Subjects -> MEDICAL SCIENCES (Total: 8196 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: 2)
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: 15)
Archives of Hematology Case Reports and Reviews     Open Access  
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 29)
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: 291)
Blood Advances     Open Access   (Followers: 6)
Blood and Lymphatic Cancer : Targets and Therapy     Open Access   (Followers: 7)
Blood Cancer Journal     Open Access   (Followers: 18)
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: 60)
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: 39)
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: 404)
Diabetes aktuell     Hybrid Journal   (Followers: 3)
Diabetes and Vascular Disease Research     Hybrid Journal   (Followers: 20)
Diabetes Care     Full-text available via subscription   (Followers: 462)
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: 71)
Diabetes Spectrum     Full-text available via subscription   (Followers: 16)
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: 144)
Diabetologia     Hybrid Journal   (Followers: 201)
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: 33)
Haemophilia     Hybrid Journal   (Followers: 66)
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: 8)
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: 8)
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: 9)
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  
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: 80)
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: 22)
Leukemia and Lymphoma     Hybrid Journal   (Followers: 12)
Leukemia Research     Hybrid Journal   (Followers: 8)
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: 140)
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: 462  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • Impact of Limited English Proficiency on the Diagnosis and Awareness of
           Diabetes: The National Health and Nutrition Examination Survey,
           2003–2018

    • Free pre-print version: Loading...

      Abstract: Approximately 20% of the U.S. resident population speaks a non-English language at home (1). A growing body of evidence indicates that the presence of limited English proficiency (LEP) can negatively influence physical health status, outside of known racial and ethnic disparities. Numerous studies have shown that individuals with LEP experience barriers in accessing health care and have lower rates of receiving and continuing necessary care (2). These studies also revealed that individuals with LEP are less likely to obtain satisfactory care, be provided with pertinent information, understand disease processes, and trust their physicians (2).
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0594
      Issue No: Vol. 45, No. 8 (2022)
       
  • Current Endocrinologist Practices in Skeletal Health Management of
           Patients With Diabetes: A Medical Record Review

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      Abstract: While it is acknowledged that people with type 1 diabetes (T1D) and type 2 diabetes (T2D) are at increased risk of cardiovascular and microvascular disease, diabetes-induced skeletal fragility is an important but generally ignored complication. People with T2D have two- to threefold higher risk of hip fracture than people without diabetes, while in patients with T1D the risk is increased sixfold (1). While bone density is reflective of fracture risk in T1D, this relationship is not as consistent in T2D. Clinical practice guidelines for osteoporosis management generally recommend that individuals aged ≥50 years with risk factors be screened with bone mineral density (BMD) testing and those at high risk for fractures be treated with antiosteoporosis medication and calcium and vitamin D supplementation (2–4). Although T1D and, more recently, T2D are considered risk factors for fractures and falls, it is unknown what proportion of patients receives osteoporosis screening and management as part of their routine diabetes care (5).
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0768
      Issue No: Vol. 45, No. 8 (2022)
       
  • Neprilysin Inhibitor May Increase Urinary C-Peptide Excretion

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      Abstract: Evaluation of pancreatic β-cell functions is an important issue for precise management of diabetes. C-peptide, the molecule produced at an equimolar concentration by proinsulin cleavage, has been used as a superior biomarker over insulin in ordinary clinical settings because C-peptide has a longer half-life, higher serum concentration, and less variable peripheral clearance than insulin (1,2). Furthermore, C-peptide is principally cleared by the kidneys, with 5–10% being excreted unchanged in urine, unlike insulin (3). Thus, the C-peptide concentration in urine collected for a day is a useful marker in evaluation of β-cell functions throughout a day.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0538
      Issue No: Vol. 45, No. 8 (2022)
       
  • Hybrid Closed-Loop Systems and Glycemic Outcomes in Children and Adults
           With Type 1 Diabetes: Real-World Evidence From a U.S.-Based Multicenter
           Collaborative

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      Abstract: Increasing evidence demonstrates the benefits of new diabetes technologies, including insulin pumps and continuous glucose monitors (CGM), for glycemic management in people with type 1 diabetes (T1D). In addition to the independent use of these technologies, hybrid closed-loop systems (HCLS), which combine insulin pumps and CGM with a closed-loop algorithm controller to automate insulin delivery, can improve glucose levels (1,2). This study compared glycemic outcomes in users of HCLS with those of users of insulin pumps and CGM without automated insulin delivery and those using multiple daily insulin injections (MDI) with CGM in youth and adults with T1D.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0329
      Issue No: Vol. 45, No. 8 (2022)
       
  • In This Issue of Diabetes Care

    • Free pre-print version: Loading...

      Pages: 1705 - 1706
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      Issue No: Vol. 45, No. 8 (2022)
       
  • A Special Thanks to Lyn Reynolds, Director of the ADA Editorial Office, as
           She Embarks on Her Retirement

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      Pages: 1707 - 1708
      Abstract: For the past 26 years, the American Diabetes Association and its professional constituents have had the great pleasure of working with Lynda (“Lyn”) Reynolds, the director of the ADA Editorial Office. Lyn first joined ADA’s publishing team in 1997, when she was hired by editor in chief Charles M. Clark, Jr., MD, to help manage the peer review operations for Diabetes Care.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-en08
      Issue No: Vol. 45, No. 8 (2022)
       
  • Bernard Zinman: A Canadian Clinician Scientist Changing the Management of
           Diabetes

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      Pages: 1709 - 1714
      Abstract: Bernard Zinman is one of Canada’s leading diabetes clinician scientists, and his body of work has considerably expanded our knowledge of both type 1 and type 2 diabetes. The findings of his studies have resulted in major changes in clinical practice guidelines nationally and internationally, positively impacting the lives of millions of families.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dci22-0017
      Issue No: Vol. 45, No. 8 (2022)
       
  • Diabetes Distress, Depressive Symptoms, and Anxiety Symptoms in People
           With Type 2 Diabetes: A Network Analysis Approach to Understanding
           Comorbidity

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      Pages: 1715 - 1723
      Abstract: OBJECTIVEIn this study, we aimed to explore interactions between individual items that assess diabetes distress, depressive symptoms, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis.RESEARCH DESIGN AND METHODSParticipants (N = 1,796) were from the Montreal Evaluation of Diabetes Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the DDS-17 items, the nine items of the Patient Health Questionnaire (PHQ-9), and the seven items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central items, clusters of items, and items that may act as bridges between diabetes distress, depressive symptoms, and anxiety symptoms.RESULTSRegimen-related and physician-related problems were among the most central (highly connected) and influential (most positive connections) in the diabetes distress network. The depressive symptom of failure was found to be a potential bridge between depression and diabetes distress, being highly connected to diabetes distress items. The anxiety symptoms of worrying too much, uncontrollable worry, and trouble relaxing were identified as bridges linking both anxiety and depressive items and anxiety and diabetes distress items, respectively.CONCLUSIONSRegimen-related and physician-related diabetes-specific problems may be important in contributing to the development and maintenance of diabetes distress. Feelings of failure and worry are potentially strong candidates for explaining comorbidity. These individual diabetes-specific problems and mental health symptoms could hold promise for targeted interventions for people with type 2 diabetes.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2297
      Issue No: Vol. 45, No. 8 (2022)
       
