Subjects -> MEDICAL SCIENCES (Total: 8186 journals)
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    - HEMATOLOGY (160 journals)
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    - INTERNAL MEDICINE (178 journals)
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    - UROLOGY, NEPHROLOGY AND ANDROLOGY (151 journals)

HEMATOLOGY (160 journals)                     

Showing 1 - 151 of 151 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 3)
Acta Haematologica     Full-text available via subscription   (Followers: 23)
Acta Haematologica Polonica     Open Access  
Adipocyte     Open Access  
Advances in Hematology     Open Access   (Followers: 13)
Africa Sanguine     Full-text available via subscription  
American Journal of Hematology     Hybrid Journal   (Followers: 52)
Anemia     Open Access   (Followers: 6)
Annals of Hematology     Hybrid Journal   (Followers: 16)
Archives of Hematology Case Reports and Reviews     Open Access  
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 28)
Artery Research     Hybrid Journal   (Followers: 4)
Artificial Cells, Nanomedicine and Biotechnology     Hybrid Journal   (Followers: 4)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Best Practice & Research Clinical Haematology     Hybrid Journal   (Followers: 5)
Blood     Hybrid Journal   (Followers: 307)
Blood Advances     Open Access   (Followers: 7)
Blood and Lymphatic Cancer : Targets and Therapy     Open Access   (Followers: 7)
Blood Cancer Journal     Open Access   (Followers: 19)
Blood Cells, Molecules, and Diseases     Hybrid Journal   (Followers: 8)
Blood Coagulation & Fibrinolysis     Hybrid Journal   (Followers: 60)
Blood Pressure     Open Access  
Blood Pressure Monitoring     Hybrid Journal   (Followers: 1)
Blood Purification     Full-text available via subscription   (Followers: 6)
Blood Reviews     Hybrid Journal   (Followers: 26)
BMC Hematology     Open Access   (Followers: 7)
BMJ Open Diabetes Research & Care     Open Access   (Followers: 29)
Bone Marrow Transplantation     Hybrid Journal   (Followers: 17)
British Journal of Diabetes & Vascular Disease     Open Access   (Followers: 21)
British Journal of Haematology     Hybrid Journal   (Followers: 61)
British Journal of Primary Care Nursing - Cardiovascular Disease, Diabetes and Kidney Care     Full-text available via subscription   (Followers: 10)
Canadian Journal of Diabetes     Hybrid Journal   (Followers: 28)
Case Reports in Hematology     Open Access   (Followers: 10)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32)
Clinical Diabetes     Full-text available via subscription   (Followers: 40)
Clinical Diabetes and Endocrinology     Open Access   (Followers: 20)
Clinical Lymphoma & Myeloma     Full-text available via subscription   (Followers: 2)
Clinical Lymphoma Myeloma and Leukemia     Hybrid Journal   (Followers: 5)
Clinical Medicine Insights : Blood Disorders     Open Access   (Followers: 1)
Conquest : The Official Journal of Diabetes Australia     Full-text available via subscription   (Followers: 3)
Current Angiogenesis     Hybrid Journal   (Followers: 1)
Current Diabetes Reports     Hybrid Journal   (Followers: 24)
Current Diabetes Reviews     Hybrid Journal   (Followers: 27)
Current Hematologic Malignancy Reports     Hybrid Journal   (Followers: 2)
Current Opinion in Hematology     Hybrid Journal   (Followers: 20)
Cytotherapy     Full-text available via subscription   (Followers: 2)
Der Diabetologe     Hybrid Journal   (Followers: 2)
Diabetes     Full-text available via subscription   (Followers: 418)
Diabetes aktuell     Hybrid Journal   (Followers: 3)
Diabetes and Vascular Disease Research     Hybrid Journal   (Followers: 20)
Diabetes Care     Full-text available via subscription   (Followers: 478)
Diabetes Case Reports     Open Access  
Diabetes Educator     Hybrid Journal   (Followers: 27)
Diabetes Management     Full-text available via subscription   (Followers: 15)
Diabetes Research and Clinical Practice     Hybrid Journal   (Followers: 70)
Diabetes Spectrum     Full-text available via subscription   (Followers: 17)
Diabetes Technology & Therapeutics     Hybrid Journal   (Followers: 50)
Diabetes Therapy     Open Access   (Followers: 23)
Diabetic Foot & Ankle     Open Access   (Followers: 10)
Diabetic Medicine     Hybrid Journal   (Followers: 149)
Diabetologia     Hybrid Journal   (Followers: 215)
Diabetologia Kliniczna     Hybrid Journal  
Diabetologie und Stoffwechsel     Hybrid Journal   (Followers: 2)
Egyptian Journal of Haematology     Open Access  
eJHaem     Open Access  
European Journal of Haematology     Hybrid Journal   (Followers: 16)
Experimental Hematology     Hybrid Journal   (Followers: 6)
Experimental Hematology & Oncology     Open Access   (Followers: 6)
Expert Review of Hematology     Hybrid Journal   (Followers: 5)
Fluids and Barriers of the CNS     Open Access   (Followers: 1)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Haematologica - the Hematology journal     Open Access   (Followers: 34)
Haemophilia     Hybrid Journal   (Followers: 68)
Hematologia     Full-text available via subscription   (Followers: 3)
Hematología     Open Access  
Hematology     Open Access   (Followers: 15)
Hematology Reports     Open Access   (Followers: 4)
Hematology, Transfusion and Cell Therapy     Open Access   (Followers: 2)
Hematology/Oncology and Stem Cell Therapy     Open Access   (Followers: 6)
Hemodialysis International     Hybrid Journal   (Followers: 3)
Hepatitis Monthly     Open Access   (Followers: 3)
Immunohematology : Journal of Blood Group Serology and Molecular Genetics     Hybrid Journal   (Followers: 1)
Indian Journal of Hematology and Blood Transfusion     Hybrid Journal   (Followers: 2)
Info Diabetologie     Full-text available via subscription   (Followers: 1)
InFo Hämatologie + Onkologie : Interdisziplinäre Fortbildung von Ärzten für Ärzte     Full-text available via subscription  
Integrated Blood Pressure Control     Open Access  
International Blood Research & Reviews     Open Access  
International Journal of Clinical Transfusion Medicine     Open Access   (Followers: 3)
International Journal of Diabetes in Developing Countries     Hybrid Journal   (Followers: 6)
International Journal of Diabetes Research     Open Access   (Followers: 9)
International Journal of Hematologic Oncology     Open Access   (Followers: 2)
International Journal of Hematology     Hybrid Journal   (Followers: 4)
International Journal of Hematology Research     Open Access   (Followers: 2)
International Journal of Hematology-Oncology and Stem Cell Research     Open Access   (Followers: 2)
International Journal of Laboratory Hematology     Hybrid Journal   (Followers: 25)
Iraqi Journal of Hematology     Open Access  
JMIR Diabetes     Open Access  
Journal of Blood Disorders & Transfusion     Open Access   (Followers: 3)
Journal of Applied Hematology     Open Access   (Followers: 2)
Journal of Blood Medicine     Open Access   (Followers: 1)
Journal of Cerebral Blood Flow & Metabolism     Hybrid Journal   (Followers: 3)
Journal of Diabetes     Open Access   (Followers: 20)
Journal of Diabetes and its Complications     Hybrid Journal   (Followers: 25)
Journal of Diabetes and Metabolic Disorders     Open Access   (Followers: 7)
Journal of Diabetes Investigation     Open Access   (Followers: 12)
Journal of Diabetes Mellitus     Open Access   (Followers: 5)
Journal of Diabetes Research     Open Access   (Followers: 13)
Journal of Diabetes Research     Open Access   (Followers: 10)
Journal of Hematological Malignancies     Open Access  
Journal of Hematology     Open Access   (Followers: 2)
Journal of Hematology and Transfusion Medicine     Open Access   (Followers: 1)
Journal of Hematopathology     Hybrid Journal   (Followers: 3)
Journal of Hypo & Hyperglycemia     Partially Free   (Followers: 1)
Journal of Pediatric Hematology/Oncology     Hybrid Journal   (Followers: 8)
Journal of Social Health and Diabetes     Open Access   (Followers: 1)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 81)
Journal of Thrombosis and Thrombolysis     Hybrid Journal   (Followers: 35)
Journal of Transfusion Medicine     Full-text available via subscription  
Kidney and Blood Pressure Research     Open Access   (Followers: 4)
Leukemia     Hybrid Journal   (Followers: 23)
Leukemia and Lymphoma     Hybrid Journal   (Followers: 12)
Leukemia Research     Hybrid Journal   (Followers: 9)
Leukemia Research Reports     Open Access   (Followers: 1)
Leukemia Supplements     Full-text available via subscription  
Mediterranean Journal of Hematology and Infectious Diseases     Open Access  
Nederlands Tijdschrift voor Diabetologie     Hybrid Journal  
Nutrition & Diabetes     Open Access   (Followers: 20)
Oncohematology     Open Access   (Followers: 1)
Open Diabetes Journal     Open Access  
Open Hematology Journal     Open Access   (Followers: 1)
Open Hypertension Journal     Open Access  
Open Journal of Blood Diseases     Open Access  
Pediatric Blood & Cancer     Hybrid Journal   (Followers: 8)
Pediatric Hematology Oncology Journal     Open Access   (Followers: 3)
Peritoneal Dialysis International     Hybrid Journal  
Platelets     Hybrid Journal   (Followers: 3)
Practical Diabetes     Hybrid Journal   (Followers: 7)
Primary Care Diabetes     Hybrid Journal   (Followers: 26)
Research & Reviews : Journal of Oncology and Hematology     Full-text available via subscription   (Followers: 1)
Research and Practice in Thrombosis and Haemostasis     Open Access   (Followers: 1)
Revista Cubana de Hematología, Inmunología y Hemoterapia     Open Access  
Seminars in Hematology     Hybrid Journal   (Followers: 12)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 45)
Thalassemia Reports     Open Access   (Followers: 1)
The Lancet Haematology     Full-text available via subscription   (Followers: 38)
Therapeutic Advances in Hematology     Hybrid Journal  
Thrombosis & Haemostasis     Hybrid Journal   (Followers: 144)
Thrombosis Research     Hybrid Journal   (Followers: 47)
Transfusionsmedizin - Immunhämatologie, Hämotherapie, Immungenetik, Zelltherapie     Hybrid Journal  
Transplantation and Cellular Therapy     Hybrid Journal   (Followers: 13)
Veins and Lymphatics     Open Access   (Followers: 1)

           

Similar Journals
Journal Cover
Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 478  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • Response to Comment on Marcoux et al. Varying Impact of Gestational
           Diabetes Mellitus on Incidence of Childhood Cancers: An Age-Stratified
           Retrospective Cohort Study. Diabetes Care 2022;45:1177–1183

    • Free pre-print version: Loading...

