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1.
BMJ. 2017 Nov 16;359:j5064. doi: 10.1136/bmj.j5064.

Diabetic foot.

Author information

1
Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India.
2
KHM Hospital, Mumbai, India.
3
Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India.
4
Global Health and Development Group, Imperial College London, St Mary's Hospital, London, UK abha@mail.harvard.edu.
PMID:
29146579
PMCID:
PMC5688746
[Indexed for MEDLINE]
Free PMC Article
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Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: SM, KC, and AK were members of the guideline development group for the standard treatment guideline on the diabetic foot: prevention and management in India, 2016 published by the Ministry of Health and Family Welfare, government of India. AM provided technical input on methodology to this guideline development group.

2.
Diabet Med. 2018 Feb;35(2):184-194. doi: 10.1111/dme.13547. Epub 2017 Dec 8.

Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis.

Author information

1
Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.

Abstract

AIMS:

To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management.

BACKGROUND:

Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices.

METHODS:

This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.

RESULTS:

Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging').

CONCLUSION:

While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes self-management.

PMID:
29150863
DOI:
10.1111/dme.13547
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Publication type

Publication type

3.
Diabet Med. 2018 Feb;35(2):214-222. doi: 10.1111/dme.13548. Epub 2017 Dec 12.

Cost-effectiveness of the psycho-educational blended (group and online) intervention HypoAware compared with usual care for people with Type 1 and insulin-treated Type 2 diabetes with problematic hypoglycaemia: analyses of a cluster-randomized controlled trial.

Author information

1
Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.
2
Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
3
Department of Health Sciences, Faculty of Science, VU University, Amsterdam, Amsterdam, The Netherlands.
4
Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands.

Abstract

AIMS:

To evaluate the cost-effectiveness of HypoAware, a blended (group and online) psycho-educational intervention based on the evidence-based Blood Glucose Awareness Training, in comparison with usual care in people with Type 1 and Type 2 diabetes with a high risk of severe hypoglycaemia.

METHODS:

We performed an economic evaluation, from a societal and healthcare perspective, that used data from a 6-month, multicentre, cluster-randomized controlled trial (n = 137).

RESULTS:

The proportion of people with at least one severe hypoglycaemic event per 6 months was 0.22 lower (95% CI -0.39 to -0.06) and the proportion of people with impaired hypoglycaemia awareness was 0.16 lower (95% CI -0.34 to 0.02) in the HypoAware group. There was no difference in quality-adjusted life-years (-0.0; 95% CI -0.05 to 0.05). The mean total societal costs in the HypoAware group were EUR708 higher than in the usual care group (95% CI -951 to 2298). The mean incremental cost per severe hypoglycaemic event prevented was EUR2,233. At a willingness-to-pay threshold of EUR20,000 per event prevented, the probability that HypoAware was cost-effective in comparison with usual care was 54% from a societal perspective and 55% from a healthcare perspective. For quality-adjusted life-years the incremental cost-effectiveness ratio was EUR119,360/quality-adjusted life-year gained and the probability of cost-effectiveness was low at all ceiling ratios.

CONCLUSIONS:

Based on the present study, we conclude that HypoAware is not cost-effective compared to usual care. Further research in less well-resourced settings and more severely affected patients is warranted. (Clinical Trials Registry no: Dutch Trial Register NTR4538.).

PMID:
29150861
DOI:
10.1111/dme.13548
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5.
Diabetes Care. 2018 Feb;41(2):293-302. doi: 10.2337/dc17-1259. Epub 2017 Nov 17.

Declining Rates of Hospitalization for Selected Cardiovascular Disease Conditions Among Adults Aged ≥35 Years With Diagnosed Diabetes, U.S., 1998-2014.

Author information

1
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA nrios@cdc.gov.
2
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

Abstract

OBJECTIVE:

Reductions in heart attack and stroke hospitalizations are well documented in the U.S. population with diabetes. We extended trend analyses to other cardiovascular disease (CVD) conditions, including stroke by type, and used four additional years of data.

