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  • 1
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    Online Resource
    Cortisol Secretion in Patients With Type 2 Diabetes
    American Diabetes Association ; 2007
    In:  Diabetes Care Vol. 30, No. 1 ( 2007-01-01), p. 83-88
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 30, No. 1 ( 2007-01-01), p. 83-88
    Abstract: OBJECTIVE—The presence of an enhanced cortisol secretion in patients with type 2 diabetes is debated. In type 2 diabetic subjects, cortisol secretion was found to be associated with the complications and metabolic control of diabetes. We evaluated cortisol secretion in 170 type 2 diabetic subjects and in 71 sex-, age-, and BMI-matched nondiabetic subjects. RESEARCH DESIGN AND METHODS—In all subjects, we evaluated ACTH at 8:00 a.m. in basal conditions and serum cortisol levels at 12:00 p.m. (F24) and at 9:00 a.m. after a 1-mg overnight dexamethasone suppression test and 24-h urinary free cortisol (UFC). In diabetic patients, we evaluated the presence of chronic complications (incipient nephropathy, asymptomatic neuropathy, background retinopathy, and silent macroangiopathy). Patients were subdivided according to the absence (group 1, n = 53) or presence (group 2, n = 117) of diabetes complications. RESULTS—In group 2, UFC (125.2 ± 4.6 nmol/24 h) and F24 (120.6 ± 4.1 nmol/l) were higher than in group 1 (109.2 ± 6.8 nmol/24 h, P = 0.057, and 99.7 ± 6.1 nmol/l, P = 0.005, respectively) and in nondiabetic patients (101.7 ± 5.9 nmol/24 h, P = 0.002, and 100.3 ± 5.3 nmol/l, P = 0.003, respectively). In diabetic patients, the number of complications was associated with F24 (R = 0.345; P & lt; 0.0001) and diabetes duration (R = 0.39; P & lt; 0.0001). Logistic regression analysis showed that the presence of diabetes complications was significantly associated with F24, sex, duration of diabetes, and glycated hemoglobin. CONCLUSIONS—In type 2 diabetic subjects, hypothalmic-pituitary-adrenal activity is enhanced in patients with diabetes complications and the degree of cortisol secretion is related to the presence and number of diabetes complications.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc06-1267
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2007
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  • 2
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    Metabolic Syndrome and Risk of Cancer
    American Diabetes Association ; 2012
    In:  Diabetes Care Vol. 35, No. 11 ( 2012-11-01), p. 2402-2411
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 35, No. 11 ( 2012-11-01), p. 2402-2411
    Abstract: Available evidence supports the emerging hypothesis that metabolic syndrome may be associated with the risk of some common cancers. We did a systematic review and meta-analysis to assess the association between metabolic syndrome and risk of cancer at different sites. RESEARCH DESIGN AND METHODS We conducted an electronic search for articles published through October 2011 without restrictions and by reviewing reference lists from retrieved articles. Every included study was to report risk estimates with 95% CIs for the association between metabolic syndrome and cancer. RESULTS We analyzed 116 datasets from 43 articles, including 38,940 cases of cancer. In cohort studies in men, the presence of metabolic syndrome was associated with liver (relative risk 1.43, P & lt; 0.0001), colorectal (1.25, P & lt; 0.001), and bladder cancer (1.10, P = 0.013). In cohort studies in women, the presence of metabolic syndrome was associated with endometrial (1.61, P = 0.001), pancreatic (1.58, P & lt; 0.0001), breast postmenopausal (1.56, P = 0.017), rectal (1.52, P = 0.005), and colorectal (1.34, P = 0.006) cancers. Associations with metabolic syndrome were stronger in women than in men for pancreatic (P = 0.01) and rectal (P = 0.01) cancers. Associations were different between ethnic groups: we recorded stronger associations in Asia populations for liver cancer (P = 0.002), in European populations for colorectal cancer in women (P = 0.004), and in U.S. populations (whites) for prostate cancer (P = 0.001). CONCLUSIONS Metabolic syndrome is associated with increased risk of common cancers; for some cancers, the risk differs betweens sexes, populations, and definitions of metabolic syndrome.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc12-0336
