Assessment of Heart Failure in Diabetes Cardiovascular Outcomes Trials: Is What We Are Currently Capturing Adequate?
AbstractPurpose of ReviewSince the 2008 FDA guidance restructuring the design of trials for the approval of novel glucose-lowering agents, 13 medications have now been evaluated by dedicated cardiovascular outcome trials. All of the completed trials have included data (though with varying definitions) on rates of hospitalization for heart failure. This review is aimed at summarizing current heart failure outcome data available from cardiovascular safety trials for novel glucose-lowering agents in patients with type 2 diabetes mellitus.Recent FindingsThere appears to be growing evidence for the benefit of sodium –gluc...
Source: Current Diabetes Reports - May 24, 2019 Category: Endocrinology Source Type: research

Paternal Nongenetic Intergenerational Transmission of Metabolic Disease Risk
AbstractPurpose of ReviewPaternal metabolic disease before conception and during spermatogenesis can adversely impact the metabolic health of offspring in later life. Here, we review the current understanding of sperm epigenetic markers as contributors to intergenerational transmission of disease risk in both human and animal studies, and review potential intervention strategies.Recent FindingsEpidemiological studies suggest an increased risk of adverse outcomes in the offspring of fathers with obesity, diabetes, advanced age, smoking, and ancestral exposures. Potential molecular mechanisms contributing to intergenerationa...
Source: Current Diabetes Reports - May 24, 2019 Category: Endocrinology Source Type: research

School-Based Management of Pediatric Type 1 Diabetes: Recommendations, Advances, and Gaps in Knowledge
AbstractPurpose of ReviewChildren and adolescents with type 1 diabetes (T1D) spend much of their waking time in the school environment. However, there is limited empirical understanding of the challenges youth face in managing their T1D at school. There is even less literature focused on potential interventions to improve health or psychological outcomes in youth with T1D in this milieu. This review seeks to summarize the recent literature on diabetes T1D management in the school setting, including recommendations for care, barriers, and targets for intervention.Recent FindingsT1D organizations recommend strong collaborati...
Source: Current Diabetes Reports - May 24, 2019 Category: Endocrinology Source Type: research

Diabetes and the Built Environment: Evidence and Policies
AbstractPurpose of ReviewTo explore the relationship between the built environment and type 2 diabetes, considering both risk factors and policies to reduce risk. The built environment refers to the physical characteristics of the areas in which people live including buildings, streets, open spaces, and infrastructure.Recent FindingsA review of current literature suggests an association between the built environment and type 2 diabetes, likely driven by two key pathways —physical activity and the food environment. Other hypothesized mechanisms linking the built environment and type 2 diabetes include housing policy, ...
Source: Current Diabetes Reports - May 21, 2019 Category: Endocrinology Source Type: research

Advances in the Management of Peripheral Artery Disease
AbstractPurpose of ReviewThis paper provides a concise update on the management of peripheral artery disease (PAD).Recent FindingsPAD continues to denote a population at high risk for mortality but represents a threat for limb loss only when associated with foot ulcers, gangrene, or infections. Performing either angiogram or non-invasive testing for all patients with foot ulcers, gangrene, or foot infections will help increase the detection of PAD, and refined revascularization strategies may help optimize wound healing in this patient group. Structured exercise programs are becoming available to more patients with claudic...
Source: Current Diabetes Reports - May 21, 2019 Category: Endocrinology Source Type: research

Economic Impact of Diabetes in South Asia: the Magnitude of the Problem
AbstractPurpose of ReviewTo critically assess and identify gaps in the current literature on the economic impact of diabetes in South Asia.Recent FindingsThe total annual (direct medical and non-medical and indirect) costs for diabetes care in South Asia range from $483 –$2637 per patient, and on an average 5.8% of patients with diabetes suffer catastrophic spending i.e. when households reduce basic expenditure by 40% to cope with healthcare costs. The mean direct costs per patient are positively associated with a country’s gross domestic product (GDP) per capi ta, although there is wide heterogeneity across So...
Source: Current Diabetes Reports - May 16, 2019 Category: Endocrinology Source Type: research

