and middle-aged adults.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1380
      Issue No: Vol. 42, No. 1 (2018)
  • Long-term Mortality After Kidney Transplantation in a Nationwide Cohort of
           Patients With Type 1 Diabetes in Finland
    • Authors: Ortiz; F.; Harjutsalo, V.; Helanterä, I.; Lempinen, M.; Forsblom, C.; Groop, P.-H.
      Pages: 55 - 61
      Abstract: OBJECTIVETo examine time trends in mortality rates and causes of death in patients with type 1 diabetes and end-stage renal disease on dialysis and after kidney transplantation.RESEARCH DESIGN AND METHODSIn a nationwide retrospective cohort analysis, all patients with type 1 diabetes in Finland who received a kidney transplant alone were compared with patients who remained on dialysis. The main outcome was patient survival after starting dialysis. The cohort was divided into dialysis, functioning kidney transplant, and dialysis after transplant loss. Causes of death were retrieved and standardized mortality ratios calculated.RESULTSWe studied 2,383 patients. Patients survived a median of 15.9 years after a successful transplant, 11.2 years if transplant function was lost, and 2.9 years if they remained on chronic dialysis. Standardized mortality ratio decreased in all subgroups during the past four decades: from 2005 onwards, it was 3.9 in patients receiving a kidney transplant, 11.5 in patients with graft loss, and 32.5 in patients on dialysis. The most common cause of death in all patients was ischemic heart disease (45%) followed by infection (18%), which was more common in patients on dialysis.CONCLUSIONSKidney transplantation is the treatment of choice for patients with type 1 diabetes and end-stage renal disease because it substantially reduces the excess death risk when compared with dialysis. Even when kidney graft function is lost, the excess death risk is still considerably lower. Although overall mortality has decreased over the years, premature death due to ischemic heart disease remains high.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1029
      Issue No: Vol. 42, No. 1 (2018)
  • Trajectory of Excess Medical Expenditures 10 Years Before and After
           Diabetes Diagnosis Among U.S. Adults Aged 25-64 Years, 2001-2013
    • Authors: Shrestha; S. S.; Zhang, P.; Hora, I. A.; Gregg, E. W.
      Pages: 62 - 68
      Abstract: OBJECTIVEWe assessed the excess medical expenditures for adults newly diagnosed with diabetes, for up to 10 years before and after diabetes diagnosis.RESEARCH DESIGN AND METHODSUsing the 2001–2013 MarketScan data, we identified people with newly diagnosed diabetes among adults aged 25–64 years (diabetes cohort) and matched them with people who did not have diagnosed diabetes (control cohort) using 1:1 propensity score matching. We followed these two cohorts up to ±10 years from the index date, with annual matched cohort sizes ranging from 3,922 to 39,726 individuals. We estimated the yearly and cumulative excess medical expenditures of the diabetes cohorts before and after the diagnosis of diabetes.RESULTSThe per capita annual total excess medical expenditure for the diabetes cohort was higher for the entire 10 years prior to their index date, ranging between $1,043 in year –10 and $4,492 in year –1. Excess expenditure spiked in year 1 ($8,109), declined in year 2, and then increased steadily, ranging from $4,261 to $6,162 in years 2–10. The cumulative excess expenditure for the diabetes cohort during the entire 20 years of follow-up was $69,177 ($18,732 before and $50,445 after diagnosis).CONCLUSIONSPeople diagnosed with diabetes had higher medical expenditures compared with their counterparts, not only after diagnosis but also up to 10 years prior to diagnosis. Managing risk factors for type 2 diabetes and cardiovascular disease before diagnosis, and for diabetes-related complications after diagnosis, could alleviate medical expenditure in people with diabetes.
      Keywords: Health Care Delivery-Economics
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc17-2683
      Issue No: Vol. 42, No. 1 (2018)
  • 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
    • 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.
