Diabetes In High-risk Population Research Articles

High levels of discordance between office-based and ambulatory blood pressure measurements for diagnosing optimal blood pressure control in high-risk diabetic populations from a developing country

This study investigated the concordance between office-based blood pressure (BP) readings and ambulatory BP monitoring (ABPM) in 51 consenting type 2 diabetes patients (25 males) in Cameroon with hypertension who had been receiving stable treatment for at least 3 months. The prevalence of optimal BP control was 63% based on office measurements and 23% based on ABPM. Agreement between the two methods was poor (kappa statistic: 0.15; 95% confidence interval: -0.08 to 0.29). Using ABPM as the standard, office BP was helpful for ruling out optimal BP control (specificity: 75%), but not for ruling it in (sensitivity: 41%). Our results suggest that ABPM should be recommended in such settings as ours only for those patients who have already achieved stable optimal BP control according to office measurements.

Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic Syndrome

Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic SyndromeRetinol-binding protein 4 is an adipocytokine separately implicated in the development of obesity-related insulin resistance and proatherogenic lipid profile, however, its role in humans is unclear. This study was carried out to assess the role of retinol-binding protein 4 as a potential marker of metabolic syndrome in obese Asian Indians (a high-risk population for diabetes). 52 obese (BMI >23 kg/m2) Asian Indians were grouped into those with and without metabolic syndrome based on IDF criteria and compared with healthy controls. The anthropometric and biochemical parameters (fasting blood sugar, lipid profile, serum insulin, high-sensitivity C-reactive protein, and retinol-binding protein 4) were estimated. The obese groups had significantly altered adiposity indices, insulin resistance parameters (fasting blood sugar (only in the metabolic syndrome group), serum insulin, HOMA-IR and QUICKI), index of inflammation (C-reactive protein) and proatherogenic dyslipidemic profile (serum triglycerides, VLDL-cholesterol, and triglyceride/HDL-cholesterol ratio). Retinol-binding protein 4 levels were elevated in the obese groups, but were not significant. Retinol-binding protein 4 levels were correlated with anthro-pometric parameters and atherogenic lipids, while C-reactive protein was correlated with anthropometric and insulin resistance parameters in the entire group of subjects. Although these correlations were not observed in the obese groups, in the control group, retinol-binding protein 4 was correlated to the lipid parameters and C-reactive protein to adiposity indices. Thus, the role of retinol-binding protein 4 as a potential marker of metabolic syndrome is limited to the prediction of proatherogenic risk among Asian Indians.

Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial.

OBJECTIVETo evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost, peer-educator format (Project Dulce) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c >8% were randomly assigned to the Project Dulce peer intervention or continuation of standard diabetes care. The primary outcome of interest was HbA1c.RESULTSThe majority of subjects were born in Mexico, were female, were middle-aged, had less than an eighth-grade education, and had high baseline HbA1c levels. Significant time-by-group interaction effects for HbA1c (P = 0.02) and diastolic blood pressure (P = 0.04) indicated that the Project Dulce group exhibited greater improvement (i.e., decreases) across time. Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c (−1.7%, P = 0.001) and HDL cholesterol (+1.4 mg/dL, P = 0.01) and from baseline to month 10 in absolute levels of HbA1c (−1.5%, P = 0.01), total cholesterol (−7.2 mg/dL, P = 0.04), HDL cholesterol (+1.6 mg/dL, P = 0.01), and LDL cholesterol (−8.1 mg/dL, P = 0.02). No significant changes were noted in the control group.CONCLUSIONSThis randomized trial, using the Project Dulce model of culturally sensitive, peer-led education, demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic populations is effective.

