Vivian Fonseca

Tulane University, New Orleans, Louisiana, United States

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Publications (320)1831.37 Total impact

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    ABSTRACT: Diabetic retinopathy (DR) is associated with a higher risk of renal and cardiovascular events. We sought to compare the risk for renal versus cardiovascular (CV) outcomes, stratified by retinopathy severity. Methods ACCORD was a randomized trial of people with type 2 diabetes, at high-risk for CV disease. A subgroup (n = 3,369 from 71 clinics) had stereoscopic fundus photographs graded centrally. Participants were stratified at baseline to moderate/severe DR or no/mild DR and were monitored for renal and CV outcomes at follow-up visits over 4 years. The composite renal outcome was comprised of serum creatinine doubling, macroalbuminuria, or end-stage renal disease. The composite CV outcome was the ACCORD trial primary outcome. Competing risk techniques were used to estimate the relative risk (RR) of renal versus CV composite outcomes within each DR stratum. Results The hazards ratio for doubling of serum creatinine and incident CV event in the moderate/severe DR versus no/mild DR strata were: 2.31 (95%CI: 1.25-4.26) and 1.98 (95%CI: 1.49-2.62), respectively. The RR of the two composite outcomes was highly similar in the no/mild DR stratum (adjusted RR at 4 years for CV versus renal events = 0.96, 95%CI:0.72-1.28) and the moderate/severe DR stratum (adjusted RR = 0.92, 95%CI:0.64-1.31). Conclusions Thus, in people with type 2 diabetes at high risk for cardiovascular disease, incident CV versus renal events was similar, irrespective of the severity of the DR. Further evaluation of the specificity of DR for microvascular versus macrovascular events in other populations is warranted.
    Journal of Diabetes and its Complications 11/2014; · 2.06 Impact Factor
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    ABSTRACT: Effective treatment algorithms are needed to guide diabetes care at hospital discharge in general medicine and surgery patients with type 2 diabetes.
    Diabetes care. 08/2014;
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    ABSTRACT: Aim We examined the effects of adding glargine to metformin-sitagliptin (MS + G) or sitagliptin to metformin-glargine (MG + S) therapy in type 2 diabetic persons uncontrolled after 24-week MS or MG dual therapy Methods Subjects with A1c ≥ 7% on MS or MG treatment were respectively given glargine (0.2 unit/kg starting dose) or sitagliptin (100 mg daily) for 12 weeks. The primary endpoint was number of subjects attaining A1c goal defined as < 7%. Results After receiving 24-week MS or MG dual therapy in the original EASIE Study, 42% (104/248) on MS and 68% (152/224) on MG attained A1c < 7% (p < 0.0001). The reduction in A1c was negatively associated with baseline fasting blood glucose (FBG) only in the MG group. Reduction in A1c was not related to baseline postprandial blood glucose (PPBG) in either the MG or MS group. Amongst 194 eligible patients, 57.7% (n = 111) entered the 12-week extension trial [MS + G:74/131, 57.3%; MG + S:37/63, 58.7%) with 55 (51.9%) subjects attaining goal [MS + G:59.2%; MG + S:37.1%] at week 12. The final insulin dosage was similar in both groups [MS + G: 0.46 unit/kg; MG + S: 0.45 unit/kg] with a higher rate of hypoglycemia in the MG + S (6.5 events/patient-year) than the MS + G group (3.2 events/patient-year), although neither group had severe hypoglycemia. Conclusion In metformin-treated type 2 diabetes patients, high fasting BG predicted greater A1c reductions with the addition of glargine, but not with sitagliptin. In subjects uncontrolled with 6-month dual therapy of MS or MG, 50% attained A1c < 7% with triple therapy of MS + G or MG + S in 12 weeks. The increased rate of hypoglycemia with MG + S (but not with MS + G) underlines the need to take measures to avoid the hypoglycemia.
