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Journal Cover Diabetes Care
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   ISSN (Print) 0149-5992 - ISSN (Online) 1935-5548
   Published by American Diabetes Association Homepage  [4 journals]
  • Trends in Diabetes-Related Preventable Hospitalizations in the U.S.,
    • Authors: Rubens; M.; Saxena, A.; Ramamoorthy, V.; Khera, R.; Hong, J.; Veledar, E.; Nasir, K.
      Keywords: Epidemiology-Diabetes Complications, Costs of Diabetes
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-1942
      Issue No: Vol. 41, No. 5 (2018)
  • Zygodactyly (Syndactyly Type A1) Associated With Midfoot Charcot
           Neuropathy and Diabetes
    • Authors: McConville; D. O.; Archbold, G. P.; Lewis, A.; Morrison, P. J.
      Keywords: Genetics-Type 2 Diabetes
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-0011
      Issue No: Vol. 41, No. 5 (2018)
  • Effect of Food Order on Ghrelin Suppression
    • Authors: Shukla; A. P.; Mauer, E.; Igel, L. I.; Truong, W.; Casper, A.; Kumar, R. B.; Saunders, K. H.; Aronne, L. J.
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2244
      Issue No: Vol. 41, No. 5 (2018)
  • Comment on Chan et al. FGF23 Concentration and APOL1 Genotype Are Novel
           Predictors of Mortality in African Americans With Type 2 Diabetes.
           Diabetes Care 2018;41:178-186
    • Authors: Zheng; Y.; Wang, Z.
      Keywords: Complications-Macrovascular-Atherosclerotic Cardiovascular Disease and Human Diabetes
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-0031
      Issue No: Vol. 41, No. 5 (2018)
  • Response to Comment on Chan et al. FGF23 Concentration and APOL1 Genotype
           Are Novel Predictors of Mortality in African Americans With Type 2
           Diabetes. Diabetes Care 2018;41:178-186
    • Authors: Divers; J.; Freedman, B. I.
      Keywords: Complications-Nephropathy-Clinical and Translational Research
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dci18-0005
      Issue No: Vol. 41, No. 5 (2018)
  • Comment on Pareek et al. Enhanced Predictive Capability of a 1-Hour Oral
           Glucose Tolerance Test: A Prospective Population-Based Cohort Study.
           Diabetes Care 2018;41:171-177
    • Authors: Jovanovic L.
      Keywords: Pregnancy-Clinical/Epidemiology
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2714
      Issue No: Vol. 41, No. 5 (2018)
  • Comment on Li et al. Time Trends of Dietary and Lifestyle Factors and
           Their Potential Impact on Diabetes Burden in China. Diabetes Care
    • Authors: Mattioli; A. V.; Coppi, F.; Farinetti, A.
      Keywords: Nutrition-Clinical
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-0143
      Issue No: Vol. 41, No. 5 (2018)
  • Response to Comment on Li et al. Time Trends of Dietary and Lifestyle
           Factors and Their Potential Impact on Diabetes Burden in China. Diabetes
           Care 2017;40:1685-1694
    • Authors: Li; Y.; Hu, F. B.
      Keywords: Nutrition-Clinical
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dci18-0008
      Issue No: Vol. 41, No. 5 (2018)
  • In This Issue of Diabetes Care
    • Pages: 915 - 916
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc18-ti05
      Issue No: Vol. 41, No. 5 (2018)
  • Economic Costs of Diabetes in the U.S. in 2017
    • Authors: American Diabetes Association
      Pages: 917 - 928
      Abstract: OBJECTIVEThis study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2017.RESEARCH DESIGN AND METHODSWe use a prevalence-based approach that combines the demographics of the U.S. population in 2017 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S.RESULTSThe total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ~$16,750 per year, of which ~$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ~2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).CONCLUSIONSAfter adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older, contributing to a growing economic cost to the Medicare program. The estimates in this article highlight the substantial financial burden that diabetes imposes on society, in addition to intangible costs from pain and suffering, resources from care provided by nonpaid caregivers, and costs associated with undiagnosed diabetes.
      Keywords: Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dci18-0007
      Issue No: Vol. 41, No. 5 (2018)
  • The Cost of Diabetes Care--An Elephant in the Room
    • Authors: Riddle; M. C.; Herman, W. H.
      Pages: 929 - 932
      Keywords: Diabetes Education, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dci18-0012
      Issue No: Vol. 41, No. 5 (2018)
  • Unstable Housing and Diabetes-Related Emergency Department Visits and
           Hospitalization: A Nationally Representative Study of Safety-Net Clinic
    • Authors: Berkowitz; S. A.; Kalkhoran, S.; Edwards, S. T.; Essien, U. R.; Baggett, T. P.
      Pages: 933 - 939
      Abstract: OBJECTIVEHomelessness is associated with worse diabetes outcomes, but the relationship between other forms of unstable housing and diabetes is not well studied. We assessed whether unstable housing was associated with increased risk for diabetes-related emergency department use or hospitalization.RESEARCH DESIGN AND METHODSWe used data from the 2014 Health Center Patient Survey (HCPS), a cross-sectional, nationally representative survey of patients who receive care at federally funded safety-net health centers. We included nonhomeless adults (aged ≥18 years) with self-reported diabetes. Unstable housing was defined as not having enough money to pay rent or mortgage, moving two or more times in the past 12 months, or staying at a place one does not own or rent. The primary outcome was self-report of diabetes-related emergency department visit or inpatient hospitalization in the last 12 months. We also examined use of housing assistance.RESULTSOf 1,087 participants, representing 3,277,165 adults with diabetes, 37% were unstably housed. Overall, 13.7% of participants reported a diabetes-related emergency department visit or hospitalization in the past year. In logistic regression analyses adjusted for multiple potential confounders, unstable housing was associated with greater odds of diabetes-related emergency department use or hospitalization (adjusted odds ratio 5.17 [95% CI 2.08–12.87]). Only 0.9% of unstably housed individuals reported receiving help with housing through their clinic.CONCLUSIONSUnstable housing is common and associated with increased risk of diabetes-related emergency department and inpatient use. Addressing unstable housing in clinical settings may help improve health care utilization for vulnerable individuals with diabetes.
