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  • 1
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    Online Resource
    Clinical and Metabolic Characterization of Adults With Type 2 Diabetes by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) Cohort
    American Diabetes Association ; 2022
    In:  Diabetes Care Vol. 45, No. 7 ( 2022-07-07), p. 1512-1521
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 45, No. 7 ( 2022-07-07), p. 1512-1521
    Abstract: Differences in type 2 diabetes phenotype by age are described, but it is not known whether these differences are seen in a more uniformly defined adult population at a common early stage of care. We sought to characterize age-related clinical and metabolic characteristics of adults with type 2 diabetes on metformin monotherapy, prior to treatment intensification. RESEARCH DESIGN AND METHODS In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), participants were enrolled who had type 2 diabetes duration & lt;10 years, had HbA1c 6.8–8.5%, and were on metformin monotherapy. Participants were randomly assigned to one of four additional glucose-lowering medications. We compared baseline clinical and metabolic characteristics across age categories ( & lt;45, 45 to & lt;55, 55 to & lt;65, and ≥65 years) using ANOVA and Pearson χ2 tests. RESULTS Within the GRADE cohort (n = 5,047), we observed significant differences by age, with younger adults having greater racial diversity, fewer medications for common comorbidities, lower prevalence of CVD, higher weight and BMI, and more pronounced hyperglycemia and diabetic dyslipidemia and with metabolic profile indicating lower insulin sensitivity (inverse fasting insulin [1/(fasting insulin)], HOMA of steady-state insulin sensitivity, Matsuda index) and inadequate β-cell response (oral disposition index) (P & lt; 0.05 across age categories). CONCLUSIONS Clinical and metabolic characteristics of type 2 diabetes differ by age within the GRADE cohort. Younger adults exhibit more prominent obesity-related characteristics, including higher obesity levels and lower insulin sensitivity and β-cell compensation. Given the increasing burden of type 2 diabetes and complications, particularly among younger populations, these age-related distinctions may inform risk factor management approaches and treatment priorities. Further study will determine whether age-related differences impact response to therapy.
    Type of Medium: Online Resource
    ISSN: 0149-5992
    URL: Article
    DOI: 10.2337/dc21-2659
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 2
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    Evaluation of Web-Based and In-Person Methods to Recruit Adults With Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study
    JMIR Publications Inc. ; 2021
    In:  JMIR Diabetes Vol. 6, No. 3 ( 2021-7-8), p. e28309-
    Details
    In: JMIR Diabetes, JMIR Publications Inc., Vol. 6, No. 3 ( 2021-7-8), p. e28309-
    Abstract: Our clinical trial of a mobile exercise intervention for adults 18 to 65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic. Objective Our objectives for this study were to (1) evaluate the effectiveness and cost of using social media news feed advertisements, a clinic-based approach method, and web-based snowball sampling to reach inadequately active adults with T1D and (2) compare characteristics of enrollees against normative data. Methods Participants were recruited between November 2019 and August 2020. In method #1, Facebook and Instagram news feed advertisements ran for five 1-to-8-day windows targeting adults (18 to 64 years old) in the greater New Haven and Hartford, Connecticut, areas with one or more diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. In method #2, patients 18 to 24 years old with T1D were approached in person at clinical visits in November and December 2019. Those who were interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. In method #3, snowball sampling was conducted by physically active individuals with T1D contacting their peers on Facebook and via email for 48 days, with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants to the study similarly to snowball sampling. Results In method #1, advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%); 20 participants from this group (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%; P 〈 .001), but their responsiveness and eligibility rates did not differ. In method #2, we approached 40 patients; 32 of these patients (80%) inquired about the study, of whom 20 (63%) volunteered, and 2 of these volunteers (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. In method #3, snowball sampling generated 13 inquirers; 12 of these inquirers (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $20.59 per eligible volunteer. Other methods yielded 7 inquirers; 5 of these inquirers (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (ie, optimal glycemic control, obesity, and low exercise), among those recruited by news feed advertisements (ie, obesity and older age), and among those recruited by snowball sampling (ie, optimal glycemic control and low exercise). Conclusions Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, with costs comparing favorably to prior trials despite targeting an uncommon condition (ie, T1D) and commitment to an intervention. These strategies should be tailored in future studies to increase access to higher-risk participants. Trial Registration ClinicalTrials.gov NCT04204733; https://clinicaltrials.gov/ct2/show/NCT04204733
    Type of Medium: Online Resource
    ISSN: 2371-4379
