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  • 1
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    Online Resource
    Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission
    American Diabetes Association ; 2018
    In:  Diabetes Care Vol. 41, No. 2 ( 2018-02-01), p. 341-347
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 41, No. 2 ( 2018-02-01), p. 341-347
    Abstract: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40–89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. RESULTS A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. CONCLUSIONS Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc17-1590
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2018
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  • 2
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    Programming of Adiposity in Offspring of Mothers With Type 1 Diabetes at Age 7 Years
    American Diabetes Association ; 2010
    In:  Diabetes Care Vol. 33, No. 5 ( 2010-05-01), p. 1080-1085
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 33, No. 5 ( 2010-05-01), p. 1080-1085
    Abstract: The goals of this study were to examine the influence of maternal type 1 diabetes during pregnancy on offspring adiposity and glucose tolerance at age 7 years and to assess whether metabolic factors at birth (neonatal leptin and insulin) predict adverse outcomes. RESEARCH DESIGN AND METHODS We examined 100 offspring of mothers with type 1 diabetes (OT1DM) and 45 offspring of control mothers. Mothers had previously been recruited during pregnancy, and, where possible, birth weight, umbilical cord insulin, and leptin were measured. Children were classed as overweight and obese using age-specific reference ranges. RESULTS OT1DM had similar height (control, 1.25 ± 0. 06 m; OT1DM, 1.24 ± 0.06 m; P = 0.81) but were heavier (control, 25.5 ± 3.8 kg; OT1DM, 27.1 ± 5.7 kg; P = 0.048) and had an increased BMI (control, 16.4 kg/m2; OT1DM, 17.4 ± 2.6 kg/m2, P = 0.005). Waist circumference (control, 56.0 ± 3.7 cm; OT1DM, 58 ± 6.8 cm; P = 0.02) and sum of skinfolds were increased (control, 37.5 ± 17.0 mm [n = 42] ; OT1DM, 46.1 ± 24.2 mm [n = 91]; P = 0.02), and there was a marked increase in the prevalence of overweight and obese children (OT1DM, 22% overweight and 12% obese; control, 0% overweight and 7% obese; χ2 P = 0.001). Glucose tolerance was not different compared with that in control subjects. BMI at age 7 years correlated with cord leptin (OT1DM, r = 0.25; n = 61, P = 0.047), weakly with adjusted birth weight (r = 0.19; P = 0.06) and hematocrit (r = 0.25; n = 50, P = 0.07), but not cord insulin (OT1DM, r = −0.08; P = 0.54). CONCLUSIONS OT1DM are at increased risk of overweight and obesity in childhood. This risk appears to relate, in part, to fetal leptin and hematocrit but not insulin.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc09-1766
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2010
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  • 3
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    Baseline Predictors and Influence of Early Weight Loss during an Intensive Weight Management Programme on Remission of Type 2 Diabetes after 12 Months—Post-Hoc Analysis of the Diabetes Remission Clinical Trial (DiRECT)
    American Diabetes Association ; 2018
    In:  Diabetes Vol. 67, No. Supplement_1 ( 2018-07-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 67, No. Supplement_1 ( 2018-07-01)
    Abstract: Introduction: An intensive weight management programme (Counterweight-Plus), including low-energy formula diet for up to 16 weeks, then a structured approach for weight-loss maintenance, delivered within routine primary care, has shown striking remissions of type 2 diabetes (T2DM diagnosis & lt;6 years). Remissions at 12 months were achieved by 46% overall, by 73% with weight loss & gt;10kg. Methods: Baseline factors, and weight losses of 2-10kg from baseline, at 4, 6, and 8 weeks, were examined as potential predictors of remission of T2DM at 12 months (nondiabetic HbA1c & gt;48mmol/mol, on no antidiabetes medications) in the Intervention group (n=149, mean age 54 years, BMI 34.5kg/m2). Results: Significant baseline predictors of diabetes remission at 12 months, all modest, included older age, lower HbA1c, fewer antidiabetic and more antihypertensive drugs (both stopped at baseline) and higher blood pressure. Weight losses at 4, 6, and 8 weeks were significantly associated with remission of diabetes at 12 months. Sixteen patients (11%) failed to achieve 2kg weight loss at 6 weeks, none of whom achieved remissions of diabetes. However, 14 of these patients failed to start, or withdrew from the intervention, within 6 weeks. At 8 weeks, 31 patients (21%) had failed to achieve 6kg weight loss, of whom only 5 achieved remission (95% sensitivity, 32% specificity). However, 15 of these patients had withdrawn from treatment. Excluding earlier withdrawals from treatment, achieving & lt;6kg loss had only 17% specificity for identifying failure to achieve remission. Conclusions: Early weight loss predicts treatment success. However, many failing patients withdraw spontaneously and early ‘stopping rules’ would deny treatment to a significant minority who gain remissions from continued support. Disclosure M.E.J. Lean: Advisory Panel; Self; Novo Nordisk Inc., Orexigen Therapeutics, Inc.. Research Support; Self; Cambridge Weight Plan. Consultant; Self; Counterweight Ltd. Stock/Shareholder; Self; Eat Balanced. W.S. Leslie: None. N. Sattar: Advisory Panel; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Amgen Inc.. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Mitsubishi Tanabe Pharma Corporation, Medscape, Sanofi-Aventis Deutschland GmbH. G. Thom: Research Support; Self; Cambridge Weight Plan. E.L. McCombie: Research Support; Self; Cambridge Weight Plan. Consultant; Self; Counterweight. N.T. Brosnahan: Employee; Self; Counterweight Ltd.. Stock/Shareholder; Self; Counterweight Ltd.. Research Support; Self; Cambridge Weight Plan. A.C. Barnes: None. R. Taylor: None. A. McConnachie: None.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db18-291-OR
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2018
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  • 4
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    Infant Body Composition and Adipokine Concentrations in Relation to Maternal Gestational Weight Gain
