Higher Incidence Of Type Research Articles

Abstract P147: Differences in the Treatment of Resistant Hypertension in African Americans and European Americans in a Clinical Setting

Using Vanderbilt University Medical Center’s electronic health record (EHR), we tested the hypothesis that we could identify patients with resistant hypertension (RH) and patterns of treatment of RH in a real-world clinical setting. Patients were identified as having RH if they had blood pressure (BP) >140/90 mmHg despite concurrent treatment with three different classes of antihypertensive medications including a thiazide diuretic or amlodipine or similar dihydropyridine (DHP) calcium channel blocker (CCB) or if they were treated with four antihypertensive medications including the same classes. Secondary causes and chronic kidney disease were excluded. Among 186,015 European American (EA) and 33,576 African American (AA) hypertensive patients, 13,541 (7.3%) and 3,541 (10.5%) had RH, respectively. AA with RH were younger, heavier, more often female, had a higher incidence of type 2 diabetes, and had higher systolic and diastolic BPs than EA with RH. AA with RH were more likely than EA to be treated with vasodilators, DHP CCB, and α2-agonists. EA were more likely to be treated with angiotensin receptor blockers, renin inhibitors, and beta-blockers. Mineralocorticoid receptor (MR) antagonists were used in both EA and AA patients and use was increased in patients treated with > four antihypertensive medications compared to patients treated with three (2.6% vs 12.4% in EA, p<0.001; 2.8% vs 12.3% in AA, p<0.001). The number of patients treated with an MR antagonist increased to 36.6% in EA and 40.3% in AA over a mean follow-up period of 7.4 and 8.7 years, respectively. Our results demonstrate that clinicians use different classes of medication to treat RH in AA and EA.

High incidence of type 1 diabetes in the immigrant population of Osona and Baix Camp

Abstract Introduction It has been postulated that migration could act as a modifying factor in the incidence of type 1 diabetes mellitus (T1DM), so the aim of this study is to determine if there are differences in the incidence of T1DM by origin. Material and methods Retrospective study of cases of T1DM onset in the population younger than 19 years old in Osona and Baix Camp between 2000 and 2012, using the medical histories of endocrinology units of the health centres and demographics from Catalonia Statistical Institute as sources. Results The child population in Osona and Baix Camp increased by 36.6%, with 18.9% in the local population, and 482% in the immigrant population, and most of this increase (90%) in the Maghreb immigrant group. A total of 118 diabetics onset were found, 66.9% in the local population, 32.2% Maghrebi population, and 0.9% in children from other countries, with a total incidence rate of 14.4 cases per 100,000 population/year (c/105p-y). The incidence is higher in the Maghrebi population compared to the local population, 37.1 vs 11.2 c/105p-y (P .05). The relative risk is 3.1 for the Maghrebi population, and 1.5 for children under 5 years. Conclusions The total incidence of T1DM remains stable, but is higher in the Maghrebi than in the local population, and in children under 5 years compared to 5–18 years group. These results open a study field of which risk factors could be affecting this immigrant population in their destination countries.

Increasing incidence of type 1 diabetes between 1986 and 2015 in Bauru, Brazil.

To assess temporal trends in the incidence of type 1 diabetes in Bauru, São Paulo State, Brazil from 1986 to 2015. The yearly incidence of type 1 diabetes (per 100,000/yr) from 1986 to 2015 was determined in children ≤14yr of age, using individual case notification and the capture and recapture method. During thirty years (1986-2015), 302 cases were diagnosed in our population. The overall incidence was of 12.8/100,000 (95% CI: 11.2-14.4), ranging from 2.8/100,000 in 1987 to 25.6/100,000 in 2013 with a 9.1-fold variation. It was non-significantly higher in girls [13.7 (95% CI: 11.4-16.1)] than in boys [12.0 (95% CI: 9.8-14.2)] (p=0.48) and significantly higher in the 5-9yr [14.6 (95% CI: 11.8-17.4)] and 10-14yr [15.8 (95% CI: 12.7-18.8)] age ranges compared to the 0-4yr [8.1 (95% CI: 6.0-10.2)] age range (p<0.001). The majority of diagnoses were made in colder months. The patterns of incidence were very high and high in 80.0% of the study-years. The incidence of type1 diabetes in children ≤14yr has increased in Bauru, Brazil, in the last thirty years, in approximately 3.1% annually, with an absolute crude increase of 2.5-fold. These findings pose Brazil as a country with high incidence of type 1 diabetes. All Brazilian regions should be enrolled in future studies to determine the factors that contribute to the predisposition to type 1 diabetes in our population and to the steep rise in its incidence.