      Pages: 69 - 76
      Abstract: OBJECTIVEMaturity-onset diabetes of the young (MODY) is an autosomal dominant form of diabetes, with multiple causative genes. Some MODY subtypes can be treated with sulfonylureas instead of insulin, improving glycemic control, complication rates, quality of life (QoL), and costs. Using massively parallel sequencing (MPS), we recently determined the prevalence of pathogenic/likely pathogenic MODY variants in an Australian pediatric diabetes cohort. Here, these data are used to estimate cost-effectiveness of using MPS for MODY in all pediatric diabetes cases compared with standard practice (sequencing limited to individuals with specific clinical features).RESEARCH DESIGN AND METHODSA Markov decision model was developed to estimate incremental costs and quality-adjusted life-years (QALYs) of MPS screening, modeled over 30 years. We used our observed prevalence of 2.14% compared with 0.7% for standard practice, based on published data. The probabilities and utility weightings of long-term diabetes complications were based on HbA1c and estimated from published data. A series of one-way sensitivity analyses were performed using the net monetary benefit framework.RESULTSRoutine MPS screening for MODY was more effective and less costly than standard care screening, with 26 QALYs gained and 1,016,000 AUD (782,000 USD) saved per 1,000 patients. Cost of screening was fully offset within 10 years. Routine MPS screening remained dominant until MODY prevalence fell to
      Keywords: Health Care Delivery-Economics
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-0261
      Issue No: Vol. 42, No. 1 (2018)
  • Factors Contributing to Increases in Diabetes-Related Preventable
           Hospitalization Costs Among U.S. Adults During 2001-2014
    • Authors: Shrestha; S. S.; Zhang, P.; Hora, I.; Geiss, L. S.; Luman, E. T.; Gregg, E. W.
      Pages: 77 - 84
      Abstract: OBJECTIVETo examine changes in diabetes-related preventable hospitalization costs and to determine the contribution of each underlying factor to these changes.RESEARCH DESIGN AND METHODSWe used data from the 2001–2014 U.S. National (Nationwide) Inpatient Sample (NIS) for adults (≥18 years old) to estimate the trends in hospitalization costs (2014 USD) in total and by condition (short-term complications, long-term complications, uncontrolled diabetes, and lower-extremity amputation). Using regression and growth models, we estimated the relative contribution of following underlying factors: total number of hospitalizations, rate of hospitalization, the number of people with diabetes, mean cost per admission, length of stay, and cost per day.RESULTSDuring 2001–2014, the estimated total cost of diabetes-related preventable hospitalizations increased annually by 1.6% (92.9 million USD; P < 0.001). Of this 1.6% increase, 75% (1.2%) was due to the increase in the number of hospitalizations, which is a result of a 3.8% increase in diabetes population and a 2.6% decrease in the hospitalization rate, and 25% (0.4%) was due to the increase in cost per admission, for a net result of a 1.6% increase in cost per day and a 1.3% decline in mean length of stay. By component, the cost of short-term complications, lower-extremity amputations, and long-term complications increased annually by 4.2, 1.9, and 1.5%, respectively, while the cost of uncontrolled diabetes declined annually by 2.6%.CONCLUSIONSThe total cost of diabetes-related preventable hospitalizations had been increasing during 2001–2014, mainly resulting from increases in number of people with diabetes and cost per hospitalization day. The underlying factors identified in our study could lead to efforts that may lower future hospitalization costs.
      Keywords: Health Care Delivery-Economics
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1078
      Issue No: Vol. 42, No. 1 (2018)
  • Pharmacokinetics, Pharmacodynamics, and Modulation of Hepatic Glucose
           Production With Insulin Glargine U300 and Glargine U100 at Steady State
           With Individualized Clinical Doses in Type 1 Diabetes
    • Authors: Porcellati; F.; Lucidi, P.; Candeloro, P.; Cioli, P.; Marinelli Andreoli, A.; Curti, G.; Bolli, G. B.; Fanelli, C. G.