      Keywords: Epidemiology-Diabetes Complications, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1812
      Issue No: Vol. 41, No. 5 (2018)
  • Effect of High-Deductible Insurance on High-Acuity Outcomes in Diabetes: A
           Natural Experiment for Translation in Diabetes (NEXT-D) Study
    • Authors: Wharam; J. F.; Zhang, F.; Eggleston, E. M.; Lu, C. Y.; Soumerai, S. B.; Ross-Degnan, D.
      Pages: 940 - 948
      Abstract: OBJECTIVEHigh-deductible health plans (HDHPs) are now the predominant commercial health insurance benefit in the U.S. We sought to determine the effects of HDHPs on emergency department and hospital care, adverse outcomes, and total health care expenditures among patients with diabetes.RESEARCH DESIGN AND METHODSWe applied a controlled interrupted time–series design to study 23,493 HDHP members with diabetes, aged 12–64, insured through a large national health insurer from 2003 to 2012. HDHP members were enrolled for 1 year in a low-deductible (≤$500) plan, followed by 1 year in an HDHP (≥$1,000 deductible) after an employer-mandated switch. Patients transitioning to HDHPs were matched to 192,842 contemporaneous patients whose employers offered only low-deductible coverage. HDHP members from low-income neighborhoods (n = 8,453) were a subgroup of interest. Utilization measures included emergency department visits, hospitalizations, and total (health plan plus member out-of-pocket) health care expenditures. Proxy health outcome measures comprised high-severity emergency department visit expenditures and high-severity hospitalization days.RESULTSAfter the HDHP transition, emergency department visits declined by 4.0% (95% CI –7.8, –0.1), hospitalizations fell by 5.6% (–10.8, –0.5), direct (nonemergency department–based) hospitalizations declined by 11.1% (–16.6, –5.6), and total health care expenditures dropped by 3.8% (–4.3, –3.4). Adverse outcomes did not change in the overall HDHP cohort, but members from low-income neighborhoods experienced 23.5% higher (18.3, 28.7) high-severity emergency department visit expenditures and 27.4% higher (15.5, 39.2) high-severity hospitalization days.CONCLUSIONSAfter an HDHP switch, direct hospitalizations declined by 11.1% among patients with diabetes, likely driving 3.8% lower total health care expenditures. Proxy adverse outcomes were unchanged in the overall HDHP population with diabetes, but members from low-income neighborhoods experienced large, concerning increases in high-severity emergency department visit expenditures and hospitalization days.
      Keywords: Health Care Delivery-Economics, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1183
      Issue No: Vol. 41, No. 5 (2018)
  • Impact of the 2013 National Rollout of CMS Competitive Bidding Program:
           The Disruption Continues
    • Authors: Puckrein; G. A.; Hirsch, I. B.; Parkin, C. G.; Taylor, B. T.; Xu, L.; Marrero, D. G.
      Pages: 949 - 955
      Abstract: OBJECTIVEUse of glucose monitoring is essential to the safety of individuals with insulin-treated diabetes. In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact of this rollout to determine if the adverse outcomes seen in 2011 persisted.RESEARCH DESIGN AND METHODSThis longitudinal study followed 529,627 insulin-treated beneficiaries from 2009 through 2013 to assess changes in beneficiary acquisition of testing supplies in the initial nine test markets (TEST, n = 43,939) and beneficiaries not affected by the 2011 rollout (NONTEST, n = 485,688). All Medicare beneficiary records for analysis were obtained from CMS.RESULTSThe percentages of beneficiaries with partial/no SMBG acquisition were significantly higher in both the TEST (37.4%) and NONTEST (37.6%) groups after the first 6 months of the national CBP rollout, showing increases of 48.1% and 60.0%, respectively (both P < 0.0001). The percentage of beneficiaries with no record for SMBG acquisition increased from 54.1% in January 2013 to 62.5% by December 2013.CONCLUSIONSDisruption of beneficiary access to their prescribed SMBG supplies has persisted and worsened. Diabetes testing supplies should be excluded from the CBP until transparent, science-based methodologies for safety monitoring are adopted and implemented.
      Keywords: Health Care Delivery-Economics, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-0960
      Issue No: Vol. 41, No. 5 (2018)
  • Changes in Health Insurance Coverage Under the Affordable Care Act: A
           National Sample of U.S. Adults With Diabetes, 2009 and 2016
    • Authors: Casagrande; S. S.; McEwen, L. N.; Herman, W. H.
      Pages: 956 - 962
      Abstract: OBJECTIVETo assess national changes in health insurance coverage and related costs before and after implementation of the Affordable Care Act (ACA) among U.S. adults with diabetes.RESEARCH DESIGN AND METHODSData were cross-sectional from the 2009 and 2016 National Health Interview Surveys (NHIS). Participants were adults age ≥18 years with a previous diagnosis of diabetes who self-reported on their health insurance coverage, demographic information, diabetes-related factors, and amount spent on medical expenses and insurance premiums (N = 6,220).RESULTSAmong adults with diabetes age 18–64 years, health insurance coverage increased from 84.7% in 2009 to 90.1% in 2016 (P < 0.001). Coverage remained near universal for those age ≥65 years (99.5%). For adults age 18–64 years, coverage increased for almost all subgroups and significantly for men; non-Hispanic whites, non-Hispanic blacks, and Hispanics; those who were married; those with less than or more than a high school education, family income
      Keywords: Epidemiology-Other, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-2524
      Issue No: Vol. 41, No. 5 (2018)
  • Global Economic Burden of Diabetes in Adults: Projections From 2015 to
    • Authors: Bommer; C.; Sagalova, V.; Heesemann, E.; Manne-Goehler, J.; Atun, R.; Bärnighausen, T.; Davies, J.; Vollmer, S.
      Pages: 963 - 970
      Abstract: OBJECTIVEDespite the importance of diabetes for global health, the future economic consequences of the disease remain opaque. We forecast the full global costs of diabetes in adults through the year 2030 and predict the economic consequences of diabetes if global targets under the Sustainable Development Goals (SDG) and World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 are met.RESEARCH DESIGN AND METHODSWe modeled the absolute and gross domestic product (GDP)-relative economic burden of diabetes in individuals aged 20–79 years using epidemiological and demographic data, as well as recent GDP forecasts for 180 countries. We assumed three scenarios: prevalence and mortality 1) increased only with urbanization and population aging (baseline scenario), 2) increased in line with previous trends (past trends scenario), and 3) achieved global targets (target scenario).RESULTSThe absolute global economic burden will increase from U.S. $1.3 trillion (95% CI 1.3–1.4) in 2015 to $2.2 trillion (2.2–2.3) in the baseline, $2.5 trillion (2.4–2.6) in the past trends, and $2.1 trillion (2.1–2.2) in the target scenarios by 2030. This translates to an increase in costs as a share of global GDP from 1.8% (1.7–1.9) in 2015 to a maximum of 2.2% (2.1–2.2).CONCLUSIONSThe global costs of diabetes and its consequences are large and will substantially increase by 2030. Even if countries meet international targets, the global economic burden will not decrease. Policy makers need to take urgent action to prepare health and social security systems to mitigate the effects of diabetes.
