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1.
Diabet Med. 2018 Jan;35(1):147-151. doi: 10.1111/dme.13543.

History of mood or anxiety disorders and risk of gestational diabetes mellitus in a population-based cohort.

Author information

1
School of Public Health, University of Alberta, Edmonton, Canada.
2
Department of Medicine, University of Alberta, Edmonton, Canada.
3
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.

Abstract

AIM:

To examine the association between mood and anxiety disorders and the development of gestational diabetes mellitus in a retrospective population-based cohort study.

METHODS:

Clinical data from a provincial perinatal health registry were linked to physician claims, hospitalization records and emergency visits to identify any diagnoses of mood or anxiety disorders in the 2 years prior to pregnancy and a subsequent diagnosis of gestational diabetes during pregnancy. The study population included all singleton pregnancies in the Canadian province of Alberta from 1 April 2000 to 31 March 2010. Generalized estimating equations were used to determine the adjusted odds ratio of gestational diabetes, comparing women with and without a history of mood or anxiety disorders.

RESULTS:

Among 373 674 pregnancies from 253 911 women, 25.7% had a history of mood or anxiety disorders, and 3.8% developed gestational diabetes. The multivariate-adjusted odds of developing gestational diabetes were higher among women with a history of mood or anxiety disorders (odds ratio 1.10, 95% CI 1.06-1.14).

CONCLUSIONS:

Women with a history of mood or anxiety disorders had a moderately increased risk of developing gestational diabetes.

PMID:
29120506
DOI:
10.1111/dme.13543
[Indexed for MEDLINE]
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2.
Diabet Med. 2018 Jan;35(1):63-71. doi: 10.1111/dme.13541.

Route to improving Type 1 diabetes mellitus glycaemic outcomes: real-world evidence taken from the National Diabetes Audit.

Author information

1
School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
2
Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK.
3
Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK.
4
Institute for Applied Clinical Sciences, Keele University, Keele, UK.
5
Co-ordinator of the Obesity Clinic in the Medicine School of Instituto Politécnico Nacional, Mexico City, Mexico.
6
Warwick Medical School, University of Warwick, Coventry, UK.
7
RES Consortium, Andover, Wiltshire, UK.
8
National Diabetes Audit, Central Office Diabetes UK, London, UK.

Abstract

AIM:

To use general practice-level data for England, available through the National Diabetes Audit, and primary care prescribing data to identify prescription treatment factors associated with variations in achieved glucose control (HbA1c ).

METHODS:

General practice-level National Diabetes Audit data on Type 1 diabetes, including details of population characteristics, services, proportion of people achieving target glycaemic control [HbA1c ≤58 mmol/mol (7.5%)] and proportion of people at high glycaemic risk [HbA1c >86 mmol/ml (10%)], were linked to 2013-2016 primary care diabetes prescribing data on insulin types and blood glucose monitoring for all people with diabetes.

RESULTS:

A wide variation was found between the 10th percentile and the 90th percentile of general practices in both target glycaemic control (15.6% to 44.8%, respectively) and high glycaemic risk (4.8% to 28.6%, respectively). Our analysis suggests that, given the extrapolated total of 280 000 people with Type 1 diabetes in the UK, there may be the potential to increase the number of those within target glycaemic control from 80 000 to 101 000; 53% of this increase (11 000 people) would result from service improvements and 47% (10 000 people) from medication and technology changes. The same improvements would also provide the opportunity to reduce the number of people at high glycaemic risk from 42 000 to 26 500. A key factor associated with practice-level target HbA1c achievement would be greater use of insulin pumps for up to an additional 56 000 people.

CONCLUSION:

If the HbA1c achievement rates in service provision, medication and use of technology currently seen in practices in the 90th percentile were to be matched with regard to HbA1c achievement rates in all general practices, glycaemic control might be improved for 36 500 people, with all the attendant health benefits.

PMID:
29120503
DOI:
10.1111/dme.13541
[Indexed for MEDLINE]
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3.
4.
Diabet Med. 2018 Feb;35(2):173-183. doi: 10.1111/dme.13546.

Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review.

Author information

1
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
2
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
3
Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.

Abstract

AIMS:

To examine whether, in neonates of mothers with Type 1, Type 2 and gestational diabetes, in-target intrapartum glycaemic control was associated with a lower risk of neonatal hypoglycaemia compared with out-of-target glycaemic control.

METHODS:

We searched PubMed and EMBASE for all available publications, regardless of year, based on a published protocol (PROSPERO CRD42016052439). Studies were excluded if they did not report original data or were animal studies. Data were extracted from published reports in duplicate using a prespecified data extraction form. The main outcome of interest was the association between in-target intrapartum glycaemic control and neonatal hypoglycaemia.

RESULTS:

We screened 2846 records for potential study inclusion; 23 studies, including approximately 2835 women with diabetes, were included in the systematic review. Only two of those studies specifically examined in-target vs out-of-target intrapartum glycaemic control. Of the studies included, six showed a relationship between intrapartum glucose and neonatal hypoglycaemia, five others showed a relationship in at least one of the analyses performed and 12 did not find a significant relationship. Only one study was identified as having a low risk of bias.

CONCLUSIONS:

There is a paucity of high-quality data supporting the association of glucose during labour and delivery with neonatal hypoglycaemia in pregnancies complicated by diabetes. Further studies are required to examine the impact of tight glycaemic targets in labour.

PMID:
29117445
DOI:
10.1111/dme.13546
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Publication type

Publication type

5.
Diabet Med. 2018 Jan;35(1):112-120. doi: 10.1111/dme.13544.

Mortality and acute complications in children and young adults diagnosed with Type 1 diabetes in Yorkshire, UK: a cohort study.

Author information

1
Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK.
2
Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Abstract

AIMS:

To examine all-cause and cause-specific mortality in a population-based cohort of people with early and late onset of Type 1 diabetes.

METHODS:

The Yorkshire Register of Diabetes in Children and Young People includes individuals with early (0-14 years) and late (15-29 years) Type 1 diabetes onset, diagnosed between 1978 and 2013. This register was linked to death certification data from the Office for National Statistics to calculate standardized mortality ratios, cumulative mortality curves using Kaplan-Meier survival estimates, and Cox regression modelling. Ethnicity was derived using Onomap. Deprivation status was classified using the Townsend index. The underlying cause of death in each case was clinically verified.

RESULTS:

There were 229 deaths in 5498 individuals with 100 959 person-years of follow-up. The overall standardized mortality ratio was 4.3 (95% CI 3.8 to 4.9). There were no significant differences in standardized mortality ratios according to age of onset, sex or deprivation status. The standardized mortality ratios were significantly higher for people of white ethnic origin [8.1 (95% CI 6.9 to 9.4)] than for those of South-Asian ethnic origin [3.4 (95% CI 1.7 to 6.4)]. The mortality risk was lower in those diagnosed in later years (2002 to 2013 for the early-onset and 2006 to 2013 for the late-onset group) compared with earlier years (1991 to 1997 for the early-onset and 1991 to 1997 for the late-onset group) for both onset groups [hazard ratio 0.13 (95% CI 0.05 to 0.33) vs 0.24 (95% CI 0.07 to 0.81)]. Mortality risk improved over time for chronic complications in the early-onset group only, but there was no improvement in either onset group with regard to acute complications.

CONCLUSIONS:

An excess of deaths in the population with Type 1 diabetes remains. Although the all-cause mortality risk has fallen over time, no improvement has been found in the mortality risk associated with acute complications.

PMID:
29111600
DOI:
10.1111/dme.13544
[Indexed for MEDLINE]
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6.
Diabet Med. 2018 Jan;35(1):41-52. doi: 10.1111/dme.13542.

Association between diabetes mellitus and olfactory dysfunction: current perspectives and future directions.