  • Continuous Glucose Monitoring Metrics and Birth Weight: Informing
           Management of Type 1 Diabetes Throughout Pregnancy

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      Pages: 1724 - 1734
      Abstract: OBJECTIVETo determine gestational weekly changes in continuous glucose monitoring (CGM) metrics and 24-h glucose profiles and their relationship to infant birth weight in pregnant women with type 1 diabetes.RESEARCH DESIGN AND METHODSAn analysis of >10.5 million CGM glucose measures from 386 pregnant women with type 1 diabetes from two international multicenter studies was performed. CGM glucose metrics and 24-h glucose profiles were calculated for each gestational week, and the relationship to normal (10–90th percentile) and large (>90th percentile) for gestational age (LGA) birth weight infants was determined.RESULTSMean CGM glucose concentration fell and percentage of time spent in the pregnancy target range of 3.5–7.8 mmol/L (63–140 mg/dL) increased in the first 10 weeks of pregnancy and plateaued until 28 weeks of gestation, before further improvement in mean glucose and percentage of time in range until delivery. Maternal CGM glucose metrics diverged at 10 weeks of gestation, with significantly lower mean CGM glucose concentration (7.1 mmol/L; 95% CI 7.05–7.15 [127.8 mg/dL; 95% CI 126.9–128.7] vs. 7.5 mmol/L; 95% CI 7.45–7.55 [135 mg/dL; 95% CI 134.1–135.9]) and higher percentage of time in range (55%; 95% CI 54–56 vs. 50%; 95% CI 49–51) in women who had normal versus LGA. The 24-h glucose profiles were significantly higher across the day from 10 weeks of gestation in LGA.CONCLUSIONSNormal birth weight is associated with achieving significantly lower mean CGM glucose concentration across the 24-h day and higher CGM time in range from before the end of the first trimester, emphasizing the need for a shift in clinical management, with increased focus on using weekly CGM glucose targets for optimizing maternal glycemia from early pregnancy.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0078
      Issue No: Vol. 45, No. 8 (2022)
       
  • The SNAP Cycle and Diabetes Management During a One-Time Change in
           Disbursement Schedule

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      Pages: 1735 - 1741
      Abstract: OBJECTIVEThe 2018–2019 federal government partial shutdown resulted in a one-time disruption to the usual disbursement schedule of Supplemental Nutrition Assistance Program (SNAP) benefits nationwide. We assessed the relationship between this disruption and hyperglycemia and hypoglycemia medical encounters among beneficiaries with diabetes.RESEARCH DESIGN AND METHODSTo estimate whether the one-time change in benefit disbursement affected the monthly cycle of hyperglycemia or hypoglycemia encounter rates, we used linked administrative Medicaid claims and SNAP disbursement data from West Virginia in a fixed-effects model with interactions between week of the month and the two months of interest—January and February 2019. We controlled for week, month, year, and county effects as well as individual characteristics, and we clustered SEs by individual.RESULTSWe found that the early disbursement of SNAP benefits in January 2019 resulted in a spike in hyperglycemia four times the rate in a typical month. Further, we found a decrease in both hyperglycemia and hypoglycemia in late February.CONCLUSIONSOur findings suggest that the early distribution of benefits led to a temporary increase in food consumption among West Virginia Medicaid beneficiaries with diabetes. Findings from late February also imply that individuals may have a way to prepare for reduced food resources. These results shed new light on the effects of unexpected changes to the timing of safety net payments as well as an understanding of unintended consequences of government shutdowns.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2047
      Issue No: Vol. 45, No. 8 (2022)
       
  • Dietary Protein Sources, Mediating Biomarkers, and Incidence of Type 2
           Diabetes: Findings From the Women’s Health Initiative and the UK Biobank
           

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      Pages: 1742 - 1753
      Abstract: OBJECTIVEWhether and how dietary protein intake is linked to type 2 diabetes (T2D) remains unclear. The aim of this study was to investigate the associations of protein intake with development of T2D and the potential mediating roles of T2D biomarkers.RESEARCH DESIGN AND METHODSWe included 108,681 postmenopausal women without T2D at baseline from the Women’s Health Initiative (WHI) (primary cohort) and 34,616 adults without T2D from the U.K. Biobank (UKB) (replication cohort). Cox proportional hazard models were used for estimation of protein-T2D associations. Mediation analysis was performed to assess the mediating roles of biomarkers in case-control studies nested in the WHI.RESULTSIn the WHI, 15,842 incident T2D cases were identified during a median follow-up of 15.8 years. Intake of animal protein was associated with increased T2D risk (hazard ratio in comparing the highest to the lowest quintile = 1.31 [95% CI 1.24–1.37]) and plant protein with decreased risk (0.82 [0.78–0.86]). Intakes of red meat, processed meat, poultry, and eggs were associated with increased T2D risk and whole grains with decreased risk. Findings from the UKB were similar. These findings were materially attenuated after additional adjustment for BMI. Substituting 5% energy from plant protein for animal protein was associated with 21% decreased T2D risk (0.79 [0.74–0.84]), which was mediated by levels of hs-CRP, interleukin-6, leptin, and SHBG.CONCLUSIONSFindings from these two large prospective cohorts support the notion that substituting plant protein for animal protein may decrease T2D risk mainly by reducing obesity-related inflammation.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0368
      Issue No: Vol. 45, No. 8 (2022)
       
  • Diabetes Microvascular Disease Diagnosis and Treatment After
           High-Deductible Health Plan Enrollment

