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Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 556  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • Bariatric Surgery in Patients With Obesity and Latent Autoimmune Diabetes
           in Adults (LADA)
    • Authors: Aminian; A.; Sharma, G.; Wilson, R. L.; Kashyap, S. R.; Lo Menzo, E.; Szomstein, S.; Rosenthal, R. J.; Schauer, P. R.; Vangoitsenhoven, R.
      Keywords: Obesity-Human
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2388
      Issue No: Vol. 43, No. 5 (2020)
       
  • Facility-Level Variation in Cardiac Stress Test Use Among Patients With
           Diabetes: Findings From the Veterans Affairs National Database
    • Authors: Mahtta; D.; Ahmed, S. T.; Shah, N. R.; Ramsey, D. J.; Akeroyd, J. M.; Nasir, K.; Hamzeh, I. R.; Elgendy, I. Y.; Waldo, S. W.; Al-Mallah, M. H.; Jneid, H.; Ballantyne, C. M.; Petersen, L. A.; Virani, S. S.
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2160
      Issue No: Vol. 43, No. 5 (2020)
       
  • Markers of Early Life Infection in Relation to Adult Diabetes: Prospective
           Evidence From a National Birth Cohort Study Over Four Decades
    • Authors: Hamer; M.; Batty, G. D.
      Keywords: Epidemiology-Other
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2471
      Issue No: Vol. 43, No. 5 (2020)
       
  • In This Issue of Diabetes Care
    • Pages: 937 - 938
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc20-ti05
      Issue No: Vol. 43, No. 5 (2020)
       
  • A Special Thanks to the Reviewers of Diabetes Care
    • Pages: 939 - 939
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc20-en05
      Issue No: Vol. 43, No. 5 (2020)
       
  • Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body
           Weight
    • Authors: Sivitz; W. I.; Phillips, L. S.; Wexler, D. J.; Fortmann, S. P.; Camp, A. W.; Tiktin, M.; Perez, M.; Craig, J.; Hollander, P. A.; Cherrington, A.; Aroda, V. R.; Tan, M. H.; Krakoff, J.; Rasouli, N.; Butera, N. M.; Younes, N.; the GRADE Research Group; GRADE Research Group
      Pages: 940 - 947
      Abstract: OBJECTIVEWe evaluated the effect of optimizing metformin dosing on glycemia and body weight in type 2 diabetes.RESEARCH DESIGN AND METHODSThis was a prespecified analysis of 6,823 participants in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) taking metformin as the sole glucose-lowering drug who completed a 4- to 14-week (mean ± SD 7.9 ± 2.4) run-in in which metformin was adjusted to 2,000 mg/day or a maximally tolerated lower dose. Participants had type 2 diabetes for
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1769
      Issue No: Vol. 43, No. 5 (2020)
       
  • The Long-term Effects of Metformin on Patients With Type 2 Diabetic Kidney
           Disease
    • Authors: Kwon; S.; Kim, Y. C.; Park, J. Y.; Lee, J.; An, J. N.; Kim, C. T.; Oh, S.; Park, S.; Kim, D. K.; Oh, Y. K.; Kim, Y. S.; Lim, C. S.; Lee, J. P.
      Pages: 948 - 955
      Abstract: OBJECTIVEMetformin is the first pharmacological option for treating type 2 diabetes. However, the use of this drug is not recommended in individuals with impaired kidney function because of the perceived risk of lactic acidosis. We aimed to assess the efficacy and safety of metformin in patients with type 2 diabetic kidney disease (DKD).RESEARCH DESIGN AND METHODSWe conducted a retrospective observational cohort study of 10,426 patients with type 2 DKD from two tertiary hospitals. The primary outcomes were all-cause mortality and end-stage renal disease (ESRD) progression. The secondary outcome was metformin-associated lactic acidosis. Taking into account the possibility that patients with less severe disease were prescribed metformin, propensity score matching (PSM) was conducted.RESULTSAll-cause mortality and incident ESRD were lower in the metformin group according to the multivariate Cox analysis. Because the two groups had significantly different baseline characteristics, PSM was performed. After matching, metformin usage was still associated with lower all-cause mortality (adjusted hazard ratio [aHR] 0.65; 95% CI 0.57–0.73; P < 0.001) and ESRD progression (aHR 0.67; 95% CI 0.58–0.77; P < 0.001). Only one event of metformin-associated lactic acidosis was recorded. In both the original and PSM groups, metformin usage did not increase the risk of lactic acidosis events from all causes (aHR 0.92; 95% CI 0.668–1.276; P = 0.629).CONCLUSIONSIn the present retrospective study, metformin usage in advanced chronic kidney disease (CKD) patients, especially those with CKD 3B, decreased the risk of all-cause mortality and incident ESRD. Additionally, metformin did not increase the risk of lactic acidosis. However, considering the remaining biases even after PSM, further randomized controlled trials are needed to change real-world practice.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-0936
      Issue No: Vol. 43, No. 5 (2020)
       
  • Associations Between Racial and Ethnic Groups and Foot Self-Inspection in
           People With Diabetes
    • Authors: Littman; A. J.; Knott, C. J.; Boyko, E. J.; Hawes, S. E.
      Pages: 956 - 963
      Abstract: OBJECTIVEDaily foot self-inspection may permit earlier detection and treatment of a foot lesion, reducing the risk of infection and lower-limb amputation (LLA). Though race and ethnicity are strongly associated with LLA risk, with higher risk seen in African Americans (AA), American Indians/Alaska Natives (AI/AN), and Native Hawaiians/Pacific Islanders (NH/PI), associations between foot self-inspection and racial and ethnic groups are inconsistent. We aimed to assess differences in foot self-inspection among people with diabetes by race/ethnicity.RESEARCH DESIGN AND METHODSUsing national, cross-sectional data from the 2015–2017 Behavioral Risk Factor Surveillance System surveys and including 88,424 individuals with diabetes, we estimated prevalence ratios (PRs) and associated 95% CIs of daily foot checking for sores or irritation by racial and ethnic groups using log-binomial linear regression models, after accounting for survey weights.RESULTSCompared with whites (who had a weighted prevalence [P] of daily foot self-inspection of 57%), AA (P 67%, PR 1.18 [95% CI 1.14, 1.23]), AI/AN (P 66%, PR 1.15 [95% CI 1.07, 1.25]), and NH/PI (P 71%, PR 1.25 [95% CI 1.03, 1.52]) had higher prevalences of daily foot self-inspection. The prevalence of daily foot inspection was significantly lower among Asians (P 35%, PR 0.62 [95% CI 0.48, 0.81]) and Hispanics (P 53%, PR 0.93 [95% CI 0.88, 0.99]) compared with whites. Associations did not vary importantly by insulin use, years since diabetes diagnosis, or having received diabetes self-management education.CONCLUSIONSThe higher frequency of foot self-inspection in racial and ethnic groups at elevated risk of diabetes-related LLA is not sufficient to eliminate LLA disparities; additional interventions are needed to achieve this aim.
      Keywords: Foot Care-Lower Extremities
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1486
      Issue No: Vol. 43, No. 5 (2020)
       
