Publisher: American Diabetes Association   (Total: 4 journals)   [Sort alphabetically]

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Diabetes Care     Full-text available via subscription   (Followers: 448, SJR: 6.693, CiteScore: 8)
Diabetes     Full-text available via subscription   (Followers: 390, SJR: 4.435, CiteScore: 6)
Clinical Diabetes     Full-text available via subscription   (Followers: 40, SJR: 0.741, CiteScore: 1)
Diabetes Spectrum     Full-text available via subscription   (Followers: 17, SJR: 0.623, CiteScore: 1)
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Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 448  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • Comment on Dunne et al. The Women’s Leadership Gap in Diabetes: A Call
           for Equity and Excellence. Diabetes Care 2021;44:1734–1743

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      Authors: Schmittdiel JA; Adams AS, Haire-Joshu D, et al.
      Abstract: We read with interest the recent article by Dunne et al. (1) outlining the women’s leadership gap in diabetes. The authors’ detailed examination of gender representation in scientific organizations such as the American Diabetes Association and the European Association for the Study of Diabetes illustrates concerning gender disparities in the field. We applaud their efforts to quantify gender underrepresentation and provide recommendations and potential solutions. However, the assessment of leadership in the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) P30 program only examined Diabetes Research Centers, overlooking another major P30 program funded by the NIDDK: the Centers for Diabetes Translation Research (CDTRs) (2) https://www.diabetes-translation.org.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2178
      Issue No: Vol. 45, No. 5 (2022)
       
  • Response to Comment on Dunne et al. The Women’s Leadership Gap in
           Diabetes: A Call for Equity and Excellence. Diabetes Care
           2021;44:1734–1743

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      Authors: Dunne JL; Maizel JL, Posgai AL, et al.
      Abstract: We applaud the Centers for Diabetes Translation Research leadership efforts, thank them for their comments, and concur with their conclusions (1). Having parity in Centers for Diabetes Translation Research principal investigators is an important step forward. Further examination of factors contributing to this observed leadership difference would be of great interest as the diabetes community works to address areas where inequities persist.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci21-0055
      Issue No: Vol. 45, No. 5 (2022)
       
  • Comment on Aminian et al. Cardiovascular Outcomes in Patients With Type 2
           Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve Gastrectomy,
           and Usual Care. Diabetes Care 2021;44:2552–2563

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      Authors: Violante-Cumpa J; Sánchez-Gómez R, Lavalle-González F, et al.
      Abstract: We read with great interest the article published by Aminian et al. (1), where the authors found greater weight loss, better diabetes control, and lower risk of major adverse cardiovascular events 6 (MACE-6) (composite outcome including all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and nephropathy) for Roux-en-Y gastric bypass (RYGB) than for sleeve gastrectomy (SG) in patients with obesity and type 2 diabetes; however, we found some aspects of the study worth further discussion.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2317
      Issue No: Vol. 45, No. 5 (2022)
       
  • Response to Comment On Aminian et al. Cardiovascular Outcomes in Patients
           With Type 2 Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve
           Gastrectomy, and Usual Care. Diabetes Care 2021;44:2552–2563

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      Authors: Aminian A; Nissen SE.
      Abstract: We would like to thank Dr. Violante-Cumpa and colleagues for their interest in our recent publication in Diabetes Care (1,2). Our analysis showed that in patients with obesity and type 2 diabetes, compared with usual nonsurgical treatment, Roux-en-Y gastric bypass (RYGB) was significantly associated with 47% lower risk of incident major adverse cardiovascular events (MACE) and 40% lower risk of death, and sleeve gastrectomy was significantly associated with 31% lower risk of MACE and 48% lower risk of death (2).
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci21-0061
      Issue No: Vol. 45, No. 5 (2022)
       
  • Distinct Dimensions of Depression Are Associated With Different
           Brain-Related Biomarkers

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      Authors: Soleimani L; Schnaider Beeri M, Heymann A, et al.
      Abstract: Management of depression, a potentially modifiable risk factor for dementia, is of significant importance in elderly with type 2 diabetes (T2D), specifically because of their higher risk for depression and for dementia. We recently published in Diabetes Care evidence showing that in older adults (aged ≥65 years) with T2D participating in the Israel Diabetes and Cognitive Decline (IDCD) study, different dimensions of depression were associated with distinct patterns of cognitive outcomes. Specifically, apathy, but not other depression dimensions, was associated with faster decline in executive functions (1).
      PubDate: Thu, 31 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1792
      Issue No: Vol. 45, No. 5 (2022)
       
  • Sodium–Glucose Cotransporter 2 Inhibitors and Risk of Bladder and Renal
           Cancer: Scandinavian Cohort Study

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      Authors: Ueda P; Svanström H, Hviid A, et al.
      Abstract: There are concerns that sodium–glucose cotransporter 2 (SGLT2) inhibitors may increase risk of bladder cancer. Such an association was indicated early in the development of the drug class and was subsequently shown in meta-analyses of randomized trials (1) and in analyses of spontaneous reports (2), although the evidence is conflicting (3). Based on animal studies, concerns have also been raised regarding an increased risk of renal cancer. Randomized trials have shown an imbalance for this cancer among patients receiving SGLT2 inhibitors versus placebo or other glucose-lowering drugs (3).
      PubDate: Mon, 21 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1917
      Issue No: Vol. 45, No. 5 (2022)
       
  • Social Determinants of Health in U.S. Counties Where Guideline-Influencing
           Diabetes Studies Were Conducted

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      Authors: Weeda ER; Alnewais ME, Zecopoulos A, et al.
      Abstract: Social determinants of health (SDOH) strongly influence the development and progression of diabetes (1). As SDOH are infrequently measured in diabetes clinical trials, little is known about how these measures, on both county and individual levels, influence the findings of clinical trials. We sought to compare SDOH in U.S. counties used versus not used for clinical trial sites in guideline-changing studies evaluating pharmacologic treatment for glycemic control.
      PubDate: Mon, 21 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2105
      Issue No: Vol. 45, No. 5 (2022)
       
  • Sodium–Glucose Cotransporter 2 Inhibitor–Linked Pericolonoscopy
           Hyperketonemia: A Retrospective Study

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      Authors: Thiruvenkatarajan V; Smithson-Tomas G, Jothin A, et al.
      Abstract: Patients with type 2 diabetes (T2D) on sodium–glucose cotransporter 2 inhibitors (SGLT2i) may be at increased risk of pericolonoscopy ketoacidosis, attributed to bowel preparation, fasting, and inappropriate SGLT2i management. We recently reviewed the SGLT2i-linked perioperative euglycemic diabetic ketoacidosis (EDKA) risk (1) and reported pericolonoscopy EDKA in this context (2). Subsequently, we educated our institution about the importance of ketone monitoring in mitigating this risk and implemented pre- and postprocedure capillary ketone assessment for T2D patients undergoing colonoscopy. Using retrospective analysis, we aimed to determine the incidence of pericolonoscopy hyperketonemia in patients with T2D prescribed SGLT2i therapy, comparing its magnitude with non-SGLT2i therapy. We reviewed electronic records of patients undergoing colonoscopy at The Queen Elizabeth Hospital between July 2019 and August 2020 (Central Adelaide Local Health Network Human Research Ethics Committee, no. 14166). The FreeStyle Optium Neo H point-of-care kit (Abbott Laboratories, Abbott Park, U.K.) capable of measuring capillary blood glucose and β-hydroxybutyrate (BHB) was used in the measurement. The highest BHB value either before or after colonoscopy was deemed the periprocedure estimate. Hyperketonemia was defined as BHB >1.0 mmol/L.
      PubDate: Mon, 21 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1870
      Issue No: Vol. 45, No. 5 (2022)
       
  • Mental Health During Pregnancy and Postpartum in Mothers With Type 1
           Diabetes

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      Authors: Price SL.
      Pages: 1027 - 1028
      Abstract: Type 1 diabetes (T1D) has been associated with an increased risk of depression, anxiety, and other mental health disorders (1). Pregnancy is also recognized as a period of potentially increased susceptibility to poor mental health (2). Although both of these associations are well recognized and generally acknowledged, the combined impact of T1D and pregnancy on mental health has so far been variably described and has not included a large cohort of women.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0007
      Issue No: Vol. 45, No. 5 (2022)
       
  • Individualized Glycemic Goals for Older Adults Are a Moving Target

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      Authors: Pilla SJ; Shahidzadeh Yazdi Z, Taylor SI.
      Pages: 1029 - 1031
      Abstract: Treatment of type 2 diabetes (T2D) has several objectives: 1) decreasing risks of microvascular complications (retinopathy, nephropathy, and neuropathy), 2) decreasing risks of cardiovascular complications, and 3) avoiding hypoglycemia and symptomatic hyperglycemia. The American Diabetes Association (ADA) and European Association for the Study of Diabetes advocate a patient-centered approach to achieve these goals (1–3). This general guidance implicitly raises questions. Which patient-related factors should be considered in designing a therapeutic regimen' How should the treatment regimen be modified to take these factors into account' The ADA’s guidelines incorporate an approach to select an individualized hemoglobin A1c (HbA1c) target for older adults based on their comorbidities and function, which act as proxies for life expectancy (3). In this issue of Diabetes Care, Le et al. (4) focus on how this specific guidance was implemented in older Americans (aged ≥65 years) between 2001 and 2018. They conclude that “in accordance with the ADA’s recommendation, glycemic targets for older patients have been relaxed.” In other words, as the guidelines transitioned to less aggressive individualized targets, the average HbA1c for older Americans with T2D receiving diabetes medications increased from 6.9% to 7.2%. Further, older Americans in this cohort achieved similar mean HbA1c levels regardless of whether they were judged to be in “good,” “intermediate,” or “poor” health.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0004
      Issue No: Vol. 45, No. 5 (2022)
       
