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2.
Diabet Med. 2017 Oct;34(10):1447-1455. doi: 10.1111/dme.13419. Epub 2017 Aug 3.

Difficult conversations: adults with diabetes and the discussion of microvascular complications.

Author information

1
Joslin Diabetes Center, Boston, MA, USA.
2
Harvard Medical School, Boston, MA, USA.
3
Boston Children's Hospital, Boston, MA, USA.

Abstract

AIMS:

To investigate the experiences among adults with diabetes of discussions of microvascular complications and provide recommendations for providers.

METHODS:

We performed a qualitative study in 148 adults with Type 1 and Type 2 diabetes (56% women, 95% white, mean age 60±13 years, 65% with Type 1 diabetes, 71% with ≥1 microvascular complication). Data were analysed using content analysis.

RESULTS:

At their first discussion of microvascular complications, 93% of participants (138/148) recalled providers using a preventative approach including clinical suggestions, factual information and warnings. At complication diagnosis, 78% of participants (82/105) perceived provider support through comprehensive interactive education, specific self-care guidance, reassuring messages, and referrals and follow-ups. In response to complication diagnosis, 48% (50/105) felt scared, 46% (48/105) had 'a wake-up call', and 86% (90/105) reported increasing ≥1 specific area of self-care. Participants recommended providers offer factual and complete information, specific self-care guidance, and positive honesty, with an individualized and collaborative approach that includes psychosocial assessment and referrals and lacks 'scare tactics' and blame.

CONCLUSIONS:

Adults with diabetes want to learn about diabetes microvascular complications and apply preventative strategies as early as possible. Paradoxically, the diagnosis of a diabetes microvascular complication in itself may represent a unique learning opportunity because 86% of participants improved diabetes self-care after this event. Recommendations offer providers simple but important clinical approaches to improve these difficult conversations and thus support necessary behaviour changes and psychosocial well-being. Training is needed to help providers discuss the threat of diabetes complications with honest but positive messages so that people with diabetes can be fully informed but also maintain hope in the face of complications.

PMID:
28703926
DOI:
10.1111/dme.13419
[Indexed for MEDLINE]
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3.
Diabet Med. 2017 Nov;34(11):1603-1607. doi: 10.1111/dme.13425. Epub 2017 Aug 3.

Prevalence and characteristics of paediatric Type 2 diabetes in the Republic of Ireland.

Author information

1
Department of Paediatrics, Midland Regional Hospital, Mullingar, Co, Westmeath.
2
Department of Paediatrics and Child Health, Cork University Hospital, Wilton, Cork, Ireland.

Abstract

OBJECTIVE:

To establish the prevalence of paediatric Type 2 diabetes in the Republic of Ireland and describe patient demographics, initial presentation, management, outcomes, comorbidities and complications.

METHODS:

Using a standardized proforma we conducted a cross-sectional survey of children and adolescents aged < 16 years with a diagnosis of Type 2 diabetes between October and December 2015 in each of the 19 centres in the Republic of Ireland responsible for the care of children with diabetes.

RESULTS:

Twelve cases of Type 2 diabetes were identified, giving a prevalence in children aged <16 years of 1.2/100 000 (95% CI 0.6 to 2). Six of these children (50%) were white, two (33%) of whom were members of the travelling community. Four (33%) were of black ethnicity. The prevalence of Type 2 diabetes in traveller children was 16.1/100 000 (95% CI 1.9 to 58.1) and was similar to that in black children, a known high-risk group, which was 13.3/100 000 (95% CI 3.6 to 34.1). The median current HbA1c value was 51 mmol/mol (6.8%) and four (33%) of the children achieved the International Society for Pediatric and Adolescent Diabetes target HbA1c of ≤48 mmol/mol (6.5%). Seven (59%) children were managed on metformin monotherapy, three (25%) were managed on insulin and metformin in combination, and two (16%) were receiving dietary management.

CONCLUSION:

This was the first national study to estimate the prevalence of childhood Type 2 diabetes in Ireland. Despite their white ethnicity, traveller children appear to be a high-risk group, but this finding requires further study.

PMID:
28703902
DOI:
10.1111/dme.13425
[Indexed for MEDLINE]
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4.
Diabet Med. 2017 Nov;34(11):1623-1628. doi: 10.1111/dme.13422. Epub 2017 Aug 3.

Individual and partner's level of occupation and the association with HbA1c levels in people with Type 2 diabetes mellitus: the Dutch Diabetes Pearl cohort.