Updates in Gestational Diabetes Prevalence, Treatment, and Health Policy
AbstractPurpose of ReviewGestational diabetes (GDM) is associated with adverse pregnancy and neonatal outcomes and increased maternal risk for subsequent type 2 diabetes. The best diagnostic strategy for GDM is debated and the role of oral antidiabetic medications (OAD) for treatment is unclear. In this paper, we review methods of GDM diagnosis, updates in GDM therapy, and interventions to reduce future type 2 diabetes in women with a history of GDM.Recent FindingsA “one-step” screening protocol for GDM using 75-g, 2-h oral glucose tolerance testing at 24–28 weeks gestation is recommended by the Inte...
Source: Current Diabetes Reports - May 9, 2019 Category: Endocrinology Source Type: research

Painful and Painless Diabetic Neuropathies: What Is the Difference?
AbstractPurpose of ReviewThe prevalence of diabetes mellitus and its chronic complications are increasing to epidemic proportions. This will unfortunately result in massive increases in diabetic distal symmetrical polyneuropathy (DPN) and its troublesome sequelae, including disabling neuropathic pain (painful-DPN), which affects around 25% of patients with diabetes. Why these patients develop neuropathic pain, while others with a similar degree of neuropathy do not, is not clearly understood. This review will look at recent advances that may shed some light on the differences between painful and painless-DPN.Recent Finding...
Source: Current Diabetes Reports - May 7, 2019 Category: Endocrinology Source Type: research

Epigenetic Markers and Microbiota/Metabolite-Induced Epigenetic Modifications in the Pathogenesis of Obesity, Metabolic Syndrome, Type 2 Diabetes, and Non-alcoholic Fatty Liver Disease
AbstractPurpose of ReviewThe metabolic syndrome is a pathological state in which one of the key components is insulin resistance. A wide spectrum of body compartments is involved in its pathophysiology. Genetic and environmental factors such as diet and physical activity are both related to its etiology. Reversible modulation of gene expression without altering the DNA sequence, known as epigenetic modifications, has been shown to drive this complex metabolic cluster of conditions. Here, we aim to examine some of the recent research of specific epigenetically mediated mechanisms and microbiota-induced epigenetic modificati...
Source: Current Diabetes Reports - May 1, 2019 Category: Endocrinology Source Type: research

Bringing Social Context into Diabetes Care: Intervening on Social Risks versus Providing Contextualized Care
AbstractPurpose of ReviewPatient social and economic risk information can guide diabetes care through social risk –targeted care (directly intervening on social risk factors) or social risk–informed care (modifying or tailoring care to accommodate social risks). We review evidence supporting these approaches and highlight critical gaps in the current evidence.Recent FindingsLiterature is scarce on isolated social care interventions and the impact on glycemic control is unclear, while blended social-behavioral interventions more consistently point to reductions in HbA1c. Social risk –informed care naturall...
Source: Current Diabetes Reports - April 29, 2019 Category: Endocrinology Source Type: research

Economics and Policy in Bariatric Surgery
AbstractPurpose of ReviewThe purpose of this review is to provide current synthesis of the evidence on the cost-effectiveness of bariatric surgery for persons with diabetes.Recent FindingsVirtually, every study that has evaluated the cost-effectiveness of bariatric surgery for persons who are obese and have type 2 diabetes has concluded that surgery is cost-effective. A few studies outside the USA found that surgery is cost-saving. Currently, most but not all US insurers cover bariatric surgery in persons with type 2 diabetes and BMI ≥ 35 kg/m2.SummaryBariatric surgery is a cost-effective treatment for perso...
Source: Current Diabetes Reports - April 29, 2019 Category: Endocrinology Source Type: research

Effect of Health Information Technologies on Cardiovascular Risk Factors among Patients with Diabetes
AbstractPurpose of ReviewTo identify a common effect of health information technologies (HIT) on the management of cardiovascular disease (CVD) risk factors among people with type 2 diabetes (T2D) across randomized control trials (RCT).Recent FindingsCVD is the most frequent cause of morbidity and mortality among patients with diabetes. HIT are effective in reducing HbA1c; however, their effect on cardiovascular risk factor management for patients with T2D has not been evaluated.SummaryWe identified 21 eligible studies (23 estimates) with measurement of SBP, 20 (22 estimates) of DBP, 14 (17 estimates) of HDL, 14 (17 estima...
Source: Current Diabetes Reports - April 27, 2019 Category: Endocrinology Source Type: research

