Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Comparison of Dose Escalation Versus Switching to Tirzepatide Among People With Type 2 Diabetes Inadequately Controlled on Lower Doses of Dulaglutide : A Randomized Clinical Trial

BACKGROUND

Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for the treatment of adults with type 2 diabetes or obesity, showed clinically meaningful reductions in hemoglobin A1c (HbA1c) and body weight in the SURPASS phase 3 clinical trial program.

OBJECTIVE

To compare efficacy and safety of escalation of dulaglutide dose versus switching to tirzepatide in inadequately controlled type 2 diabetes.

DESIGN

Multicenter, randomized, open-label, phase 4 trial (SURPASS-SWITCH [A Phase 4, Randomized, Open-Label, Active-Controlled Study to Investigate the Efficacy and Safety of Switching from Weekly Dulaglutide to Weekly Tirzepatide in Adults with Type 2 Diabetes], ClinicalTrials.gov: NCT05564039).

SETTING

38 sites across 5 countries.

PARTICIPANTS

Adults with HbA1c 7.0% or greater to 9.5% or less, stable body weight, body mass index of 25 kg/m2 or greater, receiving a stable dose of dulaglutide (0.75 or 1.5 mg) for at least 6 months and 0 to 3 oral antihyperglycemic medications for at least 3 months.

INTERVENTION

Escalation of dulaglutide to 4.5 mg or maximum tolerated dose (MTD) or switching to tirzepatide.

MEASUREMENTS

The primary end point was change from baseline in HbA1c at week 40. The key secondary end point was change from baseline in weight at week 40.

RESULTS

A total of 282 adults were randomly assigned to tirzepatide (n = 139) or dulaglutide (n = 143). Change from baseline in HbA1c at week 40 was -1.44% (SE, 0.07) with tirzepatide, 15 mg or MTD, and -0.67% (SE, 0.08) with dulaglutide, 4.5 mg or MTD (estimated treatment difference, -0.77% [95% CI, -0.98% to -0.56%; P < 0.001]). Change from baseline in weight at week 40 was -10.5 kg (SE, 0.5) with tirzepatide and -3.6 kg (SE, 0.5) with dulaglutide (estimated treatment difference, -6.9 kg [CI, -8.3 to -5.5 kg; P < 0.001]). Serious adverse events were reported by 10 (7.2%) tirzepatide and 10 (7.0%) dulaglutide participants. The most common treatment-emergent adverse events were nausea and diarrhea.

LIMITATION

Open-label design.

CONCLUSION

In SURPASS-SWITCH, switching treatment to tirzepatide provided additional HbA1c reduction and weight loss compared with escalating treatment with dulaglutide.

PRIMARY FUNDING SOURCE

Eli Lilly and Company.

Disparities in Respiratory Syncytial Virus Risk Factors, Diagnosis, and Outcomes in Adults by Race, Ethnicity, and Other Social Determinants of Health in the United States

INTRODUCTION

Respiratory syncytial virus (RSV) vaccination could improve health equity by protecting individuals who are disproportionally at increased risk of RSV infection and severe RSV-related outcomes. However, limited information is available about RSV-related disparities among United States (US) adults.

AREAS COVERED

We reviewed US-specific literature regarding disparities across adult populations in having risk factors for severe RSV disease (cardiopulmonary disease, diabetes, liver disease, kidney disease). We summarize available evidence regarding disparities in having or being diagnosed with RSV, as well as experiencing severe RSV-related health outcomes. Disparities are analyzed by race, ethnicity, socioeconomic status, and other social determinants of health.

EXPERT OPINION

RSV-related disparities are observed across all outcomes of interest, although RSV-specific data are limited in some cases. Racial and ethnic minority groups and socioeconomically disadvantaged populations are more likely to have risk factors for severe RSV disease, overall and at younger ages, yet individuals from these groups are more often underdiagnosed. Disparities in RSV-related hospitalizations, emergency department visits, and deaths are observed, especially among adults from racial and ethnic minority groups, of lower socioeconomic status, and in poorer or more crowded neighborhoods. Findings highlight the importance of RSV vaccination among these groups to improve health equity.

Daytime napping and risk of incident main adverse cardiovascular events and mortality among adults with type 2 diabetes

AIMS

To explore the link between daytime napping and the risk of major adverse cardiovascular events (MACE) and mortality in individuals with type 2 diabetes.

METHODS

This prospective study included 21,129 participants with diabetes from the UK Biobank, all of whom were free of MACE and cancer at baseline. Data on habitual daytime napping and sleep duration were collected via a baseline questionnaire. Cox proportional hazards regression models were employed to assess the relationship between daytime napping and MACE, all-cause mortality, and cardiovascular disease (CVD) specific mortality. MACE was defined as a composite of myocardial infarction, heart failure, and stroke.

RESULTS

Over an average 11.9-year follow-up, 5,611 MACE cases, 3,854 all-cause deaths, and 1,839 CVD deaths were identified. Compared to those who never/rarely napped, the multivariable-adjusted hazard ratios for usually napping were: 1.39 (1.08, 1.65) for MACE; 1.44 (1.01, 1.92) for myocardial infarction; 1.33 (1.07, 1.64) for heart failure; 1.57 (1.06, 2.33) for stroke; 1.28 (1.01, 1.60) for all-cause mortality; 1.33 (0.97, 1.94) for CVD mortality.

CONCLUSIONS

Frequent daytime napping is significantly associated with an increased risk of MACE and mortality among individuals with diabetes, particularly those who have extended sleep durations of more than 10 h and severe diabetes.

Cardiovascular, kidney and safety outcomes with canagliflozin in older adults: A combined analysis from the CANVAS Program and CREDENCE trial

AIM

SGLT2 inhibitors may be underused in older adults with type 2 diabetes due to concerns about safety and tolerability. This pooled analysis of the CANVAS Program and CREDENCE trial examined the efficacy and safety of canagliflozin according to age.

METHODS

Pooled individual participant data from the CANVAS Program (n = 10 142) and CREDENCE trial (n = 4401) were analysed by baseline age (<65 years, 65 to <75 years, and ≥75 years). A range of adjudicated clinical outcomes were assessed, including major adverse cardiovascular events and CKD progression, as well as safety outcomes. Cox proportional hazards models and Fine and Gray competing risk analysis were used.

RESULTS

Among the 14 543 participants, 7927 (54.5%) were <65 years, 5281 (36.3%) were 65 to <75 years and 1335 (9.2%) were ≥75 years. Older participants had higher rates of atherosclerotic cardiovascular disease and heart failure, longer diabetes duration and lower mean eGFR. Reductions in cardiovascular and kidney outcomes with canagliflozin were consistent across age categories (all p trend >0.10), although there was some evidence that effects on cardiovascular death and all-cause death were attenuated with older age (p trend = 0.02 and 0.03, respectively). Although the incidence of adverse events increased with age, effects of canagliflozin on safety outcomes including acute kidney injury, volume depletion, urinary tract infections and hypoglycaemia, were not modified by age (all p trend >0.10).

CONCLUSIONS

In patients with varying degrees of kidney function, canagliflozin reduced cardiovascular and kidney outcomes, regardless of age, with no additional safety concerns identified in older patients.

Testing of a Culinary Medicine Intervention for Racially/Ethnically Diverse Adults With Type 2 Diabetes

OBJECTIVE

Assess if a virtual culinary medicine program improves healthy eating, glycosylated hemoglobin (HbA1c), and associated variables among adults with type 2 diabetes.

DESIGN

Mixed-methods, intervention-only pilot study.

SETTING

Classes via video conferencing from the teaching kitchen, with participants cooking from their homes.

PARTICIPANTS

One hundred and four patients from a Texas primary care system.

INTERVENTIONS

Five-session program (Spanish and English) led by a dietitian.

MAIN OUTCOME MEASURES

HbA1c. Secondary outcomes included MyPlate knowledge, self-efficacy, healthy eating and cooking behaviors, diabetes self-management, perceived health, and blood pressure.

ANALYSIS

Multilevel mixed-effects regression to analyze changes at pretreatment, posttreatment, and 6-month follow-up. Framework analysis to analyze postintervention interviews.

RESULTS

Participants with complete posttest data (n = 61) demonstrated statistically significant (P <0.05) improvements in MyPlate knowledge, cooking self-efficacy, servings of fruits and vegetables, frequency of healthy food intake, shopping, cooking and eating behaviors, diabetes self-management, and perceived health, compared with pretest. HbA1c levels showed statistically significant reductions from pretest to posttest (P = 0.02) and at 6-month follow-up (P <0.001). Participants reported high satisfaction and sustained new habits.

CONCLUSIONS AND IMPLICATIONS

We saw improvements in healthy eating and cooking behaviors and HbA1c. While further rigorous testing is needed, this program could be incorporated into clinical practices as a brief intervention for patients with type 2 diabetes.

Effects of the leisure-time physical activity environment on odds of glycemic control among a nationwide cohort of United States veterans with a new type-2 diabetes diagnosis

OBJECTIVE

This study examined associations between access to leisure-time physical activity (LTPA) facilities and parks and repeated measures of glycated hemoglobin (A1C) over time, using follow-up tests among United States Veterans with newly diagnosed type-2 diabetes (T2D).

METHODS

Data were analyzed from 274,463 patients in the Veterans Administration Diabetes Risk cohort who were newly diagnosed with T2D between 2008 and 2018 and followed through 2023. Generalized estimating equations with a logit link function and binomial logistic regression were used to examine associations.

RESULTS

Patients were on average 60.5 years of age, predominantly male (95.0 %) and white (66.9 %), and had an average of 11.7 A1C tests during the study follow-up period. In high- and low-density urban communities, a one-unit higher LTPA facility density score was associated with 1 % and 3 % greater likelihood of in-range A1C tests during follow-up, respectively, but no association was observed among patients living in suburban/small town and rural communities. Across community types, closer park distance was not associated with subsequent greater odds of in-range A1C tests. Unexpectedly, in low-density urban areas, the likelihood of in-range A1C tests was 1 % lower at farther park distances.

CONCLUSIONS

These results suggest that broader access to LTPA facilities, but not park proximity, may contribute in small ways to maintaining glycemic control after T2D diagnosis in urban communities. Tailored interventions may be needed to promote patients' effective use of LTPA facilities and parks.

