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American Diabetes Association

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• Racial Differences in Association of Elevated Interleukin-18 Levels With Type 2 Diabetes: The Atherosclerosis Risk in Communities Study.

  Authors: Smita I Negi, James S Pankow, Karl Fernstrom, Ron C Hoogeveen, Na Zhu, David Couper, Maria I Schmidt, Bruce B Duncan, Christie M Ballantyne

  Diabetes care.

  OBJECTIVEElevated plasma interleukin-18 (IL-18) has been linked to onset of diabetes mellitus (DM) and its complications. However, so far this association has been shown only in predominantly whiteOBJECTIVEElevated plasma interleukin-18 (IL-18) has been linked to onset of diabetes mellitus (DM) and its complications. However, so far this association has been shown only in predominantly white populations. We examined IL-18 levels and their association with incident DM in a racially heterogeneous population.RESEARCH DESIGN AND METHODSIn a nested case-cohort design representing a 9-year follow-up of 9,740 middle-aged, initially healthy, nondiabetic white and African American participants of the Atherosclerosis Risk in Communities study, we selected and measured analytes on race-stratified (50% white, 50% African American) random samples of both cases of incident diabetes (n = 548) and eligible members of the full cohort (n = 536).RESULTSBaseline IL-18 levels were significantly higher in white participants compared with African American participants (P < 0.001). Although white participants in the fourth (versus first) quartile of IL-18 levels had a significant hazard ratio (HR) for developing DM (HR: 2.1, 95% CI: 1.3-3.4), after adjustment for age, sex, and study center, no difference was seen among African Americans (HR: 1.0, 95% CI: 0.6-1.7). Unlike those in African Americans, IL-18 levels in whites had a significant correlation with age (P < 0.01); anthropometric characteristics such as waist circumference (P < 0.001), height (P = 0.04), waist-to-hip ratio (P < 0.001), and BMI (P < 0.01); and total (P < 0.001) and high-molecular-weight (P < 0.001) adiponectin.CONCLUSIONSThere are racial differences in levels of IL-18 and the association of IL-18 with risk factors and incident type 2 DM. In addition, there seems to be a complex interplay of inflammation and adiposity in the development of DM.

• Meat Consumption and Its Association With C-Reactive Protein and Incident Type 2 Diabetes: The Rotterdam Study.

  Authors: Geertruida J van Woudenbergh, Anneleen Kuijsten, Basia Tigcheler, Eric J G Sijbrands, Frank J A van Rooij, Albert Hofman, Jacqueline C M Witteman, Edith J M Feskens

  Diabetes care.

  OBJECTIVETo investigate whether intake of different types of meat is associated with circulating C-reactive protein (CRP) and risk of type 2 diabetes in a prospective cohort study.RESEARCH DESIGN ANDOBJECTIVETo investigate whether intake of different types of meat is associated with circulating C-reactive protein (CRP) and risk of type 2 diabetes in a prospective cohort study.RESEARCH DESIGN AND METHODSOur analysis included 4,366 Dutch participants who did not have diabetes at baseline. During a median follow-up period of 12.4 years, 456 diabetes cases were confirmed. Intake of red meat, processed meat, and poultry was derived from a food frequency questionnaire, and their association with serum high-sensitivity CRP was examined cross-sectionally using linear regression models. Their association with risk of type 2 diabetes was examined using multivariate Cox proportional hazards model, including age, sex, family history of diabetes, and lifestyle and dietary factors.RESULTSAn increment of 50 g of processed meat was associated with increased CRP concentration (β(processed meat) = 0.12; P = 0.01), whereas intake of red meat and poultry was not. When comparing the highest to the lowest category of meat intake with respect to diabetes incidence, the adjusted relative risks were as follows: for red meat (1.42 [95% CI 1.06-1.91]), for processed meat (1.87 [1.26-2.78]), and for poultry (0.95 [0.74-1.22]). Additional analysis showed that the associations were not affected appreciably after inclusion of CRP into the model. After adjustment for BMI, however, the association for red meat attenuated to 1.18 (0.88-1.59).CONCLUSIONSIntake of processed meat is associated with higher risk of type 2 diabetes. It appears unlikely that CRP mediates this association.

