Followed Journals
Journal you Follow: 0
 
Sign Up to follow journals, search in your chosen journals and, optionally, receive Email Alerts when new issues of your Followed Journals are published.
Already have an account? Sign In to see the journals you follow.
Similar Journals
Journal Cover
Diabetes Care
Journal Prestige (SJR): 6.693
Citation Impact (citeScore): 8
Number of Followers: 580  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
Published by American Diabetes Association Homepage  [4 journals]
  • Renoprotective Effects of the Combination of Empagliflozin and Liraglutide
           Compared With Roux-en-Y Gastric Bypass in Early-Stage Diabetic Kidney
           Disease: A Post Hoc Analysis of the Microvascular Outcomes after Metabolic
           Surgery (MOMS) Randomized Controlled Clinical Trial

    • Free pre-print version: Loading...

      Authors: Cohen; R. V.; Petry, T. B. Z.; Miras, A. D.; Aboud, C. M.; Johnson, B.; dos Santos, T. M.; le Roux, C. W.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-1192
      Issue No: Vol. 44, No. 10 (2021)
       
  • Trends in Total and Out-of-pocket Payments for Insulin Among Privately
           Insured U.S. Adults With Diabetes From 2005 to 2018

    • Free pre-print version: Loading...

      Authors: Laxy; M.; Zhang, P.; Benoit, S. R.; Imperatore, G.; Cheng, Y. J.; Gregg, E. W.; Yang, S.; Shao, H.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2529
      Issue No: Vol. 44, No. 10 (2021)
       
  • Metabolic Profiles of Maori, Pacific, and European New Zealanders With
           Type 2 Diabetes Over 25 Years

    • Free pre-print version: Loading...

      Authors: Yu; D.; Cai, Y.; Osuagwu, U. L.; Pickering, K.; Baker, J.; Cutfield, R.; Jansen, R. M.; Orr-Walker, B. J.; Sundborn, G.; Zhao, Z.; Simmons, D.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-1255
      Issue No: Vol. 44, No. 10 (2021)
       
  • An Insulin Resistance Score Improved Diabetes Risk Assessment in the
           MalmoĢˆ Prevention Project--A Longitudinal Population-Based Study of Older
           Europeans

    • Free pre-print version: Loading...

      Authors: Shiffman; D.; Louie, J. Z.; Meigs, J. B.; Devlin, J. J.; McPhaul, M. J.; Melander, O.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-1328
      Issue No: Vol. 44, No. 10 (2021)
       
  • Improving Prediction of Risk for the Development of Type 1
           Diabetes--Insights From Populations at High Risk

    • Free pre-print version: Loading...

      Authors: Wherrett; D. K.
      Pages: 2189 - 2191
      PubDate: 2021-10-07T12:05:27-07:00
      DOI: 10.2337/dci21-0018
      Issue No: Vol. 44, No. 10 (2021)
       
  • A Clinical Conundrum: Intensifying Glycemic Control in the Presence of
           Advanced Diabetic Retinopathy

    • Free pre-print version: Loading...

      Authors: Ipp; E.; Kumar, M.
      Pages: 2192 - 2193
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dci21-0029
      Issue No: Vol. 44, No. 10 (2021)
       
  • Less Sitting for Preventing Type 2 Diabetes

    • Free pre-print version: Loading...

      Authors: Dunstan; D. W.; Owen, N.
      Pages: 2194 - 2196
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dci21-0028
      Issue No: Vol. 44, No. 10 (2021)
       
  • Hemoglobin A1c--Using Epidemiology to Guide Medical Practice: Kelly West
           Award Lecture 2020

    • Free pre-print version: Loading...

      Authors: Selvin; E.
      Pages: 2197 - 2204
      Abstract: The discovery that HbA1c was a valid and reliable measure of average glucose exposure was one of the most important advances in diabetes care. HbA1c was rapidly adopted for monitoring glucose control and is now recommended for the diagnosis of diabetes. HbA1c has several advantages over glucose. Glucose assessment requires fasting, has poor preanalytic stability, and is not standardized; concentrations are acutely altered by a number of factors; and measurement can vary depending on sample type (e.g., plasma or whole blood) and source (e.g., capillary, venous, interstitial). HbA1c does not require fasting, reflects chronic exposure to glucose over the past 2–3 months, and has low within-person variability, and assays are well standardized. One reason HbA1c is widely accepted as a prognostic and diagnostic biomarker is that epidemiologic studies have demonstrated robust links between HbA1c and complications, with stronger associations than those observed for usual measures of glucose. Clinical trials have also demonstrated that lowering HbA1c slows or prevents the development of microvascular disease. As with all laboratory tests, there are some clinical situations in which HbA1c is unreliable (e.g., certain hemoglobin variants, alterations in red blood cell turnover). Recent studies demonstrate that fructosamine and glycated albumin may be substituted as measures of hyperglycemia in these settings. Other approaches to monitoring glucose have recently been introduced, including continuous glucose monitoring, although this technology relies on interstitial glucose and epidemiologic evidence supporting its routine use has not yet been established for most clinical settings. In summary, a large body of epidemiologic evidence has convincingly established HbA1c as a cornerstone of modern diabetes care.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dci21-0035
      Issue No: Vol. 44, No. 10 (2021)
       
  • Causation Research on Diabetic Foot Complications--What I Learned From
           Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

    • Free pre-print version: Loading...

      Authors: Boyko; E. J.
      Pages: 2205 - 2211
      Abstract: Roger Pecoraro made important contributions to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a nonspecialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under the receiver operating characteristic curve [AUROC] 0.81 at 1 year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dci21-0026
      Issue No: Vol. 44, No. 10 (2021)
       
  • Lingering Effects of Hyperglycemia in Recently Diagnosed Diabetes During
           Long-term Follow-up of the DCCT/EDIC and UKPDS Cohorts: More Evidence That
           Early Control Matters

    • Free pre-print version: Loading...

      Authors: Riddle; M. C.; Gerstein, H. C.; Home, P. D.
      Pages: 2212 - 2215
      Keywords: Long-term Effects of Earlier Glycemic Control
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dci21-0030
      Issue No: Vol. 44, No. 10 (2021)
       
  • Understanding Metabolic Memory: The Prolonged Influence of Glycemia During
           the Diabetes Control and Complications Trial (DCCT) on Future Risks of
           Complications During the Study of the Epidemiology of Diabetes
           Interventions and Complications (EDIC)

    • Free pre-print version: Loading...

      Authors: Lachin; J. M.; Nathan, D. M.; on behalf of the DCCT/EDIC Research Group
      Pages: 2216 - 2224
      Abstract: The Diabetes Control and Complications Trial (DCCT, 1983–1993) showed that intensive therapy (mean HbA1c 7.2%) compared with conventional therapy (mean HbA1c 9.0%) markedly reduced the risks of retinopathy, nephropathy, and neuropathy, and these reductions in complications were entirely attributable, statistically, to the difference in mean HbA1c levels. The DCCT cohort has been followed in the Epidemiology of Diabetes Interventions and Complications (EDIC) study (1994 to date). Early in EDIC, mean HbA1c levels in the former intensively and conventionally treated groups converged. Nevertheless, the beneficial effects of DCCT intensive versus conventional therapy on microvascular complications not only persisted but increased during EDIC. The differences in complications during EDIC were wholly explained, statistically, by differences between groups in HbA1c levels during DCCT. These observations give rise to the concept of metabolic memory. Subsequent similar findings from the UKPDS gave rise to a similar concept, which they called the legacy effect. In this report, we present the evidence to support metabolic memory as both a biological and epidemiological phenomenon and discuss potential underlying mechanisms. We also compare metabolic memory and the legacy effect and conclude that the two are likely biologically similar, with comparable effects on long-term outcomes. The long-term influence of metabolic memory on the risk of micro- and macrovascular complications supports the implementation of intensive therapy, with the goal of maintaining near-normal levels of glycemia, as early and as long as safely possible in order to limit the risk of complications.
      Keywords: Long-term Effects of Earlier Glycemic Control
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-3097
      Issue No: Vol. 44, No. 10 (2021)
       
  • The Beneficial Effects of Earlier Versus Later Implementation of Intensive
           Therapy in Type 1 Diabetes

    • Free pre-print version: Loading...

