Diabetes-related Comorbidities Research Articles

Combined associations of 25-hydroxivitamin D and parathyroid hormone with diabetes risk and associated comorbidities among U.S. white and black women

Background/objectivesThere is evidence of black–white differences in vitamin D status and cardiometabolic health. This study aimed to further evaluate the joint associations of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) with risks of diabetes and related cardiometabolic comorbidities among white and black women.Subjects/methodsWe cross-sectionally and prospectively analyzed data from 1850 black and 3000 white postmenopausal women without cardiovascular disease or dialysis at baseline from the Women’s Health Initiative—Observational Study. Weighted Cox proportional hazards analyses and weighted logistic regression models were used to examine the joint associations of 25(OH)D and PTH with incident diabetes and prevalence of other diabetes-related cardiometabolic comorbidities (including CKD, hypertension, or obesity).ResultsWe identified 3322 cases of obesity (n = 1629), hypertension (n = 2759), or CKD (n = 318) at baseline and 453 incident cases of diabetes during 11 years of follow-up. Cross-sectionally, lower 25(OH)D and higher PTH were independently associated with higher prevalence of hypertension [odds ratio (OR) = 0.79; 95% confidence interval (CI): 0.72–0.87 and OR = 1.55; 95% CI: 1.39–1.73] among white women only. When stratified by diabetes status, compared to women with 25(OH)D ≥50 nmol/L and PTH ≤6.89 pmol/L (65 pg/mL), women who did not have diabetes with vitamin D deficiency (<50 nmol/L) and PTH excess (>6.89 pmol/L) had higher prevalence of CKD, hypertension, or obesity (OR = 4.23; 95% CI: 2.90–6.18) than women who had diabetes (OR = 1.89; 95% CI: 0.96–3.71). Prospectively, lower 25(OH)D was associated with lower diabetes incidence [hazard ratio (HR) = 0.73; 95% CI: 0.62–0.86] in white women. Jointly, compared to the group with 25(OH)D ≥50 nmol/L and PTH ≤6.89 pmol/L, white women with 25(OH)D deficiency (<50 nmol/L) had elevated risk for diabetes, regardless of PTH levels.ConclusionsLow 25(OH)D and high PTH were jointly associated with increased risk of diabetes among white women only. Their joint associations with high prevalence of CKD, hypertension, and obesity were more pronounced among women without diabetes.

Elevated Liver Enzymes and Comorbidities in Type 2 Diabetes: A Population-Based Multicenter Analysis of 51,645 Patients of the DPV Database

Background: Awareness of fatty liver disease in people with diabetes is low and reliable epidemiological data on diabetes and liver enzymes are scarce. This population-based analysis of the DPV database assessed the prevalence of elevated liver enzymes and associated diabetes related comorbidities in type 2 diabetes (T2D). Methods: This analysis comprises 281,245 patients with T2D between the age of 18 and 75 years from 501 diabetes centers from January 2010 until December 2019. Among these, complete demographic and concomitant data on liver enzymes were available in a total of 51,645 patients. Findings: Elevated liver enzymes were found in 40·2% of all patients. In contrast, only 8·6% of these patients were ICD-10 coded as nonalcoholic fatty liver disease (NAFLD) and/or nonalcoholic steatohepatitis (NASH), respectively. After adjustment for age, sex, diabetes duration, BMI, and HbA1c, a higher prevalence of arterial hypertension (p<·0001), dyslipidemia (p<·0001), peripheral artery disease (PAD) (p=·0029), myocardial infarction (p=·0003), coronary artery disease (CAD) (p=·0001), microalbuminuria (p<·0001), and chronic kidney disease (CKD) (p<·0001), respectively, was seen in patients with elevated versus normal liver enzymes. The prevalence of elevated liver enzymes was lowest in patients receiving SGLT2 inhibitors (SGLT2i) or a combination therapy of SGLT2i and GLP-1 receptor agonists (GLP-1RA). Interpretation: Elevated liver enzymes are common in patients with T2D and clearly correlate with a higher prevalence of clinically relevant comorbidities. Assessing liver enzymes should be part of standard clinical routine in T2D to identify liver disease due to its predictive role for comorbidities and complications. Funding: This study was supported by the German Federal Ministry for Education, research within the German Center for Diabetes Research (DZD, 82DZD14A02), the German Robert Koch Institute (RKI), and the German Diabetes Association (DDG). Sponsors were not involved in data acquisition or analysis. Declaration of Interests: MR reports personal fees from Eli Lilly, Poxel S.A. Societe, Boehringer-Ingelheim, Terra Firma, Sanofi, Servier Labatories, Novo Nordisk, Fishawack Group, Novartis, Target Pharmasolutions, Gilead Sciences, Kenes Group, Bristol-Myers Squibb, Intercept Pharma, Inventiva, AstraZeneca, Pfizer, all outside the submitted work. SMS reports personal fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daichii-Sanyo, Gilead, Ipsen, Lilly, MSD, Novartis, Novo Nordisk, Pfizer, Sandoz, Sanofi, and a grant from the German Diabetes Center (funded by the German Federal Ministry of Education and Research) for Diabetes research, all outside the submitted work. S.M., A.J.E., M.H., M.L., S.K., J.S., M.R., S.M.S. and R.W.H. declare no competing interest. Ethics Approval Statement: Analysis of anonymized routine data within the DPV initiative has been approved by the Ethics Committee of the Medical Faculty of the University of Ulm, Germany.