  • Protecting the Liver: Should We Substitute Fruit Juices for
           Sugar-Sweetened Beverages'

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      Authors: Avignon A.
      Pages: 1032 - 1034
      Abstract: With an overall prevalence of 25.2%, nonalcoholic fatty liver disease (NAFLD) is the world’s leading cause of chronic liver disease. NAFLD is defined as the detection of hepatic steatosis by either imaging or histology in the absence of any other cause of secondary accumulation of intrahepatic lipids (IHLs), such as alcohol, viral infection, or drugs. The spectrum of NAFLD includes steatosis, nonalcoholic steatohepatitis (NASH) and associated fibrosis, and cirrhosis, and it is associated with an increased risk of hepatocellular carcinoma (1). Although NAFLD is generally considered benign, 30% of affected patients present with NASH, which has a high probability of progression to later stages of disease (2). Thus, even if the risk of progression to cirrhosis and hepatocellular carcinoma is much lower for NAFLD than for chronic hepatitis B, its high prevalence makes it the second leading etiology of liver disease among adults awaiting liver transplantation in the U.S. (3), and the number of liver transplants performed for NASH is increasing (4,5). Therefore, NAFLD is a public health issue.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0005
      Issue No: Vol. 45, No. 5 (2022)
       
  • Preventing, Screening, and Treating Suicidality in Pediatric Type 1
           Diabetes: Roles for Behavioral Health Care Professionals

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      Authors: Jaser SS; Hilliard ME.
      Pages: 1035 - 1037
      Abstract: Recognizing the increased risk for depression in youth and young people with diabetes and the implications for glycemic outcomes (1), the American Diabetes Association (ADA) advises routine screening for psychological concerns, including depressive symptoms (2,3). This aligns with the U.S. Preventive Services Task Force recommended screening for depression in adolescents, which notes the need for adequate systems to ensure appropriate follow-up (4). Suicidal behaviors increased significantly in the general population of adolescents from 2009 to 2019 (5), and rates have risen further during the coronavirus disease 2019 pandemic (6). Given the pandemic and other recent societal stressors (e.g., climate disasters, struggles for racial justice), the U.S. Surgeon General issued an advisory for youth mental health (7), and U.S. pediatric groups declared a national emergency in child and adolescent mental health (8). Thus, it is more critical than ever to determine the best ways to screen for and treat depression and suicidality among youth with diabetes.
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0008
      Issue No: Vol. 45, No. 5 (2022)
       
  • Pregnancy Outcomes of Young Women With Type 2 Diabetes: Poor Care and
           Inadequate Attention to Glycemia

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      Authors: Murphy HR; Moses RG.
      Pages: 1046 - 1048
      Abstract: Type 2 diabetes (T2D), characterized by rising insulin resistance and deteriorating β-cell function, is one of the most common metabolic conditions worldwide (1,2). In parallel with the increasing prevalence of obesity during childhood and adolescence, ∼5% of T2D cases now occur in people under the age of 40 years (3). Compared with those who develop T2D after 40 years of age, those with early-onset T2D are more likely to be female, of minority ethnicity, socially deprived, and obese (3). T2D is now the commonest form of pregestational diabetes in pregnancy, with 5,085 pregnancies in women with T2D compared with 4,175 in women with type 1 diabetes (T1D), in England and Wales during 2019–2020 (4). This represents a doubling in the prevalence of T2D in pregnancy in the past two decades (4,5).
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dci21-0059
      Issue No: Vol. 45, No. 5 (2022)
       
  • Longitudinal Association of Depressive Symptoms, Binge Eating, and Quality
           of Life With Cardiovascular Risk Factors in Young Adults With Youth-Onset
           Type 2 Diabetes: The TODAY2 Study

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      Authors: .
      Pages: 1073 - 1081
      Abstract: OBJECTIVETo report the prevalence of depression, eating disorder symptoms, and impaired health-related quality of life (HRQOL) and examine their longitudinal associations with glycemia and diabetes complications in young adults with youth-onset type 2 diabetes.RESEARCH DESIGN AND METHODSParticipants recruited over a 4-year period were enrolled at 15 clinical diabetes centers in the follow-up observational Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. From 2014–2020, prevalence of symptoms of depression, eating disorders, and HRQOL by sex, race/ethnicity, and baseline family income were assessed annually. Longitudinal relationships between assessments of glycemia and complications with psychiatric symptoms and HRQOL were evaluated in adjusted models.RESULTSParticipants (n = 514) were 21.7 ± 2.5 years old with a diabetes duration of 8.6 ± 1.5 years in year 1 of TODAY 2 (2014). Symptoms of depression and impaired HRQOL were common and increased significantly over 6 years (14.0% to 19.2%, P = 0.003; and 13.1% to 16.7%, P = 0.009, respectively). Depression and impaired HRQOL were more common in women and those with lower baseline family income but did not differ by race/ethnicity. Rates of binge eating were stable over time; self-reported purging increased. Over time, symptoms of depression were associated with higher HbA1c, hypertension, and retinopathy progression; impaired HRQOL was associated with higher BMI, systolic blood pressure, hypertension, and retinopathy progression; and symptoms of eating disorders were associated with higher BMI.CONCLUSIONSSignificant psychiatric symptoms and impaired HRQOL are common among emerging adults with youth-onset type 2 diabetes and are positively associated with glycemia, hypertension, and retinopathy progression in this group that is at ongoing risk for medical morbidity.
      PubDate: Tue, 15 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1995
      Issue No: Vol. 45, No. 5 (2022)
       
  • Mental Health During Late Pregnancy and Postpartum in Mothers With and
           Without Type 1 Diabetes: The ENDIA Study

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      Authors: Hall M; Oakey H, Penno MS, et al.
      Pages: 1082 - 1090
      Abstract: OBJECTIVEPregnancy and type 1 diabetes are each associated with increased anxiety and depression, but the combined impact on well-being is unresolved. We compared the mental health of women with and without type 1 diabetes during pregnancy and postpartum and examined the relationship between mental health and glycemic control.RESEARCH DESIGN AND METHODSParticipants were women enrolled from 2016 to 2020 in the Environmental Determinants of Islet Autoimmunity (ENDIA) study, a pregnancy to birth prospective cohort following children with a first-degree relative with type 1 diabetes. Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS) were completed during the third trimester (T3) (median [interquartile range] 34 [32, 36] weeks) and postpartum (14 [13, 16] weeks) by 737 women (800 pregnancies) with (n = 518) and without (n = 282) type 1 diabetes.RESULTSEPDS and PSS scores did not differ between women with and without type 1 diabetes during T3 and postpartum. EPDS scores were marginally higher in T3: predicted mean (95% CI) 5.7 (5.4, 6.1) than postpartum: 5.3 (5.0, 5.6), independent of type 1 diabetes status (P = 0.01). HbA1c levels in type 1 diabetes were 6.3% [5.8, 6.9%] in T3 and did not correlate with EPDS or PSS scores. Reported use of psychotropic medications was similar in women with (n = 44 of 518 [8%]) and without type 1 diabetes (n = 17 of 282 [6%]), as was their amount of physical activity.CONCLUSIONSOverall, mental health in late pregnancy and postpartum did not differ between women with and without type 1 diabetes, and mental health scores were not correlated with glycemic control.
      PubDate: Wed, 02 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2335
      Issue No: Vol. 45, No. 5 (2022)
       
  • Changes in Physical Activity and the Risk of Dementia in Patients With
           New-Onset Type 2 Diabetes: A Nationwide Cohort Study

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      Authors: Yoo J; Han K, Kim B, et al.
      Pages: 1091 - 1098
      Abstract: OBJECTIVEWe investigated the association between interval changes in physical activity (PA) and dementia risk among patients with new-onset type 2 diabetes.RESEARCH DESIGN AND METHODSWe identified 133,751 participants newly diagnosed with type 2 diabetes in a health screening (2009–2012), with a follow-up health screening within 2 years (2010–2015). PA level changes were categorized into continuous lack of PA, decreaser, increaser, and continuous PA groups. Dementia was determined using dementia diagnosis codes and antidementia drug prescriptions.RESULTSDuring the median follow-up of 4.8 years, 3,240 new cases of all-cause dementia developed. Regular PA was associated with lower risks of all-cause dementia (adjusted hazard ratio [aHR] 0.82; 95% CI 0.75–0.90), Alzheimer disease (AD) (aHR 0.85; 95% CI 0.77–0.95), and vascular dementia (VaD) (aHR 0.78; 95% CI 0.61–0.99). Increasers who started to engage in regular PA had a lower risk of all-cause dementia (aHR 0.86; 95% CI 0.77–0.96). Moreover, the risk was further reduced among those with continuous regular PA: all-cause dementia (aHR 0.73; 95% CI 0.62–0.85), AD (aHR 0.74; 95% CI 0.62–0.88), and VaD (aHR 0.62; 95% CI 0.40–0.94). Consistent results were noted in various subgroup analyses.CONCLUSIONSRegular PA was independently associated with lower risks of all-cause dementia, AD, and VaD among individuals with new-onset type 2 diabetes. Those with continuous regular PA and, to a lesser extent, those who started to engage in regular PA had a lower risk of dementia. Regular PA should be encouraged to prevent dementia in high-risk populations and those with new-onset type 2 diabetes.
      PubDate: Tue, 22 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1597
      Issue No: Vol. 45, No. 5 (2022)
       