Author information

1
Clinical Research Core, Weill Cornell Medicine, Doha, Qatar.
2
Department of Medicine, Weill Cornell Medicine, Doha, Qatar.
3
Weill Cornell Medicine, New York, NY, USA.
4
Carnegie Mellon University, Doha, Qatar.
5
Carnegie Mellon University, Pittsburgh, PA, USA.

Abstract

The increasing global prevalence of diabetes mellitus presents a significant challenge to healthcare systems today. Although diabetic retinopathy, nephropathy and neuropathy are well-established complications of diabetes, there is a paucity of research examining the impact of dysglycaemia on the olfactory system. Olfaction is an important sense, playing a role in the safety, nutrition and quality of life of an individual, but its importance is often overlooked when compared with the other senses. As a result, olfactory dysfunction is often underdiagnosed. The present review article aims to present and discuss the available evidence on the relationship between diabetes and olfaction. It also explores the associations between olfactory dysfunction and diabetes complications that could explain the underlying pathogenesis. Finally, it summarizes the putative pathological mechanisms underlying olfactory dysfunction in diabetes that require further investigation.

PMID:
29108100
DOI:
10.1111/dme.13542
[Indexed for MEDLINE]
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10.
Diabetes Care. 2018 Jan;41(1):120-127. doi: 10.2337/dc17-1635. Epub 2017 Nov 9.

Subclinical First Trimester Renal Abnormalities Are Associated With Preeclampsia in Normoalbuminuric Women With Type 1 Diabetes.

Author information

1
Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, U.K.
2
Division of Endocrinology, Medical University of South Carolina, Charleston, SC.
3
The Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland, U.K.
4
National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia.
5
Diabetes Service, The Royal Women's Hospital, Melbourne, Victoria, Australia.
6
Department of Endocrinology, Oslo University Hospital, Oslo, Norway.
7
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
8
Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, CO.
9
Spartanburg Regional Medical Center, Spartanburg, SC.
10
Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC.
11
Division of Materno-Fetal Medicine, University of North Carolina, Chapel Hill, NC.
12
Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
13
Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, U.K. lyonstj@musc.edu.

Abstract

OBJECTIVE:

This study was conducted to determine the utility of tubular (urinary/plasma neutrophil gelatinase-associated lipocalin [NGAL] and urinary kidney injury molecule 1 [KIM-1]) and glomerular (estimated glomerular filtration rate [eGFR]) biomarkers in predicting preeclampsia (PE) in pregnant women with type 1 diabetes mellitus (T1DM) who were free of microalbuminuria and hypertension at the first trimester.

RESEARCH DESIGN AND METHODS:

This was a prospective study of T1DM pregnancy. Maternal urinary and plasma NGAL, urinary KIM-1 (ELISA of frozen samples), and eGFR (Chronic Kidney Disease Epidemiology Collaboration equation) were determined at three study visits (V1: 12.4 ± 1.8; V2: 21.7 ± 1.4; V3: 31.4 ± 1.5 weeks' gestation [mean ± SD]) in 23 women with T1DM with subsequent PE (DM+PE+), 24 who remained normotensive (DM+PE-), and, for reference, in 19 normotensive pregnant women without diabetes (DM-). The groups with diabetes were matched for age, diabetes duration, and parity. All subjects were normotensive and free of microalbuminuria or albuminuria at V1. All study visits preceded the onset of PE.

RESULTS:

Urinary creatinine-corrected NGAL (uNGALcc, ng/mg) was significantly elevated at V1 in DM+PE+ vs. DM+PE- women (P = 0.01); this remained significant after exclusion of leukocyte-positive samples (5 DM+PE+ and 2 DM+PE-) (P = 0.02). Accounting for BMI, HbA1c, and total daily insulin dose, a doubling of uNGALcc at V1 conferred a sevenfold increase in risk for PE (P = 0.026). In contrast, neither plasma NGAL nor urinary KIM-1 predicted PE. Also at V1, eGFR was elevated in DM+PE+ vs. DM+PE- (P = 0.04).