      Pages: 85 - 92
      Abstract: OBJECTIVEThis study characterized the pharmacokinetics (PK), pharmacodynamics (PD), and endogenous (hepatic) glucose production (EGP) of clinical doses of glargine U300 (Gla-300) and glargine U100 (Gla-100) under steady-state (SS) conditions in type 1 diabetes mellitus (T1DM).RESEARCH DESIGN AND METHODST1DM subjects (N = 18, age 40 ± 12 years, T1DM duration 26 ± 12 years, BMI 23.4 ± 2 kg/m2, A1C 7.19 ± 0.52% [55 ± 5.7 mmol · mol–1–1]) were studied after 3 months of Gla-300 or Gla-100 (evening dosing) titrated to fasting euglycemia (random, crossover) with the euglycemic clamp using individualized doses (Gla-300 0.35 ± 0.08, Gla-100 0.28 ± 0.07 units · kg–1).RESULTSPlasma free insulin concentrations (free immunoreactive insulin area under the curve) were equivalent over 24 h with Gla-300 versus Gla-100 (point estimate 1.11 [90% CI 1.03; 1.20]) but were reduced in the first 6 h (0.91 [90% CI 0.86; 0.97]) and higher in the last 12 h postdosing (1.38 [90% CI 1.21; 1.56]). Gla-300 and Gla-100 both maintained 24 h euglycemia (0.99 [90% CI 0.98; 1.0]). The glucose infusion rate was equivalent over 24 h (1.03 [90% CI 0.88; 1.21]) but was lower in first (0.77 [90% CI 0.62; 0.95]) and higher (1.53 [90% CI 1.23; 1.92]) in the second 12 h with Gla-300 versus Gla-100. EGP was less suppressed during 0–6 h but more during 18–24 h with Gla-300. PK and PD within-day variability (fluctuation) was 50% and 17% lower with Gla-300.CONCLUSIONSIndividualized, clinical doses of Gla-300 and Gla-100 resulted in a similar euglycemic potential under SS conditions. However, Gla-300 exhibited a more stable profile, with lower variability and more physiological modulation of EGP compared with Gla-100.
      Keywords: Clinical Therapeutics/New Technology-Insulins
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-0706
      Issue No: Vol. 42, No. 1 (2018)
  • Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an
           International Study of Patients With Type 1 Diabetes and Advanced
    • Authors: Skupien; J.; Smiles, A. M.; Valo, E.; Ahluwalia, T. S.; Gyorgy, B.; Sandholm, N.; Croall, S.; Lajer, M.; McDonnell, K.; Forsblom, C.; Harjutsalo, V.; Marre, M.; Galecki, A. T.; Tregouet, D.-A.; Wu, C. Y.; Mychaleckyj, J. C.; Nickerson, H.; Pragnell, M.; Rich, S. S.; Pezzolesi, M. G.; Hadjadj, S.; Rossing, P.; Groop, P.-H.; Krolewski, A. S.
