OBJECTIVEWe evaluated the addition of liraglutide to metformin in type 2 diabetes followed by intensification with basal insulin (detemir) if glycated hemoglobin (A1C) ≥7%.RESEARCH DESIGN AND METHODSIn 988 participants from North America and Europe uncontrolled on metformin … [Read more...]
Health-Related Quality of Life Among German Youths With Early-Onset and Long-Duration Type 1 Diabetes
May 18, 2012 By
OBJECTIVETo evaluate self- and parent-reports of general health status and health-related quality of life (QoL) in children and adolescents with early-onset and long-lasting type 1 diabetes compared with the general population in Germany.RESEARCH DESIGN AND METHODSA total of 629 subjects aged 11 to 17 years, with a type 1 diabetes onset occurring from age 0 to 4 years during the years 1993–1999, and their parents, completed questionnaires, including the generic KINDL-R Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, revised version, to assess QoL. The comparison group (n = 6,813) was a representative sample from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study. Regression analyses were conducted using sociodemographic and health-related covariates.RESULTSIntensified insulin therapy was used to treat 93% of children and adolescents with type 1 diabetes. They reported "excellent" general health as … [Read more...]
Diabetes Differentially Affects Depression and Self-Rated Health by Age in the U.S.
May 18, 2012 By
OBJECTIVETo determine whether the relationship between age and physical and mental health varies by diabetes status in older U.S. adults.RESEARCH DESIGN AND METHODSUsing data from the National Social Life, Health, and Aging Project, a national sample of 3,005 adults aged 57–85 years, we tested the significance of the interaction between age and diabetes in association with health states.RESULTSRespondents with diabetes in the youngest age cohort had more medical conditions than those without diabetes, a difference that narrowed with age (P for interaction … [Read more...]
Autonomic Cardiac Regulation During Spontaneous, Nocturnal Hypoglycemia in Patients With Type 1 Diabetes
May 18, 2012 By
OBJECTIVEExperimental clamp studies have suggested that hypoglycemia evokes a reduction of cardiac vagal control in patients with type 1 diabetes. However, there are limited data on the influence of spontaneous nocturnal hypoglycemia on cardiac autonomic regulation.RESEARCH DESIGN AND METHODSAdults with type 1 diabetes (n = 37) underwent continuous glucose monitoring via a subcutaneous sensor as well as recording of R-R interval or electrocardiogram for 3 nights. Heart rate (HR) variability was analyzed during periods of hypoglycemia (glucose3.9 mmol/L) of equal duration and at the same time of night.RESULTSThe duration of hypoglycemic and control episodes (n = 18) ranged from 20 to 190 min (mean 71 min). HR (62 … [Read more...]
Insights Into the Pathogenicity of Rare Missense GCK Variants From the Identification and Functional Characterization of Compound Heterozygous and Double Mutations Inherited in Cis
May 18, 2012 By
OBJECTIVETo demonstrate the importance of using a combined genetic and functional approach to correctly interpret a genetic test for monogenic diabetes.RESEARCH DESIGN AND METHODSWe identified three probands with a phenotype consistent with maturity-onset diabetes of the young (MODY) subtype GCK-MODY, in whom two potential pathogenic mutations were identified: [R43H/G68D], [E248 K/I225M], or [G261R/D217N]. Allele-specific PCR and cosegregation were used to determine phase. Single and double mutations were kinetically characterized.RESULTSThe mutations occurred in cis (double mutants) in two probands and in trans in one proband. Functional studies of all double mutants revealed inactivating kinetics. The previously reported GCK-MODY mutations R43H and G68D were inherited from an affected father and unaffected mother, respectively. Both our functional and genetic studies support R43H as the cause of GCK-MODY and G68D as a neutral rare variant.CONCLUSIONSThese data highlight the need for … [Read more...]
Racial Differences in Association of Elevated Interleukin-18 Levels With Type 2 Diabetes: The Atherosclerosis Risk in Communities Study
May 17, 2012 By
OBJECTIVEElevated plasma interleukin-18 (IL-18) has been linked to onset of diabetes mellitus (DM) and its complications. However, so far this association has been shown only in predominantly white populations. We examined IL-18 levels and their association with incident DM in a racially heterogeneous population.RESEARCH DESIGN AND METHODSIn a nested case-cohort design representing a 9-year follow-up of 9,740 middle-aged, initially healthy, nondiabetic white and African American participants of the Atherosclerosis Risk in Communities study, we selected and measured analytes on race-stratified (50% white, 50% African American) random samples of both cases of incident diabetes (n = 548) and eligible members of the full cohort (n = 536).RESULTSBaseline IL-18 levels were significantly higher in white participants compared with African American participants (P < 0.001). Although white participants in the fourth (versus first) quartile of IL-18 levels had a significant hazard ratio (HR) for … [Read more...]
