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Diabet. Med. 29, 404-409 (2012) Abstract Aims To investigate validity of waist circumference measurements obtained by self-report and self-measurement with non-verbal pictorial instructions among a multi-ethnic population. Methods Five hundred and twenty-six individuals aged 40-75 years (91 South Asian, 430 White European and five other), who attended a screening programme for Type 2 diabetes, estimated their waist circumference and measured their waist with a paper tape measure. Participants were also provided with simple pictorial instructions for measurement of waist circumference in their preferred language and remeasured their waist circumference. We calculated 95% limits of agreement with measures undertaken by a healthcare professional unaware of prior measures. Results Mean age was 56.8 years ( sd 9.0), mean BMI 30.0 kg/m2 ( sd 5.6) and mean waist circumference 98.4 cm ( sd 14.1). Seventy-nine per cent had high waist circumference according to International Diabetes Federation criteria. The mean of participants' self-reported value was 6.8 cm lower than the healthcare professional measure ( sd 8.8; 95% limits of agreement −10.4 to 24.0 cm), with significant differences by sex and ethnicity (South Asian men 7.5 cm, South Asian women 0.1 cm, White European men 7.8 cm, White European women 7.0 cm, P < 0.001). Compared with healthcare professional measures, mean self-measured waist circumference was very similar, both with instructions (0.4 cm higher; sd 5.5 cm; −11.1 to 10.4 cm) and without instructions (0.5 cm lower; sd 5.6; −10.4 to 11.4 cm), but with significant differences by sex and ethnicity ( P < 0.001). Conclusions There was systematic underestimation of self-reported waist circumference in this multi-ethnic UK population. The magnitude of underestimation might reduce the performance of risk scores; however, this can be corrected through self-measurement with pictorial instructions. [ABSTRACT FROM AUTHOR]

Aims The burden of diabetes is considerable for racial and ethnic minority populations in many places in the USA and worldwide, often disproportionately affecting immigrant communities. This paper reports findings from a community-based participatory research study that described diabetes risk and awareness, assessed the association between perceived and actual risk (high, two or more diabetes risk factors; low, fewer than two risk factors) and identified factors associated with disease risk among Chinese and Hispanic / Latino immigrant populations in Portland, OR, USA. Methods Cross-sectional, self-reported data were collected from a purposive sample of 324 Chinese (n = 159) and Hispanic / Latino (n = 165) adults, aged 18-86 years [mean (SD) age, 45.2(17.9) years; 50.7% women). Analyses described differences in variable distributions. Logistic regression estimated odds ratios and 95%confidence intervals in pooled and ethnic group-specific samples. Results Approximately 43% of participants were at high risk for diabetes, regardless of ethnicity or age. Of those unaware of their risk, or who perceived themselves not to be at risk, 25-53%had two or more risk factors (high risk); these patterns varied by ethnicity. The proportion of participants who reported two or more risk factors and were unaware of their risk status (31.8% Hispanic / Latino; 17% Chinese) or self-identified as not at risk (12.5% Hispanic / Latino; 13.0% Chinese) was substantial. Factors associated with diabetes risk also varied by ethnicity. Conclusions This study assessed the degree and determinants of diabetes risk and awareness among local Hispanic / Latino and Chinese communities and identified significant variation between groups. The results are important because they highlight substantial diabetes risk among persons who misestimate or are unaware of their risk status, regardless of ethnicity, and, in the USA, the Chinese immigrant population commonly is not considered a high-risk group for Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Women at increased risk for type 2 diabetes, due to recognized prediabetes (PD) or previous gestational diabetes (GD), stand to benefit from meeting U.S. physical activity (PA) recommendations. This study examined the association of diabetes risk status with meeting aerobic activity (AA), muscle strengthening activity (MSA) and both recommendations. Methods: Non‐pregnant women, 18–44, free of recognized diabetes, who participated in the 2011, 2013, 2015, or 2017 U.S. Behavioral Risk Factor Surveillance System survey (N = 211,114) were categorized as no diabetes (ND; n = 202,766, referent) versus at‐risk for diabetes (RD; n = 8348). Logistic regression models generated odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for demographics and BMI. Tests for multiplicative interactions were performed for BMI category and race and ethnicity. Results: There were lower odds of meeting AA, MSA and both recommendations in the RD group (referent = ND; OR 0.95 [5% CI 0.78, 0.97], 0.83 [95% CI 0.91, 0.98] and 0.87 [95% CI 0.78, 0.97], respectively). Effect modification by BMI category was detected for models assessing MSA (p = 0.10), both (p = 0.07) and neither recommendation (p = 0.005), but not for AA. Among those with a BMI in the healthy and overweight groups, RD had decreased odds of meeting MSA recommendations (referent = ND; 0.69 [95% CI 0.58, 0.81] and 0.78 [95% CI 0.65, 0.93], respectively); among the healthy BMI, RD had 24% decreased odds of meeting both recommendations (referent = ND; 95% CI 0.63, 0.91). There was no difference in meeting PA recommendations among groups in the obese category, but the increased odds of meeting the AA recommendation among the RD group were approaching significance (referent = ND; [95% CI 1.00, 1.29], p = 0.06]. Conclusion: Reproductive‐aged women with previous GD or recognized PD stand to benefit from increasing PA, especially MSA, the least often met recommendation. [ABSTRACT FROM AUTHOR]

