Journal Cover Diabetes Care
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   ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
   Published by American Diabetes Association Homepage  [4 journals]
  • Comment on Gagnum et al. Long-term Mortality and End-Stage Renal Disease
           in a Type 1 Diabetes Population Diagnosed at Age 15-29 Years in Norway.
           Diabetes Care 2017;40:38-45
    • Authors: Sun; X.; Shan, P.-F.; Ding, Y.; Yu, H.; Song, Z.-Y.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dc17-0420
      Issue No: Vol. 40, No. 9 (2017)
       
  • Response to Comment on Gagnum et al. Long-term Mortality and End-Stage
           Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15-29 Years
           in Norway. Diabetes Care 2017;40:38-45
    • Authors: Gagnum; V.; Stene, L. C.; Leivestad, T.; Joner, G.; Skrivarhaug, T.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dci17-0018
      Issue No: Vol. 40, No. 9 (2017)
       
  • Comment on Young-Hyman et al. Psychosocial Care for People With Diabetes:
           A Position Statement of the American Diabetes Association. Diabetes Care
           2016;39:2126-2140
    • Authors: Kalra; S.; Balhara, Y. P. S.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dc16-2599
      Issue No: Vol. 40, No. 9 (2017)
       
  • Comment on Young-Hyman et al. Psychosocial Care for People With Diabetes:
           A Position Statement of the American Diabetes Association. Diabetes Care
           2016;39:2126-2140
    • Authors: Mezuk; B.; Pouwer, F.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dc16-2694
      Issue No: Vol. 40, No. 9 (2017)
       
  • Comment on Young-Hyman et al. Psychosocial Care for People With Diabetes:
           A Position Statement of the American Diabetes Association. Diabetes Care
           2016;39:2126-2140
    • Authors: Macdonald; G. C.; Campbell, L. V.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dc16-2718
      Issue No: Vol. 40, No. 9 (2017)
       
  • Response to Comments on Young-Hyman et al. Psychosocial Care for People
           With Diabetes: A Position Statement of the American Diabetes Association.
           Diabetes Care 2016;39:2126-2140
    • Authors: Young-Hyman; D.; de Groot, M.; Hill-Briggs, F.; Gonzalez, J.; Hood, K.; Peyrot, M.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dci16-0051
      Issue No: Vol. 40, No. 9 (2017)
       
  • Comment on Timmers et al. Resveratrol as Add-on Therapy in Subjects With
           Well-Controlled Type 2 Diabetes: A Randomized Controlled Trial. Diabetes
           Care 2016;39:2211-2217
    • Authors: Mendez-del Villar; M.; Gonzalez-Ortiz, M.; Martinez-Abundis, E.; Perez-Rubio, K. G.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dc17-0465
      Issue No: Vol. 40, No. 9 (2017)
       
  • Response to Comment on Timmers et al. Resveratrol as Add-on Therapy in
           Subjects With Well-Controlled Type 2 Diabetes: A Randomized Controlled
           Trial. Diabetes Care 2016;39:2211-2217
    • Authors: de Ligt; M.; Timmers, S.; Schrauwen, P.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dci17-0019
      Issue No: Vol. 40, No. 9 (2017)
       
  • Comment on Ekblad et al. Insulin Resistance Predicts Cognitive Decline: An
           11-Year Follow-up of a Nationally Representative Adult Population Sample.
           Diabetes Care 2017;40:751-758
    • Authors: Ayubi; E.; Safiri, S.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dc17-0876
      Issue No: Vol. 40, No. 9 (2017)
       
  • Response to Comment by Ayubi and Safiri. Insulin Resistance Predicts
           Cognitive Decline: An 11-Year Follow-up of a Nationally Representative
           Adult Population Sample. Diabetes Care 2017;40:751-758
    • Authors: Ekblad; L. L.; Rinne, J. O.; Puukka, P.; Laine, H.; Ahtiluoto, S.; Sulkava, R.; Viitanen, M.; Jula, A.
      PubDate: 2017-08-22T12:04:09-07:00
      DOI: 10.2337/dci17-0023
      Issue No: Vol. 40, No. 9 (2017)
       
  • The Relationship of Serum Soluble Receptor for Advanced Glycation End
           Products (sRAGE) and Carboxymethyl Lysine (CML) to the Incidence of
           Diabetic Nephropathy in Persons With Type 1 Diabetes
    • Authors: Klein; R.; Horak, K.; Lee, K. E.; Danforth, L.; Cruickshanks, K. J.; Tsai, M. Y.; Gangnon, R. E.; Klein, B. E. K.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0421
      Issue No: Vol. 40, No. 9 (2017)
       