  • Glycemic Control and Clinical Outcomes in U.S. Patients With COVID-19:
           Data From the National COVID Cohort Collaborative (N3C) Database

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      Authors: Wong R; Hall M, Vaddavalli R, et al.
      Pages: 1099 - 1106
      Abstract: OBJECTIVEThe purpose of the study is to evaluate the relationship between HbA1c and severity of coronavirus disease 2019 (COVID-19) outcomes in patients with type 2 diabetes (T2D) with acute COVID-19 infection.RESEARCH DESIGN AND METHODSWe conducted a retrospective study using observational data from the National COVID Cohort Collaborative (N3C), a longitudinal, multicenter U.S. cohort of patients with COVID-19 infection. Patients were ≥18 years old with T2D and confirmed COVID-19 infection by laboratory testing or diagnosis code. The primary outcome was 30-day mortality following the date of COVID-19 diagnosis. Secondary outcomes included need for invasive ventilation or extracorporeal membrane oxygenation (ECMO), hospitalization within 7 days before or 30 days after COVID-19 diagnosis, and length of stay (LOS) for patients who were hospitalized.RESULTSThe study included 39,616 patients (50.9% female, 55.4% White, 26.4% Black or African American, and 16.1% Hispanic or Latino, with mean ± SD age 62.1 ± 13.9 years and mean ± SD HbA1c 7.6% ± 2.0). There was an increasing risk of hospitalization with incrementally higher HbA1c levels, but risk of death plateaued at HbA1c >8%, and risk of invasive ventilation or ECMO plateaued >9%. There was no significant difference in LOS across HbA1c levels.CONCLUSIONSIn a large, multicenter cohort of patients in the U.S. with T2D and COVID-19 infection, risk of hospitalization increased with incrementally higher HbA1c levels. Risk of death and invasive ventilation also increased but plateaued at different levels of glycemic control.
      PubDate: Thu, 24 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2186
      Issue No: Vol. 45, No. 5 (2022)
       
  • Adherence to the American Diabetes Association’s Glycemic Goals in the
           Treatment of Diabetes Among Older Americans, 2001–2018

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      Authors: Le P; Ayers G, Misra-Hebert AD, et al.
      Pages: 1107 - 1115
      Abstract: OBJECTIVETo assess trends in HbA1c and appropriateness of diabetes medication use by patient health status.RESEARCH DESIGN AND METHODSWe conducted cross-sectional analysis of 2001–2018 National Health and Nutrition Examination Survey (NHANES). We included older adults age ≥65 years who had ever been told they had diabetes, had HbA1c >6.4%, or had fasting plasma glucose >125 mg/dL. Health status was categorized as good, intermediate, or poor. Being below goal was defined as taking medication despite having HbA1c ≥1% below the glycemic goals of the American Diabetes Association (ADA), which varied by patient health status and time period. Drugs associated with hypoglycemia included sulfonylureas, insulin, and meglitinides.RESULTSWe included 3,539 patients. Mean HbA1c increased over time and did not differ by health status. Medication use increased from 59% to 74% with metformin being the most common drug in patients with good or intermediate health and sulfonylureas and insulin most often prescribed to patients with poor health. Among patients taking medications, prevalence of patients below goal increased while prevalence of those above goal decreased from 2001 to 2018. One-half of patients with poor health and taking medications had below-goal HbA1c; two-thirds received drugs associated with hypoglycemia. Patients with poor health who were below goal had 4.9 (95% CI 2.3–10.4) times the adjusted odds of receiving drugs associated with hypoglycemia than healthy patients.CONCLUSIONSIn accordance with ADA’s newer Standards of Medical Care in Diabetes, HbA1c goals were relaxed but did not differ by health status. Below-goal HbA1c was common among patients with poor health; many were prescribed medications associated with a higher risk of hypoglycemia.
      PubDate: Tue, 25 Jan 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1507
      Issue No: Vol. 45, No. 5 (2022)
       
  • Fructose Intake From Fruit Juice and Sugar-Sweetened Beverages Is
           Associated With Higher Intrahepatic Lipid Content: The Maastricht Study

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      Authors: Buziau AM; Eussen SM, Kooi M, et al.
      Pages: 1116 - 1123
      Abstract: OBJECTIVEEpidemiological evidence regarding the relationship between fructose intake and intrahepatic lipid (IHL) content is inconclusive. We, therefore, assessed the relationship between different sources of fructose and IHL at the population level.RESEARCH DESIGN AND METHODSWe used cross-sectional data from The Maastricht Study, a population-based cohort study (n = 3,981; mean ± SD age: 60 ± 9 years; 50% women). We assessed the relationship between fructose intake (assessed with a food-frequency questionnaire)—total and derived from fruit, fruit juice, and sugar-sweetened beverages (SSB)—and IHL (quantified with 3T Dixon MRI) with adjustment for age, sex, type 2 diabetes, education, smoking status, physical activity, and intakes of total energy, alcohol, saturated fat, protein, vitamin E, and dietary fiber.RESULTSEnergy-adjusted total fructose intake and energy-adjusted fructose from fruit were not associated with IHL in the fully adjusted models (P = 0.647 and P = 0.767). In contrast, energy-adjusted intake of fructose from fruit juice and SSB was associated with higher IHL in the fully adjusted models (P = 0.019 and P = 0.009). Individuals in the highest tertile of energy-adjusted intake of fructose from fruit juice and SSB had a 1.04-fold (95% CI 0.99; 1.11) and 1.09-fold (95% CI 1.03; 1.16) higher IHL, respectively, in comparison with the lowest tertile in the fully adjusted models. Finally, the association for fructose from fruit juice was stronger in individuals with type 2 diabetes (P for interaction = 0.071).CONCLUSIONSFructose from fruit juice and SSB is independently associated with higher IHL. These cross-sectional findings contribute to current knowledge in support of measures to reduce the intake of fructose-containing beverages as a means to prevent nonalcoholic fatty liver disease at the population level.
      PubDate: Mon, 14 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2123
      Issue No: Vol. 45, No. 5 (2022)
       
  • Utility of Diabetes Type–Specific Genetic Risk Scores for the
           Classification of Diabetes Type Among Multiethnic Youth

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      Authors: Oram RA; Sharp SA, Pihoker C, et al.
      Pages: 1124 - 1131
      Abstract: OBJECTIVEGenetic risk scores (GRS) aid classification of diabetes type in White European adult populations. We aimed to assess the utility of GRS in the classification of diabetes type among racially/ethnically diverse youth in the U.S.RESEARCH DESIGN AND METHODSWe generated type 1 diabetes (T1D)- and type 2 diabetes (T2D)-specific GRS in 2,045 individuals from the SEARCH for Diabetes in Youth study. We assessed the distribution of genetic risk stratified by diabetes autoantibody positive or negative (DAA+/−) and insulin sensitivity (IS) or insulin resistance (IR) and self-reported race/ethnicity (White, Black, Hispanic, and other).RESULTST1D and T2D GRS were strong independent predictors of etiologic type. The T1D GRS was highest in the DAA+/IS group and lowest in the DAA−/IR group, with the inverse relationship observed with the T2D GRS. Discrimination was similar across all racial/ethnic groups but showed differences in score distribution. Clustering by combined genetic risk showed DAA+/IR and DAA−/IS individuals had a greater probability of T1D than T2D. In DAA− individuals, genetic probability of T1D identified individuals most likely to progress to absolute insulin deficiency.CONCLUSIONSDiabetes type–specific GRS are consistent predictors of diabetes type across racial/ethnic groups in a U.S. youth cohort, but future work needs to account for differences in GRS distribution by ancestry. T1D and T2D GRS may have particular utility for classification of DAA− children.
      PubDate: Mon, 21 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc20-2872
      Issue No: Vol. 45, No. 5 (2022)
       
  • Admission Blood Glucose Level and Its Association With Cardiovascular and
           Renal Complications in Patients Hospitalized With COVID-19

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      Authors: Norris T; Razieh C, Yates T, et al.
      Pages: 1132 - 1140
      Abstract: OBJECTIVETo investigate the association between admission blood glucose levels and risk of in-hospital cardiovascular and renal complications.RESEARCH DESIGN AND METHODSIn this multicenter prospective study of 36,269 adults hospitalized with COVID-19 between 6 February 2020 and 16 March 2021 (N = 143,266), logistic regression models were used to explore associations between admission glucose level (mmol/L and mg/dL) and odds of in-hospital complications, including heart failure, arrhythmia, cardiac ischemia, cardiac arrest, coagulation complications, stroke, and renal injury. Nonlinearity was investigated using restricted cubic splines. Interaction models explored whether associations between glucose levels and complications were modified by clinically relevant factors.RESULTSCardiovascular and renal complications occurred in 10,421 (28.7%) patients; median admission glucose level was 6.7 mmol/L (interquartile range 5.8–8.7) (120.6 mg/dL [104.4–156.6]). While accounting for confounders, for all complications except cardiac ischemia and stroke, there was a nonlinear association between glucose and cardiovascular and renal complications. For example, odds of heart failure, arrhythmia, coagulation complications, and renal injury decreased to a nadir at 6.4 mmol/L (115 mg/dL), 4.9 mmol/L (88.2 mg/dL), 4.7 mmol/L (84.6 mg/dL), and 5.8 mmol/L (104.4 mg/dL), respectively, and increased thereafter until 26.0 mmol/L (468 mg/dL), 50.0 mmol/L (900 mg/dL), 8.5 mmol/L (153 mg/dL), and 32.4 mmol/L (583.2 mg/dL). Compared with 5 mmol/L (90 mg/dL), odds ratios at these glucose levels were 1.28 (95% CI 0.96, 1.69) for heart failure, 2.23 (1.03, 4.81) for arrhythmia, 1.59 (1.36, 1.86) for coagulation complications, and 2.42 (2.01, 2.92) for renal injury. For most complications, a modifying effect of age was observed, with higher odds of complications at higher glucose levels for patients age <69 years. Preexisting diabetes status had a similar modifying effect on odds of complications, but evidence was strongest for renal injury, cardiac ischemia, and any cardiovascular/renal complication.CONCLUSIONSIncreased odds of cardiovascular or renal complications were observed for admission glucose levels indicative of both hypo- and hyperglycemia. Admission glucose could be used as a marker for risk stratification of high-risk patients. Further research should evaluate interventions to optimize admission glucose on improving COVID-19 outcomes.
      PubDate: Fri, 11 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1709
      Issue No: Vol. 45, No. 5 (2022)
       
