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  • 1
    In: Diabetes Care, American Diabetes Association, Vol. 44, No. 12 ( 2021-12-01), p. 2775-2782
    Abstract: To determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. RESEARCH DESIGN AND METHODS From 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively. RESULTS Over a median of 21 years (interquartile range 20–21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52] ), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28] ), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81] ) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality. CONCLUSIONS Cancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
    detail.hit.zdb_id: 1490520-6
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  • 2
    In: Diabetes Care, American Diabetes Association, Vol. 42, No. 8 ( 2019-08-01), p. 1454-1463
    Abstract: Higher serum uric acid (SUA) is associated with diabetic kidney disease (DKD). Preventing Early Renal Loss in Diabetes (PERL) evaluates whether lowering SUA with allopurinol slows glomerular filtration rate (GFR) loss in people with type 1 diabetes (T1D) and mild to moderate DKD. We present the PERL rationale, design, and baseline characteristics. RESEARCH DESIGN AND METHODS This double-blind, placebo-controlled, multicenter trial randomized 530 participants with T1D, estimated GFR (eGFR) of 40–99.9 mL/min/1.73 m2, SUA ≥4.5 m/dL, and micro- to macroalbuminuric DKD or normoalbuminuria with declining kidney function (NDKF) (defined as historical eGFR decline ≥3 mL/min/1.73 m2/year) to allopurinol or placebo. The primary outcome is baseline-adjusted iohexol GFR (iGFR) after 3 years of treatment plus a 2-month washout period. RESULTS Participants are 66% male and 84% white. At baseline, median age was 52 years and diabetes duration was 35 years, 93% of participants had hypertension, and 90% were treated with renin-angiotensin system inhibitors (median blood pressure 127/71 mmHg). Median HbA1c was 8%, SUA 5.9 mg/dL, iGFR 68 mL/min/1.73 m2, and historical eGFR slope −3.5 mL/min/1.73 m2/year. Compared with participants with albuminuria (n = 419), those with NDKF (n = 94) were significantly older (56 vs. 52 years), had lower HbA1c (7.7 vs. 8.1%) and SUA (5.4 vs. 6.0 mg/dL), and had higher eGFR (82 vs. 74 mL/min/1.73 m2) and historical eGFR loss (−4.7 vs. −2.5 mL/min/1.73 m2/year). These differences persisted when comparing groups with similar rates of historical eGFR loss. CONCLUSIONS PERL will determine the effect of allopurinol on mild to moderate DKD in T1D, with or without albuminuria. Participants with normoalbuminuria and rapid GFR loss manifested many DKD risk factors of those with albuminuria, but with less severity.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
    detail.hit.zdb_id: 1490520-6
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  • 3
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-07-09)
    Abstract: In type 2 diabetes, hyperuricemia is associated with cardiovascular disease (CVD) and the metabolic syndrome (MetS), but associations in type 1 diabetes (T1D) have not been well-defined. This study examined the relationships between serum urate (SU) concentrations, clinical and biochemical factors, and subsequent cardiovascular events in a well-characterized cohort of adults with T1D. In 973 participants with T1D in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC), associations were defined between SU, measured once in blood collected 1997–2000, and (a) concurrent MetS and (b) incident ‘any CVD’ and major adverse cardiovascular events (MACE) through 2013. SU was higher in men than women [mean (SD): 4.47 (0.99) vs. 3.39 (0.97) mg/dl, respectively, p  〈  0.0001], and was associated with MetS features in both (men: p = 0.0016; women: p  〈  0.0001). During follow-up, 110 participants (11%) experienced “any CVD”, and 53 (5%) a MACE. Analyzed by quartiles, SU was not associated with subsequent CVD or MACE. In women, SU as a continuous variable was associated with MACE (unadjusted HR: 1.52; 95% CI 1.07–2.16; p = 0.0211) even after adjustment for age and HbA1c (HR: 1.47; 95% CI 1.01–2.14; p = 0.0467). Predominantly normal range serum urate concentrations in T1D were higher in men than women and were associated with features of the MetS. In some analyses of women only, SU was associated with subsequent MACE. Routine measurement of SU to assess cardiovascular risk in T1D is not merited. Trial registration clinicaltrials.gov NCT00360815 and NCT00360893.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2615211-3