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      Pages: 1754 - 1761
      Abstract: OBJECTIVEThe Affordable Care Act mandates that primary preventive services have no out-of-pocket costs but does not exempt secondary prevention from out-of-pocket costs. Most commercially insured patients with diabetes have high-deductible health plans (HDHPs) that subject key microvascular disease–related services to high out-of-pocket costs. Brief treatment delays can significantly worsen microvascular disease outcomes.RESEARCH DESIGN AND METHODSThis cohort study used a large national commercial (and Medicare Advantage) health insurance claims data set to examine matched groups before and after an insurance design change. The study group included 50,790 patients with diabetes who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year, followed by up to 4 years in high-deductible (≥$1,000) plans after an employer-mandated switch. HDHPs had low out-of-pocket costs for nephropathy screening but not retinopathy screening. A matched control group included 335,178 patients with diabetes who were contemporaneously enrolled in low-deductible plans. Measures included time to first detected microvascular disease screening, severe microvascular disease diagnosis, vision loss diagnosis/treatment, and renal function loss diagnosis/treatment.RESULTSHDHP enrollment was associated with relative delays in retinopathy screening (0.7 months [95% CI 0.4, 1.0]), severe retinopathy diagnosis (2.9 months [0.5, 5.3]), and vision loss diagnosis/treatment (3.8 months [1.2, 6.3]). Nephropathy-associated measures did not change to a statistically significant degree among HDHP members relative to control subjects at follow-up.CONCLUSIONSPeople with diabetes in HDHPs experienced delayed retinopathy diagnosis and vision loss diagnosis/treatment of up to 3.8 months compared with low-deductible plan enrollees. Findings raise concerns about visual health among HDHP members and call attention to discrepancies in Affordable Care Act cost sharing exemptions.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-0407
      Issue No: Vol. 45, No. 8 (2022)
       
  • Incidence of Type 1 Diabetes in Children and Adolescents During the
           COVID-19 Pandemic in Germany: Results From the DPV Registry

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      Pages: 1762 - 1771
      Abstract: OBJECTIVEThe aim of this study was to investigate the incidence of type 1 diabetes in children and adolescents during the coronavirus disease 2019 (COVID-19) pandemic in Germany compared with previous years.RESEARCH DESIGN AND METHODSBased on data from the multicenter German Diabetes Prospective Follow-up Registry, we analyzed the incidence of type 1 diabetes per 100,000 patient-years in children and adolescents from 1 January 2020 through 30 June 2021. Using Poisson regression models, expected incidences for 2020/21 were estimated based on the data from 2011 to 2019 and compared with observed incidences in 2020/21 by estimating incidence rate ratios (IRRs) with 95% CIs.RESULTSFrom 1 January 2020 to 30 June 2021, 5,162 children and adolescents with new-onset type 1 diabetes in Germany were registered. The observed incidence in 2020/21 was significantly higher than the expected incidence (24.4 [95% CI 23.6–25.2] vs. 21.2 [20.5–21.9]; IRR 1.15 [1.10–1.20]; P < 0.001). IRRs were significantly elevated in June 2020 (IRR 1.43 [1.07–1.90]; P = 0.003), July 2020 (IRR 1.48 [1.12–1.96]; P < 0.001), March 2021 (IRR 1.29 [1.01–1.65]; P = 0.028), and June 2021 (IRR 1.39 [1.04–1.85]; P = 0.010).CONCLUSIONSA significant increase in the incidence of type 1 diabetes in children was observed during the COVID-19 pandemic, with a delay in the peak incidence of type 1 diabetes by ∼3 months after the peak COVID-19 incidence and also after pandemic containment measures. The underlying causes are yet unknown. However, indirect rather than direct effects of the pandemic are more likely to be the cause.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-0969
      Issue No: Vol. 45, No. 8 (2022)
       
  • Historic Residential Redlining and Present-day Diabetes Mortality and
           Years of Life Lost: The Persistence of Structural Racism

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      Pages: 1772 - 1778
      Abstract: OBJECTIVEThe association between structural racism, as captured by historic residential redlining practices under the Home Owners’ Loan Corporation (HOLC), and present-day diabetes mortality, and years of life lost (YLL), remains unknown.RESEARCH DESIGN AND METHODSAge-standardized mortality and YLL data were combined with historic HOLC redlining data for the city of Seattle, WA (a sample of 109 census tract–level observations) for each of the years 1990 through 2014 (25 years). Spatial autoregressive regression analyses were used for assessment of the association between an area’s historic HOLC redlining score and diabetes (and all-cause) mortality and YLL.RESULTSSpatial autoregressive model estimates indicate that an area’s HOLC redlining score explains 45%–56% of the variation in the census tract–level diabetes mortality rate and 51%–60% of the variation in the census tract diabetes YLL rate between the years of 1990 and 2014. For 2014, estimates indicate that areas with a unit-higher HOLC grade are associated with 53.7% (95% CI 43.3–64.9; P < 0.01) higher diabetes mortality rates and 66.5% (53.7–80.4; P < 0.01) higher diabetes YLL rate. Magnitudes of marginal effects were consistently larger for diabetes than for all-cause outcomes.CONCLUSIONSResults indicate sizable, and statistically significant, associations between historic redlining practices and present-day diabetes mortality and YLL rates. In addition, the persistence of these associations across the 1990–2014 period highlight a need for targeted action to undo the impact of historical redlining on current health.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2563
      Issue No: Vol. 45, No. 8 (2022)
       
  • Brain Structure Among Middle-aged and Older Adults With Long-standing Type
           1 Diabetes in the DCCT/EDIC Study

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      Pages: 1779 - 1787
      Abstract: OBJECTIVEIndividuals with type 1 diabetes mellitus (T1DM) are living to ages when neuropathological changes are increasingly evident. We hypothesized that middle-aged and older adults with long-standing T1DM will show abnormal brain structure in comparison with control subjects without diabetes.RESEARCH DESIGN AND METHODSMRI was used to compare brain structure among 416 T1DM participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study with that of 99 demographically similar control subjects without diabetes at 26 U.S. and Canadian sites. Assessments included total brain (TBV) (primary outcome), gray matter (GMV), white matter (WMV), ventricle, and white matter hyperintensity (WMH) volumes and total white matter mean fractional anisotropy (FA). Biomedical assessments included HbA1c and lipid levels, blood pressure, and cognitive assessments of memory and psychomotor and mental efficiency (PME). Among EDIC participants, HbA1c, severe hypoglycemia history, and vascular complications were measured longitudinally.RESULTSMean age of EDIC participants and control subjects was 60 years. T1DM participants showed significantly smaller TBV (least squares mean ± SE 1,206 ± 1.7 vs. 1,229 ± 3.5 cm3, P < 0.0001), GMV, and WMV and greater ventricle and WMH volumes but no differences in total white matter mean FA versus control subjects. Structural MRI measures in T1DM were equivalent to those of control subjects who were 4–9 years older. Lower PME scores were associated with altered brain structure on all MRI measures in T1DM participants.CONCLUSIONSMiddle-aged and older adults with T1DM showed brain volume loss and increased vascular injury in comparison with control subjects without diabetes, equivalent to 4–9 years of brain aging.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2438
      Issue No: Vol. 45, No. 8 (2022)
       
  • Management and Outcomes of Severe Hypoglycemia Treated by Emergency
           Medical Services in the U.S. Upper Midwest