• Association of Adiposity Trajectories With Insulin Sensitivity and Glycemic Deterioration: A longitudinal study of rural Chinese twin adults.

  Authors: Rong Liu, Wendy J Brickman, Katherine K Christoffel, Xin Liu, Guoying Wang, Lester Arguelles, Shanchun Zhang, Donald Zimmerman, Binyan Wang, Xiping Xu, Zhiping Li, Houxun Xing, Xiaobin Wang

  Diabetes care.

  OBJECTIVETo evaluate associations between adiposity trajectories over time and insulin sensitivity and glucose deterioration in a Chinese twin cohort.RESEARCH DESIGN AND METHODSThis study focused onOBJECTIVETo evaluate associations between adiposity trajectories over time and insulin sensitivity and glucose deterioration in a Chinese twin cohort.RESEARCH DESIGN AND METHODSThis study focused on 341 males and 292 females aged 20-50 years at baseline who had physical clinical examinations and oral glucose tolerance test at two time points with an average of 6 years apart. BMI, waist circumference, percent body fat (PBF), and percent trunk fat (PTF) trajectories were classified into five track groups based on age- and sex-specific tertiles at each visit. We calculated the odds of the insulin sensitivity index((0,120)) [ISI((0.120))] or glycemic deterioration at follow-up among five defined trajectories (tertile(baseline) → tertile(follow-up)) using generalized estimate equation models. Additionally, we applied structural equation models to examine genetic and environmental influences on adiposity, adiposity change over time (ACO), ISI((0,120)), and the interrelationships among them.RESULTSParticipants with stable adiposity (BMI, waist circumference, PBF, and PTF) in the highest tertile or shifting to the highest tertile tended to have the lowest ISI((0,120)) at follow-up or experience glycemic deterioration. Genetic factors exerted the major influence on adiposity, but environmental factors unique to each twin contributed more strongly to ISI and ACO. Correlations between adiposity/ACO and insulin sensitivity were mainly due to environmental influences.CONCLUSIONSWhen adiposity stays or becomes high, insulin sensitivity falls and risk of glycemic deterioration rises. Additionally, we found that genetic factors exerted the major influence on adiposity, while environmental factors played the principal role for ACO and insulin sensitivity.

• Role of Muscle Mass and Muscle Quality in the Association Between Diabetes and Gait Speed.

  Authors: Stefano Volpato, Lara Bianchi, Fulvio Lauretani, Fabrizio Lauretani, Stefania Bandinelli, Jack M Guralnik, Giovanni Zuliani, Luigi Ferrucci

  Diabetes care.

  OBJECTIVEOlder people with type 2 diabetes are at high risk of mobility disability. We investigated the association of diabetes with lower-limb muscle mass and muscle quality to verify whetherOBJECTIVEOlder people with type 2 diabetes are at high risk of mobility disability. We investigated the association of diabetes with lower-limb muscle mass and muscle quality to verify whether diabetes-related muscle impairments mediate the association between diabetes and low walking speed.RESEARCH DESIGN AND METHODSWe performed a cross-sectional analysis of 835 participants (65 years old and older) enrolled in the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) population-based study. Total, muscular, and fat cross-sectional areas of the calf and relative muscle density were measured using peripheral quantitative computerized tomography. Indicators of muscle performance included knee extension torque, ankle plantar flexion and dorsiflexion strength, lower-extremity muscle power, and ankle muscle quality (ratio of ankle strength to the muscle area [kilograms per centimeters squared]). Gait performance was assessed by 4- and 400-m walking speed. Diabetes was ascertained by standard American Diabetes Association criteria.RESULTSPrevalence of diabetes was 11.4%. After adjustment for age and sex, participants with diabetes had lower muscle density, knee and ankle strength, and muscle power and worse muscle quality (all P < 0.05). Diabetic participants were also slower on both 4-m (β: -0.115 ± 0.024 m/s, P < 0.001) and 400-m (β:-0.053 ± 0.023 m/s, P < 0.05) walking tests. In multivariable linear regression models, lower-limb muscle characteristics accounted for 24.3 and 15.1% of walking speed difference comparing diabetic and nondiabetic subjects in the 4- and 400-m walks, respectively.CONCLUSIONSIn older persons, diabetes is associated with reduced muscle strength and worse muscle quality. These impairments are important contributors of walking limitations related to diabetes.

