121 results on '"Cowie CC"'
Search Results
2. Secular changes in US prediabetes prevalence defined by hemoglobin A(1c) and fasting plasma glucose national health and nutrition examination surveys, 1999-2010
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Bullard, KM, Saydah, SH, Imperatore, G, Cowie, CC, Gregg, EW, Geiss, LS, Cheng, YJ, Rolka, DB, Williams, DE, and Caspersen, CJ
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Adult ,Blood Glucose ,Male ,DIABETES PREVENTION PROGRAM ,Glycated Hemoglobin A ,Adolescent ,European Continental Ancestry Group ,DIAGNOSIS ,Prediabetic State ,Endocrinology & Metabolism ,MELLITUS ,Diabetes Mellitus ,Prevalence ,Humans ,11 Medical and Health Sciences ,African Continental Ancestry Group ,Aged ,RISK ,Hemoglobin A, Glycosylated ,Science & Technology ,Fasting ,Middle Aged ,Nutrition Surveys ,United States ,COMMUNITY ,REDUCTION ,CARDIOVASCULAR-DISEASE ,LIFE-STYLE INTERVENTION ,Female ,Biological Markers ,Hispanic Americans ,Life Sciences & Biomedicine ,Biomarkers - Abstract
OBJECTIVE Using a nationally representative sample of the civilian noninstitutionalized U.S. population, we estimated prediabetes prevalence and its changes during 1999–2010. RESEARCH DESIGN AND METHODS Data were from 19,182 nonpregnant individuals aged ≥12 years who participated in the 1999–2010 National Health and Nutrition Examination Surveys. We defined prediabetes as hemoglobin A1c (A1C) 5.7 to
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- 2013
3. Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the US population implications for diabetes diagnostic thresholds
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Cheng, YJ, Gregg, EW, Geiss, LS, Imperatore, G, Williams, DE, Zhang, X, Albright, AL, Cowie, CC, Klein, R, and Saaddine, JB
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Blood Glucose ,Male ,Glycated Hemoglobin A ,endocrine system diseases ,PREVENTION PROGRAM ,Ethnic Groups ,Sensitivity and Specificity ,HEMOGLOBIN A(1C) ,Endocrinology & Metabolism ,MELLITUS ,Prevalence ,CRITERIA ,Humans ,TOLERANCE ,11 Medical and Health Sciences ,Hemoglobin A, Glycosylated ,Science & Technology ,Diabetic Retinopathy ,Continental Population Groups ,Patient Selection ,nutritional and metabolic diseases ,BLOOD-GLUCOSE ,Fasting ,Middle Aged ,Nutrition Surveys ,United States ,HBA(1C) ,TESTS ,Hypertension ,Female ,Life Sciences & Biomedicine ,Diabetic Angiopathies - Abstract
OBJECTIVE To examine the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy in the U.S. population and to compare the ability of the two glycemic measures to discriminate between people with and without retinopathy. RESEARCH DESIGN AND METHODS This study included 1,066 individuals aged ≥40 years from the 2005–2006 National Health and Nutrition Examination Survey. A1C, FPG, and 45° color digital retinal images were assessed. Retinopathy was defined as a level ≥14 on the Early Treatment Diabetic Retinopathy Study severity scale. We used joinpoint regression to identify linear inflections of prevalence of retinopathy in the association between A1C and FPG. RESULTS The overall prevalence of retinopathy was 11%, which is appreciably lower than the prevalence in people with diagnosed diabetes (36%). There was a sharp increase in retinopathy prevalence in those with A1C ≥5.5% or FPG ≥5.8 mmol/l. After excluding 144 people using hypoglycemic medication, the change points for the greatest increase in retinopathy prevalence were A1C 5.5% and FPG 7.0 mmol/l. The coefficients of variation were 15.6 for A1C and 28.8 for FPG. Based on the areas under the receiver operating characteristic curves, A1C was a stronger discriminator of retinopathy (0.71 [95% CI 0.66–0.76]) than FPG (0.65 [0.60 – 0.70], P for difference = 0.009). CONCLUSIONS The steepest increase in retinopathy prevalence occurs among individuals with A1C ≥5.5% and FPG ≥5.8 mmol/l. A1C discriminates prevalence of retinopathy better than FPG. Tests of glycemia and their thresholds for diabetes diagnosis is an area of long-standing debate. The presence of diabetic retinopathy is arguably the best criterion from which to compare glycemic measures because it is a specific and early clinical complication usually related to diabetes, and it represents a specific and relevant clinical end point for judging an alternative test (1). For these reasons, diabetic retinopathy has served as the basis for diagnostic criteria of type 2 diabetes (2–4) and provides the rationale for the American Diabetes Association's recommendation of a threshold of a fasting plasma glucose (FPG) of 7.0 mmol/l to define the presence of diabetes (4,5). However, an analysis of three recent population-based cross-sectional studies suggested that there may be considerable variation across populations and that the association of FPG with retinopathy prevalence may be more of a continuous relationship than previously thought (5). A1C levels are being considered as an alternative diagnostic tool for diabetes diagnosis (6). Unlike FPG, A1C does not require an overnight fast, is not affected by short-term lifestyle changes, and has less variability within individuals than FPG (7–9). Nevertheless, few studies have examined the prevalence of retinopathy across the spectrum of A1C levels, which could assist in the designation of ideal A1C diagnostic cut points (2,3). The newly released National Health and Nutrition Examination Survey (NHANES) 2005–2006 incorporated a multiple-field retinal photograph examination, presenting an opportunity to reassess the selection of glucose and A1C cut points for diabetes diagnosis. Our objectives were to examine the relation between levels of A1C and FPG and prevalence of retinopathy in the U.S. population and to compare the ability of both measures to differentiate people with and without retinopathy.
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- 2009
4. Prevalence of diabetes and impaired fasting glucose in adults--United States, 1999-2000
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Cowie, CC, Rust, KF, Byrd-Holt, D, Eberhardt, MS, Saydah, S, Geiss, LS, Engelgau, MM, Ford, ES, and Gregg, EW
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Health behavior -- Surveys ,Diabetes -- Diagnosis ,Diabetes -- Statistics - Abstract
Diabetes and its complications are major causes of morbidity and mortality in the United States and contribute substantially to health-care costs. Data from the National Health Interview Survey (NHIS) and [...]
- Published
- 2003
5. Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999-2004.