CONCLUSIONS:

Early tubular and glomerular dysfunction may predict PE in first trimester women with T1DM, even if free of microalbuminuria. These data suggest that subclinical renal tubular and glomerular injury, if present early in pregnancy, may predispose women with T1DM to PE.

PMID:
29122892
PMCID:
PMC5741157
[Available on 2019-01-01]
DOI:
10.2337/dc17-1635
[Indexed for MEDLINE]
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11.
Diabetes Care. 2018 Jan;41(1):128-135. doi: 10.2337/dc17-0867. Epub 2017 Nov 8.

Association Between Inflammatory Markers and Progression to Kidney Dysfunction: Examining Different Assessment Windows in Patients With Type 1 Diabetes.

Author information

1
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC bakern@musc.edu.
2
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
3
Ralph H. Johnson VA Medical Center, Charleston, SC.
4
Discovery Biology, Fibrotic Diseases, Bristol-Myers Squibb, Pennington, NJ.
5
Translational Research and Discovery, Fibrotic Diseases, Bristol-Myers Squibb, Pennington, NJ.
6
Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC.
7
Department of Medicine and Laboratory Services, Medical University of South Carolina, Charleston, SC.

Abstract

OBJECTIVE:

To determine whether biomarkers of inflammation and endothelial dysfunction are associated with the development of kidney dysfunction and the time frame of their association.

RESEARCH DESIGN AND METHODS:

Biomarkers were measured at four time points during 28 years of treatment and follow-up in patients with type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort. In addition to traditional biomarkers of inflammation (C-reactive protein and fibrinogen), we measured interleukin-6 (IL-6) and soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1/2), markers of endothelial dysfunction (soluble intracellular adhesion molecule-1, vascular cell adhesion molecule-1, and E-selectin [sE-selectin]), and fibrinolysis (total and active plasminogen activator inhibitor-1 [PAI-1]). Renal outcomes were defined as progression to incident chronic kidney disease (stage 3 or more severe) or macroalbuminuria (albumin excretion rate ≥300 mg/24 h). Prospective multivariate event-time analyses were used to determine the association of each biomarker with each subsequent event within prespecified intervals (3-year and 10-year windows).

RESULTS:

Multivariate event-time models indicated that several markers of inflammation (sTNFR-1/2), endothelial dysfunction (sE-selectin), and clotting/fibrinolysis (fibrinogen and PAI-1) are significantly associated with subsequent development of kidney dysfunction. Although some markers showed variations in the associations between the follow-up windows examined, the results indicate that biomarkers (sTNFR-1/2, sE-selectin, PAI-1, and fibrinogen) are associated with progression to chronic kidney disease in both the 3-year and the 10-year windows.

CONCLUSIONS:

Plasma markers of inflammation, endothelial dysfunction, and clotting/fibrinolysis are associated with progression to kidney dysfunction in type 1 diabetes during both short-term and long-term follow-up.

PMID:
29118060
PMCID:
PMC5741153
[Available on 2019-01-01]
DOI:
10.2337/dc17-0867
[Indexed for MEDLINE]
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12.
Diabetes Care. 2018 Jan;41(1):88-95. doi: 10.2337/dc17-1074. Epub 2017 Nov 8.

Diabetes Care Disparities in Long-standing Type 1 Diabetes in Canada and the U.S.: A Cross-sectional Comparison.

Author information

1
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
2
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
3
Research Division, Joslin Diabetes Center, Boston, MA.
4
Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
5
Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
6
Department of Ophthalmology & Vision Sciences and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
7
Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
8
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
9
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada bruce.perkins@sinaihealthsystem.ca.

Abstract

OBJECTIVE:

To assess national differences in diabetes care and quality of life (QOL) between individuals with long-standing type 1 diabetes (≥50 years) in Canada and the U.S.

