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1.
Diabet Med. 2019 May;36(5):557-568. doi: 10.1111/dme.13939. Epub 2019 Mar 12.

Decision aids for people with Type 2 diabetes mellitus: an effectiveness rapid review and meta-analysis.

Author information

1
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.
2
Harris Manchester College, University of Oxford, Oxford, UK.

Abstract

AIMS:

To perform a rapid review and meta-analysis of randomized controlled trials (RCTs) evaluating patient decision aids (PtDAs) for people with Type 2 diabetes mellitus.

METHODS:

We searched Medline and the Cochrane Library for RCTs assessing PtDAs in people with Type 2 diabetes. PtDAs were defined as tools designed to help people engage in decision-making about healthcare options, such as making treatment choices or setting therapeutic goals. The study selection process was facilitated by an automated screening tool to identify RCTs. We classified outcomes into seven domains and conducted meta-analyses using random effects models.

RESULTS:

We included a total of 15 studies, nine of which were cluster RCTs, that evaluated 10 PtDAs. Thirteen trials compared a PtDA with usual care or usual care plus educational material, whereas two RCTs compared individually tailored vs. non-tailored PtDAs. Meta-analyses showed a favourable effect of PtDAs compared with usual care in reducing decisional conflict [weighted mean difference (WMD) -4.66, 95% confidence interval (CI) -7.93 to -1.39] and in improving knowledge (WMD 20.46, 95% CI 9.13 to 3.77). Use of PtDAs resulted in more active involvement in decision-making during the consultation, although no effect was evident in terms of glycaemic control or self-reported medication adherence.

CONCLUSIONS:

PtDAs for people with Type 2 diabetes can improve the quality of decision-making and increase knowledge transfer. Interpretation of our findings is attenuated due to limitations related to the rapid review approach, including searching only two databases and performing data extraction and risk of bias assessment by a single reviewer.

PMID:
30791131
DOI:
10.1111/dme.13939
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2.
Diabet Med. 2019 Feb 21. doi: 10.1111/dme.13940. [Epub ahead of print]

Trends in cardiovascular management of people with diabetes by primary healthcare nurses in Auckland, New Zealand.

Author information

1
School of Nursing, University of Auckland, Auckland, New Zealand.
2
School of Population Health, University of Auckland, Auckland, New Zealand.

Abstract

AIMS:

The study aim was to re-examine current work practices and evaluate time trends in the cardiovascular management of people with diabetes consulted by primary healthcare nurses in New Zealand.

METHODS:

Primary healthcare nurses in the Auckland region were surveyed in 2006-2008 and 2016, with about one-third of practice, home care and specialist nurses randomly selected to participate. Nurses completed a self-administered questionnaire about demographic and workplace details, and a telephone interview about clinical care provided for people with diabetes during nursing consultations. Information was collected on a representative sample of people with diabetes consulted on one randomly selected work-day in the previous week.

RESULTS:

Of all people with diabetes consulted by nurses, practice nurses consulted significantly more in 2016 (83%) compared with 60% in 2006-2008, whereas specialist nurse consultations decreased from 23% to 8% (P = 0.01). In 2016, in people with diabetes, BMI was higher, and total cholesterol lower, yet the proportions of those receiving lifestyle advice (dietary and activity) remained unchanged from 2006-2008 levels. Smoking prevalence in people with diabetes was unchanged between the two surveys, although more people were asked if they wished to stop in 2016 compared with 2006-2008 (98% vs. 73%). In 2016, hours of nurses' diabetes education were associated with increased routine assessments of risk factors in people with diabetes and checking laboratory results.

CONCLUSIONS:

Practice nurses are undertaking an increasing proportion of diabetes consultations. Although BMI in people with diabetes is increasing, the proportion of nurses offering lifestyle advice remains unchanged. Increasing diabetes education could strengthen the management of people with diabetes by community nurses.