      Pages: 93 - 101
      Abstract: OBJECTIVEPatients with type 1 diabetes and diabetic nephropathy are targets for intervention to reduce high risk of end-stage renal disease (ESRD) and deaths. This study compares risks of these outcomes in four international cohorts.RESEARCH DESIGN AND METHODSIn the 1990s and early 2000s, Caucasian patients with type 1 diabetes with persistent macroalbuminuria in chronic kidney disease stages 1–3 were identified in the Joslin Clinic (U.S., 432), Finnish Diabetic Nephropathy Study (FinnDiane) (Finland, 486), Steno Diabetes Center Copenhagen (Denmark, 368), and INSERM (France, 232) and were followed for 3–18 years with annual creatinine measurements to ascertain ESRD and deaths unrelated to ESRD.RESULTSDuring 15,685 patient-years, 505 ESRD cases (rate 32/1,000 patient-years) and 228 deaths unrelated to ESRD (rate 14/1,000 patient-years) occurred. Risk of ESRD was associated with male sex; younger age; lower estimated glomerular filtration rate (eGFR); higher albumin/creatinine ratio, HbA1c, and systolic blood pressure; and smoking. Risk of death unrelated to ESRD was associated with older age, smoking, and higher baseline eGFR. In adjusted analysis, ESRD risk was highest in Joslin versus reference FinnDiane (hazard ratio [HR] 1.44, P = 0.003) and lowest in Steno (HR 0.54, P < 0.001). Differences in eGFR slopes paralleled risk of ESRD. Mortality unrelated to ESRD was lowest in Joslin (HR 0.68, P = 0.003 vs. the other cohorts). Competing risk did not explain international differences in the outcomes.CONCLUSIONSDespite almost universal renoprotective treatment, progression to ESRD and mortality in patients with type 1 diabetes with advanced nephropathy are still very high and differ among countries. Finding causes of these differences may help reduce risk of these outcomes.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1369
      Issue No: Vol. 42, No. 1 (2018)
  • Development and Validation of a Simple Hip Fracture Risk Prediction Tool
           for Type 2 Diabetes: The Fremantle Diabetes Study Phase I
    • Authors: Davis; W. A.; Hamilton, E. J.; Bruce, D. G.; Davis, T. M. E.
      Pages: 102 - 109
      Abstract: OBJECTIVETo develop a type 2 diabetes hip fracture risk tool in community-based patients, to validate it in an independent cohort, and to compare its performance against the only published prediction equation to include type 2 diabetes as a risk factor (QFracture).RESEARCH DESIGN AND METHODSHip fracture hospitalizations in 1,251 participants with type 2 diabetes aged 40–89 years from the longitudinal Fremantle Diabetes Study Phase I (FDS1) were ascertained between entry (1993–1996) and end-2012. Competing risk regression modeling determined independent predictors of time to first fracture over 10 years and the coefficients incorporated in a risk model. The model was validated in 286 participants with type 2 diabetes from the Busselton Health Study (BHS).RESULTSFifty FDS1 participants (4.0%) experienced a first hip fracture during 10,306 person-years of follow-up. Independent predictors of fracture were older age, female sex, lower BMI, peripheral sensory neuropathy, and estimated glomerular filtration rate
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1486
      Issue No: Vol. 42, No. 1 (2018)
  • Improvement in Neuropathy Outcomes With Normalizing HbA1c in Patients With
           Type 2 Diabetes
    • Authors: Ishibashi; F.; Taniguchi, M.; Kosaka, A.; Uetake, H.; Tavakoli, M.
      Pages: 110 - 118
      Abstract: OBJECTIVETo investigate the impact of normalizing HbA1c by extensive HbA1c control (EHC) on neuropathy outcome measures (NOMs), nephropathy, and retinopathy in type 2 diabetes.RESEARCH DESIGN AND METHODSDetailed clinical and neurological examinations were performed in two cohorts of 38 patients with uncontrolled type 2 diabetes (HbA1c 9.6% [81.4 mmol/mol]) at baseline and after glycemic control (GC) with or without EHC by diet restriction and hypoglycemic agents over 4 years along with 48 control subjects with normal glucose tolerance (NGT) and 34 subjects with impaired glucose tolerance (IGT) only at baseline. EHC patients, control subjects, and subjects with IGT underwent oral glucose tolerance tests. Glycemic variability (GV) was evaluated by SD and coefficient of variation of monthly measured HbA1c levels and casual plasma glucose.RESULTSIn the EHC cohort, HbA1c levels over 4.3 years and the last 2 years improved to 6.1% (43.2 mmol/mol) and 5.8% (39.9 mmol/mol) with 7.3 kg body wt reduction, and 50% and 28.9% of patients returned to IGT and NGT, respectively, at end point. Baseline neurophysiological and corneal nerve fiber (CNF) measures were impaired in patients. Normalized HbA1c with EHC improved neurophysiological and CNF measures to be similar for those for IGT, while GC without EHC (mean HbA1c level 7.0% [53.5 mmol/mol]) improved only vibration perception. The mean normalized HbA1c levels by EHC determined NOM improvements. The high GV and baseline HbA1c levels compromised NOMs. Albumin excretion rate significantly decreased, while retinopathy severity and frequency insignificantly worsened on EHC.CONCLUSIONSNormalizing HbA1c in type 2 diabetes of short duration improves microvascular complications including neuropathy and nephropathy more effectively than standard GC but not retinopathy.
