Opioid prescription and diabetes among Medicare beneficiaries.

AIMS: To determine the prevalence of opioid prescriptions among U.S. Medicare beneficiaries by diabetes status, and predictors of opioid prescription among those with diabetes. METHODS: This retrospective study used claims data from the Centers for Medicare and Medicaid Services among beneficiaries age ≥ 65 years who were continuously enrolled in Part A, Part B, and Part D Medicare between 2017 and 2019 (N = 709,374). Logistic regression was used to determine the odds of opioid prescription among those with vs without diabetes; and, among those with diabetes, significant predictors of opioid prescription. RESULTS: Overall, the prevalence of any opioid prescription was 30.8 % among persons with diabetes and 24.2 % in those without diabetes (p < 0.001); chronic use was 8.0 % and 7.4 %, respectively (p < 0.001). Those with diabetes had a 45 % higher odds of having an opioid prescription compared to those without diabetes after adjusting for sociodemographic characteristics (OR = 1.45, 1.44-1.47). After adjustment for comorbidities/complications, the association reversed (OR = 0.83, 0.82-0.84). Persons with diabetes who had hypertension, obesity, CVD, neuropathy, amputation, liver disease, COPD, cancer, osteoporosis, depression, or alcohol/drug abuse had a 20 %-140 % higher odds of opioid prescription compared to those without these conditions. CONCLUSIONS: Comorbidities and complications accounted for the higher odds of opioid prescriptions among those with diabetes.

Association between gestational diabetes and 6-year incident diabetes: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: Type 2 diabetes and gestational diabetes (GDM) disproportionately affect those of Hispanic/Latino heritage. This study examined the association between GDM and prevalent and incident diabetes in a community-based study of Hispanic/Latina women living in the USA. METHODS: Participants were women aged 18-74 years in the Hispanic Community Health Study/Study of Latinos who had at least one pregnancy and had information on self-reported history of GDM at baseline (n=6389). Logistic regression was used to determine the association between GDM and prevalent (2008-2011) and incident (2014-2017) diabetes and interactions between GDM and risk factors for incident diabetes. RESULTS: At baseline, 8.7% of participants reported a history of GDM and 18.6% had prevalent diabetes. Women with Mexican heritage had the highest prevalence of GDM history (11.3%) vs women of Cuban (5.0%), Central American (4.9%), and South American (3.8%) heritage (p<0.001 for each comparison to Mexican heritage). Women with self-reported GDM were four times more likely to have prevalent diabetes compared with women without GDM, after adjusting for sociodemographic characteristics and cardiometabolic risk factors (adjusted OR (aOR)=3.94, 95% CI 2.75 to 5.64). Overall incidence of diabetes was 14.3/100 women. Women with GDM at baseline increased their odds of incident diabetes by threefold compared with women without GDM (aOR=3.25, 95% CI 2.09 to 5.05). Women with Cuban or Puerto Rican heritage and GDM had significantly higher odds of incident diabetes compared with women with Mexican heritage (aOR=2.15, 95% CI 1.17 to 3.95; aOR=1.95, 95% CI 1.07 to 3.55, respectively). CONCLUSION: Self-reported GDM was significantly associated with a threefold higher risk of incident diabetes among Hispanic/Latino women in the USA even after adjusting for several significant predictors of diabetes.

Cardiometabolic Risk Factors and Incident Cardiovascular Disease Events in Women vs Men With Type 1 Diabetes.