    Journal of Diabetes and its Complications 08/2014; · 2.06 Impact Factor
  • Circulation 08/2014; · 15.20 Impact Factor
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    ABSTRACT: GLP-1 receptor agonists may provide an alternative to prandial insulin for advancing basal insulin therapy. Harmony 6 was a randomized, open-label, active-controlled trial testing once-weekly albiglutide vs thrice-daily prandial insulin lispro as an add-on to titrated once-daily insulin glargine.RESEARCH DESIGN AND METHODS: Patients taking basal insulin (with or without oral agents) with HbA1c 7-10.5% (53-91 mmol/mol) entered a glargine standardization period, followed by randomization to albiglutide, 30 mg weekly (n = 282), subsequently uptitrated to 50 mg, if necessary, or thrice-daily prandial lispro (n = 281) while continuing metformin and/or pioglitazone. Glargine was titrated to fasting plasma glucose of <5.6 mmol/L, and lispro was adjusted based on glucose monitoring. The primary end point was the difference in the HbA1c change from baseline at week 26.RESULTS: At week 26, HbA1c decreased from baseline by -0.82 ± SE 0.06% (9.0 mmol/mol) with albiglutide and -0.66 ± 0.06% (7.2 mmol/mol) with lispro; treatment difference, -0.16% (95% CI -0.32 to 0.00; 1.8 mmol/mol; P < 0.0001), meeting the noninferiority end point (margin, 0.4%). Weight decreased with albiglutide but increased with lispro (-0.73 ± 0.19 kg vs. +0.81 ± 0.19 kg). The mean glargine dose increased from 47 to 53 IU (albiglutide) and from 44 to 51 IU (lispro). Adverse events for albiglutide versus lispro included severe hypoglycemia (0 vs. 2 events), documented symptomatic hypoglycemia (15.8% vs. 29.9%), nausea (11.2% vs. 1.4%), vomiting (6.7% vs. 1.4%), and injection site reactions (9.5% vs. 5.3%).CONCLUSIONS: Weekly albiglutide is a simpler therapeutic option than thrice-daily lispro for advancing basal insulin glargine therapy, resulting in comparable HbA1c reduction with weight loss and lower hypoglycemia risk.
    Diabetes care. 06/2014;
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    ABSTRACT: OBJECTIVE Diabetes care differs across racial and ethnic groups. This study aimed to assess the racial disparity of eye examinations among U.S. adults with diabetes.RESEARCH DESIGN AND METHODS Working-age adults (age 18-64 years) with diabetes were studied using data from the Medical Expenditure Panel Survey Household Component (2002-2009) including the Diabetes Care Survey. Racial and ethnic groups were classified as non-Hispanic whites and minorities. People reporting one or more dilated eye examination were considered to have received an eye examination in a particular year. Eye examination rates were compared between racial/ethnic groups for each year, and were weighted to national estimates. Multivariate adjusted odds ratios (aORs) and 95% CIs for racial/ethnic difference were assessed annually using logistic regression models. Other influencing factors associated with eye examination were also explored.RESULTSWhites had consistently higher unadjusted eye examination rates than minority populations across all 8 years. The unadjusted rates increased from 56% in 2002 to 59% in 2009 among whites, while the rates in minorities decreased from 56% in 2002 to 49% in 2009. The largest significant racial gap of 15% was observed in 2008, followed by 11%, 10%, and 7% in 2006, 2009, and 2005, respectively (P < 0.05). Minorities were less likely to receive eye examination (2006: aOR 0.75 [95% CI 0.57-0.99]; 2008: 0.61 [0.45-0.84]).CONCLUSIONS The racial/ethnic differences in eye examinations for patients with diabetes have persisted over the last decade. National programs to improve screening and monitoring of diabetic retinopathy are needed to target minority populations.
    Diabetes care 02/2014; · 7.74 Impact Factor
  • Vivian A Fonseca, Michelle A Haggar
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    ABSTRACT: Insulin therapy is an effective method for reducing blood glucose levels in patients with type 2 diabetes mellitus (T2DM), and most patients with T2DM eventually require insulin replacement to attain and preserve satisfactory glycaemic control. All patients with T2DM should be considered as potential candidates for intensive insulin treatment; however, there are certain considerations regarding replacement therapy for different types of people and special populations, such as patients with multiple comorbidities, adolescents, pregnant women and the elderly. Lowering HbA1c levels in isolation without assessing the patient as a whole is becoming redundant. HbA1c targets should be individualized to the specific patient, and insulin treatment ought to be customized accordingly. There are several questions that need to be taken into account when considering adding insulin therapy to other oral antidiabetic agents, for example, for whom and when insulin therapy is indicated and which basal insulin should be utilized. Potential barriers exist related to patients, providers and health-care systems that can delay the start of insulin therapy, and every effort should be made to identify and address these obstacles.