      Keywords: Complications-Neuropathy
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1560
      Issue No: Vol. 42, No. 1 (2018)
  • Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in
           Children and Adolescents: International Childhood Vascular Structure
           Evaluation Consortium
    • Authors: Zhao; M.; Lopez-Bermejo, A.; Caserta, C. A.; Medeiros, C. C. M.; Kollias, A.; Bassols, J.; Romeo, E. L.; Ramos, T. D. A.; Stergiou, G. S.; Yang, L.; Xargay-Torrent, S.; Amante, A.; Gusmao, T. M. E.; Grammatikos, E.; Zhang, Y.; Prats-Puig, A.; de Carvalho, D. F.; Yang, L.; Carreras-Badosa, G.; Simoes, M. d. O.; Hou, Y.; Mas-Pares, B.; Shui, W.; Guo, T.; Wang, M.; Chen, H.; Lou, X.; Zhang, Q.; Zhang, Y.; Bovet, P.; Magnussen, C. G.; Xi, B.; the International Childhood Vascular Structure Evaluation Consortium; International Childhood Vascular Structure Evaluation Consortium
      Pages: 119 - 125
      Abstract: OBJECTIVEIt has been argued that metabolically healthy obesity (MHO) does not increase cardiovascular disease (CVD) risk. This study examines the association of MHO with carotid intima-media thickness (cIMT), a proxy of CVD risk, in children and adolescents.RESEARCH DESIGN AND METHODSData were available for 3,497 children and adolescents aged 6–17 years from five population-based cross-sectional studies in Brazil, China, Greece, Italy, and Spain. Weight status categories (normal, overweight, and obese) were defined using BMI cutoffs from the International Obesity Task Force. Metabolic status (defined as "healthy" [no risk factors] or "unhealthy" [one or more risk factors]) was based on four CVD risk factors: elevated blood pressure, elevated triglyceride levels, reduced HDL cholesterol, and elevated fasting glucose. High cIMT was defined as cIMT ≥90th percentile for sex, age, and study population. Logistic regression model was used to examine the association of weight and metabolic status with high cIMT, with adjustment for sex, age, race/ethnicity, and study center.RESULTSIn comparison with metabolically healthy normal weight, odds ratios (ORs) for high cIMT were 2.29 (95% CI 1.58–3.32) for metabolically healthy overweight and 3.91 (2.46–6.21) for MHO. ORs for high cIMT were 1.44 (1.03–2.02) for unhealthy normal weight, 3.49 (2.51–4.85) for unhealthy overweight, and 6.96 (5.05–9.61) for unhealthy obesity.CONCLUSIONSAmong children and adolescents, cIMT was higher for both MHO and metabolically healthy overweight compared with metabolically healthy normal weight. Our findings reinforce the need for weight control in children and adolescents irrespective of their metabolic status.
      Keywords: Obesity-Human
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1536
      Issue No: Vol. 42, No. 1 (2018)
  • Racial and Ethnic Differences in Anthropometric Measures as Risk Factors
           for Diabetes
    • Authors: Luo; J.; Hendryx, M.; Laddu, D.; Phillips, L. S.; Chlebowski, R.; LeBlanc, E. S.; Allison, D. B.; Nelson, D. A.; Li, Y.; Rosal, M. C.; Stefanick, M. L.; Manson, J. E.