  • Global Disability Burdens of Diabetes-Related Lower-Extremity
           Complications in 1990 and 2016
    • Authors: Zhang; Y.; Lazzarini, P. A.; McPhail, S. M.; van Netten, J. J.; Armstrong, D. G.; Pacella, R. E.
      Pages: 964 - 974
      Abstract: OBJECTIVENo study has reported global disability burden estimates for individual diabetes-related lower-extremity complications (DRLECs). The Global Burden of Disease (GBD) study presents a robust opportunity to address this gap.RESEARCH DESIGN AND METHODSGBD 2016 data, including prevalence and years lived with disability (YLDs), for the DRLECs of diabetic neuropathy, foot ulcer, and amputation with and without prosthesis were used. The GBD estimated prevalence using data from systematic reviews and DisMod-MR 2.1, a Bayesian meta-regression tool. YLDs were estimated as the product of prevalence estimates and disability weights for each DRLEC. We reported global and sex-, age-, region-, and country-specific estimates for each DRLEC for 1990 and 2016.RESULTSIn 2016, an estimated 131 million people (1.8% of the global population) had DRLECs. An estimated 16.8 million YLDs (2.1% global YLDs) were caused by DRLECs, including 12.9 million (95% uncertainty interval 8.30–18.8) from neuropathy only, 2.5 million (1.7–3.6) from foot ulcers, 1.1 million (0.7–1.4) from amputation without prosthesis, and 0.4 million (0.3–0.5) from amputation with prosthesis. Age-standardized YLD rates of all DRLECs increased by between 14.6% and 31.0% from 1990 estimates. Male-to-female YLD ratios ranged from 0.96 for neuropathy only to 1.93 for foot ulcers. The 50- to 69-year-old age-group accounted for 47.8% of all YLDs from DRLECs.CONCLUSIONSThese first-ever global estimates suggest that DRLECs are a large and growing contributor to the disability burden worldwide and disproportionately affect males and middle- to older-aged populations. These findings should facilitate policy makers worldwide to target strategies at populations disproportionately affected by DRLECs.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1614
      Issue No: Vol. 43, No. 5 (2020)
       
  • Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type
           2 Diabetes
    • Authors: Gopalan; A.; Mishra, P.; Alexeeff, S. E.; Blatchins, M. A.; Kim, E.; Man, A.; Karter, A. J.; Grant, R. W.
      Pages: 975 - 981
      Abstract: OBJECTIVEThe prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual’s risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21–44 years) and mid-age onset (45–64 years) of type 2 diabetes.RESEARCH DESIGN AND METHODSUsing data from a large, integrated health care system, we identified 32,137 adults (aged 21–64 years) with incident diabetes (first HbA1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year.RESULTSOf identified individuals, 26.4% had younger-onset and 73.6% had mid-age–onset type 2 diabetes. Adults with younger onset had higher initial mean HbA1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA1c
      Keywords: Health Care Delivery-Economics
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1380
      Issue No: Vol. 43, No. 5 (2020)
       
  • Incidence and Associations of Chronic Kidney Disease in Community
           Participants With Diabetes: A 5-Year Prospective Analysis of the EXTEND45
           Study
    • Authors: Sukkar; L.; Kang, A.; Hockham, C.; Young, T.; Jun, M.; Foote, C.; Pecoits-Filho, R.; Neuen, B.; Rogers, K.; Pollock, C.; Cass, A.; Sullivan, D.; Wong, G.; Knight, J.; Peiris, D.; Gallagher, M.; Jardine, M.; on behalf of the EXTEND45 Study Steering Committee
      Pages: 982 - 990
      Abstract: OBJECTIVETo determine the incidence of and factors associated with an estimated glomerular filtration rate (eGFR)
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1803
      Issue No: Vol. 43, No. 5 (2020)
       
  • Early Childhood Antibiotic Treatment for Otitis Media and Other
           Respiratory Tract Infections Is Associated With Risk of Type 1 Diabetes: A
           Nationwide Register-Based Study With Sibling Analysis
    • Authors: Wernroth; M.-L.; Fall, K.; Svennblad, B.; Ludvigsson, J. F.; Sjölander, A.; Almqvist, C.; Fall, T.
      Pages: 991 - 999
      Abstract: OBJECTIVEThe effect of early-life antibiotic treatment on the risk of type 1 diabetes is debated. This study assessed this question, applying a register-based design in children up to age 10 years including a large sibling-control analysis.RESEARCH DESIGN AND METHODSAll singleton children (n = 797,318) born in Sweden between 1 July 2005 and 30 September 2013 were included and monitored to 31 December 2014. Cox proportional hazards models, adjusted for parental and perinatal characteristics, were applied, and stratified models were used to account for unmeasured confounders shared by siblings.RESULTSType 1 diabetes developed in 1,297 children during the follow-up (median 4.0 years [range 0–8.3]). Prescribed antibiotics in the 1st year of life (23.8%) were associated with an increased risk of type 1 diabetes (adjusted hazard ratio [HR] 1.19 [95% CI 1.05–1.36]), with larger effect estimates among children delivered by cesarean section (P for interaction = 0.016). The association was driven by exposure to antibiotics primarily used for acute otitis media and respiratory tract infections. Further, we found an association of antibiotic prescriptions in pregnancy (22.5%) with type 1 diabetes (adjusted HR 1.15 [95% CI 1.00–1.32]). In general, sibling analysis supported these results, albeit often with statistically nonsignificant associations.CONCLUSIONSDispensed prescription of antibiotics, mainly for acute otitis media and respiratory tract infections, in the 1st year of life is associated with an increased risk of type 1 diabetes before age 10 years, most prominently in children delivered by cesarean section.
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1162
      Issue No: Vol. 43, No. 5 (2020)
       
  • Possible Modifiers of the Association Between Change in Weight Status From
           Child Through Adult Ages and Later Risk of Type 2 Diabetes
    • Authors: Bjerregaard; L. G.; Wasenius, N.; Nedelec, R.; Gjaerde, L. K.; Ängquist, L.; Herzig, K.-H.; Jensen, G. B.; Mortensen, E. L.; Osler, M.; Overvad, K.; Skaaby, T.; Tjonneland, A.; Sorensen, T. I. A.; Järvelin, M.-R.; Eriksson, J. G.; Sebert, S.; Baker, J. L.
      Pages: 1000 - 1007
      Abstract: OBJECTIVEWe investigated the association between changes in weight status from childhood through adulthood and subsequent type 2 diabetes risks and whether educational attainment, smoking, and leisure time physical activity (LTPA) modify this association.RESEARCH DESIGN AND METHODSUsing data from 10 Danish and Finnish cohorts including 25,283 individuals, childhood BMI at 7 and 12 years was categorized as normal or high using age- and sex-specific cutoffs (
      Keywords: Pediatrics-Obesity and Type 2 Diabetes
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1726
      Issue No: Vol. 43, No. 5 (2020)
       
