Viral Shah

Viral Shah
University of Colorado | UCD · Barbara Davis Center for Childhood Diabetes

MD

About

184
Publications
45,454
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
3,108
Citations
Introduction
Dr. Shah is an Associate Professor at the Barbara Davis Center for Diabetes, at the University of Colorado Anschutz Medical Campus. His research is focused on investigating newer therapeutics and technologies to improve glycemic control in adults with type 1 diabetes and understanding the mechanisms of bone fragility in older adults with type 1 diabetes. He has been a principal investigator on a number of research project and he has published over 90 research articles.
Additional affiliations
November 2013 - present
University of Colorado
Position
  • Professor (Assistant)
June 2009 - June 2012
Postgraduate Institute of Medical Education and Research
Position
  • Medical Doctor
April 2008 - May 2009
Government Medical College, Bhavnagar
Position
  • Professor (Assistant)

Publications

Publications (184)
Article
Background Despite well-established safety and efficacy of diabetes technologies in management of diabetes, their utility in visually impaired patients is currently unknown. We aimed to identify providers’ preferences and challenges to prescribing diabetes technologies for visually impaired patients. Methods A survey-based study among health care...
Article
Aims To determine if a longer duration of continuous glucose monitoring (CGM) sampling is needed to correctly assess the quality of glycemic control given different types of data loss. Materials and Methods Data loss was generated in two different methods until the desired percentage of data loss (10-50%) was achieved with 1) eliminating random ind...
Article
Background: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. Methods: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who...
Article
Objective: To evaluate glycemic outcomes in the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) randomized clinical trial (RCT) participants during an observational extension phase. Research design and methods: WISDM RCT was a 26-week RCT comparing continuous glucose monitoring (CGM) with blood glucose monitoring (BGM) in 203 adul...
Article
Aims We aimed to evaluate the contemporary prevalence of and risk factors for symptomatic diabetic autonomic neuropathy (DAN) in participants with type 1 diabetes (T1D) enrolled in the T1D Exchange Clinic Registry. Methods DAN symptoms and severity were assessed with the Survey of Autonomic Symptoms (SAS) in adults with ≥5 years of T1D participati...
Article
OBJECTIVE To evaluate long-term glycemic outcomes of continuous glucose monitoring (CGM) initiation within the first year of type 1 diabetes diagnosis. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (N = 396) were divided into three groups: 1) CGM (CGM use within 1 year of diabetes diagnosis and continued through the study); 2) no-CGM (...
Article
Objective: To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes. Research design and methods: Of 295 adults with type 1 diabetes who were seen with DKA-related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed....
Article
Full-text available
Importance Diabetic retinopathy (DR) is a leading cause of blindness in adults worldwide. Early detection and intervention can prevent blindness; however, many patients do not receive their recommended annual diabetic eye examinations, primarily owing to limited access. Objective To evaluate the safety and accuracy of an artificial intelligence (A...
Article
Objective: We aimed to evaluate relationships between time-in-range (TIR 63-140 mg/dL), HbA1c level, and the glucose management indicator (GMI) in pregnant women with type 1 diabetes. Research design and methods: Continuous glucose monitoring (CGM) data from 27 women with type 1 diabetes were collected prospectively throughout pregnancy. Up to 9...
Article
Objective: Advances in diabetes technology have transformed the treatment paradigm for type 1 diabetes, yet the burden of disease is significant. We report on a pivotal safety study of the first tubeless, on-body automated insulin delivery system with customizable glycemic targets. Research design and methods: This single-arm, multicenter, prosp...
Article
Aim: To evaluate two methods of transition from an insulin pump to multiple daily injections (MDI) using long-acting insulin degludec (IDeg). Materials and methods: After a 1-week run-in period, adults with type 1 diabetes for longer than 1 year and HbA1c 48-69 mmol/mol (6.5%-8.5%), who had been using an insulin pump at least for 6 months, were...