      Authors: Lachin; J. M.; Bebu, I.; Nathan, D. M.; for the DCCT/EDIC Research Group
      Pages: 2225 - 2230
      Abstract: OBJECTIVEThe principal aim is to estimate the benefits of earlier versus later implementation of intensive therapy in type 1 diabetes with respect to the long-term risks of progression of a renal (microvascular) and cardiovascular (macrovascular) complication in the Epidemiology of Diabetes Interventions and Complications (EDIC) study.RESEARCH DESIGN AND METHODSCox proportional hazards regression models estimated the 20-year cumulative incidence (absolute risk) and the 20-year relative risk of cardiovascular disease (CVD) and reduced estimated glomerular filtration rate (eGFR) over the first 20 years of EDIC follow-up as a function of the mean HbA1c.RESULTSA hypothetical patient treated earlier with 10 years of intensive therapy and a mean HbA1c of 7% (53 mmol/mol) followed by 10 years with a mean of 9% (75 mmol/mol) would have a 33% reduction in the risk of CVD and a 52% reduction in reduced eGFR compared with a patient with a mean HbA1c of 9% (75 mmol/mol) over the first 10 years followed by later intensive therapy over 10 years with an HbA1c of 7% (53 mmol/mol). Despite both patients having the same average glycemic exposure over the 20 years, the patient with the lower HbA1c over the first 10 years had a lower risk of progression of complications over the 20 years than the patient who had the higher value initially.CONCLUSIONSWhile implementation of intensive therapy at any time in type 1 diabetes will be beneficial, within the 20-year period modeled, earlier relative to later implementation is associated with a greater reduction in the risks of kidney and cardiovascular complications.
      Keywords: Long-term Effects of Earlier Glycemic Control
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-1331
      Issue No: Vol. 44, No. 10 (2021)
       
  • Historical HbA1c Values May Explain the Type 2 Diabetes Legacy Effect:
           UKPDS 88

    • Free pre-print version: Loading...

      Authors: Lind; M.; Imberg, H.; Coleman, R. L.; Nerman, O.; Holman, R. R.
      Pages: 2231 - 2237
      Abstract: OBJECTIVEType 2 diabetes all-cause mortality (ACM) and myocardial infarction (MI) glycemic legacy effects have not been explained. We examined their relationships with prior individual HbA1c values and explored the potential impact of instituting earlier, compared with delayed, glucose-lowering therapy.RESEARCH DESIGN AND METHODSTwenty-year ACM and MI hazard functions were estimated from diagnosis of type 2 diabetes in 3,802 UK Prospective Diabetes Study participants. Impact of HbA1c values over time was analyzed by weighting them according to their influence on downstream ACM and MI risks.RESULTSHazard ratios for a one percentage unit higher HbA1c for ACM were 1.08 (95% CI 1.07–1.09), 1.18 (1.15–1.21), and 1.36 (1.30–1.42) at 5, 10, and 20 years, respectively, and for MI was 1.13 (1.11–1.15) at 5 years, increasing to 1.31 (1.25–1.36) at 20 years. Imposing a one percentage unit lower HbA1c from diagnosis generated an 18.8% (95% CI 21.1–16.0) ACM risk reduction 10–15 years later, whereas delaying this reduction until 10 years after diagnosis showed a sevenfold lower 2.7% (3.1–2.3) risk reduction. Corresponding MI risk reductions were 19.7% (22.4–16.5) when lowering HbA1c at diagnosis, and threefold lower 6.5% (7.4–5.3%) when imposed 10 years later.CONCLUSIONSThe glycemic legacy effects seen in type 2 diabetes are explained largely by historical HbA1c values having a greater impact than recent values on clinical outcomes. Early detection of diabetes and intensive glucose control from the time of diagnosis is essential to maximize reduction of the long-term risk of glycemic complications.
      Keywords: Long-term Effects of Earlier Glycemic Control
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2439
      Issue No: Vol. 44, No. 10 (2021)
       
  • Glucose Regulation Beyond HbA1c in Type 2 Diabetes Treated With Insulin:
           Real-World Evidence From the DIALECT-2 Cohort

    • Free pre-print version: Loading...

      Authors: den Braber; N.; Vollenbroek-Hutten, M. M. R.; Westerik, K. M.; Bakker, S. J. L.; Navis, G.; van Beijnum, B.-J. F.; Laverman, G. D.
      Pages: 2238 - 2244
      Abstract: OBJECTIVETo investigate glucose variations associated with glycated hemoglobin (HbA1c) in insulin-treated patients with type 2 diabetes.RESEARCH DESIGN AND METHODSPatients included in Diabetes and Lifestyle Cohort Twente (DIALECT)-2 (n = 79) were grouped into three HbA1c categories: low, intermediate, and high (≤53, 54–62, and ≥63 mmol/mol or ≤7, 7.1–7.8, and ≥7.9%, respectively). Blood glucose time in range (TIR), time below range (TBR), time above range (TAR), glucose variability parameters, day and night duration, and frequency of TBR and TAR episodes were determined by continuous glucose monitoring (CGM) using the FreeStyle Libre sensor and compared between HbA1c categories.RESULTSCGM was performed for a median (interquartile range) of 10 (7–12) days/patient. TIR was not different for low and intermediate HbA1c categories (76.8% [68.3–88.2] vs. 76.0% [72.5.0–80.1]), whereas in the low category, TBR was higher and TAR lower (7.7% [2.4–19.1] vs. 0.7% [0.3–6.1] and 8.2% [5.7–17.6] vs. 20.4% [11.6–27.0], respectively; P < 0.05). Patients in the highest HbA1c category had lower TIR (52.7% [40.9–67.3]) and higher TAR (44.1% [27.8–57.0]) than the other HbA1c categories (P < 0.05), but did not have less TBR during the night. All patients had more (0.06 ± 0.06/h vs. 0.03 ± 0.03/h; P = 0.002) and longer (88.0 [45.0–195.5] vs. 53.4 [34.4–82.8] minutes; P < 0.001) TBR episodes during the night than during the day.CONCLUSIONSIn this study, a high HbA1c did not reduce the occurrence of nocturnal hypoglycemia, and low HbA1c was not associated with the highest TIR. Optimal personalization of glycemic control requires the use of newer tools, including CGM-derived parameters.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2241
      Issue No: Vol. 44, No. 10 (2021)
       
  • Racial and Ethnic Disparities in Comorbidities in Youth With Type 2
           Diabetes in the Pediatric Diabetes Consortium (PDC)

    • Free pre-print version: Loading...

      Authors: Bacha; F.; Cheng, P.; Gal, R. L.; Beaulieu, L. C.; Kollman, C.; Adolph, A.; Shoemaker, A. H.; Wolf, R.; Klingensmith, G. J.; Tamborlane, W. V.
      Pages: 2245 - 2251
      Abstract: OBJECTIVEType 2 diabetes in the U.S. is more prevalent in youth of minority racial-ethnic background, but disparities in health outcomes have not been examined in this population.RESEARCH DESIGN AND METHODSWe examined racial-ethnic differences in the initial presentation and subsequent comorbidities in 1,217 youth with type 2 diabetes (63% girls) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report.RESULTSOverall, the mean age at presentation was 13.4 ± 2.4 years, and BMI was 35.0 ± 9.4 kg/m2. HbA1c was higher and C-peptide was lower in non-Hispanic Black (NHB) and Hispanic (H) youth compared with non-Hispanic White (NHW) youth. NHB were three times as likely to present in diabetic ketoacidosis (19%) versus NHW (6.3%) and H (7.5%), and NHB and H both had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34%, and dyslipidemia in 42% of Registry participants, with no significant difference among racial-ethnic groups. Nonalcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively, versus 2% in NHB.CONCLUSIONSNHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0143
      Issue No: Vol. 44, No. 10 (2021)
       
  • Unchanged Prevalence of Preeclampsia After Implementation of Prophylactic
           Aspirin for All Pregnant Women With Preexisting Diabetes: A Prospective
           Cohort Study

    • Free pre-print version: Loading...

