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1.
BMJ. 2019 Mar 12;364:l1128. doi: 10.1136/bmj.l1128.

Sixty seconds on . . . reversing type 2 diabetes.

PMID:
30862641
DOI:
10.1136/bmj.l1128
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2.
Diabet Med. 2019 Mar 13. doi: 10.1111/dme.13946. [Epub ahead of print]

Exploring organizational support for the provision of structured self-management education for people with Type 2 diabetes: findings from a qualitative study.

Author information

1
Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
2
College of Life Sciences, University of Leicester, Leicester, UK.
3
Belfast Health and Social Care Trust, Belfast, UK.
4
School of Nursing, Ulster University, Coleraine, UK.
5
Western Health and Social Care Trust, Londonderry, UK.

Abstract

AIM:

To explore the organizational context in which Type 2 diabetes structured group education is provided.

METHODS:

Four Clinical Commissioning Groups in England providing Type 2 diabetes structured self-management education participated in a qualitative study exploring the context for provision of that education. Using UK National Diabetes Audit returns, two Clinical Commissioning Groups were selected that had non-attendance rates of ≤25%, and two that had non-attendance rates of ≥50%. Between May 2016 and August 2017, 20 interviews were conducted with Clinical Commissioning Group staff including: commissioners, healthcare professionals, managers, general practitioners and diabetes educators. Data gathering was prolonged as it proved challenging to engage with healthcare staff as a result of frequent local restructuring and service disruption.

RESULTS:

Local audits revealed discrepancies in basic data such as referral and attendance numbers compared with national audit data. There was a commonality in the themes identified from interviews: diabetes education was rarely embedded in service structure; where education uptake was poor, a lack of central support to delivery teams was noticeable; and where education uptake was positive, delivery teams were actively engaged, sometimes relying on enthusiastic individuals. Both situations put the local sustainability of diabetes education at risk.

CONCLUSIONS:

There appears to be a link between attendance rates and organizational issues, therefore, when considering how to increase attendance rates, the state of the diabetes education infrastructure should be reviewed. Good uptake of diabetes education can be too reliant on the enthusiastic commitment of small teams or individuals delivering the education.

PMID:
30868654
DOI:
10.1111/dme.13946
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3.
Diabetes. 2019 Mar 12. pii: db181313. doi: 10.2337/db18-1313. [Epub ahead of print]

Cardiac Autonomic Function is Associated With Myocardial Flow Reserve in Type 1 Diabetes.

Author information

1
Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, 2820 Gentofte, Denmark emilie.hein.zobel@regionh.dk.
2
Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen, Denmark.
3
Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, 2820 Gentofte, Denmark.
4
Steno Diabetes Center Aarhus, Aarhus, Denmark.
5
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
6
University of Copenhagen, Copenhagen, Denmark.

Abstract

The link between cardiac autonomic neuropathy and risk of cardiovascular disease is highlighted as an area in which research is needed. This study was undertaken to evaluate the association between measures of cardiac autonomic function and cardiac vascular function in type 1 diabetes using new and sensitive methods.Cross-sectional study in type 1 diabetes, stratified by normoalbuminuria (n=30) and macroalbuminuria (n=30), and in healthy controls (n=30). Cardiac autonomic function was evaluated using heart rate variability (HRV) indices, cardiovascular autonomic reflex tests (CARTs) and cardiac 123I-metaiodobenzylguanidine (MIBG) imaging. Cardiac vascular function was assessed as myocardial flow reserve (MFR) measured by cardiac 82Rb-positron-emission-tomography/computed-tomography.The measures of cardiac autonomic function (except low-frequency-to-high-frequency ratio and the Valsalva test ratio) were positively correlated to MFR in unadjusted analysis. All the HRV indices lost significance after adjustment for age and heart rate. After further adjustment for relevant cardiovascular risk factors, the late heart-to-mediastinum ratio directly measuring the function of adrenergic receptors and sympathetic integrity (from the MIBG scintigraphy) and the 30-to-15 ratio (a CART), remained positively associated with MFR (p ≤0.04).Cardiac autonomic dysfunction including loss of cardiac sympathetic integrity in type 1 diabetes is associated with and may contribute to impaired myocardial blood flow regulation.