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Bainbridge KE, Hoffman HJ, Cowie CC, Bainbridge, Kathleen E, Hoffman, Howard J, and Cowie, Catherine C
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DIABETES complications ,DIABETES ,HEARING disorders ,SURVEYS - Abstract
Objective: The objective of this study was to examine the risk factors of low/mid-frequency and high-frequency hearing impairment among a nationally representative sample of diabetic adults.Research Design and Methods: Data came from 536 participants, aged 20-69 years, with diagnosed or undiagnosed diabetes who completed audiometric testing during 1999-2004 in the National Health and Nutrition Examination Survey (NHANES). We defined hearing impairment as the pure-tone average>25 dB hearing level of pure-tone thresholds at low/mid-frequencies (500; 1,000; and 2,000 Hz) and high frequencies (3,000; 4,000; 6,000; and 8,000 Hz) and identified independent risk factors using logistic regression.Results: Controlling for age, race/ethnicity, and marital status, odds ratios for associations with low/mid-frequency hearing impairment were 2.20 (95% CI 1.28-3.79) for HDL<40 mg/dL and 3.55 (1.57-8.03) for poor health. Controlling for age, race/ethnicity, sex, and income-to-poverty ratio, odds ratios for associations with high-frequency hearing impairment were 4.39 (1.26-15.26) for history of coronary heart disease and 4.42 (1.26-15.45) for peripheral neuropathy.Conclusions: Low HDL, coronary heart disease, peripheral neuropathy, and having poor health are potentially preventable correlates of hearing impairment for people with diabetes. Glycemic control, years since diagnosis, and type of glycemic medication were not associated with hearing impairment. [ABSTRACT FROM AUTHOR]- Published
- 2011
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6. Potential mediators of diabetes-related hearing impairment in the U.S. population: National Health and Nutrition Examination Survey 1999-2004.
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Bainbridge KE, Cheng YJ, Cowie CC, Bainbridge, Kathleen E, Cheng, Yiling J, and Cowie, Catherine C
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Objective: We examined potential mediators of the reported association between diabetes and hearing impairment.Research Design and Methods: Data come from 1,508 participants, aged 40-69 years, who completed audiometric testing during 1999-2004 in the National Health and Nutrition Examination Survey (NHANES). We defined hearing impairment as the pure-tone average >25 decibels hearing level of pure-tone thresholds at low/mid (500, 1,000, and 2,000 Hz) and high (3,000, 4,000, 6,000, and 8,000 Hz) frequencies. Using logistic regression, we examined whether controlling for vascular or neuropathic conditions, cardiovascular risk factors, glycemia, or inflammation diminished the association between diabetes and hearing impairment.Results: Diabetes was associated with a 100% increased odds of low/mid-frequency hearing impairment (odds ratio 2.03 [95% CI 1.32-3.10]) and a 67% increased odds of high-frequency hearing impairment (1.67 [1.14-2.44]) in preliminary models after controlling for age, sex, race/ethnicity, education, smoking, and occupational noise exposure. Adjusting for peripheral neuropathy attenuated the association with low/mid-frequency hearing impairment (1.70 [1.02-2.82]). Adjusting for albuminuria and C-reactive protein attenuated the association with high-frequency hearing impairment (1.54 [1.02-2.32] and 1.50 [1.01-2.23], respectively). Diabetes was not associated with high-frequency hearing impairment after controlling for A1C (1.09 [0.60-1.99]) but remained associated with low/mid-frequency impairment. We found no evidence suggesting that our observed relationship between diabetes and hearing impairment is due to hypertension or dyslipidemia.Conclusions: Mechanisms related to neuropathic or microvascular factors, inflammation, or hyperglycemia may be mediating the association of diabetes and hearing impairment. [ABSTRACT FROM AUTHOR]- Published
- 2010
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7. Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the U.S. population: Implications for diabetes diagnostic thresholds.
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Cheng YJ, Gregg EW, Geiss LS, Imperatore G, Williams DE, Zhang X, Albright AL, Cowie CC, Klein R, Saaddine JB, Cheng, Yiling J, Gregg, Edward W, Geiss, Linda S, Imperatore, Giuseppina, Williams, Desmond E, Zhang, Xinzhi, Albright, Ann L, Cowie, Catherine C, Klein, Ronald, and Saaddine, Jinan B
- Abstract
Objective: To examine the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy in the U.S. population and to compare the ability of the two glycemic measures to discriminate between people with and without retinopathy.Research Design and Methods: This study included 1,066 individuals aged >or=40 years from the 2005-2006 National Health and Nutrition Examination Survey. A1C, FPG, and 45 degrees color digital retinal images were assessed. Retinopathy was defined as a level >or=14 on the Early Treatment Diabetic Retinopathy Study severity scale. We used joinpoint regression to identify linear inflections of prevalence of retinopathy in the association between A1C and FPG.Results: The overall prevalence of retinopathy was 11%, which is appreciably lower than the prevalence in people with diagnosed diabetes (36%). There was a sharp increase in retinopathy prevalence in those with A1C >or=5.5% or FPG >or=5.8 mmol/l. After excluding 144 people using hypoglycemic medication, the change points for the greatest increase in retinopathy prevalence were A1C 5.5% and FPG 7.0 mmol/l. The coefficients of variation were 15.6 for A1C and 28.8 for FPG. Based on the areas under the receiver operating characteristic curves, A1C was a stronger discriminator of retinopathy (0.71 [95% CI 0.66-0.76]) than FPG (0.65 [0.60 - 0.70], P for difference = 0.009).Conclusions: The steepest increase in retinopathy prevalence occurs among individuals with A1C >or=5.5% and FPG >or=5.8 mmol/l. A1C discriminates prevalence of retinopathy better than FPG. [ABSTRACT FROM AUTHOR]- Published
- 2009
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8. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999-2002.