Medical and Psychological Considerations for Carbohydrate-Restricted Diets in Youth With Type 1 Diabetes
AbstractPurpose of ReviewGiven the challenges achieving recommended glycemic targets in youth with type 1 diabetes (T1D), providers may consider recommending carbohydrate-restricted diets (CRDs) to optimize glycemic control. The goal of the present review is to describe relevant literature on the potential medical and psychosocial benefits and risks of CRDs in youth with T1D.Recent FindingsLimited data exist on the effects of CRDs in pediatric populations. Findings from studies with youth and adults are mixed; some indicate that CRDs may be associated with desirable medical outcomes, such as improved glycemic control and r...
Source: Current Diabetes Reports - April 27, 2019 Category: Endocrinology Source Type: research

Islet Transplantation Alone Versus Solitary Pancreas Transplantation: an Outcome-Driven Choice?
AbstractPurpose of reviewIn patients with type 1 diabetes with extreme glycemic variability, the restoration of pancreas endocrine function is potentially and completely achieved with islets of Langerhans (tissue derived from whole organ) or pancreas (whole organ) transplantation. The aim of our review is to report on the latest studies and to highlight the benefits and risks of the two procedures, providing clearer, more selective, evidence-based clinical indications that also consider the impact on the degenerative complications of diabetes as a potential benefit.Recent findingsClinical experience in this field has been ...
Source: Current Diabetes Reports - April 25, 2019 Category: Endocrinology Source Type: research

The Contribution of Low-Frequency and Rare Coding Variation to Susceptibility to Type 2 Diabetes
AbstractPurpose of ReviewSoon after the first genome-wide association study (GWAS) for type 2 diabetes (T2D) was published, it was hypothesized that rare and low-frequency variants might explain a substantial proportion of disease risk. Rare coding variants in particular were emphasized given their large expected role in disease. This review summarizes the extent to which recent T2D genetic studies provide evidence for or against this hypothesis.Recent FindingsFollowing a comprehensive study of T2D genetic architecture using three sequencing and genotyping technologies, four even larger studies have provided a yet higher r...
Source: Current Diabetes Reports - April 8, 2019 Category: Endocrinology Source Type: research

Diabetes Prevention and Care Programs in the US-Affiliated Pacific Islands: Challenges, Innovation, and Recommendations for Effective Scale-Up
AbstractPurpose of ReviewThis review describes some of the unique challenges faced by the US-Affiliated Pacific Islands (USAPIs) in addressing diabetes prevention and care and presents innovative population-level strategies that have been employed to address them.Recent FindingsChallenges include an unhealthy food environment and a strained health care infrastructure, both compounded by geography. Innovations in addressing these challenges include attempts to modify the food environment, a focus on early life prevention, and task shifting among the health workforce. Many of the successful interventions share a focus on cul...
Source: Current Diabetes Reports - March 27, 2019 Category: Endocrinology Source Type: research

Economics of Genetic Testing for Diabetes
This article briefly summarizes the barriers to timely monogenic diabetes diagnosis and then summarizes findings from CEAs on genetic testing for monogenic diabetes.Recent FindingsCEAs have shown that routine genetic testing of all patients with a clinical diagnosis of type 1 diabetes can be cost-saving when applied to the scenarios of neonatal diabetes or in a pediatric population. Routine screening has not been shown to be cost-effective in adult populations. However, next-generation sequencing strategies and applying biomarkers to identify and limit genetic testing to people most likely to have monogenic diabetes are pr...
Source: Current Diabetes Reports - March 27, 2019 Category: Endocrinology Source Type: research

Current Status on Immunological Therapies for Type 1 Diabetes Mellitus
AbstractPurpose of ReviewType 1 diabetes (T1D) occurs when there is destruction of beta cells within the islets of Langerhans in the pancreas due to autoimmunity. It is considered a complex disease, and different complications can surface and worsen the condition if T1D is not managed well. Since it is an incurable disease, numerous treatments and therapies have been postulated in order to control T1D by balancing hyperglycemia control while minimizing hypoglycemic episodes. The purpose of this review is to primarily look into the current state of the available immunological therapies and their advantages for the treatment...
Source: Current Diabetes Reports - March 23, 2019 Category: Endocrinology Source Type: research