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2012
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  • 3
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    Prevalence of Morphometric Vertebral Fractures in Patients With Type 1 Diabetes
    American Diabetes Association ; 2013
    In:  Diabetes Care Vol. 36, No. 6 ( 2013-06-01), p. 1635-1640
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 36, No. 6 ( 2013-06-01), p. 1635-1640
    Abstract: Several studies showed low bone mineral density (BMD) and elevated risk of symptomatic fractures in patients with type 1 diabetes (T1D). To our knowledge, there has been no investigation on the prevalence of asymptomatic vertebral fractures (VFx) in T1D. In the current study, we assessed BMD and the prevalence of VFx in T1D. RESEARCH DESIGN AND METHODS We evaluated 82 T1D patients (26 males and 56 females, aged 31.1 ± 8.6 years, BMI 23.5 ± 3.3 kg/m2, disease duration 12.8 ± 8.3 years) and 82 controls (22 females and 60 males, aged 32.9 ± 5.8 years, BMI 23.9 ± 4.8 kg/m2). Spinal and femoral BMD (as Z-score, Z-LS and Z-FN, respectively) and the prevalence of VFx were evaluated by dual X-ray absorptiometry. RESULTS T1D patients had lower Z-LS and Z-FN than controls (−0.55 ± 1.3 vs. 0.35 ± 1.0, P & lt; 0.0001, and −0.64 ± 1.1 vs. 0.29 ± 0.9, P & lt; 0.0001, respectively) and a higher prevalence of VFx (24.4 vs. 6.1%, P = 0.002). Age, diabetes duration, age at diabetes manifestation, glycosylated hemoglobin, Z-LS, Z-FN, and the prevalence of chronic complications were similar for patients with and without VFx. In the logistic regression analysis, the presence of VFx was associated with the presence of T1D but not with lumbar spine BMD. Whereas moderate or severe VFx was associated with low lumbar spine BMD in the whole combined group of T1D patients and controls, there was no association between moderate or severe VFx and lumbar spine BMD in the T1D group. CONCLUSIONS T1D patients have low BMD and elevated prevalence of asymptomatic VFx, which is associated with the presence of T1D independently of BMD.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc12-1355
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2013
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  • 4
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    Online Resource
    Efficacy of Insulin Analogs in Achieving the Hemoglobin A1c Target of 〈7% in Type 2 Diabetes
    American Diabetes Association ; 2011
    In:  Diabetes Care Vol. 34, No. 2 ( 2011-02-01), p. 510-517
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 34, No. 2 ( 2011-02-01), p. 510-517
    Abstract: Insulin analogs are increasingly used in patients with type 2 diabetes. We compared the effect of basal, biphasic, prandial, and basal-bolus insulin regimens with insulin analogs to reach the hemoglobin A1c (HbA1c) target of & lt;7% in people with type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted an electronic search for randomized controlled trials (RCTs) involving insulin analogs. RCTs were included if they lasted at least 12 weeks, reported the proportion of diabetic patients reaching the HbA1c target of & lt;7% (primary outcome), and the number of patients in any arm was & gt;30. RESULTS We found 16 RCTs, with 20 comparisons and 7,759 patients. A greater proportion of patients achieved the HbA1c goal of & lt;7% with both biphasic (odds ratio 1.88 [95% CI 1.38–2.55]) and prandial (2.07 [1.16–3.69] ) insulin compared with basal insulin; this was associated for biphasic insulin with greater hypoglycemia (event/patient/30 days, mean difference, 0.34 [range 0–0.69]) and weight gain in kg (1.0 kg [0.28–1.73] ). Compared with biphasic insulin, the basal-bolus regimen was associated with a greater chance to reach the HbA1c goal (odds ratio 1.75 [95% CI 1.11–2.77]), with no greater hypoglycemia or weight gain. The effect of insulin analogs on long-term diabetes complications is still lacking. CONCLUSIONS A greater proportion of type 2 diabetic patients can achieve the HbA1c goal & lt;7% with biphasic or prandial insulin compared with basal insulin; in absolute terms, the basal-bolus regimen was best for the attainment of the HbA1c goal.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc10-1710
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2011