Importance: The lower risk of cardiovascular disease (CVD) among women compared with men in the general population may be diminished among those with diabetes. Objective: To evaluate cardiometabolic risk factors and their management in association with CVD events in women vs men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Design, Setting, and Participants: This cohort study used data obtained during the combined DCCT (randomized clinical trial, conducted 1983-1993) and EDIC (observational study, conducted 1994 to present) studies through April 30, 2018 (mean [SD] follow-up, 28.8 [5.8] years), at 27 clinical centers in the US and Canada. Data analyses were performed between July 2021 and April 2022. Exposure: During the DCCT phase, patients were randomized to intensive vs conventional diabetes therapy. Main Outcomes and Measures: Cardiometabolic risk factors and CVD events were assessed via detailed medical history and focused physical examinations. Blood and urine samples were assayed centrally. CVD events were adjudicated by a review committee. Linear mixed models and Cox proportional hazards models evaluated sex differences in cardiometabolic risk factors and CVD risk over follow-up. Results: A total of 1441 participants with type 1 diabetes (mean [SD] age at DCCT baseline, 26.8 [7.1] years; 761 [52.8%] men; 1390 [96.5%] non-Hispanic White) were included. Over the duration of the study, compared with men, women had significantly lower body mass index (BMI, calculated as weight in kilograms divided by height in meters squared; ß = -0.43 [SE, 0.16]; P = .006), waist circumference (ß = -10.56 cm [SE, 0.52 cm]; P < .001), blood pressure (systolic: ß = -5.77 mm Hg [SE, 0.35 mm Hg]; P < .001; diastolic: ß = -3.23 mm Hg [SE, 0.26 mm Hg]; P < .001), and triglyceride levels (ß = -10.10 mg/dL [SE, 1.98 mg/dL]; P < .001); higher HDL cholesterol levels (ß = 9.36 mg/dL [SE, 0.57 mg/dL]; P < .001); and similar LDL cholesterol levels (ß = -0.76 mg/dL [SE, 1.22 mg/dL]; P = .53). Women, compared with men, achieved recommended targets more frequently for blood pressure (ie, <130/80 mm Hg: 90.0% vs 77.4%; P < .001) and triglycerides (ie, <150 mg/dL: 97.3% vs 90.5%; P < .001). However, sex-specific HDL cholesterol targets (ie, ≥50 mg/dL for women, ≥40 mg/dL for men) were achieved less often (74.3% vs 86.6%; P < .001) and cardioprotective medications were used less frequently in women than men (ie, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker: 29.6% [95% CI, 25.7%-33.9%] vs 40.0% [95% CI, 36.1%-44.0%]; P = .001; lipid-lowering medication: 25.3% [95% CI, 22.1%-28.7%] vs 39.6% [95% CI, 36.1%-43.2%]; P < .001). Women also had significantly higher pulse rates (mean [SD], 75.2 [6.8] beats per minute vs 71.8 [6.9] beats per minute; P < .001) and hemoglobin A1c levels (mean [SD], 8.3% [1.0%] vs 8.1% [1.0%]; P = .01) and achieved targets for tighter glycemic control less often than men (ie, hemoglobin A1c <7%: 11.2% [95% CI, 9.3%-13.3%] vs 14.0% [95% CI, 12.0%-16.3%]; P = .03). Conclusions and Relevance: These findings suggest that despite a more favorable cardiometabolic risk factor profile, women with type 1 diabetes did not have a significantly lower CVD event burden than men, suggesting a greater clinical impact of cardiometabolic risk factors in women vs men with diabetes. These findings call for conscientious optimization of the control of CVD risk factors in women with type 1 diabetes.

Diabetes Incidence Among Hispanic/Latino Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: To examine diabetes incidence in a diverse cohort of U.S. Hispanic/Latinos. RESEARCH DESIGN AND METHODS: The Hispanic Community Health Study/Study of Latinos is a prospective cohort study with participants aged 18-74 years from four U.S. metropolitan areas. Participants were assessed for diabetes at the baseline examination (2008-2011), annually via telephone interview, and at a second examination (2014-2017). RESULTS: A total of 11,619 participants returned for the second examination. The overall age-adjusted diabetes incidence rate was 22.1 cases/1,000 person-years. The incidence was high among those with Puerto Rican and Mexican backgrounds as well as those aged ≥45 years and with a BMI ≥30 kg/m2. Significant differences in diabetes awareness, treatment, and health insurance coverage, but not glycemic control, were observed across Hispanic/Latino background groups, age groups, and BMI categories. CONCLUSIONS: Differences in diabetes incidence by Hispanic/Latino background, age, and BMI suggest the susceptibility of these factors.

Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study.

OBJECTIVE: Intensive glycemic control reduces the risk of kidney, retinal, and neurologic complications in type 1 diabetes (T1D), but whether it reduces the risk of lower-extremity complications is unknown. We examined whether former intensive versus conventional glycemic control among Diabetes Control and Complications Trial (DCCT) participants with T1D reduced the long-term risk of diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) in the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study. RESEARCH DESIGN AND METHODS: DCCT participants (n = 1,441) completed 6.5 years on average of intensive versus conventional diabetes treatment, after which 1,408 were enrolled in EDIC and followed annually over 23 years for DFU and LEA occurrences by physical examination. Multivariable Cox proportional hazard regression models estimated associations of DCCT treatment assignment and time-updated exposures with DFU or LEA. RESULTS: Intensive versus conventional glycemic control was associated with a significant risk reduction for all DFUs (hazard ratio 0.77 [95% CI 0.60, 0.97]) and a similar magnitude but nonsignificant risk reduction for first-recorded DFUs (0.78 [0.59, 1.03]) and first LEAs (0.70 [0.36, 1.36]). In adjusted Cox models, clinical neuropathy, lower sural nerve conduction velocity, and cardiovascular autonomic neuropathy were associated with higher DFU risk; estimated glomerular filtration rate <60 mL/min/1.73 m2, albuminuria, and macular edema with higher LEA risk; and any retinopathy and greater time-weighted mean DCCT/EDIC HbA1c with higher risk of both outcomes (P < 0.05). CONCLUSIONS: Early intensive glycemic control decreases long-term DFU risk, the most important antecedent in the causal pathway to LEA.

Cognitive function among older adults with diabetes and prediabetes, NHANES 2011-2014.

AIMS: To determine the association between diabetes status, glycemia, and cognitive function among a national U.S. sample of older adults in the 2011-2014 National Health and Nutrition Examinations Surveys. METHODS: Among 1,552 adults age ≥ 60 years, linear and multivariable logistic regressions were used to determine the association between diabetes status (diabetes, prediabetes, normoglycemia) and cognitive function [Consortium to Establish a Registry for Alzheimer's Disease-Word Learning (CERAD W-L), Animal Fluency test, Digit Symbol Substitution Test (DSST)]. RESULTS: Overall, diabetes was associated with mild cognitive dysfunction. In age-adjusted models, adults with diabetes had significantly poorer performance on the delayed and total word recalls (CERAD W-L) compared to those with normoglycemia (5.8 vs. 6.8 words; p = 0.002 and 24.5 vs. 27.6 words; p < 0.001, respectively); the association was non-significant after adjusting for cardiovascular disease. Among all adults, cognitive function scores decreased with increasing HbA1c for all assessments, but remained significant in the fully adjusted model for the Animal Fluency and DSST [beta coefficient = -0.44;-1.11, p < 0.05, respectively]. As measured by the DSST, the proportion with cognitive impairment was significantly higher for older adults with HbA1c ≥ 8.0% (≥64 mmol/mol) vs. HbA1c < 7.0% (<53 mmol/mol) (14.6% vs. 6.3%, p = 0.04). CONCLUSIONS: Dysglycemia, as measured by HbA1c, was associated with poorer executive function and processing speed.

Comparison of several survey-based algorithms to ascertain type 1 diabetes among US adults with self-reported diabetes.

INTRODUCTION: Defining type of diabetes using survey data is challenging, although important, for determining national estimates of diabetes. The purpose of this study was to compare the percentage and characteristics of US adults classified as having type 1 diabetes as defined by several algorithms. RESEARCH DESIGN AND METHODS: This study included 6331 respondents aged ≥18 years who reported a physician diagnosis of diabetes in the 2016-2017 National Health Interview Survey. Seven algorithms classified type 1 diabetes using various combinations of self-reported diabetes type, age of diagnosis, current and continuous insulin use, and use of oral hypoglycemics. RESULTS: The percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/m2, respectively) and percentage using oral hypoglycemics (16.1%, 11.1%, and 19.0%, respectively) were lower than for all other algorithms assessed. Among those defined by continuous insulin use alone (algorithm 1), the estimates for mean age and age of diagnosis (54.3 and 30.9 years, respectively) and BMI (30.9 kg/m2) were higher than for other algorithms. CONCLUSIONS: Estimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification.