Aims To investigate the long-term efficacy and safety of empagliflozin as add-on to metformin in people with Type 2 diabetes. Methods Of 637 participants treated with empagliflozin 10 mg, empagliflozin 25 mg, or placebo once daily for 24 weeks, 463 (72.7%) were treated in a double-blind extension trial for ≥ 52 weeks. Prespecified exploratory endpoints included changes from baseline in HbA1c, weight and blood pressure at week 76. Results Compared with placebo, adjusted mean changes from baseline in HbA1c (overall baseline mean ± sd 63 ± 9 mmol/mol [7.9 ± 0.9%]) were â'7 mmol/mol [(â'0.6%) 95% CI â'8, â'5 mmol/mol (â'0.8, â'0.5%); P < 0.001] and â'8 mmol/mol [(â'0.7%) 95% CI â'10, â'6 mmol/mol (â'0.9, â'0.6%); P < 0.001], for empagliflozin 10 mg and 25 mg, respectively. Compared with placebo, adjusted mean changes from baseline in weight were â'1.9 kg (95% CI â'2.5, â'1.3; P < 0.001) and â'2.2 kg (95% CI â'2.8, â'1.6; P < 0.001) for empagliflozin 10 mg and 25 mg, respectively. Empagliflozin led to sustained reductions in systolic blood pressure vs. placebo. Adverse events were reported in 77.7, 80.2 and 72.0% of participants on placebo, empagliflozin 10 mg and empagliflozin 25 mg, respectively. Confirmed hypoglycaemic adverse events (glucose ≥ 3.9 mmol/l and/or event requiring assistance) were reported in 3.4, 4.1 and 4.2% of participants in these groups, respectively. Conclusions In people with Type 2 diabetes, empagliflozin 10 mg and 25 mg given as add-on to metformin for 76 weeks were well tolerated and led to sustained reductions in HbA1c, weight and systolic blood pressure. [ABSTRACT FROM AUTHOR]

Aims To estimate the immediate and long-term inpatient and non-inpatient costs for Type 2 diabetes-related complications. Methods The costs of all consultations, visits, admissions and procedures associated with diabetes-related complications during UK Prospective Diabetes Study post-trial monitoring in the period 1997-2007 were estimated using hospitalization records for 2791 patients in England and resource use questionnaires that were administered to 3589 patients across the UK. Results The estimated (95% CI) inpatient care costs (in 2012 pounds sterling) in the event year for the example of a 60-year-old man were: non-fatal ischaemic heart disease £9767 (£7038-£12 696); amputation £9546 (£6416-£13 463); non-fatal stroke £6805 (£3856-£10 278); non-fatal myocardial infarction £6379 (£4290-£8339); fatal stroke £3954 (£2012-£6428); fatal ischaemic heart disease £3766 (£746-£5512); heart failure £3191 (£1678-4903); fatal myocardial infarction £1521 (£647-£2670); and blindness in one eye £1355 (£415-£2655). In subsequent years, estimated (95% CI) costs ranged from £1792 (£1060-£2943) for amputations to £453 (£315-£691) for blindness in one eye. Costs of non-inpatient healthcare in the event year were: amputation £2699 (£1409-£4126); blindness in one eye £1790 (£878-£3056); non-fatal stroke £1019 (£770-£1499); nonfatal myocardial infarction £1963 (£794-£1157); heart failure £979 (£708-£1344); non-fatal ischaemic heart disease £864 (£718-£1014); and cataract extraction £700 (£619-£780). In each subsequent year, non-inpatient costs ranged from £1611 (£1193-£2116) for amputations to £654 (£572-£799) for ischaemic heart disease. Conclusions Diabetic complications are associated with substantial immediate and long-term healthcare costs. Our comprehensive new estimates of these costs, derived from detailed recent UK Prospective Diabetes Study post-trial data, should aid researchers and health policy analyses. [ABSTRACT FROM AUTHOR]