      Abstract: Canadian Institutes of Health Research10.13039/501100000024PCC-170244
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0028
      Issue No: Vol. 45, No. 11 (2022)
       
  • Response to Comment on Lontchi-Yimagou et al. An Atypical Form of Diabetes
           Among Individuals With Low BMI. Diabetes Care 2022;45:1428–1437

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      Abstract: National Institute of Diabetes and Digestive and Kidney Diseases10.13039/100000062R01 DK069861
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0031
      Issue No: Vol. 45, No. 11 (2022)
       
  • Comment on Marcoux et al. Varying Impact of Gestational Diabetes Mellitus
           on Incidence of Childhood Cancers: An Age-Stratified Retrospective Cohort
           Study. Diabetes Care 2022;45:1177–1183

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      Abstract: We were interested by the recent article in Diabetes Care from Marcoux et al. (1), who reported that children exposed to gestational diabetes mellitus (GDM) had 1.47 times higher risk of any cancer (95% CI 1.21–1.79), 1.61 times higher risk of blood cancer (95% CI 1.09–2.36), and 1.48 times higher risk of acute myeloid leukemia (95% CI 0.51–4.25) before 2 years of age. Interestingly, the associations between high cancer risks and GDM faded in older children. In their discussion, the authors proposed that this could be related to fetal exposure to maternal hyperglycemia and hyperinsulinemia. However, the precise mechanisms underlying GDM and the increased risks of childhood cancer remain uncertain.
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0954
      Issue No: Vol. 45, No. 11 (2022)
       
  • Comment on Lontchi-Yimagou et al. An Atypical Form of Diabetes Among
           Individuals With Low BMI. Diabetes Care 2022;45:1428–1437

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      Abstract: We read with interest the article by Lontchi-Yimagou et al. (1), in which they describe diabetes in individuals with low BMI from India. This is a valuable contribution to the literature that suggests the need for more investigation into this phenotypic category. However, it seems premature to suggest that the findings indicate the need to revisit the category of “malnutrition-related diabetes mellitus,” given the lack of any causal link between malnutrition and the findings reported.
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1257
      Issue No: Vol. 45, No. 11 (2022)
       
  • Climate Change and Ambient Temperature Extremes: Association With Serious
           Hypoglycemia, Diabetic Ketoacidosis, and Sudden Cardiac Arrest/Ventricular
           Arrhythmia in People With Type 2 Diabetes

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      Abstract: National Institute of Mental Health10.13039/100000025R01MH130435
      PubDate: Fri, 07 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1161
      Issue No: Vol. 45, No. 11 (2022)
       
  • Neighborhood Socioeconomic Deprivation and 30-Day Mortality and
           Readmission for Patients Admitted for Diabetes Management

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      Abstract: Duke University Health System
      PubDate: Thu, 15 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0913
      Issue No: Vol. 45, No. 11 (2022)
       
  • Is Son Preference a Potential Risk Factor for Diabetes'

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      Abstract: Diabetes is a chronic condition that disrupts body metabolism and is characterized by decreased insulin secretion, insulin resistance, and hyperglycemic state. It is a global burden that increases day by day, affecting millions of people worldwide. According to the latest statistics, global prevalence of diabetes was found to be 10.5% in a population of 20- to 79-year-old individuals, with 432.7 million patients with diabetes living in low- to middle-income countries. Furthermore, the prevalence is estimated to rise to 12.2%, with nearly 783.2 million patients, by the year 2045 (1). A number of factors predispose individuals to development of diabetes; some well-known contributors are obesity, hypertension, dyslipidemia, low HDL (or good cholesterol), and age. One element contributing to diabetes is grand multiparity, a term most commonly defined as having five or more children. Not much is known about the risk of diabetes and its connection with multiparity; however, a study reported an increased risk of diabetes among grand multiparous women (2).
      PubDate: Wed, 14 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1413
      Issue No: Vol. 45, No. 11 (2022)
       
  • Commercially Available Insulin Products Demonstrate Consistency With
           Product Labeling Throughout All Seasons in the U.S.

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      Abstract: The Leona M. and Harry B. Helmsley Charitable Trust
      PubDate: Wed, 14 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0972
      Issue No: Vol. 45, No. 11 (2022)
       
  • Economic Evaluation of the $35 Insulin Copay Cap Policy in Medicare and
           Its Implication for Future Interventions

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      Abstract: The price of insulin has increased threefold since 2007 (1), imposing a substantial economic burden on patients and payers, which has resulted in reduced insulin adherence and dosage rationing (2). Significant legislative efforts were made in 2022 to cap the copayments needed to access insulin to $35 per month to ensure its affordability. In a previous analysis (3), we showed that this copayment cap policy is likely to reduce copayment for insulin by about $500 per year for 1.6 million people and avoid thousands of diabetes complications and fatal events that would lead to generating an additional 32,000 life-years and 21,000 quality-adjusted life-years (QALYs). However, even after accounting for the cost-saving due to a reduced risk for diabetes complications, the policy would still increase total medical costs by $5.6 billion over 20 years. To assess whether the additional costs are justifiable, in this work, we report the cost-effectiveness of this policy and draw economic implications on future policy interventions.
      PubDate: Mon, 12 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1230
      Issue No: Vol. 45, No. 11 (2022)
       
  • Spending on Insulin by U.S. Payers and Patients From 2008 to 2017

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      Abstract: Insulin prices have risen rapidly over time, making costs a major public health concern. Understanding annual spending net of discounts—rather than the list price, which does not reflect amount paid—may inform strategies to contain insulin-related spending. We examined trends in U.S. per-beneficiary spending on insulin from 2008 to 2017, including pre- and post-discount expenditures by payer type and out-of-pocket costs.
      PubDate: Tue, 30 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0054
      Issue No: Vol. 45, No. 11 (2022)
       
  • In This Issue of Diabetes

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      Pages: 2479 - 2480
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-ti11
      Issue No: Vol. 45, No. 11 (2022)
       
  • Phenotype and Lifestyle Intervention: Potential for Predicting and
           Improving Metabolic Outcomes'

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      Pages: 2481 - 2483
      Abstract: National Institute of Diabetes and Digestive and Kidney Diseases10.13039/100000062P30-DK111022
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0022
      Issue No: Vol. 45, No. 11 (2022)
       
  • Epidemiology and Therapeutic Strategies for Women With Preexisting
           Diabetes in Pregnancy: How Far Have We Come' The 2021 Norbert Freinkel
           Award Lecture

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      Pages: 2484 - 2491
      Abstract: The field of diabetes in pregnancy has witnessed tremendous changes over the past 30 years, with an explosive growth in case numbers along with new and exciting opportunities to affect outcomes. Type 1 diabetes in pregnancy has increased by 40%, but type 2 diabetes in pregnancy, rarely seen 30 years ago, has more than doubled and, in some cases, tripled in prevalence. Compared with women with type 2 diabetes, women with type 1 diabetes have higher HbA1c, more large-for-gestational-age infants, and more preterm births. Women with type 2 diabetes have more chronic hypertension, more socioeconomic deprivation, and higher rates of perinatal mortality. Large randomized trials in women with diabetes in pregnancy have helped us understand the effectiveness of new technologies (i.e., continuous glucose monitoring) in women with type 1 diabetes, and the addition of metformin to insulin in women with type 2 diabetes, in improving pregnancy outcomes. Future endeavors, including artificial pancreas systems in women with type 1 diabetes and the use of continuous glucose monitoring, a better understanding of nutrition during pregnancy, and approaches to improve preconception and pregnancy self-care in women with type 2 diabetes, may lead to further improved outcomes.
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dci21-0027
      Issue No: Vol. 45, No. 11 (2022)
       
  • Flexor Tendon Tenotomy Treatment of the Diabetic Foot: A Multicenter
           Randomized Controlled Trial