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Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM, Saydah SH, Williams DE, Geiss LS, and Gregg EW
- Abstract
OBJECTIVE: The purpose of this study was to examine the prevalences of diagnosed and undiagnosed diabetes, and impaired fasting glucose (IFG) in U.S. adults during 1999-2002, and compare prevalences to those in 1988-1994. RESEARCH DESIGN AND METHODS: The National Health and Nutrition Examination Survey (NHANES) contains a probability sample of adults aged >/=20 years. In the NHANES 1999-2002, 4,761 adults were classified on glycemic status using standard criteria, based on an interview for diagnosed diabetes and fasting plasma glucose measured in a subsample. RESULTS: The crude prevalence of total diabetes in 1999-2002 was 9.3% (19.3 million, 2002 U.S. population), consisting of 6.5% diagnosed and 2.8% undiagnosed. An additional 26.0% had IFG, totaling 35.3% (73.3 million) with either diabetes or IFG. The prevalence of total diabetes rose with age, reaching 21.6% for those aged >/=65 years. The prevalence of diagnosed diabetes was twice as high in non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites (both P < 0.00001), whereas the prevalence of undiagnosed diabetes was similar by race/ethnicity, adjusted for age and sex. The prevalence of diagnosed diabetes was similar by sex, but prevalences of undiagnosed diabetes and IFG were significantly higher in men. The crude prevalence of diagnosed diabetes rose significantly from 5.1% in 1988-1994 to 6.5% in 1999-2002, but the crude prevalences were stable for undiagnosed diabetes (from 2.7 to 2.8%) and IFG (from 24.7 to 26.0%). Results were similar after adjustment for age and sex. CONCLUSIONS: Although the prevalence of diagnosed diabetes has increased significantly over the last decade, the prevalences of undiagnosed diabetes and IFG have remained relatively stable. Minority groups remain disproportionately affected. [ABSTRACT FROM AUTHOR]
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- 2006
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9. Diabetes and decline in heart disease mortality in US adults.
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Gu K, Cowie CC, Harris MI, Gu, K, Cowie, C C, and Harris, M I
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Context: Mortality from coronary heart disease has declined substantially in the United States during the past 30 years. However, it is unknown whether patients with diabetes have also experienced a decline in heart disease mortality.Objective: To compare adults with diabetes with those without diabetes for time trends in mortality from all causes, heart disease, and ischemic heart disease.Design, Setting, and Participants: Representative cohorts of subjects with and without diabetes were derived from the First National Health and Nutrition Examination Survey (NHANES I) conducted between 1971 and 1975 (n = 9639) and the NHANES I Epidemiologic Follow-up Survey conducted between 1982 and 1984 (n = 8463). The cohorts were followed up prospectively for mortality for an average of 8 to 9 years.Main Outcome Measure: Changes in mortality rates per 1000 person-years for all causes, heart disease, and ischemic heart disease for the 1982-1984 cohort compared with the 1971-1975 cohort.Results: For the 2 periods, nondiabetic men experienced a 36.4% decline in age-adjusted heart disease mortality compared with a 13.1% decline for diabetic men. Age-adjusted heart disease mortality declined 27% in nondiabetic women but increased 23% in diabetic women. These patterns were also found for all-cause mortality and ischemic heart disease mortality.Conclusions: The decline in heart disease mortality in the general US population has been attributed to reduction in cardiovascular risk factors and improvement in treatment of heart disease. The smaller declines in mortality for diabetic subjects in the present study indicate that these changes may have been less effective for people with diabetes, particularly women. [ABSTRACT FROM AUTHOR]- Published
- 1999
10. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study.
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Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD, Harris, M I, Klein, R, Cowie, C C, Rowland, M, and Byrd-Holt, D D
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- 1998
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11. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971-1993.
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Gu K, Cowie CC, Harris MI, Gu, K, Cowie, C C, and Harris, M I
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- 1998
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12. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994.
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Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD, Harris, M I, Flegal, K M, Cowie, C C, Eberhardt, M S, Goldstein, D E, Little, R R, Wiedmeyer, H M, and Byrd-Holt, D D
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- 1998
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13. Model of complications of NIDDM. I. Model construction and assumptions.
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Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Zbrozek AS, Dong F, Manninen D, Garfield SA, Copley-Merriman C, Maier W, Eastman JF, Kotsanos J, Cowie CC, Harris M, Eastman, R C, Javitt, J C, Herman, W H, Dasbach, E J, Zbrozek, A S, and Dong, F
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- 1997
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14. Effect of multiple risk factors on differences between Blacks and Whites in the prevalence of non-insulin-dependent diabetes mellitus in the United States.
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Cowie CC, Harris MI, Silverman RE, Johnson EW, and Rust KF
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- 1993
15. Diurnal variation in fasting plasma glucose: implications for diagnosis of diabetes in patients examined in the afternoon.
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Troisi RJ, Cowie CC, Harris MI, Troisi, R J, Cowie, C C, and Harris, M I
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Context: Current diagnostic criteria for diabetes are based on plasma glucose levels in blood samples obtained in the morning after an overnight fast, with a value of 7.0 mmol/L (126 mg/dL) or more indicating diabetes. However, many patients are seen by their physicians in the afternoon. Because plasma glucose levels are higher in the morning, it is unclear whether these diagnostic criteria can be applied to patients who are tested for diabetes in the afternoon.Objectives: To document diurnal variation in fasting plasma glucose levels in adults not known to have diabetes, and to examine the applicability to afternoon-examined patients of the current diagnostic criteria for diabetes.Design, Setting, and Participants: Analysis of data from the US population-based Third National Health and Nutrition Examination Survey (1988-1994) on participants aged 20 years or older who had no previously diagnosed diabetes, who were randomly assigned to morning (n = 6483) or afternoon (n = 6399) examinations, and who fasted prior to blood sampling.Main Outcome Measures: Fasting plasma glucose levels in morning vs afternoon-examined participants; diabetes diagnostic value for afternoon-examined participants.Results: The morning and afternoon groups did not differ in age, body mass index, waist-to-hip ratio, physical activity index, glycosylated hemoglobin level, and other factors. Mean (SD) fasting plasma glucose levels were higher in the morning group (5.41 [0.01] mmol/L [97.4 ¿0.3¿ mg/dL]) than in the afternoon group (5.12 [0.02] mmol/L [92.4 ¿0.4¿ mg/dL]; P<.001). Consequently, prevalence of afternoon-examined participants with fasting plasma glucose levels of 7.0 mmol/L (126 mg/dL) or greater was half that of participants examined in the morning. The diagnostic fasting plasma glucose value for afternoon-examined participants that resulted in the same prevalence of diabetes found in morning-examined participants was 6.33 mmol/L (114 mg/dL) or greater.Conclusions: Our results indicate that if current diabetes diagnostic criteria are applied to patients seen in the afternoon, approximately half of all cases of undiagnosed diabetes in these patients will be missed. [ABSTRACT FROM AUTHOR]- Published
- 2000
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16. Opioid prescription and diabetes among Medicare beneficiaries.