  • Insulin-Associated Weight Gain in Type 2 Diabetes Is Associated With
           Increases in Sedentary Behavior
    • Authors: Hartman; Y. A. W.; Jansen, H. J.; Hopman, M. T. E.; Tack, C. J.; Thijssen, D. H. J.
      Keywords: Exercise
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0787
      Issue No: Vol. 40, No. 9 (2017)
       
  • High Illicit Drug Abuse and Suicide in Organ Donors With Type 1 Diabetes
    • Authors: Jacobsen; L. M.; Haller, M. J.; Parish, A.; Gurka, M. J.; Levine, S. R.; Wasserfall, C.; Campbell-Thompson, M.; Kaddis, J.; Pugliese, A.; Atkinson, M. A.; Schatz, D. A.
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0996
      Issue No: Vol. 40, No. 9 (2017)
       
  • In This Issue of Diabetes Care
    • Pages: 1137 - 1138
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-ti09
      Issue No: Vol. 40, No. 9 (2017)
       
  • Declines in the Incidence of Diabetes in the U.S.--Real Progress or
           Artifact'
    • Authors: Selvin; E.; Ali, M. K.
      Pages: 1139 - 1143
      Abstract: National surveillance data show a sustained decline in the incidence rate of diagnosed diabetes, which has been heralded as a success in the battle against diabetes in the U.S. In this Perspective, we take a closer look at these data and provide additional insights to help interpret these trends. We examine multiple sources of data on the prevalence and incidence of diabetes in the U.S. as well as data on trends in diabetes risk factors to provide context for these national surveillance findings. Although some of the incidence decline may represent real progress against diabetes, it is likely that there are also nonbiological factors at play, especially changes in diagnostic criteria for diabetes. We present and discuss data that suggest improved detection and changes in screening and diagnostic practices may have resulted in the depletion of the "susceptible population." Providing this context for the recent declines in new diabetes diagnoses observed in national data is critical to help avoid misinterpretation. We argue that it is premature to declare victory against the epidemic of diabetes in the U.S. and discuss how we might better focus current public health efforts, including a specific emphasis to address prediabetes.
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-2442
      Issue No: Vol. 40, No. 9 (2017)
       
  • Composite Primary End Points in Cardiovascular Outcomes Trials Involving
           Type 2 Diabetes Patients: Should Unstable Angina Be Included in the
           Primary End Point'
    • Authors: Marx; N.; McGuire, D. K.; Perkovic, V.; Woerle, H.-J.; Broedl, U. C.; von Eynatten, M.; George, J. T.; Rosenstock, J.
      Pages: 1144 - 1151
      Abstract: Reductions in cardiovascular (CV) outcomes in recently reported trials, along with the recent approval by the U.S. Food and Drug Administration of an additional indication for empagliflozin to reduce the risk of CV death in type 2 diabetes patients with evidence of CV disease, have renewed interest in CV outcome trials (CVOTs) of glucose-lowering drugs. Composite end points are a pragmatic necessity in CVOTs to ensure that sample size and duration of follow-up remain reasonable. Combining clinical outcomes into a composite end point increases the numbers of events ascertained and thus statistical power and precision. Historically, composite CV end points in diabetes trials have included a larger number of components, while more recent CVOTs almost exclusively use a composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke—the so-called three-point major adverse CV event (3P-MACE) composite—or add hospitalization for unstable angina (HUA) to these three outcomes (4P-MACE). The inclusion of HUA increases the number of events for analysis, but noteworthy disadvantages include clinical subjectivity in ascertainment of HUA and its lower prognostic relevance compared with CV death, MI, or stroke. Furthermore, results from recent CVOTs indicate that glucose-lowering agents seem to have minimal impact on HUA. Its inclusion therefore potentially favors a shift of the hazard ratio (HR) toward the null, which is especially problematic in trials designed to demonstrate noninferiority. The primary outcome of 3P-MACE may offer a better balance than 4P-MACE between statistical efficiency, operational complexity, the likelihood of diagnostic precision (and therefore clinical relevance) for each of the component outcomes, clinical importance, and the aim to adequately capture any potential treatment effect of the intervention. Nevertheless, as individual medications may mechanistically differ in their impact on CV outcomes, no particular individual or composite end point can be seen as a "gold standard" for CVOTs of all glucose-lowering drugs.
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0068
      Issue No: Vol. 40, No. 9 (2017)
       
  • The War Is Not Yet Won
    • Authors: Young; L. A.; Buse, J. B.
      Pages: 1152 - 1153
      Keywords: Epidemiology-Other
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dci17-0008
      Issue No: Vol. 40, No. 9 (2017)
       
  • George Alberti: A Myriad of Contributions to Diabetes and Beyond
    • Authors: Home; P.
      Pages: 1154 - 1158
      Keywords: Profiles in Progress
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dci17-0006
      Issue No: Vol. 40, No. 9 (2017)
       