• Analysis of Glucose Responses to Automated Insulin Suspension With Sensor-Augmented Pump Therapy.

  Authors: Trang T Ly, Jennifer A Nicholas, Adam Retterath, Elizabeth A Davis, Timothy W Jones

  Diabetes care.

  OBJECTIVEThe advent of sensor-augmented pump therapy with a low-glucose suspend (LGS) function (Medtronic Paradigm Veo System), allowing insulin to be automatically suspended for up to 2 h whenOBJECTIVEThe advent of sensor-augmented pump therapy with a low-glucose suspend (LGS) function (Medtronic Paradigm Veo System), allowing insulin to be automatically suspended for up to 2 h when sensor glucose falls below a preset threshold, has the potential to reduce the duration of hypoglycemia. In this report, we analyzed blood glucose profiles following a full 2-h insulin suspension activated by the LGS function, as well as examined different patterns of use among patients.RESEARCH DESIGN AND METHODSData from a cohort of participants using the Veo system for up to 6 months were analyzed to determine the time and duration of insulin suspension activated by the LGS function. We further evaluated overnight suspend events with no patient response occurring prior to 3:00 a.m., which allowed us to determine the pattern of sensor glucose values with no patient intervention during and after the period of insulin suspension.RESULTSThere were 3,128 LGS events during the 2,493 days evaluated. The median duration was 11.2 min, and 36% of events occurred overnight. There were 126 full 2-h suspend events that occurred overnight with no patient response, occurring before 3:00 a.m. For these events, the mean sensor glucose at the end of the 2-h suspend period was 99 ± 6 mg/dL ([means ± SE] 5.5 ± 0.3 mmol/L). The mean sensor glucose 2 h after insulin delivery resumed was 155 ± 10 mg/dL (8.6 ± 0.6 mmol/L). There were no episodes of severe hypoglycemia or diabetic ketoacidosis.CONCLUSIONSAnalyses of sensor glucose patterns following insulin suspension activated by LGS suggest that this technology is safe and unlikely to be associated with adverse outcomes.

• Severe Hypoglycemia and Cardiovascular Disease Incidence in Type 1 Diabetes: The EURODIAB Prospective Complications Study.

  Authors: Gabriella Gruden, Federica Barutta, Nish Chaturvedi, Casper Schalkwijk, Coen D Stehouwer, Daniel R Witte, John H Fuller, Paolo Cavallo Perin, Graziella Bruno

  Diabetes care.

  OBJECTIVEFrequent episodes of severe hypoglycemia may increase the risk of cardiovascular disease (CVD) in people with diabetes. Our aim was to study the relationship between severe hypoglycemicOBJECTIVEFrequent episodes of severe hypoglycemia may increase the risk of cardiovascular disease (CVD) in people with diabetes. Our aim was to study the relationship between severe hypoglycemic episodes and CVD incidence in subjects with type 1 diabetes, and further, to assess if markers of inflammation/endothelial injury were enhanced in individuals who experienced hypoglycemic episodes.RESEARCH DESIGN AND METHODSThe prospective study included 2,181 type 1 diabetic patients from the EURODIAB Prospective Complications Study. At baseline, frequency of self-reported severe hypoglycemia, defined as episodes serious enough to require the help of another person, was assessed based on responses to a patient questionnaire. Both fatal/nonfatal CVD was assessed 7.3 years after baseline examination. At the follow-up visit, data on both severe and nonsevere hypoglycemic episodes in the previous year were collected through a questionnaire and markers of inflammation/stress response/endothelial injury measured by enzyme-linked immunosorbent assays in the 531 subjects of the nested case-control study, including 363 case subjects with one or more complications of diabetes and 168 control subjects with no evidence of any complication.RESULTSDuring the follow-up period, 176 patients had incident CVD. Logistic regression analysis showed that severe hypoglycemia at the baseline examination was not associated with incidence of CVD (adjusted odds ratios [95% CI]: one to two episodes, 0.87 [0.55-1.37]; three or more episodes, 1.09 [0.68-1.75]). Furthermore, follow-up serum levels of markers of endothelial damage/inflammation were not cross-sectionally associated with the frequency of hypoglycemic episodes.CONCLUSIONSTaken together our data do not support the hypothesis that in type 1 diabetes, severe hypoglycemia increases the risk of CVD.

