High Risk Of Diabetes Research Articles

1184-P: Adolescent Growth Spurt and Type 2 Diabetes Risk in an American Indian Population

Background: Some studies suggest that earlier pubertal development is associated with obesity and metabolic disorders in adulthood, but whether accelerated adolescent linear growth spurt influences type 2 diabetes (T2D) in populations at high risk of diabetes is unclear. Aim: To examine associations of age at initiation of the adolescent growth spurt (i.e., take-off) (ATO) , velocity at take-off (VTO) , and age at peak velocity (APV) with T2D incidence. Methods: Height measurements obtained from a longitudinal study of diabetes in American Indians were used to estimate biological growth parameters using the Preece-Baines growth model I, a parametric model of the human growth curve. Diabetes incidence was analyzed among individuals who had ≥ 4 height examinations at ages 5-17 years and who remained nondiabetic at first examination after age 18. Participants were followed until diabetes developed or last examination. Associations of growth parameters with diabetes incidence were analyzed by Poisson regression. Results: Among 649 originally nondiabetic participants, 135 females and 82 males developed diabetes in a median follow-up of years. With adjustment for age, birth date and maternal diabetes, younger ATO and APV were associated with T2D incidence in males (incidence rate ratio (IRR) =1.75 per year, 95% CI, 1.23, 2.50; and IRR=1.33, 95% CI, 1.01, 1.75, respectively) but not in females (IRR=0.93, 95% CI, 0.75, 1.16; and IRR=1.04, 95% CI, 0.86, 1.26, respectively) . Higher VTO was associated with T2D incidence in males (IRR=1.80 per cm/y, 95% CI, 1.15, 2.81) but not in females (IRR=1.15, 95% CI, 0.88, 1.50) . With further adjustment for adult and childhood BMI and fasting insulin, the associations were attenuated for APV and VTO but remained significant for ATO in males. Conclusion: Our findings suggest that an early and accelerated adolescent growth spurt is a risk factor for T2D, at least in males. These associations are only partially explained by measures of adiposity and insulinemia. Disclosure M.J.Ramirez-luzuriaga: n/a. S.Kobes: None. M.Sinha: None. W.C.Knowler: None. R.L.Hanson: None.

Coarse Grain Consumption and Risk of Cardiometabolic Diseases: A Prospective Cohort Study of Chinese Adults

BackgroundLower consumption of whole grains is associated with higher risks of diabetes and coronary heart disease in Western populations, but evidence is still limited for stroke. Moreover, little is known in China, where the rates of cardiometabolic diseases are high and the grain types consumed are different from those in Western countries. ObjectivesTo examine the associations between coarse-grain (e.g., millet, corn, and sorghum) consumption and incident cardiometabolic diseases among Chinese adults. MethodsThe prospective China Kadoorie Biobank enrolled >0.5 million adults aged 30–79 years from 10 urban and rural areas during 2004–2008. At baseline, consumption frequencies (in 5 categories from “never” to “daily”) of 12 major food groups, including coarse grains, were collected using a validated FFQ. After a median of 11 years of follow-up, 17,149 cases of diabetes, 29,876 ischemic strokes, 6097 hemorrhagic strokes, and 6704 major coronary events were recorded among 461,047 participants without a prevalence of major chronic diseases at baseline. Cox regression analyses were used to yield adjusted HRs for each disease associated with coarse-grain consumption. ResultsOverall, 13.8% of participants reported regularly consuming (i.e., ≥4 days/week, regular consumers) and 29.4% reported never or rarely consuming coarse grains (i.e., nonconsumers) at baseline. Compared with nonconsumers, regular consumers had lower risks of diabetes (adjusted HR, 0.88; 95% CI, 0.78–0.98) and ischemic stroke (adjusted HR, 0.86; 95% CI, 0.81–0.93), but not hemorrhagic stroke (adjusted HR, 0.96; 95% CI, 0.76–1.20) or major coronary events (adjusted HR, 0.95; 95% CI, 0.81–1.12). For diabetes and ischemic stroke, each 100 g/day increase in the usual intake of coarse grains was associated with 14% (adjusted HR, 0.86; 95% CI, 0.76–0.97) and 13% (adjusted HR, 0.87; 95% CI, 0.81–0.94) lower risks, respectively, with similar results in various subgroups. ConclusionsIn Chinese adults, higher coarse-grain consumption is associated with lower risks of diabetes and ischemic stroke, supporting the promotion of coarse-grain consumption in China.