Author information

1
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
2
Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
3
Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
4
Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands.
5
Department of Internal Medicine, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
6
Department of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands.
7
Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
8
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
9
Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
10
Department of Endocrinology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
11
Department of Endocrinology, Maastricht University Medical Centre, Maastricht, The Netherlands.
12
School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
13
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.

Abstract

AIMS:

Individual indicators of socio-economic status have been associated with glycaemic control in people with Type 2 diabetes, but little is known about the association between partner's socio-economic status and HbA1c levels. We therefore examined the cross-sectional association between individual and partner's level of occupation on HbA1c levels in people with Type 2 diabetes in the Netherlands.

METHODS:

We included people with Type 2 diabetes with a partner who were treated in primary, secondary and tertiary care in the Diabetes Pearl cohort. Occupational level was classified according to International Standard Classification of Occupations (ISCO)-08 skill levels. Linear regression analyses were performed stratified for sex, and corrected for age, recruitment centre and diabetes medication.

RESULTS:

In total, 3257 participants (59.8% men, mean 62.2±9.4 years) were included. For men, having a partner with an intermediate level of occupation was associated with lower HbA1c levels [e.g. ISCO level 3: -2 mmol/mol (95% CI -4;-1) or -0.2% (95% CI -0.4;-0.1)], compared with having a partner of the highest occupational level (ISCO level 4). In women, having an unemployed partner was associated with higher HbA1c levels [14 mmol/mol (95% CI 6; 22) or 1.3% (95% CI 0.6; 2.0)], compared with having a partner of the highest occupational level.

CONCLUSIONS:

Partner's occupational status provided additional information on the association between socio-economic status and HbA1c levels in people with Type 2 diabetes. Women seemed to benefit from a partner with a higher occupational status, while men seemed to benefit from a partner with a lower status. Because of the cross-sectional nature of the present study, more research is necessary to explore this association.

PMID:
28703888
DOI:
10.1111/dme.13422
[Indexed for MEDLINE]
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5.
Diabet Med. 2017 Oct;34(10):1428-1434. doi: 10.1111/dme.13421. Epub 2017 Aug 17.

Cardiac vagal tone, a non-invasive measure of parasympathetic tone, is a clinically relevant tool in Type 1 diabetes mellitus.

Author information

1
Department of Mech-Sense, Department of Gastroenterology and Hepatology and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.
2
Department of Pharmacotherapy and Development, University of Copenhagen, Copenhagen.
3
Department of Rheumatology, Aarhus University Hospital, Aarhus.
4
Department of Clinical Medicine, Aarhus University Hospital, Aarhus.
5
Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus.
6
Department of Biomedicine, Aarhus University Hospital, Aarhus.
7
Department of Biochemistry, Aarhus University Hospital, Aarhus.
8
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
9
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus.
10
Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
11
Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
12
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
13
Centre for Neuroscience and Trauma, Wingate Institute of Neurogastroenterology, Blizard Institute, London School of Medicine and Dentistry, Queen Mary University of London, London.
14
Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, Staffordshire, UK.

Abstract

AIMS:

To compare a novel index of parasympathetic tone, cardiac vagal tone, with established autonomic variables and to test the hypotheses that (1) cardiac vagal tone would be associated with established time and frequency domain measures of heart rate and (2) cardiac vagal tone would be lower in people with Type 1 diabetes than in a matched healthy cohort and lower still in people with established neuropathy.

METHODS:

Cardiac vagal tone is a validated cardiometrically derived index of parasympathetic tone. It is measured using a standard three-lead electrocardiogram which connects, via Bluetooth, to a smartphone application. A 5-min resting recording of cardiac vagal tone was undertaken and observational comparisons were made between 42 people with Type 1 diabetes and peripheral neuropathy and 23 without peripheral neuropathy and 65 healthy people. In those with neuropathy, 24-h heart rate variability values were compared with cardiac vagal tone. Correlations between cardiac vagal tone and clinical variables were also made.

RESULTS:

Cardiac vagal tone was lower in people with established neuropathy and Type 1 diabetes in comparison with healthy participants [median (interquartile range) linear vagal scale 3.4 (1.6-5.5 vs 7.0 (5.5-9.6); P < 0.0001]. Cardiac vagal tone was positively associated with time (r = 0.8, P < 0.0001) and frequency domain markers of heart rate variability (r = 0.75, P < 0.0001), representing established measures of parasympathetic function. Cardiac vagal tone was negatively associated with age (r=-0.32, P = 0.003), disease duration (r=-0.43, P < 0.0001) and cardiovascular risk score (r=-0.32, P = 0.006).

CONCLUSIONS:

Cardiac vagal tone represents a convenient, clinically relevant method of assessing parasympathetic nervous system tone, potentially facilitating the earlier identification of people with Type 1 diabetes who should undergo formal autonomic function testing.