Hyperuricemia Accompanied with Changes in the Retinal Microcirculation in a Chinese High-risk Population for Diabetes

Objective To investigate the association of retinal vascular calibers with hyperuricemia in a middle-aged and elderly population. Methods A cross-sectional design was applied in this study and 869 participants aged =40 years from a high-risk group for diabetes were recruited. All participants received the anthropometrical measurements and laboratory tests. Retinal arteriolar and venular caliber of the participants were measured with a semi-automated system. Hyperuricemia was defined as a serum uric acid level >420 μmol/L in men and >360 μmol/L in women. Linear regression models were used to assess the association of hyperuricemia with retinal vascular calibers. These models were additionally adjusted for age, central obesity, hypertension, dyslipidemia, weekly activity, smoking status, and education. Results Among the 869 participants, 133 (15.3%) suffered from hyperuricemia. The crude mean serum uric acid level was 312.3 μmol/L (Standard Deviation 79.5); mean concentration was 355.0 μmol/L (SD 75.5) in male participants, and 288.0 μmol/L (SD 71.1) in female participants (age-adjusted difference 58.1 μmol/L, 95% Confidence Internal 48.5, 67.6). After adjusting for additional covariates, male participants with hyperuricemia had 3.77 μm (95% CI −0.46, 8.00) smaller arteriolar caliber and 6.20 μm (95% CI 0.36, 12.04) larger venule than those without hyperuricemia; the corresponding numbers among female participants were 1.57 μm (95% CI −1.07, 4.21) for retinal arteriolar caliber and 2.28 μm (95% CI −1.72, 6.27) for retinal venular caliber. Conclusion Hyperuricemia was associated with smaller retinal arteriolar caliber and larger venular caliber mainly in male participants in this study.

Multiple risk factor interventions for primary prevention of coronary heart disease

Multiple risk factor interventions using counselling and educational methods assumed to be efficacious and cost-effective in reducing coronary heart disease (CHD) mortality and morbidity and that they should be expanded. Trials examining risk factor changes have cast doubt on the effectiveness of these interventions. To assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence CHD.. We updated the original search BY SEARCHING CENTRAL (2006, Issue 2), MEDLINE (2000 to June 2006) and EMBASE (1998 to June 2006), and checking bibliographies. Randomised controlled trials of more than six months duration using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups or specific risk factors (i.e. diabetes, hypertension, hyperlipidaemia, obesity). Two authors extracted data independently. We expressed categorical variables as odds ratios (OR) with 95% confidence intervals (CI). Where studies published subsequent follow-up data on mortality and event rates, we updated these data. We found 55 trials (163,471 participants) with a median duration of 12 month follow up. Fourteen trials (139,256 participants) with reported clinical event endpoints, the pooled ORs for total and CHD mortality were 1.00 (95% CI 0.96 to 1.05) and 0.99 (95% CI 0.92 to 1.07), respectively. Total mortality and combined fatal and non-fatal cardiovascular events showed benefits from intervention when confined to trials involving people with hypertension (16 trials) and diabetes (5 trials): OR 0.78 (95% CI 0.68 to 0.89) and OR 0.71 (95% CI 0.61 to 0.83), respectively. Net changes (weighted mean differences) in systolic and diastolic blood pressure (53 trials) and blood cholesterol (50 trials) were -2.71 mmHg (95% CI -3.49 to -1.93), -2.13 mmHg (95% CI -2.67 to -1.58 ) and -0.24 mmol/l (95% CI -0.32 to -0.16), respectively. The OR for reduction in smoking prevalence (20 trials) was 0.87 (95% CI 0.75 to 1.00). Marked heterogeneity (I(2) > 85%) for all risk factor analyses was not explained by co-morbidities, allocation concealment, use of antihypertensive or cholesterol-lowering drugs, or by age of trial. Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations.