      Keywords: Health Care Delivery-Economics, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1962
      Issue No: Vol. 41, No. 5 (2018)
  • Health Care Costs Associated With Incident Complications in Patients With
           Type 2 Diabetes in Germany
    • Authors: Kähm; K.; Laxy, M.; Schneider, U.; Rogowski, W. H.; Lhachimi, S. K.; Holle, R.
      Pages: 971 - 978
      Abstract: OBJECTIVEThe aim of this study is to provide reliable regression-based estimates of costs associated with different type 2 diabetes complications.RESEARCH DESIGN AND METHODSWe used nationwide statutory health insurance (SHI) data from 316,220 patients with type 2 diabetes. Costs for inpatient and outpatient care, pharmaceuticals, rehabilitation, and nonmedical aids and appliances were assessed in the years 2013–2015. Quarterly observations are available for each year. We estimated costs (in 2015 euro) for complications using a generalized estimating equations model with a normal distribution adjusted for age, sex, occurrence of different complications, and history of complications at baseline, 2012. Two- and threefold interactions were included in an extended model.RESULTSThe base case model estimated total costs in the quarter of event for the example of a 60- to 69-year-old man as follows: diabetic foot 1,293, amputation 14,284, retinopathy 671, blindness 2,933, nephropathy 3,353, end-stage renal disease (ESRD) 22,691, nonfatal stroke 9,769, fatal stroke 11,176, nonfatal myocardial infarction (MI)/cardiac arrest (CA) 8,035, fatal MI/CA 8,700, nonfatal ischemic heart disease (IHD) 6,548, fatal IHD 20,942, chronic heart failure 3,912, and angina pectoris 2,695. In the subsequent quarters, costs ranged from 681 for retinopathy to 6,130 for ESRD.CONCLUSIONSType 2 diabetes complications have a significant impact on total health care costs in the SHI system, not only in the quarter of event but also in subsequent years. Men and women from different age-groups differ in their costs for complications. Our comprehensive estimates may support the parametrization of diabetes models and help clinicians and policy makers to quantify the economic burden of diabetes complications in the context of new prevention and treatment programs.
      Keywords: Health Care Delivery-Economics, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1763
      Issue No: Vol. 41, No. 5 (2018)
  • The Productivity Burden of Diabetes at a Population Level
    • Authors: Magliano; D. J.; Martin, V. J.; Owen, A. J.; Zomer, E.; Liew, D.
      Pages: 979 - 984
      Abstract: OBJECTIVERecent studies suggest that diabetes may impact work productivity. In the current study, we sought to estimate the lifetime and population impact of diabetes on productivity using the novel measure of "productivity-adjusted life years" (PALYs).RESEARCH DESIGN AND METHODSUsing age-specific mortality rates and a productivity index attributable to diabetes (akin to the quality of life index, but which adjusts for reduction in productivity) and life table modeling, we estimated years of life and PALYs lost to diabetes among Australians with diabetes currently aged 20–65 years, with follow-up until 69 years. Life tables were first constructed for the cohort with diabetes and then repeated for the same cohort but with the assumption that they no longer had diabetes. The "nondiabetic" cohort had lower mortality rates and improved productivity. The differences in total years of life lived and PALYs lived between the two cohorts reflected the impact of diabetes.RESULTSOverall, diabetes reduced total years of life lived by the cohort by 190,219 years or almost 3%. Diabetes reduced PALYs by 11.6% and 10.5% among men and women, respectively. For both sexes, the impact of diabetes on productivity was lowest in those aged 65–69 years and highest in those 20–24 years. Among the latter, PALYs were reduced by 12.2% and 11.0% for men and women, respectively.CONCLUSIONSElimination of diabetes can prolong life years lived by the whole population and increase the amount of productive years lived. Employers and government should be aware that having diabetes affects work force productivity and implement prevention programs to reduce the impact of diabetes on the workforce.
      Keywords: Epidemiology-Other, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-2138
      Issue No: Vol. 41, No. 5 (2018)
  • Economic Evaluation of Quality Improvement Interventions Designed to
           Improve Glycemic Control in Diabetes: A Systematic Review and Weighted
           Regression Analysis
    • Authors: Nuckols; T. K.; Keeler, E.; Anderson, L. J.; Green, J.; Morton, S. C.; Doyle, B. J.; Shetty, K.; Arifkhanova, A.; Booth, M.; Shanman, R.; Shekelle, P.
      Pages: 985 - 993
      Abstract: OBJECTIVEQuality improvement (QI) interventions can improve glycemic control, but little is known about their value. We systematically reviewed economic evaluations of QI interventions for glycemic control among adults with type 1 or type 2 diabetes.RESEARCH DESIGN AND METHODSWe used English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, chosen from PubMed, EconLit, Centre for Reviews and Dissemination, New York Academy of Medicine's Grey Literature Report, and WorldCat (January 2004 to August 2016). We extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost (studies lasting ≤3 years), incremental cost-effectiveness ratio (ICER) (studies lasting ≥20 years), and study quality. Weighted least-squares regression analysis was used to estimate mean changes in HbA1c and incremental net cost.RESULTSOf 3,646 records, 46 unique studies were eligible. Across 19 randomized controlled trials (RCTs), HbA1c declined by 0.26% (95% CI 0.17–0.35) or 3 mmol/mol (2 to 4) relative to usual care. In 8 RCTs lasting ≤3 years, incremental net costs were $116 (95% CI –$612 to $843) per patient annually. Long-term ICERs were $100,000–$115,000/quality-adjusted life year (QALY) in 3 RCTs, $50,000–$99,999/QALY in 1 RCT, $0–$49,999/QALY in 4 RCTs, and dominant in 1 RCT. Results were more favorable in non-RCTs. Our limitations include the fact that the studies had diverse designs and involved moderate risk of bias.CONCLUSIONSDiverse multifaceted QI interventions that lower HbA1c appear to be a fair-to-good value relative to usual care, depending on society’s willingness to pay for improvements in health.