Association between Dietary Energy Density and Incident Type 2 Diabetes in the Women’s Health Initiative

BackgroundDietary energy density, or energy available in relation to gram intake, can inform disease risk. ObjectiveThe objective of this study was to investigate the association between baseline dietary energy density and risk of incident type 2 diabetes in postmenopausal women. DesignDietary energy density, weight status, and type 2 diabetes incidence were prospectively characterized in a large cohort of postmenopausal women participating in one or more clinical trials or an observational study. Participants/settingThe study involved 161,808 postmenopausal women recruited to the Women's Health Initiative observational study or clinical trials at 40 centers across the United States between 1993 and 1998. Main outcome measuresThe primary outcome was incident type 2 diabetes. Statistical analyses performedThe association between dietary energy density quintiles and incident diabetes was tested using Cox proportional hazards regression. ResultsA total of 143,204 participants without self-reported diabetes at enrollment completed baseline dietary assessment and were followed for 12.7±4.6 years. Risk of diabetes developing was 24% greater for women in the highest dietary energy density quintile compared with the lowest after adjusting for confounders (95% CI 1.17 to 1.32). Body mass index (calculated as kg/m2) and waist circumference mediated the relationship between dietary energy density and diabetes. In waist circumference−stratified analysis, women in dietary energy density quintiles 2 to 5 with waist circumferences >88 cm were at 9% to 12% greater risk of diabetes developing compared with women with waist circumference ≤88 cm. ConclusionsIn this prospective study, a higher baseline dietary energy density was associated with higher incidence of type 2 diabetes among postmenopausal women, both overall, and in women with elevated waist circumference.

Evaluating Diabetes Care for Patients With Serious Mental Illness Using the Chronic Care Model: A Pilot Study.

People with serious mental illness (SMI) have a higher incidence of type 2 diabetes mellitus (T2DM) and shorter life span due to medical health problems. The chronic care model (CCM) has been used to improve care of patients with T2DM. One clinical organization that provided primary care to patients with SMI had excellent diabetes outcomes but did not have information on how they achieved those outcomes. Thus, we conducted a pilot study chart review for 30 patients with T2DM and SMI to determine how well the clinic’s system aligned with the overall CCM components and which components correlated with diabetes control. We also evaluated use of the CCM using the Assessment of Chronic Illness Care provider survey. Results showed that the clinic had an overall basic implementation level of the CCM, which allows opportunity for improvement. Two elements of the CCM were correlated with hemoglobin A1C and both were in an unexpected direction: self-management support in the variable of percentage of visits that included patient-specific goal-setting (rs = .52; P = .004) and delivery system design in the variable of number of nurse practitioner visits per study period (r s = .43; P = .02). These findings suggest that the clinic may have made more concentrated efforts to manage diabetes for patients who were not in good diabetes control. Providers noted the influence of SMI and social service organization support on these patients’ clinical outcomes. The findings will be reexamined after a fuller implementation of the CCM to further improve management in this population.

Cognitive reappraisal ability buffers against the indirect effects of perceived stress reactivity on Type 2 diabetes.

Stress contributes to poor health outcomes; importantly, a stress reaction begins with the negative appraisal of a situation. The ability to use cognitive reappraisal, an emotion regulation strategy that involves reinterpreting an initial appraisal to change its emotional impact, could be a protective factor against the health consequences of stress reactivity. The present study investigated (a) if cognitive reappraisal ability (CRA) acts as a stress buffer against a body mass index (BMI) indicative of being overweight (≥25 kg/m2) or obese (≥30 kg/m2), and (b) if this buffering effect persists against the indirect influences of perceived stress reactivity (PSR) on Type 2 diabetes. One hundred fifty participants (54% female; mean age = 40.4 years ± 12.4 years) completed an online CRA task, self-report measures of PSR, height, weight, and Type 2 diabetes diagnosis on Amazon's Mechanical Turk. Results revealed that CRA significantly interacted with PSR to predict BMI, which indirectly predicted Type 2 diabetes. Individuals with higher PSR and higher CRA exhibited BMIs within a normal weight range and lower incidence of Type 2 diabetes. In contrast, individuals with higher PSR and lower CRA were overweight or obese, with a higher incidence of Type 2 diabetes. Interestingly, higher CRA was not protective in those who had lower levels of PSR. Findings from this study suggest that emotion regulation interventions can be developed to indirectly target Type 2 diabetes and similar obesity-related illnesses, and that emotion regulation interventions should be tailored to the individual. (PsycINFO Database Record