    American Diabetes Association ; 2014
    In:  Diabetes Care Vol. 37, No. 5 ( 2014-05-01), p. 1432-1438
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 37, No. 5 ( 2014-05-01), p. 1432-1438
    Abstract: To investigate associations of maternal gestational weight gain and body composition and their impact on offspring body composition and adipocytokine, glucose, and insulin concentrations at age 4 months. RESEARCH DESIGN AND METHODS This was a prospective study including 31 mother-infant pairs (N = 62). Maternal body composition was assessed using doubly labeled water. Infant body composition was assessed at 4 months using air displacement plethysmography, and venous blood was assayed for glucose, insulin, adiponectin, interleukin-6 (IL-6), and leptin concentrations. RESULTS Rate of gestational weight gain in midpregnancy was significantly associated with infant fat mass (r = 0.41, P = 0.03); rate of gestational weight in late pregnancy was significantly associated with infant fat-free mass (r = 0.37, P = 0.04). Infant birth weight was also strongly correlated with infant fat-free mass at 4 months (r = 0.63, P = 0.0002). Maternal BMI and maternal fat mass were strongly inversely associated with infant IL-6 concentrations (r = −0.60, P = 0.002 and r = −0.52, P = 0.01, respectively). Infant fat-free mass was inversely related to infant adiponectin concentrations (r = −0.48, P = 0.008) and positively correlated with infant blood glucose adjusted for insulin concentrations (r = 0.42, P = 0.04). No significant associations for leptin were observed. CONCLUSIONS Timing of maternal weight gain differentially impacts body composition of the 4-month-old infant, which in turn appears to affect the infant’s glucose and adipokine concentrations.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc13-2265
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2014
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  • 5
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    The Relative and Combined Ability of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Cardiovascular Events and Death in Patients With Type 2 Diabetes
    American Diabetes Association ; 2014
    In:  Diabetes Care Vol. 37, No. 1 ( 2014-01-01), p. 295-303
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 37, No. 1 ( 2014-01-01), p. 295-303
    Abstract: Current methods of risk stratification in patients with type 2 diabetes are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort study was performed in 3,862 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS Seven hundred nine (18%) patients experienced a major cardiovascular event (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and 706 (18%) died during a median of 5 years of follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio for cardiovascular events for NT-proBNP was 1.95 per 1 SD increase (95% CI 1.72, 2.20) and the hazard ratio for hs-cTnT was 1.50 per 1 SD increase (95% CI 1.36, 1.65). The hazard ratios for death were 1.97 (95% CI 1.73, 2.24) and 1.52 (95% CI 1.37, 1.67), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification index in continuous model, 39% for NT-proBNP and 46% for hs-cTnT). Likewise, both markers greatly improved the accuracy with which the 5-year risk of death was predicted. The combination of both markers provided optimal risk discrimination. CONCLUSIONS NT-proBNP and hs-cTnT appear to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc13-1165
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2014
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  • 6
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    Response to Comment on Hillis et al. The Relative and Combined Ability of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Cardiovascular Events and Death in Patients With Type 2 Diabetes. Diabetes Care 2014;37:295–303
    American Diabetes Association ; 2014
    In:  Diabetes Care Vol. 37, No. 6 ( 2014-06-01), p. e154-e154
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 37, No. 6 ( 2014-06-01), p. e154-e154
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc14-0485
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2014
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  • 7
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    First-Trimester Prediction of Gestational Diabetes Mellitus: Examining the Potential of Combining Maternal Characteristics and Laboratory Measures
    American Diabetes Association ; 2010
    In:  Diabetes Vol. 59, No. 12 ( 2010-12-01), p. 3017-3022
    Details
    In: Diabetes, American Diabetes Association, Vol. 59, No. 12 ( 2010-12-01), p. 3017-3022
    Abstract: Predictors of gestational diabetes mellitus (GDM) have been widely studied, but few studies have considered multiple measures. Our objective was to integrate several potential GDM predictors with consideration to both simple and novel measures and to determine the extent to which GDM can be predicted in the first trimester. RESEARCH DESIGN AND METHODS We identified first-trimester maternal samples from 124 women who developed GDM and 248 control subjects who did not. We gathered data on age, BMI, parity, race, smoking, prior GDM, family history of diabetes, and blood pressure. Using retrieved samples, we measured routine (lipids, high-sensitivity C-reactive protein, and γ-glutamyltransferase) and novel (adiponectin, E-selectin, and tissue plasminogen activator [t-PA] ) parameters. We determined independent predictors from stepwise regression analyses, calculated areas under the receiver-operating characteristic curves (AUC-ROC), and integrated discrimination improvement (IDI) for relevant models. RESULTS Compared with control subjects, women who subsequently developed GDM were older, had higher BMIs, were more likely to be of Asian origin, had a history of GDM or family history of type 2 diabetes, and had higher systolic blood pressure (P & lt; 0.05 for all). With regard biochemical measures, stepwise analyses identified only elevated t-PA and low HDL cholesterol levels as significant (P ≤ 0.015) independent predictors of GDM beyond simple non–laboratory-based maternal measures. Their inclusion improved the AUC-ROC from 0.824 to 0.861 and IDI by 0.052 (0.017–0.115). CONCLUSIONS GDM can be usefully estimated from a mix of simple questions with potential for further improvement by specific blood measures (lipids and t-PA).