Genetic Mechanisms Highlight Shared Pathways for the Pathogenesis of Polygenic Type 1 Diabetes and Monogenic Autoimmune Diabetes
AbstractPurpose of ReviewTo highlight pathways important for the development of autoimmune diabetes by investigating shared mechanisms of disease in polygenic and monogenic diabetes.Recent FindingsGenome-wide association studies have identified 57 genetic risk loci for type 1 diabetes. Progress has been made in unravelling the mechanistic effects of some of these variants, providing key insights into the pathogenesis of type 1 diabetes. Seven monogenic disorders have also been described where diabetes features as part of an autoimmune syndrome. Studying these genes in relation to polygenic risk loci provides a unique oppor...
Source: Current Diabetes Reports - March 19, 2019 Category: Endocrinology Source Type: research

The Interconnection Between Immuno-Metabolism, Diabetes, and CKD
AbstractPurpose of ReviewMetabolic reprogramming is increasingly recognized as an essential trait of functional activation of immune cells. Here, we describe the link between immuno-metabolism, diabetes, and diabetic nephropathy.Recent FindingsCrosstalk between cellular metabolic functions and immune activation occurs when plasma levels of glucose, triglycerides, and free fatty acids increase, thus promoting systemic low-grade inflammation that further boosts the development of metabolic complications. In the long run, this settles an “apparent paradox,” where, despite excessive inflammation, the immune system ...
Source: Current Diabetes Reports - March 19, 2019 Category: Endocrinology Source Type: research

Diabetes Disparities and Promising Interventions to Address Diabetes in Native Hawaiian and Pacific Islander Populations
AbstractPurpose of ReviewThe Native Hawaiian and Pacific Islander (NHPI) population is rapidly growing in the USA. NHPIs face significant health disparities and have a high prevalence of diabetes compared to the general US population.Recent FindingsRecent culturally-adapted diabetes interventions have shown promise in addressing these disparities among NHPI communities. The interventions showed success by utilizing a community-based approach that honored NHPIs ’ collectivist culture, addressed social determinants of health that influence disease control and prevention, and utilized NHPI community health workers (CHWs...
Source: Current Diabetes Reports - March 18, 2019 Category: Endocrinology Source Type: research

The Global Burden of Diabetic Kidney Disease: Time Trends and Gender Gaps
AbstractPurpose of ReviewDiabetes mellitus prevalence is increasing throughout the world as a consequence of growing rates of obesity, metabolic syndrome, and westernization of lifestyle. It is currently unknown to what extent these trends affect the global burden of diabetic kidney disease (DKD). This review seeks to describe the global burden of DKD and how it has changed throughout time using recently released results of the Global Burden of Disease 2017 Study.Recent FindingsDKD prevalence has remained fairly stable at the global level and among many world regions since 1990. At the global level, the proportion of DKD d...
Source: Current Diabetes Reports - March 2, 2019 Category: Endocrinology Source Type: research

Cognitive Frailty in Older People with Type 2 Diabetes Mellitus: the Central Role of Hypoglycaemia and the Need for Prevention
AbstractPurpose of ReviewTo highlight the central role of hypoglycaemia in the causation of cognitive frailty and explore ways of recognition and prevention of hypoglycaemia.Recent FindingsCognitive frailty is an emerging new concept defined as the concomitant presence of physical frailty and cognitive impairment. In older people with diabetes, cognitive frailty is associated with an increased risk of mortality greater than from either physical frailty or cognitive impairment alone. Hypoglycaemia is directly associated with increased risk of cognitive impairment and physical frailty which are the two components of cognitiv...
Source: Current Diabetes Reports - February 26, 2019 Category: Endocrinology Source Type: research

The Continuing Evolution of Precision Health in Type 2 Diabetes: Achievements and Challenges
AbstractPurpose of ReviewThe purpose of this review was to summarize recent advances in the genomics of type 2 diabetes (T2D) and to highlight current initiatives to advance precision health.Recent FindingsGeneration of multi-omic data to measure each of the “biologic layers,” developments in describing genomic function and annotation in T2D relevant tissue, along with the increasing recognition that T2D is a heterogeneous disease, and large-scale collaborations have all contributed to advancing our understanding of the molecular basis of T2D.SummarySubstantial advances have been made in understanding the molec...
Source: Current Diabetes Reports - February 26, 2019 Category: Endocrinology Source Type: research