RESEARCH DESIGN AND METHODS:

Using 1998-2014 National (Nationwide) Inpatient Sample (NIS) data, we estimated the number of discharges having acute coronary syndrome (ACS) (ICD-9 codes 410-411), cardiac dysrhythmia (427), heart failure (428), hemorrhagic stroke (430-432), or ischemic stroke (433.x1, 434, and 436) as first-listed diagnosis and diabetes (250) as secondary diagnosis. Hospitalization rates for adults aged ≥35 years were calculated using estimates from the population with and the population without diabetes from the National Health Interview Survey (NHIS) and age-adjusted to the 2000 U.S. standard population. Joinpoint regression was used to analyze trends and calculate an average annual percentage change (AAPC) with 95% confidence limits (CLs).

RESULTS:

From 1998 to 2014, in the population with diabetes, age-adjusted hospitalization rates declined significantly for ACS (AAPC -4.6% per year [95% CL -5.3, -3.8]), cardiac dysrhythmia (-0.7% [-1.1, -0.2]), heart failure (-3.6% [-4.6, -2.7]), hemorrhagic stroke (-1.1% [-1.4, -0.7]), and ischemic stroke (-2.9% [-3.9, -1.8]). In the population without diabetes, rates also declined significantly for these conditions, with the exception of dysrhythmia. By 2014, rates in the population with diabetes population remained two to four times as high as those for the population without diabetes, with the largest difference in heart failure rates.

CONCLUSIONS:

CVD hospitalization rates declined significantly in both the population with diabetes and the population without diabetes. This may be due to several factors, including new or more aggressive treatments and reductions in CVD risk factors and CVD incidence.

PMID:
29150530
PMCID:
PMC6051534
[Available on 2019-02-01]
DOI:
10.2337/dc17-1259
[Indexed for MEDLINE]
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6.
Diabetes Care. 2018 Jan;41(1):79-87. doi: 10.2337/dc17-1042. Epub 2017 Nov 16.

N-Glycan Profile and Kidney Disease in Type 1 Diabetes.

Author information

1
MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K. mairead.bermingham@igmm.ed.ac.uk.
2
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, U.K.
3
MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K.
4
Genos Glycoscience Research Laboratory, Zagreb, Croatia.
5
Pharmatics, Ltd., Edinburgh, U.K.
6
MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, U.K.
7
Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, U.K.
8
Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K.
9
Diabetes Centre, Victoria Hospital, Kirkcaldy, U.K.
10
Diabetic Day Centre University Hospital, Ayr, U.K.
11
Research & Development Support Unit, Dumfries & Galloway Royal Infirmary, Dumfries, U.K.
12
Highland Diabetes Institute, Raigmore Hospital, NHS Highland, Inverness, U.K.
13
Western General Hospital, NHS Lothian, Edinburgh, U.K.
14
Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, U.K.
15
David Matthews Diabetes Centre, Monklands Hospital, Airdrie, U.K.
16
Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia.
17
Department of Public Health, NHS Fife, Kirkcaldy, U.K.

Abstract

OBJECTIVE:

Poorer glycemic control in type 1 diabetes may alter N-glycosylation patterns on circulating glycoproteins, and these alterations may be linked with diabetic kidney disease (DKD). We investigated associations between N-glycans and glycemic control and renal function in type 1 diabetes.

RESEARCH DESIGN AND METHODS:

Using serum samples from 818 adults who were considered to have extreme annual loss in estimated glomerular filtration rate (eGFR; i.e., slope) based on retrospective clinical records, from among 6,127 adults in the Scottish Diabetes Research Network Type 1 Bioresource Study, we measured total and IgG-specific N-glycan profiles. This yielded a relative abundance of 39 total (GP) and 24 IgG (IGP) N-glycans. Linear regression models were used to investigate associations between N-glycan structures and HbA1c, albumin-to-creatinine ratio (ACR), and eGFR slope. Models were adjusted for age, sex, duration of type 1 diabetes, and total serum IgG.