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      Pages: 2492 - 2500
      Abstract: OBJECTIVEThe aim of this study was to evaluate the effects of needle flexor tendon tenotomy treatment of the diabetic hammertoe deformity.RESEARCH DESIGN AND METHODSA multicenter randomized controlled trial of individuals with diabetes and ulcers or impending ulcers associated with hammertoes was performed between 1 November 2019 and 31 March 2021. Participants were stratified by the presence of ulcers or impending ulcers. Participants were randomly assigned to tenotomy and standard nonsurgical treatment or to standard nonsurgical treatment alone. Primary outcomes were time to ulcer healing and progression from impending ulcer to active ulcer.RESULTSOf 224 screened participants with diabetes, 95 (59.0% men) were included. The mean follow-up was 291 ± 70 days, 28 (29.5%) had type 1 diabetes, mean diabetes (presented with 25–75% quartile) duration was 20 (13–26) years, and mean age was 67.7 ± 9.8 years. Of the included participants, 16 had ulcers, of whom 8 were randomly assigned to intervention. Of the remaining 79 with impending ulcers, 39 were randomly assigned to intervention. For participants with ulcers, healing rates favored tenotomy (100% vs. 37.5%, P = 0.026) as did time to ulcer healing (P = 0.04). For those with impending ulcers, incidence of progression to an active ulcer was lower (1 vs. 7, P = 0.028) and the number of ulcer-free days higher (P = 0.043) in the tenotomy group. No serious adverse events were recorded.CONCLUSIONSThis randomized study showed that the simple procedure of needle flexor tendon tenotomy was effective and safe when treating and preventing ulcers associated with the diabetic hammertoe deformity.
      PubDate: Sat, 24 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0085
      Issue No: Vol. 45, No. 11 (2022)
       
  • Adjusted Cutoff Scores Increase Sensitivity of Depression Screening
           Measures in Adolescents With Type 1 Diabetes

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      Pages: 2501 - 2508
      Abstract: OBJECTIVETo measure the acceptability and diagnostic accuracy of commonly used depression screening measures to determine ideal cutoff scores that sensitively identify depressive disorders in adolescents with type 1 diabetes (T1D).RESEARCH DESIGN AND METHODSOne hundred adolescents (12–17 years old) completed a reference standard, semistructured diagnostic interview and both long and short versions of five commonly used depression screening measures in the United States. To assess feasibility and acceptability, we used screener completion time and participant ratings, respectively. We used descriptive statistics, area under the receiver operating characteristic (ROC) curve analyses, and paired-sample area differences under the ROC curve to assess each measure’s diagnostic validity against our reference standard and to determine ideal cutoff scores for this sample.RESULTSAdolescents had a mean age of 15.0 ± 1.7 years, time since T1D diagnosis of 6.0 ± 4.1 years, and glycated hemoglobin (HbA1c) of 8.9 ± 1.8%. Sixty percent of adolescents were male, 15% endorsed a current depressive disorder, and 15% endorsed lifetime suicidality. Measures demonstrated low sensitivity (0.33–0.67) to detect current depressive disorders using preexisting cutoff scores. However, adjusted cutoff scores increased sensitivity and reduced false negatives. All depression screening measures demonstrated “good” to “excellent” predictive validity, and the Children’s Depression Inventory-2 Short version demonstrated significantly greater diagnostic accuracy than the Patient Health Questionnare-2 item version for adolescents.CONCLUSIONSClinics should consider using screening measures with the greatest diagnostic accuracy as identified in this study and adjusting measure cutoff scores to increase sensitivity and reduce false negatives.
      PubDate: Fri, 19 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0275
      Issue No: Vol. 45, No. 11 (2022)
       
  • Health Care Utilization Trends Across the Transition Period in a National
           Cohort of Adolescents and Young Adults With Type 1 Diabetes

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      Pages: 2509 - 2517
      Abstract: OBJECTIVELack of effective transition from pediatric to adult care may contribute to adverse outcomes in young adults with type 1 diabetes. The understanding of outpatient and acute care utilization patterns across the adolescent to young adult transition age in type 1 diabetes populations is suboptimal in the U.S.RESEARCH DESIGN AND METHODSWe studied claims data from 14,616 individuals diagnosed with type 1 diabetes, aged 16–24 years, and enrolled in a large national health plan for ≥1 year from 2005 to 2012. Annual outpatient and emergency department visits and hospitalization rates were calculated at each age. Generalized estimating equations were used to assess the association of age-group (adolescents [age 16–18 years] vs. young adults [age 19–24 years]), outpatient visits, and sociodemographic variables with emergency department visit and hospitalization rates.RESULTSEndocrinologist visits declined from 2.3 per year at age 16 years to 1.5 per year by age 22. Emergency department rates increased per year from 45 per 100 at age 16 to 63 per 100 at age 20, then decreased to 60 per 100 by age 24. Hospitalizations per year climbed from 14 per 100 at age 16 to 21 per 100 at age 19, then decreased to 17 per 100 by age 24. In statistical models, young adults experienced higher rates of emergency department visits (incidence rate ratio [IRR] 1.24 [95% CI 1.18, 1.31]) and hospitalizations (IRR 1.25 [95% CI 1.15, 1.36]) than adolescents. Additional significant predictors of emergency department visits and hospitalizations included female sex and Black race. Individuals with two or more endocrinologist visits per year were less likely to have emergency department visits and hospitalizations; higher income was also protective.CONCLUSIONSResults highlight concerning increases in acute care utilization for young adults with type 1 diabetes who are less engaged with outpatient diabetes care and highlight socioeconomic risk factors that warrant further study.
      PubDate: Wed, 24 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0152
      Issue No: Vol. 45, No. 11 (2022)
       
  • Relationships of Serum 25-Hydroxyvitamin D Concentrations, Diabetes,
           Genetic Susceptibility, and New-Onset Chronic Kidney Disease

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      Pages: 2518 - 2525
      Abstract: OBJECTIVEThe prospective relation of vitamin D status with the risk of chronic kidney diseases (CKD) remains uncertain. We aimed to examine the association of serum 25-hydroxyvitamin D (25OHD) with new-onset CKD in participants with and without diabetes at baseline and examine the potential modifications by genetic susceptibility on the association.RESEARCH DESIGN AND METHODSIncluded were 348,243 adults from the UK Biobank without prior CKD at baseline. Serum 25OHD concentrations were measured by chemiluminescent immunoassay method. Genetic risk score of CKD was calculated by 263 single nucleotide polymorphisms, which showed significant associations with estimated glomerular filtration rate. The primary outcome was new-onset CKD.RESULTSDuring a median follow-up duration of 12.1 years, 9,344 new-onset CKD were documented. Overall, there was a significant inverse association between baseline serum 25OHD and new-onset CKD in participants with diabetes (per SD increment, adjusted hazard ratio [HR] 0.91; 95% CI 0.86–0.96), but not in those without diabetes (per SD increment, adjusted HR 0.98; 95% CI 0.96–1.01; P-interaction between serum 25OHD and diabetes = 0.004). Accordingly, among participants with diabetes, compared with those baseline serum 25OHD <25 nmol/L, a significantly lower risk of new-onset CKD was found in those with 25OHD ≥50 nmol/L (adjusted HR 0.77; 95% CI 0.67–0.89). Moreover, the genetic risk of CKD did not significantly modify the association between baseline serum 25OHD and new-onset CKD among participants with diabetes (P-interaction = 0.127).CONCLUSIONSThere was an inverse association between baseline serum 25OHD and new-onset CKD in participants with diabetes. The inverse association was not found in participants without diabetes.
      PubDate: Wed, 14 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1194
      Issue No: Vol. 45, No. 11 (2022)
       
  • Clinical Decision Support for Glycemic Management Reduces Hospital Length
           of Stay

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      Pages: 2526 - 2534
      Abstract: OBJECTIVEDysglycemia influences hospital outcomes and resource utilization. Clinical decision support (CDS) holds promise for optimizing care by overcoming management barriers. This study assessed the impact on hospital length of stay (LOS) of an alert-based CDS tool in the electronic medical record that detected dysglycemia or inappropriate insulin use, coined as gaps in care (GIC).RESEARCH DESIGN AND METHODSUsing a 12-month interrupted time series among hospitalized persons aged ≥18 years, our CDS tool identified GIC and, when active, provided recommendations. We compared LOS during 6-month-long active and inactive periods using linear models for repeated measures, multiple comparison adjustment, and mediation analysis.RESULTSAmong 4,788 admissions with GIC, average LOS was shorter during the tool’s active periods. LOS reductions occurred for all admissions with GIC (−5.7 h, P = 0.057), diabetes and hyperglycemia (−6.4 h, P = 0.054), stress hyperglycemia (−31.0 h, P = 0.054), patients admitted to medical services (−8.4 h, P = 0.039), and recurrent hypoglycemia (−29.1 h, P = 0.074). Subgroup analysis showed significantly shorter LOS in recurrent hypoglycemia with three events (−82.3 h, P = 0.006) and nonsignificant in two (−5.2 h, P = 0.655) and four or more (−14.8 h, P = 0.746). Among 22,395 admissions with GIC (4,788, 21%) and without GIC (17,607, 79%), LOS reduction during the active period was 1.8 h (P = 0.053). When recommendations were provided, the active tool indirectly and significantly contributed to shortening LOS through its influence on GIC events during admissions with at least one GIC (P = 0.027), diabetes and hyperglycemia (P = 0.028), and medical services (P = 0.019).CONCLUSIONSUse of the alert-based CDS tool to address inpatient management of dysglycemia contributed to reducing LOS, which may reduce costs and improve patient well-being.
      PubDate: Tue, 06 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc21-0829
      Issue No: Vol. 45, No. 11 (2022)
       
  • Measurement and Validation of the Comprehensive Score for Financial
           Toxicity (COST) in a Population With Diabetes