      Authors: Do; N. C.; Vestgaard, M.; Asbjörnsdottir, B.; Norgaard, S. K.; Andersen, L. L. T.; Jensen, D. M.; Ringholm, L.; Damm, P.; Mathiesen, E. R.
      Pages: 2252 - 2259
      Abstract: OBJECTIVETo evaluate the prevalence of preeclampsia after implementation of prophylactic aspirin for all pregnant women with preexisting diabetes compared with the prevalence in a previous risk-based prophylaxis.RESEARCH DESIGN AND METHODSA prospective observational cohort study of 410 consecutive pregnant women with preexisting diabetes categorized according to aspirin prophylaxis strategy, with the prevalence of preeclampsia as primary outcome. In total, 207 women were included after implementation of prophylactic aspirin for all pregnant women with preexisting diabetes in February 2018 (all-cohort). The 203 women included before this date, where aspirin prophylaxis was risk based and only prescribed to selected women (selected-cohort), were studied for comparison.RESULTSAspirin was prescribed at ~10 gestational weeks for 88% (all-cohort) compared with 25% (selected-cohort). HbA1c, parity, chronic hypertension, home blood pressure, microalbuminuria/diabetic nephropathy, and smoking were similar in the two cohorts in early pregnancy. In the all-cohort, fewer women had type 2 diabetes (32% vs. 42%, respectively; P = 0.04) and BMI tended to be lower (P = 0.05). The prevalence of preeclampsia was similar (12% vs. 11%, P = 0.69) in the two cohorts, and this was also the case with stratification for diabetes type. Prevalence of preterm delivery
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-1182
      Issue No: Vol. 44, No. 10 (2021)
       
  • An Age-Related Exponential Decline in the Risk of Multiple Islet
           Autoantibody Seroconversion During Childhood

    • Free pre-print version: Loading...

      Authors: Bonifacio; E.; Weiss, A.; Winkler, C.; Hippich, M.; Rewers, M. J.; Toppari, J.; Lernmark, A.; She, J.-X.; Hagopian, W. A.; Krischer, J. P.; Vehik, K.; Schatz, D. A.; Akolkar, B.; Ziegler, A.-G.; for the TEDDY Study Group
      Pages: 2260 - 2268
      Abstract: OBJECTIVEIslet autoimmunity develops before clinical type 1 diabetes and includes multiple and single autoantibody phenotypes. The objective was to determine age-related risks of islet autoantibodies that reflect etiology and improve screening for presymptomatic type 1 diabetes.RESEARCH DESIGN AND METHODSThe Environmental Determinants of Diabetes in the Young study prospectively monitored 8,556 genetically at-risk children at 3- to 6-month intervals from birth for the development of islet autoantibodies and type 1 diabetes. The age-related change in the risk of developing islet autoantibodies was determined using landmark and regression models.RESULTSThe 5-year risk of developing multiple islet autoantibodies was 4.3% (95% CI 3.8–4.7) at 7.5 months of age and declined to 1.1% (95% CI 0.8–1.3) at a landmark age of 6.25 years (P < 0.0001). Risk decline was slight or absent in single insulin and GAD autoantibody phenotypes. The influence of sex, HLA, and other susceptibility genes on risk subsided with increasing age and was abrogated by age 6 years. Highest sensitivity and positive predictive value of multiple islet autoantibody phenotypes for type 1 diabetes was achieved by autoantibody screening at 2 years and again at 5–7 years of age.CONCLUSIONSThe risk of developing islet autoimmunity declines exponentially with age, and the influence of major genetic factors on this risk is limited to the first few years of life.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2122
      Issue No: Vol. 44, No. 10 (2021)
       
  • Islet Autoimmunity and HLA Markers of Presymptomatic and Clinical Type 1
           Diabetes: Joint Analyses of Prospective Cohort Studies in Finland,
           Germany, Sweden, and the U.S.

    • Free pre-print version: Loading...

      Authors: Anand; V.; Li, Y.; Liu, B.; Ghalwash, M.; Koski, E.; Ng, K.; Dunne, J. L.; Jönsson, J.; Winkler, C.; Knip, M.; Toppari, J.; Ilonen, J.; Killian, M. B.; Frohnert, B. I.; Lundgren, M.; Ziegler, A.-G.; Hagopian, W.; Veijola, R.; Rewers, M.; for the T1DI Study Group
      Pages: 2269 - 2276
      Abstract: OBJECTIVETo combine prospective cohort studies, by including HLA harmonization, and estimate risk of islet autoimmunity and progression to clinical diabetes.RESEARCH DESIGN AND METHODSFor prospective cohorts in Finland, Germany, Sweden, and the U.S., 24,662 children at increased genetic risk for development of islet autoantibodies and type 1 diabetes have been followed. Following harmonization, the outcomes were analyzed in 16,709 infants-toddlers enrolled by age 2.5 years.RESULTSIn the infant-toddler cohort, 1,413 (8.5%) developed at least one autoantibody confirmed at two or more consecutive visits (seroconversion), 865 (5%) developed multiple autoantibodies, and 655 (4%) progressed to diabetes. The 15-year cumulative incidence of diabetes varied in children with one, two, or three autoantibodies at seroconversion: 45% (95% CI 40–52), 85% (78–90), and 92% (85–97), respectively. Among those with a single autoantibody, status 2 years after seroconversion predicted diabetes risk: 12% (10–25) if reverting to autoantibody negative, 30% (20–40) if retaining a single autoantibody, and 82% (80–95) if developing multiple autoantibodies. HLA-DR-DQ affected the risk of confirmed seroconversion and progression to diabetes in children with stable single-autoantibody status. Their 15-year diabetes incidence for higher- versus lower-risk genotypes was 40% (28–50) vs. 12% (5–38). The rate of progression to diabetes was inversely related to age at development of multiple autoantibodies, ranging from 20% per year to 6% per year in children developing multipositivity in ≤2 years or >7.4 years, respectively.CONCLUSIONSThe number of islet autoantibodies at seroconversion reliably predicts 15-year type 1 diabetes risk. In children retaining a single autoantibody, HLA-DR-DQ genotypes can further refine risk of progression.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-1836
      Issue No: Vol. 44, No. 10 (2021)
       
  • Effects of Patient-Initiated Visits on Patient Satisfaction and Clinical
           Outcomes in a Type 1 Diabetes Outpatient Clinic: A 2-Year Randomized
           Controlled Study

    • Free pre-print version: Loading...

      Authors: Drojdahl Ryg; N.; Gram, J.; Haghighi, M.; Juhl, C. B.
      Pages: 2277 - 2285
      Abstract: OBJECTIVEWe investigated the effects of replacing regular outpatient follow-up through prescheduled visits with patient-initiated visits on patient satisfaction and clinical variables of type 1 diabetes (T1D).RESEARCH DESIGN AND METHODSA 24-month randomized controlled trial in which adults with T1D were allocated to either patient-initiated unlimited access to outpatient visits or usual care through regular prescheduled visits. The primary outcome was seven patient-reported experience measures of patient satisfaction focused on benefit of consultation and accessibility of the outpatient clinic. Secondary outcomes included clinical variables of diabetes and use of staff resources.RESULTSWe enrolled 357 outpatients (intervention, n = 178; control, n = 179). After 24 months, participants in the intervention group experienced more benefit from consultations compared with baseline within groups (P < 0.05) and fewer unnecessary visits compared with control subjects (P < 0.05). Patient needs covered and satisfaction with the outpatient clinic were high and unchanged in both groups, and accessibility was increased (three questions, all P < 0.05). A calculated 7-item patient satisfaction sum score favored the intervention group over control subjects (P < 0.001). There were no significant changes in glycated hemoglobin (HbA1c), LDL, blood pressure, and complication status. The mean number of outpatient visits over 24 months (± SD) was lower in the intervention group compared with control subjects (4.4 ± 2.8 vs. 6.3 ± 2.7; P < 0.001), while the number of telephone contacts was higher (3.1 ±3.4 vs. 2.5 ± 3.2; P < 0.001).CONCLUSIONSPatient satisfaction remained high or improved with patient-initiated on-demand use of the diabetes outpatient clinic, with no decline in the quality of diabetes care, and a reduction in the use of staff resources.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-3083
      Issue No: Vol. 44, No. 10 (2021)
       
  • Association of Glycemia, Lipids, and Blood Pressure With Cognitive
           Performance in People With Type 2 Diabetes in the Glycemia Reduction
           Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

    • Free pre-print version: Loading...