  • Trends in Bone Mineral Density, Osteoporosis, and Osteopenia Among U.S.
           Adults With Prediabetes, 2005-2014
    • Authors: Chen; C.; Chen, Q.; Nie, B.; Zhang, H.; Zhai, H.; Zhao, L.; Xia, P.; Lu, Y.; Wang, N.
      Pages: 1008 - 1015
      Abstract: OBJECTIVEWe aimed to evaluate trends in bone mineral density (BMD) and the prevalence of osteoporosis/osteopenia in U.S. adults with prediabetes and normal glucose regulation (NGR) and further investigate the association among prediabetes, osteopenia/osteoporosis, and fracture.RESEARCH DESIGN AND METHODSWe collected and analyzed data from the U.S. National Health and Nutrition Examination Surveys during the period from 2005 to 2014. Femoral neck and lumbar spine BMD data were available for 5,310 adults with prediabetes and 5,162 adults with NGR>40 years old.RESULTSA shift was observed toward a lower BMD and a higher prevalence of osteopenia/osteoporosis at the femoral neck and lumbar spine in U.S. adults>40 years old with prediabetes since 2005, especially in men 40 years old with NGR. Moreover, prediabetes was associated with a higher prevalence of hip fracture, although participants with prediabetes had higher BMD and a lower prevalence of osteopenia/osteoporosis at the femoral neck.CONCLUSIONSThere was a declining trend in BMD from 2005 to 2014 in U.S. adults>40 years old with prediabetes and NGR, and this trend was more significant in men
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1807
      Issue No: Vol. 43, No. 5 (2020)
       
  • Multilevel Variation in Diabetes Screening Within an Integrated Health
           System
    • Authors: Obinwa; U.; Perez, A.; Lingvay, I.; Meneghini, L.; Halm, E. A.; Bowen, M. E.
      Pages: 1016 - 1024
      Abstract: OBJECTIVEVariation in diabetes screening in clinical practice is poorly described. We examined the interplay of patient, provider, and clinic factors explaining variation in diabetes screening within an integrated health care system in the U.S.RESEARCH DESIGN AND METHODSWe conducted a retrospective cohort study of primary care patients aged 18–64 years with two or more outpatient visits between 2010 and 2015 and no diagnosis of diabetes according to electronic health record (EHR) data. Hierarchical three-level models were used to evaluate multilevel variation in screening at the patient, provider, and clinic levels across 12 clinics. Diabetes screening was defined by a resulted gold standard screening test.RESULTSOf 56,818 patients, 70% completed diabetes screening with a nearly twofold variation across clinics (51–92%; P < 0.001). Of those meeting American Diabetes Association (ADA) (69%) and U.S. Preventive Services Task Force (USPSTF) (36%) screening criteria, three-quarters were screened with a nearly twofold variation across clinics (ADA 53–92%; USPSTF 49–93%). The yield of ADA and USPSTF screening was similar for diabetes (11% vs. 9%) and prediabetes (38% vs. 36%). Nearly 70% of patients not eligible for guideline-based screening were also tested. The USPSTF guideline missed more cases of diabetes (6% vs. 3%) and prediabetes (26% vs. 19%) than the ADA guideline. After adjustment for patient, provider, and clinic factors and accounting for clustering, twofold variation in screening by provider and clinic remained (median odds ratio 1.97; intraclass correlation 0.13).CONCLUSIONSScreening practices vary widely and are only partially explained by patient, provider, and clinic factors available in the EHR. Clinical decision support and system-level interventions are needed to optimize screening practices.
      Keywords: Epidemiology-Clinical-Diagnosis and Screening
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-1622
      Issue No: Vol. 43, No. 5 (2020)
       
  • The Synergic Association of hs-CRP and Serum Amyloid P Component in
           Predicting All-Cause Mortality in Patients With Type 2 Diabetes
    • Authors: Scarale; M. G.; Copetti, M.; Garofolo, M.; Fontana, A.; Salvemini, L.; De Cosmo, S.; Lamacchia, O.; Penno, G.; Trischitta, V.; Menzaghi, C.
      Pages: 1025 - 1032
      Abstract: OBJECTIVEType 2 diabetes is characterized by increased death rate. In order to tackle this dramatic event, it becomes essential to discover novel biomarkers capable of identifying high-risk patients to be exposed to more aggressive preventive and treatment strategies. hs-CRP and serum amyloid P component (SAP) are two acute-phase inflammation proteins, which interact physically and share structural and functional features. We investigated their combined role in associating with and improving prediction of mortality in type 2 diabetes.RESEARCH DESIGN AND METHODSFour cohorts comprising 2,499 patients with diabetes (643 all-cause deaths) were analyzed. The improvement of mortality prediction was addressed using two well-established prediction models, namely, EstimatioN oF mORtality risk in type 2 diabetiC patiEnts (ENFORCE) and Risk Equations for Complications of Type 2 Diabetes (RECODe).RESULTSBoth hs-CRP and SAP were independently associated with all-cause mortality (hazard ratios [HRs] [95% CIs]: 1.46 [1.34–1.58] [P < 0.001] and 0.82 [0.76–0.89] [P < 0.001], respectively). Patients with SAP ≤33 mg/L were at increased risk of death versus those with SAP>33 mg/L only if hs-CRP was relatively high (>2 mg/L) (HR 1.96 [95% CI 1.52–2.54] [P < 0.001] and 1.20 [0.91–1.57] [P = 0.20] in hs-CRP>2 and ≤2 mg/L subgroups, respectively; hs-CRP-by-SAP strata interaction P < 0.001). The addition of hs-CRP and SAP significantly (all P < 0.05) improved several discrimination and reclassification measures of both ENFORCE and RECODe all-cause mortality prediction models.CONCLUSIONSIn type 2 diabetes, hs-CRP and SAP show opposite and synergic associations with all-cause mortality. The use of both markers, possibly in combination with others yet to be unraveled, might improve the ability to predict the risk of death in the real-life setting.
      Keywords: Epidemiology-Other
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-2489
      Issue No: Vol. 43, No. 5 (2020)
       