  • Characteristics and Clinical Course of Diabetes of the Exocrine Pancreas:
           A Nationwide Population-Based Cohort Study

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      Authors: Lee N; Park S, Kang D, et al.
      Pages: 1141 - 1150
      Abstract: OBJECTIVEThe natural course of diabetes of the exocrine pancreas (DEP) is not well established. We aimed to compare the risk of insulin initiation, diabetic complications, and mortality between DEP and type 2 diabetes.RESEARCH DESIGN AND METHODSUsing the Korean National Health Insurance Service–Health Screening Cohort between 2012 and 2017, we divided patients with diabetes into those with diabetes without prior pancreatic disease (indicated type 2 diabetes, n = 153,894) and diabetes with a prior diagnosis of pancreatic disease (indicated DEP, n = 3,629). ICD-10 codes and pharmacy prescription information were used to define type 2 diabetes, DEP, and acute and chronic diabetes complications. Kaplan-Meier curves were produced to compare insulin use over time between groups. We created logistic regression models for odds of progression to diabetic complications and mortality.RESULTSDEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% CI 1.30–1.47], P < 0.0001). Individuals with DEP showed higher risks of hypoglycemia (odds ratio 1.85 [1.54–2.21], P < 0.0001), diabetic neuropathy (1.38 [1.28–1.49], P < 0.0001), nephropathy (1.38 [1.27–1.50], P < 0.0001), retinopathy (1.10 [1.01–1.20], P = 0.0347), coronary heart disease (1.59 [1.48–1.70], P < 0.0001), cerebrovascular disease (1.38 [1.28–1.49], P < 0.0001), and peripheral arterial disease (1.34 [1.25–1.44], P < 0.0001). All-cause mortality was higher in those with DEP (1.74 [1.57–1.93], P < 0.0001) than in those with type 2 diabetes.CONCLUSIONSDEP is more likely to require insulin therapy than type 2 diabetes. Hypoglycemia, micro- and macrovascular complications, and all-cause mortality events are higher in DEP compared with type 2 diabetes.
      PubDate: Mon, 28 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1659
      Issue No: Vol. 45, No. 5 (2022)
       
  • Incidence and Characteristics of Remission of Type 2 Diabetes in England:
           A Cohort Study Using the National Diabetes Audit

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      Authors: Holman N; Wild SH, Khunti K, et al.
      Pages: 1151 - 1161
      Abstract: OBJECTIVETo assess the incidence of remission of type 2 diabetes in routine care settings.RESEARCH DESIGN AND METHODSPeople with type 2 diabetes (HbA1c ≥48 mmol/mol [6.5%] or <48 mmol/mol [6.5%] with a prescription for glucose-lowering medications) alive on 1 April 2018 were identified from a national collation of health records in England and followed until 31 December 2019. Remission was defined as two HbA1c measurements of <48 mmol/mol (6.5%) at least 182 days apart, with no prescription for glucose-lowering medications 90 days before these measurements.RESULTSIn 2,297,700 people with type 2 diabetes, the overall incidence of remission per 1,000 person-years was 9.7 (95% CI 9.6–9.8) and 44.9 (95% CI 44.0–45.7) in 75,610 (3.3%) people who were diagnosed <1 year. In addition to shorter duration of diagnosis, baseline factors associated with higher odds of remission were no prescription for glucose-lowering medication, lower HbA1c and BMI, BMI reduction, White ethnicity, female sex, and lower socioeconomic deprivation. Among 8,940 (0.4%) with characteristics associated with remission (diagnosed <2 years, HbA1c <53 mmol/mol [7.0%], prescribed metformin alone or no glucose-lowering medications, BMI reduction of ≥10%), incidence of remission per 1,000 person-years was 83.2 (95% CI 78.7–87.9).CONCLUSIONSRemission of type 2 diabetes was generally infrequent in routine care settings but may be a reasonable goal for a subset of people who lose a significant amount of weight shortly after diagnosis. Policies that encourage intentional remission of type 2 diabetes should seek to reduce the ethnic and socioeconomic inequalities identified.
      PubDate: Wed, 23 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2136
      Issue No: Vol. 45, No. 5 (2022)
       
  • Association Between Team-Based Continuity of Care and Risk of
           Cardiovascular Diseases Among Patients With Diabetes: A Retrospective
           Cohort Study

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      Authors: Chan K; Wan E, Chin W, et al.
      Pages: 1162 - 1169
      Abstract: OBJECTIVECardiovascular diseases (CVD) are a long-term sequela of diabetes. Better individual-based continuity of care has been reported to reduce the risk of chronic complications among patients with diabetes. Maintaining a one-to-one patient–physician relationship is often challenging, especially in public health care settings. This study aimed to evaluate the relationship between higher team-based continuity of care, defined as consultations provided by the same physician team, and CVD risks in patients with diabetes from public primary care clinics.RESEARCH DESIGN AND METHODSThis was a retrospective cohort study in Hong Kong of 312,068 patients with type 2 diabetes and without any history of CVD at baseline (defined as the earliest attendance at a doctor’s consultation in a public-sector clinic between 2008 and 2018). Team-based continuity of care was measured using the usual provider continuity index (UPCI), calculated by the proportion of consultations provided by the most visited physician team in the 2 years before baseline. Patients were divided into quartiles based on their UPCI, and the characteristics of the quartiles were balanced using propensity score fine stratification weights. Multivariable Cox regression was applied to assess the effect of team-based continuity of care on CVD incidence. Patient demographics, smoking status, physiological measurements, number of attendances, comorbidities, and medications were adjusted for in the propensity weightings and regression analyses.RESULTSAfter an average follow-up of 6.5 years, the total number of new CVD events was 52,428. Compared with patients in the 1st quartile, patients in the 2nd, 3rd, and 4th quartiles of the UCPI had a CVD hazard ratio (95% CI) of 0.95 (0.92–0.97), 0.92 (0.89–0.94), and 0.87 (0.84–0.89), respectively, indicating that higher continuity of care was associated with lower CVD risks. The subtypes of CVD, including coronary heart disease and stroke, also showed a similar pattern. Subgroup analyses suggested that patients <65 years of age had greater benefits from higher team-based continuity of care.CONCLUSIONSTeam-based continuity of care was associated with lower CVD risk among individuals with type 2 diabetes, especially those who were younger. This suggests a potential flexible alternative implementation of continuity of care in public clinics.
      PubDate: Wed, 09 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1217
      Issue No: Vol. 45, No. 5 (2022)
       
  • Immune Checkpoint Inhibitors and Risk of Type 1 Diabetes

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      Authors: Chen X; Affinati AH, Lee Y, et al.
      Pages: 1170 - 1176
      Abstract: OBJECTIVEType 1 diabetes mellitus (T1DM) is a rare, irreversible immune-related adverse event reported in patients receiving treatment with immune checkpoint inhibitors (ICI). However, clinical risk factors for ICI-induced T1DM (ICI-T1DM) and its impact on survival in patients remain unknown.RESEARCH DESIGN AND METHODSWe used Optum’s Clinformatics Data Mart database for assessment of the incidence and characteristics of T1DM in a large de-identified cohort of patients treated with ICI between 2017 and 2020. We applied Fine-Gray and cause-specific hazard models to study associations between patient/treatment characteristics and ICI-T1DM and applied the Cox model with ICI-T1DM as a time-varying covariate to assess the impact of ICI-T1DM on survival.RESULTSICI-T1DM was observed in 261 of 30,337 (0.86%) patients. Dual use of antibodies to cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) was associated with increasing risk of ICI-T1DM (hazard ratio [HR] 1.62; 95% CI 1.15–2.26) vs. anti–PD-L1 or anti–PD-1 alone. Younger age (HR 1.19 for every 5-year decrease; 95% CI 1.13–1.25) and preexisting non-T1DM diabetes (HR 4.48; 95% CI 3.45–5.83) were also associated with higher risk of ICI-T1DM. Conversely, prior use of immunosuppressive medications (HR 0.57; 95% CI 0.34–0.95) was associated with lower incidence of ICI-T1DM, but part of its protective effect may be due to the increased mortality rate. Development of ICI-T1DM does not seem to significantly impact patient survival.CONCLUSIONSThe risk of ICI-T1DM is associated with the type of ICI therapy, patient age, and preexisting non-T1DM diabetes. These data may help guide risk assessment and screening practices for patients during ICI therapy.
      PubDate: Thu, 03 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2213
      Issue No: Vol. 45, No. 5 (2022)
       
  • Varying Impact of Gestational Diabetes Mellitus on Incidence of Childhood
           Cancers: An Age-Stratified Retrospective Cohort Study