RESEARCH DESIGN AND METHODS:

Cross-sectional data from identical surveys administered in the Canadian Study of Longevity in Diabetes and the Joslin Medalist Study, collected in 2013-2016 and 2005-2011, respectively, were compared. Laboratory values and ophthalmic examination were completed by clinical care physicians for Canadians and the Joslin Clinic for Americans. Univariate comparisons and multivariable regression for HbA1c, QOL, insulin pump use, and coronary artery disease (CAD) were performed. Nephropathy, CAD, and peripheral arterial disease (PAD) were self-reported; neuropathy was defined by a Michigan Neuropathy Screening Instrument (Questionnaire component) score ≥3, and proliferative retinopathy was documented from ophthalmic examination. QOL was self-reported on an ordinal scale.

RESULTS:

Three hundred sixty-one Canadians and 668 Americans had similar ages (mean 65.78 years [SD 8.67] vs. 66.38 years [7.66], P = 0.27) and durations of diabetes (median 53.00 years [interquartile range 51.00, 58.00] vs. 53.00 years [51.00, 57.00], P = 0.51). Canadians had higher HbA1c (mean 7.53% [SD 1.03] [59 mmol/mol] vs. 7.22% [0.98] [55 mmol/mol], P < 0.0001), lower QOL (36.9% vs. 48.7% with "excellent" QOL, P = 0.0002), and less CAD (29.7% vs. 41.2%, P = 0.0003) and insulin pump use (43.3% vs. 55.6%, P = 0.0002). Other complication rates were similar. Residual differences for Canadians compared with Americans remained after adjustment for age, sex, CAD, PAD, education, and relevant a priori selected variables: 0.28% higher HbA1c (P = 0.0004); and odds ratios of 0.68 (95% CI 0.51, 0.90), 0.46 (0.31, 0.68), and 0.71 (0.52, 0.96) for higher QOL, CAD, and insulin pump use, respectively.

CONCLUSIONS:

Although Canadians and Americans have similar rates of complications other than CAD, further research is required to understand why Canadians have higher HbA1c levels, lower QOL, and less insulin pump use.

PMID:
29118059
PMCID:
PMC5741151
[Available on 2019-01-01]
DOI:
10.2337/dc17-1074
[Indexed for MEDLINE]
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13.
Diabetes Care. 2018 Jan;41(1):156-162. doi: 10.2337/dc17-1437. Epub 2017 Nov 7.

Cardiovascular Complications Over 5 Years and Their Association With Survival in the GERODIAB Cohort of Elderly French Patients With Type 2 Diabetes.

Author information

1
Endocrinology, Bégin Hospital, Saint Mandé, France.
2
Diabetology-Endocrinology, Villecresnes Medical Hospital, Villecresnes, France jplefloch@dietvill.com.
3
Diabetology, Endocrinology, Grenoble Alpes University, Grenoble, France.
4
Gerontology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France.
5
Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, Rouen, France.

Abstract

OBJECTIVE:

The GERODIAB study is a multicenter prospective observational study performed over 5 years in French patients aged 70 years or above with type 2 diabetes. This report deals with their cardiovascular complications and their relationship with survival.

RESEARCH DESIGN AND METHODS:

Consecutive patients (n = 987, median age = 77 years) were included from 56 diabetes centers over 1 year. Individual characteristics, history and complications of diabetes, geriatric factors, and clinical and biological parameters were recorded. Survival was analyzed using the Kaplan-Meier method and proportional hazards regression models.

RESULTS:

The frequency of cardiovascular complications increased from 47% at inclusion to 67% at 5 years. The most frequent complications were coronary heart disease (increasing from 30% to 41%) and vascular disease of the lower limbs (25% to 35%) and of the cerebral vessels (15% to 26%). Heart failure was less common, but its frequency doubled during the follow-up (9% to 20%). It was strongly associated with poor survival (P < 0.0001), as was vascular disease of the lower limbs (P = 0.0004), whereas coronary heart disease (P = 0.0056) and vascular disease of cerebral vessels (P = 0.026) had mild associations. Amputation (P < 0.0001) and foot wounds (P < 0.0001) were strongly associated with survival. In multivariate models, heart failure was the strongest predictor of poor survival (hazard ratio [HR] 1.96 [95% CI 1.45-2.64]; P < 0.0001). It remained significant when other factors were considered simultaneously (HR 1.92 [95% CI 1.43-2.58]; P < 0.0001).