  • Risk of Ipsilateral Reamputation Following an Incident Toe Amputation
           Among U.S. Military Veterans With Diabetes, 2005-2016
    • Authors: Littman; A. J.; Tseng, C.-L.; Timmons, A.; Moore, K.; Landry, G.; Czerniecki, J. M.; Robbins, J.; Boyko, E. J.
      Pages: 1033 - 1040
      Abstract: OBJECTIVETo assess whether the risk of subsequent lower-limb amputations and death following an initial toe amputation among individuals with diabetes has changed over time and varies by demographic characteristics and geographic region.RESEARCH DESIGN AND METHODSUsing Veterans Health Administration (VHA) electronic medical records from 1 October 2004 to 30 September 2016, we determined risk of subsequent ipsilateral minor and major amputation within 1 year after an initial toe/ray amputation among veterans with diabetes. To assess changes in the annual rate of subsequent amputation over time, we estimated age-adjusted incidence of minor and major subsequent ipsilateral amputation for each year, separately for African Americans (AAs) and whites. Geographic variation was assessed across VHA markets (n = 89) using log-linear Poisson regression models adjusting for age and ethnoracial category.RESULTSAmong 17,786 individuals who had an initial toe amputation, 34% had another amputation on the same limb within 1 year, including 10% who had a major ipsilateral amputation. Median time to subsequent ipsilateral amputation (minor or major) was 36 days. One-year risk of subsequent major amputation decreased over time, but risk of subsequent minor amputation did not. Risk of subsequent major ipsilateral amputation was higher in AAs than whites. After adjusting for age and ethnoracial category, 1-year risk of major subsequent amputation varied fivefold across VHA markets.CONCLUSIONSNearly one-third of individuals require reamputation following an initial toe amputation, although risks of subsequent major ipsilateral amputation have decreased over time. Nevertheless, risks remain particularly high for AAs and vary substantially geographically.
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-2337
      Issue No: Vol. 43, No. 5 (2020)
       
  • Every Fifth Individual With Type 1 Diabetes Suffers From an Additional
           Autoimmune Disease: A Finnish Nationwide Study
    • Authors: Mäkimattila; S.; Harjutsalo, V.; Forsblom, C.; Groop, P.-H.; on behalf of the FinnDiane Study Group
      Pages: 1041 - 1047
      Abstract: OBJECTIVEThe aim of this study was to quantify the excess risk of autoimmune hypothyroidism and hyperthyroidism, Addison disease, celiac disease, and atrophic gastritis in adults with type 1 diabetes (T1D) compared with nondiabetic individuals in Finland.RESEARCH DESIGN AND METHODSThe study included 4,758 individuals with T1D from the Finnish Diabetic Nephropathy (FinnDiane) Study and 12,710 nondiabetic control individuals. The autoimmune diseases (ADs) were identified by linking the data with the Finnish nationwide health registries from 1970 to 2015.RESULTSThe median age of the FinnDiane individuals at the end of follow-up in 2015 was 51.4 (interquartile range 42.6–60.1) years, and the median duration of diabetes was 35.5 (26.5–44.0) years. Of individuals with T1D, 22.8% had at least one additional AD, which included 31.6% of women and 14.9% of men. The odds ratios for hypothyroidism, hyperthyroidism, celiac disease, Addison disease, and atrophic gastritis were 3.43 (95% CI 3.09–3.81), 2.98 (2.27–3.90), 4.64 (3.71–5.81), 24.13 (5.60–104.03), and 5.08 (3.15–8.18), respectively, in the individuals with T1D compared with the control individuals. The corresponding ORs for women compared with men were 2.96 (2.53–3.47), 2.83 (1.87–4.28), 1.52 (1.15–2.02), 2.22 (0.83–5.91), and 1.36 (0.77–2.39), respectively, in individuals with T1D. Late onset of T1D and aging increased the risk of hypothyroidism, whereas young age at onset of T1D increased the risk of celiac disease.CONCLUSIONSThis is one of the largest studies quantifying the risk of coexisting AD in adult individuals with T1D in the country with the highest incidence of T1D in the world. The results highlight the importance of continuous screening for other ADs in individuals with T1D.
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-2429
      Issue No: Vol. 43, No. 5 (2020)
       
  • Differential Health Care Use, Diabetes-Related Complications, and
           Mortality Among Five Unique Classes of Patients With Type 2 Diabetes in
           Singapore: A Latent Class Analysis of 71,125 Patients
    • Authors: Seng; J. J. B.; Kwan, Y. H.; Lee, V. S. Y.; Tan, C. S.; Zainudin, S. B.; Thumboo, J.; Low, L. L.
      Pages: 1048 - 1056
      Abstract: OBJECTIVEWith rising health care costs and finite health care resources, understanding the population needs of different type 2 diabetes mellitus (T2DM) patient subgroups is important. Sparse data exist for the application of population segmentation on health care needs among Asian T2DM patients. We aimed to segment T2DM patients into distinct classes and evaluate their differential health care use, diabetes-related complications, and mortality patterns.RESEARCH DESIGN AND METHODSLatent class analysis was conducted on a retrospective cohort of 71,125 T2DM patients. Latent class indicators included patient’s age, ethnicity, comorbidities, and duration of T2DM. Outcomes evaluated included health care use, diabetes-related complications, and 4-year all-cause mortality. The relationship between class membership and outcomes was evaluated with the appropriate regression models.RESULTSFive classes of T2DM patients were identified. The prevalence of depression was high among patients in class 3 (younger females with short-to-moderate T2DM duration and high psychiatric and neurological disease burden) and class 5 (older patients with moderate-to-long T2DM duration and high disease burden with end-organ complications). They were the highest tertiary health care users. Class 5 patients had the highest risk of myocardial infarction (hazard ratio [HR] 12.05, 95% CI 10.82–13.42]), end-stage renal disease requiring dialysis initiation (HR 25.81, 95% CI 21.75–30.63), stroke (HR 19.37, 95% CI 16.92–22.17), lower-extremity amputation (HR 12.94, 95% CI 10.90–15.36), and mortality (HR 3.47, 95% CI 3.17–3.80).CONCLUSIONST2DM patients can be segmented into classes with differential health care use and outcomes. Depression screening should be considered for the two identified classes of patients.
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-2519
      Issue No: Vol. 43, No. 5 (2020)
       
  • Trends in Emergency Department Visits and Inpatient Admissions for
           Hyperglycemic Crises in Adults With Diabetes in the U.S., 2006-2015
    • Authors: Benoit; S. R.; Hora, I.; Pasquel, F. J.; Gregg, E. W.; Albright, A. L.; Imperatore, G.
      Pages: 1057 - 1064
      Abstract: OBJECTIVETo report U.S. national population-based rates and trends in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) among adults, in both the emergency department (ED) and inpatient settings.RESEARCH DESIGN AND METHODSWe analyzed data from 1 January 2006 through 30 September 2015 from the Nationwide Emergency Department Sample and National Inpatient Sample to characterize ED visits and inpatient admissions with DKA and HHS. We used corresponding year cross-sectional survey data from the National Health Interview Survey to estimate the number of adults ≥18 years with diagnosed diabetes to calculate population-based rates for DKA and HHS in both ED and inpatient settings. Linear trends from 2009 to 2015 were assessed using Joinpoint software.RESULTSIn 2014, there were a total of 184,255 and 27,532 events for DKA and HHS, respectively. The majority of DKA events occurred in young adults aged 18–44 years (61.7%) and in adults with type 1 diabetes (70.6%), while HHS events were more prominent in middle-aged adults 45–64 years (47.5%) and in adults with type 2 diabetes (88.1%). Approximately 40% of the hyperglycemic events were in lower-income populations. Overall, event rates for DKA significantly increased from 2009 to 2015 in both ED (annual percentage change [APC] 13.5%) and inpatient settings (APC 8.3%). A similar trend was seen for HHS (APC 16.5% in ED and 6.3% in inpatient). The increase was in all age-groups and in both men and women.CONCLUSIONSCauses of increased rates of hyperglycemic events are unknown. More detailed data are needed to investigate the etiology and determine prevention strategies.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2020-04-20T12:00:32-07:00
      DOI: 10.2337/dc19-2449
      Issue No: Vol. 43, No. 5 (2020)
       