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      Pages: 2535 - 2543
      Abstract: OBJECTIVEThe Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) is a validated instrument measuring financial distress among people with cancer. The reliability and construct validity of the 11-item COST-FACIT were examined in adults with diabetes and high A1C.RESEARCH DESIGN AND METHODSWe examined the factor structure (exploratory factor analysis), internal consistency reliability (Cronbach α), floor/ceiling effects, known-groups validity, and predictive validity among a sample of 600 adults with diabetes and high A1C.RESULTSCOST-FACIT demonstrated a two-factor structure with high internal consistency: general financial situation (7-items, α = 0.86) and impact of illness on financial situation (4-items, α = 0.73). The measure demonstrated a ceiling effect for 2% of participants and floor effects for 7%. Worse financial toxicity scores were observed among adults who were women, were below the poverty line, had government-sponsored health insurance, were middle-aged, were not in the workforce, and had less educational attainment (P < 0.01). Worse financial toxicity was observed for those engaging in cost coping behaviors, such as taking less or skipping medicines, delaying care, borrowing money, “maxing out” the limit on credit cards, and not paying bills (P < 0.01). In regression models for the full measure and its two factors, worse financial toxicity was correlated with higher A1C (P < 0.01), higher levels of diabetes distress (P < 0.01), more chronic conditions (P < 0.01), and more depressive symptoms (P < 0.01).CONCLUSIONSFindings support both the reliability and validity of the COST-FACIT tool among adults with diabetes and high A1C levels. More research is needed to support the use of the COST-FACIT tool as a clinically relevant patient-centered instrument for diabetes care.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0494
      Issue No: Vol. 45, No. 11 (2022)
       
  • A Diabetes Genetic Risk Score Is Associated With All-Cause Dementia and
           Clinically Diagnosed Vascular Dementia in the Million Veteran Program

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      Pages: 2544 - 2552
      Abstract: OBJECTIVEDiabetes and dementia are diseases of high health care burden worldwide, and studies have shown that diabetes is associated with an increased relative risk of dementia. We set out to examine whether type 2 diabetes–associated genetic variants were associated with dementia and whether they differed by race/ethnicity or clinical dementia diagnosis.RESEARCH DESIGN AND METHODSWe evaluated associations of two type 2 diabetes genetic risk scores (GRS and GRS-nonAPOE: a score without rs429358, a variant associated with Alzheimer disease [AD]) with three classifications of clinical dementia diagnoses in the Million Veteran Program (MVP): all-cause dementia, vascular dementia (VaD), and AD. We conducted our analysis stratified by European (EUR), African (AFR), and Hispanic (HIS) races/ethnicities.RESULTSIn EUR, we found associations of the GRS with all-cause dementia (odds ratio [OR] 1.06, P = 1.60e−07) and clinically diagnosed VaD (OR 1.12, P = 5.2e−05) but not with clinically diagnosed AD (OR 1.02, P = 0.43). The GRS was not associated with any dementia outcome in AFR or HIS. When testing with GRS-nonAPOE, we found that effect size estimates in EUR increased and P values decreased for all-cause dementia (OR 1.08, P = 2.6e−12), for VaD (OR 1.14, P = 7.2e−07), and for AD (OR 1.06, P = 0.018). For AFR, the association of GRS-nonAPOE and clinically diagnosed VaD (OR 1.15, P = 0.016) was statistically significant. There were no significant findings for HIS.CONCLUSIONSWe found evidence suggesting shared genetic pathogenesis of diabetes with all-cause dementia and clinically diagnosed VaD.
      PubDate: Tue, 30 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0105
      Issue No: Vol. 45, No. 11 (2022)
       
  • Productivity Loss and Medical Costs Associated With Type 2 Diabetes Among
           Employees Aged 18–64 Years With Large Employer-Sponsored Insurance

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      Pages: 2553 - 2560
      Abstract: OBJECTIVETo estimate productivity losses and costs and medical costs due to type 2 diabetes (T2D) among employees aged 18–64 years.RESEARCH DESIGN AND METHODSUsing 2018–2019 MarketScan databases, we identified employees with T2D or no diabetes among those with records on workplace absences, short-term disability (STD), and long-term disability (LTD). We estimated per capita mean annual time loss attributable to T2D and its associated costs, calculated by multiplying time loss by average hourly wage. We estimated direct medical costs of T2D in total and by service type (inpatient, outpatient, and prescription drugs). We used two-part models (productivity losses and costs and inpatient and drug costs) and generalized linear models (total and outpatient costs) for overall and subgroup analyses by age and sex. All costs were in 2019 U.S. dollars.RESULTSEmployees with T2D had 4.2 excess days lost (20.8 vs. 20.3 absences, 6.4 vs. 3.3 STD days, and 1.0 vs. 0.4 LTD days) than those without diabetes. Productivity costs were 13.3% ($680) higher and medical costs were double (total $11,354 vs. $5,101; outpatient $4,558 vs. $2,687, inpatient $3,085 vs. $1,349, prescription drugs $4,182 vs. $1,189) for employees with T2D. Employees aged 18–34 years had higher STD days and outpatient costs. Women had more absences and STD days and higher outpatient costs than men.CONCLUSIONST2D contributes nearly $7,000 higher annual per capita costs, mostly due to excess medical costs. Our estimates may assist employers to assess potential financial gains from efforts to help workers prevent or better manage T2D.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0445
      Issue No: Vol. 45, No. 11 (2022)
       
  • Urinary Zinc and Incident Type 2 Diabetes: Prospective Evidence From the
           Strong Heart Study

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      Pages: 2561 - 2569
      Abstract: OBJECTIVEHyperglycemia can increase urinary zinc excretion. We evaluated the association of higher urinary zinc level with new diagnosis of incident type 2 diabetes mellitus (T2DM) in adult populations with a high burden of T2DM from AZ, OK, and ND and SD. We also assessed the cross-sectional association of urinary zinc levels with prevalent prediabetes.RESEARCH DESIGN AND METHODSWe included 1,339 adults free of T2DM at baseline (1989–1991) followed through 1998–1999 in the Strong Heart Study (SHS) and 1,905 family members of SHS participants followed as part of the Strong Heart Family Study (SHFS) through 2006–2009.RESULTST2DM incidence was 14.7% (mean follow-up 6.6 years) in the SHS and 13.5% (mean follow-up 5.6 years) in the SHFS. After adjustment for sex, site, education, smoking status, BMI, and estimated glomerular filtration rate, the hazard ratio of T2DM in comparing 75th vs. 25th percentiles of urinary zinc distribution was 1.21 (95% CI 1.08, 1.36) in the SHS and 1.12 (0.96, 1.31) in the SHFS. These associations were attenuated but significant in the SHS after adjustment for HOMA of insulin resistance (HOMA-IR) score. With exclusion of participants with prediabetes at baseline, urinary zinc remained significantly associated with T2DM in the SHS. In cross-sectional analyses, prediabetes was associated with higher urinary zinc levels.CONCLUSIONSUrinary zinc levels were associated with T2DM incidence and prediabetes prevalence even after adjustment for HOMA-IR in populations with a high burden of T2DM. These results highlight the importance of zinc metabolism in diabetes development.
      PubDate: Thu, 22 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1152
      Issue No: Vol. 45, No. 11 (2022)
       
  • Medical Costs Associated With Diabetes Complications in Medicare
           Beneficiaries Aged 65 Years or Older With Type 2 Diabetes

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      Pages: 2570 - 2576
      Abstract: OBJECTIVETo estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 2 diabetes.RESEARCH DESIGN AND METHODSClaims data from 100% of Medicare beneficiaries enrolled in fee-for-service plans from 2006 to 2017 were analyzed. Records with type 2 diabetes and complications were identified using ICD-9, ICD-10, and diagnosis-related group codes. The index year was the year when a person was first identified as having diabetes with an inpatient claim or an outpatient claim plus another inpatient/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars.RESULTSOur study included 10,982,900 beneficiaries with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplant (occurring year $79,045, subsequent years $17,303), kidney failure treated by dialysis ($54,394, $38,670), and lower-extremity amputation ($38,982, $8,084). Congestive heart failure accounted for the largest share (18%) of total complication costs.CONCLUSIONSCosts associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment and programs to prevent and delay diabetes complications in Medicare beneficiaries.
      PubDate: Wed, 14 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2151
      Issue No: Vol. 45, No. 11 (2022)
       
  • Longitudinal Associations of Air Pollution With Body Size and Composition
           in Midlife Women: The Study of Women’s Health Across the Nation

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      Pages: 2577 - 2584
      Abstract: OBJECTIVEWe examined longitudinal associations of air pollution exposure, including fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), with weight, BMI, waist circumference, fat mass, lean mass, and proportion fat mass in midlife women.RESEARCH DESIGN AND METHODSThe study population included 1,654 White, Black, Chinese, and Japanese women from the Study of Women’s Health Across the Nation, with the baseline median age of 49.6 years, followed from 2000 to 2008. Annual air pollution exposures were assigned by linking residential addresses with hybrid estimates of air pollutant concentrations at 1-km2 resolution. Body size was measured, and body composition was measured using DXA at approximately annual visits. Linear mixed effects models were used to examine the associations between air pollution and body size and composition measures and whether these associations differed by physical activity.RESULTSAfter adjusting for potential confounders, an interquartile range increase in PM2.5 concentration (4.5 μg/m3) was associated with 4.53% (95% CI 3.85%, 5.22%) higher fat mass, 1.10% (95% CI 0.95%, 1.25%) higher proportion fat mass, and 0.39% (95% CI −0.77%, −0.01%) lower lean mass. Similar associations were also observed for NO2 and O3. Weaker associations of PM2.5 and NO2 with body composition were observed in participants who engaged in more physical activity.CONCLUSIONSOur analyses provide evidence that exposure to PM2.5, NO2, and O3, is adversely associated with body composition, including higher fat mass, higher proportional fat mass, and lower lean mass, highlighting their potential contribution to obesity.
      PubDate: Fri, 09 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0963
      Issue No: Vol. 45, No. 11 (2022)
       
