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Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Authors:Brunton SA. Pages: 138 - 139 Abstract: Even with all the advances in therapeutic options in diabetes management, our focus has only recently turned to a more difficult and perhaps more pertinent aspect of patient care: the physical environment in which people with diabetes reside. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd22-0004 Issue No:Vol. 40, No. 2 (2022)
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Pages: 140 - 140 Abstract: Each year, Clinical Diabetes calls on many scientific and medical experts in the field of diabetes to critically review submitted manuscripts. The journal’s editors and staff sincerely appreciate these reviewers, whose valuable feedback helps to ensure the high quality of the research and review articles published in each issue. We would like to take this opportunity to publicly thank all of the reviewers who have volunteered their time and expertise in the past year (1 November 2020 to 31 October 2021) for their contributions to Clinical Diabetes. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd22-en02 Issue No:Vol. 40, No. 2 (2022)
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Authors:Hehar J; Todter E, Lahiri SW. Pages: 141 - 152 Abstract: Identification of specific risk factors for severe coronavirus disease 2019 (COVID-19) is crucial for prevention of poor outcomes and mortality. This retrospective cohort study of patients hospitalized with COVID-19 demonstrated that older age, male sex, Black race, diabetes, elevated BMI, and elevated inflammatory markers were correlated with critical illness in COVID-19. Older age, male sex, diabetes, and inflammatory markers, but not elevated BMI, were associated with mortality. Despite having greater odds of critical illness, Black patients had lower odds of death than White patients. Older age, male sex, diabetes, and elevated inflammatory markers were significantly associated with venous thromboembolism. These findings suggest a need to aggressively identify and manage modifiable risk factors (i.e., diabetes and elevated BMI) and encourage vaccination of at-risk individuals to prevent poor outcomes from COVID-19. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0065 Issue No:Vol. 40, No. 2 (2022)
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Authors:Prahalad P; Leverenz B, Freeman A, et al. Pages: 153 - 157 Abstract: The coronavirus disease 2019 (COVID-19) pandemic necessitated using telehealth to bridge the clinical gap, but could increase health disparities. This article reports on a chart review of diabetes telehealth visits occurring before COVID-19, during shelter-in-place orders, and during the reopening period. Visits for children with public insurance and for those who were non-English speaking were identified. Telehealth visits for children with public insurance increased from 26.2% before COVID-19 to 37.3% during shelter-in-place orders and 34.3% during reopening. Telehealth visits for children who were non-English speaking increased from 3.5% before COVID-19 to 17.5% during shelter-in-place orders and remained at 15.0% during reopening. Pandemic-related telehealth expansion included optimization of workflows to include patients with public insurance and those who did not speak English. Increased participation by those groups persisted during the reopening phase, indicating that prioritizing inclusive telehealth workflows can reduce disparities in access to care. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd20-0123 Issue No:Vol. 40, No. 2 (2022)
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Authors:Swanner AA; Hawley CE, Li K, et al. Pages: 158 - 167 Abstract: Sodium–glucose cotransporter 2 (SGLT2) inhibitors are recommended agents for the treatment of diabetic kidney disease (DKD). Additionally, SGLT2 inhibitors lower blood glucose, decrease blood pressure, and can be useful for volume management. For these reasons, we hypothesized that initiating SGLT2 inhibitor therapy may be associated with deprescribing of other medications in patients with DKD. We compared medication lists at SGLT2 inhibitor initiation and 6 months post-initiation in 21 patients with DKD who were followed in our interprofessional outpatient nephrology clinic to evaluate deprescribing patterns in diabetes, hypertension, and diuretic medications. Six months of SGLT2 inhibitor therapy in patients with DKD was associated with deprescribing of high-risk diabetes agents, antihypertensives, and loop diuretics with minimal changes in A1C and fewer adverse events. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0078 Issue No:Vol. 40, No. 2 (2022)
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Authors:Berget C; Sherr JL, DeSalvo DJ, et al. Pages: 168 - 184 Abstract: Automated insulin delivery (AID) systems, which connect an insulin pump, continuous glucose monitoring system, and software algorithm to automate insulin delivery based on real-time glycemic data, hold promise for improving outcomes and reducing therapeutic burden for people with diabetes. This article reviews the features of the Omnipod 5 Automated Insulin Delivery System and how it compares to other AID systems available on or currently under review for the U.S. market. It also provides practical guidance for clinicians on how to effectively train and onboard people with diabetes on the Omnipod 5 System, including how to personalize therapy and optimize glycemia. Many people with diabetes receive their diabetes care in primary care settings rather than in a diabetes specialty clinic. Therefore, it is important that primary care providers have access to resources to support the adoption of AID technologies such as the Omnipod 5 System. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0083 Issue No:Vol. 40, No. 2 (2022)
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Authors:Kumar V; Encinosa W. Pages: 185 - 195 Abstract: Recent studies of diabetes suggest an obesity paradox: mortality risk increases with weight in people without diabetes but decreases with weight in people with diabetes. A recent study also reports the paradox more generally with health care utilization. Whether this paradox in health care utilization and spending is causal or instead the result of empirical biases and confounding factors has yet to be examined in detail. This study set out to examine changes in the relationship between BMI and health care expenditures in populations with versus without diabetes, controlling for confounding risk factors. It found that the obesity paradox does not exist and is the result of statistical biases such as confounding and reverse causation. Obesity is not cost-saving for people with diabetes. Thus, insurers and physicians should renew efforts to prevent obesity in people with diabetes. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd20-0122 Issue No:Vol. 40, No. 2 (2022)