PMID:
30791130
DOI:
10.1111/dme.13940
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3.
Diabet Med. 2019 Feb 20. doi: 10.1111/dme.13934. [Epub ahead of print]

Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes.

Author information

1
University of Copenhagen, Denmark.
2
Steno Diabetes Centre Copenhagen, Denmark.
3
School of Psychology, National University of Ireland, Galway, Ireland.
4
Diabetes Education and Management, Teachers College Columbia University, New York, NY, USA.
5
Family and Community Medicine, University of California San Francisco, San Francisco, LA, USA.
6
University of Michigan Medical School, Ann Arbor, MI, USA.
7
Behavioural Diabetes Institute, San Diego, CA, USA.
8
Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia.
9
Deakin University, Australia.
10
Jazindiabetes, (Diabetes & Me), Slovenia.
11
Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, Germany.
12
Open University, Milton Keynes, UK.
13
Emergency Clinical County Hospital, Cluj-Napoca, Romania.
14
Middlesex University, London, UK.
15
University of Southern Denmark, Odense, Denmark.
16
Academic Primary Health Care Centre, Stockholm, Sweden.
17
Amsterdam UMC, Amsterdam, Netherlands.
18
Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK.
19
Dalhousie University, Halifax, Canada.
20
Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA.
21
National Institute of Health, Bethesda, MD, USA.
PMID:
30785642
DOI:
10.1111/dme.13934
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4.
Diabet Med. 2019 Feb 20. doi: 10.1111/dme.13937. [Epub ahead of print]

Dietary intakes of women with Type 1 diabetes before and during pregnancy: a pre-specified secondary subgroup analysis among CONCEPTT participants.

Author information

1
Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
2
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
3
Mount Sinai Hospital, Toronto, Canada.
4
Lunenfeld-Tanenbaum Research Institute, Toronto, Canada.
5
Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Canada.
6
Department of Women and Children's Health, St Thomas' Hospital, London, UK.
7
Department of Medicine, University of East Anglia, Norwich, UK.

Abstract

AIM:

To describe the dietary intakes of women with Type 1 diabetes before and during pregnancy.

METHODS:

This was a pre-specified subgroup analysis of CONCEPTT involving 63 women planning pregnancy and 93 pregnant women from 14 sites in England, Scotland and Ireland. Two hundred and forty-six 3-day food diaries (104 planning pregnancy, 142 pregnant) were matched to data source and food reference codes, and analysed using dietary software. Participants were informed that food diaries would be de-identified and used only for research purposes.

RESULTS:

Mean (sd) daily energy intake was 1588 (346) kcal and 1673 (384) kcal in women planning pregnancy and pregnant women respectively. Total carbohydrate intake was consistent with dietary guideline recommendations [180 (52) g planning pregnancy, 198 (54) g pregnant], but non-recommended sources (e.g. sugars, preserves, confectionery, biscuits, cakes) contributed to 46% of total daily carbohydrate intake. Fat consumption exceeded guideline recommendations [70 (21) g planning pregnancy, 72 (21) g pregnant]. Fibre [15.5 (5.3) g planning pregnancy, 15.4 (5.1) g pregnant], fruit and vegetable intakes [3.5 (2.2) and 3.1 (1.8) serves/day] were inadequate. Twelve women planning pregnancy (19%) and 24 pregnant women (26%) did not meet micronutrient requirements.

CONCLUSIONS:

The diets of pregnant women from England, Scotland and Ireland are characterized by high fat, low fibre and poor-quality carbohydrate intakes. Fruit and vegetable consumption is inadequate, with one in four women at risk of micronutrient deficiencies. Further research is needed to optimize maternal nutrition for glycaemic control and for maternal and offspring health.

PMID:
30785640
DOI:
10.1111/dme.13937
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5.
Diabet Med. 2019 May;36(5):546-556. doi: 10.1111/dme.13935. Epub 2019 Mar 13.

Systematic review of randomized controlled trials on antibiotic treatment for osteomyelitis in diabetes.