      Keywords: Health Care Delivery-Economics, Costs of Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1495
      Issue No: Vol. 41, No. 5 (2018)
  • Magnitude and Pattern of Placebo Response in Clinical Trials of Oral
           Antihyperglycemic Agents: Data From the U.S. Food and Drug Administration,
    • Authors: Khan; A.; Fahl Mar, K.; Schilling, J.; Brown, W. A.
      Pages: 994 - 1000
      Abstract: OBJECTIVETo evaluate the magnitude of placebo response and treatment response patterns in clinical trials of investigational oral antihyperglycemics over time.RESEARCH DESIGN AND METHODSWe examined the U.S. Food and Drug Administration medical and statistical reviews for 19 oral antihyperglycemic agents (23,438 patients, 50 trials, and 96 treatment arms) approved between 1999 and 2015. Placebo and medication treatment response (HbA1c reduction) and effect sizes were examined over time (year of approval). Exclusively placebo-controlled and augmented/adjunctive placebo-controlled trials were analyzed separately, and differences were compared. Potential effects of trial and patient characteristics were explored.RESULTSIn more recent trials, augmented placebo-controlled arms reduced HbA1c by 0.2% on average and more frequently lowered HbA1c from baseline compared with exclusively placebo-controlled arms (63 vs. 18%; 2 = 9.93; P = 0.002). In exclusively placebo-controlled trials, placebo response increased significantly over time (β = 0.035; R2 = 0.31; P = 0.0013), reaching ~0% average change in HbA1c, whereas drug response also increased significantly (β = 0.017; R2 = 0.076; P = 0.0498). In augmented placebo-controlled trials, placebo response (β = 0.33; R2 = 0.407; P < 0.001) showed the same pattern, whereas the growth in drug response was not significant (R2 = 0.031; P = 0.207). Placebo response in both groups increased by 0.5% HbA1c reduction over time, whereas effect sizes remained stable with high success rates (100%; 96 out of 96). Drug response and effect size were not significantly predicted by patient or trial characteristics, but follow-up analysis suggested an inverse relationship of placebo baseline HbA1c with placebo response.CONCLUSIONSRemarkably, placebo-treated patients with diabetes commonly experienced reduction in HbA1c, more markedly in augmented compared with exclusively placebo-controlled treatment arms. Placebo response increased significantly over time without impacting efficacy outcomes. Nonpharmacologic effects measured in the placebo response appear stronger when used with active medication than when implemented in isolation and may be related to the level of HbA1c at baseline.
      Keywords: Clinical Therapeutics/New Technology-Oral Agents
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1316
      Issue No: Vol. 41, No. 5 (2018)
  • Improved Health-Related Quality of Life in a Phase 3 Islet Transplantation
           Trial in Type 1 Diabetes Complicated by Severe Hypoglycemia
    • Authors: Foster; E. D.; Bridges, N. D.; Feurer, I. D.; Eggerman, T. L.; Hunsicker, L. G.; Alejandro, R.; for the Clinical Islet Transplantation Consortium
      Pages: 1001 - 1008
      Abstract: OBJECTIVEAttaining glycemic targets without severe hypoglycemic events (SHEs) is a challenging treatment goal for patients with type 1 diabetes complicated by impaired awareness of hypoglycemia (IAH). The CIT Consortium Protocol 07 (CIT-07) trial showed islet transplantation to be an effective treatment for subjects with IAH and intractable SHEs. We evaluated health-related quality of life (HRQOL), functional health status, and health utility before and after pancreatic islet transplantation in CIT-07 trial participants.RESEARCH DESIGN AND METHODSFour surveys, the Diabetes Distress Scale (DDS), the Hypoglycemic Fear Survey (HFS), the Short Form 36 Health Survey (SF-36), and the EuroQoL 5 Dimensions (EQ-5D), were administered repeatedly before and after islet transplantation. Summary statistics and longitudinal modeling were used to describe changes in survey scores from baseline and to characterize change in relation to a minimally important difference (MID) threshold of half an SD.RESULTSImprovements in condition-specific HRQOL met the MID threshold. Reductions from baseline in the DDS total score and its four DDS subscales (all P ≤ 0.0013) and in the HFS total score and its two subscales (all P < 0.0001) were observed across all time points. Improvements were observed after both 1 and 2 years for the EQ-5D visual analog scale (both P < 0.0001).CONCLUSIONSIn CIT-07, 87.5% of the subjects achieved the primary end point of freedom from SHE along with glycemic control (HbA1c
      Keywords: Epidemiology-Type 1 Diabetes
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1779
      Issue No: Vol. 41, No. 5 (2018)
  • Efficacy and Safety of IDegLira Versus Basal-Bolus Insulin Therapy in
           Patients With Type 2 Diabetes Uncontrolled on Metformin and Basal Insulin:
           The DUAL VII Randomized Clinical Trial
    • Authors: Billings; L. K.; Doshi, A.; Gouet, D.; Oviedo, A.; Rodbard, H. W.; Tentolouris, N.; Gron, R.; Halladin, N.; Jodar, E.