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Authors:Momani AM; Callery P, Lin Y, et al. Pages: 196 - 203 Abstract: Adolescents with type 1 diabetes face barriers that can have a negative influence on self-management behaviors. This study was an analysis of semi-structured interviews with adolescents, parents, and health care providers to better understand these barriers among adolescents in Jordan. Adolescents with type 1 diabetes reported individual-level barriers including feeling labeled, pitied, and stigmatized for having type 1 diabetes. They also discussed the system-level barrier of an education system that does not adapt to meet their needs. Individual- and system-level barriers are interrelated and could influence adolescents’ decisions regarding whether to disclose their condition to others. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd20-0116 Issue No:Vol. 40, No. 2 (2022)
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Authors:Schwartz DD; Banuelos R, Uysal S, et al. Pages: 204 - 210 Abstract: Identifying patients at high risk for diabetic ketoacidosis (DKA) is crucial for informing efforts at preventive intervention. This study sought to develop and validate an electronic medical record (EMR)-based tool for predicting DKA risk in pediatric patients with type 1 diabetes. Based on analysis of data from 1,864 patients with type 1 diabetes, three factors emerged as significant predictors of DKA: most recent A1C, type of health insurance (public vs. private), and prior DKA. A prediction model was developed based on these factors and tested to identify and categorize patients at low, moderate, and high risk for experiencing DKA within the next year. This work demonstrates that risk for DKA can be predicted using a simple model that can be automatically derived from variables in the EMR. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0070 Issue No:Vol. 40, No. 2 (2022)
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Authors:Siemens R. Pages: 211 - 221 Abstract: This article reports on a retrospective case series evaluating glycemic outcomes using a flash continuous glucose monitoring (CGM) system in pharmacist-managed diabetes cases. The flash CGM system was used during initial assessment of patients’ diabetes control and then continued throughout the intervention to ensure the safety and efficacy of the glycemic interventions. The Cloud-based CGM software was used to monitor patients remotely and assess their glycemic metrics. Action plans were created to address areas of most pressing concern, ensuring reduction or elimination of hypoglycemia, correction of hyperglycemia, and minimization of glycemic variability. In these complex cases, use of the flash CGM system in conjunction with lifestyle and medication interventions safely and effectively improved diabetes management and achieved targeted glucose outcomes. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0088 Issue No:Vol. 40, No. 2 (2022)
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Authors:Reddy N; Venkatesh R, Jayadev C, et al. Pages: 222 - 232 Abstract: This study examined the clinical profile, treatment profile, and vision outcomes of people ≤40 years of age with diabetes and diabetic macular edema (DME). Within this age-group, the prevalence of center-involving DME was 16%, with 74% of eyes showing cystoid edema, 37% showing spongiform edema, and 41% having neurosensory detachment. Longer diabetes duration (P = 0.001) and greater severity of diabetic retinopathy (P <0.001) were associated with DME prevalence. Thus, regular and more frequent follow-up, as well as early and aggressive treatment of diabetic eye disease, are required in people diagnosed early with diabetes. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0110 Issue No:Vol. 40, No. 2 (2022)
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Authors:Chacko E. Pages: 233 - 239 Abstract: Hypoglycemia is a serious complication for people with diabetes who are on medications such as sulfonylureas and insulin (1). Severe hypoglycemia can lead to seizures, declined cognitive function, cardiovascular events, and even death. Impaired awareness of hypoglycemia (IAH) makes matters much worse (2). Up to 25% of people with type 1 diabetes and up to 10% of people with type 2 diabetes who are on insulin have IAH (2). These individuals do not experience the typical symptoms of hypoglycemia because of autonomic failure; their glucagon or catecholamine levels may not increase to trigger hepatic glucose production in time. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0037 Issue No:Vol. 40, No. 2 (2022)
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Authors:Cowart K; Patel V, Bianco J, et al. Pages: 240 - 244 Abstract: Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a pharmacist-physician collaborative effort to reduce A1C and blood pressure and thereby lower risks for complications for people with diabetes being treated at a network of family care clinics in the Tampa, FL, area. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0080 Issue No:Vol. 40, No. 2 (2022)
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Pages: 245 - 245 Abstract: Regular physical activity can help you lose weight. Losing weight lowers your risk of heart disease and stroke because it helps you control blood glucose (sugar), blood pressure, and cholesterol levels. You don’t have to lose a lot of weight to see the benefits. Even a loss of 10–15 pounds can help a lot. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd22-pe02 Issue No:Vol. 40, No. 2 (2022)
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Authors:Giannakopoulos A; Efthymiadou A, Chrysanthakopoulou A, et al. Pages: 250 - 252 PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0100 Issue No:Vol. 40, No. 2 (2022)
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Authors:Pauley ME; Tan S, Sikand G, et al. Pages: 253 - 256 Abstract: Edema is a rare complication of insulin administration most often seen in patients with type 1 diabetes at the initiation of insulin therapy (1–6) or, less commonly, with intensification of insulin treatment (6–9). It has also been reported in patients with type 2 diabetes when insulin is administered in conjunction with thiazolidinediones (10). The presentation is typically mild and self-limited but can vary from isolated lower-extremity edema to, rarely, anasarca with severe cardiopulmonary congestion (3,4,11,12). The mechanism of this edema is not definitively understood, but it has been attributed to increased capillary permeability secondary to the catabolic state caused by insulin deficiency. Insulin administration then inhibits natriuresis, resulting in edema (2). It is a diagnosis of exclusion, and common etiologies of edema should be investigated through diagnostic workup. Here, we report a severe case of prolonged insulin edema that was refractory to standard treatment in a pediatric patient with known type 1 diabetes following insulin infusion for diabetic ketoacidosis (DKA) and subsequent intensification of insulin therapy. PubDate: Fri, 15 Apr 2022 00:00:00 GMT DOI: 10.2337/cd21-0092 Issue No:Vol. 40, No. 2 (2022)
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