1429-P: Metabolically Healthy Obese Is Actually Not Healthy but at Risk for Developing Diabetes Mellitus

Objectives: Although obese individuals without obesity related metabolic abnormalities are often defined as metabolically healthy, risks for developing such abnormalities have not been evaluated well. Recently, a prospective study showed that metabolically healthy obese subjects were at higher risk of diabetes, stroke and cardiovascular disease than metabolically healthy subjects without obesity in UK. We here analyzed the association between metabolically healthy obesity and a risk for developing diabetes in a Japanese population. Research Design and Methods: The participants were recruited from Iwaki study, a health promotion study of Japanese people aimed to prevent lifestyle-related disease. Among 1167 participants of Iwaki study held in 2014, 931 individuals attended at least one time in 2015 to 2019. We excluded 7 and 75 individuals without complete data sets and who were diagnosed with diabetes in 2014 respectively, thus 849 subjects were enrolled in this study. Obesity was defined as BMI >25 kg/m2. We used the National Cholesterol Education Program ATP III Guideline to categorize metabolically unhealthy as participants meeting at least two criteria of metabolic abnormalities. Results: In 2014, the number of metabolically healthy subjects without and with obesity were 6 and 1 respectively. Cox proportional hazard model showed metabolically healthy subjects with obesity were at higher risk of diabetes compared with those without obesity (Hazard ratio 3.70, p=0.002) , even if after adjusted by age and sex (Hazard ratio 3.32, p=0.005) . Conclusions: Our analysis suggest an importance of encouraging people with obesity to reduce body weight even though they are metabolically healthy. We are extending such analyses in association with other lifestyle-related diseases. Disclosure S.Mizushiri: None. M.Daimon: None. A.Kamba: None. M.Murabayashi: None. Y.Nishiya: None. R.Ito: None. A.Tamura: None. S.Ono: None. K.Matsuki: None.

709-P: Persons with High-Risk Diabetes, Depression, and Stress Using a Digital Health Platform Experience an Improvement in Glycemic Management

Introduction: As the prevalence of type 2 diabetes (T2D) continues to grow worldwide, individuals struggle with how to integrate diabetes self-management into their lives. This is complicated by the high rate of depression and stress among persons with T2D. A multicondition behavior change-oriented digital therapeutic platform may alleviate the burdens faced by persons with comorbid diabetes and mental health conditions. Objective: To investigate blood glucose levels outcomes in persons with T2D and comorbid depression and stress who used a multicondition digital therapeutic to manage their blood glucose levels. Method: We performed a retrospective data analysis on the DarioTM database using users who activated the mobile app during 2019-2021 and who self-reported stress and depression in the App questionnaire. Participants who took at least 5 measurements at 1st and 12th month with Dario and who started with an average blood glucose >180 mg/dL were termed “high-risk.” The ratios assessed were average blood glucose and high blood glucose (>180 mg/dL) readings ratio over a year. Results: The high-risk group of 491 users significantly reduced their average blood glucose by 13% (204±60 vs. 234±55) (P<0.001) . A subset of high-risk users with type 2 (N=379) was also evaluated and significantly reduced their average blood glucose by 14% (P<0.001) (201±66 vs. 233±53) . Moreover, their high glucose events ratio (>180 mg/dL) was significantly reduced from 69.4% to 46.9% over a full year usage (P<0.001) . Conclusion: The use of a multicondition digital therapeutic platform may be associated with improved glucose management for persons with “high risk” glycemia who cope with depression and stress. The present study revealed that the digital multicondition platform has the potential to enhance self-care behaviors among people with diabetes that suffer from stress and depression. Disclosure Y.Hershcovitz: None. M.Tamir: None. M.D.Ritholz: Advisory Panel; DarioHealth Corp. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.

Relationship between Access to Nutrition and Visceral Adiposity in Stable Long-Term Inner City Kidney Transplant Recipients (KTRs)