  • Diabetes in a Large Dementia Cohort: Clinical Characteristics and
           Treatment From the Swedish Dementia Registry
    • Authors: Secnik; J.; Cermakova, P.; Fereshtehnejad, S.-M.; Dannberg, P.; Johnell, K.; Fastbom, J.; Winblad, B.; Eriksdotter, M.; Religa, D.
      Pages: 1159 - 1166
      Abstract: OBJECTIVEWe aimed to investigate the differences in clinical characteristics and pharmacological treatment associated with the presence of diabetes in a large cohort of patients with dementia.RESEARCH DESIGN AND METHODSA cross-sectional registry-based study was conducted using data from the Swedish Dementia Registry (SveDem). Data on dementia diagnosis, dementia type, and demographic determinants were extracted from SveDem. Data from the Swedish Patient Register and Prescribed Drug Register were combined for the diagnosis of diabetes. Data on antidiabetic, dementia, cardiovascular, and psychotropic medications were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to determine whether the variables were associated with diabetes after adjustment for confounders. In total, 29,630 patients were included in the study, and 4,881 (16.5%) of them received a diagnosis of diabetes.RESULTSIn the fully adjusted model, diabetes was associated with lower age at dementia diagnosis (odds ratio [OR] 0.97 [99% CI 0.97–0.98]), male sex (1.41 [1.27–1.55]), vascular dementia (1.17 [1.01–1.36]), and mixed dementia (1.21 [1.06–1.39]). Dementia with Lewy bodies (0.64 [0.44–0.94]), Parkinson disease dementia (0.46 [0.28–0.75]), and treatment with antidepressants (0.85 [0.77–0.95]) were less common among patients with diabetes. Patients with diabetes who had Alzheimer disease obtained significantly less treatment with cholinesterase inhibitors (0.78 [0.63–0.95]) and memantine (0.68 [0.54–0.85]).CONCLUSIONSPatients with diabetes were younger at dementia diagnosis and obtained less dementia medication for Alzheimer disease, suggesting less optimal dementia treatment. Future research should evaluate survival and differences in metabolic profile in patients with diabetes and different dementia disorders.
      Keywords: Epidemiology-Aging
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-2516
      Issue No: Vol. 40, No. 9 (2017)
       
  • My Child Is Islet Autoantibody Positive: Impact on Parental Anxiety
    • Authors: Johnson; S. B.; Lynch, K. F.; Roth, R.; Schatz, D.; the TEDDY Study Group
      Pages: 1167 - 1172
      Abstract: OBJECTIVETo assess parent anxiety in response to genetic and islet autoantibody (IA) testing in children at increased genetic risk for type 1 diabetes followed from birth in The Environmental Determinants of Diabetes in the Young (TEDDY) study.RESEARCH DESIGN AND METHODSParent anxiety about TEDDY children’s risk was assessed with the State Anxiety Inventory (SAI). Parents completed the SAI when the child was 3, 6, and 15 months old and annually thereafter. Children were tested for IA every 3 months for 4 years and every 6 months thereafter. Parent SAI scores of 6,799 children followed with IA testing for at least 1 and up to 6 years were examined.RESULTSAt study inception, parents showed high levels of anxiety in response to their child’s increased genetic type 1 diabetes risk; mothers were more anxious than fathers, and parents with diabetes in the family were more anxious than parents with no family history. In response to repeated IA-negative (IA–) test results, parent anxiety declined to normal levels. Anxiety increased in parents faced with an IA-positive (IA+) test result. Parents faced with two or more types of IA+ test results showed particularly high levels of anxiety (all P < 0.001).CONCLUSIONSInfant genetic screening for type 1 diabetes raises parent anxiety when the child is at increased risk, but anxiety dissipates over time in cases of repeated IA– results. IA+ results heighten parent anxiety, and parents faced with two or more types of IA+ results may experience considerable anxiety for longer periods.
      Keywords: Psychosocial, Behavioral Medicine
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0166
      Issue No: Vol. 40, No. 9 (2017)
       