Author information

1
Department of Orthopaedic Oncology, Honghui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, Shaanxi, China.
2
Department of Rheumatism and Immunity Branch, Xi an No. 5 Hospital, Xi'an, Shaanxi, China.
3
Department of Neurosurgery, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
4
Department of Paediatric Orthopedics, Honghui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, Shaanxi, China.

Abstract

AIM:

To evaluate the efficacy of antibiotic therapy in osteomyelitis treatment among people with diabetes.

METHODS:

A systematic search of PubMed, EMBASE, AMED, Web of Science, the WHO trial registry, Cochrane library databases, and ClinicalTrials.gov, in addition to hand-searching, was undertaken in July 2018. Two reviewers independently extracted data. The studies' methodological quality was assessed using the modified Jadad scale. Descriptive analysis was performed.

RESULTS:

Seven randomized controlled trials, with 393 participants in total, were included. The antibiotic regimens, treatments and follow-up durations varied among the trials. The total scores showed that the overall methodological quality of the seven studies was high, despite two studies showing some flaws in double-blinding and withdrawals/drop-outs. Of four studies comparing different antibiotic regimens, three implied a similar remission effect, while one implied that ertapenem ± vancomycin treatment showed a higher remission rate than tigecycline treatment; this conclusion was not robust because of low power and small sample size. In the other three studies, which included two different doses of ciprofloxacin, an antibiotics group and a conservative surgical group, and two durations of the same antibiotic strategy, no significant differences in remission were reported between the groups. No difference was observed in the analyses of microbiological outcomes, superinfections and relapse, except adverse events.

CONCLUSIONS:

There is no definitive evidence supporting the superiority of any particular antibiotic agent, dose, or administration duration in the treatment of osteomyelitis in diabetes. As the included studies had some flaws and limitations, further research is necessary.

PMID:
30785639
DOI:
10.1111/dme.13935
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Publication type

6.
Diabet Med. 2019 Feb 19. doi: 10.1111/dme.13936. [Epub ahead of print]

Effect of age at menarche on microvascular complications among women with Type 1 diabetes.

Author information

1
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

AIM:

To test the hypothesis that delayed menarche is associated with an increased microvascular complication risk among women with Type 1 diabetes.

METHODS:

We studied the female participants of an ongoing prospective study of childhood-onset Type 1 diabetes diagnosed during the period 1950-1980. Of 325 women, we included data from 315 who had reached menarche by the study baseline (1986-1988) and who self-reported their age at menarche. Both cross-sectional and prospective analyses over the 25-year follow-up were used to assess the relationship of age at menarche with the prevalence, incidence and cumulative incidence of microvascular complications, comprising overt nephropathy, proliferative retinopathy and confirmed distal symmetric polyneuropathy.

RESULTS:

In cross-sectional analyses at baseline, the odds of overt nephropathy increased 1.24 times (P=0.02) with each annual increase in age at menarche, and 3.2 times (P=0.009) in those with delayed menarche compared with women with normal menarche onset, after adjustment. Similarly, the cumulative incidence of overt nephropathy increased 1.16 times (P=0.01) with each older year of menarche and women with delayed menarche were at twofold increased risk of overt nephropathy (hazard ratio 2.30, P=0.001) compared with women with normal menarche onset. However, age at menarche was not significantly associated with either proliferative retinopathy or confirmed distal symmetric polyneuropathy after adjusting for covariates.

CONCLUSIONS:

Age at menarche was significantly associated with the prevalence and cumulative incidence of overt nephropathy, but not with proliferative retinopathy or confirmed distal symmetric polyneuropathy in Type 1 diabetes. Women with delayed menarche may therefore be targeted for early screening and timely interventions to prevent the development of nephropathy.

PMID:
30784109
DOI:
10.1111/dme.13936
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7.
Diabet Med. 2019 May;36(5):531-538. doi: 10.1111/dme.13933. Epub 2019 Apr 3.