Oxidative Stress in Obesity and Metabolic Syndrome in Asian Indians

Oxidative Stress in Obesity and Metabolic Syndrome in Asian IndiansOxidative stress is associated with the individual components of metabolic syndrome and has been implicated in the development of complications of these metabolic disorders. In this study oxidative stress levels have been compared in obese Indians (a high-risk population for diabetes and cardiovascular disorders) with and without metabolic syndrome. 30 adult normotensive, normoglycemic obese subjects and 35 adults with metabolic syndrome of either sex with BMI >23 kg/m2were compared with 30 adult, healthy volunteers with BMI <23 kg/m2. Anthropometric parameters, blood pressure, biochemical parameters, hydroperoxides levels and total antioxidant capacity were estimated. The obese groups with and without metabolic syndrome had significantly increased anthropometric parameters like waist circumference and index of central obesity and aqueous phase hydroperoxides when compared with normal controls. The metabolic syndrome group also had significantly increased blood sugar levels, lipid profile and hydroperoxide levels when compared to obese or control groups. There was no alteration in the total antioxidant capacity in any of the groups. The Triglyceride/HDL-Cholesterol ratio (>3), a surrogate marker of insulin resistance, indicates insulin resistance in the metabolic syndrome group. The anthropometric profile, insulin resistance and oxidative stress seen in obesity are further elaborated in metabolic syndrome. Thus, the early identification of high-risk individuals based on anthropometric parameters, lipid profile, insulin resistance and indices of oxidative stress may help to prevent the development of complications of metabolic syndrome.

Miyaki et al. Respond to "Gene x Lifestyle Interactions"

We appreciate the thorough commentary by Drs. Franks and Nettleton (1). The major finding of our paper (2) was that interaction between the cyclin-dependent kinase 5 regulatory subunit-associated protein 1-like 1 (CDKAL1) gene and total energy intake (TEI) affected hemoglobin A1c levels in apparently healthy Japanese men. Given the limited space in which to respond to Franks and Nettleton, we will focus on a few of the more pertinent issues. First, we are aware of the limitations of our study, including its low statistical power due to the small sample size, and we agree with Franks and Nettleton regarding the consequences of a low-powered study in general. These consequences can only be overcome by selecting a larger cohort. Thus, our paper is, at best, an exploratory analysis rather than a validation analysis of the effect of a well-studied CDKAL1 polymorphism. Franks and Nettleton raised a question with regard to the accuracy of the food frequency questionnaire (FFQ) used for measuring TEI. We agree that assessing the validity of the dietary intake method is essential. The FFQ we used has been compared with 7-day dietary records and has been demonstrated to have a significant correlation with TEI (3). Thus, we believe this method allowed us to place participants into broad categories along a distribution of TEI (e.g., tertiles, as we used in the study). Body height was also taken into account as a means of reducing measurement bias in the calculation of TEI from FFQ (4). The possible measurement bias was noted as a limitation of the study in our original report (2). Franks and Nettleton raised an issue regarding consistency, taking Hill's criteria (5) as an example and referring to 2 intervention studies (6, 7) and 1 cohort study (8) that were claimed to not support our data. One of the intervention studies (6), which Franks coauthored, involved a high-risk diabetic population, the majority of which received lifestyle intervention or medication. Significant differences exist in the characteristics of the populations, including mean body mass index, which was 34 in Franks’ group and 23 in our group. The cohort study (8), also coauthored by Franks, accounted for an interaction between the gene and physical activity, dichotomized into active and inactive states by means of a computer-assisted questionnaire. Whether or how TEI was measured in this group does not seem to be explained in the paper (8). Thus, the context and aims of these studies seem to be so remote from ours that we cannot infer any indication of consistency or inconsistency. In addition, Franks and Nettleton questioned the biologic plausibility of our findings. CDKAL1 is involved in β-cell function, and polymorphisms within the gene have been repeatedly shown to affect blood glucose levels and insulin secretion, but not fasting glucose levels, after a glucose tolerance test (9). Therefore, we think it is reasonable to speculate on and test whether the CDKAL1 gene × TEI interaction correlates with blood glucose levels. Here, we would like to reiterate that although we observed a correlation with hemoglobin A1c, we did not observe a correlation with fasting glucose levels (2). As for causality, Franks and Nettleton also suggested that the effect of the CDKAL1 variant might be to modify TEI but not blood glucose level. This assertion is logically true, and to ascertain the possibility one needs to stratify the population according to blood glucose level, genotype the participants, and survey TEI under an ad lib diet. The commentary by Franks and Nettleton provided us with an opportunity to review our own study. We agree that future studies using larger cohorts are needed to validate our novel finding that the CDKAL1 gene × TEI interaction affects blood glucose level. Such studies may highlight other environmental or genetic interaction factors that are prerequisites for this effect.