ObjectivesHigher % body fat has been associated with increased risk for multiple diseases especially if it has a visceral distribution. We studied body fat patterns in a population of inner-city KTRs at risk for food scarcity to explore access to nutrition and its relationship to % body fat.MethodsA random sample of 16 stable long-term pts from kidney transplant clinic were studied using the InBody S10 body composition analyzer at a regularly scheduled appointment. Pts were seated and electrodes were attached to the middle fingers, thumbs and below each ankle. Food scarcity was assessed by a standardized survey.Results63% (10) pts had body fat >25% (HIFAT). They did not differ from pts with body fat <25% (6 pts, LOFAT) in time since transplant (mean 10.6 ± 4.0 yrs), race, education, or annual income. 12 (75%) pts identified as black, 2 (12.5%) white and 2 (12.5%) other. The majority (56.3%) had an annual income < $20 k. HIFAT pts had higher visceral fat (14.0 ± 1.3 vs 5.1 ± 1.3, p < 0.001), higher BMI (34.8 ± 1.25 vs 27.7 ± 1.7, p = 0.002), and body weight (227.1 ± 12.6 vs 180.5 ± 12.1, p = 0.01), but no difference in skeletal muscle mass. HIFAT pts were more likely to be male (70% vs 30%, p = 0.039) and were older (53.9 ± 2.7 vs 43.5 ± 2.5 yrs, p = 0.01). Pts with diabetes were more likely to be HIFAT than those without (100% vs 50%, p = 0.037). 50% of pts in the LOFAT group reported they had cut down or skipped meals because there wasn't enough money for food vs none of the HIFAT pts (p = 0.018). Additionally, 100% of pts who received food from a bank, church or pantry in the last year were LOFAT (p = 0.004). There was no difference in SNAP use between the two groups.ConclusionsIn our population of long-term inner-city KTRs a majority of patients had high total body fat, meeting the definition of obesity by BMI and pts with higher body fat weighed more overall with more visceral fat but not higher skeletal muscle mass. Patients with lower body fat reported more food scarcity and reliance on food pantries. Lower body fat in this population may not be related to better dietary habits and education regarding nutritional lifestyle changes that might improve body composition is important in this population at high risk for cardiovascular disease and diabetes.Funding SourcesUnfunded.

1112-P: Prevalence of Testing for Blood Glucose among Adults with Overweight or Obesity in the U.S.

An estimated 13% of all U.S. adults aged ≥18 years have diabetes, and 34.5% meet criteria for having prediabetes. Screening adults at high risk for prediabetes and diabetes may allow earlier detection, diagnosis, and treatment, thereby improving health outcomes. The U.S. Preventive Services Task Force (USPSTF) recommends screening every three years for abnormal blood glucose in adults aged 40-70 years who have overweight or obesity (this recommendation was updated to adults aged 35-70 years in August of 2021) . Using IQVIA Ambulatory Electronic Medical Records (EMR) via the IQVIA E360 platform, we aimed to estimate the proportion of adults aged 40-70 years with overweight or obesity who received a test for blood glucose in a 3-year period from 2016-2019. We defined overweight or obesity based on body mass index (BMI of 25-29.9 kg/m2 and ≥30 kg/m2, respectively) calculated using measured height and weight. Receipt of a blood glucose test was defined as having a hemoglobin A1c or fasting plasma glucose measured, as recommended by USPSTF. Our analysis identified adults aged 40-70 years with overweight or obesity in 2016 (the index year) and without preexisting diabetes, defined using a modified SUPREME-DM algorithm for EMR data[1]. We included adults who were present in the dataset for at least two years before their index BMI in 2016 (to exclude those with prevalent diabetes) and three years after the index BMI, during which we examined the occurrence of blood glucose testing. Among 1,360,095 adults who had overweight or obesity, 33.4% received a test for blood glucose in 2016-2019. The testing rate was 28.7% among adults with overweight and 37.3% among adults with obesity. Our findings could help inform clinical and public health promotion efforts to improve screening for blood glucose levels among adults with overweight or obesity. Future studies may identify factors associated with receiving timely blood glucose screening. [1]https://pubmed.ncbi.nlm.nih.gov/25515167/ Disclosure Y.Chen: None. E.A.Lundeen: None. A.Koyama: None. L.Kompaniyets: None. L.J.Andes: None. S.R.Benoit: None. G.Imperatore: None. D.B.Rolka: None.

524-P: CME Activity Series Highlights Changes in Clinicians’ Knowledge and Competence about Novel Approaches to Reduce DKD Progression