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  • 4
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 3, No. Supplement_1 ( 2019-04-15)
    Type of Medium: Online Resource
    ISSN: 2472-1972
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2019
    detail.hit.zdb_id: 2881023-5
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  • 5
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2020
    In:  Current Diabetes Reports Vol. 20, No. 12 ( 2020-12)
    In: Current Diabetes Reports, Springer Science and Business Media LLC, Vol. 20, No. 12 ( 2020-12)
    Type of Medium: Online Resource
    ISSN: 1534-4827 , 1539-0829
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2094158-4
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  • 6
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2013
    In:  Current Diabetes Reports Vol. 13, No. 1 ( 2013-2), p. 121-129
    In: Current Diabetes Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2013-2), p. 121-129
    Type of Medium: Online Resource
    ISSN: 1534-4827 , 1539-0829
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 2094158-4
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  • 7
    In: The Lancet Diabetes & Endocrinology, Elsevier BV, Vol. 10, No. 7 ( 2022-07), p. 509-518
    Type of Medium: Online Resource
    ISSN: 2213-8587
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 8
    In: Journal of Medical Internet Research, JMIR Publications Inc., Vol. 24, No. 10 ( 2022-10-17), p. e38949-
    Abstract: Given the widespread and concerted efforts to propagate health misinformation on social media, particularly centered around vaccination during the pandemic, many groups of clinicians and scientists were organized on social media to tackle misinformation and promote vaccination, using a national or international lens. Although documenting the impact of such social media efforts, particularly at the community level, can be challenging, a more hyperlocal or “place-based approach” for social media campaigns could be effective in tackling misinformation and improving public health outcomes at a community level. Objective We aimed to describe and document the effectiveness of a place-based strategy for a coordinated group of Chicago health care workers on social media to tackle misinformation and improve vaccination rates in the communities they serve. Methods The Illinois Medical Professionals Action Collaborative Team (IMPACT) was founded in March 2020 in response to the COVID-19 pandemic, with representatives from major academic teaching hospitals in Chicago (eg, University of Chicago, Northwestern University, University of Illinois, and Rush University) and community-based organizations. Through crowdsourcing on multiple social media platforms (eg, Facebook, Twitter, and Instagram) with a place-based approach, IMPACT engaged grassroots networks of thousands of Illinois health care workers and the public to identify gaps, needs, and viewpoints to improve local health care delivery during the pandemic. Results To address vaccine misinformation, IMPACT created 8 “myth debunking” infographics and a “vaccine information series” of 14 infographics that have generated 〉 340,000 impressions and informed the development of vaccine education for the Chicago Public Libraries. IMPACT delivered 13 policy letters focusing on different topics, such as health care worker personal protective equipment, universal masking, and vaccination, with 〉 4000 health care workers signatures collected through social media and delivered to policy makers; it published over 50 op-eds on COVID-19 topics in high-impact news outlets and contributed to 〉 200 local and national news features. Using the crowdsourcing approach on IMPACT social media channels, IMPACT mobilized health care and lay volunteers to staff 〉 400 vaccine events for 〉 120,000 individuals, many in Chicago’s hardest-hit neighborhoods. The group’s recommendations have influenced public health awareness campaigns and initiatives, as well as research, advocacy, and policy recommendations, and they have been recognized with local and national awards. Conclusions A coordinated group of health care workers on social media, using a hyperlocal place-based approach, can not only work together to address misinformation but also collaborate to boost vaccination rates in their surrounding communities.
