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Objective To report the annual incidence of type 1 and type 2 diabetes among youth and to describe characteristics of youth diagnosed with diabetes in the US Virgin Islands ( USVI). Research Design and Methods: All residents ≤19 years of age diagnosed with diabetes between January 2001 and December 2010 were identified from review of medical records of all hospitals and confirmed by physician query. Results A total of 82 eligible patients were identified and the registry ascertainment was estimated to be 98.7% complete. The overall age-adjusted annual incidence rates (per 100 000) of type 1 and type 2 diabetes for the study period were 15.3 (95% CI: 11.3-20.1) and 9.6 (95% CI: 6.8-13.5), respectively. The incidence of type 1 diabetes increased significantly over the study period, with an epidemic-like threefold increase occurring from 2005 (8.7/100 000) to 2006 (26.4/100 000; p = 0.05). The incidence of type 1 diabetes was highest in the 10-19 age group in girls (25.6/100 000), but no age difference was seen in boys, resulting from the lack of a pubertal peak in non-Hispanic Black boys. The incidence of type 2 diabetes rose significantly between 2001 (5.3/100 000) and 2010 (12.5/100 000; p = 0.03). Conclusions The incidence of type 1 and type 2 diabetes in youth is increasing in the USVI, similar to global patterns. Further studies are needed to explore the missing pubertal rise in type 1 diabetes incidence in non-Hispanic Black boys and factors associated with the epidemic-like increases observed over the decade. [ABSTRACT FROM AUTHOR]

Objective To describe the clinical status of youth and adolescents (≤ 25 yr) in the Rwanda Life For A Child ( LFAC) program who had their first HbA1c measure in 2009 or 2010, and to identify factors which may relate to glycemic control ( HbA1c) and complication status. Research Design and Methods: Data were collected from June 2009 to November 2010 for the LFAC program in Rwanda and comprise clinical data from when participants' first HbA1c reading was obtained. Results From June 2009 to November 2010, 286 youth aged ≤25 yr had their first HbA1c. Mean age, duration, and age at diagnosis were 18.6 ± 4.5 yr, 3.4 ± 3.1 yr and 15.1 ± 4.8 yr, respectively. Mean HbA1c was 11.2 ± 2.7% with 15.7% (n = 45) having HbA1c <8%, while 30.8% (n = 88) had HbA1c >14%. Five (2.1%) had either abnormal tuning fork vibratory sensation or monofilament response, 21% (n = 31) had microalbuminuria (MA, A/C ratio >30 mg/g) and 5% (n = 7) had nephropathy (A/C ratio >300 mg/g). Diabetes duration and insulin dose/kg were positively associated with higher HbA1c, while residing in the southern province was associated with lower HbA1c. Duration, diastolic blood pressure, and HbA1c were positively associated with developing MA, while age was protective. Conclusions These data from the LFAC program for 2009-2010 show that there is a urgent need for dramatically improved care, as many patients have greatly elevated HbA1c measures, often >14%. We have identified correlates of better control (e.g., living in the Southern province) and MA (e.g., diastolic blood pressure), which provide potential avenues to improved quality of care. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To examine the relationship between cardiovascular autonomic neuropathy and pulse waveform analysis (PWA) measures of arterial stiffness in a childhood-onset type 1 diabetes population. RESEARCH DESIGN AND METHODS -- Cardiac autonomic nerve function was measured in the baseline examination of the Pittsburgh Epidemiology of Diabetes Complications Study of childhood-onset type 1 diabetes by heart rate variability (R-R interval) during deep breathing and expressed as expiration-to-inspiration (E/I) ratio. Other cardiovascular and diabetes factors were also assessed. PWA was performed using SphgymoCor Px on 144 participants at the 18-year follow-up examination. Univariate and multivariate analyses for associations between baseline nerve function and other cardiovascular and diabetes-related factors were performed for augmentation index (AIx), augmentation pressure (AP), and subendocardial viability ratio (SEVR), a surrogate marker of myocardial perfusion. RESULTS -- E/I ratio correlated negatively with both AIx (r = -0.18, P = 0.03) and AP (r = -0.32, P < 0.001) and positively with SEVR (r = 0.47, P < 0.001) univariately. Lower baseline E/I ratio, HDL cholesterol, and a history of smoking were associated with higher follow-up (18 years later) AIx and AP and lower SEVR in multivariate analyses. Higher baseline HbA[sub 1] was also associated with higher AP and lower SEVR multivariately. CONCLUSIONS -- Cardiovascular autonomic neuropathy is associated with increased arterial stiffness measures and decreased estimated myocardial perfusion in those with type 1 diabetes some 18 years later. This association persists after adjustment for potential confounders as well as for baseline HbA[sub 1], HDL cholesterol, and smoking history, which were also associated with these PWA measures. [ABSTRACT FROM AUTHOR]