Urinary phenols and parabens and diabetes among US adults, NHANES 2005-2014.

BACKGROUND AND AIMS: Phenols and parabens are ubiquitous and have been associated with markers of cardiovascular health. However, the literature lacks population-based studies examining the link between these endocrine disruptors and diabetes. We examined the association between paraben/phenol concentrations and diabetes among a nationally representative sample of US adults. METHODS AND RESULTS: We utilized data from the 2005-2014 National Health and Nutrition Examination Surveys (N = 8498). Total urinary concentrations of BPA, triclosan, BP-3, and propyl, butyl, ethyl, and methyl parabens were measured from urine specimens collected during the examination session. Diabetes status was based on self-report of a previous diagnosis or HbA1c≥6.5%. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CI) associated with the difference in log-transformed values of the 75th and 25th percentiles for each phenol/paraben, adjusting for potential confounders. The adjusted ORs (95% CI) of diabetes comparing the 75th to 25th percentiles of each paraben/phenol were 1.09 (0.96-1.23) for BPA, 0.84 (0.72-0.98) for triclosan, 0.69 (0.61-0.79) for BP-3, 0.71 (0.61-0.83) for propyl paraben, 0.66 (0.54-0.80) for butyl paraben, 0.60 (0.51-0.71) for ethyl paraben, and 0.79 (0.68-0.91) for methyl paraben. CONCLUSIONS: Higher concentrations of triclosan, BP-3, and propyl, butyl, ethyl, and methyl parabens were associated with lower odds of diabetes. These findings warrant further investigation into the potential mechanism behind the observed associations and the temporal direction of the associations, given that we cannot rule out reverse causation. Future studies of these endocrine disruptors may improve the understanding of their relationship with diabetes.

The Association Between Heart Rate and Glycemic Status in the National Health and Nutrition Examination Surveys.

CONTEXT: Evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease (CVD), for which persons with diabetes are at increased risk. OBJECTIVE: The objective of this article is to determine the association between HR and glycemic status in a nationally representative sample of US adults, and, among adults with diagnosed diabetes, the association between HR and hemoglobin A1c (HbA1c) level. DESIGN: A cross-sectional study was conducted. SETTING: The setting of this study is the National Health and Nutrition Examination Surveys, 2011 to 2016. PARTICIPANTS: US general adult (age ≥ 20 years) population who had information on glycemic status based on self-report, HbA1c, and fasting plasma glucose (N = 8562). INTERVENTION: There was no intervention. MAIN OUTCOME MEASURE: The main outcome measure of this study was mean HR (beats per minute). RESULTS: After adjustment for examination time, age, other demographic characteristics, health insurance, health behaviors, body mass index, CVD and kidney disease, and taking antihypertensive medications, mean HR was significantly higher for those with diagnosed (75 bpm), undiagnosed diabetes (75 bpm), and prediabetes (73 bpm) compared to those with normoglycemia (71 bpm, P < .05 for all); this association was robust both for men and women. Mean HR increased with increasing HbA1c level among individuals with diagnosed diabetes independent of other risk factors (HbA1c < 7.0% [< 53 mmol/mol], 73 bpm vs A1c ≥ 11.0% [≥ 97mmol/mol], 79 bpm, P < .001); this association was most pronounced for women. CONCLUSIONS: Adjusted mean HR was higher among individuals with diabetes and increased glycemia, which may reflect underlying autonomic and/or myocardial dysfunction among those with diabetes.

RISK FACTORS FOR HEARING IMPAIRMENT IN TYPE 1 DIABETES.