Current state-of-the-art antiplatelet and anticoagulation therapy in diabetic patients with coronary artery disease.

Diabetes mellitus is a complex disease that leads to long-term damage to various organ systems. Among the numerous cardiovascular disease-related complications, thrombotic events frequently occur in patients with diabetes. Although guidelines exist for treating and preventing most diabetes-related co-morbidities, the evidence on antithrombotic therapy in primary and secondary prevention is limited due to the scarcity of randomized trials dedicated to patients with diabetes mellitus. Most of the available data are derived from studies that only included a small proportion of patients with diabetes. The present review provides an overview of the status of knowledge on antiplatelet and anticoagulation therapy in patients with diabetes, focusing on the risk-benefit balance of these therapies and future treatment strategies.

Documented diabetes care among older people receiving home care services: a cross\u2010sectional study

BackgroundHome care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services.MethodsA cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1c was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis.ResultsA total of 92 home care records from older home-dwelling persons with diabetes, aged 66–99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1c documented and only 3 (3 %) had a documented routine for measuring HbA1c as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals.ConclusionsThe study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.

Different information needs in subgroups of people with diabetes mellitus: a latent class analysis

BackgroundCurrent evidence suggests that the information needs of people with diabetes mellitus differ across patient groups. With a view to being able to provide individualized information, this study aims to identify (i) the diabetes-related information needs of people with diabetes mellitus; (ii) different subgroups of people with specific information needs; and (iii) associated characteristics of the identified subgroups, such as sociodemographic characteristics, diabetes-related comorbidities, and well-being.MethodsThis cross-sectional study was based on data from 837 respondents with diabetes mellitus who participated in the population-based KORA (Cooperative Health Research in the Augsburg Region) Health Survey 2016 in Southern Germany (KORA GEFU 4 study) (45.6% female, mean age 71.1 years, 92.8% Type 2 diabetes). Diabetes-related information needs were assessed with a questionnaire asking about patients’ information needs concerning 11 diabetes-related topics, e.g. ‘long-term complications’ and ‘treatment/therapy’. Subgroups of people with different information needs and associated characteristics were identified using latent class analysis.ResultsWe identified the following four classes of people with different information needs: ‘high needs on all topics’, ‘low needs on all topics’, ‘moderate needs with a focus on complications and diabetes in everyday life’, and ‘advanced needs with a focus on social and legal aspects and diabetes research’. The classes differed significantly in age, years of education, type of diabetes, diabetes duration, diabetes-related comorbidities, smoking behaviour, diabetes education, current level of information, and time preference.ConclusionsKnowledge about different patient subgroups can be useful for tailored information campaigns or physician-patient interactions. Further research is needed to analyse health care needs in these groups, changes in information needs over the course of the disease, and prospective health outcomes.