RESULTS:

Higher HbA1c was associated with a lower relative abundance of simple biantennary N-glycans and a higher relative abundance of more complex structures with more branching, galactosylation, and sialylation (GP12, 26, 31, 32, and 34, and IGP19 and 23; all P < 3.79 × 10-4). Similar patterns were seen for ACR and greater mean annual loss of eGFR, which were also associated with fewer of the simpler N-glycans (all P < 3.79 × 10-4).

CONCLUSIONS:

Higher HbA1c in type 1 diabetes is associated with changes in the serum N-glycome that have elsewhere been shown to regulate the epidermal growth factor receptor and transforming growth factor-β pathways that are implicated in DKD. Furthermore, N-glycans are associated with ACR and eGFR slope. These data suggest that the role of altered N-glycans in DKD warrants further investigation.

PMID:
29146600
DOI:
10.2337/dc17-1042
[Indexed for MEDLINE]
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7.
Diabetes Care. 2018 Jan;41(1):193-205. doi: 10.2337/dc16-2765. Epub 2017 Nov 15.

Disparities in Environmental Exposures to Endocrine-Disrupting Chemicals and Diabetes Risk in Vulnerable Populations.

Author information

1
Committee on Molecular Metabolism and Nutrition, University of Chicago, Chicago, IL.
2
College of Food, Agricultural, and Environmental Sciences, School of Environment and Natural Resources, Ohio State University, Columbus, OH.
3
Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois at Chicago, Chicago, IL.
4
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL rsargis@uic.edu.

Abstract

Burgeoning epidemiological, animal, and cellular data link environmental endocrine-disrupting chemicals (EDCs) to metabolic dysfunction. Disproportionate exposure to diabetes-associated EDCs may be an underappreciated contributor to disparities in metabolic disease risk. The burden of diabetes is not uniformly borne by American society; rather, this disease disproportionately affects certain populations, including African Americans, Latinos, and low-income individuals. The purpose of this study was to review the evidence linking unequal exposures to EDCs with racial, ethnic, and socioeconomic diabetes disparities in the U.S.; discuss social forces promoting these disparities; and explore potential interventions. Articles examining the links between chemical exposures and metabolic disease were extracted from the U.S. National Library of Medicine for the period of 1966 to 3 December 2016. EDCs associated with diabetes in the literature were then searched for evidence of racial, ethnic, and socioeconomic exposure disparities. Among Latinos, African Americans, and low-income individuals, numerous studies have reported significantly higher exposures to diabetogenic EDCs, including polychlorinated biphenyls, organochlorine pesticides, multiple chemical constituents of air pollution, bisphenol A, and phthalates. This review reveals that unequal exposure to EDCs may be a novel contributor to diabetes disparities. Efforts to reduce the individual and societal burden of diabetes should include educating clinicians on environmental exposures that may increase disease risk, strategies to reduce those exposures, and social policies to address environmental inequality as a novel source of diabetes disparities.

PMID:
29142003
PMCID:
PMC5741159
[Available on 2019-01-01]
DOI:
10.2337/dc16-2765
[Indexed for MEDLINE]
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8.
Diabetes Care. 2018 Jan;41(1):49-59. doi: 10.2337/dc17-0426. Epub 2017 Nov 14.

Five-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) on Diabetes-Related Complications and Health Service Uses-A Population-Based and Propensity-Matched Cohort Study.

Author information

1
Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China ytyu@hku.hk.
2
Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China.
3
School of Nursing, The University of Hong Kong, Hong Kong, People's Republic of China.
4
Primary and Community Services Department, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, People's Republic of China.

Abstract

OBJECTIVE:

To evaluate the 5-year effectiveness of a multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

A 5-year prospective cohort study was conducted with 121,584 Chinese primary care patients with type 2 DM who were recruited between August 2009 and June 2011. Missing data were dealt with multiple imputations. After excluding patients with prior diabetes mellitus (DM)-related complications and one-to-one propensity score matching on all patient characteristics, 26,718 RAMP-DM participants and 26,718 matched usual care patients were followed up for a median time of 4.5 years. The effect of RAMP-DM on nine DM-related complications and all-cause mortality were evaluated using Cox regressions. The first incidence for each event was used for all models. Health service use was analyzed using negative binomial regressions. Subgroup analyses on different patient characteristics were performed.