  • Improvement in Glycemic Control of Type 2 Diabetes After Successful
           Treatment of Hepatitis C Virus
    • Authors: Hum; J.; Jou, J. H.; Green, P. K.; Berry, K.; Lundblad, J.; Hettinger, B. D.; Chang, M.; Ioannou, G. N.
      Pages: 1173 - 1180
      Abstract: OBJECTIVEHepatitis C virus (HCV) infection is associated with diabetes and may worsen glycemic control in patients with diabetes. We aimed to investigate whether eradication of HCV infection with direct-acting antiviral (DAA) agents is associated with improved glycemic control in patients with diabetes.RESEARCH DESIGN AND METHODSWe identified 2,435 patients with diabetes who underwent interferon-free and ribavirin-free DAA-based antiviral treatment for HCV in the national Veterans Affairs health care system. Changes in average hemoglobin A1c (HbA1c) level and use of antidiabetic medications 1 year before and after antiviral treatment were compared between patients who achieved sustained virologic response (SVR) and those who did not.RESULTSAmong patients with elevated baseline HbA1c, the drop in HbA1c associated with antiviral treatment was greater in those who achieved SVR (0.98%) than in those who sustained treatment failure (0.65%) (adjusted mean difference 0.34, P = 0.02). Use of antidiabetic medications decreased more in patients who achieved SVR than in those who sustained treatment failure, especially for the use of insulin, which dropped significantly from 41.3% to 38% in patients achieving SVR compared with a slight increase from 49.8% to 51% in those who sustained treatment failure.CONCLUSIONSDAA-based eradication of HCV is associated with improved glycemic control in patients with diabetes as evidenced by decreased mean HbA1c and decreased insulin use. These endocrine benefits of SVR provide additional justification for considering antiviral treatment in all patients with diabetes.
      Keywords: Integrated Physiology-Liver
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0485
      Issue No: Vol. 40, No. 9 (2017)
       
  • Poor Reliability and Poor Adherence to Self-Monitoring of Blood Glucose
           Are Common in Women With Gestational Diabetes Mellitus and May Be
           Associated With Poor Pregnancy Outcomes
    • Authors: Cosson; E.; Baz, B.; Gary, F.; Pharisien, I.; Nguyen, M. T.; Sandre-Banon, D.; Jaber, Y.; Cussac-Pillegand, C.; Banu, I.; Carbillon, L.; Valensi, P.
      Pages: 1181 - 1186
      Abstract: OBJECTIVETo evaluate the compliance with self-monitoring of blood glucose (SMBG) and the reliability of diabetes logbooks in women with gestational diabetes mellitus (GDM), as well as the associated determinants and outcomes.RESEARCH DESIGN AND METHODSWe prospectively selected French-speaking women with newly diagnosed GDM who had been referred to our diabetes management program and understood SMBG principles. At the next follow-up visit, we collected SMBG results from glucose meters and logbooks. We analyzed pregnancy outcomes.RESULTSData were analyzed over 13 ± 3 days in 91 women. Only 61.5% had performed ≥80% of the required tests. Poor compliance was associated with a family history of diabetes, social deprivation, and non-European origin. The average time between pre- and postprandial tests was 141 ± 20 min, with 46.5% of women performing ≥80% of postprandial measurements 100–140 min after meals. Inadequate timing was associated with ethnicity and higher HbA1c at baseline. A total of 23.1% of women had
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0369
      Issue No: Vol. 40, No. 9 (2017)
       
  • Hemoglobin A1c Variability Predicts Symptoms of Depression in Elderly
           Individuals With Type 2 Diabetes
    • Authors: Ravona-Springer; R.; Heymann, A.; Schmeidler, J.; Moshier, E.; Guerrero-Berroa, E.; Soleimani, L.; Sano, M.; Leroith, D.; Preiss, R.; Tzukran, R.; Silverman, J. M.; Beeri, M. S.
      Pages: 1187 - 1193
      Abstract: OBJECTIVEThis study aimed to analyze the relationship of variability in hemoglobin A1c (HbA1c) over years with subsequent depressive symptoms.RESEARCH DESIGN AND METHODSSubjects (n = 837) were participants of the Israel Diabetes and Cognitive Decline (IDCD) study, which aimed to examine the relationship of characteristics of long-term type 2 diabetes with cognitive decline. All pertain to a diabetes registry established in 1998, which contains an average of 18 HbA1c measurements per subject. The results presented here are based on the IDCD baseline examination. Symptoms of depression were assessed using the 15-item version of the Geriatric Depression Scale (GDS). To quantify the association between variability in glycemic control (measured as the SD of HbA1c measurements [HbA1c-SD]) since 1998 with the number of depression symptoms at IDCD baseline, incidence rate ratios (IRRs) and corresponding 95% CIs were estimated via negative binomial regression modeling and used to account for the overdispersion in GDS scores.RESULTSSubjects’ ages averaged 72.74 years (SD 4.63 years), and the mean number of years in the diabetes registry was 8.7 (SD 2.64 years). The mean GDS score was 2.16 (SD 2.26); 10% of subjects had a GDS score ≥6, the cutoff for clinically significant depression. Mean HbA1c significantly correlated with HbA1c-SD (r = 0.6625; P < 0.0001). The SD, but not the mean, of HbA1c measurements was significantly associated with the number of subsequent depressive symptoms. For each additional 1% increase in HbA1c-SD, the number of depressive symptoms increased by a factor of 1.31 (IRR = 1.31 [95% CI 1.03–1.67]; P = 0.03).CONCLUSIONSVariability in glycemic control is associated with more depressive symptoms.
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-2754
      Issue No: Vol. 40, No. 9 (2017)
       