Impact of scheduled water intake on mild cognitive impairment in patients with orthostatic hypotension

Orthostatic blood pressure (BP) dysregulation can impair cerebral blood perfusion and cognition. Water intake prevents syncope caused by orthostatic hypotension (OHypo) and improves orthostatic tolerance. However, research on scheduled water intake's effect on the association between OHypo and cognition is limited. This study aimed to investigate the impact of scheduled water intake on orthostatic BP dysregulation and mild cognitive impairment (MCI). This cross-sectional study was conducted in rural Fuxin, Liaoning Province, China, using cohort data. Water intake patterns were self-reported, and orthostatic BP was measured. MCI was assessed with the Chinese version of the Montreal Cognitive Assessment-Basic (MoCA-BC).Latent class mixed models were applied to identify systolic BP trajectory patterns. Logistic regression was used to examine the association between orthostatic BP abnormality and MCI, adjusting for potential confounders and including an interaction term for orthostatic BP abnormality and water intake regularity. Linear regression was used to analyze the relationship between orthostatic BP abnormality and total MoCA-BC score. Subgroup analyses were conducted based on age and water intake regularity. The study included 1576 participants: 1236 (78.4%) had normal recovery, 234 (14.8%) had delayed recovery, 36 (2.3%) had OHypo, and 70 (4.5%) had orthostatic hypertension. The average age was 63.2 ± 7.7 years, with a daily water intake of 1612.5 ± 978.8 ml; 1055 (66.9%) were female. Unscheduled water intake significantly interacted with OHypo on MCI (OR 5.82; 95% CI 1.17-35.34; P = 0.039). After adjusting for confounders, scheduled water intake was associated with a lower OR of MCI in those with OHypo (OR 0.11; 95% CI 0.02-0.44; P = 0.003), while unscheduled water intake showed no significant association (OR 0.99; 95% CI 0.41-2.57; P = 0.985). Scheduled water intake is linked to a lower risk of MCI in individuals with OHypo, suggesting a protective role. Promoting scheduled water intake might be inversely associated with MCI in OHypo patients. Further longitudinal studies are needed to confirm these findings and understand the mechanisms involved.

Age and Sex Differences in Efficacy of Treatments for Type 2 Diabetes: A Network Meta-Analysis

Importance

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors improve hyperglycemia, and SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACEs) among individuals with type 2 diabetes. It is not clear whether efficacy varies by age or sex.

Objective

To assess whether age or sex are associated with differences in the efficacy of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors.

Data Sources and Study Selection

The MEDLINE and Embase databases and US and Chinese clinical trial registries were searched for articles published from inception to November 2022; in August 2024, the search was updated to capture the trial results. Two reviewers screened for randomized clinical trials of SGLT2 inhibitors, GLP-1 receptor agonists, or DPP4 inhibitors vs a placebo or active comparator in adults with type 2 diabetes.

Data Extraction and Synthesis

Individual participant data and aggregate data were used to estimate age × treatment interactions and sex × treatment interactions in multilevel network meta-regression models.

Main Outcome and Measures

Hemoglobin A1c (HbA1c) and MACEs.

Results

Of the 601 eligible trials identified (592 trials with 309 503 participants reported HbA1c; mean age, 58.9 [SD, 10.8] years; 42.3% were female and 23 trials with 168 489 participants reported MACEs; mean age, 64.0 [SD, 8.6] years; 35.3% were female), individual participant data were obtained for 103 trials (103 reported HbA1c and 6 reported MACEs). The use of SGLT2 inhibitors (vs placebo) was associated with less HbA1c lowering with increasing age for monotherapy (absolute reduction [AR], 0.24% [95% credible interval {CrI}, 0.10% to 0.38%] per 30-year increment in age), for dual therapy (AR, 0.17% [95% CrI, 0.10% to 0.24%]), and for triple therapy (AR, 0.25% [95% CrI, 0.20% to 0.30%]). The use of GLP-1 receptor agonists was associated with greater HbA1c lowering with increasing age for monotherapy (AR, -0.18% [95% CrI, -0.31% to -0.05%] per 30-year increment in age) and for dual therapy (AR, -0.24% [95% CrI, -0.40% to -0.07%]), but not for triple therapy (AR, 0.04% [95% CrI, -0.02% to 0.11%]). The use of DPP4 inhibitors was associated with slightly better HbA1c lowering in older people for dual therapy (AR, -0.09% [95% CrI, -0.15% to -0.03%] per 30-year increment in age), but not for monotherapy (AR, -0.08% [95% CrI, -0.18% to 0.01%]) or triple therapy (AR, -0.01% [95% CrI, -0.06% to 0.05%]). The relative reduction in MACEs with use of SGLT2 inhibitors was greater in older vs younger participants per 30-year increment in age (hazard ratio, 0.76 [95% CrI, 0.62 to 0.93]), and the relative reduction in MACEs with use of GLP-1 receptor agonists was less in older vs younger participants (hazard ratio, 1.47 [95% CrI, 1.07 to 2.02]). There was no consistent evidence for sex × treatment interactions with use of SGLT2 inhibitors and GLP-1 receptor agonists.

Conclusions and Relevance

The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA1c; GLP-1 receptor agonists were more cardioprotective in younger people.

Dietary branched-chain amino acids intake and coronary artery calcium progression: insights from the coronary artery risk development in young adults (CARDIA) study

OBJECTIVE

Branched-chain amino acids (BCAA) have been implicated in the risk of cardiovascular disease. However, it is unclear whether dietary BCAA intake, specifically isoleucine, leucine, and valine are associated with coronary artery calcium (CAC) progression.

METHODS

We included the participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study cohort for the analysis. Dietary intake of BCAA was assessed at year 7 of the study. CAC was measured using standardized computed tomography scans at years 15, 20, and 25. CAC progression was defined as follows: for participants with a baseline CAC of 0, progression was defined as CAC > 0 at follow-up; for those with 0 < baseline CAC < 100, progression was defined as an annualized change of ≥ 10; and for those with baseline CAC ≥ 100, progression was defined as an annualized percent change of ≥ 10%. Multivariate adjusted Cox regression models were utilized to examine the associations between BCAA intake and CAC progression.

RESULTS

Among 2381 included participants (average age 40.4 ± 3.5 years, 44.9% men), 629 participants (26.4%) exhibited CAC progression during a follow-up period of 8.90 ± 2.03 years. In the fully adjusted model, high intake of total BCAA, and its individual components, isoleucine, leucine, and valine were associated with an increased risk of CAC progression by 35.6% (HR, 1.356 [95% CI, 1.040-1.769]), 30.5% (HR, 1.305 [95% CI, 1.001-1.701]), 30.9% (HR, 1.309 [95% CI, 1.003-1.706]), and 33.9% (HR, 1.339 [95% CI, 1.026-1.747]), respectively, compared to their corresponding low intake groups. The associations were consistent across various subgroups, including age, sex, race, and body mass index, but were stronger in participants without baseline CAC (interaction P < 0.001). These results remained robust in a series of sensitivity analyses.

CONCLUSIONS

High dietary intake of BCAA, including isoleucine, leucine, and valine, were independently associated with an increased risk of CAC progression. The findings may implication for dietary modifications in primary prevention of subclinical atherosclerosis.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov ; Unique identifier: NCT00005130.

Association between sleep behaviors and adiposity indices among U.S. adults: a cross-sectional study

Objectives

This study aimed to clarify the relationship between sleep behaviors and adiposity indices.

Methods

We analyzed NHANES data from 2011 to 2018 for adults aged 20-80, assessing BMI, waist circumference (WC), lean mass, and body fat percentage with DEXA scans and physical measurements. Sleep duration was categorized into short (<7 h), normal (7-9 h), and long (>9 h), as well as their sleep status based on questionnaires. Furthermore, we examined the interaction effects between sleep duration and sleep patterns.

Results

Among 19,951 participants providing BMI and WC data, and 10,716 for lean mass and body fat percentage, short sleep duration correlated with higher BMI (β = 0.56, 95% CI: 0.36-0.76), WC (β = 0.90, 95% CI: 0.43-1.37), and lean mass (β = 0.70, 95% CI: 0.32-1.07). Individuals with sleep disorders showed increased values across all indices: BMI (β = 0.93, 95% CI: 0.72-1.13), WC (β = 2.40, 95% CI: 1.92-2.88), lean mass (β = 0.71, 95% CI: 0.30-1.12), and body fat percentage (β = 0.64, 95% CI: 0.37-0.90). No significant interaction effects were found between sleep duration and sleep disorders.

Conclusion

Our findings indicate that individuals with short sleep duration and sleep disorders are likely to carry a higher weight burden, indicating potential targets for addressing obesity-related health issues.

Low-calorie diets and remission of type 2 diabetes in Chinese: phenotypic changes and individual variability

BACKGROUND

Chinese have distinct phenotypes of type 2 diabetes (T2D) and obesity compared with people of other ethnicities, but using low-calorie diets to achieve T2D remission has never been conducted in Chinese. This study aimed to assess if T2D remission can be achieved using low-calorie formula diet (LCFD) and low-calorie real food-based diet (LCRFD) in Chinese similarly to other populations and to identify determinants of individual variability in T2D remission.

METHODS

This 6-month intervention consisted of a 3-month isocaloric intensive weight loss phase (815-835 kcal/d) and a 3-month weight maintenance phase. Enrolled participants with T2D had BMI of 24-45 kg/m2 and HbA1c level of 6.5-12.0% (< 6.5% if on medication). Everyone stopped anti-diabetic drugs on day 1 and was assigned to receive LCFD (n = 21) or LCRFD (n = 20).

RESULTS

At 6 months, 29.3% of participants had ≥ 12 kg weight loss, 39.0% lost ≥ 10% weight, and 56.1% achieved T2D remission. MRI-derived liver and pancreatic fat decreased significantly. Significant improvement was also seen in insulin sensitivity, continuous glucose monitoring-derived metrics, and various other cardiometabolic risk factors but not arginine-induced insulin secretory response. There was no difference in all outcomes between LCFD and LCRFD. Compared with responders for T2D remission, nonresponders were more likely to be women, and had more fat mass, longer diabetes duration, poorer glycemic control, and lower beta-cell function.

CONCLUSIONS

T2D remission rate and weight loss amount following low-calorie diet intervention in Chinese people were comparable to those reported from other populations, although individual variability existed. LCFD and LCRFD were similarly effective.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov: NCT05472272.