• Sequential Intensification of Metformin Treatment in Type 2 Diabetes With Liraglutide Followed by Randomized Addition of Basal Insulin Prompted by A1C Targets.

  Authors: J Hans Devries, Stephen C Bain, Helena W Rodbard, Jochen Seufert, David D'Alessio, Anne B Thomsen, Marcin Zychma, Julio Rosenstock

  Diabetes care.

  OBJECTIVEWe evaluated the addition of liraglutide to metformin in type 2 diabetes followed by intensification with basal insulin (detemir) if glycated hemoglobin (A1C) ≥7%.RESEARCH DESIGN ANDOBJECTIVEWe evaluated the addition of liraglutide to metformin in type 2 diabetes followed by intensification with basal insulin (detemir) if glycated hemoglobin (A1C) ≥7%.RESEARCH DESIGN AND METHODSIn 988 participants from North America and Europe uncontrolled on metformin ± sulfonylurea, sulfonylurea was discontinued and liraglutide 1.8 mg/day added for 12 weeks (run-in). Subsequently, those with A1C ≥7% were randomized 1:1 to 26 weeks' open-label addition of insulin detemir to metformin + liraglutide (n = 162) or continuation without insulin detemir (n = 161). Patients achieving A1C <7% continued unchanged treatment (observational arm). The primary end point was A1C change between randomized groups.RESULTSOf 821 participants completing the run-in, 61% (n = 498) achieved A1C <7% (mean change -1.3% from 7.7% at start), whereas 39% (n = 323) did not (-0.6% from 8.3% at start). During run-in, 167 of 988 (17%) withdrew; 46% of these due to gastrointestinal adverse events. At week 26, A1C decreased further, by 0.5% (from 7.6% at randomization) with insulin detemir (n = 162) versus 0.02% increase without insulin detemir (n = 157) to 7.1 and 7.5%, respectively (estimated treatment difference -0.52 [95% CI -0.68 to -0.36]; P < 0.0001). Forty-three percent of participants with insulin detemir versus 17% without reached A1C <7%. Mean weight decreased by 3.5 kg during run-in, then by 0.16 kg with insulin detemir or 0.95 kg without insulin detemir. In the randomized phase, no major hypoglycemia occurred and minor hypoglycemia rates were 0.286 and 0.029 events per participant-year with and without insulin detemir (9.2 vs. 1.3%).CONCLUSIONSSupplementation of metformin with liraglutide and then insulin detemir was well tolerated in the majority of patients, with good glycemic control, sustained weight loss, and very low hypoglycemia rates.

• Effect of Intensive Versus Standard Blood Pressure Control on Depression and Health-Related Quality of Life in Type 2 Diabetes: The ACCORD trial.

  Authors: Patrick J O'Connor, K M Venkat Narayan, Roger Anderson, Patricia Feeney, Larry Fine, Mohammed K Ali, Debra L Simmons, Don G Hire, Joann M Sperl-Hillen, Lois Anne Katz, Karen L Margolis, Mark D Sullivan

  Diabetes care.

  OBJECTIVEWe tested the hypothesis that intensive (systolic blood pressure [SBP] <120 mmHg) rather than standard (SBP 130-139 mmHg) blood pressure (BP) control improves health-related quality of lifeOBJECTIVEWe tested the hypothesis that intensive (systolic blood pressure [SBP] <120 mmHg) rather than standard (SBP 130-139 mmHg) blood pressure (BP) control improves health-related quality of life (HRQL) in those with type 2 diabetes.RESEARCH DESIGN AND METHODSSubjects were 1,028 ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial HRQL substudy participants who completed baseline and one or more 12-, 36-, or 48-month HRQL evaluations. Multivariable linear regression assessed impact of BP treatment assignment on change in HRQL.RESULTSOver 4.0 years of follow-up, no significant differences occurred in five of six HRQL measures. Those assigned to intensive (vs. standard) BP control had statistically significant worsening of the Medical Outcomes Study 36-item short-form health survey (SF36) physical component scores (-0.8 vs. -0.2; P = 0.02), but magnitude of change was not clinically significant. Findings persisted across all prespecified subgroups.CONCLUSIONSIntensive BP control in the ACCORD trial did not have a clinically significant impact, either positive or negative, on depression or patient-reported HRQL.