PMID:
28703868
DOI:
10.1111/dme.13421
[Indexed for MEDLINE]
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6.
Diabet Med. 2017 Nov;34(11):1629-1636. doi: 10.1111/dme.13423. Epub 2017 Aug 14.

Diabetes and risk of occupational injury: a cohort study.

Author information

1
Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
2
Administrative Data Research Centre - Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, UK.
3
SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland.
4
Finnish Institute of Occupational Health, Turku and Helsinki, Finland.
5
Department of Epidemiology and Public Health, University College London, London, UK.
6
Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
7
Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.

Abstract

AIMS:

To investigate if diabetes is associated with a higher risk of occupational (workplace or commuting) injury.

METHODS:

Medication data from the Finnish Prescription Register were used to identify diabetes cases in 2004 in a large employee cohort (the Finnish Public Sector study). These data were linked to injury records obtained from the Federation of Accident Insurance Institutions. A total of 1020 diabetes cases (median age 52 years, range 20 to 65 years; 66% women) and their 5234 age- and sex-matched controls were followed up until 2011. Sex-stratified Cox proportional hazards models, adjusting for age, occupational status, obesity and health behaviours, were applied. Because of the small number of men in the cohort, injury types and locations were only examined among women.

RESULTS:

During the median follow-up of 6.7 years, 25% of the participants with diabetes (n=252) and 20% of those without (n=1051) experienced an occupational injury. The association between diabetes and injury was stronger in women than men (P=0.048). Diabetes was associated with a higher risk of workplace (hazard ratio 1.37, 95% CI 1.11 to 1.69) and commuting (hazard ratio 1.36, 95% CI 1.03 to 1.79) injury in women. With regard to different injury types and locations, diabetes was associated with bone fractures, dislocations, sprains and strains, and injuries to upper and lower extremities. In men, there was an association between insulin-treated diabetes and commuting injury (hazard ratio 3.14, 95% CI 1.52 to 6.49).

CONCLUSIONS:

Diabetes was associated with workplace and commuting injuries in women. Men with insulin-treated diabetes had a higher risk of commuting injuries.

PMID:
28703867
DOI:
10.1111/dme.13423
[Indexed for MEDLINE]
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7.
Diabet Med. 2017 Oct;34(10):1367-1371. doi: 10.1111/dme.13424. Epub 2017 Aug 3.

Effect of sodium-glucose co-transporter-2 inhibitors on impaired ventricular repolarization in people with Type 2 diabetes.

Author information

1
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan.
2
Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
3
Department of Cardiology, Steel Memorial Muroran Hospital, Muroran, Japan.
4
Department of Cardiology, JR Sapporo Hospital, Sapporo, Japan.

Abstract

AIMS:

To test the hypothesis that treatment with a sodium-glucose co-transporter-2 inhibitor would reverse ventricular repolarization heterogeneity, a predictor of cardiovascular mortality, in people with Type 2 diabetes.

METHODS:

We retrospectively analysed changes in indices of ventricular repolarization before and after treatment with a sodium-glucose co-transporter-2 inhibitor in 46 people with Type 2 diabetes.

RESULTS:

Sodium-glucose co-transporter-2 inhibitor treatment reduced HbA1c concentration [62±13 mmol/mol (7.7±1.2%) vs 59±16 mmol/mol (7.5±1.4%)], body weight (77.8±13.9 vs 74.7±12.5 kg) and systolic blood pressure (133±18 vs 126±12 mmHg) in the study participants. Heart rate and QTc interval were not changed by sodium-glucose co-transporter-2 inhibitor treatment, but QTc dispersion was significantly reduced (median, 48.8 vs 44.2 ms). Sodium-glucose co-transporter-2 inhibitor treatment reversed QTc dispersion more in participants who had larger QTc dispersion before the treatment. Changes in systolic blood pressure (Spearman's ρ= 0.319; P=0.031), but not in HbA1c concentration, were correlated with changes in QTc dispersion after sodium-glucose co-transporter-2 inhibitor treatment.

CONCLUSIONS:

The findings suggest that sodium-glucose co-transporter-2 inhibitor treatment reverses ventricular repolarization heterogeneity in people with Type 2 diabetes, independently of its effect on glycaemic control. The favourable effect on ventricular repolarization heterogeneity could be the mechanism by which empaglifozin reduced cardiovascular events in a recent study.

PMID:
28703863
DOI:
10.1111/dme.13424
[Indexed for MEDLINE]
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8.
Diabetes Care. 2017 Sep;40(9):1210-1217. doi: 10.2337/dc16-2238. Epub 2017 Jul 13.

Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study.

Li TC1,2, Yang CP3,4, Tseng ST5,6, Li CI7,8, Liu CS7,8,9, Lin WY8,9, Hwang KL10, Yang SY1, Chiang JH11, Lin CC12,8,9.

Author information

1
Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
2
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
3
Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan.
4
Department of Nutrition, Hungkuang University, Taichung, Taiwan.
5
Department of Food and Nutrition, Providence University, Taichung, Taiwan.
6
Department of Endocrinology and Metabolism, Kuang Tien General Hospital, Taichung, Taiwan.
7
Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
8
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
9
Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
10
Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.
11
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
12
Department of Medical Research, China Medical University Hospital, Taichung, Taiwan cclin@mail.cmuh.org.tw.

Abstract

OBJECTIVE:

The 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 METHODS:

Patients 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.

RESULTS:

During 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.

CONCLUSIONS:

FPG 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.

PMID:
28705834
DOI:
10.2337/dc16-2238
[Indexed for MEDLINE]
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10.
Diabetes Care. 2017 Aug;40(8):1017-1025. doi: 10.2337/dc17-0224.

Population-Based Assessment of a Biomarker-Based Screening Pathway to Aid Diagnosis of Monogenic Diabetes in Young-Onset Patients.

Author information

1
Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K.
2
NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K.
3
Blood Sciences, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K.
4
Molecular Genetics Diagnostic Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K.
5
Exeter Test Group, University of Exeter Medical School, Exeter, U.K.
6
Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K.
7
Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K. a.t.hattersley@exeter.ac.uk.

Abstract

OBJECTIVE:

Monogenic diabetes, a young-onset form of diabetes, is often misdiagnosed as type 1 diabetes, resulting in unnecessary treatment with insulin. A screening approach for monogenic diabetes is needed to accurately select suitable patients for expensive diagnostic genetic testing. We used C-peptide and islet autoantibodies, highly sensitive and specific biomarkers for discriminating type 1 from non-type 1 diabetes, in a biomarker screening pathway for monogenic diabetes.

RESEARCH DESIGN AND METHODS:

We studied patients diagnosed at age 30 years or younger, currently younger than 50 years, in two U.K. regions with existing high detection of monogenic diabetes. The biomarker screening pathway comprised three stages: 1) assessment of endogenous insulin secretion using urinary C-peptide/creatinine ratio (UCPCR); 2) if UCPCR was ≥0.2 nmol/mmol, measurement of GAD and IA2 islet autoantibodies; and 3) if negative for both autoantibodies, molecular genetic diagnostic testing for 35 monogenic diabetes subtypes.

RESULTS:

A total of 1,407 patients participated (1,365 with no known genetic cause, 34 with monogenic diabetes, and 8 with cystic fibrosis-related diabetes). A total of 386 out of 1,365 (28%) patients had a UCPCR ≥0.2 nmol/mmol, and 216 out of 386 (56%) were negative for GAD and IA2 and underwent molecular genetic testing. Seventeen new cases of monogenic diabetes were diagnosed (8 common Maturity Onset Diabetes of the Young [Sanger sequencing] and 9 rarer causes [next-generation sequencing]) in addition to the 34 known cases (estimated prevalence of 3.6% [51/1,407] [95% CI 2.7-4.7%]). The positive predictive value was 20%, suggesting a 1-in-5 detection rate for the pathway. The negative predictive value was 99.9%.

CONCLUSIONS:

The biomarker screening pathway for monogenic diabetes is an effective, cheap, and easily implemented approach to systematically screening all young-onset patients. The minimum prevalence of monogenic diabetes is 3.6% of patients diagnosed at age 30 years or younger.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01238380.

PMID:
28701371
PMCID:
PMC5570522
DOI:
10.2337/dc17-0224
[Indexed for MEDLINE]
Free PMC Article
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11.
Diabetes Care. 2017 Aug;40(8):1065-1072. doi: 10.2337/dc16-2228.

Twenty-Year Progression Rate to Clinical Onset According to Autoantibody Profile, Age, and HLA-DQ Genotype in a Registry-Based Group of Children and Adults With a First-Degree Relative With Type 1 Diabetes.

Author information

1
Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.
2
Department of Clinical Chemistry, Universitair Ziekenhuis Brussel, Brussels, Belgium.
3
Department of Diabetology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
4
Department of Endocrinology, Universitair Ziekenhuis Leuven, Leuven, Belgium.
5
Department of Endocrinology, Diabetology and Metabolism, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium.
6
Department of Diabetology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
7
Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium ilse.weets@uzbrussel.be.