PDB15 Healthcare Outcomes for Patients with Type 2 Diabetes with and without Comorbid Obesity

The increasing prevalence of diabetes and obesity have led to the co-occurrence being labelled as “twin epidemics.” Given the high rates of comorbid diabetes and obesity, as well as the health benefits associated with lower weight among patients with type 2 diabetes, this research examines the burden of obesity associated with comorbid T2D. This U.S. administrative claims database study uses IBM® MarketScan® Explorys Claims Electronic Medical Records data from January 1, 2012 through April 30, 2019 to identify adults with T2D, two recorded body mass index (BMI) values in the same weight category, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index 18.5 kg/m2 ≤ BMI < 30 kg/m2 (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m2 (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, resource utilization, and healthcare costs. In the 1:1 matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.21; 95% Confidence Interval [CI] 1.14 – 1.28) and an obesity-related comorbidity (OR=1.42; 95% CI 1.29 – 1.56). Obesity was associated with increased odds of the specific obesity or diabetes-related comorbidities of hypertension, hyperlipidemia, cardiovascular disease, nephropathy, neuropathy, peripheral vascular disease, and metabolic disease (all P<0.05). Obesity was also associated with increased resource utilization as well as significantly higher annual diabetes-related ($8,987 v $8,057; P<0.0001) and all-cause total costs ($26,624 v $24,838; P<0.0001). Results increase the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.

Poor glycemic control in bariatric patients: a reason to delay or a reason to proceed?

<h2>Abstract</h2><h3>Background</h3> More than 90% of patients with type 2 diabetes (T2D) have obesity, and over 85% of diabetic patients who undergo metabolic and bariatric surgery (MBS) will see improvement or resolution of diabetes. However, diabetes is a known risk factor for surgical complications. <h3>Objectives</h3> To determine whether poor preoperative glycemic control confers an increased perioperative risk after MBS. <h3>Setting</h3> Academic Hospital. <h3>Methods</h3> Retrospective review of data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). From the 2017–2018 MBSAQIP databases, we identified patients with diabetes who underwent Roux-en-Y gastric bypass or gastric sleeve surgery. Unmatched and propensity-matched univariate analyses, as well as multivariate logistic regressions, were performed to compare 30-day postoperative outcomes and complication rates between patients with poor (glycated hemoglobin [HbA1C] > 7.0) and good (HbA1C ≤ 7.0) glycemic control. <h3>Results</h3> Of 40,132 T2D patients, 19,094 (52.42%) had an HbA1C level ≤ 7.0. Patients with poor glycemic control had slightly higher rates of overall morbidity (6.53% versus 5.49%, respectively; relative risk=1.188; <i>P</i> < .001). However, in a 1:1 matched analysis of 23,930 patients controlling for body mass index, surgery type, approach, and co-morbidities, the findings of poorer outcomes were largely mitigated. In a multivariate analysis, poor glycemic control was not associated with morbidity. <h3>Conclusions</h3> In T2D patients, poor glycemic control does not independently increase the risk of 30-day morbidity following MBS. Adverse outcomes in the setting of poor glycemic control appear to be largely mediated by associated co-morbidities. Performing MBS in the setting of suboptimal glycemic control may be justified, with the understanding that delaying or refusing surgery can contribute to worsening of diabetes-related co-morbidities that, in turn, may ultimately have a more deleterious effect on outcomes.

Determinants and impact of physical impairment in patient-reported outcomes among older patients with type 2 diabetes mellitus in Japan

Objective To investigate the predictive factors associated with physical impairment among older patients with type 2 diabetes mellitus (T2DM) in Japan and to examine the potential impact of physical impairment on patient-reported health outcomes in this population. Methods A cross-sectional analysis was conducted using patient-reported data from the 2012–2014 Japan National Health and Wellness Survey. Physical impairment was measured using the Physical Component Summary (PCS) score of the Short-Form 36-Item Health Survey (SF-36) three-component model (using Japanese norms). Older T2DM patients (≥65 years old; n = 1511) were dichotomized into physically impaired (PCS ≤ 25th percentile; n = 378) and non-physically impaired (PCS > 25th percentile; n = 1133). Work productivity (absenteeism, presenteeism and overall work impairment), activity impairment and healthcare resource utilization were compared between these groups. Results Age, female sex, low and high body mass index (BMI), diabetes-related complications, cardiovascular events, unawareness of having hypoglycemic events in the past 3 months, and lack of regular exercise were significant factors associated with physical impairment in multivariable analysis. The physically impaired group reported significantly more regular outpatient visits (13.48 vs. 10.16, respectively, p < .001), 1% or greater absenteeism (16.7% vs. 4.1%, p = .005), greater presenteeism (27.8% vs. 12.2%, p = .001), overall work impairment (30.0% vs. 13.0%, p = .001) and overall activity impairment (39.5% vs. 17.2%, p < .001) than the non-physically-impaired group after adjusting for covariates. Conclusions This study identified age, BMI, diabetes-related comorbidities, history of cardiovascular events and lack of exercise as key predictors associated with physical impairment in older patients with T2DM in Japan, which predicted low work productivity as well as activity impairment. This study provides support that physical impairment in patients with T2DM may lead to low work productivity and activity impairment. Supplemental data for this article is available online at https://doi.org/10.1080/03007995.2020.1846170.

