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Persky V, Abasilim C, Tsintsifas K, Day T, Sargis RM, Daviglus ML, Cai J, Freels S, Unterman T, Chavez N, Kaplan R, Isasi CR, Pirzada A, Meyer ML, Talavera GA, Thyagarajan B, Peters BA, Madrigal JM, Grieco A, Turyk ME. Sex Hormones and Diabetes in 45- to 74-year-old Men and Postmenopausal Women: The Hispanic Community Health Study. J Clin Endocrinol Metab 2023; 108:1709-1726. [PMID: 36633580 PMCID: PMC10271226 DOI: 10.1210/clinem/dgad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Previous studies demonstrated associations of endogenous sex hormones with diabetes. Less is known about their dynamic relationship with diabetes progression through different stages of the disease, independence of associations, and role of the hypothalamic-pituitary gonadal axis. The purpose of this analysis was to examine relationships of endogenous sex hormones with incident diabetes, prediabetes, and diabetes traits in 693 postmenopausal women and 1015 men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos and followed for 6 years. Baseline hormones included estradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and, in men, testosterone and bioavailable testosterone. Associations were analyzed using multivariable Poisson and linear regressions. In men, testosterone was inversely associated with conversion from prediabetes to diabetes (incidence rate ratio [IRR] for 1 SD increase in testosterone: 0.821; 95% CI, 0.676, 0.997; P = 0.046), but not conversion from normoglycemia to prediabetes. Estradiol was positively associated with increase in fasting insulin and homeostatic model assessment of insulin resistance. In women, SHBG was inversely associated with change in glycosylated hemoglobin, postload glucose, and conversion from prediabetes to diabetes (IRR = 0.62; 95% CI, 0.44, 0.86, P = 0.005) but not from normoglycemia to prediabetes. Relationships with other hormones varied across glycemic measures. Stronger associations of testosterone and SHBG with transition from prediabetes to diabetes than from normoglycemic to prediabetes suggest they are operative at later stages of diabetes development. Biologic pathways by which sex hormones affect glucose homeostasis await future studies.
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Affiliation(s)
- Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Konstantina Tsintsifas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Tessa Day
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL,USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL,USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Terry Unterman
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL,USA
| | - Noel Chavez
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL,USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica M Madrigal
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Arielle Grieco
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL,USA
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Wittert G, Atlantis E, Allan C, Bracken K, Conway A, Daniel M, Gebski V, Grossmann M, Hague W, Handelsman DJ, Inder W, Jenkins A, Keech A, McLachlan R, Robledo K, Stuckey B, Yeap BB. Testosterone therapy to prevent type 2 diabetes mellitus in at-risk men (T4DM): Design and implementation of a double-blind randomized controlled trial. Diabetes Obes Metab 2019; 21:772-780. [PMID: 30520208 DOI: 10.1111/dom.13601] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/18/2018] [Accepted: 12/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). AIMS To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. STUDY POPULATION Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). SETTING, DRUG AND PROTOCOL Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. PRIMARY ENDPOINTS: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. SECONDARY ENDPOINTS Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. SAFETY Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. SUB-STUDIES: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.
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Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Evan Atlantis
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mathis Grossmann
- Dept. of Medicine, The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Woolloongabba, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, and Medical School, University of Western Australia, Perth, Western Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, and Medical School University of Western Australia, Perth, Western Australia
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Atlantis E, Fahey P, Martin S, O'Loughlin P, Taylor AW, Adams RJ, Shi Z, Wittert G. Predictive value of serum testosterone for type 2 diabetes risk assessment in men. BMC Endocr Disord 2016; 16:26. [PMID: 27230668 PMCID: PMC4882776 DOI: 10.1186/s12902-016-0109-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/17/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Effective prevention of type 2 diabetes (T2D) requires early identification of high-risk individuals who might benefit from intervention. We sought to determine whether low serum testosterone, a novel risk factor for T2D in men, adds clinically meaningful information beyond current T2D risk models. METHODS The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study population consists of 2563 community-dwelling men aged 35-80 years in Adelaide, Australia. Of the MAILES participants, 2038 (80.0 %) provided information at baseline (2002-2006) and follow-up (2007-2010). After excluding participants with diabetes (n = 317), underweight (n = 5), and unknown BMI status (n = 11) at baseline; and unknown diabetes status (n = 50) at follow-up; 1655 participants were followed for 5 years. T2D at baseline and follow-up was defined by self-reported diabetes, or fasting plasma glucose (FPG) ≥7.0 mmol/L (126.1 mg/dL), or glycated haemoglobin (HbA1c) ≥6.5 %, or diabetes medications. Risk models were tested using logistic regression models. Sensitivity, specificity, positive predictive values (PPV) were used to identify the optimal cut-off point for low serum testosterone for incident T2D and the area under the receiver operating characteristic (AROC) curve was used to summarise the predictive power of the model. 