      Authors: Luchsinger; J. A.; Younes, N.; Manly, J. J.; Barzilay, J.; Valencia, W.; Larkin, M. E.; Falck-Ytter, C.; Krause-Steinrauf, H.; Pop-Busui, R.; Florez, H.; Seaquist, E.; for the GRADE Research Group
      Pages: 2286 - 2292
      Abstract: OBJECTIVEType 2 diabetes is a risk factor for cognitive impairment. We examined the relation of glycemia, lipids, blood pressure (BP), hypertension history, and statin use with cognition in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).RESEARCH DESIGN AND METHODSCross-sectional analyses from GRADE at baseline examined the association of glycemia (hemoglobin A1c [HbA1c]), LDL, systolic BP (SBP) and diastolic BP (DBP), hypertension history, and statin use with cognition assessed by the Spanish English Verbal Learning Test, letter and animal fluency tests, and Digit Symbol Substitution Test (DSST).RESULTSAmong 5,047 GRADE participants, 5,018 (99.4%) completed cognitive assessments. Their mean age was 56.7 ± 10.0 years, and 36.4% were women. Mean diabetes duration was 4.0 ± 2.7 years. HbA1c was not related to cognition. Higher LDL was related to modestly worse DSST scores, whereas statin use was related to modestly better DSST scores. SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg were related to modestly better DSST scores. Hypertension history was not related to cognition.CONCLUSIONSIn people with type 2 diabetes of a mean duration of
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2858
      Issue No: Vol. 44, No. 10 (2021)
       
  • Prescribing Trends of Antidiabetes Medications in Patients With Type 2
           Diabetes and Diabetic Kidney Disease: A Cohort Study

    • Free pre-print version: Loading...

      Authors: Harris; S. T.; Patorno, E.; Zhuo, M.; Kim, S. C.; Paik, J. M.
      Pages: 2293 - 2301
      Abstract: OBJECTIVETo assess changes in antidiabetes medication class prescriptions over time among patients with diabetic kidney disease (DKD), characteristics of patients prescribed these medications, and prescribers’ specialty.RESEARCH DESIGN AND METHODSWe conducted a cohort study design using insurance claims data between 2013 and the first quarter of 2020 (2020Q1). Included are adult patients with DKD who initiated a new antidiabetes medication between 2013 and 2020Q1 (N = 160,489 patients). The primary outcome is the yearly and quarterly percent of medication initiation for each antidiabetes medication class over all antidiabetes medication initiations.RESULTSFor patients with DKD, sodium–glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP-1RA) initiations steadily increased between 2013 and 2020Q1. Internists and endocrinologists were the most frequent prescriber specialties. Patients 75 years of age had a smaller percentage of all initiations that were SGLT2i or GLP-1RA, 11% and 13%, in 2019.CONCLUSIONSFor patients with DKD, SGLT2i and GLP-1RA prescriptions have increased over time, likely reflecting evolving prescribing patterns in response to the results of recent clinical trials and new clinical guidelines.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0529
      Issue No: Vol. 44, No. 10 (2021)
       
  • Second-Line Therapy for Type 2 Diabetes Management: The Treatment/Benefit
           Paradox of Cardiovascular and Kidney Comorbidities

    • Free pre-print version: Loading...

      Authors: McCoy; R. G.; Van Houten, H. K.; Karaca-Mandic, P.; Ross, J. S.; Montori, V. M.; Shah, N. D.
      Pages: 2302 - 2311
      Abstract: OBJECTIVETo examine whether glucagon-like peptide 1 receptor agonists (GLP-1RA) and sodium–glucose cotransporter 2 inhibitors (SGLT2i) are preferentially initiated among patients with cardiovascular disease, heart failure (HF), or nephropathy, where these drug classes have established benefit, compared with dipeptidyl peptidase 4 inhibitors (DPP-4i), for which corresponding benefits have not been demonstrated.RESEARCH DESIGN AND METHODSWe retrospectively analyzed claims of adults with type 2 diabetes included in OptumLabs Data Warehouse, a deidentified database of commercially insured and Medicare Advantage beneficiaries, who first started GLP-1RA, SGLT2i, or DPP-4i therapy between 2016 and 2019. Using multinomial logistic regression, we examined the relative risk ratios (RRR) of starting GLP-1RA and SGLT2i compared with DPP-4i for those with a history of myocardial infarction (MI), cerebrovascular disease, HF, and nephropathy after adjusting for demographic and other clinical factors.RESULTSWe identified 75,395 patients who started GLP-1RA, 58,234 who started SGLT2i, and 91,884 who started DPP-4i. Patients with prior MI, cerebrovascular disease, or nephropathy were less likely to start GLP-1RA rather than DPP-4i compared with patients without these conditions (RRR 0.83 [95% CI 0.78–0.88] for MI, RRR 0.77 [0.74–0.81] for cerebrovascular disease, and RRR 0.87 [0.84–0.91] for nephropathy). Patients with HF or nephropathy were less likely to start SGLT2i (RRR 0.83 [0.80–0.87] for HF and RRR 0.57 [0.55–0.60] for nephropathy). Both medication classes were less likely to be started by non-White and older patients.CONCLUSIONSPatients with cardiovascular disease, HF, and nephropathy, for whom evidence suggests a greater likelihood of benefiting from GLP-1RA and/or SGLT2i therapy, were less likely to start these drugs. Addressing this treatment/benefit paradox, which was most pronounced in non-White and older patients, may help reduce the morbidity associated with these conditions.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2977
      Issue No: Vol. 44, No. 10 (2021)
       
  • Monogenic Diabetes in Youth With Presumed Type 2 Diabetes: Results From
           the Progress in Diabetes Genetics in Youth (ProDiGY) Collaboration

    • Free pre-print version: Loading...

      Authors: Todd; J. N.; Kleinberger, J. W.; Zhang, H.; Srinivasan, S.; Tollefsen, S. E.; Levitsky, L. L.; Levitt Katz, L. E.; Tryggestad, J. B.; Bacha, F.; Imperatore, G.; Lawrence, J. M.; Pihoker, C.; Divers, J.; Flannick, J.; Dabelea, D.; Florez, J. C.; Pollin, T. I.
      Pages: 2312 - 2319
      Abstract: OBJECTIVEMaturity-onset diabetes of the young (MODY) is frequently misdiagnosed as type 1 or type 2 diabetes. Correct diagnosis may result in a change in clinical treatment and impacts prediction of complications and familial risk. In this study, we aimed to assess the prevalence of MODY in multiethnic youth under age 20 years with a clinical diagnosis of type 2 diabetes.RESEARCH DESIGN AND METHODSWe evaluated whole-exome sequence data of youth with a clinical diagnosis of type 2 diabetes. We considered participants to have MODY if they carried a MODY gene variant classified as likely pathogenic (LP) or pathogenic (P) according to current guidelines.RESULTSOf 3,333 participants, 93 (2.8%) carried an LP/P variant in HNF4A (16 participants), GCK (23), HNF1A (44), PDX1 (5), INS (4), and CEL (1). Compared with those with no LP/P variants, youth with MODY had a younger age at diagnosis (12.9 ± 2.5 vs. 13.6 ± 2.3 years, P = 0.002) and lower fasting C-peptide levels (3.0 ± 1.7 vs. 4.7 ± 3.5 ng/mL, P < 0.0001). Youth with MODY were less likely to have hypertension (6.9% vs. 19.5%, P = 0.007) and had higher HDL cholesterol (43.8 vs. 39.7 mg/dL, P = 0.006).CONCLUSIONSBy comprehensively sequencing the coding regions of all MODY genes, we identified MODY in 2.8% of youth with clinically diagnosed type 2 diabetes; importantly, in 89% (n = 83) the specific diagnosis would have changed clinical management. No clinical criterion reliably separated the two groups. New tools are needed to find ideal criteria for selection of individuals for genetic testing.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0491
      Issue No: Vol. 44, No. 10 (2021)
       
  • Disparities in Hemoglobin A1c Testing During the Transition to Adulthood
           and Association With Diabetes Outcomes in Youth-Onset Type 1 and Type 2
           Diabetes: The SEARCH for Diabetes in Youth Study

    • Free pre-print version: Loading...