A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes.

Author information

1
Diabetes Research Group, London, UK.
2
St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
3
Diabetes, UK.
4
Diabetes, NHS England, London, UK.

Abstract

In both adults and children with diabetes, technologies such as continuous subcutaneous insulin infusion using insulin pumps and continuous glucose monitoring can help improve diabetes control, reduce hypoglycaemia and improve quality of life. Access to these technologies in the UK is very variable. Some technologies are recommended by the National Institute for Health and Care Excellence, while others have not been appraised, and new technologies are emerging all the time. Additionally, different guidelines for adults and children further complicate access to diabetes technology in the transition from paediatric to adult care. Against this background, Diabetes UK and NHS England have brought together a multidisciplinary group of experts, including clinicians and people with diabetes, to develop this consensus guideline, combining the different technologies into a common pathway to aid clinical and policy decision-making. We created a pathway that supports the incremental addition of technology as monotherapy and then dual therapy in the same way that we incrementally add in therapeutic agents to support people with Type 2 diabetes to achieve their personalized glycaemic targets. The pathway emphasizes the importance of structured education, specialist support and appropriate access to psychological therapies, as essential pillars for optimized use of diabetes-related technology, and recommends the re-evaluation of its use when the individual is unable either to use the technology appropriately or to achieve the intended outcomes. This pathway is endorsed by UK-wide clinical and patient associations and we recommend that providers and commissioners use it to ensure the right individual with diabetes has access to the right technology in a timely way to help achieve better outcomes.

PMID:
30773681
DOI:
10.1111/dme.13933
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8.
Diabetes. 2019 Mar;68(3):479-489. doi: 10.2337/dbi18-0036.

Leveraging Genetics to Improve Cardiovascular Health in Diabetes: The 2018 Edwin Bierman Award Lecture.

Doria A1,2,3.

Author information

1
Research Division, Joslin Diabetes Center, Boston, MA alessandro.doria@joslin.harvard.edu.
2
Department of Medicine, Harvard Medical School, Boston, MA alessandro.doria@joslin.harvard.edu.
3
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA alessandro.doria@joslin.harvard.edu.

Abstract

The past decade has witnessed an exponential increase in our ability to search the genome for genetic factors predisposing to cardiovascular disease (CVD) and in particular coronary heart disease (CHD). Identifying these genes could lead to the development of innovative strategies to prevent the cardiovascular complications of diabetes by allowing us to 1) create predictive algorithms for the identification of patients at especially high risk of CVD so that these individuals can undergo preventive interventions early in the natural history of the disease; 2) discover as yet unknown disease pathways linking diabetes to atherosclerosis, which can be used as targets for the development of new CVD-preventing drugs specifically directed at subjects with diabetes; and 3) devise personalized programs increasing the cost-effectiveness of preventive interventions by tailoring them to the genetic background of each patient. Substantial progress has been made in each of these three areas as exemplified by the recent development of a CHD genetic risk score improving CHD prediction among subjects with type 2 diabetes, the discovery of a diabetes-specific CHD locus on 1q25 pointing to glutamine synthase (GLUL) and the γ-glutamyl cycle as key regulators of CHD risk in diabetes, and the identification of two genetic loci allowing the selection of patients with type 2 diabetes who may especially benefit from intensive glycemic control. Translating these discoveries into clinical practice will not be without challenges, but the potential rewards, from the perspective of public health as well as that of persons with diabetes, make this goal worth pursuing.

PMID:
30787070
PMCID:
PMC6385753
[Available on 2020-03-01]
DOI:
10.2337/dbi18-0036
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9.
Diabetes. 2019 Mar;68(3):476-478. doi: 10.2337/dbi18-0051.

Targeting the Brain to Cure Type 2 Diabetes.

Author information

1
Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland bernard.thorens@unil.ch.
10.
Diabetes. 2019 Mar;68(3):474-475. doi: 10.2337/dbi18-0053.