  • Increase in Endogenous Glucose Production With SGLT2 Inhibition Is
           Unchanged by Renal Denervation and Correlates Strongly With the Increase
           in Urinary Glucose Excretion
    • Authors: Solis-Herrera; C.; Daniele, G.; Alatrach, M.; Agyin, C.; Triplitt, C.; Adams, J.; Patel, R.; Gastaldelli, A.; Honka, H.; Chen, X.; Abdul-Ghani, M.; Cersosimo, E.; Del Prato, S.; DeFronzo, R.
      Pages: 1065 - 1069
      Abstract: OBJECTIVESodium–glucose cotransporter 2 (SGLT2) inhibition causes an increase in endogenous glucose production (EGP). However, the mechanisms are unclear. We studied the effect of SGLT2 inhibitors on EGP in subjects with type 2 diabetes (T2D) and without diabetes (non-DM) in kidney transplant recipients with renal denervation.RESEARCH DESIGN AND METHODSFourteen subjects who received a renal transplant (six with T2D [A1C 7.2 ± 0.1%] and eight non-DM [A1C 5.6 ± 0.1%) underwent measurement of EGP with [3-3H]glucose infusion following dapagliflozin (DAPA) 10 mg or placebo. Plasma glucose, insulin, C-peptide, glucagon, and titrated glucose-specific activity were measured.RESULTSFollowing placebo in T2D, fasting plasma glucose (FPG) (143 ± 14 to 124 ± 10 mg/dL; P = 0.02) and fasting plasma insulin (12 ± 2 to 10 ± 1.1 μU/mL; P < 0.05) decreased; plasma glucagon was unchanged, and EGP declined. After DAPA in T2D, FPG (143 ± 15 to 112 ± 9 mg/dL; P = 0.01) and fasting plasma insulin (14 ± 3 to 11 ± 2 μU/mL; P = 0.02) decreased, and plasma glucagon increased (all P < 0.05 vs. placebo). EGP was unchanged from baseline (2.21 ± 0.19 vs. 1.96 ± 0.14 mg/kg/min) in T2D (P < 0.001 vs. placebo). In non-DM following DAPA, FPG and fasting plasma insulin decreased, and plasma glucagon was unchanged. EGP was unchanged from baseline (1.85 ± 0.10 to 1.78 ± 0.10 mg/kg/min) after DAPA, whereas EGP declined significantly with placebo. When the increase in EGP production following DAPA versus placebo was plotted against the difference in urinary glucose excretion (UGE) for all patients, a strong correlation (r = 0.824; P < 0.001) was observed.CONCLUSIONSRenal denervation in patients who received a kidney transplant failed to block the DAPA-mediated stimulation of EGP in both individuals with T2D and non-DM subjects. The DAPA-stimulated rise in EGP is strongly related to the increase in UGE, blunting the decline in FPG.
      Keywords: Clinical Therapeutics/New Technology-Pharmacological Treatment of Complications
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2177
      Issue No: Vol. 43, No. 5 (2020)
       
  • Medication Adherence During Adjunct Therapy With Statins and ACE
           Inhibitors in Adolescents With Type 1 Diabetes
    • Authors: Niechciał; E.; Acerini, C. L.; Chiesa, S. T.; Stevens, T.; Dalton, R. N.; Daneman, D.; Deanfield, J. E.; Jones, T. W.; Mahmud, F. H.; Marshall, S. M.; Neil, H. A. W.; Dunger, D. B.; Marcovecchio, M. L.; on behalf of the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) Study Group
      Pages: 1070 - 1076
      Abstract: OBJECTIVESuboptimal adherence to insulin treatment is a main issue in adolescents with type 1 diabetes. However, to date, there are no available data on adherence to adjunct noninsulin medications in this population. Our aim was to assess adherence to ACE inhibitors and statins and explore potential determinants in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODSThere were 443 adolescents with type 1 diabetes recruited into the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) and exposed to treatment with two oral drugs—an ACE inhibitor and a statin—as well as combinations of both or placebo for 2–4 years. Adherence was assessed every 3 months with the Medication Event Monitoring System (MEMS) and pill count.RESULTSMedian adherence during the trial was 80.2% (interquartile range 63.6–91.8) based on MEMS and 85.7% (72.4–92.9) for pill count. Adherence based on MEMS and pill count dropped from 92.9% and 96.3%, respectively, at the first visit to 76.3% and 79.0% at the end of the trial. The percentage of study participants with adherence ≥75% declined from 84% to 53%. A good correlation was found between adherence based on MEMS and pill count (r = 0.82, P < 0.001). Factors associated with adherence were age, glycemic control, and country.CONCLUSIONSWe report an overall good adherence to ACE inhibitors and statins during a clinical trial, although there was a clear decline in adherence over time. Older age and suboptimal glycemic control at baseline predicted lower adherence during the trial, and, predictably, reduced adherence was more prevalent in subjects who subsequently dropped out.
      Keywords: Pediatrics-Type 1 Diabetes
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-0884
      Issue No: Vol. 43, No. 5 (2020)
       
  • Dalcetrapib Reduces Risk of New-Onset Diabetes in Patients With Coronary
           Heart Disease
    • Authors: Schwartz; G. G.; Leiter, L. A.; Ballantyne, C. M.; Barter, P. J.; Black, D. M.; Kallend, D.; Laghrissi-Thode, F.; Leitersdorf, E.; McMurray, J. J. V.; Nicholls, S. J.; Olsson, A. G.; Preiss, D.; Shah, P. K.; Tardif, J.-C.; Kittelson, J.
      Pages: 1077 - 1084
      Abstract: OBJECTIVEIncident type 2 diabetes is common among patients with recent acute coronary syndrome and is associated with an adverse prognosis. Some data suggest that cholesteryl ester transfer protein (CETP) inhibitors reduce incident type 2 diabetes. We compared the effect of treatment with the CETP inhibitor dalcetrapib or placebo on incident diabetes in patients with recent acute coronary syndrome.RESEARCH DESIGN AND METHODSIn the dal-OUTCOMES trial, 15,871 patients were randomly assigned to treatment with dalcetrapib 600 mg daily or placebo, beginning 4–12 weeks after an acute coronary syndrome. Absence of diabetes at baseline was based on medical history, no use of antihyperglycemic medication, and hemoglobin A1c and serum glucose levels below diagnostic thresholds. Among these patients, incident diabetes after randomization was defined by any diabetes-related adverse event, new use of antihyperglycemic medication, hemoglobin A1c ≥6.5%, or a combination of at least two measurements of serum glucose ≥7.0 mmol/L (fasting) or ≥11.1 mmol/L (random).RESULTSAt baseline, 10,645 patients (67% of the trial cohort) did not have diabetes. During a median follow-up of 30 months, incident diabetes was identified in 403 of 5,326 patients (7.6%) assigned to dalcetrapib and in 516 of 5,319 (9.7%) assigned to placebo, corresponding to absolute risk reduction of 2.1%, hazard ratio of 0.77 (95% CI 0.68–0.88; P < 0.001), and a need to treat 40 patients for 3 years to prevent 1 incident case of diabetes. Considering only those with prediabetes at baseline, the number needed to treat for 3 years to prevent 1 incident case of diabetes was 25. Dalcetrapib also decreased the number of patients who progressed from normoglycemia to prediabetes and increased the number who regressed from diabetes to no diabetes.CONCLUSIONSIn patients with a recent acute coronary syndrome, incident diabetes is common and is reduced substantially by treatment with dalcetrapib.
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2204
      Issue No: Vol. 43, No. 5 (2020)
       