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Casagrande SS, Beccera AZ, Rust KF, and Cowie CC
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- Humans, Aged, United States, Medicare, Retrospective Studies, Drug Prescriptions, Analgesics, Opioid therapeutic use, Diabetes Mellitus drug therapy
- Abstract
Aims: To determine the prevalence of opioid prescriptions among U.S. Medicare beneficiaries by diabetes status, and predictors of opioid prescription among those with diabetes., Methods: This retrospective study used claims data from the Centers for Medicare and Medicaid Services among beneficiaries age ≥ 65 years who were continuously enrolled in Part A, Part B, and Part D Medicare between 2017 and 2019 (N = 709,374). Logistic regression was used to determine the odds of opioid prescription among those with vs without diabetes; and, among those with diabetes, significant predictors of opioid prescription., Results: Overall, the prevalence of any opioid prescription was 30.8 % among persons with diabetes and 24.2 % in those without diabetes (p < 0.001); chronic use was 8.0 % and 7.4 %, respectively (p < 0.001). Those with diabetes had a 45 % higher odds of having an opioid prescription compared to those without diabetes after adjusting for sociodemographic characteristics (OR = 1.45, 1.44-1.47). After adjustment for comorbidities/complications, the association reversed (OR = 0.83, 0.82-0.84). Persons with diabetes who had hypertension, obesity, CVD, neuropathy, amputation, liver disease, COPD, cancer, osteoporosis, depression, or alcohol/drug abuse had a 20 %-140 % higher odds of opioid prescription compared to those without these conditions., Conclusions: Comorbidities and complications accounted for the higher odds of opioid prescriptions among those with diabetes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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17. Cardiometabolic Risk Factors and Incident Cardiovascular Disease Events in Women vs Men With Type 1 Diabetes.
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Braffett BH, Bebu I, El Ghormli L, Cowie CC, Sivitz WI, Pop-Busui R, Larkin ME, Gubitosi-Klug RA, Nathan DM, Lachin JM, and Dagogo-Jack S
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- Adult, Cardiometabolic Risk Factors, Cholesterol, HDL, Cohort Studies, Female, Glycated Hemoglobin analysis, Humans, Male, Risk Factors, Young Adult, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 epidemiology
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Importance: The lower risk of cardiovascular disease (CVD) among women compared with men in the general population may be diminished among those with diabetes., Objective: To evaluate cardiometabolic risk factors and their management in association with CVD events in women vs men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study., Design, Setting, and Participants: This cohort study used data obtained during the combined DCCT (randomized clinical trial, conducted 1983-1993) and EDIC (observational study, conducted 1994 to present) studies through April 30, 2018 (mean [SD] follow-up, 28.8 [5.8] years), at 27 clinical centers in the US and Canada. Data analyses were performed between July 2021 and April 2022., Exposure: During the DCCT phase, patients were randomized to intensive vs conventional diabetes therapy., Main Outcomes and Measures: Cardiometabolic risk factors and CVD events were assessed via detailed medical history and focused physical examinations. Blood and urine samples were assayed centrally. CVD events were adjudicated by a review committee. Linear mixed models and Cox proportional hazards models evaluated sex differences in cardiometabolic risk factors and CVD risk over follow-up., Results: A total of 1441 participants with type 1 diabetes (mean [SD] age at DCCT baseline, 26.8 [7.1] years; 761 [52.8%] men; 1390 [96.5%] non-Hispanic White) were included. Over the duration of the study, compared with men, women had significantly lower body mass index (BMI, calculated as weight in kilograms divided by height in meters squared; β = -0.43 [SE, 0.16]; P = .006), waist circumference (β = -10.56 cm [SE, 0.52 cm]; P < .001), blood pressure (systolic: β = -5.77 mm Hg [SE, 0.35 mm Hg]; P < .001; diastolic: β = -3.23 mm Hg [SE, 0.26 mm Hg]; P < .001), and triglyceride levels (β = -10.10 mg/dL [SE, 1.98 mg/dL]; P < .001); higher HDL cholesterol levels (β = 9.36 mg/dL [SE, 0.57 mg/dL]; P < .001); and similar LDL cholesterol levels (β = -0.76 mg/dL [SE, 1.22 mg/dL]; P = .53). Women, compared with men, achieved recommended targets more frequently for blood pressure (ie, <130/80 mm Hg: 90.0% vs 77.4%; P < .001) and triglycerides (ie, <150 mg/dL: 97.3% vs 90.5%; P < .001). However, sex-specific HDL cholesterol targets (ie, ≥50 mg/dL for women, ≥40 mg/dL for men) were achieved less often (74.3% vs 86.6%; P < .001) and cardioprotective medications were used less frequently in women than men (ie, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker: 29.6% [95% CI, 25.7%-33.9%] vs 40.0% [95% CI, 36.1%-44.0%]; P = .001; lipid-lowering medication: 25.3% [95% CI, 22.1%-28.7%] vs 39.6% [95% CI, 36.1%-43.2%]; P < .001). Women also had significantly higher pulse rates (mean [SD], 75.2 [6.8] beats per minute vs 71.8 [6.9] beats per minute; P < .001) and hemoglobin A1c levels (mean [SD], 8.3% [1.0%] vs 8.1% [1.0%]; P = .01) and achieved targets for tighter glycemic control less often than men (ie, hemoglobin A1c <7%: 11.2% [95% CI, 9.3%-13.3%] vs 14.0% [95% CI, 12.0%-16.3%]; P = .03)., Conclusions and Relevance: These findings suggest that despite a more favorable cardiometabolic risk factor profile, women with type 1 diabetes did not have a significantly lower CVD event burden than men, suggesting a greater clinical impact of cardiometabolic risk factors in women vs men with diabetes. These findings call for conscientious optimization of the control of CVD risk factors in women with type 1 diabetes.
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- 2022
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18. Diabetes Incidence Among Hispanic/Latino Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
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Cordero C, Schneiderman N, Llabre MM, Teng Y, Daviglus ML, Cowie CC, Cai J, Talavera GA, Gallo LC, Kaplan RC, Cespedes Feliciano EM, Espinoza Giacinto RA, Giachello AL, and Avilés-Santa L
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- Humans, Incidence, Prevalence, Prospective Studies, Public Health, Risk Factors, United States epidemiology, Diabetes Mellitus epidemiology, Hispanic or Latino
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Objective: To examine diabetes incidence in a diverse cohort of U.S. Hispanic/Latinos., Research Design and Methods: The Hispanic Community Health Study/Study of Latinos is a prospective cohort study with participants aged 18-74 years from four U.S. metropolitan areas. Participants were assessed for diabetes at the baseline examination (2008-2011), annually via telephone interview, and at a second examination (2014-2017)., Results: A total of 11,619 participants returned for the second examination. The overall age-adjusted diabetes incidence rate was 22.1 cases/1,000 person-years. The incidence was high among those with Puerto Rican and Mexican backgrounds as well as those aged ≥45 years and with a BMI ≥30 kg/m2. Significant differences in diabetes awareness, treatment, and health insurance coverage, but not glycemic control, were observed across Hispanic/Latino background groups, age groups, and BMI categories., Conclusions: Differences in diabetes incidence by Hispanic/Latino background, age, and BMI suggest the susceptibility of these factors., (© 2022 by the American Diabetes Association.)