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      Authors: Marcoux S; Côté-Corriveau G, Healy-Profitós J, et al.
      Pages: 1177 - 1183
      Abstract: OBJECTIVEWe studied the association between gestational diabetes mellitus and early versus late childhood cancer.RESEARCH DESIGN AND METHODSWe conducted a retrospective cohort study of 1 million children born between 2006 and 2019 in Quebec, Canada. We identified children who were exposed to gestational diabetes mellitus in utero and followed them from birth up to 14 years of age to identify new-onset cancers. We estimated hazard ratios (HRs) for the association between gestational diabetes mellitus and childhood cancer using Cox proportional regression models with adjustment for covariates through inverse propensity score weights.RESULTSA total of 83,626 children (8.2%) were exposed to gestational diabetes mellitus, and 1,702 developed cancer during 7.6 million person-years of follow-up. Children exposed to gestational diabetes mellitus had a higher risk of any cancer (HR 1.19, 95% CI 1.01–1.40), with signals present for blood cancer (HR 1.27, 95% CI 0.92–1.76) and solid tumors (HR 1.14, 95% CI 0.94–1.40). The association between gestational diabetes mellitus and cancer was strongest early in life and decreased with age. Gestational diabetes mellitus was associated with 1.47 times the risk of any cancer (95% CI 1.21–1.79), 1.44 times the risk of solid cancer (95% CI 1.12–1.87), and 1.61 times the risk of blood cancer (95% CI 1.09–2.36) in children age <2 years. Gestational diabetes mellitus was not significantly associated with blood or solid cancers after 2 years of age, and all associations disappeared after 6 years.CONCLUSIONSHyperglycemia may be carcinogenic in utero and may be a novel risk factor for early childhood cancer.
      PubDate: Wed, 09 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2107
      Issue No: Vol. 45, No. 5 (2022)
       
  • GLP-1RAs for Ischemic Stroke Prevention in Patients With Type 2 Diabetes
           Without Established Atherosclerotic Cardiovascular Disease

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      Authors: Yang Y; Chen H, Huang C, et al.
      Pages: 1184 - 1192
      Abstract: OBJECTIVEWe assessed the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on ischemic stroke prevention in the Asian population with type 2 diabetes (T2D) without established cardiovascular disease.RESEARCH DESIGN AND METHODSThis retrospective cohort study examined data obtained from the Taiwan National Health Insurance Research Database for the period from 1998 to 2018. The follow-up ended upon the occurrence of hospitalization for ischemic stroke. The median follow-up period was 3 years. The effect of GLP-1RA exposure time on the development of hospitalization for ischemic stroke was assessed.RESULTSThe GLP-1RA and non–GLP-1RA user groups both included 6,534 patients. Approximately 53% of the patients were women, and the mean age was 49 ± 12 years. The overall risk of ischemic stroke hospitalization for GLP-1RA users was not significantly lower than that for GLP-1RA nonusers (adjusted hazard ratio [HR] 0.69 [95% CI 0.47–1.00]; P = 0.0506), but GLP-1RA users with a >251-day supply during the study period had a significantly lower risk of ischemic stroke hospitalization than GLP-1RA nonusers (adjusted HR 0.28 [95% CI 0.11–0.71]). Higher cumulative dose of GLP-1 RAs (>1,784 mg) was associated with significantly lower risk of ischemic stroke hospitalization. The subgroup analyses defined by various baseline features did not reveal significant differences in the observed effect of GLP-1RAs.CONCLUSIONSLonger use and higher dose of GLP-1 RAs were associated with a decreased risk of hospitalization for ischemic stroke among Asian patients with T2D who did not have established atherosclerotic cardiovascular diseases, but who did have dyslipidemia or hypertension.
      PubDate: Fri, 11 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1993
      Issue No: Vol. 45, No. 5 (2022)
       
  • Association Between High-Deductible Health Plans and Engagement in Routine
           Medical Care for Type 2 Diabetes in a Privately Insured Population: A
           Propensity Score–Matched Study

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      Authors: Wu YM; Huang J, Reed ME.
      Pages: 1193 - 1200
      Abstract: OBJECTIVEHigh-deductible health plans (HDHPs) are increasingly more common but can be challenging for patients to navigate and may negatively affect care engagement for chronic conditions such as type 2 diabetes. We sought to understand how higher out-of-pocket costs affect participation in provider visits, medication adherence, and routine monitoring by patients with type 2 diabetes with an HDHP.RESEARCH DESIGN AND METHODSIn a retrospective cohort of 19,379 Kaiser Permanente Northern California patients with type 2 diabetes (age 18–64 years), 6,801 patients with an HDHP were compared with those with a no-deductible plan using propensity score matching. We evaluated the number of telephone and office visits with primary care, oral diabetic medication adherence, and rates of HbA1c testing, blood pressure monitoring, and retinopathy screening.RESULTSPatients with an HDHP had fewer primary care office visits compared with patients with no deductible (4.25 vs. 4.85 visits per person; P < 0.001), less retinopathy screening (49.9% vs. 53.3%; P < 0.001), and fewer A1c and blood pressure measurements (46.7% vs. 51.4%; P < 0.001 and 93.2% vs. 94.4%; P = 0.004, respectively) compared with the control group. Medication adherence was not significantly different between patients with an HDHP and those with no deductible (57.4% vs. 58.6%; P = 0.234).CONCLUSIONSHDHPs seem to be a barrier for patients with type 2 diabetes and reduce care participation in both visits with out-of-pocket costs and preventive care without out-of-pocket costs, possibly because of the increased complexity of cost sharing under an HDHP, potentially leading to decreased monitoring of important clinical measurements.
      PubDate: Fri, 18 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1885
      Issue No: Vol. 45, No. 5 (2022)
       
  • Enhancement of Impaired Olfactory Neural Activation and Cognitive Capacity
           by Liraglutide, but Not Dapagliflozin or Acarbose, in Patients With Type 2
           Diabetes: A 16-Week Randomized Parallel Comparative Study

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      Authors: Cheng H; Zhang Z, Zhang B, et al.
      Pages: 1201 - 1210
      Abstract: OBJECTIVEThe comparative neuroprotective effects of different antidiabetes drugs have not been characterized in randomized controlled trials. Here, we investigated the therapeutic effects of liraglutide, dapagliflozin, or acarbose treatment on brain functional alterations and cognitive changes in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSThirty-six patients with type 2 diabetes inadequately controlled with metformin monotherapy were randomized to receive liraglutide, dapagliflozin, or acarbose treatment for 16 weeks. Brain functional MRI (fMRI) scan and a battery of cognitive assessments were evaluated pre- and postintervention in all subjects.RESULTSThe 16-week treatment with liraglutide significantly enhanced the impaired odor-induced left hippocampal activation with Gaussian random field correction and improved cognitive subdomains of delayed memory, attention, and executive function (all P < 0.05), whereas dapagliflozin or acarbose did not. Structural equation modeling analysis demonstrated that such improvements of brain health and cognitive function could be partly ascribed to a direct effect of liraglutide on left hippocampal activation (β = 0.330, P = 0.022) and delayed memory (β = 0.410, P = 0.004) as well as to the metabolic ameliorations of reduced waist circumference, decreased body fat ratio, and elevated fasting insulin (all P < 0.05).CONCLUSIONSOur head-to-head study demonstrated that liraglutide enhanced impaired brain activation and restored impaired cognitive domains in patients with type 2 diabetes, whereas dapagliflozin and acarbose did not. The results expand the clinical application of liraglutide and provide a novel treatment strategy for individuals with diabetes and a high risk of cognitive decline.
      PubDate: Wed, 09 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2064
      Issue No: Vol. 45, No. 5 (2022)
       
  • Estimated Life-Years Gained Free of New or Recurrent Major Cardiovascular
           Events With the Addition of Semaglutide to Standard of Care in People With
           Type 2 Diabetes and High Cardiovascular Risk

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      Authors: Westerink J; Matthiessen K, Nuhoho S, et al.
      Pages: 1211 - 1218
      Abstract: OBJECTIVESemaglutide, a glucagon-like peptide 1 receptor agonist, reduced major adverse cardiovascular events (MACE) in people with type 2 diabetes (T2D) at high risk of cardiovascular disease (CVD) in a post hoc analysis of pooled data from Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects With Type 2 Diabetes (SUSTAIN) 6 and Peptide Innovation for Early Diabetes Treatment (PIONEER) 6. We estimated the benefit of adding semaglutide to standard of care (SoC) on life-years free of new/recurrent CVD events in people with T2D at high risk of CVD.RESEARCH DESIGN AND METHODSThe Diabetes Lifetime-perspective prediction (DIAL) competing risk–adjusted lifetime CVD risk model for people with T2D was developed previously. Baseline characteristics of the pooled cohort from SUSTAIN 6 and PIONEER 6 (POOLED cohort) (N = 6,480) were used to estimate individual life expectancy free of CVD for patients in the POOLED cohort. The hazard ratio of MACE from adding semaglutide to SoC was derived from the POOLED cohort (hazard ratio [HR] 0.76 [95% CI 0.62–0.92]) and combined with an individual’s risk to estimate their CVD benefit.RESULTSAdding semaglutide to SoC was associated with a wide distribution in life-years free of CVD gained, with a mean increase of 1.7 (95% CI 0.5–2.9) life-years. Estimated life-years free of CVD gained with semaglutide was dependent on baseline risk (life-years free of CVD gained in individuals with established CVD vs. those with cardiovascular risk factors only: 2.0 vs. 0.2) and age at treatment initiation.CONCLUSIONSAdding semaglutide to SoC was associated with a gain in life-years free of CVD events that was dependent on baseline CVD risk and age at treatment initiation. This study helps contextualize the results of semaglutide clinical trials.
      PubDate: Wed, 09 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1138
      Issue No: Vol. 45, No. 5 (2022)
       
