Risk Of Diabetes-related Complications Research Articles

Prediabetes and Diabetes Screening in Dental Care Settings: NHANES 2013 to 2016.

Introduction:Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted.Objectives:The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes.Methods:Data from 10,472 adults in the National Health and Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression.Results:A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test (Centers for Disease Control and Prevention), and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old.Conclusion:Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications.Knowledge Transfer Statement:Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being.

AdDIT Editorial comment—challenges in medication treatment of renal and cardiovascular diseases and risk factors in adolescents with type 1 diabetes

A large body of evidence revealed that compared with children and adolescents in the general population, those with type 1 diabetes mellitus (T1DM) are at excessive risk of diabetes related complications (1,2). Presence and long-term diabetes complications are known to increase cardiovascular (CV) morbidity and mortality in population with T1DM in which 26.1% of all deaths are associated with diabetes complications (3).

DEVOTE 5: Evaluating the Short-Term Cost-Utility of Insulin Degludec Versus Insulin Glargine U100 in Basal-Bolus Regimens for Type 2 Diabetes in the UK.

IntroductionThe aim of this study was to evaluate the short-term cost-utility of insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) for the treatment of type 2 diabetes in the basal–bolus subgroup of the head-to-head cardiovascular (CV) outcome trial, DEVOTE.MethodsA cost-utility analysis was conducted over a 2-year time horizon using a decision analytic model to compare costs in patients receiving once daily degludec or glargine U100, both as part of a basal–bolus regimen, in addition to standard care. Clinical outcomes and patient characteristics were taken exclusively from DEVOTE, whilst health-related quality of life utilities and UK-specific costs (expressed in 2016 GBP) were obtained from the literature. The analysis was conducted from the perspective of the National Health Service.ResultsDegludec was associated with mean cost savings of GBP 28.78 per patient relative to glargine U100 in patients with type 2 diabetes at high CV risk. Cost savings were driven by the reduction in risk of diabetes-related complications with degludec, which offset the higher treatment costs relative to glargine U100. Degludec was associated with a mean improvement of 0.0064 quality-adjusted life-years (QALYs) compared with glargine U100, with improvements driven predominantly by lower rates of severe hypoglycemia with degludec versus glargine U100. Improvements in quality-adjusted life expectancy combined with cost neutrality resulted in degludec being dominant over glargine U100. Sensitivity analyses demonstrated that the incremental cost-utility ratio was stable to variations in the majority of model inputs.ConclusionThe present short-term modeling analysis found that for the basal–bolus subgroup of patients in DEVOTE, with a high risk of CV events, degludec was cost neutral (no additional costs) compared with glargine U100 over a 2-year time horizon in the UK setting. Furthermore, there were QALY gains with degludec, particularly due to the reduction in the risk of severe hypoglycemia.FundingNovo Nordisk A/S.Trial RegistrationClinicalTrials.gov identifier, NCT01959529.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0430-4) contains supplementary material, which is available to authorized users.

Haemoglobin glycation index and risk for diabetes-related complications in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial

Aims/hypothesisPrevious studies have suggested that the haemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications in individuals with type 1 and type 2 diabetes. We investigated whether HGI was a predictor of adverse outcomes of intensive glucose lowering and of diabetes-related complications in general, using data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.MethodsWe studied participants in the ADVANCE trial with data available for baseline HbA1c and fasting plasma glucose (FPG) (n = 11,083). HGI is the difference between observed HbA1c and HbA1c predicted from a simple linear regression of HbA1c on FPG. Using Cox regression, we investigated the association between HGI, both categorised and continuous, and adverse outcomes, considering treatment allocation (intensive or standard glucose control) and compared prediction of HGI and HbA1c.ResultsIntensive glucose control lowered mortality risk in individuals with high HGI only (HR 0.74 [95% CI 0.61, 0.91]; p = 0.003), while there was no difference in the effect of intensive treatment on mortality in those with high HbA1c. Irrespective of treatment allocation, every SD increase in HGI was associated with a significant risk increase of 14–17% for macrovascular and microvascular disease and mortality. However, when adjusted for identical covariates, HbA1c was a stronger predictor of these outcomes than HGI.Conclusions/interpretationHGI predicts risk for complications in ADVANCE participants, irrespective of treatment allocation, but no better than HbA1c. Individuals with high HGI have a lower risk for mortality when on intensive treatment. Given the discordant results and uncertain relevance beyond HbA1c, clinical use of HGI in type 2 diabetes cannot currently be recommended.