Estimates and projections in the economic impacts of fifteen dietary risk factors for two hundred four countries and territories from 2020 to 2050: A health-augmented macroeconomic modeling study

BACKGROUND

Suboptimal diet results in significant health and economic burdens. However, the global economic costs of dietary risks remain unclear.

OBJECTIVES

This study aimed to estimate the macroeconomic burden of 15 dietary risk factors in 204 countries and territories from 2020 to 2050.

METHODS

This health-augmented macroeconomic modeling study assessed the macroeconomic burden that accounted for the decrease in labor supply across different education levels due to mortality and morbidity, as well as the impact of healthcare expenses on investment and savings. Country-specific data were drawn from publicly accessible databases. The cumulative difference in the aggregate output between a realistic scenario without intervention and a counterfactual scenario assuming complete disease elimination was quantified as the macroeconomic burden attributable to diseases. The proportion of disease burden attributed to dietary risk factors was quantified using population-attributable fractions derived from the global burden of disease study 2019, which was integrated into the health-augmented macroeconomic model. Estimates were converted to 2017 international dollars (INT $).

RESULTS

The estimated global macroeconomic burden attributable to dietary risks from 2020 to 2050 was INT $15,491 [uncertainty interval 13078, 18742] billion, representing 0.34% (uncertainty interval 0.29%, 0.41%) of the total gross domestic product. The macroeconomic burden was unevenly distributed across countries, regions, income groups, disease types, and dietary risk factors. The United States (INT $3972 billion), China (INT $2764 billion), and India (INT $1300 billion) had the largest macroeconomic burden. Ischemic heart disease (INT $9384 billion), diabetes (INT $2392 billion), and stroke (INT $1954 billion) accounted for ∼90% of the overall macroeconomic burden. A diet low in whole grains (INT $3808 billion) incurred the highest cost, followed by a diet high in sodium (INT $2812 billion) and red meat (INT $2337 billion).

CONCLUSIONS

The global macroeconomic burden attributable to dietary risks was substantial and varied across countries, regions, income groups, disease types, and individual dietary risk factors.

Trends in prevalence and multimorbidity of metabolic, cardiovascular, and chronic kidney diseases among US adults with depression from 2005 to 2020

BACKGROUND

Comorbid depression and cardiometabolic diseases are prevalent and increase risk of mortality. However, trends in the prevalence and multimorbidity of cardiometabolic diseases in depression are unclear.

METHODS

Data of adults aged ≥20 years with depression from the National Health and Nutrition Examination Survey 2005-2020 were analyzed. Joinpoint regression analysis was used to estimate trends in the prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, non-alcoholic fatty liver disease, and cardiovascular disease as well as having ≥3 of these diseases. Differences in the prevalence of these diseases in depression vs no depression were assessed using Poisson regressions after applying propensity score weighting.

RESULTS

A total of 3412 adults with depression were included. The prevalence of cardiometabolic diseases as well as having ≥3 diseases remained high and stable in the overall sample from 2005 to 2020 (P for trend >0.05). In 2017-2020, the prevalence ranged from 17.1 % (95 % CI, 12.7 %-21.5 %) for cardiovascular disease to 58.4 % (95 % CI, 50.4 %-66.3 %) for dyslipidemia; 40.7 % (95 % CI, 34.4 %-46.9 %) had ≥3 diseases. The prevalence of diabetes, cardiovascular disease, and having≥3 diseases was 23 %-85 % higher in adults with depression than those without.

LIMITATIONS

The utilization of self-reported data and/or one-time laboratory measurements may misclassify participants.

CONCLUSIONS

Prevalence of cardiometabolic diseases was high and multimorbidity was common in US adults with depression. Addressing the prevention, treatment, and management of cardiometabolic diseases in depression requires greater public health and clinical attention.

Incidence and Risk Factors of Diagnosed Young-Adult-Onset Type 2 Diabetes in the U.S.: The National Health Interview Survey 2016-2022

OBJECTIVE

To estimate the incidence and identify risk factors for diagnosed type 2 diabetes (T2D) among young U.S. adults.

RESEARCH DESIGN AND METHODS

We analyzed 142,884 adults aged 18-79 years with self-reported diabetes type from the cross-sectional National Health Interview Survey in 2016-2022, representing the noninstitutionalized U.S. civilian population. Incidence of diagnosed T2D was calculated for three age groups: young-adult onset (18-44 years), middle-age onset (45-64 years), and older-adult onset (65-79 years); the latter two groups were included to highlight the distinct risk factor profile of young-adult-onset T2D. Multivariable logistic regressions were used to identify risk factors for young-adult-onset T2D.

RESULTS

The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1,000 adults (95% CI 2.6-3.5). Minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions had a higher incidence of diagnosed young-adult-onset T2D compared with their counterparts. Lipid-lowering medication use (adjusted odds ratio [aOR] 13.15, 95% CI 8.85-19.55), antihypertensive medication use (aOR 11.89, 95% CI 7.97-17.73), and obesity (BMI ≥30 vs. <25 kg/m2, aOR 10.89, 95% CI 6.69-17.7) were the strongest risk factors for young-adult-onset T2D; these risk factors, along with hypertension, hyperlipidemia, and coronary heart disease, were more strongly associated with young-adult-onset T2D compared with later-onset T2D, with up to 4.5 times higher aORs.

CONCLUSIONS

This study quantified the incidence of diagnosed young-adult-onset T2D in U.S. adults and identified its distinct risk factor profile. Targeted prevention strategies for young-adult-onset T2D are needed for minority and socioeconomically disadvantaged people and those with cardiometabolic diseases.

Blood pressure control among Veterans with high cardiovascular disease risk

Objective

Blood pressure (BP) control reduces risk of cardiovascular disease (CVD), the major cause of disability and mortality among the nine million U.S. Veterans receiving care in Veterans Affairs (VA) medical centers. This study examined BP control, defined as a systolic BP < 130 mmHg and diastolic BP < 80 mmHg, among U.S. Veterans with hypertension at high risk for primary or secondary CVD events.

Methods

We utilized data from the VA Informatics and Computing Infrastructure Corporate Data Warehouse on primary care visits within the eight Great Lakes VA medical centers for Veterans with at least one visit between January 1, 2019, and February 28, 2020 and a documented visit within the 12 months prior to study initiation date. Analyses focused on Veterans with diagnosed hypertension and one or more of the following: age ≥65 years, and/or diagnosis of CVD, diabetes mellitus (DM) or chronic kidney disease (CKD). BP control was based on the last recorded BP measurement during the study period.

Results

The mean age of 83,633 Veterans with hypertension was 71.6 years (10.4) years, 96.4 % were male and race/ethnicity was reported as non-Hispanic White in 74.8 %, non-Hispanic Black or African American in 18.4 %, non-Hispanic Asian in 0.3 %, Alaskan Indian or Pacific Islander in 2.6 % and Hispanic in 2.5 %. Mean SBP and DBP based on vital signs at the last clinic visit were 130.8 mmHg (standard deviation [SD] 11.6) and 73.7 mmHg (SD 8.8), respectively. Overall, BP was controlled to < 130/80 mmHg in 38.7 % (95 % Confidence Interval [CI] 38.4, 39.1) and <140/90 mmHg in 76.9 % (95 % CI 76.7, 77.2). Among subgroups, BP was controlled to < 130/80 mmHg in 39.8 % (95 % CI 39.4, 40.2) of the Veterans aged ≥65 years, 45.3 % (95 % CI 44.7, 45.9) with CVD, 39.8 % (95 % CI 39.2, 40.3) with DM, 42.8 % (95 % CI 41.9, 43.6) with CKD and 47.1 % (95 % CI 45.5, 48.6) with CVD +DM +CKD. In contrast, BP control <140/90 mmHg was noted in over 75 % of Veterans within all subgroups.

Conclusion

In this group of Veterans with hypertension and high risk for CVD events, less than half had BP controlled to < 130/80 mmHg. Future studies should investigate strategies to improve BP control such as team-based care with home BP monitoring, education of clinicians on hypertension management, and increased utilization of automated office BP.

Trends and Racial/Ethnic Differences in Age at Diagnosis of Adult-Onset Type 1 and Type 2 Diabetes in the United States, 2016-2022

INTRODUCTION

Age at diagnosis of diabetes is important for informing public health planning and treatment strategies. This study aimed to estimate trends and racial/ethnic differences in age at diagnosis of adult-onset diabetes by type in the U.S.

METHODS

This serial nationwide cross-sectional study used data from the National Health Interview Survey in 2016-2022. Adults aged ≥18 years with self-reported age at diagnosis of adult-onset type 1 diabetes or type 2 diabetes were included. Trends in mean age at diagnosis of type 1 diabetes and type 2 diabetes and in proportions of people with type 1 diabetes or type 2 diabetes diagnosed at different ages were assessed by linear and logistic regressions. Racial/ethnic differences in mean age at diagnosis of type 1 diabetes and type 2 diabetes were determined.

RESULTS

Included were 1,224 type 1 diabetes cases and 14,221 type 2 diabetes cases. From 2016 to 2022, the mean age at diagnosis of type 2 diabetes increased by 0.18 years annually (95% CI=0.05, 0.30 years, p=0.005), but no significant trend was observed for type 1 diabetes. The proportion of type 2 diabetes cases with diagnosis age ≥60 years increased by 3.17% and with diagnosis age in 18-29 years decreased by 5.62% annually (p≤0.01). On average, Hispanic individuals had type 1 diabetes diagnosed 3.2 years older and minority groups had type 2 diabetes diagnosed 2.0-6.1 years younger than non-Hispanic White individuals (p≤0.02).

CONCLUSIONS

Among U.S. adults, the mean age at diagnosis of adult-onset type 1 diabetes remained stable, and of adult-onset type 2 diabetes increased significantly from 2016 to 2022. Substantial and opposite differences in mean diagnosis age of type 1 diabetes and type 2 diabetes by race/ethnicity were identified.

Associations between the timing of 24 h physical activity and diabetes mellitus: results from a nationally representative sample of the US population

AIMS/HYPOTHESIS

Growing evidence suggests that timing may be an important aspect of physical activity that influences cardiometabolic health. However, the current literature is inconclusive regarding the time of day that physical activity offers the greatest metabolic advantages. We investigated associations between hourly physical activity levels and diabetes mellitus and glycaemic biomarkers in a cross-sectional and nationally representative sample of US adults.