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- 2022
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19. Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study.
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Boyko EJ, Zelnick LR, Braffett BH, Pop-Busui R, Cowie CC, Lorenzi GM, Gubitosi-Klug R, Zinman B, and de Boer IH
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- Amputation, Surgical, Blood Glucose metabolism, Extremities, Glycated Hemoglobin metabolism, Humans, Risk Factors, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 surgery, Diabetic Foot complications, Diabetic Foot epidemiology, Diabetic Foot surgery
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Objective: Intensive glycemic control reduces the risk of kidney, retinal, and neurologic complications in type 1 diabetes (T1D), but whether it reduces the risk of lower-extremity complications is unknown. We examined whether former intensive versus conventional glycemic control among Diabetes Control and Complications Trial (DCCT) participants with T1D reduced the long-term risk of diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) in the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study., Research Design and Methods: DCCT participants (n = 1,441) completed 6.5 years on average of intensive versus conventional diabetes treatment, after which 1,408 were enrolled in EDIC and followed annually over 23 years for DFU and LEA occurrences by physical examination. Multivariable Cox proportional hazard regression models estimated associations of DCCT treatment assignment and time-updated exposures with DFU or LEA., Results: Intensive versus conventional glycemic control was associated with a significant risk reduction for all DFUs (hazard ratio 0.77 [95% CI 0.60, 0.97]) and a similar magnitude but nonsignificant risk reduction for first-recorded DFUs (0.78 [0.59, 1.03]) and first LEAs (0.70 [0.36, 1.36]). In adjusted Cox models, clinical neuropathy, lower sural nerve conduction velocity, and cardiovascular autonomic neuropathy were associated with higher DFU risk; estimated glomerular filtration rate <60 mL/min/1.73 m2, albuminuria, and macular edema with higher LEA risk; and any retinopathy and greater time-weighted mean DCCT/EDIC HbA1c with higher risk of both outcomes (P < 0.05)., Conclusions: Early intensive glycemic control decreases long-term DFU risk, the most important antecedent in the causal pathway to LEA., (© 2022 by the American Diabetes Association.)
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- 2022
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20. Cognitive function among older adults with diabetes and prediabetes, NHANES 2011-2014.
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Casagrande SS, Lee C, Stoeckel LE, Menke A, and Cowie CC
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- Cognition, Cross-Sectional Studies, Humans, Middle Aged, Nutrition Surveys, Cognitive Dysfunction epidemiology, Cognitive Dysfunction etiology, Diabetes Mellitus epidemiology, Prediabetic State epidemiology
- Abstract
Aims: To determine the association between diabetes status, glycemia, and cognitive function among a national U.S. sample of older adults in the 2011-2014 National Health and Nutrition Examinations Surveys., Methods: Among 1,552 adults age ≥ 60 years, linear and multivariable logistic regressions were used to determine the association between diabetes status (diabetes, prediabetes, normoglycemia) and cognitive function [Consortium to Establish a Registry for Alzheimer's Disease-Word Learning (CERAD W-L), Animal Fluency test, Digit Symbol Substitution Test (DSST)]., Results: Overall, diabetes was associated with mild cognitive dysfunction. In age-adjusted models, adults with diabetes had significantly poorer performance on the delayed and total word recalls (CERAD W-L) compared to those with normoglycemia (5.8 vs. 6.8 words; p = 0.002 and 24.5 vs. 27.6 words; p < 0.001, respectively); the association was non-significant after adjusting for cardiovascular disease. Among all adults, cognitive function scores decreased with increasing HbA1c for all assessments, but remained significant in the fully adjusted model for the Animal Fluency and DSST [beta coefficient = -0.44;-1.11, p < 0.05, respectively]. As measured by the DSST, the proportion with cognitive impairment was significantly higher for older adults with HbA1c ≥ 8.0% (≥64 mmol/mol) vs. HbA1c < 7.0% (<53 mmol/mol) (14.6% vs. 6.3%, p = 0.04)., Conclusions: Dysglycemia, as measured by HbA1c, was associated with poorer executive function and processing speed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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21. Comparison of several survey-based algorithms to ascertain type 1 diabetes among US adults with self-reported diabetes.
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Casagrande SS, Lessem SE, Orchard TJ, Bullard KM, Geiss LS, Saydah SH, Menke A, Imperatore G, Rust KF, and Cowie CC
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- Adolescent, Adult, Algorithms, Humans, Insulin therapeutic use, Self Report, Surveys and Questionnaires, Diabetes Mellitus, Type 1 diagnosis, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 epidemiology
- Abstract
Introduction: Defining type of diabetes using survey data is challenging, although important, for determining national estimates of diabetes. The purpose of this study was to compare the percentage and characteristics of US adults classified as having type 1 diabetes as defined by several algorithms., Research Design and Methods: This study included 6331 respondents aged ≥18 years who reported a physician diagnosis of diabetes in the 2016-2017 National Health Interview Survey. Seven algorithms classified type 1 diabetes using various combinations of self-reported diabetes type, age of diagnosis, current and continuous insulin use, and use of oral hypoglycemics., Results: The percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/m
2 , respectively) and percentage using oral hypoglycemics (16.1%, 11.1%, and 19.0%, respectively) were lower than for all other algorithms assessed. Among those defined by continuous insulin use alone (algorithm 1), the estimates for mean age and age of diagnosis (54.3 and 30.9 years, respectively) and BMI (30.9 kg/m2 ) were higher than for other algorithms., Conclusions: Estimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2020
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22. Urinary phenols and parabens and diabetes among US adults, NHANES 2005-2014.