RESULTS:

The cumulative incidence of all events (DM-related complications and all-cause mortality) was 23.2% in the RAMP-DM group and 43.6% in the usual care group. RAMP-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 56.6% (95% CI 54.5, 58.6), microvascular complications by 11.9% (95% CI 7.0, 16.6), mortality by 66.1% (95% CI 64.3, 67.9), specialist attendance by 35.0% (95% CI 33.6, 36.4), emergency attendance by 41.2% (95% CI 39.8, 42.5), and hospitalizations by 58.5% (95% CI 57.2, 59.7). Patients with low baseline CVD risks benefitted the most from RAMP-DM, which decreased CVD and mortality risk by 60.4% (95% CI 51.8, 67.5) and 83.6% (95% CI 79.3, 87.0), respectively.

CONCLUSIONS:

This naturalistic study highlighted the importance of early optimal DM control and risk factor management by risk stratification and multidisciplinary, protocol-driven, chronic disease model care to delay disease progression and prevent complications.

PMID:
29138274
DOI:
10.2337/dc17-0426
[Indexed for MEDLINE]
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9.
Diabetes Care. 2017 Dec;40(12):1756-1762. doi: 10.2337/dc16-2523.

Impact of Excessive Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes: Results From the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study.

Collaborators (556)

Nathan DM, Zinman B, Crofford O, Genuth S, Brown-Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi-Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith-Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory NS, Lackaye ME, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones JK, Edwards PA, Bhan A, Carey JD, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello LP, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello LM, Jacobson A, Rand L, Rosenzwieg J, Nathan DM, Larkin ME, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, deManbey A, Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier-Kelly C, Service FJ, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk WF, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes-Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub-Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud-Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz WI, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman WH, Martin CL, Pop-Busui R, Greene DA, Stevens MJ, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade DS, Canady JL, Burge MR, Das A, Avery RB, Ketai LH, Chapin JE, Schluter ML, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne PA, Brucker A, Braunstein S, Schwartz S, Maschak-Carey BJ, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren RL, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad PW, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone JI, Bernal ML, Pavan PR, Grove N, Tanaka EA, McMillan D, Vaccaro-Kish J, Babbione L, Solc H, DeClue TJ, Dagogo-Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy MB, Moser S, Meyer D, Iannacone A, Yoser S, Bryer-Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, Boer IH, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger NW, Jenner M, Smith T, Brown W, May M, Hagan JL, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White NH, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi-Klug R, Meadema-Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman EZ, Zhang ZM, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman EL, Albers JW, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridg K, Lima J, Bluemke D, Turkbey E, van der Geest RJ, Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan DM, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes-Virella M, Lyons TJ, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey WT, Lackland D, Brabham M, McGee D, Zheng D, Mayfield RK, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K.

Abstract

OBJECTIVE:

Intensive treatment (INT) of type 1 diabetes reduces the incidence of cardiovascular disease (CVD) events compared with conventional treatment (CONV), but it also results in more weight gain. Our objective was to examine whether excessive weight gain from INT of type 1 diabetes is independently associated with subsequent CVD events.

RESEARCH DESIGN AND METHODS:

Quartiles (Q) of weight gain in 1,213 participants aged 18 years and older at enrollment in the Diabetes Control and Complications Trial (DCCT) were determined within randomized treatment groups (INT vs. CONV) using change in BMI from baseline to the closeout DCCT visits. Effects of this weight gain on CVD risk factors and outcomes during an additional 20 years of observational follow-up were then determined.