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      Pages: 1788 - 1798
      Abstract: OBJECTIVETo examine factors associated with emergency department (ED) transport after hypoglycemia treated by emergency medical services (EMS) and assess the impact of ED transport on severe hypoglycemia recurrence.RESEARCH DESIGN AND METHODSWe retrospectively analyzed electronic health records of a multistate advanced life support EMS provider and an integrated healthcare delivery system serving an overlapping geographic area in the upper Midwest. For adults with diabetes treated by EMS for hypoglycemia between 2013 and 2019, we examined rates of ED transport, factors associated with it, and its impact on rates of recurrent hypoglycemia requiring EMS, ED, or hospital care within 3, 7, and 30 days.RESULTSWe identified 1,977 hypoglycemia-related EMS encounters among 1,028 adults with diabetes (mean age 63.5 years [SD 17.7], 55.2% male, 87.4% non-Hispanic White, 42.4% rural residents, and 25.6% with type 1 diabetes), of which 46.4% resulted in ED transport (31.1% of calls by patients with type 1 diabetes and 58.0% of calls by patients with type 2 diabetes). Odds of ED transport were lower in patients with type 1 diabetes (odds ratio [OR] 0.44 [95% CI 0.31–0.62] vs. type 2 diabetes) and higher in patients with prior ED visits (OR 1.38 [95% CI 1.03–1.85]). Within 3, 7, and 30 days, transported patients experienced recurrent severe hypoglycemia 2.8, 5.2, and 10.6% of the time, respectively, compared with 7.4, 11.2, and 22.8% of the time among nontransported patients (all P < 0.001). This corresponds to OR 0.58 (95% CI 0.42–0.80) for recurrent severe hypoglycemia within 30 days for transported versus nontransported patients. When subset by diabetes type, odds of recurrent severe hypoglycemia among transported patients were 0.64 (95% CI 0.43–0.96) and 0.42 (95% CI 0.24–0.75) in type 1 and type 2 diabetes, respectively.CONCLUSIONSTransported patients experienced recurrent hypoglycemia requiring medical attention approximately half as often as nontransported patients, reinforcing the importance of engaging patients in follow-up to prevent recurrent events.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1811
      Issue No: Vol. 45, No. 8 (2022)
       
  • Model for Integration of Monogenic Diabetes Diagnosis Into Routine Care:
           The Personalized Diabetes Medicine Program

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      Pages: 1799 - 1806
      Abstract: OBJECTIVETo implement, disseminate, and evaluate a sustainable method for identifying, diagnosing, and promoting individualized therapy for monogenic diabetes.RESEARCH DESIGN AND METHODSPatients were recruited into the implementation study through a screening questionnaire completed in the waiting room or through the patient portal, physician recognition, or self-referral. Patients suspected of having monogenic diabetes based on the processing of their questionnaire and other data through an algorithm underwent next-generation sequencing for 40 genes implicated in monogenic diabetes and related conditions.RESULTSThree hundred thirteen probands with suspected monogenic diabetes (but most diagnosed with type 2 diabetes) were enrolled from October 2014 to January 2019. Sequencing identified 38 individuals with monogenic diabetes, with most variants found in GCK or HNF1A. Positivity rates for ascertainment methods were 3.1% for clinic screening, 5.3% for electronic health record portal screening, 16.5% for physician recognition, and 32.4% for self-referral. The algorithmic criterion of non–type 1 diabetes before age 30 years had an overall positivity rate of 15.0%.CONCLUSIONSWe successfully modeled the efficient incorporation of monogenic diabetes diagnosis into the diabetes care setting, using multiple strategies to screen and identify a subpopulation with a 12.1% prevalence of monogenic diabetes by molecular testing. Self-referral was particularly efficient (32% prevalence), suggesting that educating the lay public in addition to clinicians may be the most effective way to increase the diagnosis rate in monogenic diabetes. Scaling up this model will assure access to diagnosis and customized treatment among those with monogenic diabetes and, more broadly, access to personalized medicine across disease areas.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1975
      Issue No: Vol. 45, No. 8 (2022)
       
  • Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes
           Associated With Socioeconomic Deprivation and Urbanization: Results From
           the German Multicenter DPV Registry

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      Pages: 1807 - 1813
      Abstract: OBJECTIVETo investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes.RESEARCH DESIGN AND METHODSChildren and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the Diabetes Prospective Follow-up Registry (DPV; Diabetes-Patienten-Verlaufsdokumentation), were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat) by using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization and whether associations differed by age-group, sex, or migration status.RESULTSIn 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95% CI 19.0–22.4], and increased with growing socioeconomic deprivation to 26.9% [25.0–28.8] in the most deprived regions [Q5]; P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas) or in cities (27.6% [95% CI 26.0–29.3] vs. 22.7% [21.4–24.0], P < 0.001, or vs. 24.3% [22.9–25.7], P = 0.007, respectively). The results did not significantly differ by age-group, sex, or migration background or after additional adjustment for socioeconomic deprivation or urbanization.CONCLUSIONSThis study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for presymptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2227
      Issue No: Vol. 45, No. 8 (2022)
       
  • Projected Impact of the Medicare Part D Senior Savings Model on
           Diabetes-Related Health and Economic Outcomes Among Insulin Users Covered
           by Medicare

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      Pages: 1814 - 1821
      Abstract: OBJECTIVEThe Medicare Part D Senior Savings Model (SSM) took effect on 1 January 2021. In this study we estimated the number of beneficiaries who would benefit from SSM and the long-term health and economic consequences of implementing this new policy.RESEARCH DESIGN AND METHODSData for Medicare beneficiaries with diabetes treated with insulin were extracted from the 2018 Medical Expenditure Panel Survey. A validated diabetes microsimulation model estimated health and economic impacts of the new policy for the 5-year initial implementation period and a 20-year extended policy horizon. Costs were estimated from a health system perspective.RESULTSOf 4.2 million eligible Medicare beneficiaries, 1.6 million (38.3%) would benefit from the policy, and out-of-pocket (OOP) costs per year per beneficiary would decrease by 61% or $500 on average. Compared with non-White subgroups, the White population subgroups would have a higher proportion of SSM enrollees (29.6% vs. 43.7%) and a higher annual OOP cost reduction (reduction of $424 vs. $531). Among the SSM enrollees, one-third (605,125) were predicted to have improved insulin adherence due to lower cost sharing and improved health outcomes. In 5 years, the SSM would 1) avert 2,014 strokes, 935 heart attacks, 315 heart failure cases, and 344 end-stage renal disease cases; 2) gain 3,220 life-years and 3,381 quality-adjusted life-years (QALY); and 3) increase insulin cost and total medical cost by $3.5 billion and $2.8 billion. In 20 years, the number of avoided clinical outcomes, number of life-years and QALY gained, and the total and insulin cost would be larger.CONCLUSIONSThe Medicare SSM may reduce the OOP costs for approximately one-third of the Medicare beneficiaries treated with insulin, improving health outcomes via increased insulin adherence. However, the SSM will also increase overall Medicare spending for insulin and overall medical costs, which may impact future premiums and benefits. Our findings can inform policy makers about the potential impact of the new Medicare SSM.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2601
      Issue No: Vol. 45, No. 8 (2022)
       