    Nature Reviews Endocrinology 02/2014; · 11.03 Impact Factor
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    ABSTRACT: Aims To quantify the effect of liraglutide on systolic blood pressure (SBP) and pulse in patients with type 2 diabetes (T2D), and assess the influence of covariates on observed SBP reductions. Methods A patient-level pooled analysis of six phase 3, randomized trials was conducted. Results The analysis included 2792 randomized patients. In the intention-to-treat population (n = 2783), mean [± SE] SBP reductions from baseline with liraglutide 1.2 mg (2.7 [0.8] mmHg) and 1.8 mg (2.9 [0.7] mmHg) once daily were significantly greater than with placebo (0.5 [0.9] mmHg; P = 0.0029 and P = 0.0004, respectively) after 26 weeks, and were evident after 2 weeks. Liraglutide was also associated with significantly greater SBP reductions than glimepiride and, at a dose of 1.8 mg, insulin glargine and rosiglitazone. SBP reductions with liraglutide weakly correlated with weight loss (Pearson’s correlation coefficient: 0.08-0.12; P ≤ 0.0148). No dependence of these reductions on concomitant antihypertensive medications was detected (P = 0.1304). Liraglutide 1.2 and 1.8 mg were associated with mean increases in pulse of 3 beats per minute (bpm), versus a 1 bpm increase with placebo (P < 0.0001 for each dose versus placebo). Conclusions Liraglutide reduces SBP in patients with T2D, including those receiving concomitant antihypertensive medication.
    Journal of diabetes and its complications 01/2014; · 2.11 Impact Factor
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    ABSTRACT: Aims This analysis evaluated HbA1c-adjusted hypoglycemia risk with glargine versus neutral protamine Hagedorn (NPH) over a 5-year study in patients with Type 2 diabetes mellitus (T2DM). Clinical significance was assessed using number needed to harm (NNH) to demonstrate the risk of one additional patient experiencing at least one hypoglycemic event. Methods Individual patient-level data for symptomatic documented hypoglycemia and HbA1c values from a 5-year randomized study comparing once-daily glargine (n = 513) with twice-daily NPH (n = 504) were analyzed. Symptomatic hypoglycemia was categorized according to concurrent self-monitoring blood glucose levels and need for assistance. Hypoglycemic events per patient-year as a function of HbA1c were fitted by negative binomial regression using treatment and HbA1c at endpoint as independent variables. An estimate of NNH was derived from logistic regression models. Results The cumulative number of symptomatic hypoglycemia events was consistently lower with glargine compared with NPH over 5 years. Compared with twice-daily NPH, once-daily glargine treatment resulted in significantly lower adjusted odds ratios (OR) for all daytime hypoglycemia (OR 0.74; p = 0.030) and any severe event (OR 0.64; p = 0.035), representing a 26% and 36% reduction in the odds of daytime and severe hypoglycemia, respectively. Our model predicts that, if 25 patients were treated with NPH instead of glargine, then one additional patient would experience at least one severe hypoglycemic event. Conclusions This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM.