PMID:
30862683
DOI:
10.2337/db18-1313
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4.
Diabetes. 2019 Mar 12. pii: db180837. doi: 10.2337/db18-0837. [Epub ahead of print]

Diabetes-Induced DUSP4 Reduction Promotes Podocyte Dysfunction and Progression of Diabetic Nephropathy.

Author information

1
From the Research Center of the Centre Hospitalier Universitaire de Sherbrooke and.
2
Division of Cardiology.
3
Nephrology and.
4
From the Research Center of the Centre Hospitalier Universitaire de Sherbrooke and Pedro.Geraldes@USherbrooke.ca.
5
Endocrinology, Department of Medicine, Université de Sherbrooke, Québec, Canada.

Abstract

Diabetic nephropathy (DN) remains the leading cause of end-stage renal disease. Hyperglycemia-induced podocyte dysfunction is a major contributor of renal function impairment in DN. Previous studies showed that activation of mitogen-activated protein kinase (MAPK) in diabetes promotes podocyte dysfunction and cell death. Dual specificity phosphatase (DUSP) are a family of phosphatases mainly responsible for MAPK inhibition. In this study, we demonstrated that diabetes and high glucose exposure decreased DUSP4 expression in cultured podocytes and glomeruli. Diabetes-induced DUSP4 reduction enhanced p38 and JNK activity, and podocyte dysfunction. The overexpression of DUSP4 prevented the activation of p38, JNK, caspase 3/7 activity and NOX4 expression induced by high glucose level exposure. Deletion of DUSP4 exacerbated albuminuria and increased mesangial expansion and glomerular fibrosis in diabetic mice. These morphological changes were associated with profound podocyte foot process effacement, cell death and sustained p38 and JNK activation. Moreover, inhibition of protein kinase C-δ prevented DUSP4 expression decline and p38/JNK activation in podocytes and renal cortex of diabetic mice. Analysis of DUSP4 expression in renal cortex of diabetic patients revealed that decreased DUSP4 mRNA expression correlated with reduced eGFR (<60 ml/min/1.73 m2). Thus, this study demonstrates that preserving DUSP4 expression could protect against podocyte dysfunction and preserve glomerular function in DN.

PMID:
30862678
DOI:
10.2337/db18-0837
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5.
Diabetes Care. 2019 Apr;42(4):601-608. doi: 10.2337/dc18-1970.

Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study.

Collaborators (286)