Self-monitoring of blood glucose: Is it justified?

Despite the availability of robust evidence demonstrating that lowering glycaemic levels reduces the risks of diabetes-related complications, there has been little improvement in recent years in glycaemic control among individuals with diabetes in Europe and the US. Although widely used, there has been considerable controversy surrounding the role of self-monitoring of blood glucose (SMBG) as a means of achieving glycaemic control. This has resulted in a re-consideration of the prescription of blood glucose strips especially in the current climate of health care cost-containment. Existing clinical recommendations lack specific guidance to patients and health professionals regarding SMBG practice intensity and frequency, particularly for those not treated with insulin. Previous studies of the association between SMBG and glycaemic control found often weak, and sometimes conflicting, evidence. More rigorous longitudinal studies are needed to examine the role of SMBG with special attention to the unique needs of patients using different diabetes treatments, within special clinical sub-populations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG are also needed to capture variability in glycaemic patterns in order to facilitate more specific guideline development.

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

Background and aimsTo study trends of barriers to receiving recommended eye care among subjects with diabetes aged 20–81 years in northeast Germany. Methods and resultsWe analyzed population-based data from two repeated cross-sectional surveys conducted in 1997–2001 and 2008–2012 (Ns of 4308 and 4402). Andersen's Behavioral Model of Health Services Utilization was used to identify individual-level demographic, financial and health-related barriers to annual eye-care utilization in subjects with a self-reported physician's diabetes and to examine population trends in these barriers. The prevalence of diabetes increased from 6.5% to 11.4%. The prevalence of annual eye-care utilization among persons with diabetes decreased from 69.4% to 56.0% (adjusted relative risk = 0.77, p < 0.001). The decline of eye care utilization over the past decade in eye-care use was more pronounced in groups at risk for diabetes-related complications (i.e., lower socio–economic status, >5 years since diagnosis of diabetes, poor glycemic control, obesity, smoking, lack of physical activity, co-existing diseases). We identified relevant predictors of missed annual eye-care use among diabetics. ConclusionThe increase of diabetes prevalence and downward trend of eye-care visits at the recommended level call for development, implementation and evaluation of continued efforts to improve access to eye specialists, particularly among those with poor diabetic control, co-existing diabetic complications, and comorbidities.

Promoting smoking cessation as an essential part of diabetes care

Smoking can increase the risks of diabetes-related complications. Emma Wilkinson explains the effects of smoking on diabetes patients and how practice nurses can support them to stop

Physiological and glycemic responses following acute ingestion of a popular functional drink in patients with type 1 diabetes.

To determine the physiologic and glycemic responses to energy drinks by people with type 1 diabetes. In a double-blind randomized comparison of Red Bull, Red Bull Light and a control drink, 16 adults (11 females; average age 31.5 years) with type 1 diabetes and an average glycated hemoglobin (A1C) of 68 mmol/mol were given 750 mL of Red Bull, Red Bull Light and Suso Orange in a random order. During 3 hours, comparisons were made of blood pressure and blood glucose and caffeine levels; 4-choice reaction time (4CRT) and a digit symbol substitution test were used to assess cognitive performance. Mood was measured using the University of Wales Institute of Science and Technology mood adjective checklist. Consumption of Red Bull and Suso Orange were associated with an early sustained rise in blood glucose, which was augmented by Red Bull (p=0.02). A transient rise in systolic blood pressure (115.9mm Hg to 124.5 mm Hg and 115.8 mm Hg to 125.9 mm Hg, respectively, both p<0.01) followed consumption of Red Bull and Red Bull Light. There were less consistent changes in diastolic blood pressure and heart rate. Consumption of both energy drinks resulted in modest improvement in performance on the digit substitution test but had no effect on 4CRT. Energy arousal and hedonic tone were influenced transiently only, following the consumption of Suso Orange. Consumption of energy drinks can result in a significant carbohydrate load for people with diabetes, and patients must consider the need to adjust their insulin regimens appropriately. Caffeine-containing energy drinks can cause a rise in blood pressure, which may be an important consideration for individuals at risk for diabetes-related complications.

29. Excessive HbA1c Testing among Patients with Controlled Non-insulin-requiring Type 2 Diabetes (1154-P)

Glycemic control in the management of diabetes has been correlated with reduced risk of diabetes-related complications, and health care providers and policy makers have promoted multiple processes to help achieve and maintain glycosylated hemoglobin (HbA1c) targets.