Abstract: In an earlier study, we failed to confirm a clinical impression that the incidence of acute myocardial infarction (AMI) was increasing in Navajo men. Extending our data collection an additional three years, through 1986, we observed that the attack rate in men more than doubled and there was a gradual increase among women. Most Navajos who sustain AMI are hypertensive (51 per ¢), diabetic (50 per ¢) or both (31 per ¢), but few smoke cigarettes. (Am J Public Health 1988; 78:1351-1352.) [ABSTRACT FROM AUTHOR]

Aims To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined. Methods A 1–2 year follow-up of 214 members of the Rwanda Life for a Child program (aged <26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (<18 years, ≥18 years). Trajectory analysis was performed to identify trends in HbA1c. Results Mean overall HbA1c decreased significantly from baseline (11.2 ± 2.7%; 99 ± 30 mmol/mol) to one- (10.2 ± 2.6%; 88 ± 28 mmol/mol) and two- (9.8 ± 26%; 84 ± 25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week. Conclusions The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern. [ABSTRACT FROM AUTHOR]

Introduction: Lifestyle interventions promoting weight loss and physical activity are important elements of prevention efforts with the evaluation of program impact typically limited to weight loss. Unfortunately, diabetes/cardiovascular disease risk factors and activity are infrequently reported and inconsistent in findings when examined. This inconsistency may partially be due to a lack of consideration for ceiling effects because of broad risk profile inclusion criteria in community translation efforts. To demonstrate this, change in each individual cardiometabolic risk factor limited to those who, at baseline, had a clinically defined abnormal value for that risk factor was examined in 2 cohorts using identical community translations of the Diabetes Prevention Program lifestyle intervention.Methods: For both studies (2010-2014, 2014-2019), adults with prediabetes and/or metabolic syndrome were recruited through community centers. Outcome measures collected at baseline and 6 months included BMI, activity, blood pressure, lipids, and fasting glucose. Data analyses examined pre-post change in each variable after 6 months of intervention and change within randomized groups at 6 months.Results: Change results were examined for the entire cohort and separately for participants with baseline values outside the recommended range for that risk factor. Whether assessing the pre-post intervention change or change within the randomized groups at 6 months, often the risk factor-specific approach demonstrated a greater effect size for that variable and sometimes newly reached statistical significance.Conclusions: When examining the effectiveness of community translation efforts, consideration of the individual's baseline profile with risk factor-specific analysis is suggested to understand the full extent of the impact of the intervention. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Type 1 diabetes (T1D) is associated with a high risk for and mortality from premature coronary artery disease (CAD), including coronary artery calcification (CAC), a subclinical marker, and lower extremity arterial disease (LEAD). Pulse wave analysis (PWA) arterial stiffness indices have been associated with cardiovascular disease (CVD) risk factors and outcomes in various populations, but little is known regarding these relationships in T1D. Methods: PWA was performed using the SphygmoCor Px device on 144 participants in the Pittsburgh EDC Study of childhood-onset T1D. The cross-sectional associations between arterial stiffness indices, augmentation index (AIx) and augmentation pressure (AP), and subendocardial viability ratio (SEVR), an estimate of myocardial perfusion, with prevalent CAD, electron beam computed tomography-measured CAC and low (<0.90) ankle–brachial index (ABI) were examined. Results: Higher AP (but not AIx) and lower SEVR were univariately associated with prevalent CAD, high CAC score, and low ABI. AP and SEVR''s association with CAD and CAC did not, however, remain significant after adjustment for age. In individuals not using nitrates, which profoundly affect PWA measures, AP was significantly higher in those with CAD events and explained more of the variance than either age or brachial blood pressure measures. SEVR was associated with low ABI in multivariable models. Conclusions: Greater augmentation pressure is independently associated with prevalent CAD and estimated myocardial perfusion with low ABI in type 1 diabetes. These measures may thus help to better characterize CVD risk in type 1 diabetes and need to be examined prospectively. [Copyright &y& Elsevier]