  • Genetic and Environmental Interactions Modify the Risk of Diabetes-Related
           Autoimmunity by 6 Years of Age: The TEDDY Study
    • Authors: Krischer; J. P.; Lynch, K. F.; Lernmark, A.; Hagopian, W. A.; Rewers, M. J.; She, J.-X.; Toppari, J.; Ziegler, A.-G.; Akolkar, B.; the TEDDY Study Group
      Pages: 1194 - 1202
      Abstract: OBJECTIVEWe tested the associations between genetic background and selected environmental exposures with respect to islet autoantibodies and type 1 diabetes.RESEARCH DESIGN AND METHODSInfants with HLA-DR high-risk genotypes were prospectively followed for diabetes-related autoantibodies. Single nucleotide polymorphisms (SNPs) came from the Illumina ImmunoChip and environmental exposure data were by parental report. Children were followed to age 6 years.RESULTSInsulin autoantibodies occurred earlier than GAD antibody (GADA) and then declined, while GADA incidence rose and remained constant (significant in HLA-DR4 but not in the DR3/3 children). The presence of SNPs rs2476601 (PTPN22) and rs2292239 (ERBB3) demonstrated increased risk of both autoantibodies to insulin (IAA) only and GADA only. SNP rs689 (INS) was protective of IAA only, but not of GADA only. The rs3757247 (BACH2) SNP demonstrated increased risk of GADA only. Male sex, father or sibling as the diabetic proband, introduction of probiotics under 28 days of age, and weight at age 12 months were associated with IAA only, but only father as the diabetic proband and weight at age 12 months were associated with GADA only. Mother as the diabetic proband was not a significant risk factor.CONCLUSIONSThese results show clear differences in the initiation of autoimmunity according to genetic factors and environmental exposures that give rise to IAA or GADA as the first appearing indication of autoimmunity.
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0238
      Issue No: Vol. 40, No. 9 (2017)
       
  • Cardiac Stress and Inflammatory Markers as Predictors of Heart Failure in
           Patients With Type 2 Diabetes: The ADVANCE Trial
    • Authors: Ohkuma; T.; Jun, M.; Woodward, M.; Zoungas, S.; Cooper, M. E.; Grobbee, D. E.; Hamet, P.; Mancia, G.; Williams, B.; Welsh, P.; Sattar, N.; Shaw, J. E.; Rahimi, K.; Chalmers, J.; on behalf of the ADVANCE Collaborative Group
      Pages: 1203 - 1209
      Abstract: OBJECTIVEThis study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSA nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.RESULTSA higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP.CONCLUSIONSOnly NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0509
      Issue No: Vol. 40, No. 9 (2017)
       
  • Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated
           With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study
    • Authors: Li; T.-C.; Yang, C.-P.; Tseng, S.-T.; Li, C.-I.; Liu, C.-S.; Lin, W.-Y.; Hwang, K.-L.; Yang, S.-Y.; Chiang, J.-H.; Lin, C.-C.
      Pages: 1210 - 1217
      Abstract: OBJECTIVEThe relationship between glycemic variability and the incidence of Alzheimer disease (AD) in patients with type 2 diabetes mellitus (T2DM) is unclear. The aim of this study was to examine visit-to-visit variations in fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) represented by the coefficient of variation (CV) and to determine whether they were independently associated with AD, irrespective of HbA1c and other traditional risk factors in such patients.RESEARCH DESIGN AND METHODSPatients with T2DM enrolled in the National Diabetes Care Management Program, age ≥60 years, and without diagnosis of AD (n = 16,706) were included in the study. Potential risk factors were analyzed using extended Cox proportional hazards regression models for competing risk of mortality on AD incidence.RESULTSDuring a median follow-up of 8.88 years, 831 incident cases of AD were identified, with a crude incidence rate of 3.5/1,000 person-years. After adjustment for sociodemographic factors, lifestyle behaviors, diabetes-related variables, FPG and HbA1c, drug-related variables, and comorbidities, both FPG CV and HbA1c CV were found to be significant predictors of AD, with corresponding hazard ratios of 1.27 (95% CI 1.06–1.52) for the third tertile in FPG CV and 1.32 (95% CI 1.11–1.58) for the third tertile in HbA1c CV.CONCLUSIONSFPG CV and HbA1c CV are independently associated with AD. The associations between glycemic variability and AD demonstrated in this study suggest a linked pathophysiological mechanism, which is worthy of further investigation. Further research is required to confirm our results and to evaluate whether FPG CV and HbA1c CV can be valuable therapeutic targets for patients with T2DM at risk.
      Keywords: Epidemiology-Other
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-2238
      Issue No: Vol. 40, No. 9 (2017)
       