Linking Coronary Microvascular and Cardiac Diastolic Dysfunction in Diabetes: Are Women More Vulnerable?

Bender SB1,2,3.

Author information

1
Biomedical Sciences, University of Missouri, Columbia, MO benders@missouri.edu.
2
Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO benders@missouri.edu.
3
Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO benders@missouri.edu.
PMID:
30787068
PMCID:
PMC6385759
[Available on 2020-03-01]
DOI:
10.2337/dbi18-0053
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11.
Diabetes. 2019 Mar;68(3):469-470. doi: 10.2337/db19-ti03.

In This Issue of Diabetes.

[No authors listed]
PMID:
30787066
DOI:
10.2337/db19-ti03
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12.
Diabetes Care. 2019 Mar;42(3):e51-e52. doi: 10.2337/dc18-2288.

Comment on Warren et al. Diabetes and Trajectories of Estimated Glomerular Filtration Rate: A Prospective Cohort Analysis of the Atherosclerosis Risk in Communities Study. Diabetes Care 2018;41:1646-1653.

Author information

1
Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
2
Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China pengfeishan@zju.edu.cn.
PMID:
30787065
DOI:
10.2337/dc18-2288
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Publication type

Publication type

13.
Diabetes Care. 2019 Mar;42(3):e49-e50. doi: 10.2337/dci18-0058.

Response to Comment on Pongrac Barlovic et al. The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up. Diabetes Care 2018;41:2487-2494.

Author information

1
University Medical Center Ljubljana, Ljubljana, Slovenia.
2
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
3
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
4
Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
5
Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland.
6
The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.
7
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland per-henrik.groop@helsinki.fi.
8
Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Publication type

Publication type

14.
Diabetes Care. 2019 Mar;42(3):e48. doi: 10.2337/dc18-2202.

Comment on Pongrac Barlovic et al. The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up. Diabetes Care 2018;41:2487-2494.

Author information

1
Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France.
2
Ophthalmology Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France.
3
Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France vincent.rigalleau@chu-bordeaux.fr.
PMID:
30787063
DOI:
10.2337/dc18-2202
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15.
Diabetes Care. 2019 Mar;42(3):396-399. doi: 10.2337/dci18-0055.

Metformin for Gestational Diabetes Mellitus: Progeny, Perspective, and a Personalized Approach.

Author information

1
Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado, Anschutz Medical Campus, Aurora, CO lynn.barbour@ucdenver.edu.
2
Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada.
16.
Diabetes Care. 2019 Mar;42(3):359-363. doi: 10.2337/dci18-0056.

Lois Jovanovič, MD, MACE: Pioneer in the Field of Diabetes and Pregnancy and Beyond.

Author information

1
Sansum Diabetes Research Institute, Santa Barbara, CA djpettittret@gmail.com.
2
Sansum Diabetes Research Institute, Santa Barbara, CA.
17.
Diabetes Care. 2019 Mar;42(3):352-358. doi: 10.2337/dci18-0051.

2018 Health Care & Education Presidential Address: The American Diabetes Association in the Era of Health Care Transformation.

Author information

1
Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health; Department of Acute and Chronic Care, Johns Hopkins School of Nursing; and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD fbriggs3@jhmi.edu.