    Journal of Diabetes and its Complications. 01/2014;
  • Vivian A. Fonseca
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    ABSTRACT: Background Suboptimal blood glucose control among patients with type 2 diabetes continues to support the need for new pharmacologic approaches. Objective The purpose of this commentary was to highlight newly available and soon-to-be available agents that are promising tools for targeting specific pathophysiologic pathways in the management of diabetes. Methods Published evidence to support the application of novel incretin-based therapies, dipeptidyl peptidase (DPP)-4 inhibitors, sodium-glucose cotransporter (SGLT)-2 inhibitors, other oral agents and insulins for managing specific aspects of type 2 diabetes, as well as disadvantages associated with those novel medications, are discussed. Results Several new glucagon-like peptide (GLP)-1 receptor agonists with different time frames of action, although each has unique advantages and disadvantages, have been through clinical trials. Examples of these are lixisenatide and albiglutide. Currently available DPP-4 inhibitor agents, important for inhibiting the breakdown of endogenous GLP-1, have not been associated with weight gain or hypoglycemia. SGLT-2 inhibitors, which do not depend on insulin secretion or insulin action, may be advantageous in that they appear to be broadly efficacious at all stages of diabetes. New insulin analogues, such as degludec and U-500, improve glycemic control without contributing to hypoglycemia. Conclusions Advances in pharmacologic options offer the promise of improving glycemic control for longer periods, with limited glycemic fluctuations, hypoglycemia, and weight gain. However, the effectiveness of these agents ultimately depends on their availability to providers managing the health care of patients at high risk for poor diabetes outcomes and patients’ use of them as directed. Long-term effectiveness and safety trials are ongoing.
    Clinical Therapeutics 01/2014; · 2.23 Impact Factor
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    ABSTRACT: Background Salsalate is a non-acetylated salicylate that lowers glucose levels in people with type 2 diabetes (T2DM). Here we examined whether salsalate also lowered serum protein-bound levels of early and advanced glycation end products (AGEs) that have been implicated in diabetic vascular complications.Methods Participants were from the Targeting Inflammation Using Salsalate for Type-2 Diabetes (TINSAL-T2D) study which examined the impact of salsalate treatment on HbA1c and a wide variety of other parameters. 118 participants received salsalate, 3.5 grams per day for 48 weeks; 109 received placebo. Early glycation product levels (HbA1c and fructose-lysine (measured as furosine) and AGE levels (glyoxal and methyglyoxal hydroimidazolones [G-H1, MG-H1], carboxymethyl-lysine [CML], carboxyethyl-lysine [CEL], pentosidine) were measured in patient serum samples.Results48 weeks of salsalate treatment lowered levels of HbA1c and serum furosine (p<0.001) and CML compared to placebo. The AGEs CEL, G-H1 and MG-H1 levels were unchanged, whereas pentosidine levels increased more than two-fold (p<0.001). Among salsalate users, increases in adiponectin levels were associated with lower HbA1c levels during follow up (p<0.001). Changes in renal and inflammation factor levels were not associated with changes in levels of early or late glycation factors. Pentosidine level changes were unrelated to changes in levels of renal function, inflammation, or cytokines.Conclusions Salsalate therapy was associated with a reduction in early but not late glycation end products. There was a paradoxical increase in serum pentosidine levels suggestive of an increase in oxidative stress or decreased clearance of pentosidine precursor.
    Diabetes care 11/2013; · 7.74 Impact Factor
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    ABSTRACT: Purpose: This systematic review and meta-analysis aimed to assess the associations of metformin intake with incidence and mortality of prostate cancer. Methods: A comprehensive literature search was performed using EMBASE, MEDLINE and PubMed databases with their latest available date of May 8th 2013. The following keywords and/or corresponding MESH terms were used: (metformin'' OR biguanides'' OR diabetes mellitus, type 2/therapy'' OR hypoglycemic agents'' OR glucose-lowering therapy'') AND (prostate cancer'' OR prostate carcinoma'' OR prostatic carcinoma''). In addition, a hand-check was done to identify relevant publications from other meta-analyses or from reference lists. Inclusion Criteria included: (1) epidemiological studies conducted in humans (case-control or cohort); (2) exposure to metformin; (3) prostate cancer risk estimates including relative risk/odds ratio/hazard ratio (RR/OR/HR) with their 95% confidence intervals (CIs) were reported or data for these risk estimates can be calculated; (4) if there were multiple publications for the same study, the most recent and complete publication was considered. Epidemiological studies which reported prostate cancer incidence or mortality (RR/OR/HR with 95% CI) were selected for meta-analysis of prostate cancer outcomes associated with metformin use. Summery Risk Ratio (SRR) was calculated using random-effect models. Heterogeneity was tested using Chi2 statistics and measured with the I2statistic. Funnel plot and Egger's regression asymmetry test were used to evaluate publication bias. Results: A total of 17 studies (12 reported prostate cancer incidence, 5 reported prostate cancer mortality) which met inclusion/exclusion criteria were evaluated for meta-analysis, after reviewing a total of 1266 articles. Among 1,071,130 participants (with or without type 2 diabetes), metformin use was associated with a lower risk of incident prostate cancer compared with no metformin use. The SRR for prostate cancer incidence was 0.86 (95% CI: 0.78-0.94). Heterogeneity and publication bias were also found. Among 117,164 patients with prostate cancer, metformin users were not found to reduce prostate cancer-specific mortality, as compared with those without exposure to metformin. The SRR for prostate cancer mortality was 0.92 (95% CI: 0.69-1.24). Conclusions: Metformin use appears to reduce prostate cancer incidence in the meta-analysis. However, there was no significant association of metformin with reducing mortality among patients with prostate cancer. Associations of other anti-diabetic medications and health outcomes among patients with prostate cancer should be examined in future systematic reviews and meta-analyses.