RESULTS:

The Q4 INT group experienced greater proportional weight gain (median change in BMI, 6.08 kg/m2), increases in CVD risk factors, and need for medications for hypertension and lipids compared with the Q1-3 INT and comparable CONV groups. Over a mean of 26 years of follow-up, the numbers of major and total CVD events were not statistically different in Q4 compared with Q1-3 of either the INT or CONV group. By year 14, however, the incident CVD event curve became significantly higher in the Q4 INT group than in the Q1-3 INT groups (P = 0.024) and was similar to that for the CONV group.

CONCLUSIONS:

For the first 13 years after DCCT, INT for type 1 diabetes reduced macrovascular events compared with CONV, even when excessive weight gain occurred. After this, total CVD events significantly increased in the Q4 INT group, becoming equivalent to those in the CONV group. Longer follow-up is needed to determine whether this trend continues and results in more major CVD events.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00360815 NCT00360893.

PMID:
29138273
PMCID:
PMC5711332
[Available on 2018-12-01]
DOI:
10.2337/dc16-2523
[Indexed for MEDLINE]
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10.
Diabetes Care. 2017 Dec;40(12):1678-1684. doi: 10.2337/dc17-0643.

The Role of Peers for Diabetes Management in Adolescents and Emerging Adults With Type 1 Diabetes: A Longitudinal Study.

Author information

1
University of Leuven, Leuven, Belgium koen.raymaekers@kuleuven.be.
2
University of Leuven, Leuven, Belgium.
3
Research Foundation Flanders, Brussels, Belgium.
4
University of Gothenburg, Gothenburg, Sweden.
5
Free University Brussels, Brussels, Belgium.

Abstract

OBJECTIVE:

The increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged. However, longitudinal research linking the peer context to diabetes management and outcomes is scarce. The present longitudinal study in a large sample of youths with type 1 diabetes related both positive and negative peer variables to diabetes outcomes over a time interval of 1 year.

RESEARCH DESIGN AND METHODS:

Our sample consisted of 467 adolescents (14-17 years of age) and emerging adults (18-25 years of age) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-related distress, and treatment adherence. HbA1c values were obtained from the treating physicians of patients. Cross-lagged analysis from a structural equation modeling approach was performed to assess the directionality of effects.

RESULTS:

Peer support negatively predicted diabetes-related distress over time. Extreme peer orientation positively predicted treatment distress over time. Parental responsiveness negatively predicted food distress over time. Treatment adherence negatively predicted extreme peer orientation, treatment distress, and HbA1c values over time. For emerging adults specifically, there was a reciprocal relationship between HbA1c values and extreme peer orientation because they positively predicted each other.

CONCLUSIONS:

This study highlights the importance of peers in predicting the functioning of youths with type 1 diabetes. Additionally, treatment adherence at baseline was found to negatively predict extreme peer orientation, treatment distress, and worse glycemic control over time. In sum, the current study underscores the importance of the peer context for adolescents and emerging adults with type 1 diabetes.

PMID:
29138272
DOI:
10.2337/dc17-0643
[Indexed for MEDLINE]
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11.
Diabetes Care. 2018 Jan;41(1):104-111. doi: 10.2337/dc17-1669. Epub 2017 Nov 10.

The Association of Severe Hypoglycemia With Incident Cardiovascular Events and Mortality in Adults With Type 2 Diabetes.

Author information

1
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
2
Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD.
3
Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD.
4
Section of Internal Medicine, University of Chicago Medicine, Chicago, IL.
5
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD eselvin@jhu.edu.

Abstract

OBJECTIVE:

There is suggestive evidence linking hypoglycemia with cardiovascular disease, but few data have been collected in a community-based setting. Information is lacking on individual cardiovascular outcomes and cause-specific mortality.

RESEARCH DESIGN AND METHODS:

We conducted a prospective cohort analysis of 1,209 participants with diagnosed diabetes from the Atherosclerosis Risk in Communities (ARIC) study (analytic baseline, 1996-1998). Severe hypoglycemic episodes were identified using first position ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls through 2013. Cardiovascular events and deaths were captured through 2013. We used adjusted Cox regression models with hypoglycemia as a time-varying exposure.