    Type of Medium: Online Resource
    ISSN: 1438-8871
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2028830-X
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  • 9
    In: Diabetes, American Diabetes Association, Vol. 69, No. Supplement_1 ( 2020-06-01)
    Abstract: Prescribing of SGLT2 inhibitors (SGLT2i) has been on the rise. A 2016 FDA safety alert raised concerns of a possible risk for lower extremity amputations for patients initiating treatment with SGLT2i. We used a large national claims database to compare amputation events among patients newly prescribed one of 3 different SGLT2is: Canagliflozin (Cana), Dapagliflozin (Dapa), Empagliflozin (Empa). Study included adults with a first prescription fill for a SGLT2i between January 2014 and May 2017. We estimated adjusted incident rate ratios for any subsequent non-traumatic amputation over a mean of about 16.7 months of follow up using a multi-variable Poisson regression model adjusting for demographics, insurance, year of start, and clinical covariates (prior non-traumatic amputation and Diabetes Complication Severity Index (DCSI)). Among 43017 new SGLT2i starts, 64% (N=27528) were Cana, 22% (N=9487) were Empa and 14% (N=6002) were Dapa. Mean age was 58.0 ± 11.4 years and 42% were women. Use of Empa increased over time (1.3% of new starts in 2014 to 45.3% in 2017). 14% of Dapa patients had Medicare, compared with 32% of Cana and 35% of Empa. Unadjusted event rates (per 1000 patient years) were 2.81 for Cana, 2.71 for Dapa, and 2.43 for Empa. In the adjusted model, no differences in amputation rates for Cana (IRR 1.26 CI [0.81, 1.97]) or Dapa (IRR 1.31 CI [0.72, 2.36] ) when compared to Empa. Significant predictors were prior amputation (IRR 21.44 CI [11.88-36.69]) and DCSI score of 3 or higher (IRR 8.44 CI [5.55-12.82] ). Non-traumatic amputation rates for patients on SGLT2is were low and did not differ among Cana, Dapa or Empa. Limitations include short follow-up and non-randomized study design. Understanding the risk of amputation in patients with diabetes related complications, who may otherwise benefit from SGLT2i use, is needed especially given benefit in cardiovascular outcomes and mortality. More research should investigate if patients’ risk of amputation can be predicted prior to initiation. Disclosure S. Hakimian: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group. R. Kang: Research Support; Self; UnitedHealth Group. A.J. Cooper: None. M. O’Brien: Research Support; Self; UnitedHealth Group. D.T. Liss: None. S.A. Harris: None. M. Cherupally: None. E.D. Parker: None. R.T. Ackermann: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, UnitedHealth Group. Funding UnitedHealth Group (SP0036847)
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
    detail.hit.zdb_id: 1501252-9
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  • 10
    Online Resource
    Online Resource
    American Diabetes Association ; 2020
    In:  Diabetes Vol. 69, No. Supplement_1 ( 2020-06-01)
    In: Diabetes, American Diabetes Association, Vol. 69, No. Supplement_1 ( 2020-06-01)
    Abstract: Hyperglycemia is associated with infection and rejection in post-solid organ transplant (Tx) patients (pts), but little is known about peak insulin requirements and morbidity. We previously reported an unexpected finding in a retrospective cohort study of 207 liver Tx pts that evaluated the relationship to peak IV insulin requirements and subsequent morbidity. Pts were separated into quartiles (Q) by peak insulin drip rate [U/hr]. In that study, pts in Q4 of insulin requirements had significantly reduced infections out to 6 months post-Tx compared to Q1-3. In the present study, we sought to replicate these findings in 188 heart Tx pts. Peak drip rate Qs are shown in the Figure below. Compared to Q1-3, Q4 pts were similar in age (53 ± 10.7 vs. 50.3 ± 9.4) and BMI (30.4 ± 6.4 vs. 29.2 ± 6.8), but more had DM (42.6% vs. 38.3%, p=0.003). Q4 pts had significantly fewer infections (19.1% vs. 53.9%, p & lt;0.000001) up to 6 mos but similar rejections (4.3% vs. 11.3%, p=0.15). Also, we showed that avg blood glucose levels were not significantly different between Q1-3 and Q4 (p = 1.03). These data in heart Tx pts confirm our findings in liver Tx pts that pts requiring higher insulin doses for glycemic control have decreased infections out to 6 months post Tx. We hypothesize that pts able to mount a greater counterregulatory hormone response to surgery may be healthier and able to better respond to infection. Alternatively, higher insulin doses could be protective. Disclosure G. Upadrasta: None. S.J. Kumar: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group. M. Molitch: Advisory Panel; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc. Consultant; Self; AstraZeneca. Research Support; Self; Novartis Pharmaceuticals Corporation, Novo Nordisk Inc.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
    detail.hit.zdb_id: 1501252-9
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