Diabetic kidney disease (DKD) is one of the most common complications of diabetes, significantly impacting morbidity and mortality. Novel approaches to target DKD progression are needed, and non-steroidal mineralocorticoid receptor antagonists (MRAs) have recently emerged as a viable option, however, clinicians may not be aware of them. Based on this gap, CMHC organized 4 accredited virtual symposia from 2020 to 2021 to educate multi-disciplinary clinicians and assess knowledge/competence changes using pre-/post assessment questions. The activities took place between Oct. 2020 - Oct 2021 with the participation of 829 healthcare professionals (MD/DO, PAs, RNs, NPs, PharmDs) representing specialties that treat high-risk diabetes patients. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p &amp;lt;0.05) . A significant increase in knowledge regarding the pathophysiology of DKD and emerging non-steroidal MRAs in DKD was observed (43% and 34% relative increase in knowledge compared to baseline, p &amp;lt;0.0001) . Additionally, a significant increase in competency regarding identifying patients at-risk for DKD progression and management of DKD patients was demonstrated (37% relative increased to baseline, p&amp;lt;0.0001) . At post-activity evaluation, 99.7% indicated that information via these activities is useful for their practice. Furthermore, the majority of participants indicated that they intended to change their practice based on information received, including monitoring clinical trial advances with non-steroidal MRAs, evaluating the risk of potential hyperkalemia with DKD treatments, and screen for risk of DKD progression. It is evident from the outcomes of these educational activities that they led to significant improvement in knowledge and competence related to novel DKD treatment options and commitment to change among learners. Disclosure S.Karandrea: None. N.Agarwal: None. A.Jamrogiewicz: None. Funding Bayer HealthCare Pharmaceuticals (24656) Bayer HealthCare Pharmaceuticals (66351473) Bayer HealthCare Pharmaceuticals (25319) Bayer HealthCare Pharmaceuticals (67463661)

1067-P: A National Physician Survey Examining Clinical Scenarios for Deintensifying Diabetes Medications

Many older adults with type 2 diabetes (T2D) are tightly controlled with high hypoglycemia risk medications and may benefit from deintensifying (stopping/reducing) or switching to newer medications. As deintensifying rarely occurs in practice, we aimed to determine how physicians make these decisions. We conducted a national survey of a random sample of US physicians in general medicine, geriatrics, and endocrinology. The survey was designed by a team of patients, caregivers, and physicians, and distributed in 3 mailing waves. Physicians were asked what action they would take in three scenarios of patients with T2D treated below individualized targets: 1) a healthy 79F with HbA1c 6.3% on a sulfonylurea; 2) a 77M with stage 4 kidney disease with HbA1c 7.3% on basal insulin; 3) a 78F with advanced dementia with HbA1c 7.7% on a sulfonylurea. Scenarios started with a base case of the patient reporting no medication issues, then varied hypoglycemia history, health, and patient preferences. Statistical comparisons used multinomial logistic regression accounting for clustering. We received 427 responses to date, response rate 27%. In the base case, 57% of physicians made no change to the high-risk medication, 16% switched, 12% decreased, 12% stopped, and 3% increased. Decreasing/stopping occurred over twice as often in scenario 1 than other scenarios (p&amp;lt;0.001) . In scenario variations, hypoglycemia of any severity led &amp;gt;95% of physicians to decrease, stop or switch the high-risk medication. Worsening health status also caused substantially more deintensification, but polypharmacy, financial barriers, and patient preference did not. Endocrinologists were 3-5 times as likely to switch medications compared to other specialties (p&amp;lt;0.001) . Overall, we found clinical inertia to deintensify high-risk diabetes medications, especially in medically complex patients with HbA1c &amp;gt;7.0%. Hypoglycemia and worsening health were strong motivators to deintensify or switch to newer medications. Disclosure S.J.Pilla: None. N.Schoenborn: None. C.Boyd: Other Relationship; Dynamed, UpToDate. S.Golden: Advisory Panel; Abbott Diabetes, Medtronic. N.N.Mathioudakis: None. N.M.Maruthur: Other Relationship; Johns Hopkins HealthCare Solutions. Funding National Institutes of Health (1R24AG064025 and 1K23DK128572)

Predicting the Risk of Incident Type 2 Diabetes Mellitus in Chinese Elderly Using Machine Learning Techniques.

Early identification of individuals at high risk of diabetes is crucial for implementing early intervention strategies. However, algorithms specific to elderly Chinese adults are lacking. The aim of this study is to build effective prediction models based on machine learning (ML) for the risk of type 2 diabetes mellitus (T2DM) in Chinese elderly. A retrospective cohort study was conducted using the health screening data of adults older than 65 years in Wuhan, China from 2018 to 2020. With a strict data filtration, 127,031 records from the eligible participants were utilized. Overall, 8298 participants were diagnosed with incident T2DM during the 2-year follow-up (2019–2020). The dataset was randomly split into training set (n = 101,625) and test set (n = 25,406). We developed prediction models based on four ML algorithms: logistic regression (LR), decision tree (DT), random forest (RF), and extreme gradient boosting (XGBoost). Using LASSO regression, 21 prediction features were selected. The Random under-sampling (RUS) was applied to address the class imbalance, and the Shapley Additive Explanations (SHAP) was used to calculate and visualize feature importance. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. The XGBoost model achieved the best performance (AUC = 0.7805, sensitivity = 0.6452, specificity = 0.7577, accuracy = 0.7503). Fasting plasma glucose (FPG), education, exercise, gender, and waist circumference (WC) were the top five important predictors. This study showed that XGBoost model can be applied to screen individuals at high risk of T2DM in the early phrase, which has the strong potential for intelligent prevention and control of diabetes. The key features could also be useful for developing targeted diabetes prevention interventions.