Retinal Neurodegeneration as an Early Manifestation of Diabetic Eye Disease and Potential Neuroprotective Therapies
AbstractPurpose of ReviewDiabetic retinopathy (DR) is a major cause of visual impairment and blindness throughout the world. Microvascular changes have long been regarded central to disease pathogenesis. In recent years, however, retinal neurodegeneration is increasingly being hypothesized to occur prior to the vascular changes classically associated with DR and contribute to disease pathogenesis.Recent FindingsThere is growing structural and functional evidence from human and animal studies that suggests retinal neurodegeneration to be an early component of DR. Identification of new therapeutic targets is an ongoing area ...
Source: Current Diabetes Reports - February 26, 2019 Category: Endocrinology Source Type: research

Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes
AbstractPurpose of ReviewModerate hypertriglyceridemia is exceedingly common in diabetes, and there is growing evidence that it contributes to residual cardiovascular risk in statin-optimized patients. Major fibrate trials yielded inconclusive results regarding the cardiovascular benefit of lowering triglycerides, although there was a signal for improvement among patients with high triglycerides and low high-density lipoprotein (HDL) —the “diabetic dyslipidemia” phenotype. Until recently, no trials have examined a priori the impact of triglyceride lowering in patients with diabetic dyslipidemia, who are l...
Source: Current Diabetes Reports - February 26, 2019 Category: Endocrinology Source Type: research

Perioperative Management of Diabetes Mellitus: Novel Approaches
AbstractPurpose of ReviewSeveral studies have demonstrated the benefits of glycemic control in the perioperative period and there is ongoing interest in development of systematic approaches to achieving glycemic control. This review discusses currently available data and proposes a new approach to the management of hyperglycemia in the perioperative period.Recent FindingsIn a recent study, we demonstrated that early preoperative identification of patients with poorly controlled diabetes and proactive treatment through various phases of surgery improves glycemic control, lowers the risk of surgical complications, and decrea...
Source: Current Diabetes Reports - February 26, 2019 Category: Endocrinology Source Type: research

Genetic Dissection and Clinical Features of MODY6 (NEUROD1-MODY)
AbstractPurpose of ReviewMODY6 due to mutations in the gene NEUROD1 is very rare, and details on its clinical manifestation and pathogenesis are scarce. In this review, we have summarized all reported cases of MODY6 diagnosed by genetic testing, and examined their clinical features in detail.Recent FindingsMODY6 is a low penetrant MODY, suggesting that development of the disease is affected by genetic modifying factors, environmental factors, and/or the effects of interactions of genetic and environmental factors, as is the case with MODY5. Furthermore, while patients with MODY6 can usually achieve good glycemic control wi...
Source: Current Diabetes Reports - February 22, 2019 Category: Endocrinology Source Type: research

Diabetes Management in Older Adults With Chronic Kidney Disease
AbstractPurpose of ReviewOlder adults often live with chronic disease including diabetes and its complications. In this review, we examine the complexity and heterogeneity of older adults with diabetes and chronic kidney disease, explore the nuances in their diabetes-related monitoring, and discuss their best diabetes management.Recent FindingsAlthough there remains an overall lack of studies in older adults with diabetes and chronic kidney disease, recent reports have highlighted their vulnerabilities. These individuals face an increased risk of cognitive impairment and dementia, frailty, dysglycemia, polypharmacy, declin...
Source: Current Diabetes Reports - February 15, 2019 Category: Endocrinology Source Type: research

Type 2 Diabetes Self-Management in Non-Hispanic Black Men: a Current State of the Literature
This article discusses the state of type 2 diabetes (T2D) self-management research on non-Hispanic Black men with a focus on their knowledge of diabetes, factors that impact T2D self-management and intervention research that specifically targets non-Hispanic Black men with T2D.Recent FindingsStudies on T2D knowledge and barriers and facilitators to T2D self-management in non-Hispanic Black men are limited to small qualitative focus group and in-depth interviews. To date, few T2D interventions for non-Hispanic Black men have been developed and tested.SummaryResearch shows that non-Hispanic Black men ’s knowledge of T2...
Source: Current Diabetes Reports - February 11, 2019 Category: Endocrinology Source Type: research