Article
Full-text available
Advances in diabetes technology have transformed the treatment paradigm for type 1 diabetes (T1D), yet the burden of disease remains significant. The Omnipod 5 Automated Insulin Delivery System is a novel hybrid closed-loop (HCL) system with fully on-body operation. The system consists of a tubeless insulin pump (pod) containing a personalized Mode...
Article
Introduction: Despite the significant impact of type 1 diabetes (T1D) on family, few instruments are available to assess health-related quality of life (HRQOL) among family members of people with T1D. This study aimed to develop and evaluate the psychometric properties of new measures of diabetes-specific HRQOL for parents and partners of people w...
Article
The role of continuous glucose monitoring (CGM) in type 1 diabetes is well established in improving glycemic control and reducing hypoglycemia. Type 2 diabetes (T2D) is more prevalent than type 1 diabetes and management of type 2 diabetes is more heterogeneous, requiring treatment ranging from lifestyle modification to oral medications to intensive...
Article
Full-text available
IntroductionThe biosimilar SAR341402 insulin aspart (SAR-Asp) was compared to its originator NovoLog®/NovoRapid® insulin aspart (NN-Asp) in terms of efficacy, safety, and immunogenicity, in adults with type 1 or type 2 diabetes switching from different rapid-acting insulin analogs.Methods This phase 3, randomized, open-label, multinational, 52-week...
Article
The hybrid closed-loop (HCL) system has been shown to improve glycemic control and reduce hypoglycemia. Optimization of HCL settings requires interpretation of the glucose, insulin, and factors affecting glucose such as food intake and exercise. To the best of our knowledge, there is no published guidance on the standardized reporting of HCL system...
Article
Aims To use a three-phase process to develop and validate new self-report measures of diabetes-specific health-related quality of life (HRQOL) for adults with type 1 diabetes. We report on four versions of the Type 1 Diabetes and Life (T1DAL) measure for people age 18-25, 26-45, 46-60, and over 60 years. Methods We first conducted qualitative inte...
Article
Full-text available
Purpose of review: To provide an update on the acute effects of glucose, insulin, and incretins on markers of bone turnover in those with and without diabetes. Recent findings: Bone resorption is suppressed acutely in response to glucose and insulin challenges in both healthy subjects and patients with diabetes. The suppression is stronger with...
Article
Objective To evaluate the association between Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) and risk for major osteoporotic fractures (MOF) in type 1 diabetes. Methods Subjects with type 1 diabetes and without diabetes from the ‘Coronary Artery Calcification in Type 1 Diabetes’ study were included. Risk for MOF was calcul...
Article
Continuous glucose monitoring (CGM) is safe and effective in improving glycemic control in insulin-treated patients with diabetes. However, the safety of CGM use in legally blind patients with diabetes is unknown. This is a retrospective study of seven legally blind patients with diabetes on intensive insulin therapy who were using Dexcom G6 with v...
Article
Full-text available
ABSTRACT Type 1 diabetes (T1D) increases fracture risk across the lifespan. The low bone turnover associated with T1D is thought to be related to glycemic control, but it is unclear whether peripheral hyperinsulinemia due to dependence on exogenous insulin has an independent effect on suppressing bone turnover. The purpose of this study was to test...
Article
Importance Continuous glucose monitoring (CGM) provides real-time assessment of glucose levels and may be beneficial in reducing hypoglycemia in older adults with type 1 diabetes. Objective To determine whether CGM is effective in reducing hypoglycemia compared with standard blood glucose monitoring (BGM) in older adults with type 1 diabetes. Des...
Article
Women's health and sex differences research remain understudied. In 2016, to address the topic of sex differences, the Center for Women' s Health Research (CWHR) at the University of Colorado (cwhr@ucdenver.edu) held its inaugural National Conference, "Sex Differences Across the Lifespan: A Focus on Metabolism" and published a report summarizing th...
Article
Full-text available
Context Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective To describe racial-ethnic disparities among YA with T1D, and identify drivers of glycemic disparity other th...