0239 A Latent Profile Analysis of actigraphic sleep and physical activity measures among Cambodian-Americans: Relationship with specific trauma symptoms

Abstract Introduction Sleep and physical activity are related to psychological trauma. Less is known about how individuals with distinct sleep and activity profiles differ on specific clusters of trauma symptoms. Cambodian-Americans who survived the Pol Pot genocide experienced severe collective trauma. This analysis explored group differences between sleep/activity profiles on specific trauma symptoms among Cambodian-Americans. Methods Participants in a diabetes prevention trial for Cambodian-Americans (NCT02502929) met inclusion criteria for depression and high diabetes risk (but did not have diabetes). They wore wrist actigraphy (sleep) and hip actigraphy (physical activity) for 7 days (≥3 days to be included) and completed the 16-item trauma symptom scale of the Harvard Trauma Questionnaire (HTQ; N=166). Latent Profile Analyses identified profiles using 3 mean actigraphic sleep and activity variables: total nightly sleep time, sleep maintenance efficiency, and minutes in moderate-vigorous physical activity. ANOVAs explored differences between sleep/activity profiles on the HTQ, specifically total scores and the “Avoidance/Numbing” and “Re-experiencing/Hyperarousal” subscales. Models were adjusted for psychotropic medication use. Results Participants were predominantly women (79%), mean age 55.3, with elevated trauma symptoms (17% were higher than 2.5 cutpoint; mean±SD= 1.90±0.61). Sleep and physical activity patterns yielded a BIC best fit with 3 sleep/activity profiles: Inactive Poor Sleepers (n=30, 18%), Highly Active Short Sleepers (n=35, 21%), and Moderately Active Good Sleepers (n=101, 61%). Differences were observed between profiles on the HTQ total score (p=0.03). Tukey’s post hoc test revealed that Inactive Poor Sleepers exhibited greater HTQ scores than Highly Active Short Sleepers (p&amp;lt;0.05), but did not differ from Moderately Active Good Sleepers. There was also a significant difference between profiles in the Avoidance/Numbing subscale (p=0.01); Inactive Poor Sleepers had higher Avoidance/Numbing than Highly Active Short Sleepers (p&amp;lt;0.05, Cohen’s d: 0.47). There were no differences between profiles on the Re-experiencing/Hyperarousal subscale (p=.09). Conclusion Individuals with contrasting actigraphic sleep/activity profiles differed on trauma symptoms. Inactive Poor Sleepers may benefit from specific interventions for Avoidance/Numbing symptoms. Future analyses will evaluate how changes in sleep/activity profiles are longitudinally related to psychological health and diabetes risk following interventions. Support (If Any) 5R01DK103663

Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD).ObjectiveWe assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications.MethodsWe analyzed data from January 2018–June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests.ResultsHemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤ 2.0 mmol/L by 45.3% of patients. There were 4377 patients on glucose lowering medications; metformin was most common (77.7%), followed by insulin (24.6%), insulin secretagogues (23.6%), SGLT2i (19.7%), dipeptidyl peptidase-4 inhibitor (19.3%), and GLP-1RA (9.4%). A quarter of patients had cardiorenal indications for SGLT2i or GLP-1RA. Use of SGLT2i in these patients was lower than in patients without cardiorenal comorbidities (14.9% vs 21.2%, p < 0.05). GLP-1RA use in these patients was 4.6% compared with 11% in those without cardiorenal comorbidities (p < 0.05).DiscussionContrary to current evidence and recommendations, SGLT2i and GLP1-RA were less likely to be prescribed to patients with pre-existing CVD, HF, and/or CKD, revealing opportunities to improve prescribing for patients with diabetes at high-risk for worsening cardiorenal complications.

Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study.

