Diabetes Association Recommends Research Articles

Abstract 13169: US Prevalence Estimates of Individuals With Diabetes and Chronic Kidney Disease Indicated for SGLT-2 Inhibitor Initiation

Introduction: Since the CREDENCE trial results, the American Diabetes Association (ADA) recommends SGLT-2 inhibitors as first line therapy for patients with stage III Chronic Kidney Disease (CKD) or proteinuric CKD, regardless of baseline A1C. We project the number of US individuals with diabetes and renal disease that meets inclusion into the CREDENCE trial and that are recommended for SGLT-2 inhibitors based on the guidelines. Methods: Our initial cohort consisted of 48,710 individuals from the 2007-2016 National Health and Nutrition Examination Survey with survey weights designed to estimate the US population. CREDENCE eligible patients were patients with diabetes who had an eGFR of 30-90 and urine albumin-to-creatinine ratio (UACR) of >300 mg/g. Guideline eligible patients were stage III CKD individuals and those with a UACR > 30 mg/g. Results: In the US population, 21,411,059 (+/-708,233) individuals are >=18 years and have diabetes. Of these individuals, 578,514 (+/-72,385) are CREDENCE eligible. Based on the ADA recommendations, 7,504,508 (+/- 342,139) adults with CKD and diabetes are recommended for an SGLT-2 inhibitor, representing 35.0% of individuals with diabetes. The mean age of guideline eligible individuals is 64.4 years, with 3,886,904 males (51.8%) and 3,617,604 females (48.2%). Conclusions: In the United States, a large number of individuals--approximately 35% of adults with diabetes--have renal disease characteristics that give them a first-line indication for SGLT-2 inhibitor initiation.

Improving Glycemic Control in African Americans With Diabetes and Mild Cognitive Impairment.

Improving glycemic control in older African Americans with diabetes and mild cognitive impairment (MCI) is important as the population ages and becomes more racially diverse. Randomized controlled trial. Recruitment from primary care practices of an urban academic medical center. Community-based treatment delivery. Older African Americans with MCI, low medication adherence, and poor glycemic control (N = 101). Occupational therapy (OT) behavioral intervention and diabetes self-management education. The primary outcome was a reduction in hemoglobin A1c level of at least 0.5% at 6 months, with maintenance effects assessed at 12 months. At 6 months, 25 of 41 (61.0%) OT participants and 22 of 46 (48.2%) diabetes self-management education participants had a reduction in hemoglobin A1c level of at least 0.5%. The model-estimated rates were 58% (95% confidence interval [CI] = 45%-75%) and 48% (95% CI = 36%-64%), respectively (relative risk [RR] = 1.21; 95% CI = 0.84-1.75; P = .31). At 12 months, the respective rates were 21 of 39 (53.8%) OT participants and 24 of 49 (49.0%) diabetes self-management education participants. The model-estimated rates were 50% (95% CI = 37%-68%) and 48% (95% CI = 36%-64%), respectively (RR = 1.05; 95% CI = 0.70-1.57; P = .81). Both interventions improved glycemic control in older African Americans with MCI and poor glycemic control. This result reinforces the American Diabetes Association's recommendation to assess cognition in older persons with diabetes and demonstrates the potential to improve glycemic control in this high-risk population. J Am Geriatr Soc 68:1015-1022, 2020.

Associations of greenness with diabetes mellitus and glucose-homeostasis markers: The 33 Communities Chinese Health Study

Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes - Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. A 0.1-unit increase in NDVI500 m and SAVI500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82-0.94) and 0.80 (0.72-0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9-51.1% and 8.6-78.7% these associations, respectively, while no mediation role was observed for physical activity. Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.

Clinic-Wide Screening of Fear of Hypoglycemia in Mothers and Fathers of Children with Type 1 Diabetes