METHODS

We studied 7074 adults (mean age 48 years; 52% women) from the National Health and Nutrition Examination Survey (2011-2014). Physical activity was measured by actigraphy. A monitor-independent movement summary (MIMS) unit was used to derive the total activity level (divided into quintiles) for hourly windows that were defined relative to sleep timing and according to clock time. The primary outcome was prevalent diabetes, and secondary outcomes included fasting glucose, fasting insulin, HOMA-IR and 2 h OGTT results.

RESULTS

Physical activity levels in late morning and late afternoon were associated with lower adjusted odds of diabetes. Specifically, in late morning (8:01-9:00 h after the sleep midpoint), the highest quintile of activity was associated with a 35% decrease (OR 0.65; 95% CI 0.44, 0.96) in the odds of diabetes when compared with the lowest quintile, while in late afternoon (11:01-17:00 h after the sleep midpoint), the highest quintiles were associated with 56% and 36% lower odds (OR 0.44; 95% CI 0.29, 0.69 and OR 0.64; 95% CI 0.43, 0.95). Higher night-time activity was associated with higher odds of diabetes. Similar patterns of results were observed with OGTT data and across subgroups of age, gender, race/ethnicity, chronotype and sleep duration.

CONCLUSIONS/INTERPRETATION

Our findings suggest that the timing of physical activity may modulate its metabolic effects.

Nutrition Knowledge Varies by Food Group and Nutrient Among Adults

The United States Dietary Guidelines for Americans (DGA) have provided recommendations for healthy eating patterns to meet nutrient needs and reduce chronic disease risk for decades. However, few Americans fully meet these guidelines, especially regarding five shortfall nutrients, and the vegetable, fruit, pulse, whole grain, and dairy food groups. Nutrition knowledge is a modifiable factor associated with improved dietary behavior, yet it is unclear whether individuals with nutrition-related chronic diseases possess greater knowledge. The study objectives were to (1) describe knowledge of 10 nutrient sources across six food groups, and (2) determine predictive factors for nutrient source and food group knowledge. A national sample of 930 adults from an online panel answered demographic, nutrition-disease knowledge, desired benefits from foods, chronic disease status questions, and identified the presence or absence of 10 nutrients in six food groups. Respondents were 77% White, 51% women, and 70% married, with a mean age of 45 years. Nutrition-disease knowledge was higher for those who were older, women, and highly educated. Having a nutrition-related disease, e.g., heart disease, was not predictive of nutrient-disease knowledge. Whole grains had the highest average nutrient knowledge score (6.26 ± 2.5; range 0-10), while vegetables had the lowest (4.89 ± 2.3). Fat food sources were the best known (3.98 ± 1.5; range 0-6), and folate was the least recognized (2.16 ± 1.4). General linear models of survey variables for the six food groups explained 10.2% to 19.4% of nutrient knowledge variation and described 4.7% to 27.1% of differences in food-source scores for the 10 nutrients. Nutrient-disease knowledge had the most significant influence on nutrient source scores. Gaps in understanding nutrient sources suggest the public needs more applied education.

Trends in modifiable risk factors for dementia among midlife adults in the United States: The National Health and nutrition examination survey 1999-2018

OBJECTIVE

Dementia has a large public health burden, and modifiable risk factors, particularly in midlife, may provide an opportunity for early prevention. We aimed to examine trends in age-adjusted prevalence of modifiable risk factors for dementia and the number of modifiable risk factors among midlife adults from 1999 to 2018.

METHODS

A total of 14,851 participants aged 40 to 64 years without a history of cardiovascular disease in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were included in the analysis. The age-adjusted prevalence of six modifiable risk factors consistently measured across all surveys, including hypertension, diabetes, hyperlipidemia, obesity, smoking, and heavy drinking, as well as the average number of these modifiable risk factors, were estimated and compared across survey periods. Subgroup analyses were conducted by sex, race/ethnicity, education, and family income.

RESULTS

The age-adjusted prevalence of diabetes (p for linear trend <0.0001) and obesity (p for linear trend = 0.0001) showed increasing trends from 1999 to 2018 among midlife adults in the U.S. and in virtually all subgroups, while smoking showed a decreasing trend (p for linear trend <0.0001). The average number of modifiable risk factors remained around two (p for linear trend = 0.84).

CONCLUSION

The prevalence of diabetes and obesity increased in this large, nationally representative U.S. study population, while the prevalence of smoking decreased. More effective public health interventions are needed to mitigate the impact of these risk factors and ultimately reduce the burden of dementia in aging populations.

Unveiling inequalities: Racial, ethnic, and socioeconomic disparities in diabetes: Findings from the 2007-2020 NHANES data among U.S. adults

Objective

Despite persistent disparities in diabetes prevalence among racial and ethnic minorities, there remains a significant lack of understanding regarding the intersectionality of racial and ethnic groups and socioeconomic status (SES) with diabetes.

Methods

The data came from the National Health and Nutrition Examination Survey (NHANES; N = 30,754, mean age = 47.4) using cross-sectional survey cycles from 2007 to 2008 through 2017-2020. Diabetes status was self-reported by physician diagnosis. Sociodemographic factors included racial and ethnic groups and SES. Weighted Poisson models were used to examine the association of racial and ethnic groups and SES with diabetes, stratified by age groups (20-44, 45-64, 65-79), sex, and racial and ethnic groups for SES, separately.

Results

Non-Hispanic Black, Hispanic, and other adults had a 47 %, 31 %, and 76 % higher prevalence of diabetes than non-Hispanic White adults, while adults from low and middle SES compared to high SES had a 37 % and 22 % higher prevalence of diabetes. Non-Hispanic Black, Hispanic, and other adults aged 45-64 years had a 45 %, 34 %, and 78 % higher prevalence of diabetes, and low and middle SES had a 57 % and 32 % higher prevalence of diabetes. Similar patterns were observed for adults aged 65-79. Males among non-Hispanic Black, Hispanic, and other adults and females from low and middle-SES families had a higher prevalence of diabetes.

Conclusion

Minority groups, middle and older-aged adults, males from minority groups, and females from low SES had a greater prevalence of diabetes. Effective interventions should prioritize tailoring efforts to specific minoritized and low SES groups to address diabetes disparities.

Disparities in Diabetes Distress and Nutrition Management Among Black and Hispanic Adults: A Mixed Methods Exploration of Social Determinants

PURPOSE

The purpose of this study was to explore self-reported diabetes management strategies, social determinants of health (SDOH), and barriers to care among people with diabetes receiving care in a safety-net setting to identify factors contributing to disparities in outcomes for Black and Hispanic adults and inform future interventions.

METHODS

Sequential, explanatory, mixed methods study comprised a survey of adults with diabetes seen in primary care at a safety-net hospital in New England, followed by qualitative semistructured interviews with a subset of the Black and Hispanic respondents. Descriptive statistics, chi-square and t tests were used to analyze quantitative data. The health equity implementation framework was used to guide qualitative data collection and directed content analysis.

RESULTS

A total of 496 respondents completed the survey; 48 Black and Hispanic adults participated in interviews. Diabetes-related distress was significantly higher among Black and Hispanic participants compared to White participants. Nutrition management use was significantly lower among Black and Hispanic participants. Qualitative findings suggest that SDOH and lack of education and support, specifically, nutrition and access to self-management resources, contributed to diabetes-related distress and prevented optimal self-management.

CONCLUSIONS

High rates of diabetes-related distress and low rates of nutrition management were identified in Black and Hispanic adults in a safety-net setting. Qualitative interviews demonstrated a relationship between adverse SDOH and lack of nutrition education with diabetes distress and challenges to self-management, potentially contributing to disparities in outcomes. Findings suggest that increased uptake of nutrition therapy and self-management education and support may be critical for improving diabetes outcomes and promoting health equity.

Trends in the prevalence of cardiometabolic diseases in US adults with newly diagnosed and undiagnosed diabetes, 1988-2020

OBJECTIVES

Early detection and timely management of cardiometabolic diseases (CMDs) in diabetes are critical for preventing vascular complications and premature mortality. However, the prevalence of CMDs over time in adults with newly diagnosed and undiagnosed diabetes is unclear.

STUDY DESIGN

Cross-sectional study.

METHODS

Included were US adults aged ≥20 years with newly diagnosed diabetes and undiagnosed diabetes using data from the National Health and Nutrition Examination Survey in 1988-2020. CMDs included obesity, severe obesity, dyslipidemia, hypertension, metabolic dysfunction-associated fatty liver disease (MAFLD), chronic kidney disease (CKD), and cardiovascular disease (CVD). Poisson regressions were used to assess trends in the prevalence of CMDs and to compare the prevalence between newly diagnosed and undiagnosed diabetes.

RESULTS

For both diabetes phenotypes in 1988-2020, the prevalence of obesity and severe obesity increased and CKD decreased (P < 0.05). The prevalence of dyslipidemia decreased and MAFLD increased in undiagnosed diabetes (P < 0.05). In 2011-2020, the prevalence of CMDs ranged from 14.3 % for CVD to 78.6 % for dyslipidemia. No significant difference in the prevalence of all CMDs between the 2 diabetes phenotypes was observed.

CONCLUSIONS

The prevalence of CMDs remained high in US adults with newly diagnosed and undiagnosed diabetes during the previous 3 decades, with no significant difference in the prevalence between the 2 diabetes phenotypes.

Twenty-Year Trends in Prevalence and Incidence of Diabetic Retinal Disease

PURPOSE

To determine how the rates of diabetic retinal disease (DRD) and its vision-threatening components (VTDR), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) among patients with diabetes mellitus (DM) have changed over the past 20 years.

DESIGN

Retrospective cohort study.

PARTICIPANTS

All DM patients insured by commercial and Medicare Advantage insurance plans in a claims database from 2000 through 2022 and at least 1 full calendar year of data. Cohorts were created using International Classification of Diseases codes to determine the yearly prevalence and incidence of DRD, VTDR, DME, and PDR.

METHODS

Logistic and Poisson regression models created prevalence and incidence estimates, respectively.

MAIN OUTCOME MEASURES

DRD, DME, and PDR prevalence and incidence.