Metabolic syndrome predicts vascular changes in whole body magnetic resonance imaging in patients with long standing diabetes mellitus

BackgroundAlthough diabetic patients have an increased rate of cardio-vascular events, there is considerable heterogeneity with respect to cardiovascular risk, requiring new approaches to individual cardiovascular risk factor assessment. In this study we used whole body-MR-angiography (WB-MRA) to assess the degree of atherosclerosis in patients with long-standing diabetes and to determine the association between metabolic syndrome (MetS) and atherosclerotic burden.MethodsLong standing (≥10 years) type 1 and type 2 diabetic patients (n = 59; 31 males; 63.3 ± 1.7 years) were examined by WB-MRA. Based on the findings in each vessel, we developed an overall score representing the patient's vascular atherosclerotic burden (MRI-score). The score's association with components of the MetS was assessed.ResultsThe median MRI-score was 1.18 [range: 1.00-2.41] and MetS was present in 58% of the cohort (type 2 diabetics: 73%; type 1 diabetics: 26%). Age (p = 0.0002), HDL-cholesterol (p = 0.016), hypertension (p = 0.0008), nephropathy (p = 0.0093), CHD (p = 0.001) and MetS (p = 0.0011) were significantly associated with the score. Adjusted for age and sex, the score was significantly (p = 0.02) higher in diabetics with MetS (1.450 [1.328-1.572]) compared to those without MetS (1.108 [0.966-1.50]). The number of MetS components was associated with a linear increase in the MRI-score (increase in score: 0.09/MetS component; r2 = 0.24, p = 0.038). Finally, using an established risk algorithm, we found a significant association between MRI-score and 10-year risk for CHD, fatal CHD and stroke.ConclusionIn this high-risk diabetic population, WB-MRA revealed large heterogeneity in the degree of systemic atherosclerosis. Presence and number of traits of the MetS are associated with the extent of atherosclerotic burden. These results support the perspective that diabetic patients are a heterogeneous population with increased but varying prevalence of atherosclerosis and risk.

Early Insulin Use in Type 2 Diabetes

It is generally recognized that type 2 diabetes is one of the major challenges of the 21st century. Its prevalence is growing rapidly worldwide, particularly in developing countries (1). It remains the first cause of blindness, end-stage renal disease, and nontraumatic lower-limb amputation and one of the major causes of cardiovascular disease (2,3). Because of its high morbidity and excess mortality, it has become a tremendous burden on health care cost (4). In the last decade, a number of interventions have been shown to be effective in the prevention of diabetes in high-risk populations with impaired glucose tolerance and/or impaired fasting glucose (5–7). Yet, few countries have adopted policies for the screening and strategies for treating subjects with pre-diabetes. Furthermore, despite the development of newer therapies for treatment of diabetes, the disease is still associated with a high incidence of microangiopathy and macrovascular complications. Any new strategies that could help to curtail the burden of diabetes would be greatly appreciated. More recently, it was postulated that early insulin replacement in type 2 diabetes, and perhaps even in pre-diabetes, may reduce cardiovascular risk and may even offer protection for the β-cell (8,9). However, a closer look at the available data does not support the hypothesis. The Outcome Reduction with an Initial Glargine Intervention (ORIGIN) study is still ongoing and therefore does not allow any conclusion in pre-diabetes. In type 2 diabetes, however, the published data support neither a beneficial effect of insulin therapy per se on microvascular complications, nor on cardiovascular events and mortality. In addition, the data suggesting that insulin therapy can improve the β-cell response to a glucose challenge could just as well be interpreted as being due to the improvement in glycemic control, rather than to the insulin therapy. And finally, …