Nathan DM, Knowler WC, Edelstein S, Crandall JP, Dabelea D, Goldberg RB, Kahn SE, Mather KJ, Trandafirescu G, Walker EA, Temprosa M, Bray GA, Gadde K, Chatellier A, Arceneaux J, Dragg A, Duncan C, Greenway FL, Hsia D, Levy E, Lockett M, Ryan DH, Ehrmann D, Matulik MJ, Czech K, DeSandre C, Goldstein BJ, Furlong K, Smith KA, Wildman W, Pepe C, Calles J, Ojito J, Castillo-Florez S, Giannella A, Lara O, Veciana B, Haffner SM, Hazuda HP, Montez MG, Hattaway K, Lorenzo C, Martinez A, Walker T, Hamman RF, Testaverde L, Anderson D, Bouffard A, Jenkins T, Lenz D, Perreault L, Price DW, Steinke SC, Horton ES, Poirier CS, Swift K, Caballero E, Fargnoli B, Guidi A, Guido M, Jackson SD, Lambert L, Lawton KE, Ledbury S, Sansoucy J, Spellman J, Montgomery BK, Fujimoto W, Knopp RH, Lipkin EW, Morgan-Taggart I, Murillo A, Taylor L, Thomas A, Tsai EC, Trence D, Kitabchi AE, Dagogo-Jack S, Murphy ME, Taylor L, Dolgoff J, Clark D, Ibebuogu U, Lambeth H, Ricks H, Rutledge LMK, Soberman JE, Molitch ME, Metzger BE, Johnson MK, Giles MM, Larsen D, Pen SC, Larkin M, McKitrick C, Turgeon H, Anderson E, Bissett L, Bondi K, Cagliero E, D'Anna K, Delahanty L, Florez JC, Goldman V, Lou P, Poulos A, Raymond E, Stevens C, Tsent B, Barrett-Connor E, Carrion-Petersen ML, Claravall LN, Dowden JM, Horne J, Leos D, Mudaliar S, Smith J, Szerdi Janisch S, Vejvoda K, Pi-Sunyer FX, Lee JE, Foo ST, Hagamen S, Marrero DG, Kelly SM, Putenney P, Jackson MA, McAtee G, Ackermann RT, Cantrell CM, Fineberg ES, Hadden A, Kirkman MS, O'Kelly Phillips E, Roach PJ, Ratner RE, Aroda V, Shapiro S, Bavido-Arrage C, Gibbs P, Uwaifo G, Wiggins R, Saad MF, Watson K, Botrous M, Jinagouda S, Budget M, Conzues C, Magpuri P, Ngo K, Xapthalamous K, White NH, Brown AL, Das S, Khare-Ranade P, Stich T, Santiago A, Wernimont C, Saudek CD, Hill Golden S, Whittington T, Brancati FL, Clark JM, Greene A, Jiggetts D, Mosley H, Reusing J, Rubin RR, Stephens S, Utsey E, Shade DS, Adams KS, Hemphill C, Hyde P, Canady JL, Colleran K, Gonzeles Y, Hernandez-McGinnis DA, King C, Crandall J, Brown JO, Adorno E, Duffy H, Goldstein A, Lukin J, Martinez H, Pompi D, Shamoon H, Scheindlin J, Wylie-Rosett J, Orchard T, Kriska A, Jeffries S, Kramer MK, Smith M, Benchoff C, Guimond S, Pettigrew J, Rubinstein D, Semler L, Venditti E, Weinzierl V, Arakaki RF, Baker-Ladao NK, Isonaga MK, Bermudez NE, Mau MK, Melish JS, Yamamoto RE, Cooeyate N, Enote A, Hoskin MA, Natewa C, Percy CA, Acton KJ, Andre VL, Barber R, Begay S, Bucca BC, Cook S, Curtis J, Dodge C, Doughty MS, Kurland J, Glass J, Glass M, Hanson RL, Ingraham LE, Kobus KM, Krakoff J, Manus C, McCabe C, Michaels S, Morgan T, Nelson JA, Piromalli C, Roy RJ, Sangster S, Smart M, Tonemah DP, Williams R, Wilson C, Fowler S, Larsen M, Brenneman T, Sherif H, Abebe S, Bamdad J, Barkalow M, Bethepu J, Bezebeh T, Butler N, Callaghan J, Carter CE, Christophi C, Dwyer GM, Foulkes M, Gao Y, Gooding R, Gottlieb A, Grover N, Hoffman H, Hogan AN, Jablonski K, Katz R, Kolinjivadi P, Lachin JM, Ma Y, Pan Q, Reamer S, Sapozhnikova A, Venditti EM, Kriska AM, Semler L, Weinzierl V, Marcovina S, Strylewicz G, Albers J, Fradkin J, Garfield S, Lee C, Gregg E, Zhang P, Herman WH, Brändle M, Brown MB.

Abstract

OBJECTIVE:

We examined the effects of metformin on diabetes prevention and the subgroups that benefited most over 15 years in the Diabetes Prevention Program (DPP) and its follow-up, the Diabetes Prevention Program Outcomes Study (DPPOS).