      Pages: 1009 - 1016
      Abstract: OBJECTIVEIn patients with uncontrolled type 2 diabetes on basal insulin, prandial insulin may be initiated. We assessed the efficacy and safety of initiating insulin degludec/liraglutide fixed-ratio combination (IDegLira) versus basal-bolus insulin.RESEARCH DESIGN AND METHODSA phase 3b trial examined patients with uncontrolled type 2 diabetes on insulin glargine (IGlar U100) 20–50 units/day and metformin, randomized to IDegLira or IGlar U100 and insulin aspart ≤4 times per day.RESULTSGlycated hemoglobin (HbA1c) decreased from 8.2% (66 mmol/mol) to 6.7% (50 mmol/mol) with IDegLira and from 8.2% (67 mmol/mol) to 6.7% (50 mmol/mol) with basal-bolus (estimated treatment difference [ETD] –0.02% [95% CI –0.16, 0.12]; –0.2 mmol/mol [95% CI –1.7, 1.3]), confirming IDegLira noninferiority versus basal-bolus (P < 0.0001). The number of severe or blood glucose–confirmed symptomatic hypoglycemia events was lower with IDegLira versus basal-bolus (risk ratio 0.39 [95% CI 0.29, 0.51]; rate ratio 0.11 [95% CI 0.08, 0.17]). Body weight decreased with IDegLira and increased with basal-bolus (ETD –3.6 kg [95% CI –4.2, –2.9]). Fasting plasma glucose reductions were similar; lunch, dinner, and bedtime self-monitored plasma glucose measurements were significantly lower with basal-bolus. Sixty-six percent of patients on IDegLira vs. 67.0% on basal-bolus achieved HbA1c
      Keywords: Clinical Therapeutics/New Technology-Insulins
      PubDate: 2018-04-20T12:00:22-07:00
      DOI: 10.2337/dc17-1114
      Issue No: Vol. 41, No. 5 (2018)
  • Racial/Ethnic Minority Youth With Recent-Onset Type 1 Diabetes Have Poor
           Prognostic Factors
    • Authors: Redondo; M. J.; Libman, I.; Cheng, P.; Kollman, C.; Tosur, M.; Gal, R. L.; Bacha, F.; Klingensmith, G. J.; Clements, M.; for the Pediatric Diabetes Consortium
      Pages: 1017 - 1024
      Abstract: OBJECTIVETo compare races/ethnicities for characteristics, at type 1 diabetes diagnosis and during the first 3 years postdiagnosis, known to influence long-term health outcomes.RESEARCH DESIGN AND METHODSWe analyzed 927 Pediatric Diabetes Consortium (PDC) participants
      Keywords: Epidemiology-Diabetes Complications
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2335
      Issue No: Vol. 41, No. 5 (2018)
  • Obesity Progression Between Young Adulthood and Midlife and Incident
           Diabetes: A Retrospective Cohort Study of U.S. Adults
    • Authors: Stokes; A.; Collins, J. M.; Grant, B. F.; Scamuffa, R. F.; Hsiao, C.-W.; Johnston, S. S.; Ammann, E. M.; Manson, J. E.; Preston, S. H.
      Pages: 1025 - 1031
      Abstract: OBJECTIVEUnderstanding how changes in weight over the life course shape risk for diabetes is critical for the prevention of diabetes. Using data from the National Health and Nutrition Examination Survey (NHANES), we investigated the association between self-reported weight change from young adulthood to midlife and incident diabetes.RESEARCH DESIGN AND METHODSWe categorized individuals into four weight-change groups: those who remained nonobese (stable nonobese), those who moved from an obese BMI to a nonobese BMI (losing), those who moved from a nonobese BMI to an obese BMI (gaining), and those who remained obese (stable obese). Diabetes status was determined by self-report of a prior diagnosis, and age at diagnosis was used to establish time of diabetes onset. Hazard ratios (HRs) relating weight change to incident diabetes over 10 years of follow-up were calculated using Cox models adjusting for covariates.RESULTSThose who were obese and lost weight exhibited a significantly lower risk (HR 0.33; 95% CI 0.14, 0.76) of diabetes compared with those with stable obesity. We also observed lower risk among those who were stable nonobese (HR 0.22; 95% CI 0.18, 0.28) and those in the gaining category (HR 0.70; 95% CI 0.57, 0.87). Further, there was evidence of an increased incidence of diabetes among obese individuals who lost weight compared with individuals who were stable nonobese; however, weight loss was rare, and the association was not statistically significant. If those who were obese had become nonobese during the 10-year period, we estimate that 9.1% (95% CI 5.3, 12.8) of observed diabetes cases could have been averted, and if the population had maintained a normal BMI during the period, 64.2% (95% CI 59.4, 68.3) of cases could have been averted.CONCLUSIONSThe findings from this study underscore the importance of population-level approaches to the prevention and treatment of obesity across the life course of individuals.
      Keywords: Obesity-Human
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2336
      Issue No: Vol. 41, No. 5 (2018)
  • Prevalence of Major Behavioral Risk Factors for Type 2 Diabetes
    • Authors: Siegel; K. R.; Bullard, K. M.; Imperatore, G.; Ali, M. K.; Albright, A.; Mercado, C. I.; Li, R.; Gregg, E. W.
      Pages: 1032 - 1039
      Abstract: OBJECTIVEWe examined the proportion of American adults without type 2 diabetes that engages in lifestyle behaviors known to reduce type 2 diabetes risk.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional analysis of 3,679 nonpregnant, nonlactating individuals aged ≥20 years without diabetes (self-reported diagnosis or glycated hemoglobin ≥6.5% [8 mmol/mol] or fasting plasma glucose ≥126 mg/dL) and who provided 2 days of reliable dietary data in the 2007–2012 National Health and Nutrition Examination Surveys (NHANES). We used the average of 2 days of dietary recall and self-reported leisure-time physical activity to assess whether participants met type 2 diabetes risk reduction goals (meeting four or more MyPlate recommendations [adequate consumption of fruits, vegetables, dairy, grains, meat, beans, and eggs]; not exceeding three maximum allowances for alcoholic beverages, added sugars, fat, and cholesterol; and meeting physical activity recommendations [≥150 min/week]).RESULTSApproximately 21%, 29%, and 13% of individuals met fruit, vegetable, and dairy goals, respectively. Half (51.6%) met the goal for total grains, compared with 18% for whole grains, and 54.2% met the meat/beans goal and 40.6% met the oils goal. About one-third (37.8%) met the physical activity goal, and 58.6% met the weight loss/maintenance goal. Overall, 3.1% (95% CI 2.4–4.0) of individuals met the majority of type 2 diabetes risk reduction goals. Younger age and lower educational attainment were associated with lower probability of meeting goals.CONCLUSIONSA small proportion of U.S. adults engages in risk reduction behaviors. Research and interventions targeted at young and less-educated segments of the population may help close gaps in risk reduction behaviors.