      Pages: 126 - 133
      Abstract: OBJECTIVEThe study objective was to examine the impact of race/ethnicity on associations between anthropometric measures and diabetes risk.RESEARCH DESIGN AND METHODSA total of 136,112 postmenopausal women aged 50–79 years participating in the Women’s Health Initiative without baseline cancer or diabetes were followed for 14.6 years. BMI, waist circumference (WC), and waist-to-hip ratio (WHR) were measured in all participants, and a subset of 9,695 had assessment of whole-body fat mass, whole-body percent fat, trunk fat mass, and leg fat mass by DXA. Incident diabetes was assessed via self-report. Multivariate Cox proportional hazards regression models were used to assess associations between anthropometrics and diabetes incidence.RESULTSDuring follow-up, 18,706 cases of incident diabetes were identified. BMI, WC, and WHR were all positively associated with diabetes risk in each racial and ethnic group. WC had the strongest association with risk of diabetes across all racial and ethnic groups. Compared with non-Hispanic whites, associations with WC were weaker in black women (P < 0.0001) and stronger in Asian women (P < 0.0001). Among women with DXA determinations, black women had a weaker association with whole-body fat (P = 0.02) but a stronger association with trunk-to-leg fat ratio (P = 0.03) compared with white women.CONCLUSIONSIn postmenopausal women across all racial/ethnic groups, WC was a better predictor of diabetes risk, especially for Asian women. Better anthropometric measures that reflect trunk-to-leg fat ratio may improve diabetes risk assessment for black women.
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1413
      Issue No: Vol. 42, No. 1 (2018)
  • Visit-to-Visit Variability of Hemoglobin A1c in People Without Diabetes
           and Risk of Major Adverse Cardiovascular Events and All-Cause Mortality
    • Authors: Ghouse; J.; Skov, M. W.; Kanters, J. K.; Lind, B.; Isaksen, J. L.; Blanche, P.; Haunso, S.; Kober, L.; Svendsen, J. H.; Olesen, M. S.; Holst, A. G.; Gerds, T. A.; Nielsen, J. B.
      Pages: 134 - 141
      Abstract: OBJECTIVEWe aimed to study whether visit-to-visit variability of glycated hemoglobin A1c (HbA1c) is associated with incident major adverse cardiovascular events (MACE), all-cause mortality, and type 2 diabetes in people without diabetes.RESEARCH DESIGN AND METHODSWe included primary care patients with no history of diabetes or cardiovascular disease and with three annual HbA1c measurements within normal range (
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1396
      Issue No: Vol. 42, No. 1 (2018)
  • Hypoglycemia and Incident Cognitive Dysfunction: A Post Hoc Analysis From
           the ORIGIN Trial
    • Authors: Cukierman-Yaffe; T.; Bosch, J.; Jung, H.; Punthakee, Z.; Gerstein, H. C.
      Pages: 142 - 147
      Abstract: OBJECTIVEEpidemiological studies have reported a relationship between severe hypoglycemia, cognitive dysfunction, and dementia in middle-aged and older people with type 2 diabetes. However, whether severe or nonsevere hypoglycemia precedes cognitive dysfunction is unclear. Thus, the aim of this study was to analyze the relationship between hypoglycemia and incident cognitive dysfunction in a group of carefully followed patients using prospectively collected data in the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial.RESEARCH DESIGN AND METHODSThis prospective cohort analysis of data from a randomized controlled trial included individuals with dysglycemia who had additional cardiovascular risk factors and a Mini-Mental State Examination (MMSE) score ≥24 (N = 11,495). Severe and nonsevere hypoglycemic events were collected prospectively during a median follow-up time of 6.2 years. Incident cognitive dysfunction was defined as either reported dementia or an MMSE score of
      Keywords: Epidemiology-Aging
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-0690
      Issue No: Vol. 42, No. 1 (2018)
  • Impact of the Diabetes Canada Guideline Dissemination Strategy on the
           Prescription of Vascular Protective Medications: A Retrospective Cohort
           Study, 2010-2015
    • Authors: Rigobon; A. V.; Kalia, S.; Nichols, J.; Aliarzadeh, B.; Greiver, M.; Moineddin, R.; Sullivan, F.; Yu, C.