Epigenetic Risk Profile of Diabetic Kidney Disease in High-Risk Populations
AbstractPurpose of ReviewEpigenetic variations have been shown to reveal vulnerability to diabetes and its complications. Although it has become clear that metabolic derangements, especially hyperglycemia, can impose a long-term metabolic memory that predisposes to diabetic complications, the underlying mechanisms remain to be understood. It has been suggested that epigenetics (e.g., histone modification, DNA methylation, and non-coding RNAs) help link metabolic disruption to aberrancies related to diabetic kidney disease (DKD). In this review, we discuss the key findings and advances made in the epigenetic risk profile of...
Source: Current Diabetes Reports - February 7, 2019 Category: Endocrinology Source Type: research

Diabetes in the Middle East: Government Health Care Policies and Strategies that Address the Growing Diabetes Prevalence in the Middle East
AbstractPurpose of reviewDiabetes is a primary public health concern and a challenge for health decision makers in this century. Though the number of people with diabetes is increasing all over the globe, the very high prevalence of diabetes in many Middle East countries has made this region one of the global diabetes hot spots. Due to rapid socioeconomic growth, lifestyle changes and increasing obesity prevalence, the number of people with diabetes is expected to double by 2045 in this region. This high prevalence of diabetes imposes a substantial socioeconomic impact on the individual and governments in this region. The ...
Source: Current Diabetes Reports - February 4, 2019 Category: Endocrinology Source Type: research

New Areas of Interest: Is There a Role for Omega-3 Fatty Acid Supplementation in Patients With Diabetes and Cardiovascular Disease?
AbstractPurpose of ReviewSummarize studies on omega-3 fatty acids in prevention of albuminuria in subjects with diabetes.Recent FindingsSeveral small, short-term trials suggested benefit on albuminuria in subjects with diabetes; however, results were not definitive. Welty et al. showed that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for 1  year slowed progression of early-stage albuminuria in subjects with diabetes with clinical coronary artery disease on an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, the majority of whom had an albumin/creatinine ratio (ACR)  &thins...
Source: Current Diabetes Reports - January 25, 2019 Category: Endocrinology Source Type: research

Adaptive Intervention Designs to Promote Behavioral Change in Adults: What Is the Evidence?
AbstractPurpose of ReviewAdaptive behavioral interventions tailor the type or dose of intervention strategies to individuals over time to improve saliency and intervention efficacy. This review describes the unique characteristics of adaptive intervention designs, summarizes recent diabetes-related prevention studies, which used adaptive designs, and offers recommendations for future research.Recent FindingsEight adaptive intervention studies were reported since 2013 to reduce sedentary behavior or improve weight management in overweight or obese adults. Primarily, feasibility studies were conducted. Preliminary results su...
Source: Current Diabetes Reports - January 25, 2019 Category: Endocrinology Source Type: research

Economic Impact of Diabetes in Africa
AbstractPurpose of ReviewThis review seeks to address knowledge gaps around the economic burden of diabetes in Africa. Africa is home to numerous endemic infections and also prevalent non-communicable diseases including diabetes. It is projected that the greatest increases in diabetes prevalence will occur in Africa. The importance of this review therefore lies in providing adequate knowledge on the economic challenges that diabetes poses to the continent and describe the way forward in tackling this epidemic.Recent FindingsDiabetes contributes to a huge amount of the global health expenditure in the world. There is a dear...
Source: Current Diabetes Reports - January 24, 2019 Category: Endocrinology Source Type: research

Mineralocorticoid Antagonism and Diabetic Kidney Disease
AbstractPurpose of ReviewType 2 diabetes (T2D) is associated with an increased risk of diabetic kidney disease (DKD), cardiovascular disease, and heart failure, in part through activation of the renin-angiotensin-aldosterone system (RAAS). Although recent cardiovascular outcome trials have identified newer therapeutic agents such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1)-receptor agonists that reduce the risk of these complications, patients still exhibit residual cardiorenal morbidity and mortality. Accordingly, the identification of pharmacological agents that attenuate mic...
Source: Current Diabetes Reports - January 23, 2019 Category: Endocrinology Source Type: research

Youth-Onset Type 2 Diabetes and the Developing Brain
AbstractPurpose of ReviewThis review describes the literature evaluating the potential adverse effects of youth-onset type 2 diabetes on the developing brain. A summary of recently published articles and the current state of knowledge are covered succinctly in this manuscript.Recent FindingsCurrent literature suggests both cognitive and brain structural differences are found in youth with type 2 diabetes. Studies have shown poorer scores in a number of neurocognitive domains, particularly in areas of executive functioning and memory. Additionally, imaging studies have found differences in brain gray matter volume, white ma...
Source: Current Diabetes Reports - January 21, 2019 Category: Endocrinology Source Type: research