Identification and prediction of group-based glycemic control trajectories during the transition to adolescence.

To identify trajectories of glycemic control over a period of 3 years in a pediatric sample of youth diagnosed with Type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family level baseline predictors of glycemic control group membership. This multisite, prospective study included 239 children and adolescents (ages 9-11 years at baseline) diagnosed with Type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at 6-month intervals over a period of 3 years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and 3 trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high-risk group membership. These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.

A Community-Based Pilot Study of a Diabetes Pharmacist Intervention in Latinos: Impact on Weight and Hemoglobin A1c

Type 2 diabetes disproportionately affects Latinos increasing their risk of diabetes-related complications. This study used a randomized controlled design with a community-based approach to evaluate the impact of a culturally tailored pharmacist intervention on clinical outcomes in Latino diabetics. The intervention included a focused discussion and two individual pharmacist counseling sessions on medication, nutrition, exercise, and self-care to promote behavior changes. Sessions were culturally adapted for language, diet, family participation, and cultural beliefs. Clinical outcomes were measured at baseline and three months. Nineteen intervention and 24 control participants completed the study. Mean BMI reduction was greater for intervention than for control group participants (-0.73 ± 0.07 kg/m2 versus + 0.37 ± 0.02 kg/m2 p<.009 respectively). Hemoglobin A1c was significantly reduced by 0.93 ± 0.45% in the intervention group only. There was no significant difference in blood glucose, blood pressure, or lipid levels. An innovative culturally-sensitive pharmacist intervention improved selected clinical outcomes among Latino diabetics.

Potential coeliac disease in Type 1 diabetes mellitus: Does a positive antibody lead to increased complications?

Background and aimsCoeliac disease (CD) is more common in people with Type 1 diabetes and is associated with poorer glycaemic control, lipid profiles, nephropathy and retinopathy. Potential CD (positive serology but normal duodenal biopsy) is associated with neuropathy but patients with coexisting Type 1 diabetes were excluded. The aim was to determine whether potential CD is associated with increased microvascular complications in patients with Type 1 diabetes. Methods and resultsFour groups were recruited; 1) patients with Type 1 diabetes and potential CD, 2) patients with Type 1 diabetes and newly identified CD, 3) patients with Type 1 diabetes alone and 4) patients with CD alone. Glycaemic control, quality of life, lipid profile and microvascular complication rates were examined.As many as 76 individuals were included in the study: 22 in group 1, 14 in group 2, 24 in group 3 and 16 in group 4. There were no differences in age, gender, BMI and diabetes duration between the groups. Patients in group 1 had significantly lower total cholesterol compared to group 3 (p = 0.003) but higher than group 2 (p = 0.027). There were no significant differences in HbA1c, HDL cholesterol, cholesterol:HDL ratio, creatinine, quality of life scores or prevalence of neuropathy between individuals in group 1 and the other groups. ConclusionsThis is the first study to assess the effects of potential CD in patients with Type 1 diabetes. It appears that an enteropathy is required as well as antibody positivity in order to increase the risk of diabetes related complications. This pilot data requires further longitudinal validation.

Assessment of depression in people with diabetes attending outpatient clinics for the treatment of foot ulceration

Background: People with diabetes and foot ulceration experience more depressed mood particularly when healing does not occur after prolonged treatment. Those who have depression and diabetes have poorer adherence to selfcare or treatment regimes, poor glycaemic control along with a greater risk of diabetes related complications and mortality. Screening for depression has been shown to be effective to determining the severity of depression as well as the type of treatment required. Methods: The study required participants to complete a validated self-reporting 9 item Patient Health Questionnaire (PHQ) that provides a diagnosis of major depressive syndrome and continuous severity score. Participants were classified in the depressed category if they had PHQ score ≥5. Group differences were examined using chisquare for categorical variables and t-tests for continuous variables. Results: A higher proportion of participants had diabetes for >10 years, however no other demographic variables were associated with depression. Of the 60 participants, 31 (51.7%) were categorised as depressed, with 10 (17%) having had a prior diagnosis of depression and 21 (35%) participants had unrecognised cases of depression. Conclusion: This study demonstrated the prevalence of depression in people with diabetes and the often hidden impact it has in managing diabetes foot ulceration.