  • Association of Serum 25-Hydroxyvitamin D With Cardiovascular Outcomes and
           All-Cause Mortality in Individuals With Prediabetes and Diabetes: Results
           From the UK Biobank Prospective Cohort Study

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      Authors: Zhang P; Guo D, Xu B, et al.
      Pages: 1219 - 1229
      Abstract: OBJECTIVETo examine the associations of circulating 25-hydroxyvitamin D (25[OH]D) concentrations with cardiovascular disease (CVD) and all-cause mortality in individuals with prediabetes and diabetes from the large population-based UK Biobank cohort study.RESEARCH DESIGN AND METHODSA total of 67,789 individuals diagnosed with prediabetes and 24,311 with diabetes who had no CVD or cancer at baseline were included in the current study. Serum 25(OH)D concentrations were measured at baseline. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for cardiovascular outcomes and mortality after 10–14 years.RESULTSAfter multivariable adjustment, higher serum 25(OH)D levels were significantly and nonlinearly associated with lower risk of cardiovascular outcomes and all-cause mortality among participants with prediabetes and diabetes (all P nonlinearity < 0.05). Compared with those in the lowest category of 25(OH)D levels (<25 nmol/L), participants with prediabetes in the highest category of 25(OH)D levels (≥75 nmol/L) had a significant association with lower risk of cardiovascular events (HR 0.78; 95% CI 0.71–0.86), coronary heart disease (CHD) (HR 0.79; 95% CI 0.71–0.89), heart failure (HR 0.66; 95% CI 0.54–0.81), stroke (HR 0.75; 95% CI 0.61–0.93), CVD mortality (HR 0.43; 95% CI 0.32–0.59), and all-cause mortality (HR 0.66; 95% CI 0.58–0.75). Likewise, these associations with cardiovascular events, CHD, heart failure, CVD mortality, and all-cause mortality were observed among participants with diabetes, except for stroke.CONCLUSIONSThese findings highlight the importance of monitoring and correcting vitamin D deficiency in the prevention of CVD and mortality among adults with prediabetes and diabetes.
      PubDate: Mon, 28 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2193
      Issue No: Vol. 45, No. 5 (2022)
       
  • Treating Gestational Diabetes Reduces Birth Weight but Does Not Affect
           Infant Adiposity Across the 1st Year of Life

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      Authors: Retnakaran R; Ye C, Hanley AJ, et al.
      Pages: 1230 - 1238
      Abstract: OBJECTIVEThe continuum of maternal glycemia in pregnancy shows continuous associations with both 1) neonatal birth weight at delivery and 2) subsequent adiposity later in childhood. While treating gestational diabetes mellitus (GDM) can lower birth weight and thereby disrupt the former association, it is unclear if such treatment reduces childhood adiposity. Thus, we sought to compare anthropometry across the 1st year of life between infants born to women who were treated for GDM and those with lesser degrees of gestational dysglycemia (untreated).RESEARCH DESIGN AND METHODSAnthropometric measurements were performed at 3 months and 12 months of life in 567 infants born to women comprising the following four gestational glucose tolerance groups: 1) women with normoglycemia on both glucose challenge test (GCT) and oral glucose tolerance test (OGTT) in pregnancy; 2) women with an abnormal GCT but normal OGTT; 3) those with mild gestational impaired glucose tolerance; and 4) women treated for GDM.RESULTSBirth weight progressively increased across the three untreated groups but was lowest in women treated for GDM (P = 0.0004). Similarly, women treated for GDM had the lowest rate of macrosomia (P = 0.02). Conversely, however, there were no differences among the four groups in weight z score, length z score, weight-for-length z score, or BMI z score at either 3 months or 12 months (all P values = NS). Similarly, there were no differences among the groups in triceps/biceps/subscapular/suprailiac skinfold thickness or sum of skinfolds at either 3 months or 12 months (all P values = NS).CONCLUSIONSDespite reducing birth weight and macrosomia, the treatment of GDM does not have analogous effects on infant adiposity across the 1st year of life.
      PubDate: Tue, 08 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2640
      Issue No: Vol. 45, No. 5 (2022)
       
  • U-Shaped Associations Between Body Weight Changes and Major Cardiovascular
           Events in Type 2 Diabetes Mellitus: A Longitudinal Follow-up Study of a
           Nationwide Cohort of Over 1.5 Million

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      Authors: Park C; Choi Y, Rhee T, et al.
      Pages: 1239 - 1246
      Abstract: OBJECTIVEDespite the benefits of weight loss on metabolic profiles in patients with type 2 diabetes mellitus (T2DM), its association with myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause death remains elusive.RESEARCH DESIGN AND METHODSUsing the National Health Insurance Service Database, we screened subjects who underwent general health checkups twice in a 2-year interval between 2009 and 2012. After identifying 1,522,241 patients with T2DM without a previous history of MI, IS, AF, and HF, we followed them until December 2018. Patients were stratified according to the magnitude of weight changes between two general health checkups: ≤ −10%, −10 to ≤ −5%, −5 to ≤5%, 5 to ≤10%, and >10%.ResultsDuring the follow-up (median 7.0 years), 32,106 cases of MI, 44,406 cases of IS, 34,953 cases of AF, 68,745 cases of HF, and 84,635 all-cause deaths occurred. Patients with weight changes of −5 to ≤5% showed the lowest risk of each cardiovascular event. Both directions of weight change were associated with an increased cardiovascular risk. Stepwise increases in the risks of MI, IS, AF, HF, and all-cause death were noted with progressive weight gain (all P < 0.0001). Similarly, the more weight loss occurred, the higher the cardiovascular risks observed (all P < 0.0001). The U-shaped associations were consistently observed in both univariate and multivariate analyses. Explorative subgroup analyses also consistently showed a U-shaped association.CONCLUSIONSBoth weight loss and gain >5% within a 2-year interval were associated with an increased risk of major cardiovascular events in patients with T2DM.
      PubDate: Wed, 09 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2299
      Issue No: Vol. 45, No. 5 (2022)
       
  • Empagliflozin Improves Cognitive Impairment in Frail Older Adults With
           Type 2 Diabetes and Heart Failure With Preserved Ejection Fraction

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      Authors: Mone P; Lombardi A, Gambardella J, et al.
      Pages: 1247 - 1251
      Abstract: OBJECTIVETo assess whether the sodium–glucose cotransporter 2 (SGLT2) inhibitor empagliflozin improves cognitive impairment in frail older adults with diabetes and heart failure with preserved ejection fraction (HFpEF).RESEARCH DESIGN AND METHODSWe designed a prospective study to assess cognitive and physical function in consecutive frail older adults with diabetes and HFpEF, comparing the effects of empagliflozin, metformin, and insulin.RESULTSA total of 162 frail older adults with HFpEF and diabetes successfully completed the study. Montreal Cognitive Assessment scores at baseline and after 1 month were 19.80 ± 3.77 vs. 22.25 ± 3.27 (P < 0.001) in the empagliflozin group, 19.95 ± 3.81 vs. 20.71 ± 3.56 (P = 0.26) in the metformin group, and 19.00 ± 3.71 vs. 19.1 ± 3.56 (P = 0.81) in the insulin group. A multivariable regression analysis confirmed the beneficial effects of empagliflozin. Additionally, we observed a marked amelioration of physical impairment, assessed by the 5-m gait speed test, in the empagliflozin and metformin groups but not in the insulin group.CONCLUSIONSThis study is the first to show significant beneficial effects of the SGLT2 inhibitor empagliflozin on cognitive and physical impairment in frail older adults with diabetes and HFpEF.
      PubDate: Mon, 14 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2434
      Issue No: Vol. 45, No. 5 (2022)
       
  • Effects of Intensive Lifestyle Intervention on All-Cause Mortality in
           Older Adults With Type 2 Diabetes and Overweight/Obesity: Results From the
           Look AHEAD Study

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      Authors: .
      Pages: 1252 - 1259
      Abstract: OBJECTIVELook AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5,145 individuals with overweight/obesity and type 2 diabetes, found no significant differences in all-cause or cardiovascular mortality or morbidity during 9.6 (median) years of intervention. Participants in ILI who lost ≥10% at 1 year had lower risk of composite cardiovascular outcomes relative to DSE. Since effects of ILI may take many years to emerge, we conducted intent-to-treat analyses comparing mortality in ILI over 16.7 years (9.6 years of intervention and then observation) to DSE. In a secondary exploratory analysis, we compared mortality by magnitude of weight loss in ILI relative to DSE.RESEARCH DESIGN AND METHODSPrimary outcome was all-cause mortality from randomization to 16.7 years. Other outcomes included cause-specific mortality, interactions by subgroups (age, sex, race/ethnicity, and cardiovascular disease history), and an exploratory analysis by magnitude of weight loss in ILI versus DSE as reference. Analyses used proportional hazards regression and likelihood ratio.RESULTSThe incidence of all-cause mortality did not differ significantly in ILI and DSE (549 and 589 participants, respectively) (hazard ratio [HR] 0.91 [95% CI 0.81, 1.02]; P = 0.11). There were no significant differences between treatments in cause-specific mortality or within prespecified subgroups. ILI participants who lost ≥10% at 1 year had a 21% reduced risk of mortality (HR 0.79 [95% CI 0.67, 0.94]; P = 0.007) relative to DSE.CONCLUSIONSILI focused on weight loss did not significantly affect mortality risk. However, ILI participants who lost ≥10% had reduced mortality relative to DSE.
      PubDate: Mon, 21 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1805
      Issue No: Vol. 45, No. 5 (2022)
       