Background:Whether the combination of different blood pressure and arterial stiffness (AS) status is independently associated with diabetes has not been fully investigated so far. This study aimed at investigating the status of hypertension and AS in determining diabetes.Methods:This prospective cohort study included 11 156 participants from the Kailuan study. AS was measured by brachial-ankle pulse wave velocity. We compared the risk of diabetes between individuals with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS.Results:After a median follow-up of 6.16 years, diabetes occurred in 768 participants. Compared with ideal vascular function group, the highest risk of diabetes was observed in hypertension with elevated AS group (hazard ratio, 2.42 [95% CI, 1.93–3.03]), followed by normotension with elevated AS group (hazard ratio, 2.11 [95% CI, 1.68–2.66]), hypertension with normal AS group exhibited the lowest risk of diabetes (hazard ratio, 1.48 [95% CI, 1.08–2.02]). Multiple sensitivity and subgroup analyses yielded similar results. Furthermore, the additional of AS to a conventional model including traditional risk factors had a higher incremental effect on the predictive value for diabetes than the addition of hypertension (the C statistics was 0.707 versus 0.695; the integrated discrimination improvement was 0.65% versus 0.28%; net reclassification improvement was 40.48% versus 34.59%).Conclusions:Diabetes is associated with not only hypertension but also AS. Additionally, AS shows a better predictive ability than hypertension in predicting diabetes.

Management of patients with heart failure and type 2 diabetes

The management of patients with cardiometabolic diseases is particularly complex and involves multiple professionals. Cardiologists and diabetologists, the coordinators of this process, should cooperate in the implementation of a joint treatment and care plan. Based on these premises, a group formed by ARCA (Regional Association of Ambulatory Cardiologists) cardiologists and AMD (Association of Diabetes Physicians) diabetologists, operating in Campania, was set up to define the critical points and create shared diagnostic and therapeutic processes. The document reviews the current evidence and gathers the opinions of the group regarding the identification of patients at higher risk of diabetes and/or heart failure and the management of patients with a known diagnosis of diabetes mellitus and heart failure. PAROLE CHIAVE diabetes; heart failure; cardiovascular risk.

An adverse lipoprotein phenotype—hypertriglyceridaemic hyperapolipoprotein B—and the long-term risk of type 2 diabetes: a prospective, longitudinal, observational cohort study

This study examines the risk of new-onset diabetes in patients with hypertriglyceridaemic hyperapolipoprotein B (high triglycerides, high apolipoprotein B [apoB], low LDL cholesterol to apoB ratio, and low HDL cholesterol). The aim was to establish whether this lipoprotein phenotype identified a substantial group at high risk of developing diabetes over the next 20 years. In this prospective, longitudinal, observational cohort study, we used data from the Framingham Offspring cohort (recruited in Framingham, MA, USA). Participants were aged 40-69 years and free of diabetes and cardiovascular disease at a baseline examination done between April, 1987, and November, 1991, and were followed up until March, 2014. Cox proportional hazards regression with hierarchical adjustment for age and sex, waist circumference, and fasting blood glucose were used to model the relationship between each lipid marker and incident diabetes, as well as the relationship between hypertriglyceridaemic hyperapoB (defined as values greater than sample medians of triglycerides and apoB, and less than medians of HDL cholesterol and LDL cholesterol to apoB ratio) and incident diabetes. Of 3446 individuals aged 40-69 years who completed baseline examination, 2515 participants were eligible and included in all analyses. During median 21·1 years (IQR 11·1-23·1) of follow-up, 402 (16·0%) individuals developed diabetes. Age (p=0·032), waist circumference (p<0·0001), fasting blood glucose (p<0·0001), and natural logarithm-transformed triglycerides (p<0·0001) were associated with new-onset diabetes, as were apoB (p=0·0016), LDL cholesterol to apoB ratio (p=0·0018), and HDL cholesterol (p=0·0016) when added to this model. The age and sex-adjusted incidence of diabetes in the hypertriglyceridaemic hyperapoB group was 32·4% (95% CI 27·8-37·7) versus 5·5% (3·5-8·6) in the optimal lipid phenotype group and 15·5% (13·5-17·7) in the mixed lipid phenotype group. The fully adjusted hazard ratio, including glucose and waist circumference, for individuals with hypertriglyceridaemic hyperapoB was 3·30 (95% CI 2·06-5·30; p=0·0008) and for mixed lipid phenotype was 2·17 (1·38-3·40; p<0·0001) compared with those with the optimal lipid phenotype. Our findings suggest that individuals with hypertriglyceridaemic hyperapoB are at high risk of new-onset diabetes and might benefit from intensive measures to prevent diabetes. The association between this phenotype and incident diabetes is consistent with a pro-diabetic effect due to increased clearance of apoB particles from plasma, which could injure pancreatic islet cells. This mechanism might explain the increased risk of diabetes with statin therapy. Doggone Foundation.