    The 35th Annual Meeting of the Society for Medical Decision Making; 10/2013
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    ABSTRACT: OBJECTIVE To test whether inhibiting inflammation with salsalate improves endothelial function in patients with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODS We conducted an ancillary study to the National Institutes of Health-sponsored, multicenter, randomized, double-masked, placebo-controlled trial evaluating the safety and efficacy of salsalate in targeting inflammation to improve glycemia in patients with T2D. Flow-mediated, endothelium-dependent dilation (FMD) and endothelium-independent, nitroglycerin-mediated dilation (NMD) of the brachial artery were assessed at baseline and 3 and 6 months following randomization to either salsalate 3.5 g/day or placebo. The primary end point was change in FMD at 6 months.RESULTSA total of 88 participants were enrolled in the study, and data after randomization were available for 75. Patients in the treatment and control groups had similar ages (56 years), BMI (33 kg/m(2)), sex (64% male), ethnicity, current treatment, and baseline HbA1c (7.7% [61 mmol/mol]).In patients treated with salsalate versus placebo, HbA1c was reduced by 0.46% (5.0 mmol/mol; P < 0.001), fasting glucose by 16.1 mg/dL (P < 0.001), and white blood cell count by 430 cells/µL (P < 0.02). There was no difference in the mean change in either FMD (0.70% [95% CI -0.86 to 2.25%]; P = 0.38) or NMD (-0.59% [95% CI -2.70 to 1.51%]; P = 0.57) between the groups treated with salsalate and placebo at 6 months. Total and LDL cholesterol were 11 and 16 mg/dL higher, respectively, and urinary albumin was 2.0 µg/mg creatinine higher in the patients treated with salsalate compared with those treated with placebo (all P < 0.009).CONCLUSIONS Salsalate does not change FMD in peripheral conduit arteries in patients with T2D despite lowering HbA1c. This finding suggests that salsalate does not have an effect on vascular inflammation, inflammation does not cause endothelial dysfunction in T2D, or confounding effects of salsalate mitigate favorable effects on endothelial function.
    Diabetes care 10/2013; · 7.74 Impact Factor
  • Vivian A Fonseca
    Journal of diabetes and its complications 10/2013; · 2.11 Impact Factor
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    Diabetes care 09/2013; 36(9):e159-60. · 7.74 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of initial combination therapy of sitagliptin 100 mg/day coadministered with all marketed doses of pioglitazone in patients with type 2 diabetes. Patients with A1C ≥7.5% and ≤11.0% were randomized among 7 arms that received, once daily, 100 mg sitagliptin alone, 15, 30, or 45 mg pioglitazone alone, or 100 mg sitagliptin plus 15, 30, or 45 mg pioglitazone for 54 weeks. The primary endpoint was change from baseline in A1C at Week 24. Protocol-specified analyses compared combination therapies with monotherapies at respective dose-strengths and combination of sitagliptin plus pioglitazone 30 mg with pioglitazone 45 mg monotherapy. Post-hoc analyses compared sitagliptin plus pioglitazone 15 mg with pioglitazone monotherapy at the two higher doses. Initial combination therapy with sitagliptin and pioglitazone provided significantly greater reductions in A1C (0.4-0.7% differences) and other glycemic endpoints than either monotherapy at the same doses. Combining sitagliptin with low-dose pioglitazone generally produced greater glycemic improvements than higher doses of pioglitazone monotherapy (0.3-0.4% differences in A1C ). Combination therapy was generally well tolerated; AEs of hypoglycemia were reported with similar incidence (7.8-11.1%) in all treatment groups over the 54 weeks of study; edema was reported in 0.5% of patients in the sitagliptin monotherapy group and 2.7-5.3% among pioglitazone-treated groups. Significant weight gain was observed in all combination-treated groups compared with the sitagliptin monotherapy group. Initial combination therapy with sitagliptin and pioglitazone provided better glycemic control than either monotherapy and was generally well tolerated.