      Authors: Sauder; K. A.; Stafford, J. M.; Ehrlich, S.; Lawrence, J. M.; Liese, A. D.; Marcovina, S.; Mottl, A. K.; Pihoker, C.; Saydah, S.; Shah, A. S.; DAgostino, R. B.; Dabelea, D.; for the SEARCH for Diabetes in Youth Study Group
      Pages: 2320 - 2328
      Abstract: OBJECTIVETo identify correlates of hemoglobin A1c (HbA1c) testing frequency and associations with HbA1c levels and microvascular complications in youth-onset diabetes.RESEARCH DESIGN AND METHODSThe SEARCH for Diabetes in Youth study collected data from individuals diagnosed with diabetes before age 20 at 8 years (n = 1,885 type 1, n = 230 type 2) and 13 years (n = 649 type 1, n = 84 type 2) diabetes duration. We identified correlates of reporting ≥3 HbA1c tests/year using logistic regression. We examined associations of HbA1c testing with HbA1c levels and microvascular complications (retinopathy, neuropathy, or nephropathy) using sequentially adjusted linear and logistic regression.RESULTSFor type 1 diabetes, odds of reporting ≥3 HbA1c tests/year at 8 and 13 years diabetes duration decreased with older age at diagnosis (odds ratio [OR] 0.91 [95% CI 0.88–0.95]), longer duration of diabetes (OR 0.90 [0.82–0.99]), not having a personal doctor (OR 0.44 [0.30–0.65]), and lapses in health insurance (OR 0.51 [0.27–0.96]). HbA1c testing ≥3 times/year over time was associated with lower HbA1c levels (OR –0.36% [–0.65 to –0.06]) and lower odds of microvascular complications (OR 0.64 [0.43–0.97]) at 13 years’ duration, but associations were attenuated after adjustment for HbA1c testing correlates (OR –0.17 [–0.46 to 0.13] and 0.70 [0.46–1.07], respectively). For type 2 diabetes, not seeing an endocrinologist decreased the odds of reporting ≥3 HbA1c tests/year over time (OR 0.19 [0.06–0.63]), but HbA1c testing frequency was not associated with HbA1c levels or microvascular complications.CONCLUSIONSWe observed disparities in HbA1c testing frequency predominately by health care–related factors, which were associated with diabetes outcomes in type 1 diabetes.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2983
      Issue No: Vol. 44, No. 10 (2021)
       
  • Time to Peak Glucose and Peak C-Peptide During the Progression to Type 1
           Diabetes in the Diabetes Prevention Trial and TrialNet Cohorts

    • Free pre-print version: Loading...

      Authors: Voss; M. G.; Cuthbertson, D. D.; Cleves, M. M.; Xu, P.; Evans-Molina, C.; Palmer, J. P.; Redondo, M. J.; Steck, A. K.; Lundgren, M.; Larsson, H.; Moore, W. V.; Atkinson, M. A.; Sosenko, J. M.; Ismail, H. M.; for the DPT-1 TrialNet Study Groups
      Pages: 2329 - 2336
      Abstract: OBJECTIVETo assess the progression of type 1 diabetes using time to peak glucose or C-peptide during oral glucose tolerance tests (OGTTs) in autoantibody-positive relatives of people with type 1 diabetes.RESEARCH DESIGN AND METHODSWe examined 2-h OGTTs of participants in the Diabetes Prevention Trial Type 1 (DPT-1) and TrialNet Pathway to Prevention (PTP) studies. We included 706 DPT-1 participants (mean ± SD age, 13.84 ± 9.53 years; BMI Z-score, 0.33 ± 1.07; 56.1% male) and 3,720 PTP participants (age, 16.01 ± 12.33 years; BMI Z-score, 0.66 ± 1.3; 49.7% male). Log-rank testing and Cox regression analyses with adjustments (age, sex, race, BMI Z-score, HOMA-insulin resistance, and peak glucose/C-peptide levels, respectively) were performed.RESULTSIn each of DPT-1 and PTP, higher 5-year diabetes progression risk was seen in those with time to peak glucose >30 min and time to peak C-peptide >60 min (P < 0.001 for all groups), before and after adjustments. In models examining strength of association with diabetes development, associations were greater for time to peak C-peptide versus peak C-peptide value (DPT-1: 2 = 25.76 vs. 2 = 8.62; PTP: 2 = 149.19 vs. 2 = 79.98; all P < 0.001). Changes in the percentage of individuals with delayed glucose and/or C-peptide peaks were noted over time.CONCLUSIONSIn two independent at-risk populations, we show that those with delayed OGTT peak times for glucose or C-peptide are at higher risk of diabetes development within 5 years, independent of peak levels. Moreover, time to peak C-peptide appears more predictive than the peak level, suggesting its potential use as a specific biomarker for diabetes progression.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0226
      Issue No: Vol. 44, No. 10 (2021)
       
  • Intakes of Fish and Long-Chain n-3 Polyunsaturated Fatty Acid Supplements
           During Pregnancy and Subsequent Risk of Type 2 Diabetes in a Large
           Prospective Cohort Study of Norwegian Women

    • Free pre-print version: Loading...

      Authors: Oyen; J.; Brantsaeter, A. L.; Nostbakken, O. J.; Birkeland, K. I.; Haugen, M.; Madsen, L.; Egeland, G. M.
      Pages: 2337 - 2345
      Abstract: OBJECTIVETo investigate associations between intakes of total fish, lean fish, fatty fish, and long-chain n-3 polyunsaturated fatty acid (LCn-3PUFA) supplements and risk of type 2 diabetes in women after pregnancy. Furthermore, we sought to compare the estimated intakes of methylmercury (MeHg) and sum of dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) with tolerable weekly intakes (TWI).RESEARCH DESIGN AND METHODSWomen free of diabetes at baseline (n = 60,831) who participated in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa) were prospectively evaluated for incident type 2 diabetes, identified on the basis of medication usage >90 days after delivery, ascertained through the Norwegian Prescription Database. Dietary intake data were obtained with a validated 255-item food-frequency questionnaire (FFQ), which assessed habitual diet during the first 4–5 months of pregnancy. Intakes of MeHg and sum of dioxins and dl-PCBs were derived with use of a contaminant database and the FFQ.RESULTSMedian age was 31 years (interquartile range 27, 34) at time of delivery, and follow-up time was 7.5 years (6.5, 8.5). Type 2 diabetes occurred in 683 (1.1%) participants. Multivariable Cox regression analyses identified lower risk of type 2 diabetes with increasing energy-adjusted lean fish intake (25 g/1,000 kcal: hazard ratio 0.71, 95% CI 0.53–0.95, P = 0.022). However, in stratified analyses, a lower risk was found only in women with prepregnancy BMI ≥25 kg/m2. There were no associations between intake of total fish, fatty fish, or LCn-3PUFA supplements and type 2 diabetes. MeHg intake was low, but the intake of the sum of dioxins and dl-PCBs (picograms of toxic equivalents/kilograms of body weight/week) exceeded the TWI set by the European Food Safety Authority (EFSA) for the majority of participants.CONCLUSIONSIntake of lean fish, but not fatty fish or LCn-3PUFA supplements, was associated with lower risk of pharmacologically treated type 2 diabetes in Norwegian women who were overweight or obese. Fatty fish, which contain dioxins and dl-PCBs, did not increase the risk of type 2 diabetes, but the exceedance of the EFSA TWI for dioxins and dl-PCBs is a health concern.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0447
      Issue No: Vol. 44, No. 10 (2021)
       
  • Gestational Diabetes and Incident Heart Failure: A Cohort Study

    • Free pre-print version: Loading...