• Plasma Fatty Acid-Binding Protein 4, Nonesterified Fatty Acids, and Incident Diabetes in Older Adults.

  Authors: Luc Djoussé, Owais Khawaja, Traci M Bartz, Mary L Biggs, Joachim H Ix, Susan J Zieman, Jorge R Kizer, Russell P Tracy, David S Siscovick, Kenneth J Mukamal

  Diabetes care.

  OBJECTIVESTo examine the relation of fatty acid-binding protein (FABP)4 and nonesterified fatty acids (NEFAs) to diabetes in older adults.RESEARCH DESIGN AND METHODSWe ascertained incident diabetesOBJECTIVESTo examine the relation of fatty acid-binding protein (FABP)4 and nonesterified fatty acids (NEFAs) to diabetes in older adults.RESEARCH DESIGN AND METHODSWe ascertained incident diabetes among 3,740 Cardiovascular Health Study participants (1992-2007) based on use of hypoglycemic medications, fasting glucose ≥126 mg/dL, or nonfasting glucose ≥200 mg/dL. FABP4 and NEFA were measured on specimens collected between 1992 and 1993.RESULTSMean age of the 3,740 subjects studied was 74.8 years. For each SD increase in log-FABP4, hazard ratios (HRs) for diabetes were 1.35 (95% CI 1.10-1.65) for women and 1.45 (1.13-1.85) for men controlling for age, race, education, physical activity, cystatin C, alcohol intake, smoking, self-reported health status, and estrogen use for women (P for sex-FABP4 interaction 0.10). BMI modified the FABP4-diabetes relation (P = 0.009 overall; 0.02 for women and 0.135 for men), in that statistically significant higher risk of diabetes was mainly seen in men with BMI <25 kg/m(2) (HR per SD: 1.78 [95% CI 1.13-2.81]). There was a modest and nonsignificant association of NEFA with diabetes (P(trend) = 0.21). However, when restricted to the first 5 years of follow-up, multivariable-adjusted HRs for diabetes were 1.0 (ref.), 1.68 (95% CI 1.12-2.53), and 1.63 (1.07-2.50) across consecutive tertiles of NEFA (P(trend) = 0.03).CONCLUSIONSPlasma FABP4 was positively associated with incident diabetes in older adults, and such association was statistically significant in lean men only. A significant positive association between plasma NEFA and incident diabetes was observed during the first 5 years of follow-up.

• Can the Retinal Screening Interval Be Safely Increased to 2 Years for Type 2 Diabetic Patients Without Retinopathy?

  Authors: Daniel Chalk, Martin Pitt, Bijay Vaidya, Ken Stein

  Diabetes care.

  OBJECTIVEIn the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model toOBJECTIVEIn the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved.RESEARCH DESIGN AND METHODSWe developed a model that simulates the progression of retinopathy in type 2 diabetes patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies.RESULTSThe simulation model predicts that implementing a 2-year screening interval for type 2 diabetes patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ∼25%.CONCLUSIONSScreening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.

• Circulating Metabolite Predictors of Glycemia in Middle-Aged Men and Women.

  Authors: Peter Würtz, Mika Tiainen, Ville-Petteri Mäkinen, Antti J Kangas, Pasi Soininen, Juha Saltevo, Sirkka Keinänen-Kiukaanniemi, Pekka Mäntyselkä, Terho Lehtimäki, Markku Laakso, Antti Jula, Mika Kähönen, Mauno Vanhala, Mika Ala-Korpela

  Diabetes care.