RESEARCH DESIGN AND METHODS:

During the DPP (1996-2001), adults at high risk of developing diabetes were randomly assigned to masked placebo (n = 1,082) or metformin 850 mg twice daily (n = 1,073). Participants originally assigned to metformin continued to receive metformin, unmasked, in the DPPOS (2002-present). Ascertainment of diabetes development was based on fasting or 2-h glucose levels after an oral glucose tolerance test or on HbA1c. Reduction in diabetes incidence with metformin was compared with placebo in subgroups by hazard ratio (HR) and rate differences (RDs).

RESULTS:

During 15 years of postrandomization follow-up, metformin reduced the incidence (by HR) of diabetes compared to placebo by 17% or 36% based on glucose or HbA1c levels, respectively. Metformin's effect on the development of glucose-defined diabetes was greater for women with a history of prior gestational diabetes mellitus (GDM) (HR 0.59, RD -4.57 cases/100 person-years) compared with parous women without GDM (HR 0.94, RD -0.38 cases/100 person-years [interaction P = 0.03 for HR, P = 0.01 for RD]). Metformin also had greater effects, by HR and RD, at higher baseline fasting glucose levels. With diabetes development based on HbA1c, metformin was more effective in subjects with higher baseline HbA1c by RD, with metformin RD -1.03 cases/100 person-years with baseline HbA1c <6.0% (42 mmol/mol) and -3.88 cases/100 person-years with 6.0-6.4% (P = 0.0001).

CONCLUSIONS:

Metformin reduces the development of diabetes over 15 years. The subsets that benefitted the most include subjects with higher baseline fasting glucose or HbA1c and women with a history of GDM.

PMID:
30877090
PMCID:
PMC6429636
[Available on 2020-04-01]
DOI:
10.2337/dc18-1970
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6.
Diabetes Care. 2019 Apr;42(4):689-692. doi: 10.2337/dc18-1843.

Early Detection of Hypoglycemia in Type 1 Diabetes Using Heart Rate Variability Measured by a Wearable Device.

Author information

1
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands marleen.oldebekkink@radboudumc.nl.
2
REshape Center for Innovation, Radboud University Medical Center, Nijmegen, the Netherlands.
3
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

Abstract

OBJECTIVE:

Changes in heart rate variability (HRV) occur at the initiation of hypoglycemia due to sympathetic nervous system activity. We investigated the use of HRV detection by a wearable device as an early alert for hypoglycemia.

RESEARCH DESIGN AND METHODS:

This proof-of-principle study included 23 patients with type 1 diabetes (14 women, mean age 42 ± 11 years). Patients wore a VitalConnect HealthPatch for 5 days. Hypoglycemia was defined as glucose ≤70 mg/dL (≤3.9 mmol/L) by fingerstick measurement. HRV was analyzed in standardized periods before the hypoglycemic event.

RESULTS:

Sixty-six hypoglycemic events were recorded. Hypoglycemia caused a typical HRV pattern in 36 (55%) of the hypoglycemic events. Eighteen events (27%) showed an atypical pattern. Ten events were unclassified (15%), and two did not display a change in HRV (3%).

CONCLUSIONS:

Hypoglycemia causes early changes in HRV that can be detected by a wearable device. Measuring real-time HRV seems promising for early hypoglycemia detection.

PMID:
30877089
DOI:
10.2337/dc18-1843
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7.
Diabetes Care. 2019 Mar 12. pii: dc181985. doi: 10.2337/dc18-1985. [Epub ahead of print]

Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial.

Author information

1
College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR pamcelfish@uams.edu.
2
College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR.
3
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
4
Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL.
5
Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR.
6
College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR.
7
College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

Abstract

OBJECTIVE:

Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c).

RESEARCH DESIGN AND METHODS:

A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention, and were examined with adjusted linear mixed-effects regression models.