Economic Impact of Diabetes in Japan
AbstractPurpose of reviewThe economic burden of diabetes in Japan is already serious and will become greater in the future. We review the economic impact of diabetes in Japan to examine viable options for mitigating its effects.Recent findingsMedical costs for diabetes have been increasing by US  $1 million annually, reaching US $11 million in 2009, of which US $7 million was accounted for by people aged 65 years or older. The quality of treatment of diabetes in Japan is higher than in other regions in the world. This can be more effective for achieving glycemic control, but is also m ore expensive com...
Source: Current Diabetes Reports - January 16, 2019 Category: Endocrinology Source Type: research

Breastfeeding and Type 2 Diabetes: Systematic Review and Meta-Analysis
AbstractPurpose of ReviewBreastfeeding has short- and long-term benefits for child health. In this systematic review, we updated a review on the association between breastfeeding and type 2 diabetes.Recent FindingsA meta-analysis published in 2015 reported that breastfeeding protects against type 2 diabetes (pooled odds ratio, 0.65 (95% confidence interval, 0.48; 0.86)). In the present update, we identified three recently published studies. An internet-based study reported that at a mean age of 25.6  years, exclusive breastfeeding in the first 6 months protected against type 2 diabetes (odds ratio, 0.63 (95% conf...
Source: Current Diabetes Reports - January 14, 2019 Category: Endocrinology Source Type: research

Innovations in Professional Inpatient Diabetes Education
AbstractPurpose of reviewIn the rapidly evolving and complex field of inpatient diabetes, complex care teams of physicians, nurse practitioners, physician assistants, nurses, and pharmacists are challenged to remain well informed of the latest clinical treatments and health care trends. Traditional continuing medical education (CME) and continuing education unit (CEU) strategies that require travel and/or time away from work pose a major barrier. With advancements in technology, there are media and other electronic strategies for delivering CME/ CEU that may overcome these current challenges.Recent FindingsElectronic and i...
Source: Current Diabetes Reports - November 21, 2018 Category: Endocrinology Source Type: research

Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network
AbstractPurpose of ReviewTo advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs.FindingsStudies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health sys...
Source: Current Diabetes Reports - November 20, 2018 Category: Endocrinology Source Type: research

Genetics of Obesity in Diverse Populations
AbstractPurpose of ReviewThe prevalence of obesity continues to rise, fueling a global public health crisis characterized by dramatic increases in type 2 diabetes, cardiovascular disease, and many cancers. In the USA, several minority populations, who bear much of the obesity burden (47% in African Americans and Hispanic/Latinos, compared to 38% in European descent groups), are particularly at risk of downstream chronic disease. Compounding these disparities, most genome-wide association studies (GWAS) —including those of obesity—have largely been conducted in populations of European or East Asian ancestry. In ...
Source: Current Diabetes Reports - November 19, 2018 Category: Endocrinology Source Type: research

Phenotypic and Genetic Characteristics of Lipodystrophy: Pathophysiology, Metabolic Abnormalities, and Comorbidities
This article focuses on recent progress in understanding the genetics of lipodystrophy syndromes, the pathophysiology of severe metabolic abnormalities caused by these syndromes, and causes of severe morbidity and a possible signal of increased mortality associated with lipodystrophy. An updated classification scheme is also presented.Recent findingsLipodystrophy encompasses a group of heterogeneous rare diseases characterized by generalized or partial lack of adipose tissue and associated metabolic abnormalities including altered lipid metabolism and insulin resistance. Recent advances in the field have led to the discove...
Source: Current Diabetes Reports - November 8, 2018 Category: Endocrinology Source Type: research

The Evolving Role of the Cardiologist in the Management of Type 2 Diabetes
AbstractPurpose of ReviewTo evaluate the treatment of type 2 diabetes from a cardiologist ’s view.Recent FindingsA new era in the treatment of type 2 diabetes began for the cardiologist in 2015 with the publication of the EMPA-REG outcome trial finding a significant reduction in CV death with empagliflozin (oral sodium-glucose co-transporter-2 [SGLT2] inhibitor) in patients with type 2 diabetes at increased cardiovascular risk. Shortly thereafter, the injectable glucagon-like peptide agonists (GLP-1) liraglutide and semaglutide found a significant reduction in composite major cardiovascular events (CV death, non-fata...
Source: Current Diabetes Reports - November 8, 2018 Category: Endocrinology Source Type: research