PHS10 HbA1c Testing Frequency in Primary Care Diabetes Patients in Germany and in the UK

The HbA1c test is a lab test, which reveals average blood glucose over a period of two to three months. Tight blood glucose control could reduce the risk of diabetes related complications. Expert opinion recommends 6-monthly HbA1c testing in stable and 3-monthly testing in type 1 and unstable type 2 diabetes patients. Moreover, HbA1c should be measured more frequently for patinets whose therapy is changing. The aim of this study was to measure the quality of diabetic care as indicated by HbA1c testing frequency and to compare the frequency of HbA1c testing in primary care diabetes patients in Germany (DE) and UK. Computerized data on lab values (IMS Disease Analyzer Multi-Country Solution, 01/2011-12/2011) from general medicine practices throughout DE and UK have been analysed and compared. This data warehouse includes the complete diagnosis and therapy relevant information on diabetes patients in several countries. 159,031 T2D patients and 1,910 T1D patients from 1,001 GP practices in Germany and 34,375 T2D patients and 1.506 T1D patients from 104 GP practices in UK were included. 53.1% of T2D patients and 42.0% of T1D patients in Germany, 87.0% of T2D patients and 69.1% of T1D patients in UK had at least one HbA1c testing in the observation time. In Germany there were 1.5 HbA1c tests per year in T2D patients and 1.1 tests per year in T1D patients. In UK T2D patients have in average 3.1, T1D patients 2.0 HbA1c tests in 2011. The study revealed that HbA1c testing was underused in both T1D and T2D patients. Improvement is needed in the utilization of HbA1c testing among most diabetes patients in Germany and UK. HbA1c tests should be obtained routinely in all persons with diabetes, for the blood glucose control documentation and as part of continuing care.

Anxiety and risk of type 2 diabetes: Evidence from the Baltimore Epidemiologic Catchment Area Study

ObjectiveDepression is increasingly recognized as a risk factor for type 2 diabetes, and is also commonly comorbid with anxiety. However, few studies have examined whether anxiety is predictive of diabetes risk. The objectives of this study are to examine the prospective relationship between anxiety disorders (generalized anxiety disorder, panic disorder, social phobia, and agoraphobia) and risk of type 2 diabetes over an 11-year period, and to investigate the association between anxiety and risk of diabetes-related complications among those with prevalent type 2 diabetes. MethodsData come from the 1993/6 and 2004/5 waves of the Baltimore Epidemiologic Catchment Area Study (N=1920), a population-based prospective cohort. Anxiety disorders were assessed using the Diagnostic Interview Schedule. The prospective association between anxiety and incident type 2 diabetes was evaluated using a series of nested multivariable logistic regression models. ResultsAt baseline, 315 participants (21.8%) had an anxiety disorder. The relationship between anxiety and risk of developing type 2 diabetes was not statistically significant after controlling for demographic characteristics (Odds Ratio (OR): 1.28, 95% Confidence Interval (CI): 0.75, 2.18). There was no relationship between anxiety and diabetes risk after controlling for health behaviors and depression status (OR: 1.00, 95% CI: 0.53, 1.89). There was no significant relationship between anxiety and development of diabetes-related complications among those with prevalent type 2 diabetes (OR: 2.02, 95% CI: 0.61, 6.74). ConclusionAnxiety disorders are not associated with increased risk of type 2 diabetes or risk of diabetes complications among those who have diabetes.

Diabetes Treatment Options: One Size Does NOT Fit All

I wake up every day wondering about the challenges the day will hold. I say this in the most positive and excited manner. In 2012, there are numerous treatments for diabetes care. As a health care provider, I am challenged to stay current in my knowledge and to understand how best to incorporate the various therapies into the plan of care for each of my patients. How do I cope? As a nurse practitioner in the diabetes world, I see my role as providing support to my patients to help them achieve the best possible treatment outcomes and reduce their risk of diabetes-related complications. When recommending treatment options, I strive to keep in mind the importance of the therapy, the unique characteristics of the patient, and the impact the therapy may have on the patient's quality of life. My practice model relies on the development of an open and honest relationship with my patients that includes the expectation of frequently verbalized reality checks. I strive to provide honest answers about diabetes care, available treatments, accurate interpretation and application of research findings, and long-term views of diabetes outcomes to help the person in front of me understand the options. In addition, I rely on honesty from my patients regarding what they are willing and able to do for their diabetes care and how they will proceed upon leaving my office to go …

Insulin sensitivity in response to a single resistance exercise session in apparently healthy individuals.