CONCLUSIONS:

Cardiovascular complications are associated with poor survival in elderly patients with type 2 diabetes, especially heart failure.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01282060.

PMID:
29113984
DOI:
10.2337/dc17-1437
[Indexed for MEDLINE]
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14.
Diabetes Care. 2018 Jan;41(1):178-186. doi: 10.2337/dc17-0820. Epub 2017 Nov 7.

FGF23 Concentration and APOL1 Genotype Are Novel Predictors of Mortality in African Americans With Type 2 Diabetes.

Author information

1
Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
2
Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong, China.
3
Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
4
Department of Biochemistry, Center for Genomics and Personalized Medicine Research, and Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC.
5
Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC.
6
Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN.
7
Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC bfreedma@wakehealth.edu.

Abstract

OBJECTIVE:

Cardiovascular and renal complications contribute to higher mortality in patients with diabetes. We assessed novel and conventional predictors of mortality in African American-Diabetes Heart Study (AA-DHS) participants.

RESEARCH DESIGN AND METHODS:

Associations between mortality and subclinical atherosclerosis, urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), plasma fibroblast growth factor 23 (FGF23) concentration, African ancestry proportion, and apolipoprotein L1 genotypes (APOL1) were assessed in 513 African Americans with type 2 diabetes; analyses were performed using Cox proportional hazards models.

RESULTS:

At baseline, participants were 55.6% female with median (25th, 75th percentile) age 55 years (49.0, 62.0), diabetes duration 8 years (5.0, 13.0), glycosylated hemoglobin 60.7 mmol/mol (48.6, 76.0), eGFR 91.3 mL/min/1.73 m2 (76.4, 111.3), UACR 12.5 mg/mmol (4.2, 51.2), and coronary artery calcium 28.5 mg Ca2+ (1.0, 348.6); 11.5% had two APOL1 renal-risk variants. After 6.6-year follow-up (5.8, 7.5), 54 deaths were recorded. Higher levels of coronary artery calcified plaque, carotid artery calcified plaque, albuminuria, and FGF23 were associated with higher mortality after adjustment for age, sex, and African ancestry proportion. A penalized Cox regression that included all covariates and predictors associated with mortality identified male sex (hazard ratio [HR] 4.17 [95% CI 1.96-9.09]), higher FGF23 (HR 2.10 [95% CI 1.59-2.78]), and absence of APOL1 renal-risk genotypes (HR 0.07 [95% CI 0.01-0.69]) as the strongest predictors of mortality.

CONCLUSIONS:

Accounting for conventional risk factors, higher FGF23 concentrations and APOL1 non-renal-risk genotypes associated with higher mortality in African Americans with diabetes. These data add to growing evidence supporting FGF23 association with mortality; mechanisms whereby these novel predictors impact survival remain to be determined.

PMID:
29113983
PMCID:
PMC5741152
[Available on 2019-01-01]
DOI:
10.2337/dc17-0820
[Indexed for MEDLINE]
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15.
Diabetes Care. 2018 Jan;41(1):69-78. doi: 10.2337/dc17-1414. Epub 2017 Nov 6.

Long-term Trends in Antidiabetes Drug Usage in the U.S.: Real-world Evidence in Patients Newly Diagnosed With Type 2 Diabetes.

Author information

1
Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
2
Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.
3
Baker Heart and Diabetes Institute, Melbourne, Australia.
4
Cardiology Department, Royal Brisbane and Women's Hospital, and University of Queensland School of Medicine, Brisbane, Australia.
5
Model Answers Pty Ltd, Brisbane, Australia.
6
Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia sanjoy.paul@unimelb.edu.au.
7
Melbourne EpiCentre, University of Melbourne, Melbourne, Australia.