15.5 % of men had at least one missing predictor variable; addressed through multiple imputation. RESULTS The incidence rate of T2D was 8.9 % (147/1655) over a median follow-up of 4.95 years (interquartile range: 4.35-5.00). Serum testosterone level predicted incident T2D (relative risk 0.96 [95 % CI: 0.92,1.00], P = 0.032) independent of current risk models including the AUSDRISK, but did not improve corresponding AROC statistics. A cut-off point of <16 nmol/L for low serum testosterone, which classified about 43 % of men, returned equal sensitivity (61.3 % [95 % CI: 52.6,69.4]) and specificity (58.3 % [95 % CI: 55.6,60.9) for predicting T2D risk, with a PPV of 12.9 % (95 % CI: 10.4,15.8). CONCLUSIONS Low serum testosterone predicts an increased risk of developing T2D in men over 5 years independent of current T2D risk models applicable for use in routine clinical practice. Screening for low serum testosterone in addition to risk factors from current T2D risk assessment models or tools, including the AUSDRISK, would identify a large subgroup of distinct men who might benefit from targeted preventive interventions.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Paul Fahey
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Sean Martin
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Loughlin
- Chemical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Adams
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Zumin Shi
- Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia, Australia
| | - Gary Wittert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Mather KJ, Kim C, Christophi CA, Aroda VR, Knowler WC, Edelstein SE, Florez JC, Labrie F, Kahn SE, Goldberg RB, Barrett-Connor E. Steroid Sex Hormones, Sex Hormone-Binding Globulin, and Diabetes Incidence in the Diabetes Prevention Program. J Clin Endocrinol Metab 2015; 100. [PMID: 26200237 PMCID: PMC4596040 DOI: 10.1210/jc.2015-2328] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Steroid sex hormones and SHBG may modify metabolism and diabetes risk, with implications for sex-specific diabetes risk and effects of prevention interventions. OBJECTIVE This study aimed to evaluate the relationships of steroid sex hormones, SHBG and SHBG single-nucleotide polymorphisms (SNPs) with diabetes risk factors and with progression to diabetes in the Diabetes Prevention Program (DPP). DESIGN AND SETTING This was a secondary analysis of a multicenter randomized clinical trial involving 27 U.S. academic institutions. PARTICIPANTS The study included 2898 DPP participants: 969 men, 948 premenopausal women not taking exogenous sex hormones, 550 postmenopausal women not taking exogenous sex hormones, and 431 postmenopausal women taking exogenous sex hormones. INTERVENTIONS Participants were randomized to receive intensive lifestyle intervention, metformin, or placebo. MAIN OUTCOMES Associations of steroid sex hormones, SHBG, and SHBG SNPs with glycemia and diabetes risk factors, and with incident diabetes over median 3.0 years (maximum, 5.0 y). RESULTS T and DHT were inversely associated with fasting glucose in men, and estrone sulfate was directly associated with 2-hour post-challenge glucose in men and premenopausal women. SHBG was associated with fasting glucose in premenopausal women not taking exogenous sex hormones, and in postmenopausal women taking exogenous sex hormones, but not in the other groups. Diabetes incidence was directly associated with estrone and estradiol and inversely with T in men; the association with T was lost after adjustment for waist circumference. Sex steroids were not associated with diabetes outcomes in women. SHBG and SHBG SNPs did not predict incident diabetes in the DPP population. CONCLUSIONS Estrogens and T predicted diabetes risk in men but not in women. SHBG and its polymorphisms did not predict risk in men or women. Diabetes risk is more potently determined by obesity and glycemia than by sex hormones.
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Affiliation(s)
- K J Mather
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - C Kim
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - C A Christophi
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - V R Aroda
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - W C Knowler
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - S E Edelstein
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - J C Florez
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - F Labrie
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - S E Kahn
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - R B Goldberg
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
| | - E Barrett-Connor
- Department of Medicine (K.J.M.), Indiana University, Indianapolis, Indiana 46202; Departments of Medicine and Obstetrics & Gynecology (C.K.), University of Michigan, Ann Arbor, Michigan 48109; Biostatistics Center (C.A.C., S.E.E.), George Washington University, Rockville, Maryland 20850; Medstar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; Diabetes Research Center (Diabetes Unit) and Center for Human Genetics Research (J.C.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Program in Medical and Population Genetics (J.C.F.), Broad Institute, Cambridge, Massachusetts 02142; Department of Medicine (J.C.F.), Harvard Medical School, Boston, Massachusetts 02115; Endoceutics Inc. (F.L.), Québec City, G1W 2J5, Canada; VA Puget Sound Health Care System and University of Washington (S.E.K.), Seattle, Washington 98108; University of Miami (R.B.G.), Miami, Florida 33124; and University of California, San Diego (E.B.-C.), San Diego, California 92093
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