Regular resistance exercise completed for a number of weeks has been shown to increase insulin sensitivity and reduce the risk of diabetes-related complications. However, the acute responses to resistance exercise have not been adequately investigated in relation to training frequency. To investigate the changes to insulin sensitivity in apparently healthy individuals following a single session of unaccustomed resistance exercise. Ten sedentary, apparently healthy individuals performed a baseline oral glucose tolerance test and maximal strength testing. Participants then performed a single session of moderate-high intensity resistance exercise which was followed by 4 consecutive days of oral glucose tolerance testing, for which participants replicated their initial diet. Mean estimated insulin sensitivity change scores from baseline values and their 95% confidence intervals were compared to the previously determined values for a clinically meaningful change. Two participants were identified as having hyperinsulinemia and their data were therefore removed from the main analysis. There was a clinically meaningful increase in insulin response (mean >7237 pmol·l⁻¹·120 min⁻¹) on all days following the exercise session and a clinically meaningful increase in glucose response (mean >81 mmol·l⁻¹·120 min⁻¹) on only the 3rd day following exercise. These changes suggest a potentially adverse short-term effect. Additionally, the 2 individuals with hyperinsulinemia displayed more extreme results. These results suggest that insulin sensitivity may be impaired following a single session of unaccustomed resistance exercise for approximately 4 days in healthy untrained, older individuals. Further research is required for individuals with hyperinsulinemia.

Early remission of type 2 diabetes mellitus by laparoscopic ileal transposition with sleeve gastrectomy surgery in 23–35 BMI patients

To assess the efficacy of ileal transposition with sleeve gastrectomy (SGIT) surgery in remission of Type 2 Diabetes Mellitus (T2DM) in patients with 23–35 BMI. Diabetes is considered a life style disease. Despite medications and lifestyle changes, (HbA1c) - remains > 7 in 56 % of diabetics, predisposing them to high risk of diabetes related complications. Bariatric surgery results in remission of diabetes in over 84% patients with BMI > 35 m2s/m2. Based on hindgut hypothesis suggesting role of incretins like GLP-1, early trials of ileal interposition surgery have displayed consistent HbA1c levels below 7 in over 80% patients with BMI > 30 m2/m2. In developing countries majority of T2DM patients are not morbidly obese and surgical procedures are to be evaluated for their efficacy in this group. In this study we have assessed the efficacy of ileal transposition with sleeve gastrectomy (SGIT) in 23–35 BMI T2DM patients. Selected T2DM patients [HbA1c > 7, C Peptide > -1 ng/ml] underwent Lap SGIT by a single surgeon. Data of first five patients with minimum 6 months follow up was analyzed for glycemic control and altered need for medications. Data were analyzed using SPSS (SPSS release 16; SPSS Inc. Chicago). The study target (HbA1c < 7) was achieved in 60% of patients within 1 month and in 100% of patients within 6 months. Requirement of medications reduced significantly within 6 months and their HbA1c levels reduced from 9.65% to 6.22%. Laparoscopic SGIT may represent a new paradigm for the treatment of T2DM even in non morbidly obese patients.

P-146: Early resolution of type 2 diabetes mellitus BY laparoscopic ileal transposition with sleeve gastrectomy surgery in 23 – 35 bmi kg/m 2 patients – a novel therapy

Type 2 Diabetes Mellitus (T2DM) is considered a life style disease. 56% diabetic patients with HbA1c above 7 are at high risk of diabetes related complications. Bariatric surgery results in diabetes resolution in over 84% patients. Based on hindgut hypothesis suggesting role of incretins like GLP-1, early trials of ileal interposition surgery have displayed consistent HbA1c levels below 7 in over 80% patients with > 30 kg/m2 BMI. In developing countries majority of T2DM patients are not morbidly obese and surgical procedures are to be evaluated for their efficacy in this group. In this study we have assessed the efficacy of ileal transposition with Laparoscopic Sleeve Gastrectomy (LSG) in 23 – 35 kg/m2 BMI T2DM patients.

Psychosocial Issues That Affect Youth with Diabetes

Type 1 diabetes, one of the most common diseases of childhood, requires adherence to a complicated regimen which is often times difficult to manage resulting in stress for children, siblings, and caregivers. Many children with diabetes are nonadherent, likely due to the difficulty and complexity of the tasks required, and, thus, are at greater risk for diabetes related complications. For health care educators, it is important to understand the various psychosocial issues that affect adherence and adjustment to diabetes. This article will discuss these issues, including coping with a new diagnosis, school factors, regimen adherence and family variable and parenting strategies. Recommendations for health care educators are also discussed.