RESULTS

The prevalence of DRD initially decreased from 2001 (13.6%) to 2007 (10.9%), but then increased every year through 2021 (20.8%; P < 0.001, adjusted test for trend [aTT]). Incidence of DRD varied considerably, ranging from 17.7 cases per 1000 patient-years in 2013 to its highest of 32.2 cases per 1000 patient-years in 2022 (P < 0.001, aTT). The prevalence of VTDR and DME trended similarly, with increases from 2007 (VTDR, 5.2%; DME, 3.2%) through 2016 (VTDR, 7.5%; DME, 5.4%), followed by decreases each year through 2021 (VTDR, 6.9%; DME, 4.9%; P < 0.001, aTT). The VTDR and DME incidence rates peaked in 2009 (VTDR, 12.4 cases per 1000 patient-years; DME, 8.6 cases per 1000 patient-years) and decreased through 2022 (VTDR, 6.1 cases per 1000 patient-years; DME, 5.0 cases per 1000 patient-years; P < 0.001, aTT, for both VTDR and DME). Prevalence of PDR varied between 3.2% and 4.0% throughout the 20-year observation period (P < 0.001, aTT). Incidence of PDR decreased over time to 2.6 cases per 1000 patient-years in 2022 (P < 0.001, aTT).

CONCLUSIONS

DRD prevalence (through 2007) and incidence (through 2014) initially decreased, but the rate of each has doubled since. Despite increases in DRD, incidence rates of VTDR, DME, and PDR have improved dramatically over the past 20 years.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A Narrative Review of Cardiometabolic Profiles among U.S. Adults: Temporal Trends and Implications

PURPOSE OF REVIEW

To provide a narrative overview of trends and disparities in the cardiometabolic profiles of U.S. adults by synthesizing findings from nationally representative studies conducted between 1999 and 2020.

RECENT FINDINGS

During the study period, the cardiometabolic profiles of U.S. adults displayed a complex mix of trends. While there were notable improvements in specific risk factors, such as reductions in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels, other aspects of cardiometabolic health worsened. The mean body mass index and hemoglobin A1c levels increased, accompanied by significant rises in the prevalence of obesity, type 2 diabetes, and metabolic syndrome. Despite some progress in blood pressure and lipid profiles, the overall cardiometabolic health of the population declined, with only a small percentage of adults maintaining optimal health by 2018. Furthermore, significant disparities persisted across racial and socioeconomic groups, with non-Hispanic Black participants and those with lower education and income facing higher cardiometabolic risks compared to their counterparts. Despite improvements in certain aspects of cardiometabolic profiles among U.S. adults, significant challenges remain, particularly with the rising rates of obesity, type 2 diabetes, and metabolic syndrome. Persistent disparities in cardiometabolic health across sociodemographic groups emphasize the need for comprehensive public health strategies that address medical care, lifestyle factors, and social determinants of health. Future efforts should prioritize reducing these disparities and enhancing health equity to mitigate the overall burden of cardiometabolic disease.

The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus

BACKGROUND

The features of community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM) differ from those without. This study aims to spot a routinely tested parameter with discriminative, predictive and prognostic value to enhance CURB-65's prognostic accuracy in CAP patients with T2DM.

METHODS

We retrospectively studied consecutive CAP patients from 2020 to 2021, comparing laboratory parameters between patients with and without T2DM. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression were used to identify key parameters. The area under the ROC curve (AUC), Fagan's nomogram, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated the added predictive accuracy.

RESULTS

A total of 720 patients were included, comprising 180 diabetic CAP patients and 540 non-diabetic controls after matching for age, gender, and comorbidities through propensity score matching. In diabetic CAP patients, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio showed the highest AUC (0.676, 95% CI, 0.575-0.776) among laboratory parameters with different distributions between the groups. AST/ALT was also identified as an independent predictor of poor treatment outcome (OR = 3.672, 95% CI, 1.455-9.268, p = 0.006). Adding AST/ALT to CURB-65 slightly increased the AUC, but remarkably enhanced NRI and IDI (AUC, 0.756 vs. 0.782, p = 0.017; continuous NRI, 0.635, 95% CI, 0.304-0.966, p < 0.001; categorical NRI, 0.175, 95% CI, 0.044-0.307, p = 0.009; IDI, 0.043, 95% CI, 0.006-0.080, p = 0.021). An AST/ALT ratio of ≥ 1.625 conferred a 74% post-test probability of poor treatment outcome, while < 1.625 predicted 21%. AST/ALT also predicted outcomes for all the CAP patients enrolled (OR = 1.771, 95% CI, 1.231-2.549, p = 0.002). Predictive accuracy improved after incorporating AST/ALP into CURB-65 in these population (AUC, 0.615 vs. 0.645, p = 0.038; continuous NRI, 0.357, 95% CI, 0.196-0.517, p < 0.001; categorical NRI, 0.264, 95% CI, 0.151-0.376, p < 0.001; IDI, 0.019, 95% CI, 0.008-0.029, p < 0.001).

CONCLUSIONS

AST/ALT was identified as a discriminative, predictive and prognostic factor for CAP patients with T2DM. The integration of AST/ALT into CURB-65 enhanced outcome prediction for both diabetic and non-diabetic CAP patients.

Vitamin D: Evidence-Based Health Benefits and Recommendations for Population Guidelines

Vitamin D offers numerous under-recognized health benefits beyond its well-known role in musculoskeletal health. It is vital for extra-renal tissues, prenatal health, brain function, immunity, pregnancy, cancer prevention, and cardiovascular health. Existing guidelines issued by governmental and health organizations are bone-centric and largely overlook the abovementioned extra-skeletal benefits and optimal thresholds for vitamin D. In addition, they rely on randomized controlled trials (RCTs), which seldom show benefits due to high baseline 25-hydroxyvitamin D [25(OH)D] concentrations, moderate supplementation doses, and flawed study designs. This review emphasizes the findings from prospective cohort studies showing that higher 25(OH)D concentrations reduce the risks of major diseases and mortality, including pregnancy and birth outcomes. Serum concentrations > 30 ng/mL (75 nmol/L) significantly lower disease and mortality risks compared to <20 ng/mL. With 25% of the U.S. population and 60% of Central Europeans having levels <20 ng/mL, concentrations should be raised above 30 ng/mL. This is achievable through daily supplementation with 2000 IU/day (50 mcg/day) of vitamin D3, which prevent diseases and deaths. Furthermore, a daily dose between 4000 and 6000 IU of vitamin D3 to achieve serum 25(OH)D levels between 40 and 70 ng/mL would provide greater protection against many adverse health outcomes. Future guidelines and recommendations should integrate the findings from observational prospective cohort studies and well-designed RCTs to improve public health and personalized care.

The moderating effect of alternate Mediterranean diet on the association between sedentary behavior and insomnia in postmenopausal women

Aim

The study aimed to explore the moderating role of the alternate Mediterranean diet (aMED) adherence on the association between sedentary behavior and insomnia symptoms in postmenopausal women.

Methods

Data regarding postmenopausal women were obtained for this cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Sedentary behavior and insomnia symptoms were assessed using the questionnaire. aMED adherence was evaluated according to 24-h dietary recalls. Weighted univariate logistic regression models were utilized to screen potential covariates. The relationship between sedentary behavior, aMED adherence, and insomnia symptoms was explored using weighted univariate and multivariate logistic regression models. All results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 1,793 postmenopausal women were included in the final analysis. Of them, 643 (37.56%) reported experiencing insomnia symptoms. Among the postmenopausal women, sedentary time of >8 h was associated with insomnia symptoms (OR = 1.41, 95% CI = 1.01-1.96), prolonged nocturnal awakening (OR = 1.38, 95% CI = 1.06-1.79), and undesired early morning awakening (OR = 1.59, 95% CI = 1.09-2.30). No association was observed between adherence to the aMED and insomnia symptoms (OR = 1.05, 95% CI: 0.77-1.44). Among the postmenopausal women with lower adherence to the aMED, the odds of insomnia symptoms were higher in those with sedentary time ≥8 h (OR = 1.63, 95% CI: 1.02-2.62). Similarly, in the participants with low aMED adherence, sedentary time ≥8 h was also associated with prolonged nocturnal awakening (OR = 1.90, 95% CI = 1.27-2.83) and undesired early morning awakening (OR = 1.85, 95% CI = 1.09-3.16).

Conclusion

Adherence to the aMED modulates the association between sedentary behavior and insomnia symptoms in postmenopausal women. Interventions targeting sedentary behavior and dietary patterns may improve sleep quality and overall health in postmenopausal women.

Elevated GGT to HDL ratio as a marker for the risk of NAFLD and liver fibrosis

This study investigated the association between NAFLD and liver fibrosis and the ratio of gamma-glutamyl transferase to high-density lipoprotein cholesterol (GGT/HDL-C). In this cross-sectional study, we included 4764 subjects who participated in the National Health and Nutrition Examination Survey (NHANES) during 2017-2018. Adjusted multivariate logistic regression analysis was utilized to evaluate the relationships between GGT/HDL-C levels and NAFLD, fatty liver degree, and liver fibrosis. The non-linear link between NAFLD and the GGT/HDL-C ratio was examined using generalized additive models. There was a non-linear association between GGT/HDL-C and the risk of NAFLD, and all regression models demonstrated a strong relationship between GGT/HDL-C levels and the risk of liver fibrosis, the degree of hepatic steatosis, and the prevalence of NAFLD. Subgroup analyses revealed a significant correlation between the risk of NAFLD and the GGT/HDL-C ratio among Mexican Americans and young people in the 20-40 age range. The receiver operating characteristic (ROC) study showed that GGT/HDL-C was a more accurate predictor of NAFLD than GGT or HDL-C alone. In the U.S. population, an increased risk of NAFLD, the severity of hepatic steatosis, and the risk of liver fibrosis are independently correlated with an elevated GGT/HDL-C ratio.

The differences of metabolic profiles, socioeconomic status and diabetic retinopathy in U.S. working-age and elderly adults with diabetes: results from NHANES 1999-2018

AIMS

Controlled metabolic factors and socioeconomic status (SES) was crucial for prevention of diabetic retinopathy (DR). The study aims to assess the metabolic factors control and SES among working-age adults (18-64 years) with diabetes compared to older adults (65 years and older).