Abstract

OJBECTIVE:

To explore temporal trends in antidiabetes drug (ADD) prescribing and intensification patterns, along with glycemic levels and comorbidities, and possible benefits of novel ADDs in delaying the need for insulin initiation in patients diagnosed with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

Patients with type 2 diabetes aged 18-80 years, who initiated any ADD, were selected (n = 1,023,340) from the U.S. Centricity Electronic Medical Records. Those who initiated second-line ADD after first-line metformin were identified (subcohort 1, n = 357,482); the third-line therapy choices were further explored.

RESULTS:

From 2005 to 2016, first-line use increased for metformin (60-77%) and decreased for sulfonylureas (20-8%). During a mean follow-up of 3.4 years post metformin, 48% initiated a second ADD at a mean HbA1c of 8.4%. In subcohort 1, although sulfonylurea usage as second-line treatment decreased (60-46%), it remained the most popular second ADD choice. Use increased for insulin (7-17%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.4-21%). The rates of intensification with insulin and sulfonylureas did not decline over the last 10 years. The restricted mean time to insulin initiation was marginally longer in second-line DPP-4i (7.1 years) and in the glucagon-like peptide 1 receptor agonist group (6.6 years) compared with sulfonylurea (6.3 years, P < 0.05).

CONCLUSIONS:

Most patients initiate second-line therapy at elevated HbA1c levels, with highly heterogeneous clinical characteristics across ADD classes. Despite the introduction of newer therapies, sulfonylureas remained the most popular second-line agent, and the rates of intensification with sulfonylureas and insulin remained consistent over time. The incretin-based therapies were associated with a small delay in the need for therapy intensification compared with sulfonylureas.

PMID:
29109299
DOI:
10.2337/dc17-1414
[Indexed for MEDLINE]
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16.
Diabetes Care. 2018 Jan;41(1):32-38. doi: 10.2337/dc17-0983. Epub 2017 Nov 6.

Severity of Neuropathy Is Associated With Long-term Spinal Cord Stimulation Outcome in Painful Diabetic Peripheral Neuropathy: Five-Year Follow-up of a Prospective Two-Center Clinical Trial.

Author information

1
Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands m.vanbeek@maastrichtuniversity.nl maarten.van.kleef@mumc.nl.
2
Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
3
Department of Anesthesiology, Rijnstate Hospital, Arnhem, the Netherlands.
4
Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
5
Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands.
6
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands.
7
Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
8
Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Centre, Nijmegen, the Netherlands.

Abstract

OBJECTIVE:

Evidence from prospective studies for long-term treatment efficacy of spinal cord stimulation (SCS) in painful diabetic peripheral neuropathy (PDPN) is not available. We report prospective data on the effect of SCS on pain ratings, treatment success and failure, and complications during a 5-year follow-up in patients with PDPN.

RESEARCH DESIGN AND METHODS:

Patients with PDPN (n = 48) were included in this prospective multicenter study. The Michigan Diabetic Neuropathy Score (MDNS) was used to assess the severity of neuropathy. Numerical rating scale (NRS) score for pain, Patient's Global Impression of Change (PGIC), and treatment success (50% reduction of NRS score or significant PGIC) during 5 years of follow-up were evaluated. Complications of SCS were reported, and associations between baseline characteristics and SCS trial success or failure during a 5-year follow-up were investigated by using survival analyses.

RESULTS:

Treatment success was observed in 55% of patients after 5 years. Median duration of SCS treatment was 60 months (minimum 1 month, maximum 60 months), and 80% of patients with a permanent implant still used their SCS device after 5 years. Higher MDNS was associated with treatment failure during the 5-year follow-up (hazard ratio 3.9 [95% CI 1.3-11.6]; P = 0.014).

CONCLUSIONS:

SCS is successful in reducing chronic pain symptoms in the lower extremities of patients with PDPN up to 5 years after initiation of treatment. Furthermore, 80% of patients with PDPN still use their SCS device after 5 years. Moreover, the severity of neuropathy is associated with a higher chance of long-term treatment failure during a 5-year follow-up.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01162993 NCT00802022.