  • Maternal Dietary Glycemic Index and Glycemic Load in Pregnancy and
           Offspring Cord Blood DNA Methylation

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      Pages: 1822 - 1832
      Abstract: OBJECTIVESuboptimal nutrition in pregnancy is associated with worse offspring cardiometabolic health. DNA methylation may be an underlying mechanism. We meta-analyzed epigenome-wide association studies (EWAS) of maternal dietary glycemic index and load with cord blood DNA methylation.RESEARCH DESIGN AND METHODSWe calculated maternal glycemic index and load from food frequency questionnaires and ran EWAS on cord blood DNA methylation in 2,003 mother-offspring pairs from three cohorts. Analyses were additionally stratified by maternal BMI categories. We looked-up the findings in EWAS of maternal glycemic traits and BMI as well as in EWAS of birth weight and child BMI. We examined associations with gene expression in child blood in the online Human Early Life Exposome eQTM catalog and in 223 adipose tissue samples.RESULTSMaternal glycemic index and load were associated with cord blood DNA methylation at 41 cytosine-phosphate-guanine sites (CpGs, P < 1.17 × 10−7), mostly in mothers with overweight/obesity. We did not observe overlap with CpGs associated with maternal glycemic traits, BMI, or child birth weight or BMI. Only DNA methylation at cg24458009 and cg23347399 was associated with expression of PCED1B and PCDHG, respectively, in child blood, and DNA methylation at cg27193519 was associated with expression of TFAP4, ZNF500, PPL, and ANKS3 in child subcutaneous adipose tissue.CONCLUSIONSWe observed multiple associations of maternal glycemic index and load during pregnancy with cord blood DNA methylation, mostly in mothers with overweight/obesity; some of these CpGs were associated with gene expression. Additional studies are required to further explore functionality, uncover causality, and study pathways to offspring health.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2662
      Issue No: Vol. 45, No. 8 (2022)
       
  • Once-Weekly Exenatide in Youth With Type 2 Diabetes

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      Pages: 1833 - 1840
      Abstract: OBJECTIVEApproved treatments for type 2 diabetes in pediatric patients include metformin, liraglutide, and insulin. However, approximately one-half of the youth fail metformin monotherapy within 1 year, insulin therapy is associated with challenges, and liraglutide requires daily injections. Consequently, the efficacy and safety of once-weekly injections of exenatide for the treatment of youth with type 2 diabetes was evaluated.RESEARCH DESIGN AND METHODSParticipants (aged 10 to <18 years) were randomized (5:2) to once-weekly exenatide 2 mg or placebo, respectively. The primary efficacy end point was change in glycated hemoglobin from baseline to week 24. Secondary efficacy end points were also evaluated, and the frequency of adverse events (AEs) was assessed.RESULTSA total of 83 participants were randomized (exenatide, 59; placebo, 24) and 72 completed 24-week treatment (exenatide, 49; placebo, 23). At 24 weeks, the least squares mean change in glycated hemoglobin was −0.36% for the exenatide and +0.49% for the placebo groups (between-group difference, −0.85%; 95% CI −1.51, −0.19; P = 0.012). Nonsignificant least squares mean differences from baseline to 24 weeks favoring exenatide were observed: fasting glucose −21.6 mg/dL (−49.0, 5.7; P = 0.119), systolic blood pressure −2.8 mmHg (−8.0, 2.4; P = 0.284), and body weight −1.22 kg (−3.59, 1.15; P = 0.307). AEs occurred in 36 (61.0%) and 17 (73.9%) participants in the exenatide and placebo groups, respectively.CONCLUSIONSIn youth with type 2 diabetes suboptimally controlled with current treatments, once-weekly exenatide reduced glycated hemoglobin at 24 weeks and was well tolerated.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2275
      Issue No: Vol. 45, No. 8 (2022)
       
  • Mechanistic Insights Into the Heterogeneity of Glucose Response Classes in
           Youths With Obesity: A Latent Class Trajectory Approach

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      Pages: 1841 - 1851
      Abstract: OBJECTIVEIn a large, multiethnic cohort of youths with obesity, we analyzed pathophysiological and genetic mechanisms underlying variations in plasma glucose responses to a 180 min oral glucose tolerance test (OGTT).RESEARCH DESIGN AND METHODSLatent class trajectory analysis was used to identify various glucose response profiles to a nine-point OGTT in 2,378 participants in the Yale Pathogenesis of Youth-Onset T2D study, of whom 1,190 had available TCF7L2 genotyping and 358 had multiple OGTTs over a 5 year follow-up. Insulin sensitivity, clearance, and β-cell function were estimated by glucose, insulin, and C-peptide modeling.RESULTSFour latent classes (1 to 4) were identified based on increasing areas under the curve for glucose. Participants in class 3 and 4 had the worst metabolic and genetic risk profiles, featuring impaired insulin sensitivity, clearance, and β-cell function. Model-predicted probability to be classified as class 1 and 4 increased across ages, while insulin sensitivity and clearance showed transient reductions and β-cell function progressively declined. Insulin sensitivity was the strongest determinant of class assignment at enrollment and of the longitudinal change from class 1 and 2 to higher classes. Transitions between classes 3 and 4 were explained only by changes in β-cell glucose sensitivity.CONCLUSIONSWe identified four glucose response classes in youths with obesity with different genetic risk profiles and progressive impairment in insulin kinetics and action. Insulin sensitivity was the main determinant in the transition between lower and higher glucose classes across ages. In contrast, transitions between the two worst glucose classes were driven only by β-cell glucose sensitivity.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0110
      Issue No: Vol. 45, No. 8 (2022)
       
  • Coexistent Diabetes Is Associated With the Presence of Adverse Phenotypic
           Features in Patients With Hypertrophic Cardiomyopathy