    Diabetes Obesity and Metabolism 08/2013; · 5.18 Impact Factor
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    ABSTRACT: To determine differences in inpatient glycemic control and response to two different glargine-based insulin regimens in general medicine and surgery patients with type 2 diabetes (T2D). This is a post-hoc analysis of a prospective, multicenter, randomized trial of 298 non-ICU medicine and surgery patients with T2D treated with Basal Bolus regimen with glargine once daily and glulisine before meals and with Basal Plus regimen with glargine once daily and supplemental doses of glulisine before meals for blood glucose (BG)>140mg/dl. Major study outcomes included differences in mean daily BG, frequency of treatment failures (defined as >2 consecutive BG>240mg/dl or a mean daily BG>240mg/dl), and hypoglycemia between the medicine and surgery cohorts. Patients treated with Basal Bolus or with Basal Plus experienced similar improvement in mean daily BG after 1st day of therapy (p=0.16), number of treatment failures (p=0.11) and hypoglycemic events (p=0.50). Compared to surgery patients (n=130), medicine patients (n=168) had higher admission BG (p=0.01) and HbA1c levels (p<0.01); however, they had similar response to either treatment regimen without differences in mean daily BG after 1st day of therapy (p=0.18), number of treatment failures (p=0.58), daily insulin requirements (p=0.36), or in the frequency of hypoglycemia (p=0.79). The Basal Plus regimen with glargine once daily and correction doses with glulisine before meals resulted in similar glycemic control to basal bolus regimen. We observed no differences in response to either basal insulin regimen between medicine and surgery patients with type 2 diabetes.
    Journal of diabetes and its complications 08/2013; · 2.11 Impact Factor
  • Vanita R Aroda, Vivian A Fonseca
    American journal of preventive medicine 08/2013; 45(2):246-7. · 4.24 Impact Factor
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    ABSTRACT: OBJECTIVE This study compared the clinical and economic benefits associated with dual-goal achievement, glycated hemoglobin (HbA1c) <7% (53 mmol/mol) and LDL cholesterol (LDL-C) <100 mg/dL, with achievement of only the LDL-C goal or only the HbA1c goal in veterans with type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODS This retrospective cohort analysis evaluated electronic medical records (Veterans Integrated Service Network 16) in adult T2DM patients with two or more measurements of LDL-C and HbA1c between 1 January 2004 and 30 June 2010 (N = 75,646). Cox proportional hazards models were used to compare microvascular and cardiovascular outcomes by goal achievement status; generalized linear regression models were used to assess diabetes-related resource utilization (hospitalization days and number of outpatient visits) and medical service costs.RESULTSRelative to achievement of only the LDL-C goal, dual-goal achievement was associated with lower risk of microvascular complications (adjusted hazard ratio [aHR] 0.79), acute coronary syndrome (0.88), percutaneous coronary intervention (0.78), and coronary artery bypass graft (CABG) (0.74); it was also associated with fewer hospitalization days (adjusted incidence rate ratio [aIRR] 0.93) and outpatient visits (0.88), as well as lower diabetes-related annual medical costs (-$130.89). Compared with achievement of only the HbA1c goal, dual-goal achievement was associated with lower risk of the composite cardiovascular-related end point (aHR 0.87) and CABG (aHR 0.62), as well as fewer outpatient visits (aIRR 0.98).CONCLUSIONS Achieving both HbA1c and LDL-C goals in diabetes care is associated with additional clinical and economic benefits, as compared with the achievement of either goal alone.