Analysis of PK/PD risk factors for development of type 2 diabetes in high risk population using Bayesian analysis of glucose–insulin kinetics

This study was designed to investigate the pharmacokinetics/pharmacodynamics (PK/PD) risk factors preceding the onset of type 2 diabetes using a population-based Bayesian nonlinear hierarchical model to describe the glucose-insulin kinetics. One hundred fifty-two healthy subjects with a family history of type 2 diabetes were recruited. Each subject received an intravenous glucose tolerance test (IVGTT) and the data of glucose and insulin was collected when entering the study. After the test, subjects were followed up to 25 years and further divided into the diabetic outcome group and non-diabetic outcome group according to the follow-up results. A glucose-insulin kinetic model was developed to account for the physiology and molecular biology of the insulin biphasic secretion and glucose-insulin interactions with a minimal structure. The population PK/PD parameters of the two groups were estimated from the proposed glucose-insulin kinetic model. The relationships between the population PK/PD parameters and the diabetic follow-up results were evaluated. A high insulin baseline concentration, a lower maximum insulin-dependent glucose removal and a lower insulin removal rate constant were found associated with the development of type 2 diabetes in the high risk population. The study shows that the very early pre-diabetic pharmacokinetic differences exist and can be helpful for prediction of development of type 2 diabetes.

IMPACT OF ROSIGLITAZONE ON SURVIVAL IN A HIGH-RISK DIABETIC POPULATION WITH CORONARY ARTERY DISEASE

PURPOSE: The effects of thiazolidinediones (TZDs) on cardiovascular events remain incompletely characterized. While these insulin sensitizing agents have anti-atherogenic and anti-inflammatory effects, they induce fluid retention and worsen heart failure. Furthermore, a recent controversial meta-analysis suggested that a specific TZD (rosiglitazone) increases ischemic events in average risk populations. However, TZDs remain in widespread use. Our ongoing drug-exposure analysis is designed to assess the impact of rosiglitazone on survival in a high risk diabetic population with significant coronary artery disease (CAD).

Lessons to Take Home From CATIE

Lessons to Take Home From CATIE

Clinical and pharmaceutical management of a high-risk diabetic population undergoing percutaneous coronary interventions

Clinical and pharmaceutical management of a high-risk diabetic population undergoing percutaneous coronary interventions

Physical Activity and Prevention of Type 2 Diabetes Mellitus

The worldwide prevalence of type 2 diabetes mellitus is increasing at a rapid rate, predominantly because of changes in environmental factors interacting with individual genetic susceptibility to the disease. Data from 20 longitudinal cohort studies present a consistent picture indicating that regular physical activity substantially reduces risk of type 2 diabetes. Adjustment for differences in body mass index between active and inactive groups attenuates the magnitude of risk reduction, but even after adjustment, a high level of physical activity is associated with a 20-30% reduction in diabetes risk. The data indicate that protection from diabetes can be conferred by a range of activities of moderate or vigorous intensity, and that regular light-intensity activity may also be sufficient, although the data for this are less consistent. The risk reduction associated with increased physical activity appears to be greatest in those at increased baseline risk of the disease, such as the obese, those with a positive family history and those with impaired glucose regulation. Data from six large-scale diabetes prevention intervention trials in adults with impaired glucose tolerance or at high risk of cardiovascular disease indicate that increasing moderate physical activity by approximately 150 minutes per week reduces risk of progression to diabetes, with this effect being greater if accompanied by weight loss. However, this level of activity did not prevent all diabetes, with 2-13% of participants per annum who underwent lifestyle intervention still developing the disease. Thus, while 150 minutes per week of moderate activity confers benefits, higher levels of activity may be necessary to maximize diabetes risk reduction in those at high baseline risk of the disease. In contrast, those at low baseline risk of type 2 diabetes, e.g. people with a very low body mass index and no family history of diabetes, will remain at low risk of developing diabetes whether they are active or not. Thus, the amount of physical activity required to confer low risk of diabetes differs according to an individual's level of baseline risk. Consequently, a 'one size fits all' mass-population strategy may not provide the most appropriate approach when designing physical activity guidelines for the prevention of type 2 diabetes. Producing tailored guidelines with the specific aim of reducing risk of diabetes in high-risk populations may provide an alternative approach.