RESULTS:

Participants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005).

CONCLUSIONS:

Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members.

PMID:
30862659
DOI:
10.2337/dc18-1985
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8.
Diabetes Care. 2019 Mar 12. pii: dc190093. doi: 10.2337/dc19-0093. [Epub ahead of print]

Efficacy and Safety of Empagliflozin in Renal Transplant Recipients With Posttransplant Diabetes Mellitus.

Author information

1
Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
2
Section of Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway k.e.kvitne@farmasi.uio.no.
3
Section of Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway.
4
Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway.
5
Faculty of Medicine, University of Oslo, Oslo, Norway.
6
Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Abstract

OBJECTIVE:

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have lately become the recommended treatment in patients with type 2 diabetes and high cardiovascular risk. Patients with posttransplant diabetes mellitus (PTDM) also have high cardiovascular risk. The aim of this study was to investigate the safety and efficacy of empagliflozin in renal transplant recipients with PTDM.

RESEARCH DESIGN AND METHODS:

Forty-nine renal transplant recipients were included in an investigator-initiated, single-center, prospective, double-blind study and randomized to receive either 10 mg empagliflozin or placebo once daily for 24 weeks. Patients transplanted >1 year ago, diagnosed with PTDM, with stable renal function (estimated glomerular filtration rate [eGFR] >30 mL/min/1.73 m2), and with stable immunosuppressive therapy were studied.

RESULTS:

Forty-four renal transplant recipients (22 empagliflozin/22 placebo, 34 males) completed the study. Median (interquartile range) change in glycated hemoglobin (HbA1c) was significantly reduced with empagliflozin compared with placebo: -0.2% (-0.6, -0.1) (-2.0 mmol/mol [-6.5, -1.0]) vs. 0.1% (-0.1, 0.4) (1.0 mmol/mol [-0.75, 3.8]) (P = 0.025). The magnitude of glucose reduction was dependent on GFR and baseline HbA1c. The treatment also resulted in a significant reduction in body weight of -2.5 kg (-4.0, -0.05) compared with an increase of 1.0 kg (0.0, 2.0) in the placebo group (P = 0.014). There were no significant differences between the groups in adverse events, immunosuppressive drug levels, or eGFR.

CONCLUSIONS:

Empagliflozin appeared safe and improved glycemic control in renal transplant recipients with PTDM compared with placebo. A concomitant reduction in body weight was seen.

PMID:
30862658
DOI:
10.2337/dc19-0093
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9.
Diabetes Care. 2019 Mar 12. pii: dc182004. doi: 10.2337/dc18-2004. [Epub ahead of print]

Risk of Incident Obstructive Sleep Apnea Among Patients With Type 2 Diabetes.

Author information

1
Institute of Applied Health Research, University of Birmingham, Birmingham, U.K.
2
Institute of Clinical Sciences, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, U.K.
3
University Hospital Birmingham, Birmingham, U.K.
4
Institute of Applied Health Research, University of Birmingham, Birmingham, U.K. gneilthomas@yahoo.co.uk g.n.thomas@bham.ac.uk.
5
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K.
6
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, U.K.
7
Midlands Health Data Research, U.K.

Abstract

OBJECTIVE:

This study compared the incidence of obstructive sleep apnea (OSA) in patients with and without type 2 diabetes and investigated risk factors for OSA in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

A retrospective cohort study was performed to compare OSA incidence between adult patients with and without type 2 diabetes matched for age, sex, and BMI. Patients with a prevalent OSA diagnosis were excluded. The study cohort was derived from The Health Improvement Network (THIN), a U.K. primary care database, from 1 January 2005 to 31 December 2017.