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Ward JB, Casagrande SS, and Cowie CC
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- Biomarkers urine, Cross-Sectional Studies, Diabetes Mellitus diagnosis, Endocrine Disruptors adverse effects, Female, Humans, Male, Middle Aged, Nutrition Surveys, Parabens adverse effects, Phenols adverse effects, Risk Assessment, Risk Factors, United States epidemiology, Diabetes Mellitus epidemiology, Diabetes Mellitus urine, Endocrine Disruptors urine, Parabens metabolism, Phenols urine
- Abstract
Background and Aims: Phenols and parabens are ubiquitous and have been associated with markers of cardiovascular health. However, the literature lacks population-based studies examining the link between these endocrine disruptors and diabetes. We examined the association between paraben/phenol concentrations and diabetes among a nationally representative sample of US adults., Methods and Results: We utilized data from the 2005-2014 National Health and Nutrition Examination Surveys (N = 8498). Total urinary concentrations of BPA, triclosan, BP-3, and propyl, butyl, ethyl, and methyl parabens were measured from urine specimens collected during the examination session. Diabetes status was based on self-report of a previous diagnosis or HbA1c≥6.5%. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CI) associated with the difference in log-transformed values of the 75th and 25th percentiles for each phenol/paraben, adjusting for potential confounders. The adjusted ORs (95% CI) of diabetes comparing the 75th to 25th percentiles of each paraben/phenol were 1.09 (0.96-1.23) for BPA, 0.84 (0.72-0.98) for triclosan, 0.69 (0.61-0.79) for BP-3, 0.71 (0.61-0.83) for propyl paraben, 0.66 (0.54-0.80) for butyl paraben, 0.60 (0.51-0.71) for ethyl paraben, and 0.79 (0.68-0.91) for methyl paraben., Conclusions: Higher concentrations of triclosan, BP-3, and propyl, butyl, ethyl, and methyl parabens were associated with lower odds of diabetes. These findings warrant further investigation into the potential mechanism behind the observed associations and the temporal direction of the associations, given that we cannot rule out reverse causation. Future studies of these endocrine disruptors may improve the understanding of their relationship with diabetes., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2020 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. All rights reserved.)
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- 2020
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23. The Association Between Heart Rate and Glycemic Status in the National Health and Nutrition Examination Surveys.
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Casagrande SS, Cowie CC, Sosenko JM, Mizokami-Stout K, Boulton AJM, and Pop-Busui R
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- Adolescent, Adult, Aged, Cardiovascular Diseases metabolism, Cardiovascular Diseases pathology, Child, Child, Preschool, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prognosis, Risk Factors, Young Adult, Biomarkers metabolism, Blood Glucose metabolism, Cardiovascular Diseases epidemiology, Diabetes Mellitus physiopathology, Health Behavior, Heart Rate, Nutrition Surveys
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Context: Evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease (CVD), for which persons with diabetes are at increased risk., Objective: The objective of this article is to determine the association between HR and glycemic status in a nationally representative sample of US adults, and, among adults with diagnosed diabetes, the association between HR and hemoglobin A1c (HbA1c) level., Design: A cross-sectional study was conducted., Setting: The setting of this study is the National Health and Nutrition Examination Surveys, 2011 to 2016., Participants: US general adult (age ≥ 20 years) population who had information on glycemic status based on self-report, HbA1c, and fasting plasma glucose (N = 8562)., Intervention: There was no intervention., Main Outcome Measure: The main outcome measure of this study was mean HR (beats per minute)., Results: After adjustment for examination time, age, other demographic characteristics, health insurance, health behaviors, body mass index, CVD and kidney disease, and taking antihypertensive medications, mean HR was significantly higher for those with diagnosed (75 bpm), undiagnosed diabetes (75 bpm), and prediabetes (73 bpm) compared to those with normoglycemia (71 bpm, P < .05 for all); this association was robust both for men and women. Mean HR increased with increasing HbA1c level among individuals with diagnosed diabetes independent of other risk factors (HbA1c < 7.0% [< 53 mmol/mol], 73 bpm vs A1c ≥ 11.0% [≥ 97mmol/mol], 79 bpm, P < .001); this association was most pronounced for women., Conclusions: Adjusted mean HR was higher among individuals with diabetes and increased glycemia, which may reflect underlying autonomic and/or myocardial dysfunction among those with diabetes., (Published by Oxford University Press on behalf of the Endocrine Society 2020.)
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- 2020
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24. RISK FACTORS FOR HEARING IMPAIRMENT IN TYPE 1 DIABETES.
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Braffett BH, Lorenzi GM, Cowie CC, Gao X, Bainbridge KE, Cruickshanks KJ, Kramer JR, Gubitosi-Klug RA, Larkin ME, Barnie A, Lachin JM, and Schade DS
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- Carotid Intima-Media Thickness, Glycated Hemoglobin, Hearing Loss, Humans, Male, Middle Aged, Nutrition Surveys, Risk Factors, Diabetes Mellitus, Type 1
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Objective: Studies have demonstrated that glycated hemoglobin (HbA1c) is a significant predictor of hearing impairment in type 1 diabetes. We identified additional factors associated with hearing impairment in participants with type 1 diabetes from the Diabetes Control and Complications Trial and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods: A total of 1,150 DCCT/EDIC participants were recruited for the Hearing Study. A medical history, physical measurements, and a self-administered hearing questionnaire were obtained. Audiometry was performed by study-certified personnel and assessed centrally. Logistic regression models assessed the association of risk factors and comorbidities with speech- and high-frequency hearing impairment. Results: Mean age was 55 ± 7 years, duration of diabetes 34 ± 5 years, and DCCT/EDIC HbA1c 7.9 ± 0.9% (63 mmol/mol). In multivariable models, higher odds of speech-frequency impairment were significantly associated with older age, higher HbA1c, history of noise exposure, male sex, and higher triglycerides. Higher odds of high-frequency impairment were associated with older age, male sex, history of noise exposure, higher skin intrinsic florescence (SIF) as a marker of tissue glycation, higher HbA1c, nonprofessional/nontechnical occupations, sedentary activity, and lower low-density-lipoprotein cholesterol. Among participants who previously completed computed tomography and carotid ultrasonography, coronary artery calcification (CAC) >0 and carotid intima-medial thickness were significantly associated with high-but not speech-frequency impairment. Conclusion: Consistent with previous reports, male sex, age, several metabolic factors, and noise exposure are independently associated with hearing impairment. The association with SIF further emphasizes the importance of glycemia-as a modifiable risk factor-over time. In addition, the macrovascular contribution of CAC is novel and important. Abbreviations: AER = albumin excretion rate; CAC = coronary artery calcification; CVD = cardiovascular disease; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; eGFR = estimated glomerular filtration rate; ETDRS = Early Treatment Diabetic Retinopathy Study; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; IMT = intima-media thickness; LDL = low-density lipoprotein; NHANES = National Health and Nutrition Examination Survey; OR = odds ratio; SIF = skin intrinsic fluorescence; T1D = type 1 diabetes.