    URL: Article
    DOI: 10.2196/28309
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2021
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  • 3
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    Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Clinical Journal of Sport Medicine Vol. 33, No. 5 ( 2023-09), p. 512-520
    Details
    In: Clinical Journal of Sport Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 5 ( 2023-09), p. 512-520
    Abstract: Pilot-test personalized digital health information to substantiate human-delivered exercise support for adults with type 1 diabetes (T1D). Design: Single-group, 2-week baseline observation, then 10-week intervention with follow-up observation. Setting: Community-based sample participating remotely with physician oversight. Participants: Volunteers aged 18 to 65 years with T1D screened for medical readiness for exercise intervention offerings. N = 20 enrolled, and N = 17 completed all outcomes with 88% to 91% biosensor adherence. Intervention: Feedback on personalized data from continuous glucose monitoring (CGM), its intersection with other ecological data sets (exercise, mood, and sleep), and other informational and motivational elements (exercise videos, text-based exercise coach, and self-monitoring diary). Main Outcome Measures: Feasibility (use metrics and assessment completion), safety (mild and severe hypoglycemia, and diabetic ketoacidosis), acceptability (system usability scale, single items, and interview themes), and standard clinical and psychosocial assessments. Results: Participants increased exercise from a median of 0 (Interquartile range, 0-21) to 64 (20-129) minutes per week ( P = 0.001, d = 0.71) with no severe hypoglycemia or ketoacidosis. Body mass index increased (29.5 ± 5.1 to 29.8 ± 5.4 kg/m 2 , P = 0.02, d = 0.57). Highest satisfaction ratings were for CGM use (89%) and data on exercise and its intersection with CGM and sleep (94%). Satisfaction was primarily because of improved exercise management behavioral skills, although derived motivation was transient. Conclusions: The intervention was feasible, safe, and acceptable. However, there is a need for more intensive, sustained support. Future interventions should perform analytics upon the digital health information and molecular biomarkers (eg, genomics) to make exercise support tools that are more personalized, automated, and intensive than our present offerings.
    Type of Medium: Online Resource
    ISSN: 1050-642X
    URL: Article
    DOI: 10.1097/JSM.0000000000001078
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2045233-0
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  • 4
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    Self-esteem and neuroendocrine response to challenge: MacArthur studies of successful aging
    Elsevier BV ; 1995
    In:  Journal of Psychosomatic Research Vol. 39, No. 1 ( 1995-01), p. 69-84
    Details
    In: Journal of Psychosomatic Research, Elsevier BV, Vol. 39, No. 1 ( 1995-01), p. 69-84
    Type of Medium: Online Resource
    ISSN: 0022-3999
    URL: Article
    DOI: 10.1016/0022-3999(94)00076-H
    RVK:
    CL 1000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1995
    detail.hit.zdb_id: 1500642-6
    SSG: 5,2
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  • 5
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    1141-P: Detailed Phenotype of Randomized Participants by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)
    American Diabetes Association ; 2019
    In:  Diabetes Vol. 68, No. Supplement_1 ( 2019-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 68, No. Supplement_1 ( 2019-06-01)
    Abstract: Background: GRADE enrolled 5,047 adults & gt; 30 years, T2DM & lt; 10 years duration, on metformin, requiring a second medication, A1C 6.8-8.5%. Age-related differences in disease phenotype may affect responses to the randomized treatments being evaluated. Objective: To evaluate whether baseline characteristics differed by age. Methods: Baseline characteristics were compared across age groups, using mean ± SD (ANOVA) or % (Pearson’s chi-square). We report nominal, unadjusted p-values. Results: With the defined inclusion criteria, we enrolled a cohort with overall DM duration 4.2 ± 2.8 years, and A1c 7.5 ± 0.5%. Within this cohort, distinct clinical phenotypes by age were present. Across the age groups, older individuals had more CVD, and were on more medications for DM-related comorbidities. Younger individuals were more diverse, had higher weight, FPG, and insulin, more pronounced diabetic dyslipidemia, and were taking fewer medications for comorbidities (Table). Conclusion: Within the GRADE cohort defined by inclusion criteria representing a specific stage of glycemia, the clinical phenotype of T2DM differed by age, with older participants having greater prevalent comorbidity and younger participants having more prominent hyperglycemia and higher weight. An understanding of the distinct phenotypes by age may identify priorities and gaps in clinical care. Disclosure V.R. Aroda: Consultant; Self; ADOCIA, AstraZeneca, Becton, Dickinson and Company, Novo Nordisk Inc., Sanofi, Zafgen, Inc. Employee; Spouse/Partner; Merck & Co., Inc. Research Support; Self; AstraZeneca, Calibra Medical, Eisai Inc., Janssen Research & Development, Novo Nordisk Inc., Sanofi, Theracos, Inc. H. Krause-Steinrauf: None. J.B. Buse: Consultant; Self; Neurimmune AG. Research Support; Self; AstraZeneca, National Center for Advancing Translational Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk A/S, Sanofi, vTv Therapeutics. Stock/Shareholder; Self; Mellitus Health, PhaseBio Pharmaceuticals, Inc., Stability Health. Other Relationship; Self; ADOCIA, AstraZeneca, Dance Biopharm Holdings Inc., Eli Lilly and Company, MannKind Corporation, NovaTarg, Novo Nordisk A/S, Senseonics, vTv Therapeutics, Zafgen, Inc. B.I. Gulanski: None. H. Florez: None. A.J. Ahmann: Advisory Panel; Self; Eli Lilly and Company, MannKind Corporation, Novo Nordisk Inc., Sanofi-Aventis. Consultant; Self; Dexcom, Inc. Research Support; Self; Dexcom, Inc., Medtronic. A. Loveland: None. A. Kuhn: None. J. Lonier: None. K.J. Mather: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. D.J. Wexler: Other Relationship; Spouse/Partner; APOLO1BIO. Funding National Institute of Diabetes and Digestive and Kidney Diseases