  • Herpes Zoster Incidence and Burden in Adults With Type 2 Diabetes in the
           U.S.: A Retrospective Database Analysis

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      Pages: 2585 - 2593
      Abstract: OBJECTIVEData on the real-world burden of herpes zoster (HZ) in adults with type 2 diabetes (T2D) in the U.S. are limited. We assessed HZ in patients with and without T2D and measured the impact of HZ on health care resource use (HCRU) and costs.RESEARCH DESIGN AND METHODSThis retrospective cohort analysis used U.S. commercial claims data (sourced from claims incurred between 1 January 2012 and 31 July 2018). HZ incidence rates/1,000 person-years (PYs) were calculated in patients with and without T2D. HZ risk was evaluated using Poisson regression to generate adjusted incidence rate ratios (aIRRs). Patients with T2D with HZ were propensity score matched to patients with T2D only and to patients with HZ without T2D. HCRU and costs were compared across cohorts during a 1-year follow-up period. Cox proportional hazards analyses evaluated factors associated with HZ-related complications.RESULTSCrude HZ incidence rates in patients with and without T2D were 9.8/1,000 PY and 2.6/1,000 PY, respectively. T2D patients were almost twice as likely to be diagnosed with HZ (aIRR 1.84; 95% CI 1.82–1.85). HZ was associated with increased HCRU and health care costs. At 12 months, unadjusted incremental all-cause health care costs for patients with T2D with HZ versus patients with T2D without HZ were $5,216. The unadjusted incremental HZ-related health care costs for patients with T2D with HZ versus patients with HZ without T2D were $2,726. Age was the most important predictor for HZ-related complications.CONCLUSIONSGiven the increased risk of HZ and HCRU and cost burden in patients with T2D, HZ prevention in patients with T2D may be beneficial.
      PubDate: Fri, 23 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2053
      Issue No: Vol. 45, No. 11 (2022)
       
  • The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of
           New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry

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      Pages: 2594 - 2601
      Abstract: OBJECTIVETo analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally.RESEARCH DESIGN AND METHODSWe analyzed data on 17,280 cases of T1D diagnosed during 2018–2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models.RESULTSThe average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1–12.2) in 2018 to 21.7 (20.6–22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2–14.0) in 2018 to 26.7 (25.7–27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5–12.9) to 24.7 (24.0–25.5) for adolescents ages 12–18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018–2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic.CONCLUSIONSThe slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0278
      Issue No: Vol. 45, No. 11 (2022)
       
  • Differences in the Association of Select Dietary Measures With Risk of
           Incident Type 2 Diabetes

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      Pages: 2602 - 2610
      Abstract: OBJECTIVETo evaluate associations between a broad range of approaches to classifying diet and incident type 2 diabetes in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.RESEARCH DESIGN AND METHODSThis study included 8,750 Black and White adults without diabetes at baseline. Diabetes was defined according to fasting glucose ≥70 mmol/L, random glucose ≥111 mmol/L, or use of diabetes medications. The exposures were diet scores for Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), dietary inflammatory index (DII), dietary inflammation score (DIS), and empirical dietary patterns (plant-based and Southern) determined using data collected with use of the Block98 food-frequency questionnaire. Modified Poisson regression was used to assess association of dietary measures with risk of incident type 2 diabetes, with models adjusted for total energy intake, demographics, lifestyle factors, and waist circumference.RESULTSThere were 1,026 cases of incident type 2 diabetes during follow-up (11.7%). Adherence to the Southern dietary pattern was most strongly associated with risk of incident type 2 diabetes after adjustment for demographics and lifestyle (quintile [Q]5 vs. lowest Q1: risk ratio [RR] 1.95; 95% CI 1.57, 2.41). Of the diet scores, DIS (Q5 vs. Q1 RR 1.41) and MIND (Q1 vs. Q5 RR 1.33), demonstrated anti-inflammatory diets, had strongest associations with lower diabetes incidence.CONCLUSIONSWe found associations of several dietary approaches with incident type 2 diabetes. Investigation into mechanisms driving the association with the Southern dietary pattern is warranted. Further research into use of DIS, DII, and MIND diet score should be considered for dietary recommendations for diabetes prevention.
      PubDate: Tue, 20 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0217
      Issue No: Vol. 45, No. 11 (2022)
       
  • Nationally Subsidized Continuous Glucose Monitoring: A Cost-effectiveness
           Analysis

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      Pages: 2611 - 2619
      Abstract: OBJECTIVEThe Continuous Glucose Monitoring (CGM) Initiative recently introduced universal subsidized CGM funding for people with type 1 diabetes under 21 years of age in Australia. We thus aimed to evaluate the cost-effectiveness of this CGM Initiative based on national implementation data and project the economic impact of extending the subsidy to all age-groups.RESEARCH DESIGN AND METHODSWe used a patient-level Markov model to simulate disease progression for young people with type 1 diabetes and compared government-subsidized access to CGM with the previous user-funded system. Three years of real-world clinical input data were sourced from analysis of the Australasian Diabetes Data Network and National Diabetes Services Scheme registries. Costs were considered from the Australian health care system’s perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses.RESULTSGovernment-subsidized CGM funding for young people with type 1 diabetes compared with a completely user-funded model resulted in an incremental cost-effectiveness ratio (ICER) of AUD 39,518 per quality-adjusted life-year (QALY) gained. Most simulations (85%) were below the commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained in Australia. Sensitivity analyses indicated that base-case results were robust, though strongly impacted by the cost of CGM devices. Extending the CGM Initiative throughout adulthood resulted in an ICER of AUD 34,890 per QALY gained.CONCLUSIONSProviding subsidized access to CGM for people with type 1 diabetes was found to be cost-effective compared with a completely user-funded model in Australia.
      PubDate: Mon, 26 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0951
      Issue No: Vol. 45, No. 11 (2022)
       
  • Evaluation of Fracture Risk Among Patients With Type 2 Diabetes and
           Nonvalvular Atrial Fibrillation Receiving Different Oral Anticoagulants

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      Pages: 2620 - 2627
      Abstract: OBJECTIVEPatients with type 2 diabetes are at higher risk for fracture risk because of attenuated bone turnover and impaired bone microarchitecture. The comparative effect of warfarin over non–vitamin K antagonist oral anticoagulants (NOACs) on incident fractures among patients with type 2 diabetes comorbid with atrial fibrillation (AF) remains to be elucidated.RESEARCH DESIGN AND METHODSThis was a retrospective, propensity score–weighted, population-based cohort study of adults with type 2 diabetes and AF who were started on warfarin or NOAC between 2005 and 2019 identified from an electronic database of the Hong Kong Hospital Authority. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, proximal humerus, and wrist). Hazard ratios (HRs) were calculated using Cox proportional hazards regression models.RESULTSA total of 15,770 patients with type 2 diabetes comorbid with AF were included (9,288 on NOAC, 6,482 on warfarin). During a median follow-up of 20 months, 551 patients (3.5%) sustained major osteoporotic fractures (201 [2.2%] in the NOAC group, 350 [5.4%] in the warfarin group). The adjusted cumulative incidence was lower among NOAC users than warfarin users (HR 0.80; 95% CI 0.64, 0.99; P = 0.044). Subgroup analyses showed consistent protective effects against major osteoporotic fractures among NOAC users across sex, age, HbA1c, duration of diabetes, and history of severe hypoglycemia compared with warfarin users.CONCLUSIONSNOAC use was associated with a lower risk of major osteoporotic fractures than warfarin use among patients with type 2 diabetes comorbid with AF. NOAC may be the preferred anticoagulant from the perspective of bone health.
      PubDate: Tue, 20 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0664
      Issue No: Vol. 45, No. 11 (2022)
       
  • Transitioning of People With Type 1 Diabetes From Multiple Daily
           Injections and Self-Monitoring of Blood Glucose Directly to MiniMed 780G
           Advanced Hybrid Closed-Loop System: A Two-Center, Randomized, Controlled
           Study

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      Pages: 2628 - 2635
      Abstract: OBJECTIVEThe aim of this study was to evaluate the outcomes of transitioning to the MiniMed 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes mellitus (T1DM) naive to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) technologies.RESEARCH DESIGN AND METHODSThis was a two-center, randomized, controlled, parallel-group trial with evaluation of individuals with T1DM aged 26–60 years managed with multiple daily injections (MDI) and self-monitoring of blood glucose (BGM) with HbA1c <10%.RESULTSA total of 41 participants were recruited and randomized to either the AHCL (n = 20) or the MDI+BGM (n = 21) group, and 37 participants (mean ± SD age 40.3 ± 8.0 years, duration of diabetes 17.3 ± 12.1 years, BMI 25.1 ± 3.1 kg/m2, HbA1c 7.2 ± 1.0%) completed the study. Time spent with glucose levels in target range increased from 69.3 ± 12.3% at baseline to 85.0 ± 6.3% at 3 months in the AHCL group, while remaining unchanged in the control group (treatment effect 21.5% [95% CI 15.7, 27.3]; P < 0.001). The time with levels below range (<70 mg/dL) decreased from 8.7 ± 7.3% to 2.1 ± 1.7% in the AHCL group and remained unchanged in the MDI+BGM group (treatment effect −4.4% [95% CI −7.4, −2.1]; P < 0.001). Participants from the AHCL group also had significant improvements in HbA1c levels (treatment effect −0.6% [95% CI −0.9, −0.2]; P = 0.005) and in quality of life (QoL) in specific subscales compared with the MDI+BGM group.CONCLUSIONSPeople with T1DM naive to CSII and CGM technologies initiating AHCL significantly and safely improved their glycemic control, as well as their QoL and psychological well-being.
      PubDate: Mon, 15 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0470
      Issue No: Vol. 45, No. 11 (2022)
       