Lumbosacral Epidural Lipomatosis: A Retrospective Matched Case-Control Database Study

We present the largest known consecutive series of patients with epidural lipomatosis (EL) to characterize demographics and clinical symptoms of patients with EL on magnetic resonance imaging (MRI), and compare these characteristics against a matched control group. Patients evaluated for pathology requiring lumbar MRI imaging between September 2010 and September 2015 were retrospectively reviewed and included in this study if they were diagnosed with EL on a radiologic note during any visit to our medical center. One hundred ninety-nine patients fulfilled the study criteria andwere included in the study cohort. A separate patientcohort of 199 unique, age- and gender-matched controls without lumbosacral EL was generated from a database of patients with lumbar MRI imaging during the same period. Average age at diagnosis was 54.9 years (range, 25-84 years). One hundred thirty-three patients (66.8%) were men. On univariate analysis, patients with EL were more likely to have history of smoking (odds ratio[OR] 1.90, 95% confidence interval [CI] 1.23-2.94, P=0.004), diabetes mellitus type 2 (OR 2.17, 95% CI 1.33-3.56, P= 0.002), or be on disability (OR 4.43, 95% CI 2.48-7.91, P < 0.001). Furthermore, patients with EL had significantly increased median body mass index compared with controls (36.7 vs. 29.4 kg/m2; P < 0.001). Patients with lumbosacral EL tend to be obese with a high incidence of type 2 diabetes mellitus, suggesting that this pathology may be a sequela of metabolic syndrome. Future research topics should include the pathogenesis of EL, as well as treatment outcomes of surgical versus primary care management.

A pharmacokinetic analysis and dietary information are necessary to confirm or reject the hypothesis on persistent organic pollutants causing type 2 diabetes

A number of studies have found an association between the concentrations of persistent organic pollutants (POP) and type 2 diabetes. Causality has remained uncertain. This study describes the pharmacokinetic behavior of PCDD/Fs (polychlorinated dibenzo-p-dioxins and dibenzofurans) both in a theoretical model based on elimination rate constants, and in a group of 409 adult surgical patients with known PCDD/F concentrations and dietary information. A model assuming 10% annual decrease in past PCDD/F intake, predicted the measured profile of TEQ (toxic equivalents) in the patient population fairly well. The dominant determinant of PCDD/F level was age, and the level in patients was also associated with consumption of animal source products. Predicted daily intakes correlated with diet, but also with body mass index (BMI), indicating that high BMI was preceded by high consumption of foods containing PCDD/Fs. The results suggest that a third factor, e.g. high intake of animal source foods, could explain both higher levels of POPs in the body and higher incidence of type 2 diabetes, and BMI is not sufficient in describing the confounding caused by diet. Thus, to fully address the causality between POPs and type 2 diabetes, careful studies considering the pharmacokinetics of the studied compounds, and including the analysis of food consumption, are needed.

Australasian Diabetes Data Network: Building a Collaborative Resource.

Australasia is a region with a high incidence of type 1 diabetes (T1D). There are approximately 140 000 individuals with T1D, and of these 10 000 are children. Although the region covers a huge geographical area, most children with T1D are managed by tertiary academic centers in the major capital cities. Local longitudinal data collection has been in place for several decades in most of these centers, however ongoing national data collection had not been attempted. In 2012, with funding from the Juvenile Diabetes Research Foundation (JDRF) Australian Type 1 Clinical Research Network, a national collaboration was formed to provide ongoing longitudinal collection of T1D patient characteristics and outcomes. The initial phase of this collaboration, known as the Australasian Diabetes Data Network or ADDN, was led by the Australasian Paediatric Endocrine Group (APEG) and thus included only children and adolescents. The next phase, commenced in 2016, will see adult sites added through collaboration with the Australian Diabetes Society (ADS). As most of the initial centers had longitudinal data collection in place the model employed was to establish the transfer and collation of data already collected into a central database. This required the definition of a common data dictionary, ethics and governance procedures and the employment of technology to enable efficient and accurate information transfer and accessibility. The ADDN project received widespread support from the diabetes research community with study investigators representing 20 pediatric centers across the region. The first phase focused on the 5 largest centers and at the end of 2015 these centers were uploading patient data to the ADDN database on a quarterly basis resulting in 5271 patients with 83 506 diabetes visits.

Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study.

Increased mortality rates are found in women and young adults with non-functioning pituitary adenomas (NFPAs). This nationwide study aimed to investigate the burden of comorbidities in patients with NFPA and to examine whether gender influences the outcome. NFPA patients were identified and followed-up from National Registries in Sweden. It was a nationwide, population-based study. Standardised incidence ratios (SIRs) for comorbidities with 95% confidence intervals (CI). Comorbidities were analysed in all patients, both patients with and without hypopituitarism. Included in the analysis were 2795 patients (1502 men, 1293 women), diagnosed with NFPA between 1987 and 2011. Hypopituitarism was reported in 1500 patients (54%). Mean patient-years at risk per patient was 7 (range 0-25). Both men (SIR 2.2, 95% CI: 1.8-2.5; P<0.001) and women (2.9, 2.4-3.6; P<0.001) had a higher incidence of type 2 diabetes mellitus (T2DM) than the general population, with women having a higher incidence compared with men (P=0.02). The incidence of myocardial infarction was increased in women (1.7, 1.3-2.1; P<0.001), but not in men. Both men (1.3, 1.1-1.6; P=0.006) and women (2.3; 1.9-2.8; P<0.001) had an increased incidence of cerebral infarction, with women having a higher incidence than men (P<0.001). The incidence of sepsis was increased for both genders. The incidence of fractures was increased in women (1.8, 1.5-1.8; P<0.001), but not for men. This nationwide study shows excessive morbidity due to T2DM, cerebral infarction and sepsis in all NFPA patients. Women had higher incidence of T2DM, myocardial infarction, cerebral infarction and fracture in comparison to both the general population and to men.

Pattern of adverse drug reactions reported at a tertiary health care teaching hospital of Tripura: a retrospective study

Background: ADR monitoring and reporting activity is in its infancy in India. India rates below 1% in pharmacovigilance as against the world rate of 5%. India is the fourth largest producer of pharmaceuticals in the world. So there is an immense need to improve the pharmacovigilance system to protect the Indian population. This study is aimed to identify ADRs and assess their pattern. Methods: The reports of ADRs were recorded as per the standard guidelines fixed by pharmacovigilance programme of India (PvPI). Naranjo ADR probability scale was used to assess the causality of suspected ADRs. Severity of ADRs was identified using modified hartwig's criteria. Types of ADRs were identified using Rawlins and Thompson classification. Results: A total 266 ADRs were reported from 190 patients. Majority of the ADRs were type A reactions. Highest incidence (78.95%) of ADRs was observed between 12-59 years of age. 56.84% of patients were male and 43.16% were female. Majority of the patients were suffering from single disease and receiving less than six medications. In the assessment of severity mild, moderate and severe ADRs were 57.89%, 35.26% and 6.84% respectively. In causality assessment 3.16% cases were unlikely, 57.37% cases were possible, 38.95% cases were probable and 0.52% cases were certain. Conclusions: The present study shows ADRs are commonly encountered at this tertiary health care set up. Many ADRs are life threatening type B reactions, but the higher incidence of type A reactions means that these can be avoided.

No association between use of multivitamin supplement containing vitamin D during pregnancy and risk of Type 1 Diabetes in the child.

Sweden has the second highest incidence of type 1 diabetes in the world. Nutritional aspects in utero and in infancy affect the development. We conducted a survey to determine whether reported maternal use of vitamin D-containing micronutrient supplements during pregnancy was associated with the risk of developing type 1 diabetes in the child. This report was based on data from the ABIS (All Babies In Southeast Sweden) study, with questionnaire data on 16 339 mother and infant pairs at birth and at 1-yr of age (n = 10 879), of whom 108 children were registered with type 1 diabetes before 14-16 yr of age. The questions 'during pregnancy, did you take any vitamin/mineral supplements?' and 'if yes, which? (open answer)' in addition to other lifestyle questions were answered. Logistic regression was performed with onset of type 1 diabetes as the dependent variable and vitamin D supplementation use as the independent variable, adjusted for relevant factors. Vitamin D supplementation during pregnancy was consumed by 9.3% of mothers whose children later got type1 diabetes and among 11.3% of those mothers whose children did not get type 1 diabetes (p = 0.532). No significant association was found between reported supplement intake of vitamin D during pregnancy and risk of type 1 diabetes, even when adjusting for factors which could influence the association. Maternal use of vitamin D-containing multivitamin supplements during pregnancy was not related to the risk of developing type 1 diabetes in children before 14-16 yr of age in Southeast of Sweden.