    Diabetes care 06/2013; · 7.74 Impact Factor
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    ABSTRACT: OBJECTIVE: To examine the relationship of cognitive performance to exposure to insulin (INS) and thiazolidinediones (TZD) in the ACCORD-MIND cohort. METHODS: Participants (55-80years) with type 2 diabetes (T2D), hemoglobin A1c (HbA1c) >7.5% (>58mmol/mol), and a high risk of cardiovascular events were randomly assigned to receive intensive control targeting HbA1c to <6.0% (42mmol/mol) or a standard strategy targeting HbA1c to 7.0%-7.9% (53-63mmol/mol). The Digit Symbol Substitution Test (DSST) was assessed at baseline and at 20 and 40months. Exposure to INS was calculated as average daily dose/kg of body weight; exposure to rosiglitazone (ROS) was calculated as days of ROS prescription in the intervals preceding the 20- and 40-month DSSTs. RESULTS: At baseline, INS use was associated with reduced DSST performance, but not after controlling for comorbidities and lab values. There was no relationship between use of a TZD and DSST performance on at baseline. ROS but not INS exposure was associated with greater decline in DSST performance over 40months in subjects randomized to the intensive but not the standard group. CONCLUSIONS: Exposure to a TZD may increase cognitive decline in some patients with T2D. However, these results may be confounded by unexplained differences between participants.
    Journal of diabetes and its complications 05/2013; · 2.11 Impact Factor

Publication Stats

7k Citations
1,831.37 Total Impact Points


  • 1999–2014
    • Tulane University
      • • School of Public Health and Tropical Medicine
      • • Department of Pharmacology
      • • Department of Medicine
      • • Section of Endocrinology and Metabolism
      New Orleans, Louisiana, United States
    • Sriram Chandra Bhanj Medical College and Hospital
      Каттаке, Orissa, India
    • University of Arkansas for Medical Sciences
      • Department of Pharmacy Practice
      Little Rock, AR, United States
  • 2013
    • MedStar Health Research Institute
      Maryland, United States
    • Emory University
      • Division of Endocrinology
      Atlanta, GA, United States
  • 2002–2013
    • Louisiana State University Health Sciences Center New Orleans
      • • Department of Medicine
      • • Section of Pediatric Endocrinology
      New Orleans, Louisiana, United States
    • Central Arkansas Veterans Healthcare System
      Washington, Washington, D.C., United States
  • 2012
    • Saint Joseph's College of Maine
      Standish, Michigan, United States
    • Pontificia Universidad Javeriana
      Μπογκοτά, Bogota D.C., Colombia
    • Buffalo General Medical Center
      Buffalo, New York, United States
    • Eli Lilly
      Indianapolis, Indiana, United States
  • 2010–2012
    • Southeast Louisiana Veterans Health Care System
      Alabama, United States
    • Lund University
      Lund, Skåne, Sweden
    • Institut Pasteur de Lille
      Lille, Nord-Pas-de-Calais, France
  • 2011
    • University College London
      • Division of Medicine
      London, ENG, United Kingdom
  • 2004–2010
    • University of Nebraska Medical Center
      Omaha, Nebraska, United States
  • 2009
    • Joslin Diabetes Center
      Boston, Massachusetts, United States
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2008
    • King Edward Medical University
      Lāhaur, Punjab, Pakistan
    • Wildwood Programs
      Schenectady, New York, United States
    • University of Miami Miller School of Medicine
      Miami, Florida, United States
  • 1996–2007
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 2006
    • Baylor College of Medicine
      Houston, Texas, United States
  • 2005
    • University of Texas - Pan American
      • College of Health Sciences and Human Services
      Edinburg, TX, United States
    • University of California, San Francisco
      • Division of Cardiology
      San Francisco, CA, United States
    • Novartis
      Bâle, Basel-City, Switzerland
  • 2001
    • U.S. Food and Drug Administration
      • Division of Epidemiology
      Washington, D. C., DC, United States