  OBJECTIVEMetabolite predictors of deteriorating glucose tolerance may elucidate the pathogenesis of type 2 diabetes. We investigated associations of circulating metabolites from high-throughputOBJECTIVEMetabolite predictors of deteriorating glucose tolerance may elucidate the pathogenesis of type 2 diabetes. We investigated associations of circulating metabolites from high-throughput profiling with fasting and postload glycemia cross-sectionally and prospectively on the population level.RESEARCH DESIGN AND METHODSOral glucose tolerance was assessed in two Finnish, population-based studies consisting of 1,873 individuals (mean age 52 years, 58% women) and reexamined after 6.5 years for 618 individuals in one of the cohorts. Metabolites were quantified by nuclear magnetic resonance spectroscopy from fasting serum samples. Associations were studied by linear regression models adjusted for established risk factors.RESULTSNineteen circulating metabolites, including amino acids, gluconeogenic substrates, and fatty acid measures, were cross-sectionally associated with fasting and/or postload glucose (P < 0.001). Among these metabolic intermediates, branched-chain amino acids, phenylalanine, and α1-acid glycoprotein were predictors of both fasting and 2-h glucose at 6.5-year follow-up (P < 0.05), whereas alanine, lactate, pyruvate, and tyrosine were uniquely associated with 6.5-year postload glucose (P = 0.003-0.04). None of the fatty acid measures were prospectively associated with glycemia. Changes in fatty acid concentrations were associated with changes in fasting and postload glycemia during follow-up; however, changes in branched-chain amino acids did not follow glucose dynamics, and gluconeogenic substrates only paralleled changes in fasting glucose.CONCLUSIONSAlterations in branched-chain and aromatic amino acid metabolism precede hyperglycemia in the general population. Further, alanine, lactate, and pyruvate were predictive of postchallenge glucose exclusively. These gluconeogenic precursors are potential markers of long-term impaired insulin sensitivity that may relate to attenuated glucose tolerance later in life.

• Another shot to protect people with diabetes: add hepatitis B vaccination to the checklist.

  Authors: M Sue Kirkman, William Schaffner

  Diabetes care. 35(5):941-2.

• Bidirectional Association Between Depression and Metabolic Syndrome: A systematic review and meta-analysis of epidemiological studies.

  Authors: An Pan, Nana Keum, Olivia I Okereke, Qi Sun, Mika Kivimaki, Richard R Rubin, Frank B Hu

  Diabetes care. 35(5):1171-80.

  OBJECTIVE Epidemiological studies have repeatedly investigated the association between depression and metabolic syndrome (MetS). However, the results have been inconsistent. This meta-analysis aimedOBJECTIVE Epidemiological studies have repeatedly investigated the association between depression and metabolic syndrome (MetS). However, the results have been inconsistent. This meta-analysis aimed to summarize the current evidence from cross-sectional and prospective cohort studies that evaluated this association. RESEARCH DESIGN AND METHODS MEDLINE, EMBASE, and PsycINFO databases were searched for articles published up to January 2012. Cross-sectional and cohort studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratio (OR), and 95% CI were extracted or provided by the authors. The pooled OR was calculated separately for cross-sectional and cohort studies using random-effects models. The I(2) statistic was used to assess heterogeneity. RESULTS The search yielded 29 cross-sectional studies (n = 155,333): 27 studies reported unadjusted OR with a pooled estimate of 1.42 (95% CI 1.28-1.57; I(2) = 55.1%); 11 studies reported adjusted OR with depression as the outcome (1.27 [1.07-1.57]; I(2) = 60.9%), and 12 studies reported adjusted OR with MetS as the outcome (1.34 [1.18-1.51]; I(2) = 0%). Eleven cohort studies were found (2 studies reported both directions): 9 studies (n = 26,936 with 2,316 new-onset depression case subjects) reported adjusted OR with depression as the outcome (1.49 [1.19-1.87]; I(2) = 56.8%), 4 studies (n = 3,834 with 350 MetS case subjects) reported adjusted OR with MetS as the outcome (1.52 [1.20-1.91]; I(2) = 0%). CONCLUSIONS Our results indicate a bidirectional association between depression and MetS. These results support early detection and management of depression among patients with MetS and vice versa.

• Pathophysiologic differences among asians, native hawaiians, and other pacific islanders and treatment implications.

  Authors: William C Hsu, Edward J Boyko, Wilfred Y Fujimoto, Alka Kanaya, Wahida Karmally, Andrew Karter, George L King, Mele Look, Gertraud Maskarinec, Ranjita Misra, Fahina Tavake-Pasi, Richard Arakaki

  Diabetes care. 35(5):1189-98.