  • Efficacy and Safety of Liraglutide 3.0 mg in Individuals With Overweight
           or Obesity and Type 2 Diabetes Treated With Basal Insulin: The SCALE
           Insulin Randomized Controlled Trial
    • Authors: Garvey; W. T.; Birkenfeld, A. L.; Dicker, D.; Mingrone, G.; Pedersen, S. D.; Satylganova, A.; Skovgaard, D.; Sugimoto, D.; Jensen, C.; Mosenzon, O.
      Pages: 1085 - 1093
      Abstract: OBJECTIVEMost individuals with type 2 diabetes also have obesity, and treatment with some diabetes medications, including insulin, can cause further weight gain. No approved chronic weight management medications have been prospectively investigated in individuals with overweight or obesity and insulin-treated type 2 diabetes. The primary objective of this study was to assess the effect of liraglutide 3.0 mg versus placebo on weight loss in this population.RESEARCH DESIGN AND METHODSSatiety and Clinical Adiposity—Liraglutide Evidence (SCALE) Insulin was a 56-week, randomized, double-blind, placebo-controlled, multinational, multicenter trial in individuals with overweight or obesity and type 2 diabetes treated with basal insulin and ≤2 oral antidiabetic drugs.RESULTSIndividuals were randomized to liraglutide 3.0 mg (n = 198) or placebo (n = 198), combined with intensive behavioral therapy (IBT). At 56 weeks, mean weight change was –5.8% for liraglutide 3.0 mg versus –1.5% with placebo (estimated treatment difference –4.3% [95% CI –5.5; –3.2]; P < 0.0001). With liraglutide 3.0 mg, 51.8% of individuals achieved ≥5% weight loss versus 24.0% with placebo (odds ratio 3.41 [95% CI 2.19; 5.31]; P < 0.0001). Liraglutide 3.0 mg was associated with significantly greater reductions in mean HbA1c and mean daytime glucose values and less need for insulin versus placebo, despite a treat-to-glycemic-target protocol. More hypoglycemic events were observed with placebo than liraglutide 3.0 mg. No new safety or tolerability issues were observed.CONCLUSIONSIn individuals with overweight or obesity and insulin-treated type 2 diabetes, liraglutide 3.0 mg as an adjunct to IBT was superior to placebo regarding weight loss and improved glycemic control despite lower doses of basal insulin and without increases in hypoglycemic events.
      Keywords: Obesity-Human
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-1745
      Issue No: Vol. 43, No. 5 (2020)
       
  • The Impact of Medicaid Expansion on Diabetes Management
    • Authors: Lee; J.; Callaghan, T.; Ory, M.; Zhao, H.; Bolin, J. N.
      Pages: 1094 - 1101
      Abstract: OBJECTIVEDiabetes is a chronic health condition contributing to a substantial burden of disease. According to the Robert Wood Johnson Foundation, 10.9 million people were newly insured by Medicaid between 2013 and 2016. Considering this coverage expansion, the Affordable Care Act (ACA) could significantly affect people with diabetes in their management of the disease. This study evaluates the impact of the Medicaid expansion under the ACA on diabetes management.RESEARCH DESIGN AND METHODSThis study includes 22,335 individuals with diagnosed diabetes from the 2011 to 2016 Behavioral Risk Factor Surveillance System. It uses a difference-in-differences approach to evaluate the impact of the Medicaid expansion on self-reported access to health care, self-reported diabetes management, and self-reported health status. Additionally, it performs a triple-differences analysis to compare the impact between Medicaid expansion and nonexpansion states considering diabetes rates of the states.RESULTSSignificant improvements in Medicaid expansion states as compared with non–Medicaid expansion states were evident in self-reported access to health care (0.09 score; P = 0.023), diabetes management (1.91 score; P = 0.001), and health status (0.10 score; P = 0.026). Among states with large populations with diabetes, states that expanded Medicaid reported substantial improvements in these areas in comparison with those that did not expand.CONCLUSIONSThe Medicaid expansion has significant positive effects on self-reported diabetes management. While states with large diabetes populations that expanded Medicaid have experienced substantial improvements in self-reported diabetes management, non–Medicaid expansion states with high diabetes rates may be facing health inequalities. The findings provide policy implications for the diabetes care community and policy makers.
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-1173
      Issue No: Vol. 43, No. 5 (2020)
       
  • The Prognosis of Patients With Type 2 Diabetes and Nonalbuminuric Diabetic
           Kidney Disease Is Not Always Poor: Implication of the Effects of
           Coexisting Macrovascular Complications (JDDM 54)
    • Authors: Yokoyama; H.; Araki, S.-i.; Kawai, K.; Yamazaki, K.; Shirabe, S.-i.; Sugimoto, H.; Minami, M.; Miyazawa, I.; Maegawa, H.; for the JDDM Study Group
      Pages: 1102 - 1110
      Abstract: OBJECTIVENonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes.RESEARCH DESIGN AND METHODSA total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR (
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2049
      Issue No: Vol. 43, No. 5 (2020)
       