Implications of the CANVAS Study in Reducing Cardiovascular Outcomes
AbstractPurpose of ReviewIn recent years, Cardiovascular Outcome Event Trials (CVOTs) in type 2 diabetes mellitus (T2DM) have demonstrated that sodium glucose transporter 2 inhibitors (SGLT2i) could reduce major adverse cardiovascular events (MACE) and cardiovascular mortality independent of a glucose lowering mechanism. SGLT2i trials reported significant results that have generated biologically plausible theories with regard to the macrovascular benefit. In this review, we have summarized and discussed the results of the CANVAS program.Recent FindingsThe CANVAS program is unique as it is an analysis of two aggregated coho...
Source: Current Diabetes Reports - November 5, 2018 Category: Endocrinology Source Type: research

Genetics of Monogenic Diabetes: Present Clinical Challenges
AbstractPurpose of ReviewMonogenic forms of diabetes have specific treatments that differ from the standard care provided for type 1 and type 2 diabetes, making the appropriate diagnosis essential. In this review, we discuss current clinical challenges that remain, including improving case-finding strategies, particularly those that have transethnic applicability, and understanding the interpretation of genetic variants as pathogenic, with clinically meaningful impacts.Recent FindingsBiomarker approaches to the stratification for genetic testing now appear to be most effective in identifying cases of monogenic diabetes, an...
Source: Current Diabetes Reports - October 30, 2018 Category: Endocrinology Source Type: research

Update on Therapeutic Options in Lipodystrophy
AbstractPurpose of ReviewThe purpose of this review is to summarize the therapeutic approach for lipodystrophy syndromes with conventional treatment options and metreleptin therapy in detail and to point out the current investigational treatments in development.Recent FindingsThe observation of leptin deficiency in patients with lipodystrophy and the potential of leptin replacement to rescue metabolic abnormalities in animal models of lipodystrophy were followed by the first clinical study of leptin therapy in patients with severe lipodystrophy. This and several other long-term studies demonstrated important benefits of re...
Source: Current Diabetes Reports - October 29, 2018 Category: Endocrinology Source Type: research

Comparison of Lipid-Lowering Medications and Risk for Cardiovascular Disease in Diabetes
AbstractPurpose of the ReviewTo summarize available evidence regarding lipid-lowering interventions for the prevention of cardiovascular disease in patients with diabetes.Recent FindingsStatins and non-statin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL cholesterol.SummaryIn subjects with diabetes, with or without established cardiovascular disease, each 39  mg/dl reduction in LDL cholesterol observed with statins is associated with a 21% relative reduction in the risk of major coronary events at 5 years. Statins r...
Source: Current Diabetes Reports - October 29, 2018 Category: Endocrinology Source Type: research

Non-Diabetic Hyperglycemia in the Pediatric Age: Why, How, and When to Treat?
AbstractPurpose of reviewNon-diabetic hyperglycemia (NDHY) is a pathological condition that is not yet well known. The aim of this review is to examine approaches for management of this condition.Recent findingsWhile it is well known that persistent hyperglycemia in diabetes affects immune response and risk for diabetes-related micro- and macrovascular complications, little is known about the biological effects of transient NDHY, particularly in the pediatric age group.SummaryStress HY (SHY) is typically defined as blood glucose>  8.33 mmol/L (150 mg/dL) during physical stress, resolving spontaneously after dissi...
Source: Current Diabetes Reports - October 29, 2018 Category: Endocrinology Source Type: research

Blood Pressure Variability and Autonomic Dysfunction
AbstractPurpose of ReviewThis review considers the relationship between abnormal blood pressure (BP) variability and autonomic dysfunction through an attempt to answer questions about its clinical relevance and pertinence to diabetes and cardiovascular autonomic neuropathy (CAN) and which therapeutic measures can lessen its cardiovascular impact.Recent FindingsOffice, ambulatory, and home BP monitoring identify posture-related, circadian, short-term, and long-term BP variabilities. Abnormal BP variability is a risk marker for organ damage, mortality, and cardiovascular events. Moreover, BP variability changes are common in...
Source: Current Diabetes Reports - October 25, 2018 Category: Endocrinology Source Type: research