Background: The American Diabetes Association (ADA) recommends anxiety screening in individuals with type 1 diabetes (T1D); however, screening in parents is not addressed. This study describes fear of hypoglycemia (FOH) in parents who were screened as part of their children’s routine T1D clinic visit. Methods: Mothers (n=234) and fathers (n=79) completed the Hypoglycemia Fear Survey - Parent comprising 3 subscales: Maintaining High Blood Glucose (BG), Worry/Helplessness About Low BG, and Worry About Negative Social Consequences. Scores of ≥7, ≥24, and ≥9, respectively, were used as clinical cutoffs. Higher scores indicate greater fear/worry about hypoglycemia. Results: Child characteristics were: 53% female; mean age = 13.9±2.2 years; mean A1C = 9.3±2.2%, mean T1D duration = 5.1±4.1 years; 58% CSII. Percentage of mothers and fathers exceeding the clinical cutoffs were: 18%, 14% on Maintaining High BG; 15%, 3% Worry/Helplessness About Low BGs; and 14%, 1% Worry About Negative Social Consequences. Compared to fathers, mothers reported significantly more helplessness about low BGs (t(173.6)=3.24, p=0.001), but not more worry about negative social consequences (t(223.4)=1.42, p=0.16), or engaging in behaviors to maintain high BGs (t(290)=0.68, p=0.50). Parents of older children (≥13 years) worried equally about hypoglycemia (p>0.05), but reported engaging in fewer behaviors to maintain high BGs than parents of younger children (10-12 years) (t(307)=3.27, p<0.001). Conclusions: FOH is common in both mothers and fathers. Mothers reported more feelings of helplessness than fathers, whereas both mothers and fathers of younger children reported engaging in more behaviors to maintain high BGs than parents of older children. These results support the need to screen parents - not just patients with T1D - for FOH and provide intervention when indicated. Consideration should be given to including recommendations about FOH screening parents in the ADA Medical Standards of Care. Disclosure S. Majidi: None. H. O'Donnell: None. K. Benson: None. K.A. Driscoll: None.

Influence of Diabetes Complications on the Cost-Effectiveness of A1C Treatment Goals in Older U.S. Adults

The American Diabetes Association (ADA) recommends glycemic management goals for older diabetes patients take into account the complexity of complications. Little information is available on how cost-effectiveness (CE) of glycemic control goals relates to a patient’s level of complications. We examined the CE of intensive glycemic control (A1c <7.5%) compared to standard treatment (A1c <8.5%) among adults aged 65 y with type 2 diabetes having various complications. 2011-2016 National Health and Nutrition Examination Survey data were used to generate nationally representative samples with various complications. The CDC-RTI diabetes simulation model was used to project the long-term health and cost consequences of intensive/standard glycemic control. The CE of the intensive glycemic control was measured in costs (2017 USD) per quality adjusted life year (QALY). Based on a $50,000/QALY threshold, intensive glycemic control was only marginally cost effective for patients with no complications or any microvascular complication (excluding renal failure) but was not cost-effective for patients with one or more macrovascular complications. Current ADA standards recommend intensive glycemic control among older adults with fewer than 3 complications. From a CE perspective, our results only support the intervention among those with no complications or only microvascular complication. Disclosure H. Shao: None. D.B. Rolka: None. E.W. Gregg: None. P. Zhang: None.

Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 Communities Chinese Health Study

Health effects of air pollution on diabetes have been scarcely studied in developing countries. We aimed to explore the associations of long-term exposure to ambient particulate matter (PM) and gaseous pollutants with diabetes prevalence and glucose-homoeostasis markers in China. Between April 1 and Dec 31, 2009, we recruited a total of 15 477 participants aged 18-74 years using a random number generator and a four-staged, stratified and cluster sampling strategy from a large cross-sectional study (the 33 Communities Chinese Health Study) from three cities in Liaoning province, northeastern China. Fasting and 2 h insulin and glucose concentrations and the homoeostasis model assessment of insulin resistance index and β-cell function were used as glucose-homoeostasis markers. Diabetes was defined according to the American Diabetes Association's recommendations. We calculated exposure to air pollutants using data from monitoring stations (PM with an aerodynamic diameter of 10 μm or less [PM10], sulphur dioxide, nitrogen dioxide, and ozone) and a spatial statistical model (PM with an aerodynamic diameter of 1 μm or less [PM1] and 2·5 μm or less [PM2·5]). We used two-level logistic regression and linear regression analyses to assess associations between exposure and outcomes, controlling for confounders. All the studied pollutants were significantly associated with increased diabetes prevalence (eg, the adjusted odds ratios associated with an increase in IQR for PM1, PM2·5, and PM10 were 1·13, 95% CI 1·04-1·22; 1·14, 1·03-1·25; and 1·20, 1·12-1·28, respectively). These air pollutants were also associated with higher concentrations of fasting glucose (0·04-0·09 mmol/L), 2 h glucose (0·10-0·19 mmol/L), and 2 h insulin (0·70-2·74 μU/L). No association was observed for the remaining biomarkers. Stratified analyses indicated greater effects on the individuals who were younger (<50 years) or overweight or obese. Long-term exposure to air pollution was associated with increased risk of diabetes in a Chinese population, particularly in individuals who were younger or overweight or obese. The National Key Research and Development Program of China, the National Natural Science Foundation of China, the Fundamental Research Funds for the Central Universities, the Guangdong Province Natural Science Foundation, the Career Development Fellowship of Australian National Health and Medical Research Council, and the Early Career Fellowship of Australian National Health and Medical Research Council.