      Authors: Echouffo-Tcheugui; J. B.; Guan, J.; Retnakaran, R.; Shah, B. R.
      Pages: 2346 - 2352
      Abstract: OBJECTIVETo assess whether gestational diabetes mellitus (GDM) is associated with an increased risk of heart failure (HF).RESEARCH DESIGN AND METHODSWe conducted a population-based cohort study using information from the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. We identified all women in Ontario with a GDM diagnosis with a live birth singleton delivery between 1 July 2007 and 31 March 2018. Women with diabetes or HF before pregnancy were excluded. GDM was defined based on laboratory test results and diagnosis coding. The primary outcome was incident HF hospitalization over a period extending from the index pregnancy until 31 March 2019. The secondary outcome was prevalent peripartum cardiomyopathy at index pregnancy. Estimates of association were adjusted for relevant cardiometabolic risk factors.RESULTSAmong 906,319 eligible women (mean age 30 years [SD 5.6], 50,193 with GDM [5.5%]), there were 763 HF events over a median follow-up period of 7 years. GDM was associated with a higher risk of incident HF (adjusted hazard ratio [aHR] 1.62 [95% CI 1.28, 2.05]) compared with no GDM. This association remained significant after accounting for chronic kidney disease, postpartum diabetes, hypertension, and coronary artery disease (aHR 1.39 [95% CI 1.09, 1.79]). GDM increased the odds of peripartum cardiomyopathy (adjusted odds ratio 1.83 [95% CI 1.45, 2.33]).CONCLUSIONSIn a large observational study, GDM was associated with an increased risk of HF. Consequently, diabetes screening during pregnancy is suggested to identify women at risk for HF.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0552
      Issue No: Vol. 44, No. 10 (2021)
       
  • Nationwide Trends in Cardiac Risk and Mortality in Patients With Incident
           Type 2 Diabetes: A Danish Cohort Study

    • Free pre-print version: Loading...

      Authors: Gyldenkerne; C.; Knudsen, J. S.; Olesen, K. K. W.; Sorensen, H. T.; Botker, H. E.; Thomsen, R. W.; Maeng, M.
      Pages: 2353 - 2360
      Abstract: OBJECTIVETrends in cardiac risk and death have not been examined in patients with incident type 2 diabetes and no prior cardiovascular disease. Therefore, we aimed to examine trends in cardiac risk and death in relation to the use of prophylactic cardiovascular medications in patients with incident type 2 diabetes without prior cardiovascular disease.RESEARCH DESIGN AND METHODSIn this population-based cohort study, we included patients with incident type 2 diabetes between 1996 and 2011 through national health registries. Each patient was matched by age and sex with up to five individuals without diabetes from the general population. All individuals were followed for 7 years.RESULTSWe identified 209,311 patients with incident diabetes. From 1996–1999 to 2008–2011, the 7-year risk of myocardial infarction decreased from 6.9 to 2.8% (adjusted hazard ratio [aHR] 0.39 [95% CI 0.37–0.42]), cardiac death from 7.1 to 1.6% (aHR 0.23 [95% CI 0.21–0.24]), and all-cause death from 28.9 to 16.8% (aHR 0.68 [95% CI 0.66–0.69]). Compared with the general population, 7-year risk differences decreased from 3.3 to 0.8% for myocardial infarction, from 2.7 to 0.5% for cardiac death, and from 10.6 to 6.0% for all-cause death. Use of cardiovascular medications within ±1 year of diabetes diagnosis, especially statins (5% of users in 1996–1999 vs. 60% in 2008–2011), increased during the study period.CONCLUSIONSFrom 1996 to 2011, Danish patients with incident type 2 diabetes and no prior cardiovascular disease experienced major reductions in cardiac risk and mortality. The risk reductions coincided with increased use of prophylactic cardiovascular medications.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0383
      Issue No: Vol. 44, No. 10 (2021)
       
  • Advancing Therapy in Suboptimally Controlled Basal Insulin-Treated Type 2
           Diabetes: Clinical Outcomes With iGlarLixi Versus Premix BIAsp 30 in the
           SoliMix Randomized Controlled Trial

    • Free pre-print version: Loading...

      Authors: Rosenstock; J.; Emral, R.; Sauque-Reyna, L.; Mohan, V.; Trescoli, C.; Al Sifri, S.; Lalic, N.; Alvarez, A.; Picard, P.; Bonnemaire, M.; Demil, N.; McCrimmon, R. J.; on behalf of the SoliMix Trial Investigators
      Pages: 2361 - 2370
      Abstract: OBJECTIVETo directly compare the efficacy and safety of a fixed-ratio combination, of insulin glargine 100 units/mL and the glucagon-like peptide 1 receptor agonist lixisenatide (iGlarLixi), with those of a premix insulin analog, biphasic aspart insulin 30 (30% insulin aspart and 70% insulin aspart protamine) (BIAsp 30) as treatment advancement in type 2 diabetes suboptimally controlled on basal insulin plus oral antihyperglycemic drugs (OADs).RESEARCH DESIGN AND METHODSIn SoliMix, a 26-week, open-label, multicenter study, adults with suboptimally controlled basal insulin–treated type 2 diabetes (HbA1c ≥7.5% and ≤10%) were randomized to once-daily iGlarLixi or twice-daily BIAsp 30. Primary efficacy end points were noninferiority in HbA1c reduction (margin 0.3%) or superiority in body weight change for iGlarLixi versus BIAsp 30.RESULTSBoth primary efficacy end points were met: after 26 weeks, baseline HbA1c (8.6%) was reduced by 1.3% with iGlarLixi and 1.1% with BIAsp 30, meeting noninferiority (least squares [LS] mean difference –0.2% [97.5% CI –0.4, –0.1]; P < 0.001). iGlarLixi was also superior to BIAsp 30 for body weight change (LS mean difference –1.9 kg [95% CI –2.3, –1.4]) and percentage of participants achieving HbA1c
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0393
      Issue No: Vol. 44, No. 10 (2021)
       
  • Fast-Acting Insulin Aspart Versus Insulin Aspart Using a Second-Generation
           Hybrid Closed-Loop System in Adults With Type 1 Diabetes: A Randomized,
           Open-Label, Crossover Trial

    • Free pre-print version: Loading...

      Authors: Lee; M. H.; Paldus, B.; Vogrin, S.; Morrison, D.; Zaharieva, D. P.; Lu, J.; Jones, H. M.; Netzer, E.; Robinson, L.; Grosman, B.; Roy, A.; Kurtz, N.; Ward, G. M.; MacIsaac, R. J.; Jenkins, A. J.; ONeal, D. N.
      Pages: 2371 - 2378
      Abstract: OBJECTIVETo evaluate glucose control using fast-acting insulin aspart (faster aspart) compared with insulin aspart (IAsp) delivered by the MiniMed Advanced Hybrid Closed-Loop (AHCL) system in adults with type 1 diabetes.RESEARCH DESIGN AND METHODSIn this randomized, open-label, crossover study, participants were assigned to receive faster aspart or IAsp in random order. Stages 1 and 2 comprised of 6 weeks in closed loop, preceded by 2 weeks in open loop. This was followed by stage 3, whereby participants changed directly back to the insulin formulation used in stage 1 for 1 week in closed loop. Participants chose their own meals except for two standardized meal tests, a missed meal bolus and late meal bolus. The primary outcome was the percentage of time sensor glucose values were from 70 to 180 mg/dL (time in range [TIR]).RESULTSTwenty-five adults (52% male) were recruited; the median (interquartile range) age was 48 (37, 57) years, and the median HbA1c was 7.0% (6.6, 7.2) (53 [49, 55] mmol/mol). Faster aspart demonstrated greater overall TIR compared with IAsp (82.3% [78.5, 83.7] vs. 79.6% [77.0, 83.4], respectively; mean difference 1.9% [0.5, 3.3]; P = 0.007). Four-hour postprandial glucose TIR was higher using faster aspart compared with IAsp for all meals combined (73.6% [69.4, 80.2] vs. 72.1% [64.5, 78.5], respectively; median difference 3.5% [1.0, 7.3]; P = 0.003). There was no ketoacidosis or severe hypoglycemia.CONCLUSIONSFaster aspart safely improved glucose control compared with IAsp in a group of adults with well-controlled type 1 diabetes using AHCL. The modest improvement was mainly related to mealtime glycemia. While the primary outcome demonstrated statistical significance, the clinical impact may be small, given an overall difference in TIR of 1.9%.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0814
      Issue No: Vol. 44, No. 10 (2021)
       
  • Advanced Closed-Loop Control System Improves Postprandial Glycemic Control
           Compared With a Hybrid Closed-Loop System Following Unannounced Meal

    • Free pre-print version: Loading...