  • Diabetes, Cognitive Decline, and Mild Cognitive Impairment Among Diverse
           Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging
           Results (HCHS/SOL)
    • Authors: Gonzalez; H. M.; Tarraf, W.; Gonzalez, K. A.; Fornage, M.; Zeng, D.; Gallo, L. C.; Talavera, G. A.; Daviglus, M. L.; Lipton, R. B.; Kaplan, R.; Ramos, A. R.; Lamar, M.; Cai, J.; DeCarli, C.; Schneiderman, N.
      Pages: 1111 - 1117
      Abstract: OBJECTIVEHispanics/Latinos are the largest ethnic/racial group in the U.S., have the highest prevalence of diabetes, and are at increased risk for neurodegenerative disorders. Currently, little is known about the relationship between diabetes and cognitive decline and disorders among diverse Hispanics/Latinos. The purpose of this study is to clarify these relationships in diverse middle-aged and older Hispanics/Latinos.RESEARCH DESIGN AND METHODSThe Study of Latinos–Investigation of Neurocognitive Aging (SOL-INCA) is an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is a multisite (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA), probability-sampled (i.e., representative of targeted populations), and prospective cohort study. Between 2016 and 2018, SOL-INCA enrolled diverse Hispanics/Latinos aged ≥50 years (n = 6,377). Global cognitive decline and mild cognitive impairment (MCI) were the primary outcomes.RESULTSPrevalent diabetes at visit 1, but not incident diabetes at visit 2, was associated with significantly steeper global cognitive decline (βGC = –0.16 [95% CI –0.25; –0.07]; P < 0.001), domain-specific cognitive decline, and higher odds of MCI (odds ratio 1.74 [95% CI 1.34; 2.26]; P < 0.001) compared with no diabetes in age- and sex-adjusted models.CONCLUSIONSDiabetes was associated with cognitive decline and increased MCI prevalence among diverse Hispanics/Latinos, primarily among those with prevalent diabetes at visit 1. Our findings suggest that significant cognitive decline and MCI may be considered additional disease complications of diabetes among diverse middle-aged and older Hispanics/Latinos.
      Keywords: Epidemiology-Aging
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-1676
      Issue No: Vol. 43, No. 5 (2020)
       
  • Underweight Increases the Risk of End-Stage Renal Diseases for Type 2
           Diabetes in Korean Population: Data From the National Health Insurance
           Service Health Checkups 2009-2017
    • Authors: Kim; Y.-H.; Kang, J. G.; Lee, S. J.; Han, K.-d.; Ihm, S.-H.; Cho, K.-H.; Park, Y.-G.
      Pages: 1118 - 1125
      Abstract: OBJECTIVEThere is a controversy over the association between obesity and end-stage renal disease (ESRD) in people with or without type 2 diabetes; therefore, we examined the effect of BMI on the risk of ESRD according to glycemic status in the Korean population.RESEARCH DESIGN AND METHODSThe study monitored 9,969,848 participants who underwent a National Health Insurance Service health checkup in 2009 from baseline to the date of diagnosis of ESRD during a follow-up period of ~8.2 years. Obesity was categorized by World Health Organization recommendations for Asian populations, and glycemic status was categorized into the following five groups: normal, impaired fasting glucose (IFG), newly diagnosed diabetes, diabetes
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2095
      Issue No: Vol. 43, No. 5 (2020)
       
  • Both Prediabetes and Type 2 Diabetes Are Associated With Lower Heart Rate
           Variability: The Maastricht Study
    • Authors: Coopmans; C.; Zhou, T. L.; Henry, R. M. A.; Heijman, J.; Schaper, N. C.; Koster, A.; Schram, M. T.; van der Kallen, C. J. H.; Wesselius, A.; den Engelsman, R. J. A.; Crijns, H. J. G. M.; Stehouwer, C. D. A.
      Pages: 1126 - 1133
      Abstract: OBJECTIVELow heart rate variability (HRV), a marker for cardiac autonomic dysfunction, is a known feature of type 2 diabetes, but it remains incompletely understood whether this also applies to prediabetes or across the whole glycemic spectrum. Therefore, we investigated the association among prediabetes, type 2 diabetes, and measures of glycemia and HRV.RESEARCH DESIGN AND METHODSIn the population-based Maastricht Study (n = 2,107; mean ± SD age 59 ± 8 years; 52% men; normal glucose metabolism [n = 1,226], prediabetes [n = 331], and type 2 diabetes [n = 550, oversampled]), we determined 24-h electrocardiogram-derived HRV in time and frequency domains (individual z-scores, based upon seven and six variables, respectively). We used linear regression with adjustments for age, sex, and major cardiovascular risk factors.RESULTSAfter adjustments, both time and frequency domain HRV were lower in prediabetes and type 2 diabetes as compared with normal glucose metabolism (standardized β [95% CI] for time domain: –0.15 [–0.27; –0.03] and –0.34 [–0.46; –0.22], respectively, P for trend
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2367
      Issue No: Vol. 43, No. 5 (2020)
       
  • Intrahepatic Fat and Postprandial Glycemia Increase After Consumption of a
           Diet Enriched in Saturated Fat Compared With Free Sugars
    • Authors: Parry; S. A.; Rosqvist, F.; Mozes, F. E.; Cornfield, T.; Hutchinson, M.; Piche, M.-E.; Hülsmeier, A. J.; Hornemann, T.; Dyson, P.; Hodson, L.
      Pages: 1134 - 1141
      Abstract: OBJECTIVEDebate continues regarding the influence of dietary fats and sugars on the risk of developing metabolic diseases, including insulin resistance and nonalcoholic fatty liver disease (NAFLD). We investigated the effect of two eucaloric diets, one enriched with saturated fat (SFA) and the other enriched with free sugars (SUGAR), on intrahepatic triacylglycerol (IHTAG) content, hepatic de novo lipogenesis (DNL), and whole-body postprandial metabolism in overweight males.RESEARCH DESIGN AND METHODSSixteen overweight males were randomized to consume the SFA or SUGAR diet for 4 weeks before consuming the alternate diet after a 7-week washout period. The metabolic effects of the respective diets on IHTAG content, hepatic DNL, and whole-body metabolism were investigated using imaging techniques and metabolic substrates labeled with stable-isotope tracers.RESULTSConsumption of the SFA diet significantly increased IHTAG by mean ± SEM 39.0 ± 10.0%, while after the SUGAR diet IHTAG was virtually unchanged. Consumption of the SFA diet induced an exaggerated postprandial glucose and insulin response to a standardized test meal compared with SUGAR. Although whole-body fat oxidation, lipolysis, and DNL were similar following the two diets, consumption of the SUGAR diet resulted in significant (P < 0.05) decreases in plasma total, HDL, and non-HDL cholesterol and fasting β-hydroxybutyrate plasma concentrations.CONCLUSIONSConsumption of an SFA diet had a potent effect, increasing IHTAG together with exaggerating postprandial glycemia. The SUGAR diet did not influence IHTAG and induced minor metabolic changes. Our findings indicate that a diet enriched in SFA is more harmful to metabolic health than a diet enriched in free sugars.
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2331
      Issue No: Vol. 43, No. 5 (2020)
       