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db10-0688
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2010
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  • 8
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    C-Reactive Protein and Prognosis in Diabetes: Getting to the Heart of the Matter
    American Diabetes Association ; 2009
    In:  Diabetes Vol. 58, No. 4 ( 2009-04-01), p. 798-799
    Details
    In: Diabetes, American Diabetes Association, Vol. 58, No. 4 ( 2009-04-01), p. 798-799
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db08-1788
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2009
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  • 9
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    First-Trimester Circulating 25-Hydroxyvitamin D Levels and Development of Gestational Diabetes Mellitus
    American Diabetes Association ; 2011
    In:  Diabetes Care Vol. 34, No. 5 ( 2011-05-01), p. 1091-1093
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 34, No. 5 ( 2011-05-01), p. 1091-1093
    Abstract: To investigate the association between first-trimester maternal serum levels of 25-hydroxyvitamin D (25-OH-D) as measured by liquid chromatography-tandem mass spectrometry and development of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We conducted a case-control study involving 248 women in the first-trimester of pregnancy, 90 of whom developed GDM and 158 remained normoglycemic. RESULTS Although booking 25-OH-D levels correlated negatively with 2-h glucose post-oral glucose tolerance test and positively with HDL cholesterol, as well as with ethnicity, obesity, and smoking (all P & lt; 0.05), there were no statistically significant differences in baseline maternal mean 25-OH-D levels between those who subsequently developed GDM, 18.9 ng/mL (SD 10.7) and those who remained normoglycemic, 19.0 ng/mL (10.7) (P = 0.874), even after adjustment for possible confounders including sampling month (P = 0.784). CONCLUSIONS Our large and well-phenotyped prospective study did not find evidence of an association between first-trimester maternal levels of 25-OH-D and subsequent development of GDM.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc10-2264
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2011
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  • 10
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    Sitting Time and Waist Circumference Are Associated With Glycemia in U.K. South Asians
    American Diabetes Association ; 2011
    In:  Diabetes Care Vol. 34, No. 5 ( 2011-05-01), p. 1214-1218
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 34, No. 5 ( 2011-05-01), p. 1214-1218
    Abstract: To investigate the independent contributions of waist circumference, physical activity, and sedentary behavior on glycemia in South Asians living in Scotland. RESEARCH DESIGN AND METHODS Participants were 1,228 (523 men and 705 women) adults of Indian or Pakistani origin screened for the Prevention of Type 2 Diabetes and Obesity in South Asians (PODOSA) trial. All undertook an oral glucose tolerance test, had physical activity and sitting time assessed by International Physical Activity Questionnaire, and had waist circumference measured. RESULTS Mean ± SD age and waist circumference were 49.8 ± 10.1 years and 99.2 ± 10.2 cm, respectively. One hundred ninety-one participants had impaired fasting glycemia or impaired glucose tolerance, and 97 had possible type 2 diabetes. In multivariate regression analysis, age (0.012 mmol ⋅ L−1 ⋅ year−1 [95% CI 0.006–0.017]) and waist circumference (0.018 mmol ⋅ L−1 ⋅ cm−1 [0.012–0.024] ) were significantly independently associated with fasting glucose concentration, and age (0.032 mmol ⋅ L−1 ⋅ year−1 [0.016–0.049]), waist (0.057 mmol ⋅ L−1 ⋅ cm−1 [0.040–0.074] ), and sitting time (0.097 mmol ⋅ L−1 ⋅ h−1 ⋅ day−1 [0.036–0.158]) were significantly independently associated with 2-h glucose concentration. Vigorous activity time had a borderline significant association with 2-h glucose concentration (−0.819 mmol ⋅ L−1 ⋅ h−1 ⋅ day−1 [−1.672 to 0.034] ) in the multivariate model. CONCLUSIONS These data highlight an important relationship between sitting time and 2-h glucose levels in U.K. South Asians, independent of physical activity and waist circumference. Although the data are cross-sectional and thus do not permit firm conclusions about causality to be drawn, the results suggest that further study investigating the effects of sitting time on glycemia and other aspects of metabolic risk in South Asian populations is warranted.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc10-2313
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2011
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