  • Biobehavioral Changes Following Transition to Automated Insulin Delivery:
           A Large Real-life Database Analysis

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      Pages: 2636 - 2643
      Abstract: OBJECTIVETo document glycemic and user-initiated bolus changes following transition from predictive low glucose suspend (PLGS) system to automated insulin delivery (AID) system during real-life use.RESEARCH DESIGN AND METHODSWe conducted analysis of 2,329,166 days (6,381 patient-years) of continuous glucose monitoring (CGM) and insulin therapy data for 19,354 individuals with type 1 Diabetes, during 1-month PLGS use (Basal-IQ technology) followed by 3-month AID use (Control-IQ technology). Baseline characteristics are as follows: 55.4% female, age (median/quartiles/range) 39/19–58/1–92 years, mean ± SD glucose management indicator (GMI) 7.5 ± 0.8. Primary outcome was time in target range (TIR) (70–180 mg/dL). Secondary outcomes included CGM-based glycemic control metrics and frequency of user-initiated boluses.RESULTSCompared with PLGS, AID increased TIR on average from 58.4 to 70.5%. GMI and percent time above and below target range improved as well: from 7.5 to 7.1, 39.9 to 28.1%, and 1.66 to 1.46%, respectively; all P values <0.0001. Stratification of outcomes by age and baseline GMI revealed clinically significant differences. Glycemic improvements were most pronounced in those <18 years old (TIR improvement 14.0 percentage points) and those with baseline GMI >8.0 (TIR improvement 13.2 percentage points). User-initiated correction boluses decreased from 2.7 to 1.8 per day, while user-initiated meal boluses remained stable at 3.6 to 3.8 per day.CONCLUSIONSObserved in real life of >19,000 individuals with type 1 diabetes, transitions from PLGS to AID resulted in improvement of all glycemic parameters, equivalent to improvements observed in randomized clinical trials, and reduced user-initiated boluses. However, glycemic and behavioral changes with AID use may differ greatly across different demographic and clinical groups.
      PubDate: Tue, 20 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1217
      Issue No: Vol. 45, No. 11 (2022)
       
  • Interleukin-6 and Cardiovascular and Kidney Outcomes in Patients With Type
           2 Diabetes: New Insights From CANVAS

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      Pages: 2644 - 2652
      Abstract: OBJECTIVEThe inflammatory cytokine interleukin-6 (IL-6) is associated with cardiovascular (CV) and kidney outcomes in various populations. However, data in patients with type 2 diabetes are limited. We assessed the association of IL-6 with CV and kidney outcomes in the Canagliflozin Cardiovascular Assessment Study (CANVAS) and determined the effect of canagliflozin on IL-6.RESEARCH DESIGN AND METHODSPatients with type 2 diabetes at high CV risk were randomly assigned to canagliflozin or placebo. Plasma IL-6 was measured at baseline and years 1, 3, and 6. The composite CV outcome was nonfatal myocardial infarction, nonfatal stroke, or CV death; the composite kidney outcome was sustained ≥40% estimated glomerular filtration rate decline, end-stage kidney disease, or kidney-related death. Multivariable-adjusted Cox proportional hazards regression was used to estimate the associations between IL-6 and the outcomes. The effect of canagliflozin on IL-6 over time was assessed with a repeated-measures mixed-effects model.RESULTSThe geometric mean IL-6 at baseline, available in 3,503 (80.2%) participants, was 1.7 pg/mL. Each doubling of baseline IL-6 was associated with 14% (95% CI 4, 24) and 21% (95% CI 1, 45) increased risk of CV and kidney outcomes, respectively. Over 6 years, IL-6 increased by 5.8% (95% CI 3.4, 8.3) in the placebo group. Canagliflozin modestly attenuated the IL-6 increase (absolute percentage difference vs. placebo 4.4% [95% CI 1.3, 9.9; P = 0.01]). At year 1, each 25% lower level of IL-6 compared with baseline was associated with 7% (95% CI 1, 22) and 14% (95% CI 5, 22) lower risks for the CV and kidney outcome, respectively.CONCLUSIONSIn patients with type 2 diabetes at high CV risk, baseline IL-6 and its 1-year change were associated with CV and kidney outcomes. The effect of IL-6–lowering therapy on CV, kidney, and safety outcomes remains to be tested.
      PubDate: Thu, 22 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0866
      Issue No: Vol. 45, No. 11 (2022)
       
  • Risk Factors for the Development of Retinopathy in Prediabetes and Type 2
           Diabetes: The Diabetes Prevention Program Experience

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      Pages: 2653 - 2661
      Abstract: OBJECTIVETo determine glycemic and nonglycemic risk factors that contribute to the presence of diabetic retinopathy (DR) before and after the onset of type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSDuring the Diabetes Prevention Program (DPP) and DPP Outcome Study (DPPOS), we performed fundus photography over time in adults at high risk for developing T2D, including after they developed diabetes. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system, with DR defined as typical lesions of DR (microaneurysms, exudates, hemorrhage, or worse) in either eye.RESULTSBy DPPOS year 16 (∼20 years after random assignment into DPP), 24% of 1,614 participants who had developed T2D and 14% of 885 who remained without diabetes had DR. In univariate analyses, using results from across the entire duration of follow-up, American Indian race was associated with less frequent DR compared with non-Hispanic White (NHW) race, and higher HbA1c, fasting and 2-h plasma glucose levels during an oral glucose tolerance test, weight, and history of hypertension, dyslipidemia, and smoking, but not treatment group assignment, were associated with more frequent DR. On multivariate analysis, American Indian race was associated with less DR compared with NHW (odds ratio [OR] 0.36, 95% CI 0.20–0.66), and average HbA1c was associated with more DR (OR 1.92, 95% CI 1.46–1.74 per SD [0.7%] increase in HbA1c).CONCLUSIONSDR may occur in adults with prediabetes and early in the course of T2D. HbA1c was an important risk factor for the development of DR across the entire glycemic range from prediabetes to T2D.
      PubDate: Tue, 13 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0860
      Issue No: Vol. 45, No. 11 (2022)
       
  • Dapagliflozin Improves the Urinary Proteomic Kidney-Risk Classifier CKD273
           in Type 2 Diabetes with Albuminuria: A Randomized Clinical Trial

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      Pages: 2662 - 2668
      Abstract: OBJECTIVETo evaluate the effect of the sodium–glucose cotransporter 2 inhibitor dapagliflozin on the kidney-risk urinary proteomic classifier (CKD273) in persons with type 2 diabetes (T2D) and albuminuria.RESEARCH DESIGN AND METHODSIn a double-blind, randomized, controlled, crossover trial, we assigned participants with T2D and urinary albumin to creatinine ratio (UACR) ≥30 mg/g to receive dapagliflozin or matching placebo added to guideline-recommended treatment (ClinicalTrial.gov identifier NCT02914691). Treatment periods lasted 12 weeks, when crossover to the opposing treatment occurred. The primary outcome was change in CKD273 score. Secondary outcomes included regression from high-risk to low-risk CKD273 pattern using the prespecified cutoff score of 0.154. The primary outcome was assessed using paired t test between end-to-end CKD273 scores after dapagliflozin and placebo treatment. The McNemar test was used to assess regression in risk category.RESULTSA total of 40 participants were randomized and 32 completed the trial with intact proteomic measurements. Twenty-eight (88%) were men, the baseline mean (SD) age was 63.0 (8.3) years, mean (SD) diabetes duration was 15.4 (4.5) years, mean HbA1c was 73 (14) mmol/mol (8.8% [1.3%]), and median (interquartile range) UACR was 154 (94, 329) mg/g. Dapagliflozin significantly lowered CKD273 score compared with placebo (−0.221; 95% CI −0.356, −0.087; P = 0.002). Fourteen participants exhibited a high-risk pattern after dapagliflozin treatment compared with 24 after participants placebo (P = 0.021).CONCLUSIONSDapagliflozin added to renin-angiotensin system inhibition reduced the urinary proteomic classifier CKD273 in persons with T2D and albuminuria, paving the way for the further investigation of CKD273 as a modifiable kidney risk factor.
      PubDate: Tue, 23 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-1157
      Issue No: Vol. 45, No. 11 (2022)
       
  • High HbA 1c Levels Are Associated With Development of Trigger Finger in
           Type 1 and Type 2 Diabetes: An Observational Register-Based Study From
           Sweden

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      Pages: 2669 - 2674
      Abstract: OBJECTIVETrigger finger (TF) is a hand disorder causing the fingers to painfully lock in flexion. Diabetes is a known risk factor; however, whether strict glycemic control effectively lowers risk of TF is unknown. Our aim was to examine whether high HbA1c was associated with increased risk of TF among individuals with diabetes.RESEARCH DESIGN AND METHODSThe Swedish National Diabetes Register (NDR) was cross-linked with the health care register of the Region of Skåne in southern Sweden. In total, 9,682 individuals with type 1 diabetes (T1D) and 85,755 individuals with type 2 diabetes (T2D) aged ≥18 years were included from 2004 to 2019. Associations between HbA1c and TF were calculated with sex-stratified, multivariate logistic regression models with 95% CIs, with adjustment for age, duration of diabetes, BMI, and systolic blood pressure.RESULTSIn total, 486 women and 271 men with T1D and 1,143 women and 1,009 men with T2D were diagnosed with TF. Increased levels of HbA1c were associated with TF among individuals with T1D (women OR 1.26 [95% CI 1.1–1.4], P = 0.001, and men 1.4 [1.2–1.7], P < 0.001) and T2D (women 1.14 [95% CI 1.2–1.2], P < 0.001, and men 1.12 [95% CI 1.0–1.2], P = 0.003).CONCLUSIONSHyperglycemia increases the risk of developing TF among individuals with T1D and T2D. Optimal treatment of diabetes seems to be of importance for prevention of diabetic hand complications such as TF.
      PubDate: Thu, 25 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0829
      Issue No: Vol. 45, No. 11 (2022)
       