Risk Factor for Diabetes in Different Populations of Manipur

Type 2 diabetes mellitus (DM) is among the most common non-communicable chronic diseases in developed and developing countries around the world.The present study was conducted to find out associated risk factors, awareness of basic knowledge regarding risk factors, treatment and complications of diabetes among different populations of Manipur. Methods Individuals of both sexes belonging to three different populations were randomly selected and screened for diabetes from different districts of Manipur, which is a small hilly state, situated in the north eastern extreme corner of India sharing an international boundary with Myanmar (Burma). DM was defined according to the American Diabetes Association (ADA) recommendations as FBS>126 mg/dl ororal glucose tolerance test OGTT2>200 mg/dl. Results Majority of the present studied diabetic individuals were males i.e., 65.31%. About 30.27% had family history of diabetes. The prevalence of diabetes is more in meat eaters. Muslims shows highest percentage of overweight diabetic individuals i.e. 36.2%. Only 42.18% of diabetic individuals had basic knowledge regarding risk factors, treatment and complications of diabetes. Conclusion Large scale epidemiological studies for other populations need to be undertaken to ascertain the causes of rising DM epidemic, initiative for reducing or if possible, some serious efforts must be taken by the Government, health planners to promote physical activity, changing societal perceptions of health and improving knowledge about their associated risk factors by discussing it with the general public.

Evaluation of aspirin use in patients with diabetes receiving care in community health.

The American Diabetes Association (ADA) recommends low-dose aspirin therapy as a primary prevention strategy in patients with type 1 or type 2 diabetes mellitus (DM) at increased cardiovascular risk. However, not all patients who are indicated are taking aspirin therapy, and it is not routinely documented in the electronic health record (EHR). To determine frequencies of appropriate aspirin use and documentation in the EHR in adult patients with DM. Adult patients with DM were randomized and contacted for participation in a telephonic survey between January and October 2013. Patients who consented were administered a standardized oral telephone survey regarding aspirin use. Patient demographics, current medications, allergies, past medical history, and pertinent laboratory values were collected. Patients were then stratified by the ADA-defined indication for aspirin. The primary outcomes were rates of appropriate aspirin use and documentation of aspirin therapy in the EHR. Investigators contacted 276 patients for inclusion. Of the 81 patients surveyed, 74% were indicated for aspirin therapy. Nearly all (92.3%) patients reporting aspirin use were indicated for aspirin therapy compared with only 57.1% of patients who did not report aspirin but were indicated (P = 0.0003). Alternatively, 96.7% of patients with aspirin use documented in their EHR were indicated for aspirin therapy compared with only 60.8% of patients who did not have aspirin use documented in the EHR but had an indication (P = 0.0002). Approximately 20% of the patients indicated for and reporting aspirin use did not have aspirin documented in their EHR. Aspirin use in patients with DM who are indicated for therapy is significantly underutilized and underdocumented.

A report released by the Canadian Diabetes Association (CDA) recommends that Canada's drug review process be enhanced to ensure wider drug access.

A report released by the Canadian Diabetes Association (CDA) recommends that Canada's drug review process be enhanced to ensure wider drug access.

A Mathematical Model Supports Age-Based Screening for Diabetes

The American Diabetes Association (ADA) recommends screening for diabetes every 3 years in all asymptomatic overweight adults with at least one

Overcoming insulin “resistance”: Assisting patients in transitioning to insulin therapy

The American Diabetes Association (ADA) recommends metformin, sulfonylureas, or insulin as first-tier therapy for treating type 2 diabetes.[1][1] Insulin is recommended as the treatment of choice if a patient’s fasting blood glucose concentration exceeds 250 mg/dL or glycosylated hemoglobin

Sleepiness, physical activity, and functional outcomes in veterans with type 2 diabetes

The purpose of this study was to explore the association between daytime sleepiness on physical activity and functional outcomes in veterans with type 2 diabetes. Physical activity was based on mean self-reported minutes walked per week; the American Diabetes Association's recommendation of 150 minutes activity per week was used to dichotomize participants as sedentary or active. The Epworth Sleepiness Scale measured sleepiness. Sleepy participants had significantly lower scores on the Functional Outcomes of Sleep Questionnaire. Sleepiness was predictive of being sedentary ( p = .01) after controlling for age and body mass index. The conclusion is that daytime sleepiness may impede physical activity among veterans with diabetes, confounding self-management.

Screening for type 2 diabetes mellitus in children and adolescents

There is debate about the rationale and the most cost-effective strategy for screening adults for type 2 diabetes and a paucity of literature on the subject in children. Although tests exist to detect undiagnosed type 2 diabetes, these tests have not been extensively studied in this age group, and the outcomes of additional years of treatment in these screening-detected individuals are currently unknown. Despite this, the American Diabetes Association (ADA) recommends opportunistic screening of at-risk children. The true prevalence of childhood type 2 diabetes is unknown in many countries and the natural history of the condition has not been fully delineated in this age group. This review evaluates the rationale for screening asymptomatic children and adolescents for type 2 diabetes using modified World Health Organisation (WHO) criteria. Br J Diabetes Vasc Dis 2008; 8: 163—168

A survey of the perceptions, knowledge, and use of A1C values by home care patients and nurses.