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db19-1141-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
    detail.hit.zdb_id: 1501252-9
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  • 6
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    Association between Impaired Insulin Sensitivity and Stroke
    S. Karger AG ; 2005
    In:  Neuroepidemiology Vol. 25, No. 2 ( 2005), p. 69-74
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 25, No. 2 ( 2005), p. 69-74
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Prior research has indicated an association between insulin resistance and stroke; we sought to determine if this association persists after adjusting for stroke risk factors, including glycemic control. 〈 i 〉 Methods: 〈 /i 〉 We used data from the Third National Health and Nutrition Survey (1988–1994), including participants aged ≧40 years. We assessed insulin sensitivity using the homeostasis model assessment (HOMA): HOMA = (FPGSI × FPI)/22.5, where FPGSI refers to fasting plasma glucose (mmol/l) and FPI refers to fasting plasma insulin (µU/l). Increasing HOMA indicates decreasing insulin sensitivity. We used glycosylated hemoglobin (HbA1c) to measure glycemic control. Multivariable logistic regression analysis was used to identify factors that were independently associated with stroke. 〈 i 〉 Results: 〈 /i 〉 Among 3,844 participants, 168 (4%) reported a stroke history. Participants with stroke had lower insulin sensitivity than participants without stroke: HOMA mean ± standard deviation, 4.0 ± 4.0 vs. 3.3 ± 3.0; p = 0.022. HOMA was independently associated with stroke (odds ratio 1.06, 95% CI: 1.01–1.12; adjusted for age, hypertension, myocardial infarction, claudication, activity, and HbA1c). The strength of the association between HOMA and stroke was similar to the association between claudication and stroke (index R 〈 sup 〉 2 〈 /sup 〉 : 0.0032 vs. 0.0036). 〈 i 〉 Conclusions: 〈 /i 〉 Impaired insulin sensitivity is independently associated with stroke, even after adjustment for glycemic control.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000086286
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2005
    detail.hit.zdb_id: 1483032-2
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  • 7
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    Two measures of insulin sensitivity provided similar information in a U.S. population
    Elsevier BV ; 2004
    In:  Journal of Clinical Epidemiology Vol. 57, No. 11 ( 2004-11), p. 1214-1217
    Details
    In: Journal of Clinical Epidemiology, Elsevier BV, Vol. 57, No. 11 ( 2004-11), p. 1214-1217
    Type of Medium: Online Resource
    ISSN: 0895-4356
    URL: Article
    DOI: 10.1016/j.jclinepi.2004.05.001
    RVK:
    XA 52630
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2004
    detail.hit.zdb_id: 1500490-9
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  • 8
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    Increased Brain Transport and Metabolism of Acetate in Hypoglycemia Unawareness
    The Endocrine Society ; 2013
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 98, No. 9 ( 2013-09), p. 3811-3820
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 98, No. 9 ( 2013-09), p. 3811-3820
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/jc.2013-1701
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2013
    detail.hit.zdb_id: 2026217-6
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  • 9
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    Prevalence of Low Bone Density in Women with Developmental Disabilities
    Elsevier BV ; 2001
    In:  Journal of Clinical Densitometry Vol. 4, No. 1 ( 2001-3), p. 25-29
    Details
    In: Journal of Clinical Densitometry, Elsevier BV, Vol. 4, No. 1 ( 2001-3), p. 25-29
    Type of Medium: Online Resource
    ISSN: 1094-6950
    URL: Article
    DOI: 10.1385/JCD:4:1:25
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2001
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  • 10
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    Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort
    BMJ ; 2023
    In:  BMJ Open Diabetes Research & Care Vol. 11, No. 2 ( 2023-04), p. e003159-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 11, No. 2 ( 2023-04), p. e003159-
    Abstract: Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Research design and methods GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017. Results Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m 2 ), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes. Conclusions This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women. Trial registration number ClinicalTrials.gov ( NCT01794143 )
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2022-003159
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2732918-5
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