METHODS

Totals of 6738 participants with self-reported diagnosed diabetes from National Health and Nutrition Examination Survey were included, of whom 3482 were working-age and 3256 were elderly. The prevalence of DR, metabolic factors control, and the impact of SES and diabetic duration on DR was estimated. Subgroup analysis among working-age adults was employed across different diabetic duration and SES level.

RESULTS

The prevalence of DR was 20.8% among working-age adults and 20.6% in elderly adults. Further, working-age adults possessed suboptimal control on glycemia (median HbA1c: 7.0% vs. 6.8%, p < 0.001) and lipids (Low-density lipoprotein < 100 mg/dL: 46.4% vs. 63.5%, p < 0.001), but better blood pressure control (< 130/80 mmHg: 53.5% vs. 37.5%, p < 0.001) compared to the elderly, judging based on age-specific control targets. Prolonged diabetic duration didn't improve glycemic and composite factors control. SES like education and income impacted metabolic factors control and adults with higher SES were more likely to control well. Diabetic duration was a significant risk factor (OR = 4.006, 95%CI= (2.752,5.832), p < 0.001) while higher income (OR = 0.590, 95%CI= (0.421,0.826), p = 0.002) and educational level (OR = 0.637, 95%CI= (0.457,0.889), p = 0.008) were protective against DR.

CONCLUSIONS

Working-age adults with diabetes demonstrate suboptimal metabolic profile control, especially glycemia and lipids. Additional efforts are needed to improve metabolic factor control and reduce DR risk, particularly for those with longer diabetes duration, less education, and lower incomes.

Diabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials

OBJECTIVES

Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults.

DESIGN

A secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG).

SETTING

Emergency departments (EDs) or ICUs at 11 centers across the United States that enrolled in randomized trials of a pre-intubation checklist, fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie vs. stylet.

PATIENTS

Critically ill adults undergoing tracheal intubation with a laryngoscope in an ED or an ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

A total of 2654 patients were included in this analysis, of whom 638 (24.0%) had diabetes mellitus. The mean time from induction of anesthesia to intubation of the trachea was 169 seconds (sd, 137s). Complications occurred during intubation in 1007 patients (37.9%). Diabetes mellitus was not associated with the time from induction of anesthesia to intubation of the trachea (-4.4 s compared with nondiabetes; 95% CI, -17.2 to 8.3 s; p = 0.50). Use of a video vs. direct laryngoscope did not modify the association between diabetes mellitus and the time from induction to intubation (p for interaction = 0.064). Diabetes mellitus was not associated with the probability of successful intubation on the first attempt (85.6% vs. 84.3%; p = 0.46) or complications during intubation (39.8% vs. 37.4%; p = 0.52).

CONCLUSIONS

Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation.

Trends and Inequalities in Diabetes-Related Complications Among U.S. Adults, 2000-2020

OBJECTIVE

We examined national trends in diabetes-related complications (heart failure [HF], myocardial infarction [MI], stroke, end-stage renal disease [ESRD], nontraumatic lower-extremity amputation [NLEA], and hyperglycemic crisis) among U.S. adults with diagnosed diabetes during 2000-2020 by age-group, race and ethnicity, and sex. We also assessed trends in inequalities among those subgroups.

RESEARCH DESIGN AND METHODS

Hospitalization rates for diabetes-related complications among adults (≥18 years) were estimated using the 2000-2020 National (Nationwide) Inpatient Sample. The incidence of diabetes-related ESRD was estimated using the United States Renal Data System. The number of U.S. adults with diagnosed diabetes was estimated from the National Health Interview Survey. Annual percent change (APC) was estimated for assessment of trends.

RESULTS

After declines in the early 2000s, hospitalization rates increased for HF (2012-2020 APC 3.9%, P < 0.001), stroke (2009-2020 APC 2.8%, P < 0.001), and NLEA (2009-2020 APC 5.9%, P < 0.001), while ESRD incidence increased (2010-2020 APC 1.0%, P = 0.044). Hyperglycemic crisis increased from 2000 to 2020 (APC 2.2%, P < 0.001). MI hospitalizations declined during 2000-2008 (APC -6.0%, P < 0.001) and were flat thereafter. On average, age inequalities declined for hospitalizations for HF, MI, stroke, and ESRD incidence but increased for hyperglycemic crisis. Sex inequalities increased on average for hospitalizations for stroke and NLEA and for ESRD incidence. Racial and ethnic inequalities declined during 2012-2020 for ESRD incidence but increased for HF, stroke, and hyperglycemic crisis.

CONCLUSIONS

There was a continued increase of several complications in the past decade. Age, sex, and racial and ethnic inequalities have worsened for some complications.

Resveratrol stimulates brown of white adipose via regulating ERK/DRP1-mediated mitochondrial fission and improves systemic glucose homeostasis

PURPOSE

Diabetes mellitus and metabolic homeostasis disorders may benefit from white adipose tissue (WAT) browning, which is associated with mitochondrial fission. Resveratrol, a dietary polyphenol, exhibits beneficial effects against abnormalities related to metabolic diseases. However, it remains unknown whether resveratrol contributes to WAT browning by regulating mitochondrial fission.

METHODS

We administered resveratrol (0.4% mixed with control) to db/db mice for 12 weeks, measuring body weight, oral glucose tolerance, insulin tolerance, and histological changes. The uncoupling protein 1 (UCP1) and dynamin-related protein 1 (DRP1) expressions in the epididymal WAT were assessed via immunoblotting.

RESULTS

We found that resveratrol improved systemic glucose homeostasis and insulin resistance in db/db mice, which was associated with increased UCP1 in epididymal WAT. Resveratrol-treated mice exhibited more fragmented mitochondria and increased phosphorylation of DRP1 in the epididymal WAT of the db/db mice. These results were further confirmed in vitro, where resveratrol induced extracellular signal-regulated kinase (ERK) signaling activation, leading to phosphorylation of DRP1 at the S616 site (p-DRP1S616) and mitochondrial fission, which was reversed by an ERK inhibitor in 3T3-L1 adipocytes.

CONCLUSION

Resveratrol plays a role in regulating the phosphorylation of ERK and DRP1, resulting in the promotion of beige cells with epididymal WAT and the improvement of glucose homeostasis. Our present study provides novel insights into the potential mechanism of resveratrol-mediated effects on WAT browning, suggesting that it is, at least in part, mediated through ERK/DRP1-mediated mitochondrial fission.

Disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease Prevalence, Diagnosis, Treatment, and Outcomes: A Narrative Review

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a leading cause of morbidity and mortality, and health disparities have been shown to influence disease burden.

AIM

In this review, we aim to characterize disparities in prevalence, diagnosis, treatment, and outcomes of MASLD, and to make recommendations for next steps to minimize these disparities.

METHODS

Literature search on PubMed and Scopus databases was conducted to identify relevant articles published before September 2, 2024.

RESULTS

Relative to women and White populations, MASLD is more common in men and Hispanic populations and less common in Black populations. It is also more prevalent among those with lower SES. Noninvasive clinical scores may perform differently across groups, and screening practices vary both for initial disease and for progression to metabolic dysfunctionassociated steatohepatitis (MASH), formerly called non-alcoholic steatohepatitis (NASH). Women and Black and Hispanic patients suffer worse outcomes including rates of progression to MASH and mortality.

CONCLUSIONS

Health disparities related to race, ethnicity, gender, and socioeconomic factors impact multiple stages of care for patients with MASLD.

The CNIC polypill (Acetylsalicylic acid + Atorvastatin + Rampril) in secondary prevention of cardiovascular disease in patients with type 2 diabetes: A comparative analysis with alternative therapeutic approaches

BACKGROUND

Patients with type 2 DM (T2DM) and established cardiovascular disease (CVD) are at high risk of recurrent CV events. We analysed the use of the CNIC-polypill (acetylsalicylic acid, ramipril, and atorvastatin) compared with other therapeutic strategies in patients with T2DM and CVD from the retrospective NEPTUNO study.

METHODS

Patients were stratified into four therapeutic approaches: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. Outcomes included the 2-year cumulative incidence and risk of recurrent major adverse CV events (MACE) and CV death, risk factors control, medication persistence, and utilisation of healthcare resources and costs.

RESULTS

After two years, T2DM patients treated with Monocomponents, Equipotent drugs, or Other therapies had increased recurrent MACE risk compared to CNIC-polypill (11 %, 23 %, and 44 %, respectively; P < 0.05) and shorter median time to CV events (305-377 vs. 396 days; P < 0.05). The CNIC-polypill group achieved a significant 11.2 % increase in patients reaching LDL-c targets <70 mg/dL, outperforming other strategies. It also exhibited superior triglyceride control and a higher proportion achieving the <130/80 mmHg blood pressure goal. The CNIC-polypill cohort displayed significantly higher 24-month persistence (71.5 % vs. 54.7 %-58.3 %, p < 0.05) and lower mean adjusted costs per patient (€5083 vs. €6000-€6523; p < 0.05). In a comparative analysis, T2DM patients had lower baseline LDL-c and total cholesterol levels than non-T2DM counterparts yet experienced a higher incidence of recurrent MACE over two years.

CONCLUSION

The CNIC-polypill (ASA, atorvastatin and ramipril) emerged as a promising treatment for patients with CVD, particularly those with T2DM, offering improved clinical outcomes and economic efficiency.

Predicted Heart Age and Life's Essential 8 Among U.S. Adults: NHANES 2015-March 2020

INTRODUCTION

This study examined the association between American Heart Association's (AHA) cardiovascular health (CVH) metrics, Life's Essential 8 (LE8), and predicted heart age among U.S. adults.

METHODS

The sample comprised 7,075 participants aged 30-74 years without CVD and/or stroke from the National Health and Nutrition Examination Survey (NHANES) 2015-March 2020. LE8 was measured according to AHA's metrics (overall score ranging from 0 to 100 points), and nonlaboratory-based Framingham Risk Score was used to estimate predicted heart age. Analyses were completed in June 2024.