  • Evaluation of Factors Related to Glycemic Management in Professional
           Cyclists With Type 1 Diabetes Over a 7-Day Stage Race
    • Authors: Scott; S. N.; Christiansen, M. P.; Fontana, F. Y.; Stettler, C.; Bracken, R. M.; Hayes, C. A.; Fisher, M.; Bode, B.; Lagrou, P. H.; Southerland, P.; Riddell, M. C.
      Pages: 1142 - 1145
      Abstract: OBJECTIVETo investigate factors related to glycemic management among members of a professional cycling team with type 1 diabetes over a 7-day Union Cycliste Internationale World Tour stage race.RESEARCH DESIGN AND METHODSAn observational evaluation of possible factors related to glycemic management and performance in six male professional cyclists with type 1 diabetes (HbA1c 6.4 ± 0.6%) during the 2019 Tour of California.RESULTSIn-ride time spent in euglycemia (3.9–10.0 mmol/L glucose) was 63 ± 11%, with a low percentage of time spent in level 1 (3.0–3.9 mmol/L; 0 ± 1% of time) and level 2 (13.9 mmol/L) hyperglycemia during races. Bolus insulin use was uncommon during races, despite high carbohydrate intake (76 ± 23 g ⋅ h–1). Overnight, the riders spent progressively more time in hypoglycemia from day 1 (6 ± 12% in level 1 and 0 ± 0% in level 2) to day 7 (12 ± 12% in level 1 and 2 ± 4% in level 2) (2[1]> 4.78, P < 0.05).CONCLUSIONSProfessional cyclists with type 1 diabetes have excellent in-race glycemia, but significant hypoglycemia during recovery overnight, throughout a 7-day stage race.
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2302
      Issue No: Vol. 43, No. 5 (2020)
       
  • Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in
           Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled
           Trials
    • Authors: Maiorino; M. I.; Signoriello, S.; Maio, A.; Chiodini, P.; Bellastella, G.; Scappaticcio, L.; Longo, M.; Giugliano, D.; Esposito, K.
      Pages: 1146 - 1156
      Abstract: BACKGROUNDContinuous glucose monitoring (CGM) provides important information to aid in achieving glycemic targets in people with diabetes.PURPOSEWe performed a meta-analysis of randomized controlled trials (RCTs) comparing CGM with usual care for parameters of glycemic control in both type 1 and type 2 diabetes.DATA SOURCESMany electronic databases were searched for articles published from inception until 30 June 2019.STUDY SELECTIONWe selected RCTs that assessed both changes in HbA1c and time in target range (TIR), together with time below range (TBR), time above range (TAR), and glucose variability expressed as coefficient of variation (CV).DATA EXTRACTIONData were extracted from each trial by two investigators.DATA SYNTHESISAll results were analyzed by a random effects model to calculate the weighted mean difference (WMD) with the 95% CI. We identified 15 RCTs, lasting 12–36 weeks and involving 2,461 patients. Compared with the usual care (overall data), CGM was associated with modest reduction in HbA1c (WMD –0.17%, 95% CI –0.29 to –0.06, I2 = 96.2%), increase in TIR (WMD 70.74 min, 95% CI 46.73–94.76, I2 = 66.3%), and lower TAR, TBR, and CV, with heterogeneity between studies. The increase in TIR was significant and robust independently of diabetes type, method of insulin delivery, and reason for CGM use. In preplanned subgroup analyses, real-time CGM led to the higher improvement in mean HbA1c (WMD –0.23%, 95% CI –0.36 to –0.10, P < 0.001), TIR (WMD 83.49 min, 95% CI 52.68–114.30, P < 0.001), and TAR, whereas both intermittently scanned CGM and sensor-augmented pump were associated with the greater decline in TBR.LIMITATIONSHeterogeneity was high for most of the study outcomes; all studies were sponsored by industry, had short duration, and used an open-label design.CONCLUSIONSCGM improves glycemic control by expanding TIR and decreasing TBR, TAR, and glucose variability in both type 1 and type 2 diabetes.
      Keywords: Clinical Therapeutics/New Technology-Glucose Monitoring and Sensing
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-1459
      Issue No: Vol. 43, No. 5 (2020)
       
  • Sex Disparities in Cardiovascular Outcome Trials of Populations With
           Diabetes: A Systematic Review and Meta-analysis
    • Authors: Clemens; K. K.; Woodward, M.; Neal, B.; Zinman, B.
      Pages: 1157 - 1163
      Abstract: BACKGROUNDSex differences have been described in diabetes cardiovascular outcome trials (CVOTs).PURPOSEWe systematically reviewed for baseline sex differences in cardiovascular (CV) risk factors and CV protection therapy in diabetes CVOTs.DATA SOURCESRandomized placebo-controlled trials examining the effect of diabetes medications on major adverse cardiovascular events in people ≥18 years of age with type 2 diabetes.STUDY SELECTIONIncluded trials reported baseline sex-specific CV risks and use of CV protection therapy.DATA EXTRACTIONTwo reviewers independently abstracted study data.DATA SYNTHESISWe included five CVOTs with 46,606 participants. We summarized sex-specific data using mean differences (MDs) and relative risks (RRs) and pooled estimates using random effects meta-analysis. There were fewer women than men in included trials (28.5–35.8% women). Women more often had stroke (RR 1.28; 95% CI 1.09, 1.50), heart failure (RR 1.30; 95% CI 1.21,1.40), and chronic kidney disease (RR 1.33; 95% CI 1.17; 1.51). They less often used statins (RR 0.90; 95% CI 0.86, 0.93), aspirin (RR 0.82; 95% CI 0.71, 0.95), and β-blockers (RR 0.93; 95% CI 0.88, 0.97) and had a higher systolic blood pressure (MD 1.66 mmHg; 95% CI 0.90, 2.41), LDL cholesterol (MD 0.34 mmol/L; 95% CI 0.29, 0.39), and hemoglobin A1c (MD 0.11%; 95% CI 0.09, 0.14 [1.2 mmol/mol; 1.0, 1.5]) than men.LIMITATIONSWe could not carry out subgroup analyses due to the small number of studies. Our study is not generalizable to low CV risk groups nor to patients in routine care.CONCLUSIONSThere were baseline sex disparities in diabetes CVOTs. We suggest efforts to recruit women into trials and promote CV management across the sexes.
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc19-2257
      Issue No: Vol. 43, No. 5 (2020)
       
  • Erratum. Ten-Year Outcome of Islet Alone or Islet After Kidney
           Transplantation in Type 1 Diabetes: A Prospective Parallel-Arm Cohort
           Study. Diabetes Care 2019;42:2042-2049
    • Authors: Vantyghem; M.-C.; Chetboun, M.; Gmyr, V.; Jannin, A.; Espiard, S.; Le Mapihan, K.; Raverdy, V.; Delalleau, N.; Machuron, F.; Hubert, T.; Frimat, M.; Van Belle, E.; Hazzan, M.; Pigny, P.; Noel, C.; Caiazzo, R.; Kerr-Conte, J.; Pattou, F.
      Pages: 1164 - 1164
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/dc20-er05
      Issue No: Vol. 43, No. 5 (2020)
       
  • Issues and Events
    • Pages: 1165 - 1165
      PubDate: 2020-04-20T12:00:33-07:00
      DOI: 10.2337/DC20-ie05
      Issue No: Vol. 43, No. 5 (2020)
       
 
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