Abstract

This address was delivered by Felicia Hill-Briggs, PhD, ABPP, President, Health Care & Education of the American Diabetes Association (ADA) at the ADA's 78th Scientific Sessions in Orlando, FL, on 23 June 2018. Diabetes has become a high-priority condition in the current era of health care transformation due to diabetes and prediabetes prevalence rates, suboptimal diabetes outcomes at the health care system and population levels, and high health care and public health costs attributed to diabetes. Population health is the path forward for the ADA to facilitate diabetes health care and public health improvement nationally. Population health management initiatives underway at the ADA include Diabetes INSIDE for health care systems and a Mental Health Provider Training Program and referral directory. Population health improvement initiatives include the prediabetes Risk Test Campaign, National Diabetes Prevention Program (DPP) dissemination in underserved states and populations, a DPP Express information technology platform, and a social determinants of health scientific review and recommendations. Dr. Hill-Briggs is a professor of medicine; physical medicine and rehabilitation; health, behavior, and society; and acute and chronic care at Johns Hopkins University in Baltimore, MD. She is a core faculty member of the Welch Center for Prevention, Epidemiology & Clinical Research and colead of behavioral, social, and systems science for the Johns Hopkins Institute for Clinical and Translational Research. Dr. Hill-Briggs has been elected to the National Academy of Medicine of The National Academies of Science, Engineering, and Medicine and is the 2018 recipient of the Rachmiel Levine Medal for Leadership from the ADA.

PMID:
30787058
PMCID:
PMC6385700
[Available on 2020-03-01]
DOI:
10.2337/dci18-0051
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18.
Diabetes Care. 2019 Mar;42(3):349-351. doi: 10.2337/dci18-0030.

Therapeutic Inertia and the Legacy of Dysglycemia on the Microvascular and Macrovascular Complications of Diabetes.

Author information

1
Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K. kk22@le.ac.uk.
2
Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.
19.
Diabetes Care. 2019 Mar;42(3):343-344. doi: 10.2337/dc19-ti03.

In This Issue of Diabetes Care.

[No authors listed]
PMID:
30787055
DOI:
10.2337/dc19-ti03
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20.
Diabetes Care. 2018 Dec;41(12):2535-2543. doi: 10.2337/dc18-1132. Epub 2018 Oct 16.

Prediabetes Is Associated With Structural Brain Abnormalities: The Maastricht Study.

Author information

1
Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands marnix.van.agtmaal@mumc.nl.
2
School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands.
3
Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
4
Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands.
5
Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
6
Department of Epidemiology, Maastricht University Medical Center+, Maastricht, the Netherlands.
7
Department of Social Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
8
Department of Rehabilitation Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
9
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
10
School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands.

Abstract

OBJECTIVE:

Structural brain abnormalities are key risk factors for brain diseases, such as dementia, stroke, and depression, in type 2 diabetes. It is unknown whether structural brain abnormalities already occur in prediabetes. Therefore, we investigated whether both prediabetes and type 2 diabetes are associated with lacunar infarcts (LIs), white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and brain atrophy.

RESEARCH DESIGN AND METHODS:

We used data from 2,228 participants (1,373 with normal glucose metabolism [NGM], 347 with prediabetes, and 508 with type 2 diabetes (oversampled); mean age 59.2 ± 8.2 years; 48.3% women) of the Maastricht Study, a population-based cohort study. Diabetes status was determined with an oral glucose tolerance test. Brain imaging was performed with 3 Tesla MRI. Results were analyzed with multivariable logistic and linear regression analyses.

RESULTS:

Prediabetes and type 2 diabetes were associated with the presence of LIs (odds ratio 1.61 [95% CI 0.98-2.63] and 1.67 [1.04-2.68], respectively; P trend = 0.027), larger WMH (β 0.07 log10-transformed mL [log-mL] [95% CI 0.00-0.15] and 0.21 log-mL [0.14-0.28], respectively; P trend <0.001), and smaller white matter volumes (β -4.0 mL [-7.3 to -0.6] and -7.2 mL [-10.4 to -4.0], respectively; P trend <0.001) compared with NGM. Prediabetes was not associated with gray matter volumes or the presence of CMBs.

CONCLUSIONS:

Prediabetes is associated with structural brain abnormalities, with further deterioration in type 2 diabetes. These results indicate that, in middle-aged populations, structural brain abnormalities already occur in prediabetes, which may suggest that the treatment of early dysglycemia may contribute to the prevention of brain diseases.

PMID:
30327356
DOI:
10.2337/dc18-1132
[Indexed for MEDLINE]
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