      Keywords: Epidemiology-Nutrition
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-1775
      Issue No: Vol. 41, No. 5 (2018)
  • Impact of Intensive Lifestyle Intervention on Disability-Free Life
           Expectancy: The Look AHEAD Study
    • Authors: Gregg; E. W.; Lin, J.; Bardenheier, B.; Chen, H.; Rejeski, W. J.; Zhuo, X.; Hergenroeder, A. L.; Kritchevsky, S. B.; Peters, A. L.; Wagenknecht, L. E.; Ip, E. H.; Espeland, M. A.; for the Look AHEAD Study Group
      Pages: 1040 - 1048
      Abstract: OBJECTIVEThe impact of weight loss intervention on disability-free life expectancy in adults with diabetes is unknown. We examined the impact of a long-term weight loss intervention on years spent with and without physical disability.RESEARCH DESIGN AND METHODSOverweight or obese adults with type 2 diabetes age 45–76 years (n = 5,145) were randomly assigned to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Physical function was assessed annually for 12 years using the 36-Item Short Form Health Survey. Annual incidence of physical disability, mortality, and disability remission were incorporated into a Markov model to quantify years of life spent active and physically disabled.RESULTSPhysical disability incidence was lower in the ILI group (6.0% per year) than in the DSE group (6.8% per year) (incidence rate ratio 0.88 [95% CI 0.81–0.96]), whereas rates of disability remission and mortality did not differ between groups. ILI participants had a significant delay in moderate or severe disability onset and an increase in number of nondisabled years (P < 0.05) compared with DSE participants. For a 60-year-old, this effect translates to 0.9 more disability-free years (12.0 years [95% CI 11.5–12.4] vs. 11.1 years [95% CI 10.6–11.7]) but no difference in total years of life. In stratified analyses, ILI increased disability-free years of life in women and participants without cardiovascular disease (CVD) but not in men or participants with CVD.CONCLUSIONSLong-term lifestyle interventions among overweight or obese adults with type 2 diabetes may reduce long-term disability, leading to an effect on disability-free life expectancy but not on total life expectancy.
      Keywords: Epidemiology-Aging
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2110
      Issue No: Vol. 41, No. 5 (2018)
  • Meat Cooking Methods and Risk of Type 2 Diabetes: Results From Three
           Prospective Cohort Studies
    • Authors: Liu; G.; Zong, G.; Wu, K.; Hu, Y.; Li, Y.; Willett, W. C.; Eisenberg, D. M.; Hu, F. B.; Sun, Q.
      Pages: 1049 - 1060
      Abstract: OBJECTIVETo examine open-flame and/or high-temperature cooking (grilling/barbecuing, broiling, or roasting) and doneness preferences (rare, medium, or well done) for red meat, chicken, and fish in relation to type 2 diabetes (T2D) risk among U.S. adults who consumed animal flesh regularly (≥2 servings/week).RESEARCH DESIGN AND METHODSThe prospective studies included 52,752 women from the Nurses’ Health Study (NHS) (followed during 1996–2012), 60,809 women from NHS II (followed during 2001–2013), and 24,679 men from the Health Professionals Follow-Up Study (HPFS) (followed during 1996–2012) who were free of diabetes, cardiovascular disease, and cancer at baseline. Incident cases of T2D were confirmed by validated supplementary questionnaires.RESULTSWe documented 7,895 incident cases of T2D during 1.74 million person-years of follow-up. After multivariate adjustments including baseline BMI and total consumption of red meat, chicken, and fish, higher frequency of open-flame and/or high-temperature cooking was independently associated with an elevated T2D risk. When comparing open-flame and/or high-temperature cooking>15 times/month with
      Keywords: Epidemiology-Nutrition
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-1992
      Issue No: Vol. 41, No. 5 (2018)
  • Impact of Body Weight Loss From Maximum Weight on Fragility Bone Fractures
           in Japanese Patients With Type 2 Diabetes: The Fukuoka Diabetes Registry
    • Authors: Komorita; Y.; Iwase, M.; Fujii, H.; Ohkuma, T.; Ide, H.; Jodai-Kitamura, T.; Sumi, A.; Yoshinari, M.; Nakamura, U.; Kang, D.; Kitazono, T.
      Pages: 1061 - 1067
      Abstract: OBJECTIVEThere is growing evidence that weight loss is associated with increased fracture risk in the general population. As patients with diabetes often lose weight intentionally or unintentionally, we aimed to investigate prospectively the relationship between weight loss from maximum body weight and fracture risk.RESEARCH DESIGN AND METHODSA total of 4,706 Japanese participants with type 2 diabetes (mean age 66 years), including 2,755 men and 1,951 postmenopausal women, were followed for a median of 5.3 years and were divided according to weight loss from maximum weight:
      Keywords: Epidemiology-Other
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2004
      Issue No: Vol. 41, No. 5 (2018)
  • Risk Factors for Incident Diabetic Polyneuropathy in a Cohort With
           Screen-Detected Type 2 Diabetes Followed for 13 Years: ADDITION-Denmark
    • Authors: Andersen; S. T.; Witte, D. R.; Dalsgaard, E.-M.; Andersen, H.; Nawroth, P.; Fleming, T.; Jensen, T. M.; Finnerup, N. B.; Jensen, T. S.; Lauritzen, T.; Feldman, E. L.; Callaghan, B. C.; Charles, M.
      Pages: 1068 - 1075
      Abstract: OBJECTIVETo study incident diabetic polyneuropathy (DPN) prospectively during the first 13 years after a screening-based diagnosis of type 2 diabetes and determine the associated risk factors for the development of DPN.RESEARCH DESIGN AND METHODSWe assessed DPN longitudinally in the Danish arm of the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) using the Michigan Neuropathy Screening Instrument questionnaire (MNSIQ), defining DPN with scores ≥4. Risk factors present at the diabetes diagnosis associated with the risk of incident DPN were estimated using Cox proportional hazard models adjusted for trial randomization group, sex, and age.RESULTSOf the total cohort of 1,533 people, 1,445 completed the MNSIQ at baseline and 189 (13.1%) had DPN at baseline. The remaining 1,256 without DPN entered this study (median age 60.8 years [interquartile range 55.6; 65.6], 59% of whom were men). The cumulative incidence of DPN was 10% during 13 years of diabetes. Age (hazard ratio [HR] 1.03 [95% CI 1.00; 1.07]) (unit = 1 year), weight (HR 1.09 [95% CI 1.03; 1.16]) (unit = 5 kg), waist circumference (HR 1.14 [95% CI 1.05; 1.24]) (unit = 5 cm), BMI (HR 1.14 [95% CI 1.06; 1.23]) (unit = 2 kg/m2), log2 methylglyoxal (HR 1.45 [95% CI 1.12; 1.89]) (unit = doubling), HDL cholesterol (HR 0.82 [95% CI 0.69; 0.99]) (unit = 0.25 mmol/L), and LDL cholesterol (HR 0.92 [95% CI 0.86; 0.98]) (unit = 0.25 mmol/L) at baseline were significantly associated with the risk of incident DPN.CONCLUSIONSThis study provides further epidemiological evidence for obesity as a risk factor for DPN. Moreover, low HDL cholesterol levels and higher levels of methylglyoxal, a marker of dicarbonyl stress, are identified as risk factors for the development of DPN.