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  • 5
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    Online Resource
    Diabetic Foot Problems During the COVID-19 Pandemic in a Tertiary Care Center: The Emergency Among the Emergencies
    American Diabetes Association ; 2020
    In:  Diabetes Care Vol. 43, No. 10 ( 2020-10-01), p. e123-e124
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 43, No. 10 ( 2020-10-01), p. e123-e124
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc20-1347
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
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  • 6
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    Basal Supplementation of Insulin Lispro Protamine Suspension Versus Insulin Glargine and Detemir for Type 2 Diabetes
    American Diabetes Association ; 2012
    In:  Diabetes Care Vol. 35, No. 12 ( 2012-12-01), p. 2698-2705
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 35, No. 12 ( 2012-12-01), p. 2698-2705
    Abstract: We compared the effect of insulin lispro protamine suspension (ILPS) with that of insulin glargine and insulin detemir, all given as basal supplementation, in the treatment of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted an electronic search until February 2012, including online registries of ongoing trials and abstract books. All randomized controlled trials comparing ILPS with insulin glargine or detemir with a duration of ≥12 weeks were included. RESULTS We found four trials lasting 24–36 weeks involving 1,336 persons: three studies compared ILPS with glargine, and one trial compared ILPS with detemir. There was no significant difference in change in HbA1c level between ILPS and comparators, in the proportion of patients achieving the HbA1c goals of ≤6.5 or & lt;7%, in weight change, or in daily insulin doses. There was no difference in overall hypoglycemia, but nocturnal hypoglycemia occurred significantly more with ILPS than with comparator insulins (mean difference 0.099 events/patient/30 days [95% CI 0.03–0.17]). In a prespecified sensitivity analysis comparing data obtained in patients who remained on their once-daily insulin regimen, not significantly different event rates for nocturnal hypoglycemia were observed between ILPS and comparator insulins (0.063 [−0.007 to 0.13] ), and ILPS was associated with lower insulin dose (0.07 units/kg/day [0.05–0.09]). CONCLUSIONS There is no difference between ILPS and insulin glargine or detemir for targeting hyperglycemia, but nocturnal hypoglycemia occurred more frequently with ILPS than with comparator insulins. Nocturnal hypoglycemia was not significantly different in people who injected insulin once daily.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc12-0698
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2012
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  • 7
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    Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials
    American Diabetes Association ; 2020
    In:  Diabetes Care Vol. 43, No. 5 ( 2020-05-01), p. 1146-1156
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 43, No. 5 ( 2020-05-01), p. 1146-1156
    Abstract: Continuous glucose monitoring (CGM) provides important information to aid in achieving glycemic targets in people with diabetes. PURPOSE We performed a meta-analysis of randomized controlled trials (RCTs) comparing CGM with usual care for parameters of glycemic control in both type 1 and type 2 diabetes. DATA SOURCES Many electronic databases were searched for articles published from inception until 30 June 2019. STUDY SELECTION We selected RCTs that assessed both changes in HbA1c and time in target range (TIR), together with time below range (TBR), time above range (TAR), and glucose variability expressed as coefficient of variation (CV). DATA EXTRACTION Data were extracted from each trial by two investigators. DATA SYNTHESIS All results were analyzed by a random effects model to calculate the weighted mean difference (WMD) with the 95% CI. We identified 15 RCTs, lasting 12–36 weeks and involving 2,461 patients. Compared with the usual care (overall data), CGM was associated with modest reduction in HbA1c (WMD −0.17%, 95% CI −0.29 to −0.06, I2 = 96.2%), increase in TIR (WMD 70.74 min, 95% CI 46.73–94.76, I2 = 66.3%), and lower