RESULTS:

There were 195 participants with at least one severe hypoglycemic episode during a median fellow-up of 15.3 years. After severe hypoglycemia, the 3-year cumulative incidence of coronary heart disease was 10.8% and of mortality was 28.3%. After adjustment, severe hypoglycemia was associated with coronary heart disease (hazard ratio [HR] 2.02, 95% CI 1.27-3.20), all-cause mortality (HR 1.73, 95% CI 1.38-2.17), cardiovascular mortality (HR 1.64, 95% CI 1.15-2.34), and cancer mortality (HR 2.49, 95% CI 1.46-4.24). Hypoglycemia was not associated with stroke, heart failure, atrial fibrillation, or noncardiovascular and noncancer death. Results were robust within subgroups defined by age, sex, race, diabetes duration, and baseline cardiovascular risk.

CONCLUSIONS:

Severe hypoglycemia is clearly indicative of declining health and is a potent marker of high absolute risk of cardiovascular events and mortality.

PMID:
29127240
PMCID:
PMC5741158
[Available on 2019-01-01]
DOI:
10.2337/dc17-1669
[Indexed for MEDLINE]
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12.
J Clin Endocrinol Metab. 2017 Oct 1;102(10):3731-3738. doi: 10.1210/jc.2017-01187.

Vitamin D Stored in Fat Tissue During a 5-Year Intervention Affects Serum 25-Hydroxyvitamin D Levels the Following Year.

Author information

1
Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway.
2
Division of Internal Medicine, University Hospital of North Norway, 9019 Tromsø, Norway.
3
Research Group for Bioactives-Analysis and Application, National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.

Abstract

Context:

Vitamin D and 25-hydroxyvitamin D [25(OH)D] are stored in adipose tissue, but the clinical relevance is uncertain.

Objective:

To evaluate changes in serum 25(OH)D and adipose tissue vitamin D levels after stopping vitamin D supplementation.

Design:

A prospective, double-blind cohort follow-up study.

Setting:

Clinical Research Unit at University Hospital of North Norway.

Patients:

Seventy-six subjects were included after participation in a 3- to 5-year prevention of type 2 diabetes study and were administered 20,000 IU of vitamin D or placebo per week.

Intervention:

During the 12-month follow-up period, blood samples were drawn at the beginning and after 1, 3, 6, 9, and 12 months. Fat biopsies were taken at the start and end.

Main Outcome Measures:

Changes in 25(OH)D level in serum and 25(OH)D and vitamin D levels in adipose tissue.

Results:

Forty-one of 42 subjects who were given vitamin D and 33 of 34 subjects who were given placebo completed the study. At the inclusion, mean serum 25(OH)D levels were 122 and 71 nmol/L in the vitamin D and placebo groups, respectively. Serum 25(OH)D levels were significantly higher in the vitamin D group than in the placebo group throughout and were 84.5 and 73.1 nmol/L, respectively, after 12 months. In the vitamin D group, adipose tissue vitamin D levels decreased by 52% over 12 months.

Conclusion:

Vitamin D and 25(OH)D stored in adipose tissue after 3 to 5 years of vitamin D supplementation may have a clinically relevant effect on serum 25(OH)D level the following year.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01729013.

PMID:
28973683
DOI:
10.1210/jc.2017-01187
[Indexed for MEDLINE]
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13.
J Clin Endocrinol Metab. 2017 Oct 1;102(10):3756-3764. doi: 10.1210/jc.2017-00954.

HbA1c Identifies Subjects With Prediabetes and Subclinical Left Ventricular Diastolic Dysfunction.

Author information

1
Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy.
2
Division of Cardiology, Ferrarotto Hospital, University of Catania, 95100 Catania, Italy.

Abstract

Context:

Prediabetes is associated with subclinical cardiac changes associated with heart failure development.