Healthcare outcomes for patients with type 2 diabetes with and without comorbid obesity.

Examine the burden of comorbid obesity associated with type 2 diabetes (T2D). The IBM® MarketScan® Explorys Claims Electronic Medical Records Data were used to identify adults with T2D, two recorded body mass index (BMI) values, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index BMI ≥18 kg/m2 and <30 kg/m2 (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m2 (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, healthcare costs, and resource utilization. In the matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.29; 95% Confidence Interval [CI] 1.21-1.38) and an obesity-related comorbidity (OR = 1.42; 95% CI 1.29-1.56). Obesity was also associated with significantly higher annual diabetes-related and all-cause total costs and resource utilization. This research increases the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.

The significance of hyperglycaemia and other comorbidities during the COVID‐19 pandemic

The significance of hyperglycaemia and other comorbidities during the <scp>COVID</scp>‐19 pandemic

Hypothesized mechanisms explaining poor prognosis in type 2 diabetes patients with COVID-19: a review.

PurposeEpidemiological data suggest that comorbid patients, mostly those with type 2 diabetes (T2D), are predisposed to poor prognosis in Coronavirus disease 2019 (COVID-19), leading to serious healthcare concerns. The aim of the present manuscript is to review the main relevant mechanisms possibly contributing to worsen the clinical course of COVID-19 in T2D.ResultsPoor glucose control, high glycaemic variability and diabetes-related comorbidities at baseline, particularly cardiovascular diseases and obesity, contribute in worsening the prognosis in the above-mentioned cluster of patients. Moreover, both a lower efficient innate immune system response and cytokine dysregulation predispose patients with T2D to impaired viral clearance and more serious pulmonary and systemic inflammation once the SARS-CoV-2 infection occurred. Inconclusive data are currently available for specifically indicate or contraindicate concurrent medications for managing T2D and its comorbidities in infected patients.ConclusionsT2D individuals should be considered as more vulnerable to COVID-19 than general population, and thus require adequate advices about hygienic tips to protect themselves during the pandemic. A careful management of glucose levels and diabetes-related comorbidities remains essential for avoiding further complications, and patient monitoring during the pandemic should be performed also at distance by means of telemedicine. Further studies are needed to clarify whether medications normally used for managing T2D and its associated comorbidities could have a protective or detrimental effect on COVID-19 clinical course.

1270-P: Glycemic Control in Youth with Type 2 Diabetes Correlates with Weight Loss and Markers of Beta-Cell Function, but Not Intense Insulin Regimen

Background: Youth with type 2 diabetes develop early treatment failure to metformin and diabetes-related comorbidities. Objective: To identify risk factors for glycemic failure in youth with type 2 diabetes. Methods: Anthropomorphic measures, medication records, and laboratory studies were collected from patients attending a dedicated type 2 diabetes clinic. Repeat measures of HbA1c were averaged to prevent errors from unbalanced data points. Latent profile analysis (LPA) was performed to model longitudinal trajectory of HbA1c over 5 years. Results: The registry includes 226 patients, of which 80% are Latinx. Analysis of the glycemic outcomes showed that the odds ratio (OR) for uncontrolled diabetes 5 years after diagnosis (HbA1c&amp;gt;8%) is proportional to baseline HbA1c, with OR of 2.41 when diagnostic HbA1c &amp;gt;8.5% (sensitivity 68%, specificity 54%, P=0.015). LPA modeling identified three HbA1c profiles, all demonstrating some improvement in HbA1c at 4-6 months: (A) HbA1c &amp;lt;8% throughout the 5 years, (B) persistent elevation of HbA1c &amp;gt;9%, and (C) mean HbA1c of 12% at diagnosis, rapid decline to 6.4% by 4-6 months, but rose to 11% by 18 months. At diagnosis, group A had lower HbA1c and higher fasting c-peptide levels than B and C, suggesting that baseline beta-cell function is a dominant variable in long-term glycemic control. Our analysis of medication regimen showed that amongst patients treated with metformin, the addition of multiple daily injections (MDI) did not improve HbA1c compared to those on basal insulin. Finally, weight loss correlated with improved HbA1c outcome in patients on metformin monotherapy, but not in patients prescribed insulin. Conclusion: Patients with baseline HbA1c &amp;gt;8.5% are at high risk for glycemic failure, irrespective of short-term improvement in HbA1c. Additional studies are needed to decipher if medication omission accounts for the comparable HbA1c outcome between patients on MDI and basal insulin. Disclosure L. Chao: None. M. Yeh: None. J. Raymond: None. J. Ryoo: None. N.T. Chang: None. Funding Good Hope Foundation; Saban Research Institute