Objective: Studies have demonstrated that glycated hemoglobin (HbA1c) is a significant predictor of hearing impairment in type 1 diabetes. We identified additional factors associated with hearing impairment in participants with type 1 diabetes from the Diabetes Control and Complications Trial and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods: A total of 1,150 DCCT/EDIC participants were recruited for the Hearing Study. A medical history, physical measurements, and a self-administered hearing questionnaire were obtained. Audiometry was performed by study-certified personnel and assessed centrally. Logistic regression models assessed the association of risk factors and comorbidities with speech- and high-frequency hearing impairment. Results: Mean age was 55 ± 7 years, duration of diabetes 34 ± 5 years, and DCCT/EDIC HbA1c 7.9 ± 0.9% (63 mmol/mol). In multivariable models, higher odds of speech-frequency impairment were significantly associated with older age, higher HbA1c, history of noise exposure, male sex, and higher triglycerides. Higher odds of high-frequency impairment were associated with older age, male sex, history of noise exposure, higher skin intrinsic florescence (SIF) as a marker of tissue glycation, higher HbA1c, nonprofessional/nontechnical occupations, sedentary activity, and lower low-density-lipoprotein cholesterol. Among participants who previously completed computed tomography and carotid ultrasonography, coronary artery calcification (CAC) >0 and carotid intima-medial thickness were significantly associated with high-but not speech-frequency impairment. Conclusion: Consistent with previous reports, male sex, age, several metabolic factors, and noise exposure are independently associated with hearing impairment. The association with SIF further emphasizes the importance of glycemia-as a modifiable risk factor-over time. In addition, the macrovascular contribution of CAC is novel and important. Abbreviations: AER = albumin excretion rate; CAC = coronary artery calcification; CVD = cardiovascular disease; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; eGFR = estimated glomerular filtration rate; ETDRS = Early Treatment Diabetic Retinopathy Study; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; IMT = intima-media thickness; LDL = low-density lipoprotein; NHANES = National Health and Nutrition Examination Survey; OR = odds ratio; SIF = skin intrinsic fluorescence; T1D = type 1 diabetes.

Diabetes Diagnosis and Control: Missed Opportunities to Improve Health : The 2018 Kelly West Award Lecture.

Diabetes is a prevalent condition in the U.S. and worldwide, with expanding impact over time as it affects progressively younger ages as well as older ages as people live longer. Costs of diabetes to those affected and to society as a whole continue to increase. Costs are realized through daily treatment regimens throughout life to control glycemia and other risk factors for complications as diabetes progresses, diabetes complications and disability and their treatments, health care visits and hospitalization, and as indirect costs via lower quality of life and lost productivity. Diagnosing diabetes is key to affording the opportunity to treat diabetes, and diabetes control is key to reducing the risk of complications. Yet the magnitude of undiagnosed diabetes and poor control of diabetes is large. And just as certain subgroups of the population are affected disproportionately by diabetes and diabetes complications, so are they affected disproportionately by undiagnosed diabetes and poor control. This review addresses the epidemiology of undiagnosed diabetes and diabetes control, largely covering their magnitude, demographic variation, trends over time, and predictors. For diabetes control, it focuses on control of A1C, blood pressure, and lipid levels, although there are many other facets of diabetes control and preventive care that also could be examined. The review is based predominantly on data from the National Health and Nutrition Examination Survey (NHANES), a U.S. health survey that includes both an interview and examination component that has been conducted continuously since 1999 and episodically for decades earlier. The interview elicits self-reported health responses pertaining to diabetes and other medical conditions and an examination that measures glycemic indicators, blood pressure, and lipids, which provide much of the material presented herein. Data from other studies are also presented and described.

Risk Factors for Kidney Disease in Type 1 Diabetes.