Objective:

We investigated diastolic function and its association with markers of glycation and inflammation related to cardiovascular disease in patients with prediabetes. We focused on individuals with prediabetes identified only by glycated hemoglobin A1c [HbA1c; 5.7% to 6.4% and normal fasting glucose (NFG) and normal glucose tolerance (NGT) after an oral glucose tolerance test (OGTT)].

Design:

Cross-sectional study.

Setting:

Departments of Clinical and Experimental Medicine and Cardiology, University of Catania, Catania, Italy.

Main Outcome Measures:

HbA1c, OGTT, Doppler echocardiography, soluble receptor for advanced glycation end products (sRAGEs), and endogenous secretory RAGE (esRAGE) were evaluated.

Patients:

We recruited 167 subjects with NFG/NGT who were stratified according to HbA1c level: controls (HbA1c <5.7%) and HbA1c prediabetes (HbA1c 5.7% to 6.4%).

Results:

Patients with HbA1c prediabetes (n = 106) showed a lower peak mitral inflow in early diastole (E wave) to late diastolic atrial filling velocity (A wave) ratio (E/A ratio) than controls (n = 61) (1.10 ± 0.24 vs 1.18 ± 0.23; P < 0.05). They showed a higher left atrium volume (LAV) (28.4 ± 5 vs 22.1 ± 3; P < 0.05) and sphericity index (SI) (0.6 ± 0.06 vs 0.5 ± 0.05; P < 0.05). After multiple regression analyses, HbA1c, sRAGE, and esRAGE were the major determinants of E/A ratio, LAV, and SI.

Conclusions:

Subjects with HbA1c prediabetes exhibited subclinical cardiac alterations associated with sRAGE, esRAGE, and HbA1c. These subjects would not have been classified as having prediabetes on the basis of fasting glycemia or post-OGTT values.

PMID:
28973588
DOI:
10.1210/jc.2017-00954
[Indexed for MEDLINE]
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15.
Lancet. 2017 Nov 11;390(10108):2141-2142. doi: 10.1016/S0140-6736(17)32422-4. Epub 2017 Nov 9.

Intravitreal aflibercept for proliferative diabetic retinopathy - Authors' reply.

Author information

1
National Institute for Health Research, Moorfields Biomedical Research Centre, London EC1V 2PD, UK. Electronic address: Sobha.sivaprasad@moorfields.nhs.uk.
2
Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK.
3
King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK.
4
National Institute for Health Research, Moorfields Biomedical Research Centre, London EC1V 2PD, UK.
PMID:
29143752
DOI:
10.1016/S0140-6736(17)32422-4
[Indexed for MEDLINE]
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16.
Lancet. 2017 Nov 11;390(10108):2140-2141. doi: 10.1016/S0140-6736(17)32426-1. Epub 2017 Nov 9.

Intravitreal aflibercept for proliferative diabetic retinopathy.

Author information

1
Department of Ophthalmology, The First Affiliated Hospital, China Medical University, Shenyang 110001, China. Electronic address: liuleijiao@163.com.
2
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
3
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine National University of Singapore, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore.
PMID:
29143751
DOI:
10.1016/S0140-6736(17)32426-1
[Indexed for MEDLINE]
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18.
N Engl J Med. 2017 Nov 16;377(20):1994-5. doi: 10.1056/NEJMc1712575.

Safety of Degludec versus Glargine in Type 2 Diabetes.

Author information

1
Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA jtayek@dhs.lacounty.gov
2
FDAble, Glastonbury, CT
3
Harbor–UCLA Medical Center, Torrance, CA
PMID:
29143514
DOI:
10.1056/NEJMc1712575
[Indexed for MEDLINE]
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20.
N Engl J Med. 2017 Nov 16;377(20):1995-1996. doi: 10.1056/NEJMc1712575.

Safety of Degludec versus Glargine in Type 2 Diabetes.

Author information

1
Research Medical Center, Kansas City, MO smarso@gmail.com
2
University of North Carolina School of Medicine, Chapel Hill, NC
PMID:
29141162
DOI:
10.1056/NEJMc1712575
[Indexed for MEDLINE]
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