Abstract

OBJECTIVE:

We investigated whether islet autoantibody profile, HLA-DQ genotype, and age influenced a 20-year progression to diabetes from first autoantibody positivity (autoAb+) in first-degree relatives of patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS:

Persistently islet autoAb+ siblings and offspring (n = 462) under 40 years of age were followed by the Belgian Diabetes Registry. AutoAbs against insulin (IAA), GAD (GADA), IA-2 antigen (IA-2A), and zinc transporter 8 (ZnT8A) were determined by radiobinding assay.

RESULTS:

The 20-year progression rate of multiple-autoAb+ relatives (n = 194) was higher than that for single-autoAb+ participants (n = 268) (88% vs. 54%; P < 0.001). Relatives positive for IAA and GADA (n = 54) progressed more slowly than double-autoAb+ individuals carrying IA-2A and/or ZnT8A (n = 38; P = 0.001). In multiple-autoAb+ relatives, Cox regression analysis identified the presence of IA-2A or ZnT8A as the only independent predictors of more rapid progression to diabetes (P < 0.001); in single-autoAb+ relatives, it identified younger age (P < 0.001), HLA-DQ2/DQ8 genotype (P < 0.001), and IAA (P = 0.028) as independent predictors of seroconversion to multiple positivity for autoAbs. In time-dependent Cox regression, younger age (P = 0.042), HLA-DQ2/DQ8 genotype (P = 0.009), and the development of additional autoAbs (P = 0.012) were associated with more rapid progression to diabetes.

CONCLUSIONS:

In single-autoAb+ relatives, the time to multiple-autoAb positivity increases with age and the absence of IAA and HLA-DQ2/DQ8 genotype. The majority of multiple-autoAb+ individuals progress to diabetes within 20 years; this occurs more rapidly in the presence of IA-2A or ZnT8A, regardless of age, HLA-DQ genotype, and number of autoAbs. These data may help to refine the risk stratification of presymptomatic type 1 diabetes.

PMID:
28701370
DOI:
10.2337/dc16-2228
[Indexed for MEDLINE]
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12.
Diabetes Care. 2017 Sep;40(9):e120-e121. doi: 10.2337/dc17-0787. Epub 2017 Jul 10.

Insulin-Associated Weight Gain in Type 2 Diabetes Is Associated With Increases in Sedentary Behavior.

Author information

1
Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands.
2
Radboud Institute for Molecular Life Sciences, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
3
Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
4
Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
5
Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands dick.thijssen@radboudumc.nl.
6
Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, U.K.
PMID:
28694305
DOI:
10.2337/dc17-0787
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13.
Diabetes Care. 2017 Sep;40(9):1256-1263. doi: 10.2337/dc16-2750. Epub 2017 Jul 7.

Skeletal Muscle Microvascular-Linked Improvements in Glycemic Control From Resistance Training in Individuals With Type 2 Diabetes.

Author information

1
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
2
Department of Health and Human Performance, College of Health Services, University of Texas Rio Grande Valley, Brownsville, TX.
3
Royal Hobart Hospital, Hobart, Australia.
4
School of Medicine, University of Tasmania, Hobart, Australia.
5
Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA.
6
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia michelle.keske@deakin.edu.au.
7
Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.

Abstract

OBJECTIVE:

Insulin 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 METHODS:

Seventeen (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 × 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.

RESULTS:

After 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.

CONCLUSIONS:

RT improves OGC-stimulated muscle MBF and glycemic control concomitantly, suggesting that MBF plays a role in improved glycemic control from RT.

PMID:
28687542
DOI:
10.2337/dc16-2750
[Indexed for MEDLINE]
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14.
N Engl J Med. 2017 Jul 13;377(2):195. doi: 10.1056/NEJMc1706322.

Frequency of Evidence-Based Screening for Diabetic Retinopathy.

Author information

1
Massachusetts General Hospital Diabetes Center, Boston, MA.
2
Biostatistics Center, George Washington University, Rockville, MD jml@bsc.gwu.edu.
PMID:
28700836
DOI:
10.1056/NEJMc1706322
[Indexed for MEDLINE]
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15.
N Engl J Med. 2017 Jul 13;377(2):194-195. doi: 10.1056/NEJMc1706322.

Frequency of Evidence-Based Screening for Diabetic Retinopathy.

Author information

1
Singapore Eye Research Institute, Singapore, Singapore
2
International Council of Ophthalmology, San Francisco, CA
3
Singapore National Eye Center, Singapore, Singapore ophwty@nus.edu.sg
PMID:
28700835
DOI:
10.1056/NEJMc1706322
[Indexed for MEDLINE]
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