Comparing the acceptability of total diet replacement and food-based low energy diets for type 2 diabetes remission amongst South Asians: a public and patient involvement activity

Background: With type 2 diabetes prevalence rising, low energy diets (total diet replacement and food-based low energy diets) are increasingly used to induce weight loss and achieve diabetes remission. The effectiveness of these diets has been primarily tested in the UK white population but not in the south Asian population at high risk of diabetes. Obtaining the opinion of members of the community on what would constitute a culturally acceptable diet is essential for successful interventions aiming to achieve diabetes remission in south Asians. Methods: We organised two patient and public involvement activities in the North West of England to understand views of people from the south Asian population on whether low energy diets (850 Kcal) in the form of total diet replacement or food-based meals, are acceptable dietary interventions to achieve type 2 diabetes remission. Results: Thirteen people, with either type 2 diabetes or having someone with diabetes in the family attended a virtual or a face-to-face meeting. Low energy total diet replacement in the form of soups and shakes was considered unacceptable, while there was a preference for a culturally tailored low energy food-based diet. Ready-made portion controlled catered meals were suggested as a likely approach to improve adherence. Conclusions: This work provided valuable insights to shape a future study looking at the feasibility of a catered meal low-energy dietary intervention to induce T2D remission in primary care within the south Asian population.

Prolonged Use of Proton Pump Inhibitors and Risk of Type 2 Diabetes: Results From a Large Population-Based Nested Case-Control Study.

ContextIt is still debated whether prolonged use of proton pump inhibitors (PPIs) might affect metabolic health.ObjectiveTo investigate the relationship between prolonged use of PPIs and the risk of developing diabetes.MethodsWe performed a case-control study nested into a cohort of 777 420 patients newly treated with PPIs between 2010 and 2015 in Lombardy, Italy. A total of 50 535 people diagnosed with diabetes until 2020 were matched with an equal number of controls that were randomly selected from the cohort members according to age, sex, and clinical status. Exposure to treatment with PPIs was assessed in case-control pairs based on time of therapy. A conditional logistic regression model was fitted to estimate the odds ratios and 95% CIs for the exposure-outcome association, after adjusting for several covariates. Sensitivity analyses were performed to evaluate the robustness of our findings.ResultsCompared with patients who used PPIs for < 8 weeks, higher odds of diabetes of 19% (95% CI, 15-24), 43% (38-49), and 56% (49-64) were observed among those who used PPIs for between 8 weeks and 6 months, 6 months and 2 years, and > 2 years, respectively. The results were consistent when analyses were stratified according to age, sex, and clinical profile, with higher odds ratios being found in younger patients and those with worse clinical complexity. Sensitivity analyses revealed that the association was consistent and robust.ConclusionsRegular and prolonged use of PPIs is associated with a higher risk of diabetes. Physicians should therefore avoid unnecessary prescription of this class of drugs, particularly for long-term use.

Associations of steps per day and step intensity with the risk of diabetes: the Hispanic Community Health Study / Study of Latinos (HCHS/SOL)

BackgroundHigher levels of moderate-to-vigorous physical activity have been associated with a lower risk of diabetes, but less is known about how daily step counts (steps/day) are associated with diabetes risk. Therefore, we examined the association of steps/day and step intensity with incident diabetes.MethodsWe included 6634 adults from the population-based prospective cohort Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (2008–2017). Cox proportional hazard models that accounted for complex survey design and sampling weights were used to estimate the association of baseline accelerometer-assessed steps/day and step intensity with 6-year risk of incident diabetes as hazard ratios (HR) and 95% confidence intervals (CI). We further examined whether the percent of intense steps at a given accumulation of steps/day was associated with diabetes risk, and if associations were modified by specific cohort characteristics.ResultsThe average age of cohort members was 39 years and 52% were female. Adults had an average of 8164 steps/day and spent 12 min/day in brisk ambulation (> 100 steps/min). Over 6 years of follow-up, there were 1115 cases of diabetes. There was a suggestive lower risk of diabetes with more steps/day– adults had a 2% lower risk per 1000 steps/day (HR = 0.98 (95% CI 0.95, 1.00)). Inverse associations between average steps/day and diabetes incidence were observed across many cohort characteristics, but most importantly among adults at high risk for diabetes – those who were older, or had obesity or prediabetes. Adults who accumulated 17 min/day in brisk ambulation compared to < 2 min/day had a 31% lower risk of diabetes (HR = 0.69 (95% CI 0.53, 0.89)). A greater percent of intense steps for a given accumulation of steps/day was associated with further risk reduction.ConclusionAdults who accumulate more daily steps may have a lower risk of diabetes. Accumulating more steps/day and greater step intensity appear to be important targets for preventing diabetes.

Cumulative Exposure to High γ-Glutamyl Transferase Level and Risk of Diabetes: A Nationwide Population-Based Study.