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      Pages: 1852 - 1862
      Abstract: OBJECTIVEType 2 diabetes mellitus (T2DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. We sought to investigate whether HCM patients with T2DM comorbidity exhibit adverse cardiac alterations in myocardial energetics, function, perfusion, or tissue characteristics.RESEARCH DESIGN AND METHODSA total of 55 participants with concomitant HCM and T2DM (HCM-DM) (n = 20) or isolated HCM (n = 20) and healthy volunteers (HV) (n = 15) underwent 31P-MRS and cardiovascular MRI. The HCM groups were matched for HCM phenotype.RESULTSMean ± SD European Society of Cardiology sudden cardiac death risk scores were comparable between the HCM groups (HCM 2.2 ± 1.5%, HCM-DM 1.9 ± 1.2%; P = not significant), and sarcomeric mutations were equally common. HCM-DM patients had the highest median NT-proBNP levels (HV 42 ng/L [interquartile range 35–66], HCM 298 ng/L [157–837], HCM-DM 726 ng/L [213–8,695]; P < 0.0001). Left ventricular (LV) ejection fraction, mass, and wall thickness were similar between the HCM groups. HCM-DM patients displayed a greater degree of fibrosis burden with higher scar percentage and lower global longitudinal strain compared with HCM patients. PCr/ATP (the relative concentrations of phosphocreatine and ATP) was significantly lower in the HCM-DM group than in both HCM and HV (HV 2.17 ± 0.49, HCM 1.93 ± 0.38, HCM-DM 1.54 ± 0.27; P = 0.002). In a similar pattern, stress myocardial blood flow was significantly lower in the HCM-DM group than in both HCM and HV (HV 2.06 ± 0.42 mL/min/g, HCM 1.74 ± 0.44 mL/min/g, HCM-DM 1.39 ± 0.42 mL/min/g; P = 0.002).CONCLUSIONSWe show for the first time that HCM-DM patients display greater reductions in myocardial energetics, perfusion, and contractile function and higher myocardial scar burden and serum NT-proBNP levels compared with patients with isolated HCM despite similar LV mass and wall thickness and presence of sarcomeric mutations. These adverse phenotypic features may be important components of the adverse clinical manifestation attributable to a combined presence of HCM and T2DM.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0083
      Issue No: Vol. 45, No. 8 (2022)
       
  • Association Between Insulin Resistance and Cardiovascular Disease Risk
           Varies According to Glucose Tolerance Status: A Nationwide Prospective
           Cohort Study

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      Pages: 1863 - 1872
      Abstract: OBJECTIVETo investigate whether the association between insulin resistance and cardiovascular disease (CVD) differs by glucose tolerance status.RESEARCH DESIGN AND METHODSWe analyzed a nationwide sample of 111,576 adults without CVD at baseline, using data from the China Cardiometabolic Disease and Cancer Cohort Study. Insulin resistance was estimated by sex-specific HOMA of insulin resistance (HOMA-IR) quartiles for participants with normal glucose tolerance, prediabetes, or diabetes, separately, and by 1 SD of HOMA-IR for the overall study participants. We used Cox proportional hazards models to examine the association between insulin resistance and incident CVD according to glucose tolerance status and evaluate the CVD risk associated with the combined categories of insulin resistance and obesity in prediabetes and diabetes, as compared with normal glucose tolerance. Models were adjusted for age, sex, education attainment, alcohol drinking, smoking, physical activity, and diet quality.RESULTSIn participants with normal glucose tolerance, prediabetes, and diabetes defined by three glucose parameters, multivariable-adjusted hazard ratios (95% CIs) for incident CVD associated with the highest versus the lowest quartile of HOMA-IR were 1.03 (0.82–1.30), 1.23 (1.07–1.42), and 1.61 (1.30–2.00), respectively; the corresponding values for CVD per 1-SD increase in HOMA-IR were 1.04 (0.92–1.18), 1.12 (1.06–1.18), and 1.15 (1.09–1.21), respectively (P for interaction = 0.011). Compared with participants with normal glucose tolerance, in participants with prediabetes, the combination of the highest HOMA-IR quartile and obesity showed 17% (95% CI 2–34%) higher risk of CVD, while the combination of the lowest two HOMA-IR quartiles and nonobesity showed 15–17% lower risk of CVD. In participants with diabetes, the upper two HOMA-IR quartiles exhibited 44–77% higher risk of CVD, regardless of obesity status. Consistent findings were observed for glucose tolerance status defined by different combinations of glycemic parameters.CONCLUSIONSGlucose intolerance status exacerbated the association between insulin resistance and CVD risk. Compared with adults with normal glucose tolerance, adults with prediabetes who were both insulin resistant and obese exhibited higher risks of CVD, while in adults with diabetes, the CVD risk related to insulin resistance remained, regardless of obesity.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0202
      Issue No: Vol. 45, No. 8 (2022)
       
  • Cardiorenal Complications in Young-Onset Type 2 Diabetes Compared Between
           White Americans and African Americans

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      Pages: 1873 - 1881
      Abstract: OBJECTIVETo explore risks and associated mediation effects of developing chronic kidney disease (CKD) and heart failure (HF) in young- and usual-onset type 2 diabetes (T2D) between White Americans (WAs) and African Americans (AAs).RESEARCH DESIGN AND METHODSFrom U.S. medical records, 1,491,672 WAs and 31,133 AAs were identified and stratified by T2D age of onset (18–39, 40–49, 50–59, 60–70 years). Risks, mediation effects, and time to CKD and HF were evaluated, adjusting for time-varying confounders.RESULTSIn the 18–39, 40–49, 50–59, 60–70 age-groups, the hazard ratios (of developing CKD and HF in AAs versus WAs were 1.21 (95% CI 1.17–1.26) and 2.21 (1.98–2.45), 1.25 (1.22–1.28) and 1.86 (1.75–1.97), 1.21 (1.19–1.24) and 1.54 (1.48–1.60), and 1.10 (1.08–1.12) and 1.11 (1.07–1.15), respectively. In AAs and WAs aged 18–39 years, time in years to CKD (8.7 [95% CI 8.2–9.1] and 9.7 [9.2–10.2]) and HF (10.3 [9.3–11.2] and 12.1 [10.6–13.5]) were, on average, 3.6 and 4.0 and 3.1 and 4.1 years longer compared with those diagnosed at age 60–70 years. Compared with females, AA males aged <60 years had an 11–49% higher CKD risk, while WA males aged <40 years had a 23% higher and those aged ≥50 years a 7–14% lower CKD risk, respectively. The mediation effects of CKD on the HF risk difference between ethnicities across age-groups (range 54–91%) were higher compared with those of HF on CKD risk difference between ethnicities across age-groups (13–39%).CONCLUSIONSDeveloping cardiorenal complications within an average of 10 years of young-onset T2DM and high mediation effects of CKD on HF call for revisiting guidelines on early diagnosis and proactive treatment strategies for effective management of cardiometabolic risk.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2349
      Issue No: Vol. 45, No. 8 (2022)
       