TAR, TBR, and CV, with heterogeneity between studies. The increase in TIR was significant and robust independently of diabetes type, method of insulin delivery, and reason for CGM use. In preplanned subgroup analyses, real-time CGM led to the higher improvement in mean HbA1c (WMD −0.23%, 95% CI −0.36 to −0.10, P & lt; 0.001), TIR (WMD 83.49 min, 95% CI 52.68–114.30, P & lt; 0.001), and TAR, whereas both intermittently scanned CGM and sensor-augmented pump were associated with the greater decline in TBR. LIMITATIONS Heterogeneity was high for most of the study outcomes; all studies were sponsored by industry, had short duration, and used an open-label design. CONCLUSIONS CGM improves glycemic control by expanding TIR and decreasing TBR, TAR, and glucose variability in both type 1 and type 2 diabetes.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc19-1459
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
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  • 8
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    Online Resource
    Low Bone Mineral Density and Its Predictors in Type 1 Diabetic Patients Evaluated by the Classic Statistics and Artificial Neural Network Analysis
    American Diabetes Association ; 2011
    In:  Diabetes Care Vol. 34, No. 10 ( 2011-10-01), p. 2186-2191
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 34, No. 10 ( 2011-10-01), p. 2186-2191
    Abstract: To investigate factors associated with bone mineral density (BMD) in type 1 diabetes by classic statistic and artificial neural networks. RESEARCH DESIGN AND METHODS A total of 175 eugonadal type 1 diabetic patients (age 32.8 ± 8.4 years) and 151 age- and BMI-matched control subjects (age 32.6 ± 4.5 years) were studied. In all subjects, BMI and BMD (as Z score) at the lumbar spine (LS-BMD) and femur (F-BMD) were measured. Daily insulin dose (DID), age at diagnosis, presence of complications, creatinine clearance (ClCr), and HbA1c were determined. RESULTS LS- and F-BMD levels were lower in patients (−0.11 ± 1.2 and −0.32 ± 1.4, respectively) than in control subjects (0.59 ± 1, P & lt; 0.0001, and 0.63 ± 1, P & lt; 0.0001, respectively). LS-BMD was independently associated with BMI and DID, whereas F-BMD was associated with BMI and ClCr. The cutoffs for predicting low BMD were as follows: BMI & lt;23.5 kg/m2, DID & gt;0.67 units/kg, and ClCr & lt;88.8 mL/min. The presence of all of these risk factors had a positive predictive value, and their absence had a negative predictive value for low BMD of 62.9 and 84.2%, respectively. Data were also analyzed using the TWIST system in combination with supervised artificial neural networks and a semantic connectivity map. The TWIST system selected 11 and 12 variables for F-BMD and LS-BMD prediction, which discriminated between high and low BMD with 67 and 66% accuracy, respectively. The connectivity map showed that low BMD at both sites was indirectly connected with HbA1c through chronic diabetes complications. CONCLUSIONS In type 1 diabetes, low BMD is associated with low BMI and low ClCr and high DID. Chronic complications negatively influence BMD.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc11-0764
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2011
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  • 9
    Online Resource
    Online Resource
    Cortisol Secretion in Patients With Type 2 Diabetes: Relationship With Chronic Complications
    American Diabetes Association ; 2007
    In:  Diabetes Care Vol. 30, No. 6 ( 2007-06-01), p. e50-e50
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 30, No. 6 ( 2007-06-01), p. e50-e50
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc07-0271
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2007
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  • 10
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    Primary Prevention of Sexual Dysfunction With Mediterranean Diet in Type 2 Diabetes: The MÈDITA Randomized Trial
    American Diabetes Association ; 2016
    In:  Diabetes Care Vol. 39, No. 9 ( 2016-09-01), p. e143-e144
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 39, No. 9 ( 2016-09-01), p. e143-e144
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc16-0910
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2016
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