Diabetes, menstruation, and the uterus

Diabetes, menstruation, and the uterus

Circulating micrornas associated with glycemic impairment and progression in Asian Indians.

Aims/hypothesisAsian Indians have a high incidence of type 2 diabetes, but factors associated with glycemic progression in this population are not understood. MicroRNAs are emerging as important mediators of glucose homeostasis and have not been previously studied in Asian Indians. We examined microRNA (miR) expression associated with glycemic impairment and progression in Asian Indians from the San Francisco Bay Area. We studied 128 Asian Indians age 45–84 years without known cardiovascular disease and not taking diabetes medications. Oral glucose tolerance tests were performed at baseline and after 2.5 years. We quantified circulating miRs from plasma collected during the enrollment visit using a flow cytometry-based assay.ResultsGlycemic impairment was present in 57 % (n = 73) at baseline. MiR-191 was positively associated with glycemic impairment (odds ratio (OR) 1.7 (95 % CI 1.2, 2.4), p < 0.01). The prevalence of glycemic progression after 2.5 years was 24 % (n = 23). Six miRs were negatively associated with glycemic progression: miR-122 (OR 0.5 (0.2, 0.8), p < 0.01), miR-15a (OR 0.6 (0.4, 0.9), p < 0.01), miR-197 (OR 0.6 (0.4, 0.9), p < 0.01), miR-320a (OR 0.6 (0.4, 0.9), p < 0.01), miR-423 (OR 0.6 (0.4, 0.9), p < 0.01), and miR-486 (OR 0.5 (0.3, 0.8), p < 0.01). Further multivariate adjustment did not attenuate these results.Conclusions/interpretationThis is the first study to investigate circulating miRs associated with glycemic status among this high-risk ethnic group. Individual miRs were significantly associated with both glycemic impairment and glycemic progression. Further studies are needed to determine whether miR (s) might be useful clinical biomarkers for incident T2D in the Asian Indian population.Electronic supplementary materialThe online version of this article (doi:10.1186/s40364-015-0047-y) contains supplementary material, which is available to authorized users.

Delayed diagnosis and issues with pump usage are the leading causes of diabetic ketoacidosis in children with diabetes living in Newfoundland and Labrador, Canada.

BackgroundNewfoundland and Labrador (NL) has a very high incidence of type 1 diabetes (T1DM) and admission rate for diabetic ketoacidosis (DKA). The purpose of this study was to identify characteristics and precipitating factors associated with pediatric DKA in this population.MethodsThis was a retrospective study on children diagnosed with DKA from 2007–2011 admitted to the province’s only tertiary care pediatric hospital. Demographics, biochemical characteristics, and reasons for DKA diagnosis were analyzed. Chi-square and Fisher Exact tests were performed for categorical variables; t- and non-parametric Kruskal-Wallis tests were performed for continuous variables.ResultsA total of 90 children were admitted with DKA (39.5% newly diagnosed; 60.5% were previously diagnosed). The rate of DKA on presentation for incident cases was 22.1%. More severe cases of DKA occurred in younger, newly diagnosed patients. Almost half of preexisting diabetes cases were recurrent DKA (49.1%). The most common presenting characteristics of newly diagnosed patients were weight loss, bedwetting, polyuria, polydipsia, and neurologic symptoms. Pre-existing diabetes patients most often presented with abdominal pain and vomiting. Diagnosis of diabetes in new patients and issues related to interrupted insulin delivery in pre-existing patients using insulin pump therapy were the most common factors associated with DKA. Of the newly diagnosed patients presenting in DKA, 64% had seen a physician in the weeks leading up to diagnosis.ConclusionsPediatric patients have predictable patterns associated with a diagnosis of DKA. Most cases of DKA could be prevented with earlier diagnosis and improved education and problem-solving by families and health care providers. DKA preventative strategies are recommended and should be aimed at patients, their families, and health care professionals especially those outside of pediatric centers.

