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  • 1
    Online Resource
    Online Resource
    267-OR: Diabetes, COVID-19, and All-Cause Mortality among People with Diabetes during the COVID-Pandemic in Minnesota: Population-Based Study
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Abstract: People with diabetes have been profoundly impacted by the COVID-pandemic. Diabetes and its comorbidities are strong risk factors for severe, including fatal, COVID-disease. People with diabetes may also have limited or delayed routine and non-emergent medical services, potentially increasing their risk of death from causes unrelated to COVID-19. Granular population-level data on rates, causes, and places (i.e. home vs. hospital) of death among people with diabetes during the COVID-pandemic is scarce. We examined Minnesota death certificates from 2020 (COVID-year) and 2018-20 (comparator years) among people with diabetes to compare changes in population-adjusted rates of diabetes-specific mortality (diabetes as a primary cause of death) , and all-cause and other disease-specific mortality (other primary causes with diabetes as a contributing cause of death) . We also assessed COVID-mortality (COVID-as a primary cause and diabetes as a contributing cause) . Analyses were adjusted for multiple comparisons using the false discovery rate correction. COVID-accounted for 246 deaths per 100,000 people with diabetes. There was no significant change in diabetes-specific mortality from 2018-20to 2020 (328 to 353 per 100,000; 2020 vs. 2018-20IRR 1.[95% CI 1.01-1.15]; p=0.08) . All-cause mortality among people with diabetes increased from 1,484 to 1,922 per 100,000 (IRR 1.30 [95% CI 1.26-1.33] ; p & lt;0.001) , while non-COVID mortality among increased from 1,484 to 1,675 per 100,000 (IRR 1.13 [95% CI 1.10-1.16]; p & lt;0.001) . Deaths for cardiovascular diseases, cancers, and infectious diseases (not including COVID-19) also increased significantly, suggesting that people may have deferred care for these conditions with deadly consequences. Our findings underscore the need for uninterrupted comprehensive care for people living with diabetes to ensure that access for acute and chronic health concerns remains prioritized. Disclosure R.G.Mccoy: Consultant; Emmi. A.F.Mullan: None. M.M.Jeffery: Stock/Shareholder; Goodness Growth Holdings. C.M.Bucks: None. C.M.Clements: Consultant; Vail Scientific LLC. R.Campbell: Consultant; Bryn Pharma. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-267-OR
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
    detail.hit.zdb_id: 1501252-9
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  • 2
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    Online Resource
    127-OR: Pharmacologic Management of Diabetic Peripheral Neuropathy
    American Diabetes Association ; 2020
    In:  Diabetes Vol. 69, No. Supplement_1 ( 2020-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 69, No. Supplement_1 ( 2020-06-01)
    Abstract: Approximately half of all people with diabetes develop diabetic peripheral neuropathy (DPN) and half experience pain. Guidelines recommend pregabalin, gabapentin, and duloxetine (a selective norepinephrine and serotonin reuptake inhibitor [SNRI]) due to their demonstrated efficacy and safety. Topical analgesics, tricyclic anti-depressants (TCA), and anti-convulsants may also be used. Opioids are discouraged due to lack of effectiveness, risk of addiction, and safety concerns. To promote safe evidence-based pain management, we examined pain medication use by adults diagnosed with DPN between 2002-2019 in an integrated healthcare system across 5 states. We identified 13,815 adults with newly diagnosed DPN; mean age 66 (SD, 13) years, 42% female, 93% white, 29% insulin-treated. Overall, 56% received a pain medication from DPN diagnosis (1 month prior or continued from baseline) to 2 years later. Limiting to treatment pathways observed in ≥1% of cases, opioids were the most used 1st line medication, followed by gabapentin and others (Figure). Opioids and gabapentin were also the most prevalent 2nd line drugs. High rates of opioid use by patients with DPN, a life-long pain syndrome, are concerning particularly as safer effective treatment options are available. Further research is needed to identify drivers of opioid use and barriers to evidence-based alternatives, and develop interventions to improve DPN management in clinical practice. Disclosure J. Fan: None. M.M. Jeffery: None. W. Hooten: None. N. Shah: None. R.G. McCoy: None. Funding National Institutes of Health (K23DK114497)
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db20-127-OR
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
    detail.hit.zdb_id: 1501252-9
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  • 3
    Online Resource
    Online Resource
    Weight Change During the Postintervention Follow-up of Look AHEAD
    American Diabetes Association ; 2022
    In:  Diabetes Care Vol. 45, No. 6 ( 2022-06-02), p. 1306-1314
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 45, No. 6 ( 2022-06-02), p. 1306-1314
    Abstract: Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year 8. RESULTS Postintervention weight change averaged −3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10–18% in other trajectories (P & lt; 0001). The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1–8; and year 8, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies. CONCLUSIONS Steep weight loss postintervention was associated with increased risk of mortality. Older individuals with longer duration of diabetes and multimorbidity should be monitored for excessive unintentional weight loss.
    Type of Medium: Online Resource
    ISSN: 0149-5992
    URL: Article
    DOI: 10.2337/dc21-1990
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
    detail.hit.zdb_id: 1490520-6
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