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- 2019
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25. Diabetes Diagnosis and Control: Missed Opportunities to Improve Health : The 2018 Kelly West Award Lecture.
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Cowie CC
- Subjects
- Adult, Age of Onset, Aged, Aged, 80 and over, Blood Glucose metabolism, Diabetes Complications prevention & control, Diabetes Mellitus epidemiology, Health Surveys, Humans, Middle Aged, Prevalence, Quality Improvement organization & administration, Quality Improvement standards, Quality Improvement trends, Quality of Life, Risk Factors, Young Adult, Diabetes Mellitus diagnosis, Diabetes Mellitus therapy
- Abstract
Diabetes is a prevalent condition in the U.S. and worldwide, with expanding impact over time as it affects progressively younger ages as well as older ages as people live longer. Costs of diabetes to those affected and to society as a whole continue to increase. Costs are realized through daily treatment regimens throughout life to control glycemia and other risk factors for complications as diabetes progresses, diabetes complications and disability and their treatments, health care visits and hospitalization, and as indirect costs via lower quality of life and lost productivity. Diagnosing diabetes is key to affording the opportunity to treat diabetes, and diabetes control is key to reducing the risk of complications. Yet the magnitude of undiagnosed diabetes and poor control of diabetes is large. And just as certain subgroups of the population are affected disproportionately by diabetes and diabetes complications, so are they affected disproportionately by undiagnosed diabetes and poor control. This review addresses the epidemiology of undiagnosed diabetes and diabetes control, largely covering their magnitude, demographic variation, trends over time, and predictors. For diabetes control, it focuses on control of A1C, blood pressure, and lipid levels, although there are many other facets of diabetes control and preventive care that also could be examined. The review is based predominantly on data from the National Health and Nutrition Examination Survey (NHANES), a U.S. health survey that includes both an interview and examination component that has been conducted continuously since 1999 and episodically for decades earlier. The interview elicits self-reported health responses pertaining to diabetes and other medical conditions and an examination that measures glycemic indicators, blood pressure, and lipids, which provide much of the material presented herein. Data from other studies are also presented and described., (© 2019 by the American Diabetes Association.)
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- 2019
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26. Corrigendum to Intensive glycemic control in younger and older U.S. adults with type 2 diabetes [JDC 31 (2017) 1299-1304].
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Casagrande SS, Cowie CC, and Fradkin JE
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- 2019
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27. Factors associated with undiagnosed diabetes among adults with diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
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Casagrande SS, Menke A, Aviles-Santa L, Gallo LC, Daviglus ML, Talavera GA, Castañeda SF, Perreira K, Loop MS, Tarraf W, González HM, and Cowie CC
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- Adult, Aged, Female, Hispanic or Latino, Humans, Male, Middle Aged, Prevalence, Risk Factors, Diabetes Mellitus diagnosis, Public Health methods
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Aims: To investigate sociodemographic and health factors associated with undiagnosed diabetes among adults with diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)., Methods: Among 3384 adults with self-reported diabetes or undiagnosed diabetes in the baseline HCHS/SOL, we estimated odds ratios (OR) of being undiagnosed for demographic, cultural, access to care, and health factors., Results: Among individuals with diabetes, 37.0% were undiagnosed. After adjustment and compared to people of Mexican heritage, people of Cuban and South American heritage had 60% (OR = 1.60, 95% CI = 1.02-2.50) and 91% (OR = 1.91, 1.16-3.14) higher odds of being undiagnosed, respectively. Individuals with a higher odds of being undiagnosed were women (OR = 1.64, 1.26-2.13), those with no health insurance (OR = 1.31, 1.00-1.71), individuals who received no healthcare in the past year (OR = 3.59, 2.49-5.16), those who were overweight (vs. normal weight) (OR = 1.60, 1.02-2.50), and those with dyslipidemia (OR = 1.38, 1.10-1.74). Individuals with lower odds of being undiagnosed were those with a family history of diabetes (OR = 0.54, 0.43-0.68), and those with hypertension (OR = 0.46, 0.36-0.58)., Conclusions: Variation by Hispanic heritage group, sex, and access to medical care highlight where concentrated efforts are need to improve diabetes awareness. Our findings will inform clinical and public health practices to improve diabetes awareness among vulnerable populations., (Copyright © 2018 Elsevier B.V. All rights reserved.)
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- 2018
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28. Hearing Impairment and Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Cohort.
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Schade DS, Lorenzi GM, Braffett BH, Gao X, Bainbridge KE, Barnie A, Cruickshanks KJ, Dalton D, Diminick L, Gubitosi-Klug R, Kramer JR, Lachin JM, Larkin ME, and Cowie CC
- Subjects
- Aged, Blood Glucose metabolism, Cohort Studies, Diabetes Complications complications, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 complications, Female, Hearing Loss complications, Humans, Male, Middle Aged, Prevalence, Risk Factors, Surveys and Questionnaires, United States epidemiology, Diabetes Complications epidemiology, Diabetes Mellitus, Type 1 epidemiology, Hearing Loss epidemiology
- Abstract
Objective: To evaluate the prevalence of hearing impairment in participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study and compare with that of a spousal control group without diabetes. Among participants with type 1 diabetes, to evaluate the association of hearing impairment with prior DCCT therapy and overall glycemia., Research Design and Methods: DCCT/EDIC participants ( n = 1,150) and 288 spouses without diabetes were recruited for the DCCT/EDIC Hearing Study. All subjects completed a self-administered questionnaire, medical history, and physical measurements. Audiometry was performed by study-certified personnel; audiograms were assessed centrally. Speech-frequency (pure-tone average [PTA] thresholds at 500, 1,000, 2,000, and 4,000 Hz) and high-frequency impairment (PTA thresholds at 3,000, 4,000, 6,000, and 8,000 Hz) were defined as PTA >25 dB hearing loss. Logistic regression models were adjusted for age and sex., Results: DCCT/EDIC participants and spousal control subjects were similar in age, race, education, smoking, and systolic blood pressure. There were no statistically significant differences between groups in the prevalence or adjusted odds of speech- or high-frequency impairment in either ear. Among participants with type 1 diabetes, for every 10% increase in the time-weighted mean HbA
1c , there was a 32% (95% CI 1.15-1.50) and 19% (95% CI 1.07-1.33) increase in speech- and high-frequency hearing impairment, respectively., Conclusions: We found no significant difference in the prevalence of hearing impairment between the group with type 1 diabetes and the spousal control group. Among those with type 1 diabetes, higher mean HbA1c over time was associated with hearing impairment., (© 2018 by the American Diabetes Association.)- Published
- 2018
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29. Contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence: NHANES 2011-2014.