The purpose of this study was to provide baseline information on the perceptions, use, and knowledge of hemoglobin A1C (A1C) values among home healthcare nurses and patients. A convenience sample (44 patients, 26 nurses) from a Medicare-certified home care agency was surveyed using an investigator-developed demographic and knowledge questionnaire. Data collected from telephone interviews (patients), written questionnaires (nurses), and medical record reviews were analyzed using descriptive methods. Most of the home care nurses correctly identified the American Diabetes Association's recommendation for target A1C values; however, nurses rarely contact the physician to obtain A1C results. Nurses do not routinely teach patients about A1C values and inconsistently use A1C values to plan care for their patients with diabetes. Most patients said that they had never had an A1C test performed, and most did not recall the nurse providing any teaching about A1C. Education related to target A1C values is needed. Methods to increase the availability of A1C results in the home care setting should be explored. The importance and clinical utility of A1C values need to be more effectively conveyed to both nurses and patients in the home care setting.

Response to Wolever

We thank M.S. Wolever (1) for his letter asking about the process used to develop the American Diabetes Association (ADA) nutrition principles and recommendations. As with all ADA technical reviews and position statements, the process is determined by the ADA as outlined in the ADA Clinical Practice Recommendations 2002 introduction (2), which is used for all new and revised ADA position statements. Members of the task force reviewed the literature with emphasis on …

Strategies for better diabetes control in the US.

Recent surveys in the US have indicated that 71% of the total diabetes care is delivered by primary care physicians, and that current management practices in terms of the point of initiation of pharmacological treatment fall considerably short of the American Diabetes Association's recommendations. In part, this delay in initiating treatment is due to a fear of provoking hypoglycaemia, which in itself results from a general avoidance of blood glucose monitoring on the part of patients. As a consequence of this apparent disregard for diabetes care, blood glucose concentrations are not adequately controlled in the US and this is reflected in a high incidence of chronic complications, particularly diabetic neuropathy. This is likely to have major cost implications in the future. In an effort to improve the standard of diabetes care, a number of US authorities have begun producing guidelines for primary care physicians, and in the State of Texas, treatment algorithms that incorporate recommendations based on the current US registration trial data have been developed. These recommendations, which have now been adopted by the State of Texas and form part of the minimum standard of care mandated by the State Department of Health's Diabetes Council, provide guidance on the selection and use of oral antidiabetic drugs (including sulphonylureas, metformin, troglitazone, repaglinide and acarbose) in patients with type 2 diabetes, both for glycaemic control and for prevention of cardiovascular complications. It is hoped that organised implementation of these treatment algorithms will produce better control of diabetes and its complications than the current ad hoc strategies used by individual practitioners.

Understanding Insulin Dependent Diabetes

Understanding Insulin Dependent Diabetesis the seventh edition of the diabetes instructional manual written by H. Peter Chase, MD, and used at the Barbara Davis Center for Childhood Diabetes. It is meant to explain to parents of a child newly diagnosed the pathophysiology of diabetes and the techniques necessary to manage a child with diabetes. Dr Chase has written his teaching tool clearly, so that most high school students and adults can understand the information. He includes the many technological advances in diabetes management of the 1980s. He emphasizes home glucose monitoring and consistency in food management and clearly outlines the American Diabetic Association's recommendations for the standard of care for children with insulin-dependent diabetes. The seventh edition includes a much stronger look at the social and psychological aspects of being a child with diabetes. The author discusses age-appropriate expectations for children with diabetes, and children are not expected in

A regional diabetes nutrition education program: its effect on knowledge and eating behavior.

The effect of a nutrition education program on knowledge and self-care behavior in a group of individuals with diabetes was evaluated. The nutrition education program was developed using outlines and knowledge tests produced by the University of Michigan Diabetes Research and Training Center. The program, sponsored by the American Diabetes Association, Akron Chapter, was presented free of charge to Northeast Ohio area residents. Forty-four individuals participated in the study. Results indicated a statistically significant (p < 0.01) gain in knowledge but no statistically significant change in eating behavior for the sample. However, post-food records indicated that the mean for the percentage of total kcalories (kcals) from protein and fat (ie, 20% and 28%, respectively) were within the American Diabetes Association's recommendations of no more than 20% of kcals from protein and 30% of kcals from fat. In addition, the percentage of kcals from carbohydrate and the recommended total number of kcals improved toward the recommended levels.