Association of trace elements with lipid profiles and glycaemic control in patients with type 1 diabetes mellitus in northern Sardinia, Italy: An observational study

Sardinia is an Italian region with a high incidence of type 1 diabetes mellitus. This study aimed to determine the associations of trace elements with lipid profiles and glycaemic control in patients with T1DM. A total of 192 patients with T1DM who attended the Unit of Diabetology and Metabolic Diseases in Sassari, Italy, were enrolled. Trace elements zinc, copper, selenium, chromium, and iron were measured in whole blood by sector field inductively coupled plasma mass spectrometry. The correlations between metabolic variables and the levels of trace elements were determined. Zinc was positively correlated with total cholesterol (P=0.023), low-density lipoprotein (P=0.0015), and triglycerides (P=0.027). Iron as significantly correlated with TC (P=0.0189), LDL (P=0.0121), and high-density lipoprotein (HDL) (P=0.0466). In males, Cr was positively correlated with HDL (P=0.0079) and Se, in females was correlated with TG (P=0.0113). The mean fasting plasma glucose was166.2mgdL−1. Chromium was correlated with fasting plasma glucose (P=0.0149), particularly in males (P=0.0038). Overall, 63.5% of the patients had moderate HbA1c (7–9%). Copper was significantly correlated with HbA1c% in males (P=0.0155). In conclusion, the results of this study indicate that trace elements show different associations with lipid levels and glycaemic control in T1DM. Zinc, Fe, and Se were associated with lipid levels whereas Cu and Cr were associated with HbA1c%.

Abstract P300: Circulating MicroRNAs Associated with Glycemic Impairment and Progression in Asian Indians

Introduction: Asian Indians experience a high incidence of type 2 diabetes (T2D), but factors associated with glycemic progression from normal to pre-diabetes to diabetes in this population are not fully understood. Circulating microRNAs (miRs) appear to be implicated in T2D etiology in other racial groups. Hypothesis: Circulating miRs are associated with glycemic impairment and progression in participants in the Metabolic Syndrome and Atherosclerosis in South Asians Living in America (MASALA) study. Methods: Participants were 128 Asian Indians age 45-84 years without cardiovascular disease and not taking diabetes medications. Oral glucose tolerance tests were performed at baseline and after 2.5 years. Glycemic progression was defined as (1) progression from normal to impaired fasting glucose (fasting glucose 100-125 mg/dl) or diabetes (2-hour glucose ≥200 mg/dl, fasting glucose ≥126 mg/dl or diabetes medication use) or (2) from impaired glucose tolerance (2-hour glucose 140-199 mg/dl) to diabetes (see above). Circulating miRs from plasma collected during the enrollment visit were measured using the Firefly Circulating microRNA assay. Unadjusted and multivariate-adjusted logistic regression models were created to determine the relationship between circulating miRs and glycemic impairment and progression. Results: The mean age was 57 ± 8 years and 48% (n=62) were men. Glycemic impairment was present in 57% (n=73) at baseline. The prevalence of glycemic progression after 2.5 years was 24% (n=23). Two circulating miRs were associated with glycemic impairment and seven with glycemic progression after 2.5 years (see Table). Conclusions: To our knowledge, this is the first study to investigate circulating miRs associated with glycemic impairment in the high risk Asian Indian racial group. Individual miRs were significantly associated with both glycemic impairment and glycemic progression. Further studies are needed to determine whether miR(s) might be useful clinical biomarkers for incident T2D in this population.

Statins and type 2 diabetes: genetic studies on target

Statins and type 2 diabetes: genetic studies on target

The Influence of Statins on Glucose Tolerance and Incipient Diabetes

The US Food and Drink Administration (FDA) recently published a warning that statin usage may increase the risk for type 2 diabetes. However, the incidence of new-onset diabetes varies substantially among clinical trials investigating the efficacy and safety of statins. Meta-analyses indicate that statin therapy is associated with an increased risk for diabetes of approximately 9 %. The risk for incident diabetes may be associated with higher doses and potencies of statins. Mechanisms explaining the potentially higher incidence of type 2 diabetes with statin therapy have not been fully elucidated, and statins differ considerably in terms of their effect on glucose metabolism and ultimately incident diabetes. It is widely accepted that the cardiovascular benefits associated with statin use greatly outweigh the risks for diabetes. However, the effect of different statins on glycemic parameters may influence the choice of statin in those with risk factors for diabetes. Unlike the other stains, pitavastatin raises adiponectin levels, which in turn lowers insulin resistance and improves insulin secretion. Furthermore, numerous studies have concluded that pitavastatin and pravastatin do not affect glycemic control and may be favorable treatment options in patients with, or at risk for, type 2 diabetes.

Type 2 Diabetes Mellitus in Children and Adolescents

Type 2 Diabetes Mellitus in Children and Adolescents