Prevention of Type 2 diabetes: fact or fiction?

The growing prevalence of Type 2 diabetes with its high morbidity and excess mortality is imposing a heavy burden on healthcare systems. Because of the magnitude of the problem, obviating diabetes has been a long-standing dream. In the last decade, a number of intervention strategies have been shown to be effective for the prevention of diabetes in high-risk populations with prediabetes. Seven studies have now confirmed that lifestyle modifications, including weight-reducing diets and exercise programs, are very effective in precluding or delaying Type 2 diabetes in high-risk populations with impaired glucose tolerance (IGT). Two major trials are the Diabetes Prevention Study (n = 522) from Finland and the Diabetes Prevention Program (n = 3234) from the US. Both studies have shown that intensive lifestyle intervention could reduce the progression of IGT to diabetes by 58%. Furthermore, four currently-available drugs have been established as being effective in preventing diabetes in subjects with prediabetes. The Diabetes Prevention Program revealed that metformin 850 mg b.i.d. reduced the risk of diabetes by 31%. The STOP-NIDDM (Study To Prevent Non-Insulin-Dependent Diabetes Mellitus) trial (n = 1429) showed that acarbose 100 mg t.i.d. with meals decreased the incidence of diabetes by 36% when the diagnosis was based on 2 oral glucose tolerance tests. The XENDOS (Xenical in the Prevention of Diabetes in Obese Subjects) study examined the use of orlistat, an antiobesity drug, as an adjunct to an intensive lifestyle modification program in obese non-diabetic subjects. Orlistat treatment resulted in a 37% decline in the development of diabetes. More recently, the DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) study (n = 5269) demonstrated that rosiglitazone at 8 mg once/day in subjects with prediabetes (IGT and/or impaired fasting glucose) was effective in reducing the risk of diabetes by 60%. It can be concluded that Type 2 diabetes can be prevented or delayed through lifestyle modifications and/or pharmacologic interventions. This is a fact.

Providing diabetes care to Arab migrants in the UK: cultural and clinical aspects

Arab migrants make up a significant minority of the Muslim population of the UK. As the result of recent conflicts in the Middle East there has been an increase in the number of Arab refugee's seeking asylum in the UK, and therefore this population is expected to increase in the future. Whilst UK Arabs share the increased diabetes and cardiovascular risk that is seen in South Asian migrants, they are distinct in terms of customs and traditions. Culturally appropriate, validated, evidence-based management strategies in order to aggressively control the cardiovascular risk factors in this high risk diabetic population are required.

Multifactorial intervention in metabolic syndrome targeting at prevention of chronic kidney disease ready for prime time?

The term metabolic syndrome (MetSyn) indicates a constellation of risk factors associated with increased burden of atherosclerotic disease [1]. Despite some controversy regarding its existence as a distinct entity [2], accumulating evidence suggests that individuals with MetSyn are at increased risk of cardiovascular events and type 2 diabetes [3,4]. Several factors such as obesity, insulin resistance, physical inactivity and advancing age seem to constitute its pathophysiological basis [1,5]. The prevalence of MetSyn depends on the studied population and the definition used but in Western populations more than 20% of adults are affected [6]. Current ‘popular’ definitions of MetSyn, such as that of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III, the National Heart, Lung, and Blood Institute and the American Heart Association (NHLBI/AHA) and especially that proposed by the International Diabetes Federation (IDF) (Table 1) are continuously evaluated as to whether they can identify high-risk population for cardiovascular disease and diabetes who would benefit from intensive behavioural and/or pharmacological treatment [7,8].