Article
Full-text available
Obesity, a risk factor for multiple diseases (e.g. diabetes, hypertension, cancers) originates through complex interactions between genes and prevailing environment (food habit and lifestyle) that varies across populations. Indians exhibit a unique obesity phenotype with high abdominal adiposity for a given body weight compared to matched white pop...
Article
Aims To compare diagnosis characteristics, diabetes management and comorbidities in a population diagnosed with type 1 diabetes in childhood with those in a similar population diagnosed in adulthood to identify disease differences related to the age of diabetes onset. Methods This analysis was performed using the T1D Exchange Clinic Registry, a cr...
Article
Aim: To examine the control of cardiovascular risk factors in type 1 diabetes (T1D) registries from the USA and Germany/Austria. Materials and methods: Data on individuals aged ≥12 years with T1D for ≥1 year, from the T1D Exchange Clinic Network (T1DX, USA) and the Prospective Diabetes Follow-up Registry (DPV, Germany/Austria) between 1/1/2016 a...
Article
Background: SAR341402 (SAR-Asp) is a biosimilar/follow-on of the originator insulin aspart-NovoLog®/NovoRapid® (NN-Asp). This study investigated if the efficacy, safety, and immunogenicity findings for SAR-Asp versus NN-Asp, observed over 6 months in people with type 1 (T1D, n=497) or type 2 diabetes (T2D, n=100) treated with multiple daily inject...
Article
Objective The aim of these analyses was to characterize the effect of exercise and meals on glucose concentrations in healthy individuals without diabetes. Methods Healthy individuals without diabetes (age ≥6 years) with nonobese body mass index were enrolled at 12 centers within the T1D Exchange Clinic Network. Participants wore a blinded Dexcom...
Article
Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exc...
Article
Full-text available
Background: Residual C-peptide is detected in many people for years following the diagnosis of type 1 diabetes; however, the physiologic significance of low levels of detectable C-peptide is not known. Methods: We studied sixty-three adults with type 1 diabetes classified by peak mixed-meal tolerance test (MMTT) C-peptide as negative (<0.007; n...
Chapter
Hypoglycemia is an obstacle in achieving optimal glycemic control for patients with type 1 diabetes (T1D). Automated insulin delivery (i.e., closed-loop systems) has the potential to reduce hypoglycemia. The first step in creating a closed-loop system is suspending insulin delivery when sensor glucose values are below the prespecified threshold, te...
Article
Background Knowledge regarding the burden and predictors of hypoglycemia among older adults with type 1 diabetes (T1D) is limited. Methods We analyzed baseline data from the Wireless Innovations for Seniors with Diabetes Mellitus (WISDM) study, which enrolled participants at 22 sites in the United States. Eligibility included clinical diagnosis of...
Article
Background: This study compared the efficacy, safety, and immunogenicity of insulin aspart biosimilar/follow-on biologic product SAR341402 (SAR-Asp) with originator insulin aspart-NovoLog®/NovoRapid® (NN-Asp) in people with type 1 diabetes (T1D) or type 2 diabetes (T2D) ) treated with multiple daily injections in combination with insulin glargine...
Article
Context Fracture risk in people with type 1 diabetes (T1D) is higher than their peers without diabetes. Objective To compare bone mineral density (BMD) across the life-span in individuals with T1D and age- and sex-matched healthy controls. Design Cross-sectional Setting Subjects (5 to 71 years) with T1D and matched controls from ongoing research...
Article
Objective: We examined the frequency of diabetic ketoacidosis (DKA) in cannabis users compared with nonusers in the T1D Exchange clinic registry (T1DX). Research design and methods: The association between cannabis use by total substance score for cannabis (TSC) and DKA in the past 12 months was examined using a logistic regression model adjuste...