Quality, Functionality, and Features of Chinese Mobile Apps for Diabetes Self-Management: Systematic Search and Evaluation of Mobile Apps.

BackgroundThe emergence and advancement of mobile technologies offer a promising opportunity for people with diabetes to improve their self-management. Despite the proliferation of mobile apps, few studies have evaluated the apps that are available to the millions of people with diabetes in China.ObjectiveThis study aimed to conduct a systematic search of Chinese mobile apps for diabetes self-management and to evaluate their quality, functionality, and features by using validated rating scales.MethodsA systematic search was conducted to identify Chinese apps for diabetes self-management in the four most popular Chinese language mobile app stores. Apps were included if they were designed for diabetes self-management and contained at least one of the following components: blood glucose management, dietary and physical activity management, medication taking, and prevention of diabetes-related comorbidities. Apps were excluded if they were unrelated to health, not in Chinese, or the targeted users are health care professionals. Apps meeting the identified inclusion criteria were downloaded and evaluated by a team of 5 raters. The quality, functionalities, and features of these apps were assessed by using the Mobile App Rating Scale (MARS), the IMS Institute for Healthcare Informatics Functionality score, and a checklist of self-management activities developed based on the Chinese diabetes self-management guideline, respectively.ResultsAmong 2072 apps searched, 199 were eligible based on the inclusion criteria, and 67 apps were successfully downloaded for rating. These 67 apps had an average MARS score of 3.42 out of 5, and 76% (51/67) of the apps achieved an acceptable quality (MARS score >3.0). The scores for the four subdomains of MARS were 3.97 for functionality, 3.45 for aesthetics, 3.21 for information, and 3.07 for engagement. On average, reviewed apps applied five out of the 19 examined behavior change techniques, whereas the average score on the subjective quality for the potential impact on behavior change is 3 out of 5. In addition, the average score on IMS functionality was 6 out of 11. Functionalities in collecting, recording, and displaying data were mostly presented in the reviewed apps. Most of the apps were multifeatured with monitoring blood glucose and tracking lifestyle behaviors as common features, but some key self-management activities recommended by clinical guidelines, such as stress and emotional management, were rarely presented in these apps.ConclusionsThe general quality of the reviewed apps for diabetes self-management is suboptimal, although the potential for improvement is significant. More attention needs to be paid to the engagement and information quality of these apps through co-design with researchers, public health practitioners, and consumers. There is also a need to promote the awareness of the public on the benefit and potential risks of utilizing health apps for self-management.

The Use of GLP1R Agonists for the Treatment of Type 2 Diabetes in Kidney Transplant Recipients.