      Keywords: Complications-Neuropathy
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2062
      Issue No: Vol. 41, No. 5 (2018)
  • Accelerated Progression to Type 1 Diabetes in the Presence of HLA-A*24 and
           -B*18 Is Restricted to Multiple Islet Autoantibody-Positive Individuals
           With Distinct HLA-DQ and Autoantibody Risk Profiles
    • Authors: Balke; E. M.; Balti, E. V.; Van der Auwera, B.; Weets, I.; Costa, O.; Demeester, S.; Abrams, P.; Casteels, K.; Coeckelberghs, M.; Tenoutasse, S.; Keymeulen, B.; Pipeleers, D. G.; Gorus, F. K.; the Belgian Diabetes Registry
      Pages: 1076 - 1083
      Abstract: OBJECTIVEWe investigated the effect of HLA class I risk alleles on disease progression in various phases of subclinical islet autoimmunity in first-degree relatives of patients with type 1 diabetes.RESEARCH DESIGN AND METHODSA registry-based group of siblings/offspring (aged 0–39 years) was monitored from single- to multiple-autoantibody positivity (n = 267) and from multiple-autoantibody positivity to clinical onset (n = 252) according to HLA-DQ, -A*24, -B*18, and -B*39 status. Genetic markers were determined by PCR sequence-specific oligotyping.RESULTSUnlike HLA-B*18 or -B*39, HLA-A*24 was associated with delayed progression from single- to multiple-autoantibody positivity (P = 0.009) but not to type 1 diabetes. This occurred independently from older age (P < 0.001) and absence of HLA-DQ2/DQ8 or -DQ8 (P < 0.001 and P = 0.003, respectively), and only in the presence of GAD autoantibodies. In contrast, HLA-A*24 was associated with accelerated progression from multiple-autoantibody positivity to clinical onset (P = 0.006), but its effects were restricted to HLA-DQ8+ relatives with IA-2 or zinc transporter 8 autoantibodies (P = 0.002). HLA-B*18, but not -B*39, was also associated with more rapid progression, but only in HLA-DQ2 carriers with double positivity for GAD and insulin autoantibodies (P = 0.004).CONCLUSIONSHLA-A*24 predisposes to a delayed antigen spreading of humoral autoimmunity, whereas HLA-A*24 and -B*18 are associated with accelerated progression of advanced subclinical autoimmunity in distinct risk groups. The relation of these alleles to the underlying disease process requires further investigation. Their typing should be relevant for the preparation and interpretation of observational and interventional studies in asymptomatic type 1 diabetes.
      Keywords: Genetics-Type 1 Diabetes
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2462
      Issue No: Vol. 41, No. 5 (2018)
  • Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome:
           Insights From the International, Multicenter GEIST Registry
    • Authors: Stiermaier; T.; Santoro, F.; El-Battrawy, I.; Möller, C.; Graf, T.; Novo, G.; Santangelo, A.; Mariano, E.; Romeo, F.; Caldarola, P.; Fanelli, M.; Thiele, H.; Brunetti, N. D.; Akin, I.; Eitel, I.
      Pages: 1084 - 1088
      Abstract: OBJECTIVEIn view of low prevalence rates, diabetes is discussed as a protective factor for the occurrence of Takotsubo syndrome (TTS). Furthermore, it was associated with improved outcome in a small single-center analysis. Therefore, this study assessed the prevalence and prognostic relevance of concomitant diabetes in TTS.RESEARCH DESIGN AND METHODSA total of 826 patients with TTS were enrolled in an international, multicenter, registry-based study (eight centers in Italy and Germany). All-cause mortality was compared between patients with diabetes and patients without diabetes, and the independent predictive value of diabetes was evaluated in multivariate regression analysis.RESULTSThe prevalence of diabetes was 21.1% (n = 174). TTS patients with diabetes were older (P < 0.001), were more frequently male (P = 0.003), had a higher prevalence of hypertension (P < 0.001), physical triggers (P = 0.041), and typical apical ballooning (P = 0.010), had a lower left ventricular ejection fraction (P = 0.008), had a higher rate of pulmonary edema (P = 0.032), and had a longer hospital stay (P = 0.009). However, 28-day all-cause mortality did not differ between patients with diabetes and patients without diabetes (6.4% vs. 5.7%; hazard ratio [HR] 1.11 [95% CI 0.55–2.25]; P = 0.772). Longer-term follow-up after a median of 2.5 years revealed a significantly higher mortality among TTS patients with diabetes (31.4% vs. 16.5%; P < 0.001), and multivariate regression analysis identified diabetes as an independent predictor of adverse outcome (HR 1.66 [95% CI 1.16–2.39]; P = 0.006).CONCLUSIONSDiabetes is not uncommon in patients with TTS, is associated with increased longer-term mortality rates, and is an independent predictor of adverse outcome irrespective of additional risk factors.
      Keywords: Epidemiology-Cardiovascular Disease
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2609
      Issue No: Vol. 41, No. 5 (2018)
  • Childhood BMI and Adult Type 2 Diabetes, Coronary Artery Diseases, Chronic
           Kidney Disease, and Cardiometabolic Traits: A Mendelian Randomization
    • Authors: Geng; T.; Smith, C. E.; Li, C.; Huang, T.