Article
Full-text available
We evaluated the efficacy of 670 G HCL on changes in HbA1c and continuous glucose monitor (CGM)-based glucose metrics at 3 and 6 months between five adults with T1D with gastroparesis and nine age-, sex-, and diabetes duration-matched T1D without gastroparesis. At baseline, there were no differences in age, gender, diabetes duration, and total dail...
Article
Objective: To quantify age-related variability of insulin needs during day and night closed-loop insulin delivery. Research design and methods: We retrospectively analyzed data from hybrid closed-loop studies involving young children (1-6 years old, n = 20), children (7-12 years, n = 21), adolescents (13-17 years, n = 15), and adults (>18 years,...
Article
Context Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. While data on glycemic profiles of healthy, non-diabetic individuals exists for older sensors, assessment of glycemic metrics with new generation CGM devices is lacking. Objective To establish reference sensor glucose ranges in healthy, n...
Article
Full-text available
Adolescence is the most critical phase of human growth that radically alters physiology of the body and wherein any inconsistency can lead to serious health consequences in adulthood. The timing and pace at which various developmental events occur during adolescence is highly diverse and thus results in a drastic change in blood biochemistry. Monit...
Article
Women with type 1 diabetes (T1D) are at increased risk for fracture. We studied the association of T1D and young age at T1D onset (T1D onset before 20 years) on bone structural quality. 24 postmenopausal women with T1D (mean age 60.9 years, mean T1D duration 41.7 years) and 22 age, sex- and body mass index (BMI)-matched controls underwent dual X-ra...
Article
Background: We investigated the efficacy and safety of continuous glucose monitoring (CGM) initiation within 1 year of type 1 diabetes (T1D) diagnosis among children, adolescents, and adults. Methods: Differences in mean A1c (primary outcome) and diabetes-related emergency visits (secondary outcome) for 2.5 years between early CGM users and non-...
Article
Summary We evaluated fall frequency and factors affecting falls among middle-aged and older adults with type 1 diabetes (T1D) from T1D Exchange Registry. Twenty-nine percent of T1D participants reported falls within the past 12 months. Severe hypoglycemia, diabetic peripheral neuropathy, and depression were associated with falls in adults with T1D....
Article
Cannabis use is increasing with the shifts in legality and public perceptions in the United States.¹ Studies have reported improvement in insulin sensitivity and pancreatic beta cell function with cannabis use,²,3 generating widespread media attention suggesting cannabis as a potential therapeutic agent for treatment of type 2 diabetes. By contrast...
Article
Full-text available
Background: The achievement of glycaemic control remains challenging for patients with type 1 diabetes. We assessed the effectiveness of day-and-night hybrid closed-loop insulin delivery compared with sensor-augmented pump therapy in people with suboptimally controlled type 1 diabetes aged 6 years and older. Methods: In this open-label, multicen...
Article
Aims: To examine the prevalence/determinants of fracture in the T1D Exchange Clinic Registry. Research design/methods: Adults (≥18 years) with T1D duration ≥5 years, diagnosed before age 45 years completed a fracture questionnaire. Additional characteristics were collected from registry data. Only fractures reported as occurring after T1D diagno...
Article
Aims: To evaluate gender differences in diabetes self-care components including glycemic, blood pressure and lipid control, utilization of diabetes technologies and acute diabetes complications in adults with type 1 diabetes. Methods: A total of 9,481 participants >18 years were included in the analysis, 53% were female. Variables of interest in...
Article
Background: Gestational tight glycemic control is critical for women with type 1 diabetes (T1D). Limited data exist on the adoption and retention of diabetes technologies among women in different parity strata. Methods: We compared T1D management between T1D Exchange clinic registry participants (mean age 28 ± 9 years, 84% white non-Hispanic, an...
Article
Background: Frequent use of continuous glucose monitoring (CGM) systems is associated with improved glycemic outcomes in persons with diabetes, but the need for calibrations and sensor insertions are often barriers to adoption. In this study, we evaluated the performance of G6, a sixth-generation, factory-calibrated CGM system specified for 10-day...