Aim To investigate, with extended follow-up, cause-specific mortality among low-income Black and White Americans with Type 2 diabetes who have similar socio-economic status. Methods Black and White Americans aged 40-79 years with Type 2 diabetes ( n = 12 498) were recruited from community health centres as part of the Southern Community Cohort Study. Multivariable Cox analysis was used to estimate mortality hazard ratios and 95% CIs for subsequent cause-specific mortality, based on both underlying and contributing causes of death. Results During the follow-up (median 5.9 years), 13.3% of the study population died. The leading causes of death in each race were ischaemic heart disease, respiratory disorders, cancer, renal failure and heart failure; however, Blacks were at a lower risk of dying from ischaemic heart disease (hazard ratio 0.70, 95% CI 0.54-0.91) or respiratory disorders (hazard ratio 0.70, 0.53-0.92) than Whites but had higher or similar mortality attributable to renal failure (hazard ratio 1.57, 95% CI 1.02-2.40), heart failure (hazard ratio 1.47, 95% CI 0.98-2.19) and cancer (hazard ratio 0.87, 95% CI 0.62-1.22). Risk factors for each cause of death were generally similar in each race. Conclusions These findings suggest that the leading causes of death and their risk factors are largely similar among Black and White Americans with diabetes. For the two leading causes of death in each race, however, ischaemic heart disease and respiratory disorders, the magnitude of risk is lower among Black Americans and contributes to their higher survival rates. [ABSTRACT FROM AUTHOR]

Aims Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. Methods Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. Results Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and β-hydroxy-β-methylbutyrate group healed at week 16 compared with control subjects ( P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. Conclusions While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove clinically valuable. [ABSTRACT FROM AUTHOR]

Aims Gestational diabetes is a common pregnancy complication affecting races/ethnicities disproportionally. Adult height, an indicator of both genetic and early-life factors, is inconsistently associated with gestational diabetes risk. We examined the association and whether it varies by races in a nationally representative US cohort. Methods Analyses were conducted among 135 861 pregnancies in the Consortium on Safe Labor, 5567 of which were diagnosed with gestational diabetes based on medical records review. Generalized estimating equations were used to estimate odds ratios (95% confidence intervals) of gestational diabetes, controlling for other risk factors including body weight. Additionally, a meta-analysis of 15 761 pregnancies with gestational diabetes and 205 828 without gestational diabetes was conducted to estimate the pooled mean difference in height between those with gestational diabetes and control subjects. Results Height was inversely associated with gestational diabetes risk across races/ethnicities, with the strongest association among Asians ( P for interaction < 0.01). Comparing extreme quartiles (> 168 vs. < 157 cm), adjusted odds ratios (95% confidence intervals) were 0.18 (0.09-0.36) for Asians/Pacific Islanders, 0.33 (0.29-0.38) for non-Hispanic white women, 0.39 (0.31-0.51) for Hispanics and 0.59 (0.47-0.75) for non-Hispanic black women. Meta-analysis found women with gestational diabetes to be significantly shorter than others. Conclusions Taller women are at lower risk of developing gestational diabetes, with the magnitude of association varying significantly across races/ethnicities. [ABSTRACT FROM AUTHOR]

Aims Immunoglobulin A (IgA) measurement is advocated when case finding for coeliac disease in patients with Type 1 diabetes mellitus. Currently, there is a paucity of contemporary studies assessing IgA deficiency in Type 1 diabetes. This study evaluates the prevalence of IgA deficiency in individuals with Type 1 diabetes, compared with patients with coeliac disease and control subjects. In addition, we evaluate whether routine IgA measurement is justifiable when case finding for coeliac disease in patients with Type 1 diabetes. Methods All patients were assessed using IgA endomysial antibodies, IgA anti-tissue transglutaminase antibodies and total IgA levels. Altogether, 2434 individuals were tested: 1000 patients with Type 1 diabetes, 234 patients with coeliac disease and 1200 population control subjects. Definitive IgA deficiency was defined as total IgA levels < 0.07 g/l. Results The prevalence of IgA deficiency was significantly more common in patients with Type 1 diabetes (0.9%, n = 9/1000; P = 0.036) and coeliac disease (1.29%, n = 3/234; P = 0.041) when compared with population control subjects (prevalence of 0.17%, 2/1200). No statistical difference between Type 1 diabetes and coeliac disease for IgA deficiency was identified ( P = 0.87). Of patients in the group with Type 1 diabetes, 3.3% (33/1000) had coeliac disease, and of those only one patient had IgA deficiency leading to an antibody-negative presentation. Both IgA-deficient individuals within the population control subjects had normal duodenal biopsies and no relevant symptoms. Conclusions IgA deficiency is more common in Type 1 diabetes compared with population control subjects. Despite this, very few individuals with Type 1 diabetes and IgA deficiency appear to have villous atrophy on biopsy. These outcomes question the practice of routine IgA measurement when case finding for coeliac disease in patients with Type 1 diabetes. [ABSTRACT FROM AUTHOR]