      Pages: 148 - 156
      Abstract: OBJECTIVEThe 2013 Diabetes Canada guidelines launched targeted dissemination tools and a simple assessment for vascular protection. We aimed to 1) examine changes associated with the launch of the 2013 guidelines and additional dissemination efforts in the rates of vascular protective medications prescribed in primary care for older patients with diabetes and 2) examine differences in the rates of prescriptions of vascular protective medications by patient and provider characteristics.RESEARCH DESIGN AND METHODSThe study population included patients (≥40 years of age) from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) with type 2 diabetes and at least one clinic visit from April 2010 to December 2015. An interrupted time series analysis was used to assess the proportion of eligible patients prescribed a statin, ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB), or antiplatelet prescription in each quarter. Proton pump inhibitor (PPI) prescriptions were the reference control.RESULTSA dynamic cohort was used where participants were enrolled each quarter using a prespecified set of conditions (range 25,985–70,693 per quarter). There were no significant changes in statin (P = 0.43), ACEI/ARB (P = 0.42), antiplatelet (P = 0.39), or PPI (P = 0.16) prescriptions at baseline (guideline intervention). After guideline publication, there was a significant change in slope for statin (–0.52% per quarter, SE 0.15, P < 0.05), ACEI/ARB (–0.38% per quarter, SE 0.13, P < 0.05), and reference PPI (–0.18% per quarter, SE 0.05, P < 0.05) prescriptions.CONCLUSIONSThere was a decrease in prescribing trends over time that was not specific to vascular protective medications. More effective knowledge translation strategies are needed to improve vascular protection in diabetes in order for patients to receive the most effective interventions.
      Keywords: Epidemiology-Other
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-0935
      Issue No: Vol. 42, No. 1 (2018)
  • Effects of Severe Hypoglycemia on Cardiovascular Outcomes and Death in the
           Veterans Affairs Diabetes Trial
    • Authors: Davis; S. N.; Duckworth, W.; Emanuele, N.; Hayward, R. A.; Wiitala, W. L.; Thottapurathu, L.; Reda, D. J.; Reaven, P. D.; for the Investigators of the Veterans Affairs Diabetes Trial
      Pages: 157 - 163
      Abstract: OBJECTIVETo determine the risk factors for severe hypoglycemia and the association between severe hypoglycemia and serious cardiovascular adverse events and cardiovascular and all-cause mortality in the Veterans Affairs Diabetes Trial (VADT).RESEARCH DESIGN AND METHODSThis post hoc analysis of data from the VADT included 1,791 military veterans (age 60.5 ± 9.0 years) with suboptimally controlled type 2 diabetes (HbA1c 9.4 ± 2.0%) of 11.5 ± 7.5 years disease duration with or without known cardiovascular disease and additional cardiovascular risk factors. Participants were randomized to intensive (HbA1c
      Keywords: Complications-Hypoglycemia
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1144
      Issue No: Vol. 42, No. 1 (2018)
  • The Shape of the Glucose Response Curve During an Oral Glucose Tolerance
           Test: Forerunner of Heightened Glycemic Failure Rates and Accelerated
           Decline in {beta}-Cell Function in TODAY
    • Authors: Arslanian; S.; El ghormli, L.; Young Kim, J.; Bacha, F.; Chan, C.; Ismail, H. M.; Levitt Katz, L. E.; Levitsky, L.; Tryggestad, J. B.; White, N. H.; for the TODAY Study Group
      Pages: 164 - 172