Meat Consumption and Its Association With C-Reactive Protein and Incident Type 2 Diabetes: The Rotterdam Study
May 17, 2012 By
OBJECTIVETo investigate whether intake of different types of meat is associated with circulating C-reactive protein (CRP) and risk of type 2 diabetes in a prospective cohort study.RESEARCH DESIGN AND METHODSOur analysis included 4,366 Dutch participants who did not have diabetes at baseline. During a median follow-up period of 12.4 years, 456 diabetes cases were confirmed. Intake of red meat, processed meat, and poultry was derived from a food frequency questionnaire, and their association with serum high-sensitivity CRP was examined cross-sectionally using linear regression models. Their association with risk of type 2 diabetes was examined using multivariate Cox proportional hazards model, including age, sex, family history of diabetes, and lifestyle and dietary factors.RESULTSAn increment of 50 g of processed meat was associated with increased CRP concentration (βprocessed meat = 0.12; P = 0.01), whereas intake of red meat and poultry was not. When comparing the highest to the … [Read more...]
Role of Muscle Mass and Muscle Quality in the Association Between Diabetes and Gait Speed
May 17, 2012 By
OBJECTIVEOlder people with type 2 diabetes are at high risk of mobility disability. We investigated the association of diabetes with lower-limb muscle mass and muscle quality to verify whether diabetes-related muscle impairments mediate the association between diabetes and low walking speed.RESEARCH DESIGN AND METHODSWe performed a cross-sectional analysis of 835 participants (65 years old and older) enrolled in the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) population-based study. Total, muscular, and fat cross-sectional areas of the calf and relative muscle density were measured using peripheral quantitative computerized tomography. Indicators of muscle performance included knee extension torque, ankle plantar flexion and dorsiflexion strength, lower-extremity muscle power, and ankle muscle quality (ratio of ankle strength to the muscle area [kilograms per centimeters squared]). Gait performance was assessed by 4- and 400-m walking speed. Diabetes was ascertained … [Read more...]
Association of Adiposity Trajectories With Insulin Sensitivity and Glycemic Deterioration: A longitudinal study of rural Chinese twin adults
May 17, 2012 By
OBJECTIVETo evaluate associations between adiposity trajectories over time and insulin sensitivity and glucose deterioration in a Chinese twin cohort.RESEARCH DESIGN AND METHODSThis study focused on 341 males and 292 females aged 20–50 years at baseline who had physical clinical examinations and oral glucose tolerance test at two time points with an average of 6 years apart. BMI, waist circumference, percent body fat (PBF), and percent trunk fat (PTF) trajectories were classified into five track groups based on age- and sex-specific tertiles at each visit. We calculated the odds of the insulin sensitivity index(0,120) [ISI(0.120)] or glycemic deterioration at follow-up among five defined trajectories (tertilebaseline -> tertilefollow-up) using generalized estimate equation models. Additionally, we applied structural equation models to examine genetic and environmental influences on adiposity, adiposity change over time (ACO), ISI(0,120), and the interrelationships among … [Read more...]
Plasma Fatty Acid-Binding Protein 4, Nonesterified Fatty Acids, and Incident Diabetes in Older Adults
May 14, 2012 By
OBJECTIVESTo examine the relation of fatty acid–binding protein (FABP)4 and nonesterified fatty acids (NEFAs) to diabetes in older adults.RESEARCH DESIGN AND METHODSWe ascertained incident diabetes among 3,740 Cardiovascular Health Study participants (1992–2007) based on use of hypoglycemic medications, fasting glucose ≥126 mg/dL, or nonfasting glucose ≥200 mg/dL. FABP4 and NEFA were measured on specimens collected between 1992 and 1993.RESULTSMean age of the 3,740 subjects studied was 74.8 years. For each SD increase in log-FABP4, hazard ratios (HRs) for diabetes were 1.35 (95% CI 1.10–1.65) for women and 1.45 (1.13–1.85) for men controlling for age, race, education, physical activity, cystatin C, alcohol intake, smoking, self-reported health status, and estrogen use for women (P for sex-FABP4 interaction 0.10). BMI modified the FABP4-diabetes relation (P = 0.009 overall; 0.02 for women and 0.135 for men), in that statistically significant higher risk of … [Read more...]