• Double Heterozygous Germline HNF1A Mutations in a Patient With Liver Adenomatosis.

  Authors: Emmanuelle Jeannot, Geneviève Lacape, Henri Gin, Gabrielle Couchy, Jean Saric, Hervé Laumonier, Brigitte Le Bail, Paulette Bioulac-Sage, Charles Balabaud, Jessica Zucman-Rossi

  Diabetes care. 35(5):e35.

• Ramadan fasting: a study of changes in glucose profiles among patients with diabetes using continuous glucose monitoring.

  Authors: Nader Lessan, Haydar Hasan, Maha T Barakat

  Diabetes care. 35(5):e37.

• Response to Comment on: Bopp et al. Routine Data Sources Challenge International Diabetes Federation Extrapolations of National Diabetes Prevalence in Switzerland. Diabetes Care 2011;34:2387-2389.

  Authors: Matthias Bopp, David Faeh

  Diabetes care. 35(5):e39.

• Type 2 diabetes: an epidemic requiring global attention and urgent action.

  Authors: William H Herman, Paul Zimmet

  Diabetes care. 35(5):943-4.

• Understanding and addressing unique needs of diabetes in asian americans, native hawaiians, and pacific islanders.

  Authors: George L King, Marguerite J McNeely, Lorna E Thorpe, Marjorie L M Mau, Jocelyn Ko, Lenna L Liu, Angela Sun, William C Hsu, Edward A Chow

  Diabetes care. 35(5):1181-8.

• Liraglutide Treatment in a Patient With HIV and Uncontrolled Insulin-Treated Type 2 Diabetes.

  Authors: Michaela Diamant, Michiel van Agtmael

  Diabetes care. 35(5):e34.

• Treatment of LADA With Etanercept.

  Authors: Vince N Montes, Irl B Hirsch

  Diabetes care. 35(5):e36.

• Comment on: Bopp et al. Routine Data Sources Challenge International Diabetes Federation Extrapolations of National Diabetes Prevalence in Switzerland. Diabetes Care 2011;34:2387-2389.

  Authors: Nigel Unwin, Leonor Guariguata, David Whiting, Clara Weil

  Diabetes care. 35(5):e38.

• The Application of the Diabetes Prevention Trial-Type 1 Risk Score for Identifying a Preclinical State of Type 1 Diabetes.

  Authors: Jay M Sosenko, Jay S Skyler, Jeffrey Mahon, Jeffrey P Krischer, Craig A Beam, David C Boulware, Carla J Greenbaum, Lisa E Rafkin, Catherine Cowie, David Cuthbertson, Jerry P Palmer

  Diabetes care.

  OBJECTIVEWe assessed the utility of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for identifying individuals who are highly likely to progress to type 1 diabetes (T1D) within 2OBJECTIVEWe assessed the utility of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for identifying individuals who are highly likely to progress to type 1 diabetes (T1D) within 2 years.RESEARCH DESIGN AND METHODSThe DPTRS was previously developed from Diabetes Prevention Trial-Type 1 (DPT-1) data and was subsequently validated in the TrialNet Natural History Study (TNNHS). DPTRS components included C-peptide and glucose indexes from oral glucose tolerance testing, along with age and BMI. The cumulative incidence of T1D was determined after DPTRS thresholds were first exceeded and after the first occurrences of glucose abnormalities.RESULTSThe 2-year risks after the 9.00 DPTRS threshold was exceeded were 0.88 and 0.77 in DPT-1 (n = 90) and the TNNHS (n = 69), respectively. In DPT-1, the 2-year risks were much lower after dysglycemia first occurred (0.37; n = 306) and after a 2-h glucose value between 190 and 199 mg/dL was first reached (0.64; n = 59). Among those who developed T1D in DPT-1, the 9.00 threshold was exceeded 0.81 ± 0.53 years prior to the conventional diagnosis. Postchallenge C-peptide levels were substantially higher (P = 0.001 for 30 min; P < 0.001 for other time points) when the 9.00 threshold was first exceeded compared with the levels at diagnosis.CONCLUSIONSA DPTRS threshold of 9.00 identifies individuals who are very highly likely to progress to the conventional diagnosis of T1D within 2 years and, thus, are essentially in a preclinical diabetic state. The 9.00 threshold is exceeded well before diagnosis, when stimulated C-peptide levels are substantially higher.