  • Metabolome-Defined Obesity and the Risk of Future Type 2 Diabetes and
           Mortality

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      Authors: Ottosson F; Smith E, Ericson U, et al.
      Pages: 1260 - 1267
      Abstract: OBJECTIVEObesity is a key risk factor for type 2 diabetes; however, up to 20% of patients are normal weight. Our aim was to identify metabolite patterns reproducibly predictive of BMI and subsequently to test whether lean individuals who carry an obese metabolome are at hidden high risk of obesity-related diseases, such as type 2 diabetes.RESEARCH DESIGN AND METHODSLevels of 108 metabolites were measured in plasma samples of 7,663 individuals from two Swedish and one Italian population-based cohort. Ridge regression was used to predict BMI using the metabolites. Individuals with a predicted BMI either >5 kg/m2 higher (overestimated) or lower (underestimated) than their actual BMI were characterized as outliers and further investigated for obesity-related risk factors and future risk of type 2 diabetes and mortality.RESULTSThe metabolome could predict BMI in all cohorts (r2 = 0.48, 0.26, and 0.19). The overestimated group had a BMI similar to individuals correctly predicted as normal weight, had a similar waist circumference, were not more likely to change weight over time, but had a two times higher risk of future type 2 diabetes and an 80% increased risk of all-cause mortality. These associations remained after adjustments for obesity-related risk factors and lifestyle parameters.CONCLUSIONSWe found that lean individuals with an obesity-related metabolome have an increased risk for type 2 diabetes and all-cause mortality compared with lean individuals with a healthy metabolome. Metabolomics may be used to identify hidden high-risk individuals to initiate lifestyle and pharmacological interventions.
      PubDate: Mon, 14 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2402
      Issue No: Vol. 45, No. 5 (2022)
       
  • Association of Longitudinal Trajectories of Insulin Resistance With
           Adverse Renal Outcomes

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      Authors: Yang S; Kwak S, Song Y, et al.
      Pages: 1268 - 1275
      Abstract: OBJECTIVETo analyze the relationship between time-serial changes in insulin resistance and renal outcomes.RESEARCH DESIGN AND METHODSA prospective cohort of subjects from the general population without chronic kidney disease (CKD) underwent a biennial checkup for 12 years (n = 5,347). The 12-year duration was divided into a 6-year exposure period, where distinct HOMA for insulin resistance (HOMA-IR) trajectories were identified using latent variable mixture modeling, followed by a 6-year event accrual period, from which the renal outcome data were analyzed. The primary end point was adverse renal outcomes, defined as a composite of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in two or more consecutive checkups or albumin ≥1+ on urine strip.RESULTSTwo distinct groups of HOMA-IR trajectories were identified during the exposure period: stable (n = 4,770) and increasing (n = 577). During the event accrual period, 449 patients (8.4%) developed adverse renal outcomes, and the risk was higher in the increasing HOMA-IR trajectory group than in the stable group (hazard ratio 2.06, 95% CI 1.62–2.60, P < 0.001). The results were similar after adjustment for baseline clinical characteristics, comorbidities, anthropometric and laboratory findings, eGFR, and HOMA-IR. The clinical significance of increasing HOMA-IR trajectory was similar in three or four HOMA-IR trajectories. The increasing tendency of HOMA-IR was persistently associated with a higher incidence of adverse renal outcomes, irrespective of the prevalence of diabetes.CONCLUSIONSAn increasing tendency of insulin resistance was associated with a higher risk of adverse renal outcomes. Time-serial tracking of insulin resistance may help identify patients at high risk for CKD.
      PubDate: Tue, 15 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2521
      Issue No: Vol. 45, No. 5 (2022)
       
  • Association Between Specificity of Sulfonylureas to Cardiac Mitochondrial
           K ATP Channels and the Risk of Major Adverse Cardiovascular Events in Type
           2 Diabetes

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      Authors: Wang M; Huang Y, Lai J, et al.
      Pages: 1276 - 1287
      Abstract: OBJECTIVEPrevious studies have revealed an intraclass difference in major adverse cardiovascular events (MACE) among sulfonylureas. In vitro and ex vivo studies reported several sulfonylureas to exhibit high-affinity blockage of cardiac mitochondrial ATP-sensitive potassium (mitoKATP) channels and could interfere with ischemic preconditioning, the most important mechanism of self-cardiac protection. However, no studies have examined whether these varying binding affinities of sulfonylureas could account for their intraclass difference in MACE. We compared mitoKATP channel high-affinity versus low-affinity sulfonylureas regarding the MACE risk in real-world settings.RESEARCH DESIGN AND METHODSUsing the Taiwan nationwide health care claims database, patients with type 2 diabetes initiating sulfonylurea monotherapy between 2007 and 2016 were included in the cohort study. A total of 33,727 new mitoKATP channel high-affinity (glyburide and glipizide) and low-affinity (gliclazide and glimepiride) sulfonylurea users, respectively, were identified after 1:1 propensity score matching. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% CI.RESULTSMitoKATP channel high-affinity sulfonylureas were associated with a significantly increased risk of three-point MACE (aHR 1.21 [95% CI 1.03–1.44]), ischemic stroke (aHR 1.23 [95% CI 1.02–1.50]), and cardiovascular death (aHR 2.61 [95% CI 1.31–5.20]), but not with that of myocardial infarction (aHR 1.04 [95% CI 0.75–1.46]). The duration-response analyses revealed the highest MACE risk to be within 90 days of therapy (aHR 4.67 [95% CI 3.61–6.06]).CONCLUSIONSCardiac mitoKATP channel high-affinity sulfonylureas were associated with an increased MACE risk compared with low-affinity sulfonylureas in a nationwide population with diabetes.
      PubDate: Wed, 16 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1779
      Issue No: Vol. 45, No. 5 (2022)
       
  • Identifying Suicide Risk in Adolescents and Young Adults With Type 1
           Diabetes: Are Depression Screeners Sufficient'

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      Authors: Moss AC; Roberts AJ, Yi-Frazier JP, et al.
      Pages: 1288 - 1291
      Abstract: OBJECTIVEExamine the utility of suicide-risk items embedded within depression screeners for identifying the presence of suicide risk in adolescents and young adults (AYA) with type 1 diabetes.RESEARCH DESIGN AND METHODSSensitivity, specificity, and predictive value of self-report of suicide risk on the Patient Health Questionniaire-9 (PHQ-9) were compared with the pediatric psychologist–administered Columbia-Suicide Severity Rating Scale (C-SSRS) as the reference standard for AYA with type 1 diabetes seen in a multidisciplinary AYA Diabetes Program clinic.RESULTSOf 133 participants, 9.8% and 11.3% reported suicide risk on the PHQ-9 and C-SSRS, respectively. Sensitivity of the PHQ-9 risk item was 53.3% (95% CI 27.4%–77.7%), specificity was 95.7% (95% CI 89.9%–98.4%), positive predictive value was 61.5% (95% CI 32.3%–84.9%), and negative predictive value was 94.2% (95% CI 87.9–97.4%).CONCLUSIONSDepression screeners appear to under-identify AYA with type 1 diabetes who may otherwise be at risk for suicide.
      PubDate: Fri, 11 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1553
      Issue No: Vol. 45, No. 5 (2022)
       
  • Improvements in Parental Sleep, Fear of Hypoglycemia, and Diabetes
           Distress With Use of an Advanced Hybrid Closed-Loop System

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      Authors: Cobry EC; Bisio A, Wadwa R, et al.
      Pages: 1292 - 1295
      Abstract: OBJECTIVEParental sleep quality may contribute to glycemic control in youth with type 1 diabetes. In this article we present sleep analysis from a multicenter, randomized trial of children ages 6–13 years with type 1 diabetes evaluating the Tandem Control-IQ (CIQ) hybrid closed-loop (HCL) system.RESEARCH DESIGN AND METHODSPittsburgh Sleep Quality Index (PSQI) scores were assessed at baseline to identify parents as “poor” sleepers (PSQI >5). Glycemic and psycho-behavioral outcomes before and after CIQ use were analyzed in poor sleepers (n = 49) and their children.RESULTSNocturnal time in range (P < 0.001) and time hyperglycemic (P < 0.001), Hypoglycemia Fear Survey for Parents score (P < 0.001), Problem Areas in Diabetes scale score (P < 0.001), PSQI score (P < 0.001), and Hypoglycemia Fear Survey for Children score (P = 0.025) significantly improved. Of poor sleepers, 27 became good sleepers (PSQI score <5).CONCLUSIONSUse of CIQ in youth with type 1 diabetes ages 6–13 years significantly improved sleep and psychosocial measures in parent poor sleepers, coinciding with improvements in child nocturnal glycemia, highlighting the relationship between HCL systems and parent sleep quality.
      PubDate: Thu, 24 Feb 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1778
      Issue No: Vol. 45, No. 5 (2022)
       
  • Erratum. 10. Cardiovascular disease and risk management: Standards of
           Medical Care in Diabetes—2022 . Diabetes Care 2022;45(Suppl.
           1):S144–S174

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      Authors: .
      Pages: 1296 - 1296
      Abstract: In Table 10.3C of the article cited above, the median follow-up for VERTIS CV was inadvertently given as 3.5 years. The correct median follow-up is 3.0 years.
      PubDate: Mon, 07 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc22-er05
      Issue No: Vol. 45, No. 5 (2022)
       