RESULTS:

There were 3,110 (0.88%) and 5,968 (0.46%) incident OSA cases identified in the 360,250 exposed and 1,296,489 unexposed patient cohorts, respectively. Adjusted incidence rate ratio (aIRR) of OSA in patients with type 2 diabetes compared with those without was 1.48 (95% CI 1.42-1.55; P < 0.001). In a multivariate regression analysis of patients with type 2 diabetes, significant predictors of OSA were diabetes-related foot disease (1.23 [1.06-1.42]; P = 0.005), being prescribed insulin in the last 60 days (1.58 [1.42-1.75]; P < 0.001), male sex (2.27 [2.09-2.46]; P < 0.001), being overweight (2.02 [1.54-2.64]; P < 0.001) or obese (8.29 [6.42-10.69]; P < 0.001), heart failure (1.41 [1.18-1.70]; P < 0.001), ischemic heart disease (1.22 [1.11-1.34]; P < 0.001), atrial fibrillation (1.23 [1.04-1.46]; P = 0.015), hypertension (1.32 [1.23-1.43]; P < 0.001), and depression (1.75 [1.61-1.91]; P < 0.001).

CONCLUSIONS:

When considered alongside previous evidence, this study indicates that the association between type 2 diabetes and OSA is bidirectional. In addition to known predictors of OSA, diabetes-related foot disease and insulin treatment were identified as risk factors in patients with type 2 diabetes.

PMID:
30862657
DOI:
10.2337/dc18-2004
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10.
Diabetes Care. 2019 Mar 12. pii: dc182420. doi: 10.2337/dc18-2420. [Epub ahead of print]

Disordered Eating Behaviors in Youth and Young Adults With Type 1 or Type 2 Diabetes Receiving Insulin Therapy: The SEARCH for Diabetes in Youth Study.

Abstract

OBJECTIVE:

This study examines the prevalence of disordered eating behaviors (DEB) and its associations with glycemic control, insulin sensitivity (IS), and psychosocial functioning in a large, diverse cohort of youth and young adults with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS:

In the SEARCH for Diabetes in Youth study, 2,156 youth and young adults with type 1 diabetes (mean ± SD age 17.7 ± 4.3 years; 50.0% female) and 149 youth and young adults with type 2 diabetes (age 21.8 years ± 3.5; 64.4% female) who were receiving insulin therapy completed the Diabetes Eating Problem Survey-Revised (DEPS-R), a self-reported measure for identifying disordered eating. DEB was defined as a DEPS-R score ≥20. Demographic characteristics, clinical measures, and health behaviors of participants with DEB and those without DEB were compared by using t tests.

RESULTS:

DEB were observed in 21.2% of participants with type 1 diabetes and 50.3% of participants with type 2 diabetes. Participants encountered challenges in maintaining a healthy weight while controlling their diabetes. For both types of diabetes, individuals with DEB had a significantly higher BMI z score, lower insulin sensitivity, more depressive symptoms, and poorer quality of life than those without DEB. Diabetic ketoacidosis (DKA) episodes occurred more frequently in youth with type 1 diabetes with DEB compared to those without DEB.

CONCLUSIONS:

These findings highlight that DEB are prevalent among youth and young adults with type 1 and type 2 diabetes and who are receiving insulin therapy, and DEB are associated with poorer clinical outcomes and psychosocial well-being. Heightened awareness and early interventions are needed to address DEB for this at-risk population, as are longitudinal studies evaluating the course of DEB and diabetes outcomes.

PMID:
30862656
DOI:
10.2337/dc18-2420
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11.
Diabetes Care. 2019 Mar 12. pii: dc182365. doi: 10.2337/dc18-2365. [Epub ahead of print]

Intractable Coronary Artery Disease in a Patient with Type 2 Diabetes Presenting With Triglyceride Deposit Cardiomyovasculopathy.

Author information

1
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
2
Department of Radiology, Osaka National Hospital, National Hospital Organization, Osaka, Japan.
3
Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Graduate School of Medicine, Osaka University, Osaka, Japan khirano@cnt-osaka.com.
PMID:
30862655
DOI:
10.2337/dc18-2365
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12.
Diabetes Care. 2019 Mar 12. pii: dc181554. doi: 10.2337/dc18-1554. [Epub ahead of print]

Underuse of Medications and Lifestyle Counseling to Prevent Cardiovascular Disease in Patients With Diabetes.