  • A Team-Based Online Game Improves Blood Glucose Control in Veterans With
           Type 2 Diabetes: A Randomized Controlled Trial
    • Authors: Kerfoot; B. P.; Gagnon, D. R.; McMahon, G. T.; Orlander, J. D.; Kurgansky, K. E.; Conlin, P. R.
      Pages: 1218 - 1225
      Abstract: OBJECTIVERigorous evidence is lacking whether online games can improve patients’ longer-term health outcomes. We investigated whether an online team-based game delivering diabetes self-management education (DSME) to patients via e-mail or mobile application (app) can generate longer-term improvements in hemoglobin A1c (HbA1c).RESEARCH DESIGN AND METHODSPatients (n = 456) on oral diabetes medications with HbA1c ≥58 mmol/mol were randomly assigned between a DSME game (with a civics booklet) and a civics game (with a DSME booklet). The 6-month games sent two questions twice weekly via e-mail or mobile app. Participants accrued points based on performance, with scores posted on leaderboards. Winning teams and individuals received modest financial rewards. Our primary outcome measure was HbA1c change over 12 months.RESULTSDSME game patients had significantly greater HbA1c reductions over 12 months than civics game patients (–8 mmol/mol [95% CI –10 to –7] and –5 mmol/mol [95% CI –7 to –3], respectively; P = 0.048). HbA1c reductions were greater among patients with baseline HbA1c >75 mmol/mol: –16 mmol/mol [95% CI –21 to –12] and –9 mmol/mol [95% CI –14 to –5] for DSME and civics game patients, respectively; P = 0.031.CONCLUSIONSPatients with diabetes who were randomized to an online game delivering DSME demonstrated sustained and meaningful HbA1c improvements. Among patients with poorly controlled diabetes, the DSME game reduced HbA1c by a magnitude comparable to starting a new diabetes medication. Online games may be a scalable approach to improve outcomes among geographically dispersed patients with diabetes and other chronic diseases.
      Keywords: Diabetes Education
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0310
      Issue No: Vol. 40, No. 9 (2017)
       
  • Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth
           With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study
    • Authors: Jaiswal; M.; Divers, J.; Dabelea, D.; Isom, S.; Bell, R. A.; Martin, C. L.; Pettitt, D. J.; Saydah, S.; Pihoker, C.; Standiford, D. A.; Dolan, L. M.; Marcovina, S.; Linder, B.; Liese, A. D.; Pop-Busui, R.; Feldman, E. L.
      Pages: 1226 - 1232
      Abstract: OBJECTIVEWe assessed the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the SEARCH for Diabetes in Youth (SEARCH) study.RESEARCH DESIGN AND METHODSThe Michigan Neuropathy Screening Instrument (MNSI) was used to assess DPN in 1,734 youth with T1D (mean ± SD age 18 ± 4 years, T1D duration 7.2 ± 1.2 years, and HbA1c 9.1 ± 1.9%) and 258 youth with T2D (age 22 ± 3.5 years, T2D duration 7.9 ± 2 years, and HbA1c 9.4 ± 2.3%) who were enrolled in the SEARCH study and had ≥5 years of diabetes duration. DPN was defined as an MNSI exam score of >2. Glycemic control over time was estimated as area under the curve for HbA1c.RESULTSThe prevalence of DPN was 7% in youth with T1D and 22% in youth with T2D. Risk factors for DPN in youth with T1D were older age, longer diabetes duration, smoking, increased diastolic blood pressure, obesity, increased LDL cholesterol and triglycerides, and lower HDL cholesterol (HDL-c). In youth with T2D, risk factors were older age, male sex, longer diabetes duration, smoking, and lower HDL-c. Glycemic control over time was worse among those with DPN compared with those without for youth with T1D (odds ratio 1.53 [95% CI 1.24; 1.88]) but not for youth with T2D (1.05 [0.7; 1.56]).CONCLUSIONSThe high rates of DPN among youth with diabetes are a cause of concern and suggest a need for early screening and better risk factor management. Interventions in youth that address poor glycemic control and dyslipidemia may prevent or delay debilitating neuropathic complications.
      Keywords: Complications-Neuropathy
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0179
      Issue No: Vol. 40, No. 9 (2017)
       