OBJECTIVE: In type 1 diabetes (T1D), the course of microalbuminuria is unpredictable and timing of glomerular filtration rate (GFR) loss is uncertain. Thus, there is a need to identify the risk factors associated with the development of more advanced stages of kidney disease through large, long-term systematic analysis. RESEARCH DESIGN AND METHODS: Multivariable Cox proportional hazards models assessed the association of baseline and time-dependent glycemic and nonglycemic risk factors for incident macroalbuminuria and reduced estimated GFR (eGFR; defined as <60 mL/min/1.73 m2) over a mean of 27 years in the Diabetes Control and Complications Trial (DCCT) cohort. RESULTS: Higher mean HbA1c (hazard ratio [HR] 1.969 per 1% higher level [95% CI 1.671-2.319]) and male sex (HR 2.767 [95% CI 1.951-3.923]) were the most significant factors independently associated with incident macroalbuminuria, whereas higher mean triglycerides, higher pulse, higher systolic blood pressure (BP), longer diabetes duration, higher current HbA1c, and lower mean weight had lower magnitude associations. For incident reduced eGFR, higher mean HbA1c (HR 1.952 per 1% higher level [95% CI 1.714-2.223]) followed by higher mean triglycerides, older age, and higher systolic BP were the most significant factors. CONCLUSIONS: Although several risk factors associated with macroalbuminuria and reduced eGFR were identified, higher mean glycemic exposure was the strongest determinant of kidney disease among the modifiable risk factors. These findings may inform targeted clinical strategies for the frequency of screening, prevention, and treatment of kidney disease in T1D.

Factors associated with undiagnosed diabetes among adults with diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

AIMS: To investigate sociodemographic and health factors associated with undiagnosed diabetes among adults with diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: Among 3384 adults with self-reported diabetes or undiagnosed diabetes in the baseline HCHS/SOL, we estimated odds ratios (OR) of being undiagnosed for demographic, cultural, access to care, and health factors. RESULTS: Among individuals with diabetes, 37.0% were undiagnosed. After adjustment and compared to people of Mexican heritage, people of Cuban and South American heritage had 60% (OR = 1.60, 95% CI = 1.02-2.50) and 91% (OR = 1.91, 1.16-3.14) higher odds of being undiagnosed, respectively. Individuals with a higher odds of being undiagnosed were women (OR = 1.64, 1.26-2.13), those with no health insurance (OR = 1.31, 1.00-1.71), individuals who received no healthcare in the past year (OR = 3.59, 2.49-5.16), those who were overweight (vs. normal weight) (OR = 1.60, 1.02-2.50), and those with dyslipidemia (OR = 1.38, 1.10-1.74). Individuals with lower odds of being undiagnosed were those with a family history of diabetes (OR = 0.54, 0.43-0.68), and those with hypertension (OR = 0.46, 0.36-0.58). CONCLUSIONS: Variation by Hispanic heritage group, sex, and access to medical care highlight where concentrated efforts are need to improve diabetes awareness. Our findings will inform clinical and public health practices to improve diabetes awareness among vulnerable populations.

Hearing Impairment and Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Cohort.

OBJECTIVE: To evaluate the prevalence of hearing impairment in participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study and compare with that of a spousal control group without diabetes. Among participants with type 1 diabetes, to evaluate the association of hearing impairment with prior DCCT therapy and overall glycemia. RESEARCH DESIGN AND METHODS: DCCT/EDIC participants (n = 1,150) and 288 spouses without diabetes were recruited for the DCCT/EDIC Hearing Study. All subjects completed a self-administered questionnaire, medical history, and physical measurements. Audiometry was performed by study-certified personnel; audiograms were assessed centrally. Speech-frequency (pure-tone average [PTA] thresholds at 500, 1,000, 2,000, and 4,000 Hz) and high-frequency impairment (PTA thresholds at 3,000, 4,000, 6,000, and 8,000 Hz) were defined as PTA >25 dB hearing loss. Logistic regression models were adjusted for age and sex. RESULTS: DCCT/EDIC participants and spousal control subjects were similar in age, race, education, smoking, and systolic blood pressure. There were no statistically significant differences between groups in the prevalence or adjusted odds of speech- or high-frequency impairment in either ear. Among participants with type 1 diabetes, for every 10% increase in the time-weighted mean HbA1c, there was a 32% (95% CI 1.15-1.50) and 19% (95% CI 1.07-1.33) increase in speech- and high-frequency hearing impairment, respectively. CONCLUSIONS: We found no significant difference in the prevalence of hearing impairment between the group with type 1 diabetes and the spousal control group. Among those with type 1 diabetes, higher mean HbA1c over time was associated with hearing impairment.

Contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence: NHANES 2011-2014.

PURPOSE: Our goal was to characterize the contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence and to characterize how those contributions differ among U.S. population subgroups. METHODS: In the 2011-2014 National Health and Nutrition Examination Survey, a nationally representative sample of the U.S. population, among participants without diabetes (N = 3387), we created area-proportional three-Venn diagrams showing the proportion above the prediabetes cutpoint for each of the three markers in the overall population and in subgroups defined by age, race/ethnicity, sex, and body mass index. RESULTS: In the overall population, 28.3% had fasting plasma glucose above the prediabetes cutpoint, 21.7% had A1c above the prediabetes cutpoint, and 13.3% had 2-hour plasma glucose above the prediabetes cutpoint. Adolescents and young adults tended to have only one marker exceed the prediabetes cutpoint, while older age groups tended to have multiple markers above the prediabetes cutpoint. For non-Hispanic whites, non-Hispanic blacks, non-Hispanic Asians, and Mexican-Americans, the unadjusted total percent above the A1c cutpoint was 19.3%, 36.4%, 20.5%, and 21.4%, respectively. CONCLUSIONS: We provide a graphic reference showing fasting plasma glucose was the largest contributor to prediabetes prevalence in the overall population, followed by A1c and then 2-hour plasma glucose.

Burden of Urological Complications in Men and Women With Long-standing Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Cohort.

OBJECTIVE: Type 1 diabetes has been associated with high rates of urinary and sexual problems, but the cumulative burden and overlap of these complications are unknown. We sought to determine prevalence of urological complications in persons with type 1 diabetes, associations with clinical and diabetes-related factors, and rates of emergence, persistence, and remission. RESEARCH DESIGN AND METHODS: This ancillary longitudinal study among participants in the Diabetes Control and Complications Trial (DCCT) and observational follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC) (652 women and 713 men) was conducted in 2003 and 2010/2011. Urinary incontinence (UI), lower urinary tract symptoms, urinary tract infection, female sexual dysfunction, erectile dysfunction, low male sexual desire, and orgasmic dysfunction were measured with validated instruments. Logistic regression determined association of complications with demographics and clinical characteristics. RESULTS: Of sexually active women completing the 2010/2011 survey, 35% reported no complications, 39% had one, 19% two, 5% three, and 2% four. In men, 31% had no complications, 36% had one, 22% two, 9% three, and 3% four. Sexual dysfunction was most prevalent (42% women and 45% men) followed by UI in women (31%) and low sexual desire in men (40%). Urological complications were associated with age, BMI, and HbA1c. Remission rates ranged from 4 to 12% over the 7-year interval between surveys. CONCLUSIONS: Urological complications are prevalent and frequently co-occur in persons with type 1 diabetes. Remission rates in a minority subset indicate a rationale for future studies to mitigate the onset or impact of urological complications of diabetes.

Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women.

AIMS: The true prevalence of gestational diabetes (GDM) in the United States is unknown. This study determined the prevalence of GDM and a subsequent diagnosis of diabetes in a nationally representative sample of U.S. women. METHODS: The crude and age-adjusted prevalence of GDM and subsequent diabetes were evaluated by sociodemographic and health-related characteristics among women age ≥20 years in the National Health and Nutrition Examination Surveys, 2007-2014 (N = 8185). Logistic regression analyzed independent factors associated with GDM and subsequent diabetes. RESULTS: The prevalence of GDM was 7.6%. Women who were Mexican American (vs. non-Hispanic white), had ≥4 live births (vs. 1), had a family history of diabetes, or were obese (vs. normal weight) had a higher age-standardized prevalence of GDM (each p < 0.04). Among women with a history of GDM, 19.7% had a subsequent diagnosis of diabetes; subsequent diabetes diagnosis was higher for those with health insurance, more time since GDM diagnosis, greater parity, family history of diabetes, and obesity, and lower for those with higher education and income (all p ≤ 0.005). By logistic regression, significant factors associated with GDM were age at first birth, parity, family history of diabetes, and obesity; significant factors for subsequent diabetes were older age, greater years since GDM diagnosis, less education, family history of diabetes, and obesity (each p < 0.01). CONCLUSIONS: The prevalence of GDM in the U.S. was 7.6%, with 19.7% of these women having a subsequent diabetes diagnosis. Women with a history of GDM, family history of diabetes, and obesity should be carefully monitored for dysglycemia.