Author information

1
Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY jonathan.newman@nyumc.org.
2
Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
3
Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, NY.
4
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
PMID:
30862654
DOI:
10.2337/dc18-1554
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Publication type

Publication type

13.
Diabetes Care. 2019 Mar 12. pii: dc181991. doi: 10.2337/dc18-1991. [Epub ahead of print]

Post-ACA Racial Disparity of Eye Examinations Among the U.S. Noninstitutionalized Population With Diabetes: 2014-2015.

Author information

1
Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
2
Division of Clinical and Administrative Science, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA.
3
Section of Endocrinology, Department of Medicine, School of Medicine, Tulane University, New Orleans, LA.
4
Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA lshi1@tulane.edu.
PMID:
30862653
DOI:
10.2337/dc18-1991
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Publication type

Publication type

14.
Diabetes Care. 2019 Mar 12. pii: dc182388. doi: 10.2337/dc18-2388. [Epub ahead of print]

Testosterone Therapy in Men With Hypogonadism Prevents Progression From Prediabetes to Type 2 Diabetes: Eight-Year Data From a Registry Study.

Author information

1
Institute for Urology and Andrology, Norderstedt, Germany.
2
Dresden International University, Dresden, Germany.
3
Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar.
4
Private Urology Practice, Bremerhaven, Germany.
5
American Medical Writers Association, Fort Lauderdale, FL.
6
Department of Epidemiology and Statistics, Boston University School of Public Health, Boston, MA.
7
Medical Affairs Andrology, Bayer AG, Berlin, Germany farid.saad@bayer.com.
8
Gulf Medical University School of Medicine, Ajman, United Arab Emirates.
9
Department of Nutrition Sciences, University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham, AL.

Abstract

OBJECTIVE:

Type 2 diabetes (T2D) is a public health threat. Prediabetes represents a window of opportunity for intervention to prevent T2D. Men with T2D and prediabetes often have low testosterone. Since testosterone improves glycemic control in T2D, we investigated whether testosterone therapy (TTh) in men with hypogonadism and prediabetes prevents progression to T2D.

RESEARCH DESIGN AND METHODS:

Three hundred sixteen men with prediabetes (defined as HbA1c 5.7-6.4%) and total testosterone levels ≤12.1 nmol/L combined with symptoms of hypogonadism were analyzed. Two hundred twenty-nine men received parenteral testosterone undecanoate (T-group), and 87 men with hypogonadism served as untreated control subjects. Metabolic and anthropometric parameters were measured twice yearly for 8 years.

RESULTS:

HbA1c decreased by 0.39 ± 0.03% (P < 0.0001) in the T-group and increased by 0.63 ± 0.1% (P < 0.0001) in the untreated group. In the T-group, 90% achieved normal glucose regulation (HbA1c <5.7%). In the untreated group, 40.2% progressed to T2D (HbA1c >6.5%). TTh was also associated with significant improvements in fasting glucose, triglyceride:HDL ratio, triglyceride-glucose index, lipid accumulation product, total cholesterol, LDL, HDL, non-HDL, triglycerides, and Aging Males' Symptoms (AMS) scale. Significant deterioration in all these parameters was seen in the untreated group. Mortality was 7.4% in the T-group and 16.1% in the untreated group (P < 0.05). The incidence of nonfatal myocardial infarction was 0.4% in the T-group and 5.7% in the untreated group (P < 0.005).

CONCLUSIONS:

Long-term TTh completely prevents prediabetes progression to T2D in men with hypogonadism and improves glycemia, lipids, and AMS score. TTh holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism.