  • Impact of HbA 1c Followed 32 Years From Diagnosis of Type 1 Diabetes on
           Development of Severe Retinopathy and Nephropathy: The VISS Study

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      Pages: 2675 - 2682
      Abstract: OBJECTIVETo evaluate HbA1c followed from diagnosis, as a predictor of severe microvascular complications (i.e., proliferative diabetic retinopathy [PDR] and nephropathy [macroalbuminuria]).RESEARCH DESIGN AND METHODSIn a population-based observational study, 447 patients diagnosed with type 1 diabetes before 35 years of age from 1983 to 1987 in southeast Sweden were followed from diagnosis until 2019. Long-term weighted mean HbA1c (wHbA1c) was calculated by integrating the area under all HbA1c values. Complications were analyzed in relation to wHbA1c categorized into five levels.RESULTSAfter 32 years, 9% had no retinopathy, 64% non-PDR, and 27% PDR, and 83% had no microalbuminuria, 9% microalbuminuria, and 8% macroalbuminuria. Patients with near-normal wHbA1c did not develop PDR or macroalbuminuria. The lowest wHbA1c values associated with development of PDR and nephropathy (macroalbuminuria) were 7.3% (56 mmol/mol) and 8.1% (65 mmol/mol), respectively. The prevalence of PDR and macroalbuminuria increased with increasing wHbA1c, being 74% and 44% in the highest category, wHbA1c >9.5% (>80 mmol/mol). In comparison with the follow-up done after 20–24 years’ duration, the prevalence of PDR had increased from 14 to 27% and macroalbuminuria from 4 to 8%, and both appeared at lower wHbA1c values.CONCLUSIONSwHbA1c followed from diagnosis is a very strong biomarker for PDR and nephropathy, the prevalence of both still increasing 32 years after diagnosis. To avoid PDR and macroalbuminuria in patients with type 1 diabetes, an HbA1c <7.0% (53 mmol/mol) and as normal as possible should be recommended when achievable without severe hypoglycemia and with good quality of life.
      PubDate: Mon, 12 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0239
      Issue No: Vol. 45, No. 11 (2022)
       
  • In-Hospital Hyperglycemia Is Associated With Worse Outcomes in Patients
           Admitted With COVID-19

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      Pages: 2683 - 2688
      Abstract: OBJECTIVEDiabetes and the outpatient diabetes treatment regimen have been identified as risk factors for poor outcomes in patients with sepsis. However, little is known about the effect of tight inpatient glycemic control in the setting of coronavirus disease 2019 (COVID-19). Therefore, we examined the effect of hyperglycemia in patients with diabetes hospitalized because of COVID-19.RESEARCH DESIGN AND METHODSWe analyzed data from 1,938 COVID-19 patients with diabetes hospitalized for COVID-19 from March to May 2020 at a large academic medical center in New York City. Patients were divided into two groups based on their inpatient glycemic values, and a Cox proportional hazards regression model was used to assess the independent association of inpatient glucose levels with mortality (primary outcome) and the risk of requiring mechanical ventilation (MV) (secondary outcome).RESULTSIn our analysis, 32% of the patients were normoglycemic and 68% hyperglycemic. Moreover, 31% of the study subjects died during hospitalization, and 14% required MV, with inpatient hyperglycemia being significantly associated with both mortality and the requirement for MV. Additionally, in the Cox regression analysis, after adjustment for potential confounders, including age, sex, race, BMI, HbA1c, comorbidities, inflammatory markers, and corticosteroid therapy, patients with uncontrolled hyperglycemia had a higher risk of dying (hazard ratio [HR] 1.54, 95% CI 1.00–2.36, P = 0.049) and of requiring MV (HR 4.41, 95% CI 1.52–2.81, P = 0.006) than those with normoglycemia.CONCLUSIONSA tight control of inpatient hyperglycemia may be an effective method for improving outcomes in patients with diabetes hospitalized for COVID-19.
      PubDate: Tue, 30 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0708
      Issue No: Vol. 45, No. 11 (2022)
       
  • Long-term Outcomes Among Young Adults With Type 2 Diabetes Based on
           Durability of Glycemic Control: Results From the TODAY Cohort Study

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      Pages: 2689 - 2697
      Abstract: OBJECTIVETo examine the effect of different patterns of durable glycemic control on the development of comorbidities among youth with type 2 diabetes (T2D) and to assess the impact of fasting glucose (FG) variability on the clinical course of T2D.RESEARCH DESIGN AND METHODSFrom the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, 457 participants (mean age, 14 years) with mean diabetes duration <2 years at entry and a minimum study follow-up of 10 years were included in these analyses. HbA1c, FG concentrations, and β-cell function estimates from oral glucose tolerance tests were measured longitudinally. Prevalence of comorbidities by glycemic control status after 10 years in the TODAY study was assessed.RESULTSHigher baseline HbA1c concentration, lower β-cell function, and maternal history of diabetes were strongly associated with loss of glycemic control in youth with T2D. Higher cumulative HbA1c concentration over 4 years and greater FG variability over a year within 3 years of diagnosis were related to higher prevalence of dyslipidemia, nephropathy, and retinopathy progression over the subsequent 10 years. A coefficient of variability in FG ≥8.3% predicted future loss of glycemic control and development of comorbidities.CONCLUSIONSHigher baseline HbA1c concentration and FG variability during year 1 accurately predicted youth with T2D who will experience metabolic decompensation and comorbidities. These values may be useful tools for clinicians when considering early intensification of therapy.
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0784
      Issue No: Vol. 45, No. 11 (2022)
       
  • Does the Effect of a 3-Year Lifestyle Intervention on Body Weight and
           Cardiometabolic Health Differ by Prediabetes Metabolic Phenotype' A
           Post Hoc Analysis of the PREVIEW Study

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      Pages: 2698 - 2708
      Abstract: OBJECTIVETo examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype.RESEARCH DESIGN AND METHODSThis post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ≥25 kg ⋅ m−2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A1c (HbA1c; <39 mmol ⋅ mol−1) and 25% had intermediate HbA1c (39–47 mmol ⋅ mol−1). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used.RESULTSIn the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks −3.5% [95% CI, −4.7%, −2.3%]) than those with iIFG (mean −2.5% [−3.6%, −1.3%]) relative to baseline (P = 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks −0.54 mmol ⋅ L−1 [95% CI −0.70, −0.39], P < 0.001), and triglycerides (difference −0.07 mmol ⋅ L−1 [−0.11, −0.03], P < 0.001) during the lifestyle intervention.CONCLUSIONSIndividuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.
      PubDate: Mon, 13 Jun 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0549
      Issue No: Vol. 45, No. 11 (2022)
       
  • Effect of SARS-CoV-2 Infection and Infection Severity on Longer-Term
           Glycemic Control and Weight in People With Type 2 Diabetes

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      Pages: 2709 - 2717
      Abstract: OBJECTIVETo evaluate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severity of infection with longer-term glycemic control and weight in people with type 2 diabetes (T2D) in the U.S.RESEARCH DESIGN AND METHODSWe conducted a retrospective cohort study using longitudinal electronic health record data of patients with SARS-CoV-2 infection from the National COVID Cohort Collaborative (N3C). Patients were ≥18 years old with an ICD-10 diagnosis of T2D and at least one HbA1c and weight measurement prior to and after an index date of their first coronavirus disease 2019 (COVID-19) diagnosis or negative SARS-CoV-2 test. We used propensity scores to identify a matched cohort balanced on demographic characteristics, comorbidities, and medications used to treat diabetes. The primary outcome was the postindex average HbA1c and postindex average weight over a 1 year time period beginning 90 days after the index date among patients who did and did not have SARS-CoV-2 infection. Secondary outcomes were postindex average HbA1c and weight in patients who required hospitalization or mechanical ventilation.RESULTSThere was no significant difference in the postindex average HbA1c or weight in patients who had SARS-CoV-2 infection compared with control subjects. Mechanical ventilation was associated with a decrease in average HbA1c after COVID-19.CONCLUSIONSIn a multicenter cohort of patients in the U.S. with preexisting T2D, there was no significant change in longer-term average HbA1c or weight among patients who had COVID-19. Mechanical ventilation was associated with a decrease in HbA1c after COVID-19.
      PubDate: Tue, 13 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0730
      Issue No: Vol. 45, No. 11 (2022)
       
  • SGLT2 Inhibition, Choline Metabolites, and Cardiometabolic Diseases: A
           Mediation Mendelian Randomization Study