      Abstract: OBJECTIVEObese youth without diabetes with monophasic oral glucose tolerance test (OGTT) glucose response curves have lower insulin sensitivity and impaired β-cell function compared with those with biphasic curves. The OGTT glucose response curve has not been studied in youth-onset type 2 diabetes. Here we test the hypothesis that the OGTT glucose response curve at randomization in youth in the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study forecasts heightened glycemic failure rates and accelerated decline in β-cell function.RESEARCH DESIGN AND METHODSOGTTs (n = 662) performed at randomization were categorized as monophasic, biphasic, or incessant increase. Demographics, insulin sensitivity (1/fasting insulin), C-peptide index (C30/G30), and β-cell function relative to insulin sensitivity (oral disposition index [oDI]) were compared among the three groups.RESULTSAt randomization, 21.7% had incessant increase, 68.6% monophasic, and 9.7% biphasic glucose response curves. The incessant increase group had similar insulin sensitivity but significantly lower C-peptide index and lower oDI, despite similar diabetes duration, compared with the other two groups. Glycemic failure rates were higher in the incessant increase group (58.3%) versus the monophasic group (42.3%) versus the biphasic group (39.1%) (P < 0.0001). The 6-month decline in C-peptide index (32.8% vs. 18.1% vs. 13.2%) and oDI (32.2% vs. 11.6% vs. 9.1%) was greatest in incessant increase versus monophasic and biphasic with no difference in insulin sensitivity.CONCLUSIONSIn the TODAY study cohort, an incessant increase in the OGTT glucose response curve at randomization reflects reduced β-cell function and foretells increased glycemic failure rates with accelerated deterioration in β-cell function independent of diabetes duration and treatment assignment compared with monophasic and biphasic curves. The shape of the OGTT glucose response curve could be a metabolic biomarker prognosticating the response to therapy in youth with type 2 diabetes.
      Keywords: Pediatrics-Obesity and Type 2 Diabetes
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1122
      Issue No: Vol. 42, No. 1 (2018)
  • Inclisiran Lowers LDL-C and PCSK9 Irrespective of Diabetes Status: The
           ORION-1 Randomized Clinical Trial
    • Authors: Leiter; L. A.; Teoh, H.; Kallend, D.; Wright, R. S.; Landmesser, U.; Wijngaard, P. L. J.; Kastelein, J. J. P.; Ray, K. K.
      Pages: 173 - 176
      Abstract: OBJECTIVETo evaluate the efficacy and safety of inclisiran by diabetes status.RESEARCH DESIGN AND METHODSORION-1 (, NCT02597127) randomized 501 subjects with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk equivalents and high LDL cholesterol (LDL-C), despite maximally tolerated LDL-C–lowering therapies, to one or two doses of placebo or inclisiran. Levels of lipids and proprotein convertase subtilisin/kexin type 9 (PCSK9) at baseline and day 180 were compared.RESULTSInclisiran was associated with marked declines in LDL-C (median –28% to –52%, P < 0.0001 and –28% to –55%, P < 0.005 for all doses in the without- and with-diabetes groups, respectively) and PCSK9. The inclisiran-treated groups also had lower apolipoprotein B, non-HDL cholesterol, and lipoprotein(a) but higher HDL cholesterol. Inclisiran had an adverse profile similar to that of placebo, and adverse events were proportionally balanced in the baseline with- and without-diabetes groups.CONCLUSIONSPCSK9-targeted siRNA-driven strategies may provide a novel therapeutic option for managing dyslipidemia in the presence and absence of diabetes.
      Keywords: Diabetic Dyslipidemia
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc18-1491
      Issue No: Vol. 42, No. 1 (2018)
  • Issues and Events
    • Pages: 177 - 177
      PubDate: 2018-12-20T12:00:31-08:00
      DOI: 10.2337/dc19-ie01
      Issue No: Vol. 42, No. 1 (2018)
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