Individualized pharmacokinetic risk assessment for development of diabetes in high risk population

Aim The objective of this study is to propose a non-parametric pharmacokinetic prediction model that addresses the individualized risk of developing type-2 diabetes in subjects with family history of type-2 diabetes. Method All selected 191 healthy subjects had both parents as type-2 diabetic. Glucose was administered intravenously (0.5 g/kg body weight) and 13 blood samples taken at specified times were analyzed for plasma insulin and glucose concentrations. All subjects were followed for an average of 13–14 years for diabetic or normal (non-diabetic) outcome. Results The new logistic regression model predicts the development of diabetes based on body mass index and only one blood sample at 90 min analyzed for insulin concentration. Our model correctly identified 4.5 times more subjects (54% versus 11.6%) predicted to develop diabetes and more than twice the subjects (99% versus 46.4%) predicted not to develop diabetes compared to current non-pharmacokinetic probability estimates for development of type-2 diabetes. Conclusion Our model can be useful for individualized prediction of development of type-2 diabetes in subjects with family history of type-2 diabetes. This improved prediction may be an important mediating factor for better perception of risk and may result in an improved intervention.

Integrated analysis of medically treated diabetic patients in the TAXUS(R) program: benefits across stent platforms, paclitaxel release formulations, and diabetic treatments.

The TAXUS(R) database was used to perform an integrated analysis across several large phase II and III trials to assess outcomes of polymer-based paclitaxel-eluting TAXUS stents in diabetic patients. While drug-eluting stents have reduced the risk for restenosis, diabetic patients remain at higher risk. This post hoc analysis of clinical and angiographic outcomes combined individual patient data from four randomized, multicentre, controlled clinical trials (TAXUS II, IV, V, and VI) representing outcomes across two paclitaxel release formulations and stent platforms. Breslow-Day analysis indicated homogeneous odds ratios across dose formulations and stent platforms, thus clinical data (9 months) were pooled from 3445 patients, including 814 diabetic patients. The randomized quantitative coronary angiography subset (n=2863) included 469 diabetic patients requiring oral medications only and 216 insulin-treated. Among patients receiving bare metal stents (BMS), those with diabetes had worse clinical and angiographic outcomes than non-diabetic patients. Target lesion revascularization rates were decreased in TAXUS patients relative to BMS controls by 59% (p=0.0001) among diabetic patients requiring oral medications, by 66% (p=0.006) among insulin-treated. Insulin-treated patients showed a significant TAXUS benefit for in-stent and in-segment percent diameter stenosis (p=0.0001, p=0.001, respectively) and late loss (p=0.001); a similar TAXUS benefit was seen in diabetic patients treated with oral medications (p<0.0001). Binary restenosis in-segment was significantly decreased 65% in both diabetic subsets (p=0.0001). This post hoc analysis of data from four combined randomized TAXUS trials suggests the TAXUS benefit observed in non-diabetic patients is carried over into the high-risk diabetic population.

A Nursing Case Management Program for Low-Income High-Risk Diabetic Clients

Case management has been widely promoted as a method that can improve clinical outcomes and reduce healthcare costs. This article describes a cost-benefit analysis for a proposed nursing case management program that provides care for a low-income high-risk diabetic population in a rural county. Industry trends, objectives and functions of the case management program, timeline, financial plan, and cost analysis are described. The analysis indicated a potential net savings of 149,544 dollars annually. This would be a significant cost savings for the healthcare provider and funding source.