RESULTS

Median LE8 scores were 62.8 for men and 66.0 for women. Over 80% of participants had less than optimal CVH scores, affecting 141.5 million people and 1-in-6 participants had a low CVH score, impacting 30.0 million people. Mean predicted heart age and excess heart age (EHA, difference between actual and predicted heart age) were 56.6 (95% CI 56.1-57.1) and 8.6 (8.1-9.1) years for men and 54.0 (53.4-54.7) and 5.9 (5.2-6.5) years for women. Participants in the low CVH group (scores<50), had an EHA that was 20.7 years higher than those in the high CVH group (score 80-100). Compared to the high CVH group, participants in low CVH group had 15 times (for men) and 44 times (for women) higher risk of having EHA ≥10 years. The pattern of differences in predicted heart age, EHA, and prevalence of EHA ≥10 years by LE8 groups remained largely consistent across subpopulations.

CONCLUSIONS

These findings highlight the importance of maintaining a healthy lifestyle to improve cardiovascular health and reduce excess heart age.

Cost-effectiveness of the adjuvanted RSVPreF3 vaccine among adults aged ≥60 years in the United States

Respiratory syncytial virus (RSV) is a common cause of acute respiratory illness in individuals of all ages, with adults aged ≥60 years and adults with certain chronic conditions at increased risk of severe RSV-related outcomes. This study evaluates the cost-effectiveness of the adjuvanted RSVPreF3 vaccine versus no vaccine in adults aged ≥60 years in the United States (US). A multi-cohort Markov model was developed with a 5-year time horizon and 1-month cycle length to compare outcomes for no vaccination and one-time adjuvanted RSVPreF3 vaccination (assuming the same vaccination as for influenza vaccines). Clinical parameters (e.g., vaccine efficacy) were based on phase 3 clinical trial data over 3 seasons, with all other inputs obtained from public US sources and scientific literature. Outcomes included total and incremental quality-adjusted life year (QALY) losses and costs, as well as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to evaluate the sensitivity of results to inputs. In the base case, the model estimated that vaccinating 52.7 million adults aged ≥60 years with the adjuvanted RSVPreF3 vaccine once would result in 244,424 fewer QALY losses and an incremental societal cost of $4.5 billion over 5 years, with vaccination costs partially offset by reduced disease-related costs. From the societal perspective, adjuvanted RSVPreF3 vaccination resulted in an ICER of $18,430 per QALY gained. Results were relatively robust across sensitivity analyses and indicate that adjuvanted RSVPreF3 vaccination is a cost-effective option for the prevention of RSV in US adults aged ≥ 60 years, reducing the substantial burden within this population.

Trends and disparities in heart failure-related mortality in the US adult population from 1999 to 2020

Introduction

The rising incidence of heart failure (HF) among the U.S. population has become a major concern for healthcare providers. This study aims to assess mortality trends related to HF across different age groups, racial demographics, and geographic locations from 1999 to 2020.

Material and methods

This descriptive analysis uses death certificate data from the CDC WONDER database to track mortality trends among HF patients from 1999 to 2020. Log-linear regression models were used to delineate trends. The study used deidentified public data, complying with ethical standards.

Results

Over 21 years, 1,426,657 HF-related deaths were recorded in individuals aged 15 and older, with a slight overall increase in mortality (AAPC = 0.11). Mississippi recorded the highest age-adjusted mortality rates (AAMRs) at 58.0 per 100,000. The Midwest showed the highest regional mortality rates, while the oldest individuals (≥ 85) exhibited the highest crude mortality rate (CMR) of 663.9. Males consistently demonstrated higher AAMRs than females, despite females accounting for 57.6% of the deaths. Black ancestry individuals experienced the highest mortality rates, with rising trends, particularly in non-metropolitan areas. After 2012, significant increases in mortality were noted, especially in individuals over 85, with stable rates in younger demographics.

Conclusions

Males and Black ancestry individuals are disproportionately affected, demonstrating the need for targeted interventions.

Lean diabetes: 20-year trends in its prevalence and clinical features among Korean adults

BACKGROUND

We investigated the prevalence and clinical characteristics of type 2 diabetes mellitus in lean Korean adults.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Survey 2001-2021 among adults aged ≥ 19 years. Trend analyses between 2001 and 2019-2021 (n = 89,720) and comparative analyses of multiple clinical characteristics between patients with type 2 diabetes with and without overweight/obesity were conducted (n = 2,284).

RESULTS

Between 2001 and 2019-2021, the estimated prevalence of lean type 2 diabetes (body mass index [BMI] < 23 kg/m2) increased from 6.6 to 8.8%, representing a 33.3% increase. This was a similar extent of increase of type 2 diabetes associated with being overweight or obese (12.1-16.3%, + 34.7%). The increase in the prevalence of lean type 2 diabetes was more pronounced among females, while the increase among those who were overweight or obese was more pronounced among males than their counterparts. Although the overweight/obese type 2 diabetes group (T2DM group) showed more risk factors for cardiovascular disease, the lean T2DM group had lower insulin levels and reduced muscle mass and strength.

CONCLUSIONS

The prevalence of lean type 2 diabetes among Korean adults is increasing, at a rate similar to type 2 diabetes in overweight/obese individuals. Patients with lean type 2 diabetes showed decreased beta-cell function and sarcopenia. These findings emphasize the need for tailored management strategies for lean type 2 diabetes given its characteristics and rising prevalence.

Identify unmet needs in diabetes care in Shandong, China: a secondary analysis of a cross-sectional study using cascade of care framework

BACKGROUND

The continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.

METHODS

We conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.

RESULTS

This secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.

CONCLUSIONS

A significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.

Out-of-Pocket Costs Burden in Marketplace Plans for People With Diabetes

Background

The Affordable Care Act (ACA) aims to expand coverage and increase access to health insurance. Despite the increase of insured individuals, there are a number of concerns about whether coverage and care are affordable. Prior studies document a growing concern with rising premiums and cost-sharing, including deductibles, particularly for those with chronic conditions.

Objective

Compare the ACA marketplace plan availability and costs across 17 states for individuals with varying diabetic engagement profiles and their related medical needs.

Design

Descriptive Cost Analysis.

Methods

Using Healthcare.gov individual state marketplace websites, we utilized a descriptive cost analysis to compare plan availability and costs for premiums, deductibles, co-payments, and co-insurance for an individual aged 63 years old, who was either a non-diabetic, high-engagement or low-engagement diabetic in urban and rural areas. Using the second lowest monthly premium silver plan (the benchmark plan), we calculated annual costs for premiums, co-insurance, co-payments, and deductibles for these individual profiles. We assessed statistical differences between health care component costs, within and across urban and rural areas, using t-tests.

Results

The findings highlight within and across states, individuals with diabetes, particularly low-engagement diabetics, spend a significantly higher percent of their income on additional health care costs, above their premium, than non-diabetic individuals. In some states, low-engagement diabetic patients spend upwards of 3 times more than high-engagement diabetic patients, highlighting an additional cost burden. For low-engagement diabetics, deductibles are driving health care spending with an average of 59% of health care spending coming from deductible payments. Results do not show statistically different costs across urban and rural diabetic patients.

Conclusion

Despite the ACA's success, results highlight variation in plan availability across states and disproportionate cost burden placed on moderate income individuals, especially related to deductible, and co-payments for those with chronic diseases.

Glycemic Control With Layperson-Delivered Telephone Calls vs Usual Care for Patients With Diabetes: A Randomized Clinical Trial

Importance

Diabetes is associated with emotional distress and poor mental health, especially for individuals with low income, hindering patients' ability to manage their condition. The health care system's workforce constraints limit its capacity to holistically support patients.

Objective

To assess the effectiveness of layperson-delivered empathetic engagement over the telephone in helping improve glycemic management for patients with diabetes.

Design, Setting, and Participants

This parallel-arm randomized clinical trial with blinded outcome assessment was conducted from February 12, 2022, to April 15, 2023, with final measurements on November 18, 2023, among 260 patients with uncontrolled diabetes from a federally qualified health center in Austin, Texas, engaging telephonically from home.

Intervention

Patients assigned to the intervention group received empathy-oriented telephone calls by community-hired laypeople for 6 months, while those assigned to the control group received usual care. Patients were stratified by baseline score (≥5 vs <5) on the depressive symptom scale of the 9-item Patient Health Questionnaire (PHQ-9).

Main Outcomes and Measures

The primary outcome was hemoglobin A1c level at baseline, 3 months, and 6 months, assessed for interaction between time and trial arm. Secondary outcomes were self-perceptions of managing diabetes, diabetes-related behaviors and distress, and mental health symptoms (measured via surveys). Analysis was performed on an intention-to-treat basis.

Results

Of 260 participants (mean [SD] age, 49.5 [10.1] years; 163 of 259 women [62.9%]; 176 of 203 [86.7%] with annual income <$40 000) enrolled, 6 withdrew. At 6 months, 204 of 254 (80.3%; intervention, 109 of 127 [85.8%] and control, 95 of 127 [74.8%]) returned for measurements. Participants in the intervention group had statistically significant mean (SD) decreases in hemoglobin A1c level at 6 months (from 10.0% [1.9%] to 9.3% [2.0%]) compared with those in the control group (from 9.8% [1.6%] to 9.7% [2.3%]) (P = .004). The within-person change in hemoglobin A1c level was -0.7% (95% CI, -1.0% to -0.4%) for the intervention group and 0.02% (95% CI, -0.4% to 0.4%) for the control group. For the subgroup with a PHQ-9 score of 5 or more at baseline (38.1% [99 of 260]), the within-person change in hemoglobin A1c was -1.1% (95% CI, -1.8% to -0.5%) for the intervention group and 0.1% (95% CI, -0.7% to 0.8%; P = .004) for the control group. For the subgroup with a PHQ-9 score less than 5, the within-person change in hemoglobin A1c was -0.4% (95% CI, -0.8% to -0.1%) for the intervention group and -0.02% (95% CI, -0.5% to 0.5%; P = .21) for the control group. At 6 months, 91.7% of the participants (99 of 108) responded that the program was very or extremely beneficial.

Conclusions and Relevance

In this randomized clinical trial of telephone-based layperson-delivered empathetic engagement, patients with diabetes and low income achieved clinically meaningful improvements in glycemic control. With workforce constraints, layperson-delivered programs for diabetes show promise.

Trial Registration

ClinicalTrials.gov Identifier: NCT05173675.

Cholesterol, Triglyceride, and Glucose Levels Across Birth Cohorts in the US

Importance

Population mean levels of total cholesterol and fasting triglycerides have decreased substantially in the US in recent decades, but improvements in cardiometabolic health may have slowed among younger cohorts. Conversely, prevalence of diabetes (types 1 and 2) and obesity has increased, especially among adults younger than 65 years. It is unclear how trends in cholesterol, triglyceride, and glucose levels have changed across different birth cohorts and whether adverse trends in obesity are associated with these patterns.