• Family Support, Medication Adherence, and Glycemic Control Among Adults With Type 2 Diabetes.

  Authors: Lindsay S Mayberry, Chandra Y Osborn

  Diabetes care.

  OBJECTIVEWe used a mixed-methods approach to explore the relationships between participants' perceptions of family members' diabetes self-care knowledge, family members' diabetes-specific supportiveOBJECTIVEWe used a mixed-methods approach to explore the relationships between participants' perceptions of family members' diabetes self-care knowledge, family members' diabetes-specific supportive and nonsupportive behaviors, and participants' medication adherence and glycemic control (A1C).RESEARCH DESIGN AND METHODSAdults with type 2 diabetes participated in focus group sessions that discussed barriers and facilitators to diabetes management (n = 45) and/or completed surveys (n = 61) to collect demographic information, measures of diabetes medication adherence, perceptions of family members' diabetes self-care knowledge, and perceptions of family members' diabetes-specific supportive and nonsupportive behaviors. Most recent A1C was extracted from the medical record.RESULTSPerceiving family members who were more knowledgeable about diabetes was associated with perceiving family members who performed more diabetes-specific supportive behaviors, but was not associated with perceiving family members who performed fewer nonsupportive behaviors. Perceiving family members who performed more nonsupportive behaviors was associated with being less adherent to one's diabetes medication regimen, and being less adherent was associated with worse glycemic control. In focus groups, participants discussed family member support and gave examples of family members who were informed about diabetes but performed sabotaging or nonsupportive behaviors.CONCLUSIONSParticipant reports of family members' nonsupportive behaviors were associated with being less adherent to one's diabetes medication regimen. Participants emphasized the importance of instrumental help for diabetes self-care behaviors and reported that nonsupportive family behaviors sabotaged their efforts to perform these behaviors. Interventions should inform family members about diabetes and enhance their motivation and behavioral skills around not interfering with one's diabetes self-care efforts.

• Access to Health Care and Control of ABCs of Diabetes.

  Authors: Xuanping Zhang, Kai McKeever Bullard, Edward W Gregg, Gloria L Beckles, Desmond E Williams, Lawrence E Barker, Ann L Albright, Giuseppina Imperatore

  Diabetes care.

  OBJECTIVETo examine the relationship between access to health care and diabetes control.RESEARCH DESIGN AND METHODSUsing data from the National Health and Nutrition Examination Survey, 1999-2008, weOBJECTIVETo examine the relationship between access to health care and diabetes control.RESEARCH DESIGN AND METHODSUsing data from the National Health and Nutrition Examination Survey, 1999-2008, we identified 1,221 U.S. adults (age 18-64 years) with self-reported diabetes. Access was measured by current health insurance coverage, number of times health care was received over the past year, and routine place to go for health care. Diabetes control measures included the proportion of people with A1C >9%, blood pressure ≥140/90 mmHg, and non-HDL cholesterol ≥130 mg/dL.RESULTSAn estimated 16.0% of known diabetic adults were uninsured. Diabetes control profiles were worse among uninsured than among insured persons (A1C >9% [34.1 vs. 16.5%, P = 0.002], blood pressure ≥140/90 mmHg [31.8 vs. 22.8%, P < 0.05], and non-HDL cholesterol ≥130 mg/dL [67.1 vs. 65.4%, P = 0.7]). Compared with insured persons, uninsured persons were more likely to have A1C >9% (multivariate-adjusted odds ratio 2.4 [95% CI 1.2-4.7]). Compared with those who reported four or more health care visits in the past year, those who reported no health care visits were more likely to have A1C >9% (5.5 [1.2-26.3]) and blood pressure ≥140/90 mmHg (1.9[1.1-3.4]).CONCLUSIONSIn people with diabetes, lack of health care coverage is associated with poor glycemic control. In addition, low use of health care service is associated with poor glucose and blood pressure control.

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