  • Erratum. Effects of the SGLT2 Inhibitor Dapagliflozin on Energy Metabolism
           in Patients With Type 2 Diabetes: A Randomized, Double-Blind Crossover
           Trial. Diabetes Care 2021;44:1334–1343

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      Authors: Kamp Y; de Ligt M, Dautzenberg B, et al.
      Pages: 1297 - 1297
      Abstract: In the article cited above, a composition error resulted in the omission of references 30–35, and the reference Cusi et al. was listed as reference 30. The reference number for Cusi et al. is 36, and the correct references 30–35 are as follows:
      PubDate: Thu, 03 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc22-er05a
      Issue No: Vol. 45, No. 5 (2022)
       
  • Erratum. 2022 National Standards for Diabetes Self-Management Education
           and Support. Diabetes Care 2022;45:484–494

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      Authors: Davis J; Fischl A, Beck J, et al.
      Pages: 1298 - 1298
      Abstract: In the article cited above, Jody Davis’s affiliation was incorrectly listed as Dignity Health, San Francisco, CA. The correct affiliation is Dignity Health, Sacramento, CA. The authors regret this error.
      PubDate: Tue, 01 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc22-er05b
      Issue No: Vol. 45, No. 5 (2022)
       
  • Erratum. COVID-19 Severity Is Tripled in the Diabetes Community: A
           Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2
           Diabetes. Diabetes Care 2021;44:526–532

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      Authors: Gregory JM; Slaughter JC, Duffus SH, et al.
      Pages: 1299 - 1299
      Abstract: In the article cited above, a transcription error resulted in the presentation of incorrect data for three entries in Table 2. The odds ratio (OR) for male sex was given as 1.04; the correct OR is 0.79. The OR for BMI was given as 0.133; the correct OR is 1.04. The P value for one diabetic ketoacidosis admission within the past year was given as 0.21; the correct P value is 0.021. The authors apologize for the errors.
      PubDate: Wed, 02 Mar 2022 00:00:00 GMT
      DOI: 10.2337/dc22-er05c
      Issue No: Vol. 45, No. 5 (2022)
       
  • Issues and Events

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      Pages: 1300 - 1300
      PubDate: Thu, 05 May 2022 00:00:00 GMT
      DOI: 10.2337/dc22-ie05
      Issue No: Vol. 45, No. 5 (2022)
       
  • Pregnancy Outcomes in Young Women With Youth-Onset Type 2 Diabetes
           Followed in the TODAY Study

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      Authors: .
      Pages: 1038 - 1045
      Abstract: OBJECTIVETo assess pregnancy outcomes in young women with youth-onset type 2 diabetes followed in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.RESEARCH DESIGN AND METHODSPregnancy information (outcome and any maternal or fetal complications) was obtained from the female participants by self-report. Additionally, medical records for the pregnancy and the child’s neonatal course were obtained with data abstracted into standardized forms.RESULTSOver a maximum of 15 years, 260 pregnancies were reported by 141 women (aged 21.5 ± 3.2 years, BMI 35.6 ± 7.2 kg/m2, and diabetes duration 8.1 ± 3.2 years). Contraception use prior to pregnancy was reported by 13.5% of the women. Complications were reported by 65% of the women during their pregnancy. Pregnancy loss was observed in 25.3% and preterm birth in 32.6% of pregnancies. HbA1c ≥8% was observed in 31.9% of the pregnancies, and 35% of the pregnancies were complicated by chronic hypertension. Nephropathy prior to pregnancy was observed in 25% of the women. In the offspring, 7.8% were classified as small for gestational age, 26.8% large for gestational age, and 17.9% in the macrosomic range.CONCLUSIONSBased on observations from the TODAY cohort, young women with pregestational, youth-onset type 2 diabetes had very high rates of maternal complications stemming from significant socioeconomic disadvantage. The substantial maternal and infant complications seen in these young moms could potentially be avoided with improved contraception rates and reproductive planning.
      PubDate: Wed, 08 Dec 2021 00:00:00 GMT
      DOI: 10.2337/dc21-1071
      Issue No: Vol. 45, No. 5 (2021)
       
  • Development and Progression of Diabetic Retinopathy in Adolescents and
           Young Adults With Type 2 Diabetes: Results From the TODAY Study

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      Authors: .
      Pages: 1049 - 1055
      Abstract: OBJECTIVEThe Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with mean ± SD type 2 diabetes duration of 4.9 ± 1.5 years. After 7 years of additional follow-up, we report the risk factors for progression of DR in the TODAY cohort.RESEARCH DESIGN AND METHODSRetinal photographs (n = 517) were obtained in 2010–2011 and again in 2017–2018 (n = 420) with standard stereoscopic seven-field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. A total of 367 patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of DR, defined as an increase of three or more steps on the ETDRS scale.RESULTSWith mean ± SD age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, there was a 49% prevalence of any DR among participants. Prevalence by DR stage was as follows: 39% for very mild or mild nonproliferative DR (NPDR), 6% moderate to severe NPDR, and 3.8% proliferative DR. Compared with nonprogressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression.CONCLUSIONSPoor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood.
      PubDate: Thu, 16 Sep 2021 00:00:00 GMT
      DOI: 10.2337/dc21-1072
      Issue No: Vol. 45, No. 5 (2021)
       
  • Effects of Metabolic Factors, Race-Ethnicity, and Sex on the Development
           of Nephropathy in Adolescents and Young Adults With Type 2 Diabetes:
           Results From the TODAY Study

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      Authors: .
      Pages: 1056 - 1064
      Abstract: OBJECTIVETo describe the longitudinal effects of sex, race-ethnicity, and metabolic factors on the risk of developing diabetic kidney disease (DKD) in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort.RESEARCH DESIGN AND METHODSUrine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) by serum creatinine and cystatin C were assessed annually for up to 15 years after study entry. Markers of DKD included micro- and macroalbuminuria (UACR ≥30 mg/g and ≥300 mg/g, respectively), hyperfiltration (eGFR ≥135 mL/min/1.73 m2), and rapid eGFR annual decline (>3 mL/min/1.73 m2 and/or ≥3.3%). The relationships between risk factors and DKD were evaluated longitudinally using time-to-event models.RESULTSData were available on 677 participants, average age at baseline 14 years, with a mean ± SD follow-up of 10.2 ± 4.5 years. Each 1% increment in HbA1c conferred higher risk of microalbuminuria (hazard ratio 1.24 [95% CI 1.18, 1.30]), macroalbuminuria (1.22, [1.11, 1.34]), hyperfiltration (1.11, [1.05, 1.17]), and rapid eGFR decline (1.12, [1.04, 1.20]). No sex or race-ethnicity differences were observed for the 14-year cumulative incidence of elevated albuminuria. Higher systolic blood pressure and baseline serum uric acid, and lower indices of β-cell function (C-peptide index and oral disposition index [oDI]), increased the risk of microalbuminuria, while higher triglycerides increased risk of micro- and macroalbuminuria. Lower oDI levels, female sex, and Hispanic ethnicity were associated with higher risk of hyperfiltration.CONCLUSIONSElevated HbA1c was a shared risk factor among all phenotypes of DKD in this longitudinal cohort of adolescents and young adults with youth-onset type 2 diabetes. Other risk factors included elevated blood pressure, triglycerides, serum uric acid, and β-cell dysfunction.
      PubDate: Thu, 16 Sep 2021 00:00:00 GMT
      DOI: 10.2337/dc21-1085
      Issue No: Vol. 45, No. 5 (2021)
       
  • Risk Factors for Diabetic Peripheral Neuropathy in Adolescents and Young
           Adults With Type 2 Diabetes: Results From the TODAY Study

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      Authors: .
      Pages: 1065 - 1072
      Abstract: OBJECTIVEData related to diabetic neuropathy in youth with type 2 diabetes are limited. We examined the relationship of glycemic control, sex, race/ethnicity, BMI, and other type 2 diabetes-associated factors with the development of diabetic peripheral neuropathy (DPN) in youth with type 2 diabetes enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.RESEARCH DESIGN AND METHODSThe Michigan Neuropathy Screening Instrument (MNSI) and a 10-g monofilament exam were performed annually. DPN was defined as a score (>2) on the MNSI-exam or combined MNSI-exam and MNSI-survey scores (exam >2 and/or survey ≥4), or monofilament exam (<8 of 10 correct responses) at two or more consecutive visits. Multivariable time-to-event models assessed the association of risk factors evaluated longitudinally with DPN events.RESULTSA total of 674 participants (35% male), with a mean age of 14 years and diabetes duration <2 years at study entry, were evaluated annually over an average of 10.2 years. Male subjects had a significantly higher cumulative incidence of DPN than female subjects (38.5% vs. 27.2% via MNSI-exam, P = 0.002; 14.0% vs. 5.1% via monofilament exam, P = 0.01). Rates did not differ by race/ethnicity. Higher HbA1c and BMI were associated with higher DPN, by both MNSI and the monofilament test. In multivariable models, male sex, older age, and higher BMI were associated with MNSI-exam DPN risk.CONCLUSIONSDPN was evident early in the course of youth-onset type 2 diabetes and increased over time. It was higher in male subjects and related to glycemic control. These findings raise concern for long-term development of neuropathy-related morbidity in youth with type 2 diabetes and the need to achieve improved glycemic control.
      PubDate: Fri, 29 Oct 2021 00:00:00 GMT
      DOI: 10.2337/dc21-1074
      Issue No: Vol. 45, No. 5 (2021)
       
 
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