Prevalence of Diagnosed Diabetes in Adults by Diabetes Type - United States, 2016.

Currently 23 million U.S. adults have been diagnosed with diabetes (1). The two most common forms of diabetes are type 1 and type 2. Type 1 diabetes results from the autoimmune destruction of the pancreas's beta cells, which produce insulin. Persons with type 1 diabetes require insulin for survival; insulin may be given as a daily shot or continuously with an insulin pump (2). Type 2 diabetes is mainly caused by a combination of insulin resistance and relative insulin deficiency (3). A small proportion of diabetes cases might be types other than type 1 or type 2, such as maturity-onset diabetes of the young or latent autoimmune diabetes in adults (3). Although the majority of prevalent cases of type 1 and type 2 diabetes are in adults, national data on the prevalence of type 1 and type 2 in the U.S. adult population are sparse, in part because of the previous difficulty in classifying diabetes by type in surveys (2,4,5). In 2016, supplemental questions to help distinguish diabetes type were added to the National Health Interview Survey (NHIS) (6). This study used NHIS data from 2016 to estimate the prevalence of diagnosed diabetes among adults by primary type. Overall, based on self-reported type and current insulin use, 0.55% of U.S. adults had diagnosed type 1 diabetes, representing 1.3 million adults; 8.6% had diagnosed type 2 diabetes, representing 21.0 million adults. Of all diagnosed cases, 5.8% were type 1 diabetes, and 90.9% were type 2 diabetes; the remaining 3.3% of cases were other types of diabetes. Understanding the prevalence of diagnosed diabetes by type is important for monitoring trends, planning public health responses, assessing the burden of disease for education and management programs, and prioritizing national plans for future type-specific health services.

Variations of dietary intake by glycemic status and Hispanic/Latino heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: A healthy diet is important for diabetes prevention and control; however, few studies have assessed dietary intake among US Hispanics/Latinos, a diverse population with a significant burden of diabetes. To address this gap in the literature, we determined intake of energy, macro/micronutrients, and vitamin supplements among Hispanics/Latinos by glycemic status and heritage. RESEARCH DESIGN AND METHODS: Cross-sectional study of adults aged 18-74 years from the Hispanic Community Health Study/Study of Latinos (2008-2011) with complete baseline data on glycemic status and two 24-hour dietary recalls (n=13 089). Age-adjusted and sex-adjusted and multivariable-adjusted measures of intake were determined by glycemic status and heritage. RESULTS: Mean age-adjusted and sex-adjusted energy intake was significantly lower among Hispanics/Latinos with diagnosed diabetes compared with those with normal glycemic status (1665 vs 1873 kcal, P<0.001). Fiber intake was higher among those with diagnosed diabetes versus normal glycemic status (P<0.01). Among those with diagnosed diabetes, energy intake was highest among those with Cuban heritage compared with most other heritage groups (P<0.01 for all, except Mexicans), but there was no difference after additional adjustment. Fiber intake was significantly lower for those of Cuban heritage (vs Dominican, Central American, and Mexican), and sodium intake was significantly higher (vs all other heritage groups) (P<0.01 for all); findings were null after additional adjustment. There was no difference in supplemental intake of vitamin D, calcium, magnesium, or potassium by glycemic status. CONCLUSIONS: As part of the care of Hispanics/Latinos with diabetes, attention should be made to fiber and sodium consumption.