  • Serum Orotidine: A Novel Biomarker of Increased CVD Risk in Type 2
           Diabetes Discovered Through Metabolomics Studies

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      Pages: 1882 - 1892
      Abstract: OBJECTIVETo identify novel biomarkers of cardiovascular disease (CVD) risk in type 2 diabetes (T2D) via a hypothesis-free global metabolomics study, while taking into account renal function, an important confounder often overlooked in previous metabolomics studies of CVD.RESEARCH DESIGN AND METHODSWe conducted a global serum metabolomics analysis using the Metabolon platform in a discovery set from the Joslin Kidney Study having a nested case-control design comprising 409 individuals with T2D. Logistic regression was applied to evaluate the association between incident CVD events and each of the 671 metabolites detected by the Metabolon platform, before and after adjustment for renal function and other CVD risk factors. Significant metabolites were followed up with absolute quantification assays in a validation set from the Joslin Heart Study including 599 individuals with T2D with and without clinical evidence of significant coronary heart disease (CHD).RESULTSIn the discovery set, serum orotidine and 2-piperidinone were significantly associated with increased odds of incident CVD after adjustment for glomerular filtration rate (GFR) (odds ratio [OR] per SD increment 1.94 [95% CI 1.39–2.72], P = 0.0001, and 1.62 [1.26–2.08], P = 0.0001, respectively). Orotidine was also associated with increased odds of CHD in the validation set (OR 1.39 [1.11–1.75]), while 2-piperidinone did not replicate. Furthermore, orotidine, being inversely associated with GFR, mediated 60% of the effects of declining renal function on CVD risk. Addition of orotidine to established clinical predictors improved (P < 0.05) C statistics and discrimination indices for CVD risk (ΔAUC 0.053, rIDI 0.48, NRI 0.42) compared with the clinical predictors alone.CONCLUSIONSThrough a robust metabolomics approach, with independent validation, we have discovered serum orotidine as a novel biomarker of increased odds of CVD in T2D, independent of renal function. Additionally, orotidine may be a biological mediator of the increased CVD risk associated with poor kidney function and may help improve CVD risk prediction in T2D.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1789
      Issue No: Vol. 45, No. 8 (2022)
       
  • Fasting Substrate Concentrations Predict Cardiovascular Outcomes in the
           CANagliflozin cardioVascular Assessment Study (CANVAS)

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      Pages: 1893 - 1899
      Abstract: OBJECTIVETo examine whether the circulating substrate mix may be related to the incidence of heart failure (HF) and cardiovascular (CV) mortality and how it is altered by canagliflozin treatment.RESEARCH DESIGN AND METHODSWe measured fasting glucose, free fatty acids (FFA), glycerol, β-hydroxybutyrate, acetoacetate, lactate, and pyruvate concentrations in 3,581 samples from the CANagliflozin cardioVascular Assessment Study (CANVAS) trial at baseline and at 1 and 2 years after randomization. Results were analyzed by univariate and multivariate Cox proportional hazards models.RESULTSPatients in the lowest baseline FFA tertile were more often men with a longer duration of type 2 diabetes (T2D), higher urinary albumin excretion, lower HDL-cholesterol levels, higher history of CV disease (CVD), and higher use of statins and insulin. When all seven metabolites were used as predictors, FFA were inversely associated with incident hospitalized HF (hazard ratio [HR] 0.33 [95% CI 0.21–0.55]), while glycerol was a positive predictor (2.21 [1.45–3.35]). In a model further adjusted for 16 potential confounders, including prior HF and CVD and pharmacologic therapies, FFA remained a significant negative predictor. FFA and glycerol also predicted CV mortality (HR 0.53 [95% CI 0.35–0.81] and 1.81 [1.26–2.58], respectively) and all-cause death (0.50 [0.36–0.70] and 1.64 [1.22–2.18]). When added to these models, background insulin therapy was an independent positive predictor of risk of death. Canagliflozin treatment significantly increased plasma FFA and β-hydroxybutyrate regardless of background antihyperglycemic therapy.CONCLUSIONSA constitutive metabolic setup consisting of higher lipolysis may be beneficial in delaying or preventing hospitalized HF; a further stimulation of lipolysis by canagliflozin may reinforce this influence.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2398
      Issue No: Vol. 45, No. 8 (2022)
       
  • Clinical Utility of Cardiovascular Risk Scores for Identification of
           People With Type 2 Diabetes More Likely to Benefit From Either GLP-1
           Receptor Agonist or SGLT2 Inhibitor Therapy

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      Pages: 1900 - 1906
      Abstract: OBJECTIVEDifferentiation of risk for major adverse cardiovascular events (MACE) from heart failure hospitalization (HHF) or kidney disease is important when selecting glucose-lowering therapy. We investigated the ability of separate MACE and HHF risk scores to 1) differentiate MACE from HHF risk; and 2) identify individuals more likely to benefit from either glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium–glucose cotransporter-2 inhibitors (SGLT2is).RESEARCH DESIGN AND METHODSWe identified three trials in type 2 diabetes that reported cardiovascular outcomes stratified by Thrombolysis In Myocardial Infarction Risk Scores for MACE and HHF. Pooled placebo-arm rates of HHF, MACE, and their ratio and estimated GLP-1RA– and SGLT2i-mediated reductions in events (MACE and HHF combined) were compared across cardiovascular risk strata in the trial populations.RESULTSThe HHF rate was less frequent than MACE at all risk levels but increased from 18% of the MACE rate at low-intermediate HHF risk to 61% at highest HHF risk. Similarly, with increasing MACE risk, the incidence of HHF increased from 19% of the MACE incidence in those at low MACE risk to 51% in those with the highest MACE risk. Estimated GLP-1RA– and SGLT2i-mediated reductions in cardiovascular events were similar in those at low-intermediate MACE or HHF risk but tended to favor SGLT2is at higher risk levels of both scores.CONCLUSIONSA greater increase in the rate of HHF relative to MACE was observed with progressively higher cardiovascular risk, regardless of the risk score applied. Consequently, SGLT2is may offer greater overall cardiovascular protection in those at highest MACE risk, not just those at highest HHF risk.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-1929
      Issue No: Vol. 45, No. 8 (2022)
       
  • Safety and Glycemic Outcomes With a Tubeless Automated Insulin Delivery
           System in Very Young Children With Type 1 Diabetes: A Single-Arm
           Multicenter Clinical Trial