Background.Glucagon-like peptide-1 receptor agonists (GLP1RA) have been shown to improve glucose control and diabetes-related comorbidities in patients without solid organ transplants. The effectiveness, safety, and tolerability of GLP1RA after kidney transplantation have not been adequately studied.Methods.We retrospectively reviewed data on kidney transplant recipients performed in our institution, who were initiated on GLP1RA either for the treatment of type 2 diabetes diagnosed before transplantation or posttransplant diabetes. We analyzed efficacy, safety, and the effect on kidney allograft function.Results.Seventeen kidney transplant recipients were initiated on GLP1RA therapy, 14 of which remained on the medication for at least 12 months. The use of GLP1RA had no significant impact on weight loss, but was associated with a significant reduction in the total daily insulin dose, from the median of 63 [interquartile range 43-113] IU to 44 [interquartile range 25-88] and reduction in the risk of hypoglycemia in patients who were on therapy for at least approximately 12 months. Kidney function remained stable and none of the recipients experienced acute rejection. Tacrolimus dose was not significantly changed. Five patients (29%) discontinued GLP1RA therapy—4 due to side effects and 1 due to uncontrolled hyperglycemia.Conclusions.GLP1RA may be a relatively safe and effective treatment for kidney transplant recipients with type 2 diabetes that allows for a reduction in insulin requirements. More studies are needed to determine whether the use of these agents will translate into an improvement in allograft and patient survival.

Type 2 Diabetes Prescribing Habits amongst Providers to an Underserved Population.

Type 2 diabetes mellitus (T2DM) affected over 30 million individuals in the United States as of 2015. Due to the national diabetes guidelines recommending drug selection based on several patient specific factors and varying formulary restrictions, prescribers are often inundated when selecting treatment. Currently, limited evidence is available regarding the primary factors influencing prescribers' drug therapy selection. The purpose of this study was to identify factors that influence providers during T2DM medication selection. The study was conducted with providers at a large, academic, safety net health system. All prescribers were sent an electronic, optional and anonymous survey. Prescribers treating T2DM in non-pregnant adult patients were the only prescribers assessed. Factors evaluated were: cost, A1c, comorbidities, adherence, weight, tolerability, patient limitations, and use of guidelines. A total of 86 prescribers responded, yielding a response rate of 31%. The respondents included physicians (56.3%), nurse practitioners (21.8%), medical residents (18.4%), and fellows (3.4%); with the majority practicing in internal or family medicine (47.1%). The most frequently prescribed T2DM medications included: metformin (83.8%), insulin (78.1%), and sulfonylureas (64.8%). Cost and A1c elevation were two of the major factors influencing prescribing of metformin (94.1% and 81.2%), insulin (57.4% and 69.6%), and sulfonylureas (81.2% and 89.9%) respectively. Due to cost concerns, respondents reported rarely or never prescribing glucagon-like peptide-1 agonists (GLP-1RA) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) despite recognizing benefits on diabetes related comorbidities. Although current literature from the national guidelines encourages the use of GLP-1RA and SGLT2i as first-line options after metformin in T2DM, these classes of medications were not reported among the most commonly prescribed despite providers correctly identifying positive medication attributes such as cardio- and nephroprotection and weight loss. However, cost of these medications appears to outweigh the benefits when selecting medication therapy.

Positive reinforcement by general practitioners is associated with greater physical activity in adults with type 2 diabetes

ObjectiveIn a sample of adults with type 2 diabetes mellitus (T2DM), the aim of this study was to examine whether self-reported physical activity level is associated with recall of specific...

Prevalence and coprevalence of chronic comorbid conditions in patients with type 2 diabetes in Catalonia: a population-based cross-sectional study

ObjectivesTo evaluate the prevalence and coprevalence of several chronic conditions in patients with type 2 diabetes in a Mediterranean region.DesignA cross-sectional study.SettingTwo hundred and eighty-six primary care teams of the...

Mortality after amputation in dialysis patients is high but not modified by diabetes status

BackgroundSurvival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis.MethodsData were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression).ResultsDuring follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). ConclusionsAmputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.

Antihyperglycemic therapy during colonoscopy preparation: A review and suggestions for practical recommendations.

Patients with diabetes have distinct risks during precolonoscopy bowel preparation, caused by change of diet, change of antihyperglycemic medication regimens and diabetes-related complications and comorbidities. These risks include hypoglycemia, water and electrolyte imbalance, acute renal failure, lactic acidosis, ketoacidosis and low quality of bowel preparation. Here we review the existing literature and present recommendations from a subcommittee of the Israeli National Diabetes Council for primary care physicians and gastroenterologists. The instructions include general suggestions on diet and glucose monitoring and specific recommendations on timing of modification or cessation of each of the antihyperglycemic medication types to ensure patient safety during bowel preparation.

‘Too often missing’ report findings: let's start with what our patients are telling us

‘Too often missing’ report findings: let's start with what our patients are telling us