  • The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose,
           and HbA1c in Patients With Coronary Artery Disease: A Report From
           EUROASPIRE IV: A Survey From the European Society of Cardiology
    • Authors: Shahim; B.; De Bacquer, D.; De Backer, G.; Gyberg, V.; Kotseva, K.; Mellbin, L.; Schnell, O.; Tuomilehto, J.; Wood, D.; Ryden, L.
      Pages: 1233 - 1240
      Abstract: OBJECTIVEThree tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). This study explored the prognostic value of these screening tests in patients with coronary artery disease (CAD).RESEARCH DESIGN AND METHODSFPG, 2h-PG, and HbA1c were used to screen 4,004 CAD patients without a history of diabetes (age 18–80 years) for dysglycemia. The prognostic value of these tests was studied after 2 years of follow-up. The primary end point included cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure and a secondary end point of incident diabetes.RESULTSComplete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA1c predicted the primary outcome, whereas the 2h-PG, dichotomized as
      Keywords: Epidemiology-Clinical-Diagnosis and Screening
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0245
      Issue No: Vol. 40, No. 9 (2017)
       
  • Computed Tomography Angiography Images of Coronary Artery Stenosis Provide
           a Better Prediction of Risk Than Traditional Risk Factors in Asymptomatic
           Individuals With Type 2 Diabetes: A Long-term Study of Clinical Outcomes
    • Authors: Lee; K. Y.; Hwang, B.-H.; Kim, T.-H.; Kim, C. J.; Kim, J.-J.; Choo, E.-H.; Choi, I. J.; Choi, Y.; Park, H.-W.; Koh, Y.-S.; Kim, P.-J.; Lee, J. M.; Kim, M.-J.; Jeon, D. S.; Cho, J.-H.; Jung, J. I.; Seung, K.-B.; Chang, K.
      Pages: 1241 - 1248
      Abstract: OBJECTIVEWe investigated the efficacy of coronary computed tomography angiography (CCTA) in predicting the long-term risks in asymptomatic patients with type 2 diabetes and compared it with traditional risk factors.RESEARCH DESIGN AND METHODSWe analyzed 933 patients with asymptomatic type 2 diabetes who underwent CCTA. Stenosis was considered obstructive (≥50%) in each coronary artery segment using CCTA. The extent and severity scores for coronary artery disease (CAD) were evaluated. The primary end point was major adverse cardiovascular events (MACE), including all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization during a mean follow-up period of 5.5 ± 2.1 years.RESULTSNinety-four patients with MACE exhibited obstructive CAD with a greater extent and higher severity scores (P < 0.001 for all). After adjusting for confounding risk factors, obstructive CAD remained an independent predictor of MACE (hazard ratio 3.11 [95% CI 2.00–4.86]; P < 0.001]). The performance of a risk prediction model based on C-statistics was significantly improved (C-index 0.788 [95% CI 0.747–0.829]; P = 0.0349) upon the addition of a finding of obstructive CAD using CCTA to traditional risk factors, including age, male, hypertension, hyperlipidemia, smoking, estimated glomerular filtration rate, and HbA1c. Both integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analyses further supported this finding (IDI 0.046 [95% CI 0.020–0.072], P < 0.001, and NRI 0.55 [95% CI 0.343–0.757], P < 0.001). In contrast, the risk prediction power of the coronary artery calcium score remained unimproved (C-index 0.740, P = 0.547).CONCLUSIONSBased on our data, the addition of CCTA-detected obstructive CAD to models that include traditional risk factors improves the predictions of MACE in asymptomatic patients with type 2 diabetes.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-1844
      Issue No: Vol. 40, No. 9 (2017)
       
  • Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor
           Long-term Glycemic Control
    • Authors: Duca; L. M.; Wang, B.; Rewers, M.; Rewers, A.
      Pages: 1249 - 1255
      Abstract: OBJECTIVEThis study tested the hypothesis that diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control independently of established risk factors.RESEARCH DESIGN AND METHODSThis was a prospective cohort study of 3,364 Colorado residents diagnosed with type 1 diabetes before 18 years of age, in 1998–2012, and monitored for up to 15 years. Of those, 1,297 (39%) had DKA at diagnosis (blood glucose >250 mg/dL, and venous pH
      Keywords: Pediatrics-Type 1 Diabetes
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-0558
      Issue No: Vol. 40, No. 9 (2017)
       