      Pages: 1089 - 1096
      Abstract: OBJECTIVETo test the causal effect of childhood BMI on adult cardiometabolic diseases using a Mendelian randomization analysis.RESEARCH DESIGN AND METHODSWe used 15 single nucleotide polymorphisms as instrumental variables for childhood BMI to test the causal effect of childhood BMI on cardiometabolic diseases using summary-level data from consortia.RESULTSWe found that a 1-SD increase in childhood BMI (kg/m2) was associated with an 83% increase in risk of type 2 diabetes (odds ratio [OR] 1.83 [95% CI 1.46, 2.30]; P = 2.5 x 10–7) and a 28% increase in risk of coronary artery disease (CAD) (OR 1.28 [95% CI 1.17, 1.39]; P = 2.1 x 10–8) at the Bonferroni-adjusted level of significance (P < 0.017) in adults. In addition, a 1-SD increase in childhood BMI was associated with a 0.587-SD increase in adulthood BMI (kg/m2), a 0.062-SD increase in hip circumference (cm), a 0.602-SD increase in waist circumference (cm), a 0.111 pmol/L increase in log fasting insulin, a 0.068 increase in log-transformed HOMA of ß-cell function (%), a 0.126 increase in log-transformed HOMA of insulin resistance (%), and a 0.109-SD increase in triglyceride (mg/dL) but a 0.138-SD decrease in HDL (mg/dL) in adults at the Bonferroni-adjusted level of significance (P < 0.0026).CONCLUSIONSA genetic predisposition to higher childhood BMI was associated with increased risk of type 2 diabetes and CAD in adult life. These results provide evidence supportive of a causal association between childhood BMI and these outcomes.
      Keywords: Genetics-Type 2 Diabetes
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-2141
      Issue No: Vol. 41, No. 5 (2018)
  • Gaps in Guidelines for the Management of Diabetes in Low- and
           Middle-Income Versus High-Income Countries--A Systematic Review
    • Authors: Owolabi; M. O.; Yaria, J. O.; Daivadanam, M.; Makanjuola, A. I.; Parker, G.; Oldenburg, B.; Vedanthan, R.; Norris, S.; Oguntoye, A. R.; Osundina, M. A.; Herasme, O.; Lakoh, S.; Ogunjimi, L. O.; Abraham, S. E.; Olowoyo, P.; Jenkins, C.; Feng, W.; Bayona, H.; Mohan, S.; Joshi, R.; Webster, R.; Kengne, A. P.; Trofor, A.; Lotrean, L. M.; Praveen, D.; Zafra-Tanaka, J. H.; Lazo-Porras, M.; Bobrow, K.; Riddell, M. A.; Makrilakis, K.; Manios, Y.; Ovbiagele, B.; for the COUNCIL Initiative
      Pages: 1097 - 1105
      Abstract: OBJECTIVEThe extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation.RESEARCH DESIGN AND METHODSEligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences.RESULTSMost LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001).CONCLUSIONSA new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.
      Keywords: Health Care Delivery-Economics
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-1795
      Issue No: Vol. 41, No. 5 (2018)
  • Effect of the Duodenal-Jejunal Bypass Liner on Glycemic Control in
           Patients With Type 2 Diabetes With Obesity: A Meta-analysis With Secondary
           Analysis on Weight Loss and Hormonal Changes
    • Authors: Jirapinyo; P.; Haas, A. V.; Thompson, C. C.
      Pages: 1106 - 1115
      Abstract: OBJECTIVEDuodenal-jejunal bypass liner (DJBL) is an endoscopic device that may mimic small bowel mechanisms of Roux-en-Y gastric bypass (RYGB). Previous studies have demonstrated the efficacy of DJBL at inducing weight loss. We assessed the effect of DJBL on glycemic control in patients with type 2 diabetes (T2D) with obesity.RESEARCH DESIGN AND METHODSData sources included MEDLINE, EMBASE, and Web of Science through 1 July 2017. Included were published studies that assessed DJBL outcomes in obese T2D patients.RESULTSPrimary outcomes were change in HbA1c and HOMA of insulin resistance (HOMA-IR). Secondary outcomes were change in weight and gut hormones glucose-dependent insulinotropic peptide (GIP), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and ghrelin. Seventeen studies were included. At explant, HbA1c decreased by 1.3% [95% CI 1.0, 1.6] and HOMA-IR decreased by 4.6 [2.9, 6.3]. Compared with control subjects, DJBL subjects had greater HbA1c reduction by 0.9% [0.5, 1.3]. Six months after explant, HbA1c remained lower than baseline by 0.9% [0.6, 1.2]. At explant, patients lost 11.3 kg [10.3, 12.2], corresponding to a BMI reduction of 4.1 kg/m2 [3.4, 4.9], total weight loss of 18.9% [7.2, 30.6], and excess weight loss of 36.9% [29.2, 44.6]. The amount of weight loss remained significant at 1 year postexplantation. After DJBL, GIP decreased, whereas GLP-1, PYY, and ghrelin increased.CONCLUSIONSDJBL improves glycemic control and insulin resistance in T2D patients with obesity. DJBL also appears to induce significant weight loss in this population. Additionally, changes in gut hormones suggest mechanisms similar to RYGB. Study limitations included heterogeneity among studies.
      Keywords: Obesity-Human
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc17-1985
      Issue No: Vol. 41, No. 5 (2018)
  • Erratum. Time Trends of Dietary and Lifestyle Factors and Their Potential
           Impact on Diabetes Burden in China. Diabetes Care 2017;40:1685-1694
    • Authors: Li; Y.; Wang, D. D.; Ley, S. H.; Vasanti, M.; Howard, A. G.; He, Y.; Hu, F. B.
      Pages: 1116 - 1116
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-er05
      Issue No: Vol. 41, No. 5 (2018)
  • Erratum. Metformin Use in Prediabetes Among U.S. Adults, 2005-2012.
           Diabetes Care 2017;40:887-893
    • Authors: Tseng; E.; Yeh, H.-C.; Maruthur, N. M.
      Pages: 1116 - 1116
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-er05a
      Issue No: Vol. 41, No. 5 (2018)
  • Erratum. The National Diabetes Education Program at 20 Years: Lessons
           Learned and Plans for the Future. Diabetes Care 2018;41:209-218
    • Authors: Siminerio; L. M.; Albright, A.; Fradkin, J.; Gallivan, J.; McDivitt, J.; Rodriguez, B.; Tuncer, D.; Wong, F.
      Pages: 1116 - 1116
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-er05b
      Issue No: Vol. 41, No. 5 (2018)
  • Issues and Events
    • Pages: 1117 - 1117
      PubDate: 2018-04-20T12:00:23-07:00
      DOI: 10.2337/dc18-ie05
      Issue No: Vol. 41, No. 5 (2018)
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