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      Pages: 1907 - 1910
      Abstract: OBJECTIVEVery young children with type 1 diabetes often struggle to achieve glycemic targets, putting them at risk for long-term complications and creating an immense management burden for caregivers. We conducted the first evaluation of the Omnipod 5 Automated Insulin Delivery System in this population.RESEARCH DESIGN AND METHODSA total of 80 children aged 2.0–5.9 years used the investigational system in a single-arm study for 13 weeks following 14 days of baseline data collection with their usual therapy.RESULTSThere were no episodes of severe hypoglycemia or diabetic ketoacidosis. By study end, HbA1c decreased by 0.55% (6.0 mmol/mol) (P < 0.0001). Time with sensor glucose levels in target range 70–180 mg/dL increased by 10.9%, or 2.6 h/day (P < 0.0001), while time with levels <70 mg/dL declined by median 0.27% (P = 0.0204).CONCLUSIONSUse of the automated insulin delivery system was safe, and participants experienced improved glycemic measures and reduced hypoglycemia during the study phase compared with baseline.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2359
      Issue No: Vol. 45, No. 8 (2022)
       
  • Changes in Circulating miR-375-3p and Improvements in Visceral and Hepatic
           Fat Contents in Response to Lifestyle Interventions: The CENTRAL Trial

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      Pages: 1911 - 1913
      Abstract: OBJECTIVETo investigate whether changes in circulating levels of pancreatic islet–related miRNA-375 (miR-375) are related to improved visceral and intrahepatic fat accumulation.RESEARCH DESIGN AND METHODSThis study included adults with abdominal obesity from an 18-month weight loss lifestyle intervention trial. Circulating miR-375-3p was measured at baseline and 18 months. MRI was performed (n = 139) to assess 18-month changes in abdominal and intrahepatic fat depots.RESULTSCirculating miR-375-3p was related to fasting insulin and insulin resistance in participants with prediabetes. After the interventions, there was a significant increase of miR-375-3p (P < 0.001). Greater increase in miR-375-3p was associated with greater reductions of visceral (P = 0.024) and deep subcutaneous (P < 0.001) adipose tissues and intrahepatic fat content (P = 0.012).CONCLUSIONSIncreases in circulating miR-375-3p were associated with visceral and intrahepatic fat reduction. Changes in circulating pancreatic islet–related miR-375-3p may be linked to improved diabetogenic fat depots during weight loss lifestyle interventions.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2517
      Issue No: Vol. 45, No. 8 (2022)
       
  • Caloric Restriction and Weight Loss Are Primary Factors in the Early
           Tissue-Specific Metabolic Changes After Bariatric Surgery

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      Pages: 1914 - 1916
      Abstract: OBJECTIVETo evaluate changes in insulin sensitivity, hormone secretion, and hepatic steatosis immediately after caloric restriction, vertical sleeve gastrectomy (VSG), and Roux-en-Y gastric bypass (RYGB).RESEARCH DESIGN AND METHODSObese subjects were assessed for 1) insulin sensitivity with hyperinsulinemic-euglycemic clamp with glucose tracer infusion, 2) adipokine concentrations with serum and subcutaneous adipose interstitial fluid sampling, and 3) hepatic fat content with MRI before and 7–10 days after VSG, RYGB, or supervised caloric restriction.RESULTSEach group exhibited an ∼5% total body weight loss, accompanied by similar improvements in hepatic glucose production and hepatic, skeletal muscle, and adipose tissue insulin sensitivity. Leptin concentrations in plasma and adipose interstitial fluid were equally decreased, and reductions in hepatic fat were similar.CONCLUSIONSThe improvements in insulin sensitivity and adipokine secretion observed early after bariatric surgery are replicated by equivalent caloric restriction and weight loss.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-0069
      Issue No: Vol. 45, No. 8 (2022)
       
  • Relation of Change or Substitution of Low- and No-Calorie Sweetened
           Beverages With Cardiometabolic Outcomes: A Systematic Review and
           Meta-analysis of Prospective Cohort Studies

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      Pages: 1917 - 1930
      Abstract: BACKGROUNDAdverse associations of low- and no-calorie sweetened beverages (LNCSB) with cardiometabolic outcomes in observational studies may be explained by reverse causality and residual confounding.PURPOSETo address these limitations we used change analyses of repeated measures of intake and substitution analyses to synthesize the association of LNCSB with cardiometabolic outcomes.DATA SOURCESMEDLINE, Embase, and the Cochrane Library were searched up to 10 June 2021 for prospective cohort studies with ≥1 year of follow-up duration in adults.STUDY SELECTIONOutcomes included changes in clinical measures of adiposity, risk of overweight/obesity, metabolic syndrome, type 2 diabetes (T2D), cardiovascular disease, and total mortality.DATA EXTRACTIONTwo independent reviewers extracted data, assessed study quality, and assessed certainty of evidence using GRADE. Data were pooled with a random-effects model and expressed as mean difference (MD) or risk ratio (RR) and 95% CI.DATA SYNTHESISA total of 14 cohorts (416,830 participants) met the eligibility criteria. Increase in LNCSB intake was associated with lower weight (5 cohorts, 130,020 participants; MD −0.008 kg/year [95% CI −0.014, −0.002]). Substitution of LNCSB for sugar-sweetened beverages (SSB) was associated with lower weight (three cohorts, 165,579 participants; MD, −0.12 [−0.14, −0.10,] kg/y) and lower incidence of obesity (OB) (one cohort, 15,765 participants; RR 0.88 [95% CI 0.88, 0.89]), coronary heart disease (six cohorts, 233,676 participants; 0.89 [0.81, 0.98]), cardiovascular disease mortality (one cohort, 118,363 participants; 0.95 [0.90, 0.99]), and total mortality (one cohort, 118,363 participants; 0.96 [0.94, 0.98]) with no adverse associations across other outcomes. Substitution of water for SSB showed lower weight (three cohorts, 165,579 participants; MD −0.10 kg/year [−0.13, −0.06]), lower waist circumference (one cohort, 173 participants; −2.71 cm/year [−4.27, −1.15]) and percent body fat (one cohort, 173 participants; −1.51% per year [−2.61, −0.42]), and lower incidence of OB (one cohort, 15,765 participants; RR 0.85 [0.75, 0.97]) and T2D (three cohorts, 281,855 participants; 0.96 [0.94, 0.98]). Substitution of LNCSB for water showed no adverse associations.LIMITATIONSThe evidence was low to very low certainty owing to downgrades for imprecision, indirectness, and/or inconsistency.CONCLUSIONSLNCSB were not associated with cardiometabolic harm in analyses that model the exposure as change or substitutions. The available evidence provides some indication that LNCSB in their intended substitution for SSB may be associated with cardiometabolic benefit, comparable with the standard of care, water.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc21-2130
      Issue No: Vol. 45, No. 8 (2022)
       
  • Issues and Events

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      Pages: 1931 - 1931
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.2337/dc22-ie08
      Issue No: Vol. 45, No. 8 (2022)
       
 
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