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      Pages: 2718 - 2728
      Abstract: OBJECTIVETo investigate the causal role of choline metabolites mediating sodium–glucose cotransporter 2 (SGLT2) inhibition in coronary artery disease (CAD) and type 2 diabetes (T2D) using Mendelian randomization (MR).RESEARCH DESIGN AND METHODSA two-sample two-step MR was used to determine 1) causal effects of SGLT2 inhibition on CAD and T2D; 2) causal effects of three choline metabolites, total choline, phosphatidylcholine, and glycine, on CAD and T2D; and 3) mediation effects of these metabolites. Genetic proxies for SGLT2 inhibition were identified as variants in the SLC5A2 gene that were associated with both levels of gene expression and hemoglobin A1c. Summary statistics for metabolites were from UK Biobank, CAD from CARDIoGRAMplusC4D (Coronary ARtery DIsease Genome wide Replication and Meta-analysis [CARDIoGRAM] plus The Coronary Artery Disease [C4D] Genetics) consortium, and T2D from DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) and the FinnGen study.RESULTSSGLT2 inhibition (per 1 SD, 6.75 mmol/mol [1.09%] lowering of HbA1c) was associated with lower risk of T2D and CAD (odds ratio [OR] 0.25 [95% CI 0.12, 0.54], and 0.51 [0.28, 0.94], respectively) and positively with total choline (β 0.39 [95% CI 0.06, 0.72]), phosphatidylcholine (0.40 [0.13, 0.67]), and glycine (0.34 [0.05, 0.63]). Total choline (OR 0.78 [95% CI 0.68, 0.89]) and phosphatidylcholine (OR 0.81 [0.72, 0.91]) were associated with T2D but not with CAD, while glycine was associated with CAD (0.94 [0.91, 0.98]) but not with T2D. Mediation analysis showed evidence of indirect effect of SGLT2 inhibition on T2D through total choline (0.91 [0.83, 0.99]) and phosphatidylcholine (0.93 [0.87, 0.99]) with a mediated proportion of 8% and 5% of the total effect, respectively, and on CAD through glycine (0.98 [0.96, 1.00]) with a mediated proportion of 2%. The results were well validated in at least one independent data set.CONCLUSIONSOur study identified the causal roles of SGLT2 inhibition in choline metabolites. SGLT2 inhibition may influence T2D and CAD through different choline metabolites.
      PubDate: Mon, 26 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0323
      Issue No: Vol. 45, No. 11 (2022)
       
  • Immunoglobulin G N-Glycosylation Signatures in Incident Type 2 Diabetes
           and Cardiovascular Disease

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      Pages: 2729 - 2736
      Abstract: OBJECTIVEN-glycosylation is a functional posttranslational modification of immunoglobulins (Igs). We hypothesized that specific IgG N-glycans are associated with incident type 2 diabetes and cardiovascular disease (CVD).RESEARCH DESIGN AND METHODSWe performed case-cohort studies within the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)–Potsdam cohort (2,127 in the type 2 diabetes subcohort [741 incident cases]; 2,175 in the CVD subcohort [417 myocardial infarction and stroke cases]). Relative abundances of 24 IgG N-glycan peaks (IgG-GPs) were measured by ultraperformance liquid chromatography, and eight glycosylation traits were derived based on structural similarity. End point–associated IgG-GPs were preselected with fractional polynomials, and prospective associations were estimated in confounder-adjusted Cox models. Diabetes risk associations were validated in three independent studies.RESULTSAfter adjustment for confounders and multiple testing correction, IgG-GP7, IgG-GP8, IgG-GP9, IgG-GP11, and IgG-GP19 were associated with type 2 diabetes risk. A score based on these IgG-GPs was associated with a higher diabetes risk in EPIC-Potsdam and independent validation studies (843 total cases, 3,149 total non-cases, pooled estimate per SD increase 1.50 [95% CI 1.37–1.64]). Associations of IgG-GPs with CVD risk differed between men and women. In women, IgG-GP9 was inversely associated with CVD risk (hazard ratio [HR] per SD 0.80 [95% CI 0.65–0.98]). In men, a weighted score based on IgG-GP19 and IgG-GP23 was associated with higher CVD risk (HR per SD 1.47 [95% CI 1.20–1.80]). In addition, several derived traits were associated with cardiometabolic disease incidence.CONCLUSIONSSelected IgG N-glycans are associated with cardiometabolic risk beyond classic risk factors, including clinical biomarkers.
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0833
      Issue No: Vol. 45, No. 11 (2022)
       
  • Derivation and External Validation of a Clinical Model to Predict Heart
           Failure Onset in Patients With Incident Diabetes

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      Pages: 2737 - 2745
      Abstract: OBJECTIVEHeart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific models in Ontario, Canada to predict HF at diabetes onset and externally validated these models in the U.K.RESEARCH DESIGN AND METHODSRetrospective cohort study using international population-based data. Our derivation cohort comprised all Ontario residents aged ≥18 years who were diagnosed with diabetes between 2009 and 2018. Our validation cohort comprised U.K. patients aged ≥35 years who were diagnosed with diabetes between 2007 and 2017. Primary outcome was incident HF. Sex-stratified multivariable Fine and Gray subdistribution hazard models were constructed, with death as a competing event.RESULTSA total of 348,027 Ontarians (45% women) and 54,483 U.K. residents (45% women) were included. At 1, 5, and 9 years, respectively, in the external validation cohort, the C-statistics were 0.81 (95% CI 0.79–0.84), 0.79 (0.77–0.80), and 0.78 (0.76–0.79) for the female-specific model; and 0.78 (0.75–0.80), 0.77 (0.76–0.79), and 0.77 (0.75–0.79) for the male-specific model. The models were well-calibrated. Age, rurality, hypertension duration, hemoglobin, HbA1c, and cardiovascular diseases were common predictors in both sexes. Additionally, mood disorder and alcoholism (heavy drinker) were female-specific predictors, while income and liver disease were male-specific predictors.CONCLUSIONSOur findings highlight the importance of developing sex-specific models and represent an important step toward personalized lifestyle and pharmacologic prevention of future HF development.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0894
      Issue No: Vol. 45, No. 11 (2022)
       
  • Endotrophin as a Marker of Complications in a Type 2 Diabetes Cohort

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      Pages: 2746 - 2748
      Abstract: OBJECTIVEWe investigated endotrophin, a profibrotic signaling molecule reflecting collagen VI formation, in serum and urine as risk marker for complications to type 2 diabetes.RESEARCH DESIGN AND METHODSEndotrophin was measured in 774 individuals with type 2 diabetes. Outcomes included a composite kidney end point, first major adverse cardiovascular event (MACE), mortality, progression of albuminuria, incident heart failure, and sight-threatening eye disease. Adjusted Cox proportional hazards models were applied.RESULTSDoubling of serum endotrophin was associated with the kidney end point (n = 49; hazard ratio 1.80 [95% CI 1.13–2.87]), first MACE (n = 66; 1.54 [1.04–2.28]), mortality (n = 156; 1.69 (1.31–2.19]), and incident heart failure (n = 42; 1.63 [1.02–2.60]). A doubling of urine endotrophin was associated with progression of albuminuria (n = 85; 1.20 [1.04–1.39]).CONCLUSIONSSerum endotrophin was a risk marker for mortality and kidney and cardiovascular complications in type 2 diabetes. Urine endotrophin was a marker for albuminuria progression.
      PubDate: Mon, 12 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0852
      Issue No: Vol. 45, No. 11 (2022)
       
  • Initiation of New Glucose-Lowering Therapies May Act to Reduce Physical
           Activity Levels: Pooled Analysis From Three Randomized Trials

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      Pages: 2749 - 2752
      Abstract: OBJECTIVESodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) reduce body weight and improve cardiometabolic health, but their effect on physical activity is unknown.RESEARCH DESIGN AND METHODSWe pooled data (n = 148) from three randomized trials to investigate the effect of empagliflozin (SGLT2i) and liraglutide (GLP-1RA), in comparison with sitagliptin (dipeptidyl peptidase 4 inhibitor) and dietary therapies, on accelerometer-assessed physical activity.RESULTSLiraglutide (mean −1,144 steps/day; 95% CI −2,069 to −220), empagliflozin (−1,132 steps/day; −1,739, −524), and sitagliptin (−852 steps/day; −1,625, −78) resulted in reduced total daily physical activity after 6 months (P < 0.01 vs. control). Moderate- to vigorous-intensity physical activity was also reduced. Dietary interventions led to no change or an increase in physical activity.CONCLUSIONSThe initiation of all glucose-lowering therapies was associated with reduced physical activity, warranting further investigation.
      PubDate: Fri, 19 Aug 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0888
      Issue No: Vol. 45, No. 11 (2022)
       
  • Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report
           by the American Diabetes Association (ADA) and the European Association
           for the Study of Diabetes (EASD)

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      Pages: 2753 - 2786
      Abstract: The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the previous consensus statements on the management of hyperglycemia in type 2 diabetes in adults, published since 2006 and last updated in 2019. The target audience is the full spectrum of the professional health care team providing diabetes care in the U.S. and Europe. A systematic examination of publications since 2018 informed new recommendations. These include additional focus on social determinants of health, the health care system, and physical activity behaviors, including sleep. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. The results of cardiovascular and kidney outcomes trials involving sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease. After a summary listing of consensus recommendations, practical tips for implementation are provided.
      PubDate: Wed, 28 Sep 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0034
      Issue No: Vol. 45, No. 11 (2022)
       
  • Long-term Effect of Lifestyle Interventions on the Cardiovascular and
           All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A
           Systematic Review and Meta-analysis

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      Pages: 2787 - 2795
      Abstract: BACKGROUNDLifestyle interventions improve the metabolic control of individuals with hyperglycemia.PURPOSEWe aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.DATA SOURCESSearches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).STUDY SELECTIONWe included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.DATA EXTRACTIONData from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.DATA SYNTHESISLifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79–1.23) or all-cause (RR 0.93; 95% CI 0.85–1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.LIMITATIONSMost studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.CONCLUSIONSIntensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0642
      Issue No: Vol. 45, No. 11 (2022)
       
  • Issues and Events

    • Free pre-print version: Loading...

      Pages: 2796 - 2796
      PubDate: Tue, 25 Oct 2022 00:00:00 GMT
      DOI: 10.2337/dc22-ie11
      Issue No: Vol. 45, No. 11 (2022)
       
 
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