      Authors: Garcia-Tirado; J.; Diaz, J. L.; Esquivel-Zuniga, R.; Koravi, C. L. K.; Corbett, J. P.; Dawson, M.; Wakeman, C.; Barnett, C. L.; Oliveri, M. C.; Myers, H.; Krauthause, K.; Breton, M. D.; DeBoer, M. D.
      Pages: 2379 - 2387
      Abstract: OBJECTIVEMeals are a major hurdle to glycemic control in type 1 diabetes (T1D). Our objective was to test a fully automated closed-loop control (CLC) system in the absence of announcement of carbohydrate ingestion among adolescents with T1D, who are known to commonly omit meal announcement.RESEARCH DESIGN AND METHODSEighteen adolescents with T1D (age 15.6 ± 1.7 years; HbA1c 7.4 ± 1.5%; 9 females/9 males) participated in a randomized crossover clinical trial comparing our legacy hybrid CLC system (Unified Safety System Virginia [USS]-Virginia) with a novel fully automated CLC system (RocketAP) during two 46-h supervised admissions (each with one announced and one unannounced dinner), following 2 weeks of data collection. Primary outcome was the percentage time-in-range 70–180 mg/dL (TIR) following the unannounced meal, with secondary outcomes related to additional continuous glucose monitoring-based metrics.RESULTSBoth TIR and time-in-tight-range 70–140 mg/dL (TTR) were significantly higher using RocketAP than using USS-Virginia during the 6 h following the unannounced meal (83% [interquartile range 64–93] vs. 53% [40–71]; P = 0.004 and 49% [41–59] vs. 27% [22–36]; P = 0.002, respectively), primarily driven by reduced time-above-range (TAR >180 mg/dL: 17% [1.3–34] vs. 47% [28–60]), with no increase in time-below-range (TBR
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0932
      Issue No: Vol. 44, No. 10 (2021)
       
  • Cognitive Functioning and Hippocampal Connectivity in Patients With
           Longstanding Type 1 Diabetes and Apolipoprotein E {varepsilon}4

    • Free pre-print version: Loading...

      Authors: van Duinkerken; E.; IJzerman, R. G.; Barkhof, F.; Moll, A. C.; Diamant, M.; Snoek, F. J.; Klein, M.
      Pages: 2388 - 2396
      Abstract: OBJECTIVEWhile the apolipoprotein E 4 allele (ApoE-4) is related to cognitive and brain decline in the general population, its effect on the brain in type 1 diabetes mellitus (T1DM) remains unclear. Therefore, the aim was to determine the interaction between ApoE-4 and T1DM on cognitive performance and hippocampal structure and connectivity as the brain area most vulnerable to ApoE-4 effects in adult patients with T1DM.RESEARCH DESIGN AND METHODSBlood sampling was performed in 104 patients with T1DM and 49 control subjects for ApoE genotyping, neuropsychology, and neuroimaging to determine hippocampal volume and resting-state connectivity. The interaction between T1DM status and ApoE-4 presence was investigated and adjusted for age and mean systolic blood pressure.RESULTSApoE genotyping could not be performed for three patients with T1DM. Significant interaction effects, indicating a differential effect of ApoE-4 between both groups, were found for overall cognitive functioning and for the subdomains of information processing speed and attention. Additionally, interaction effects were present for right hippocampal connectivity with the right posterior cingulate and supramarginal gyri. Subsequent group analysis showed that patients with T1DM with ApoE-4 performed worse on these cognitive domains with increased connectivity, relative to their counterparts without ApoE-4. In contrast, no cognitive effects, but decreased connectivity, were observed in control subjects with ApoE-4. In patients with T1DM, higher right hippocampus connectivity with the posterior cingulate gyrus was related to poorer overall cognitive functioning.CONCLUSIONSThe results may suggest that ApoE-4 presence leaves our patients with T1DM more susceptible to cognitive decrements at a younger age, possibly through vascular pathways, warranting further longitudinal studies.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0483
      Issue No: Vol. 44, No. 10 (2021)
       
  • Eye Outcomes in Veteran Affairs Diabetes Trial (VADT) After 17 Years

    • Free pre-print version: Loading...

      Authors: Azad; N.; Agrawal, L.; Bahn, G.; Emanuele, N. V.; Reaven, P. D.; Hayward, R.; Reda, D.; for the VADT Study Group
      Pages: 2397 - 2402
      Abstract: OBJECTIVEThe objective of this study was to assess the long-term role of intensive glycemic control (INT) compared with standard glycemic control in accumulated eye procedures in patients with advanced diabetes.RESEARCH DESIGN AND METHODSWe compared the effect of treatment assignment on the accumulated number of eye procedures during the intervention period of the Veteran Affairs Diabetes Trial (VADT) (2000–2008) (median follow-up 5.6 years), the interim VADT follow-up study (2000–2013), and the full 17 years of VADT follow-up (2000–2017). We further analyzed data using various cardiovascular markers in two models. Model I included total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, and BMI. Model II included these covariates plus age and diabetic retinopathy (DR) severity score at baseline of the original trial.RESULTSThe final analysis of the data showed a mild but nonsignificant increase in number of procedures and in retinal or retinal plus cataract surgery during the three periods of the study.CONCLUSIONSWe found no significant benefit of INT during the original trial period in eye-related procedures, such as various procedures for DR, or during the 17 years of follow-up in cataract surgery. However, after adjusting data for some known vascular markers, the increase in the number of eye procedures with INT becomes more prevalent. This finding indicates that INT might not have a protective role in events requiring surgery in individuals with advanced diabetes.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-2882
      Issue No: Vol. 44, No. 10 (2021)
       
  • Replacement of Sedentary Behavior by Various Daily-Life Physical
           Activities and Structured Exercises: Genetic Risk and Incident Type 2
           Diabetes

    • Free pre-print version: Loading...

      Authors: Li; X.; Zhou, T.; Ma, H.; Liang, Z.; Fonseca, V. A.; Qi, L.
      Pages: 2403 - 2410
      Abstract: OBJECTIVETo prospectively analyze the association of sedentary behavior time with type 2 diabetes (T2D) risk and perform the isotemporal substitution analyses to estimate the effect of substitution of sedentary behaviors by equal time of different types of daily-life physical activities and structured exercise. We also examined modifications by the genetic predisposition to T2D.RESEARCH DESIGN AND METHODSWe included 475,502 participants free of T2D in the UK Biobank. Sedentary time was quantified by summing up the time spent on television watching, computer use, and driving.RESULTSDuring a median follow-up of 11 years, we documented 18,169 incident T2D cases. In comparison of the extreme categories (≥6 vs.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0455
      Issue No: Vol. 44, No. 10 (2021)
       
  • Identification and Predictors for Cardiovascular Disease Risk Equivalents
           Among Adults With Diabetes

    • Free pre-print version: Loading...