  • Skeletal Muscle Microvascular-Linked Improvements in Glycemic Control From
           Resistance Training in Individuals With Type 2 Diabetes
    • Authors: Russell; R. D.; Hu, D.; Greenaway, T.; Blackwood, S. J.; Dwyer, R. M.; Sharman, J. E.; Jones, G.; Squibb, K. A.; Brown, A. A.; Otahal, P.; Boman, M.; Al-Aubaidy, H.; Premilovac, D.; Roberts, C. K.; Hitchins, S.; Richards, S. M.; Rattigan, S.; Keske, M. A.
      Pages: 1256 - 1263
      Abstract: OBJECTIVEInsulin increases glucose disposal in part by enhancing microvascular blood flow (MBF) and substrate delivery to myocytes. Insulin’s microvascular action is impaired with insulin resistance and type 2 diabetes. Resistance training (RT) improves glycemic control and insulin sensitivity, but whether this improvement is linked to augmented skeletal muscle microvascular responses in type 2 diabetes is unknown.RESEARCH DESIGN AND METHODSSeventeen (11 male and 6 female; 52 ± 2 years old) sedentary patients with type 2 diabetes underwent 6 weeks of whole-body RT. Before and after RT, participants who fasted overnight had clinical chemistries measured (lipids, glucose, HbA1c, insulin, and advanced glycation end products) and underwent an oral glucose challenge (OGC) (50 g x 2 h). Forearm muscle MBF was assessed by contrast-enhanced ultrasound, skin MBF by laser Doppler flowmetry, and brachial artery flow by Doppler ultrasound at baseline and 60 min post-OGC. A whole-body DEXA scan before and after RT assessed body composition.RESULTSAfter RT, muscle MBF response to the OGC increased, while skin microvascular responses were unchanged. These microvascular adaptations were accompanied by improved glycemic control (fasting blood glucose, HbA1c, and glucose area under the curve [AUC] during OGC) and increased lean body mass and reductions in fasting plasma triglyceride, total cholesterol, advanced glycation end products, and total body fat. Changes in muscle MBF response after RT significantly correlated with reductions in fasting blood glucose, HbA1c, and OGC AUC with adjustment for age, sex, % body fat, and % lean mass.CONCLUSIONSRT improves OGC-stimulated muscle MBF and glycemic control concomitantly, suggesting that MBF plays a role in improved glycemic control from RT.
      Keywords: Exercise
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-2750
      Issue No: Vol. 40, No. 9 (2017)
       
  • Exercise Training Improves but Does Not Normalize Left Ventricular
           Systolic and Diastolic Function in Adolescents With Type 1 Diabetes
    • Authors: Gusso; S.; Pinto, T.; Baldi, J. C.; Derraik, J. G. B.; Cutfield, W. S.; Hornung, T.; Hofman, P. L.
      Pages: 1264 - 1272
      Abstract: OBJECTIVETo determine the impact of 20 weeks of exercise training in aerobic capacity on left ventricular function and glycemic control in adolescents with and without type 1 diabetes.RESEARCH DESIGN AND METHODSFifty-three adolescents with type 1 diabetes (aged 15.6 years) were divided into two groups: exercise training (n = 38) and nontraining (n = 15). Twenty-two healthy adolescents without diabetes (aged 16.7 years) were included and, with the 38 participants with type 1 diabetes, participated in a 20-week exercise-training intervention. Assessments included VO2max and body composition. Left ventricular parameters were obtained at rest and during acute exercise using MRI.RESULTSExercise training improved aerobic capacity (10%) and stroke volume (6%) in both trained groups, but the increase in the group with type 1 diabetes remained lower than trained control subjects. Increased stroke volume in adolescents with type 1 diabetes resulted from greater left ventricular contractility (9% increase in ejection fraction and an 11% reduction in end-systolic volumes) and, to a lesser extent, improved left ventricular filling (6%), suggesting that impaired diastolic function can be affected by exercise training in adolescents with type 1 diabetes. Insulin use decreased by ~10%, but no change in glycemic status was observed.CONCLUSIONSThese data demonstrate that in adolescents, the impairment in left ventricular function seen with type 1 diabetes can be improved, although not normalized, with regular intense physical activity. Importantly, diastolic dysfunction, a common mechanism causing heart failure in older subjects with diabetes, appears to be partially reversible in this age group.
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc16-2347
      Issue No: Vol. 40, No. 9 (2017)
       
  • Diabetes and Hypertension: A Position Statement by the American Diabetes
           Association
    • Authors: de Boer; I. H.; Bangalore, S.; Benetos, A.; Davis, A. M.; Michos, E. D.; Muntner, P.; Rossing, P.; Zoungas, S.; Bakris, G.
      Pages: 1273 - 1284
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dci17-0026
      Issue No: Vol. 40, No. 9 (2017)
       
  • Erratum. Diabetic Retinopathy: A Position Statement by the American
           Diabetes Association. Diabetes Care 2017;40:412-418
    • Authors: Solomon; S. D.; Chew, E.; Duh, E. J.; Sobrin, L.; Sun, J. K.; VanderBeek, B. L.; Wykoff, C. C.; Gardner, T. W.
      Pages: 1285 - 1285
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-er09
      Issue No: Vol. 40, No. 9 (2017)
       
  • Issues and Events
    • Pages: 1286 - 1286
      PubDate: 2017-08-22T12:04:08-07:00
      DOI: 10.2337/dc17-ie09
      Issue No: Vol. 40, No. 9 (2017)
       
 
 
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