PMID:
29109298
DOI:
10.2337/dc17-0983
[Indexed for MEDLINE]
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17.
J Clin Endocrinol Metab. 2017 Dec 1;102(12):4343-4410. doi: 10.1210/jc.2017-01922.

Diabetic Microvascular Disease: An Endocrine Society Scientific Statement.

Author information

1
Division of Endocrinology, Department of Medicine, University of Virginia.
2
Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School.
3
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health.
4
Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine.
5
Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine.
6
EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center.

Abstract

Both type 1 and type 2 diabetes adversely affect the microvasculature in multiple organs. Our understanding of the genesis of this injury and of potential interventions to prevent, limit, or reverse injury/dysfunction is continuously evolving. This statement reviews biochemical/cellular pathways involved in facilitating and abrogating microvascular injury. The statement summarizes the types of injury/dysfunction that occur in the three classical diabetes microvascular target tissues, the eye, the kidney, and the peripheral nervous system; the statement also reviews information on the effects of diabetes and insulin resistance on the microvasculature of skin, brain, adipose tissue, and cardiac and skeletal muscle. Despite extensive and intensive research, it is disappointing that microvascular complications of diabetes continue to compromise the quantity and quality of life for patients with diabetes. Hopefully, by understanding and building on current research findings, we will discover new approaches for prevention and treatment that will be effective for future generations.

PMID:
29126250
PMCID:
PMC5718697
[Available on 2018-12-01]
DOI:
10.1210/jc.2017-01922
[Indexed for MEDLINE]
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19.
J Clin Endocrinol Metab. 2018 Jan 1;103(1):362-363. doi: 10.1210/jc.2017-02123.

Response to Letter to the Editor: "Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women With Polycystic Ovary Syndrome".

Author information

1
Department of Endocrinology, Odense University Hospital, Odense C, Denmark.
2
OPEN-Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.
3
Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark.
PMID:
29126200
DOI:
10.1210/jc.2017-02123
[Indexed for MEDLINE]
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20.
J Clin Endocrinol Metab. 2018 Jan 1;103(1):314-319. doi: 10.1210/jc.2017-01197.

Impaired Insulin Action Is Associated With Increased Glucagon Concentrations in Nondiabetic Humans.

Author information

1
Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota.
2
Department of Information Engineering, Università di Padova, Padova, Italy.
3
Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota.

Abstract

Context:

Abnormal glucagon concentrations contribute to hyperglycemia, but the mechanisms of α-cell dysfunction in prediabetes are unclear.

Objective:

We sought to determine the relative contributions of insulin secretion and action to α-cell dysfunction in nondiabetic participants across the spectrum of glucose tolerance.

Design:

This was a cross-sectional study. A subset of participants (n = 120) was studied in the presence and absence of free fatty acid (FFA) elevation, achieved by infusion of Intralipid (Baxter Healthcare, Deerfield, IL) plus heparin, to cause insulin resistance.

Setting:

An inpatient clinical research unit at an academic medical center.

Participants:

A total of 310 nondiabetic persons participated in this study.

Interventions:

Participants underwent a seven-sample oral glucose tolerance test. Subsequently, 120 participants were studied on two occasions. On one day, infusion of Intralipid plus heparin raised FFA. On the other day, participants received glycerol as a control.

Main Outcome Measure(s):

We examined the relationship of glucagon concentration with indices of insulin action after adjusting for the effects of age, sex, and weight. Subsequently, we sought to determine whether an acute decrease in insulin action, produced by FFA elevation, altered glucagon concentrations in nondiabetic participants.

Results:

Fasting glucagon concentrations correlated positively with fasting insulin and C-peptide concentrations and inversely with insulin action. Fasting glucagon was not associated with any index of β-cell function in response to an oral challenge. As expected, FFA elevation decreased insulin action and also raised glucagon concentrations.

Conclusions:

In nondiabetic participants, glucagon secretion was altered by changes in insulin action.

PMID:
29126197
PMCID:
PMC5761487
[Available on 2019-01-01]
DOI:
10.1210/jc.2017-01197
[Indexed for MEDLINE]
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