      Authors: Zhao; Y.; Malik, S.; Budoff, M. J.; Correa, A.; Ashley, K. E.; Selvin, E.; Watson, K. E.; Wong, N. D.
      Pages: 2411 - 2418
      Abstract: OBJECTIVEWe examined diabetes as a cardiovascular disease (CVD) risk equivalent based on diabetes severity and other CVD risk factors.RESEARCH DESIGN AND METHODSWe pooled four U.S. cohorts (Atherosclerosis Risk in Communities [ARIC], Jackson Heart Study [JHS], Multi-Ethnic Study of Atherosclerosis [MESA], and Framingham Heart Study Offspring Cohort [FHS-Offspring]) and classified subjects into groups by baseline diabetes/CVD status (positive or negative). CVD risks of the diabetes mellitus (DM)+/CVD– group versus DM–/CVD+ group were examined by diabetes severity and in subgroups of other CVD risk factors. We developed an algorithm to identify subjects with CVD risk equivalent diabetes by comparing the relative CVD risk of being DM+/CVD– versus DM–/CVD+.RESULTSThe pooled cohort included 27,730 subjects (mean age 58.5 years, 44.6% male). CVD rates per 1,000 person-years were 16.5, 33.4, 43.2, and 71.4 among those DM–/CVD–, DM+/CVD–, DM–/CVD+, and DM+/CVD+, respectively. Compared with those DM–/CVD+, CVD risks were similar or higher for those with HbA1c ≥ 7%, diabetes duration ≥10 years, or diabetes medication use, while those with less severe diabetes had lower risks. Hazard ratios (95% CI) for DM+/CVD– vs. DM–/CVD+ were 0.96 (95% CI 0.86–1.07), 0.97 (0.88–1.07), 0.96 (0.82–1.13), 1.18 (0.98–1.41), 0.93 (0.85–1.02), and 1.00 (0.89–1.13) among women and those of White race, age
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0431
      Issue No: Vol. 44, No. 10 (2021)
       
  • Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Retinal Vein
           Occlusion Among Patients With Type 2 Diabetes: A Propensity Score-Matched
           Cohort Study

    • Free pre-print version: Loading...

      Authors: Lee; M.-K.; Kim, B.; Han, K.; Lee, J.-H.; Kim, M.; Kim, M. K.; Baek, K.-H.; Song, K.-H.; Kwon, H.-S.; Roh, Y.-J.
      Pages: 2419 - 2426
      Abstract: OBJECTIVETo assess the association between use of sodium–glucose cotransporter 2 (SGLT2) inhibitors and retinal vein occlusion (RVO) using data from the National Health Insurance Service in South Korea.RESEARCH DESIGN AND METHODSWe used an active comparator, new user design, and nationwide data from 2014 to 2017. Based on a 1:1 propensity score match, we included 47,369 new users of SGLT2 inhibitors and 47,369 users of other glucose-lowering drugs (oGLDs). In the matched sample, we used the Cox proportional hazards model to estimate hazard ratios (HRs) with 95% CIs for developing RVO. Based on the main outcome, exploratory subgroup analyses were undertaken.RESULTSDuring a follow-up of 2.57 years, the incidence rate of RVO was 2.19 and 1.79 per 1,000 person-years in patients treated with SGLT2 inhibitors and oGLDs, respectively. The new use of SGLT2 inhibitors was associated with an increased risk of RVO compared with oGLD use (HR 1.264 [95% CI 1.056, 1.513]). In the subgroup analyses, a significant interaction with SGLT2 inhibitors was observed for age and estimated glomerular filtration rate (eGFR); the HR for RVO was higher in patients aged ≥60 years and those with eGFR
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc20-3133
      Issue No: Vol. 44, No. 10 (2021)
       
  • Preintervention Clinical Determinants and Measured {beta}-Cell Function as
           Predictors of Type 2 Diabetes Remission After Roux-en-Y Gastric Bypass
           Surgery

    • Free pre-print version: Loading...

      Authors: Ligon; C.; Shah, A.; Prasad, M.; Laferrere, B.
      Pages: 2427 - 2434
      Abstract: OBJECTIVEBariatric surgery results in improved glycemic control in individuals with type 2 diabetes. Single and clusters of clinical determinants have been identified as presurgery predictors of postsurgery diabetes remission. Our goal was to assess whether the addition of measured preoperative β-cell function would improve established clinical models of prediction of diabetes remission.RESEARCH DESIGN AND METHODSPresurgery clinical characteristics, metabolic markers, and β-cell function after oral and intravenous (IV) glucose challenges were assessed in 73 individuals with severe obesity and type 2 diabetes and again 1 year after gastric bypass surgery. Single and multivariate analyses were conducted with preoperative variables to determine the best predictive models of remission.RESULTSPresurgery β-cell glucose sensitivity, a surrogate of β-cell function, was negatively correlated with known diabetes duration, HbA1c, insulin use, and the diabetes remission scores DiaRem and advanced (Ad)-DiaRem (all P < 0.001). Measured β-cell function after oral glucose was 1.6-fold greater than after the IV glucose challenge and more strongly correlated with preoperative clinical and metabolic characteristics. The addition of preoperative β-cell function to clinical models containing well-defined diabetes remission scores did not improve the model’s ability to predict diabetes remission after Roux-en-Y gastric bypass.CONCLUSIONSThe addition of measured β-cell function does not add predictive value to defined clinical models of diabetes remission 1 year after surgical weight loss.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0395
      Issue No: Vol. 44, No. 10 (2021)
       
  • Oral Glucose Tolerance Test Predicts Episodic Memory Decline: A 10-Year
           Population-Based Follow-up Study

    • Free pre-print version: Loading...

      Authors: Toppala; S.; Ekblad, L. L.; Viitanen, M.; Rinne, J. O.; Jula, A.
      Pages: 2435 - 2437
      Abstract: OBJECTIVETo examine if the 2-h value of an oral glucose tolerance test (OGTT) can predict cognitive decline.RESEARCH DESIGN AND METHODSThis study is based on a subpopulation of the Finnish population-based Health 2000 Survey and its follow-up, the Health 2011 study. Altogether, 961 individuals aged 45–74 (mean 55.6 years; 55.8% women) underwent OGTT in 2001–2002. Categorical verbal fluency, word-list learning, and word-list delayed recall were tested at baseline and at follow-up in 2011. Statistical analyses were performed with multivariable linear models adjusted for previously reported risk factors for cognitive decline.RESULTSA higher 2-h glucose value in the OGTT at baseline predicted worse performance (slope: –0.08; P = 0.01) and greater decline (slope: –0.07; P = 0.007) in the word-list delayed recall test after 10 years.CONCLUSIONSOur results indicate that higher 2-h glucose values in the OGTT predict a decline in episodic memory after 10 years.
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-0042
      Issue No: Vol. 44, No. 10 (2021)
       
  • Consensus Report: Definition and Interpretation of Remission in Type 2
           Diabetes

    • Free pre-print version: Loading...

      Authors: Riddle; M. C.; Cefalu, W. T.; Evans, P. H.; Gerstein, H. C.; Nauck, M. A.; Oh, W. K.; Rothberg, A. E.; le Roux, C. W.; Rubino, F.; Schauer, P.; Taylor, R.; Twenefour, D.
      Pages: 2438 - 2444
      Abstract: Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dci21-0034
      Issue No: Vol. 44, No. 10 (2021)
       
  • Diabetic Truncal Neuropathy--Clinical and Radiological Image

    • Free pre-print version: Loading...

      Authors: Frey; S. E.; Riggs, J. E.
      Pages: 2445 - 2446
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-1235
      Issue No: Vol. 44, No. 10 (2021)
       
  • Erratum. Associations Between Exposure to Gestational Diabetes Mellitus In
           Utero and Daily Energy Intake, Brain Responses to Food Cues, and Adiposity
           in Children. Diabetes Care 2021;44:1185-1193

    • Free pre-print version: Loading...

      Authors: Luo; S.; Angelo, B. C.; Chow, T.; Monterosso, J. R.; Thompson, P. M.; Xiang, A. H.; Page, K. A.
      Pages: 2447 - 2447
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-er10
      Issue No: Vol. 44, No. 10 (2021)
       
  • Issues and Events

    • Free pre-print version: Loading...

      Pages: 2448 - 2448
      PubDate: 2021-10-07T12:05:28-07:00
      DOI: 10.2337/dc21-ie10
      Issue No: Vol. 44, No. 10 (2021)
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 3.236.232.99
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-