Objective

To quantify national trends in total cholesterol, fasting triglyceride, and fasting glucose levels among cohorts born between 1920 and 1999 and examine the potential association of these patterns with body mass index (BMI).

Design, Setting, and Participants

This serial cross-sectional study used National Health and Nutrition Examination Survey (NHANES) data from the 1999-2000 to 2017-2020 cycles. Data were analyzed between November 1, 2023, and July 31, 2024. Participants included nonpregnant and noninstitutionalized US adults 18 years or older, born between 1920 and 1999, who had data collected from 1999 to 2020.

Exposure

Eight 10-year birth cohorts (from 1920 to 1999).

Main Outcomes and Measures

Total cholesterol, fasting triglyceride, and fasting glucose levels and BMI. Quantile regression models reported average marginal effects to quantify mean change in cardiometabolic outcome measures per decade of birth years. Parametric regression models estimated the association of birth cohort with outcomes, assessing BMI as the mediator.

Results

Of 52 006 participants weighted to represent 264 664 915 US adults, weighted median age was 46 (IQR, 33-60) years and 50.6% were women. For the 50th percentile of measures, mean difference per 1-decade younger birth cohort was -7.1 (95% CI, -8.2 to -6.1) mg/dL for total cholesterol level, -13.1 (95% CI, -15.1 to -11.1) mg/dL for fasting triglyceride level, and 2.7 (95% CI, 2.3-3.1) mg/dL for fasting glucose level. BMI appeared to attenuate the associations between birth cohort and lipid levels and enhanced the associations between birth cohort and fasting glucose levels. However, up to 80% of the associations between birth cohorts and cardiometabolic outcomes were not mediated through BMI.

Conclusions and Relevance

In this cross-sectional study of 52 006 participants representing 264 664 915 US adults, population-level improvements in total cholesterol and triglyceride levels decelerated and adverse trends in glucose levels accelerated in more recent birth cohorts, which was partially mediated by concurrent increases in BMI. Public health initiatives that target antecedent health behaviors are needed to improve cardiometabolic health across generations.

Diabetes in China part 2: prevention, challenges, and progress

During the past 40 years, the prevalence of diabetes in China has increased from less than 1·0% in 1980 to 12·4% in 2018, an increase in line with the rapid growth of the nation's economy. To address such a burden, the Healthy China 2030 initiative and subsequent Action Plan, including a diabetes prevention and control campaign, were launched. A shift from a disease-centred approach to a health-centred approach and from treatment to prevention is the core of the Action Plan and diabetes management in China. In this Review, we discuss the challenges of diabetes prevention in China, including unhealthy lifestyle, increasing young-onset type 2 diabetes, and substantial diabetes care disparities. To address such challenges, countermeasures across different stages of diabetes prevention and targeted at different populations, are needed. Such countermeasures include primordial prevention of risk factors in the general population, primary prevention of diabetes onset in high-risk populations, and secondary prevention of cardiovascular complications for individuals with diabetes. We reflect on China's current progress, strategies, and achievements.

Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes

Background

Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, its effects on outcomes following total knee arthroplasty (TKA) are not well known. The purpose of this study was to compare the risk of complications after TKA in patients with type-2 diabetes who were on GLP-1 agonists with those who were not.

Methods

In total, 34,696 type 2 diabetes patients undergoing primary TKA between 2016 and 2021 were retrospectively reviewed utilizing a large national database. Propensity score matching was employed to match patients on GLP-1 agonists to controls at a 1:1 ratio (n = 2388 each). Multivariable logistic regression was utilized to examine 90-day and 1-year TKA outcomes between cohorts.

Results

Controls had higher odds of extended hospital stays (≥3 days) (odds ratio 1.29, P < .001). However, surgical complication rates at 90-days including surgical site infection and prosthetic joint infection were not significantly different. Similarly, no differences were seen in medical complications. There were also no significant differences in rates of all-cause revision TKA and aseptic revision TKA at 1 year postoperatively.

Conclusions

This study found that GLP-1 agonist use was not associated with increased medical or surgical complication rates in patients with diabetes undergoing TKA and was associated with lower rates of extended hospital stays after surgery. Given the potential for increased glycemic control and weight loss in patients using GLP-1 agonists, more data are needed to delineate the potential role of GLP-1 agonists in preoperative optimization of patients with diabetes prior to joint arthroplasty to minimize postoperative complications.

Utilization of Diabetes Self-Management Education and Support Among Medicare Beneficiaries Newly Diagnosed With Diabetes in Arkansas, 12 Months Postdiagnosis (2015-2018)

PURPOSE

The purpose of the study was to determine the rate of diabetes self-management education and support (DSMES) utilization among Medicare fee-for-service (FFS) and Medicare Advantage (MA) populations with type 2 diabetes in Arkansas.

METHODS

The Arkansas All-Payer Claims Database was used to identify Medicare FFS and MA beneficiaries diagnosed with type 2 diabetes from 2015 to 2018. Claims from 2013 to 2020 were analyzed to determine newly diagnosed individuals from 2015 to 2018. The criteria included 1 outpatient diabetes claim in the index year and at least 1 inpatient or outpatient claim in the 2 years following the initial claim. A total of 15 648 Medicare FFS individuals and 7520 MA individuals with newly diagnosed type 2 diabetes were identified. The use of DSMES 1 year following the diagnosis dates for both Medicare FFS and MA populations was assessed. Descriptive statistics and multiple logistic regression analyses were conducted to understand the factors associated with DSMES utilization.

RESULTS

DSMES utilization consistently remained lower in the MA population compared to Medicare FFS (2.3% vs 4.9%). The adjusted analysis indicated that factors such as older age, living in a rural area, belonging to a racial group other than White, and MA enrollment were associated with a lower likelihood of receiving DSMES.

CONCLUSIONS

DSMES utilization in Arkansas, where the prevalence of diabetes is higher than the national average, is notably low. There is a need for coordinated efforts at various levels to enhance access to DSMES.

Nucleic acid aptamers protect against lead (Pb(II)) toxicity

Lead (Pb(II)) is a pervasive heavy metal toxin with many well-established negative effects on human health. Lead toxicity arises from cumulative, repeated environmental exposures. Thus, prophylactic strategies to protect against the bioaccumulation of lead could reduce lead-associated human pathologies. Here we show that DNA and RNA aptamers protect C. elegans from toxic phenotypes caused by lead. Reproductive toxicity, as measured by brood size assays, is prevented by co-feeding of animals with DNA or RNA aptamers. Similarly, lead-induced neurotoxicity, measured by behavioral assays, are also normalized by aptamer feeding. Further, cultured human HEK293 and primary murine osteoblasts are protected from lead toxicity by transfection with DNA aptamers. The osteogenic development, which is decreased by lead exposure, is maintained by prior transfection of lead-binding DNA aptamers. Aptamers may be an effective strategy for the protection of human health in the face of increasing environmental toxicants.

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

BACKGROUND

Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories.

METHODS

We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment.

FINDINGS

In 2022, an estimated 828 million (95% credible interval [CrI] 757-908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401-496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait).

INTERPRETATION

In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention.

The impact of Composite Dietary Antioxidant Index on the relationship between eczema and depression symptoms in US adults

Aims

The study aims to explore the associations of eczema, Composite Dietary Antioxidant Index (CDAI), with depression symptoms in adults based on the National Health and Nutrition Examination Surveys (NHANES) database.

Methods

In total, 3,402 participant data were extracted from the NHANES 2005-2006. The relationship between eczema, CDAI, and depression symptoms was explored by utilizing weighted univariate and multivariate logistic regression models, presenting as odds ratios (ORs) and 95% confidence intervals (CIs). The additive interaction between eczema, CDAI, and depression symptoms was measured by relative excess risk due to interaction (RERI) and the attributable proportion of interaction (AP). Subsequently, the associations of eczema, CDAI, with depression were also explored in different gender, body mass index (BMI), and smoking subgroups.

Results

Of the 3,402 participants included, the mean age was 46.76 (0.83) years old, and 174 (5.11%) participants had depression symptoms. In the adjusted model, both eczema (OR = 3.60, 95%CI: 2.39-5.40) and CDAI (OR = 1.97, 95%CI: 1.19-3.27) were associated with a higher prevalence of depression symptoms. Compared to the participants with high CDAI and no eczema, those participants with low CDAI (eczema: OR = 7.30, 95%CI: 4.73-11.26; non-eczema: OR = 1.84, 95%CI: 1.06-3.19) have higher odds of depression symptoms, no matter have eczema or not. When under low CDAI levels, eczema was associated with increased odds of depression symptoms (OR = 3.76, 95%CI: 2.34-6.03). When under low CDAI level, eczema was also related to elevated odds of depression symptoms in those males, females, BMI <25, BMI ≥25, non-smoking, and smoking.

Conclusion

CDAI could modulate the association of eczema with depression symptoms in adults.

Trends in hyperinsulinemia and insulin resistance among nondiabetic US adults, NHANES, 1999-2018

Hyperinsulinemia and insulin resistance (IR) are critical predictors of cardiometabolic diseases, disproportionately affecting various sociodemographic groups in the United States. This study aimed to estimate and analyze trends in the prevalence of hyperinsulinemia and IR among nondiabetic adults from 1999 to 2018, using data from the National Health and Nutrition Examination Survey (NHANES). The study included 17,310 nondiabetic men and nonpregnant women aged 20 years or older. Hyperinsulinemia was defined as fasting serum insulin levels ≥10 U/ml, while IR was measured using the HOMA-IR index (≥2.6, 66.7th percentile). The age-standardized prevalence of hyperinsulinemia increased from 28.2% in 1999-2000 to 41.4% in 2017-2018, while IR prevalence rose from 24.8% to 38.4% during the same period. Higher prevalence rates were consistently observed among males, non-Hispanic Blacks, Hispanics, and individuals with lower education or income levels. Trends indicated increases across all sociodemographic groups during at least some time periods. The findings suggest a growing prevalence of hyperinsulinemia and IR in the U.S., particularly among vulnerable populations, underscoring the importance of targeted public health interventions to address these disparities and reduce the risk of cardiometabolic diseases.