BackgroundElevated γ-glutamyl transferase (γ-GTP) level is associated with metabolic syndrome, impaired glucose tolerance, and insulin resistance, which are risk factors for type 2 diabetes. We aimed to investigate the association of cumulative exposure to high γ-GTP level with risk of diabetes.MethodsUsing nationally representative data from the Korean National Health Insurance system, 346,206 people who were free of diabetes and who underwent 5 consecutive health examinations from 2005 to 2009 were followed to the end of 2018. High γ-GTP level was defined as those in the highest quartile, and the number of exposures to high γ-GTP level ranged from 0 to 5. Hazard ratio (HR) and 95% confidence interval (CI) for diabetes were analyzed using the multivariable Cox proportional-hazards model.ResultsThe mean follow-up duration was 9.2±1.0 years, during which 15,183 (4.4%) patients developed diabetes. There was a linear increase in the incidence rate and the risk of diabetes with cumulative exposure to high γ-GTP level. After adjusting for possible confounders, the HR of diabetes in subjects with five consecutive high γ-GTP levels were 2.60 (95% CI, 2.47 to 2.73) in men and 3.05 (95% CI, 2.73 to 3.41) in women compared with those who never had a high γ-GTP level. Similar results were observed in various subgroup and sensitivity analyses.ConclusionThere was a linear relationship between cumulative exposure to high γ-GTP level and risk of diabetes. Monitoring and lowering γ-GTP level should be considered for prevention of diabetes in the general population.

Oral Glucose Tolerance Test in Patients with Cystic Fibrosis Compared to the Overweight and Obese: A Different Approach in Understanding the Results.

(1) Background: In cystic fibrosis (CF), the oral glucose tolerance test (OGTT) is recommended from 10 years old annually to screen and diagnose cystic fibrosis-related diabetes (CFRD). Alternative OGTT characteristics (glucose curve shape, time to glucose peak, one-hour glucose value, and three-hour glucose value with the new shape curve) were studied in other populations considered at high risk for diabetes; (2) Methods: The study analyses classical and alternative OGGT characteristics from 44 children (22 CF, 22 obese without CF), mean age: 12.9 ± 2.2 years evaluated in a single-center from Romania. (3) Results: In 59.1% of children with CF, the predominant OGTT pattern was: abnormal glucose metabolism or CFRD, with a monophasic curve shape, a late peak glucose level, and 1 h glucose ≥ 155 mg/dL, showing a very different pattern compared with sex and age-matched obese children. Statistical estimation agreement between the late glucose peak (K = 0.60; p = 0.005), the 1 h glucose ≥ 155 mg/dL during OGTT (K = 0.69, p = 0.001), and the classical method of interpretation was found. (4) Conclusions: Late peak glucose and 1 h glucose level ≥ 155 mg/dL during OGTT can be used for diagnosing the early glucose metabolism alteration in children with CF.

Twins in Guinea-Bissau have a 'thin-fat' body composition compared to singletons.

The 'thrifty phenotype' hypothesis proposed that fetal undernutrition increases risk of diabetes in later life. Undernourished low birthweight Indian babies are paradoxically more adipose compared to well-nourished European babies, and are at higher risk of diabetes in later life. Twin pregnancies are an example of in utero growth restrictive environment due to shared maternal nutrition. There are few studies of body composition in twins. We performed secondary analysis of anthropometric body composition of twins and singletons in Guinea-Bissau, an economically deprived African country.Anthropometric data were available on 7-34 year-old twins (n = 209, 97 males) and singletons (n = 182, 86 males) in the Guinea-Bissau Twin Registry at the Bandim Health Project. Twins had lower birthweight (2420 vs 3100 g, p < 0.001); and at follow-up, lower height (HAZ mean Z-score difference, -0.21, p = 0.055), weight (WAZ -0.73, p = 0.024) and BMI (BAZ -0.22, p = 0.079) compared to singletons but higher adiposity (skinfolds: +0.33 SD, p = 0.001). Twins also had higher fasting (+0.38 SD, p < 0.001) and 2-hour OGTT glucose concentrations (+0.29 SD, p < 0.05). Linear mixed-effect model accounting for intrapair correlations and interactions confirmed that twins were thinner but fatter across the age range. Data on maternal morbidity and prematurity were not available in this cohort.African populations are known to have a muscular (less adipose) body composition. Demonstration of a thin-fat phenotype in twins in a low socio-economic African country supports the thesis that it could be a manifestation of early life undernutrition and not exclusive to Indians. This phenotype could increase risk of diabetes and related conditions.