PMID:
30862651
DOI:
10.2337/dc18-2388
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15.
J Clin Endocrinol Metab. 2019 Mar 14. pii: jc.2018-01484. doi: 10.1210/jc.2018-01484. [Epub ahead of print]

Potential Role of Metal Chelation to Prevent the Cardiovascular Complications of Diabetes.

Author information

1
From the Mount Sinai Medical Center Department of Medicine, Miami Beach, FL.
2
Columbia University Mailman School of Public Health, New York, New York.
3
Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL.
4
Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
5
Department of Medicine, New York University School of Medicine, New York, New York.
6
Roanoke Heart Institute PLC, Roanoke, Virginia.
7
Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.

Abstract

CONTEXT:

For decades, there has been epidemiologic evidence linking chronic toxic metal exposure with cardiovascular disease, suggesting a therapeutic role for metal chelation. Given the lack of compelling scientific evidence however, the indications for metal chelation were never clearly defined. To determine the safety and efficacy of chelation therapy, the National Institutes of Health funded the Trial to Assess Chelation Therapy (TACT). TACT was the first double blind, randomized, controlled trial to demonstrate an improvement in cardiovascular outcomes with edetate disodium therapy in patients with prior myocardial infarction. The therapeutic benefit was striking among the pre-specified subgroup of diabetic patients.

EVIDENCE ACQUISITION:

We review the published literature focusing on the atherogenic nature of diabetes, and available evidence from clinical trials, complete and in progress, of metal chelation with edetate disodium therapy in diabetic patients.

EVIDENCE SYNTHESIS:

The TACT results support the concept that ubiquitous toxic metals such as lead and cadmium may be modifiable risk factors for cardiovascular disease, particularly in diabetic patients.

CONCLUSIONS:

The purpose of this review is to discuss the potential mechanisms unifying the pathogenesis of atherogenic factors in diabetes with toxic metal exposure, and the potential role of metal chelation.

16.
Lancet. 2019 Mar 9;393(10175):985. doi: 10.1016/S0140-6736(18)33047-2.

Excess mortality and cardiovascular disease risk in type 1 diabetes.

Author information

1
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA. Electronic address: costacout@edc.pitt.edu.
2
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
PMID:
30860050
DOI:
10.1016/S0140-6736(18)33047-2
[Indexed for MEDLINE]
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17.
Lancet. 2019 Mar 9;393(10175):985-986. doi: 10.1016/S0140-6736(18)33061-7.

Excess mortality and cardiovascular disease risk in type 1 diabetes - Authors' reply.

Author information

1
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
2
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK. Electronic address: naveed.sattar@glasgow.ac.uk.
3
The Swedish National Diabetes Register, Västra Götalandsregionen, Gothenburg, Sweden.
4
Sahlgrenska University Hospital, Gothenburg, Sweden.
PMID:
30860049
DOI:
10.1016/S0140-6736(18)33061-7
[Indexed for MEDLINE]
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18.
Lancet. 2019 Mar 9;393(10175):984-985. doi: 10.1016/S0140-6736(18)33050-2.

Excess mortality and cardiovascular disease risk in type 1 diabetes.

Author information

1
Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW 2145, Australia; Garvan Institute of Medical Research, Sydney, NSW, Australia. Electronic address: jennifer.snaith@health.nsw.gov.au.
2
Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW 2145, Australia.
3
Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW 2145, Australia; Department of Diabetes and Endocrinology, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia; Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia.
4
Garvan Institute of Medical Research, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, St Vincent's Hospital, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
PMID:
30860047
DOI:
10.1016/S0140-6736(18)33050-2
[Indexed for MEDLINE]
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19.
Lancet. 2019 Mar 9;393(10175):1033. doi: 10.1016/S0140-6736(19)30304-6.

Involuntary choreiform movements in a diabetic patient.

Author information

1
Department of Neurology, Chongqing Key Laboratory of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
2
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
3
Department of Neurology, Chongqing Key Laboratory of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: 405034986@qq.com.

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