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Menke A, Casagrande S, and Cowie CC
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- Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prediabetic State diagnosis, United States epidemiology, Young Adult, Blood Glucose analysis, Glycated Hemoglobin analysis, Prediabetic State epidemiology
- Abstract
Purpose: Our goal was to characterize the contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence and to characterize how those contributions differ among U.S. population subgroups., Methods: In the 2011-2014 National Health and Nutrition Examination Survey, a nationally representative sample of the U.S. population, among participants without diabetes (N = 3387), we created area-proportional three-Venn diagrams showing the proportion above the prediabetes cutpoint for each of the three markers in the overall population and in subgroups defined by age, race/ethnicity, sex, and body mass index., Results: In the overall population, 28.3% had fasting plasma glucose above the prediabetes cutpoint, 21.7% had A1c above the prediabetes cutpoint, and 13.3% had 2-hour plasma glucose above the prediabetes cutpoint. Adolescents and young adults tended to have only one marker exceed the prediabetes cutpoint, while older age groups tended to have multiple markers above the prediabetes cutpoint. For non-Hispanic whites, non-Hispanic blacks, non-Hispanic Asians, and Mexican-Americans, the unadjusted total percent above the A1c cutpoint was 19.3%, 36.4%, 20.5%, and 21.4%, respectively., Conclusions: We provide a graphic reference showing fasting plasma glucose was the largest contributor to prediabetes prevalence in the overall population, followed by A1c and then 2-hour plasma glucose., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2018
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30. Sociodemographic Characteristics of Persons With Diabetes
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Eberhardt MS, Casagrande SS, Cowie CC, Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, and Fradkin JE
- Abstract
This chapter presents the demographic and socioeconomic characteristics of people with and without diabetes. The main data source is the National Health Interview Survey (NHIS), with supplemental information from the National Health and Nutrition Examination Survey (NHANES). Estimates from these surveys are nationally representative of the U.S. civilian noninstitutionalized population and are presented for adults age ≥20 years with diabetes diagnosed at either age <20 years or age ≥20 years, adults without diabetes, and when available, youth age <20 years with diabetes and people with undiagnosed diabetes or prediabetes. Overall, people with diabetes were older (76.3% were age ≥50 years compared to 28.2% of people without diagnosed diabetes). In 2009–2010, the current mean age was 46.3 years in people with diabetes diagnosed age <20 years, 60.5 years in people with diabetes diagnosed age ≥20 years, and 45.9 years in people without diabetes. More people with diabetes were male (51.2%) compared to people without diabetes (48.8%). The percentage of male adults among those diagnosed before and after age 20 years was similar (48.9% and 51.4%), and no significant sex differences existed among youth or adults with diabetes diagnosed age <20 years. Adults with diabetes were more frequently non-Hispanic black compared to adults without diabetes. Among those with diabetes diagnosed age ≥20 years, 64.4% were non-Hispanic white, 15.8% non-Hispanic black, 14.8% Hispanic, 4.1% non-Hispanic Asian/Pacific Islander, and 0.9% non-Hispanic American Indian and Alaska Native, similar to adults age ≥20 years with diabetes diagnosed age <20 years. In adults without diabetes, the percentages were 69.6%, 11.4%, 13.6%, 4.8%, and 0.6%, respectively. Among adults with diabetes diagnosed age ≥20 years, the mean age at diagnosis was 52.3 years in non-Hispanic white, 49.4 years in non-Hispanic Asian/Pacific Islander, 47.4 years in non-Hispanic black, 47.3 years in Hispanic, and 46.1 in non-Hispanic American Indian and Alaska Native adults. The mean duration of diabetes was longest for adults with diabetes diagnosed age <20 years. In 2006–2010, 77.2% of adults with diabetes diagnosed age <20 years had diabetes for ≥20 years compared to 14.6% of adults in 2009–2010 with diabetes diagnosed age ≥20 years. During 2009–2010, 80.4% of adults with diabetes diagnosed age ≥20 years lived in metropolitan counties compared to 84.3% of adults without diabetes. A similar percentage of people with diagnosed diabetes (53%) and without diabetes (52%) lived in the top 10 most populous states; the rank order of states for the largest percentage of the U.S. population with diabetes was California, Texas, Florida, New York, Ohio, Illinois, Pennsylvania, Michigan, North Carolina, and Georgia. Regionally, a slightly higher percentage lived in the Southern United States (46.1% of adults diagnosed age <20 years, 38.7% of adults diagnosed age ≥20 years, and 35.3% of adults without diagnosed diabetes). In 2009–2010, 83.2% of adults diagnosed age ≥20 years and 83.0% of adults without diabetes were U.S. born, which was similar to the 2006–2010 estimate of 85.9% for adults diagnosed age <20 years. A higher percentage of persons who were age <20 years and had diabetes were U.S. born (96.8%). English was spoken in at least 93% of homes where people with diabetes lived. Over 9% of adults with diabetes in the United States were born in Mexico, Central American, or the Caribbean Islands. Among immigrants, adults with diabetes lived in the United States longer than adults without diagnosed diabetes. For example, 72.3% and 84.2% of adults with diabetes diagnosed before or after age 20 years, respectively, had lived in the United States at least 15 years compared to 58.5% of adults without diagnosed diabetes. Marriage was more common among adults with diabetes diagnosed age ≥20 years compared to adults without diabetes or adults diagnosed age <20 years (59.2%, 56.0%, and 48.9%), but a higher percentage of adults with diabetes diagnosed age ≥20 years lived alone compared to adults without diabetes (21.1% vs. 17.1%). The level of attained education was lower in adults with diabetes compared to those without diabetes (e.g., 17.6% of adults with diabetes diagnosed age ≥20 years, 18.6% of adults with diabetes diagnosed age <20 years, and 31.4% of adults without diabetes graduated with a bachelor’s degree or higher). Among adults with diabetes diagnosed age ≥20 years, fewer women (13.8%) graduated from college than men (21.2%) compared to women (30.4%) and men (32.5%) without diabetes. College graduation was reported by 40.3% of non-Hispanic Asian/Pacific Islander, 20.1% of non-Hispanic white, 13.3% of non-Hispanic black, and 6.1% of Hispanic adults with diabetes diagnosed age ≥20 years, which was lower than their respective groups without diabetes. Adults with diabetes had lower family income (54.3% diagnosed age <20 years, 43.8% diagnosed age ≥20 years, and 32.4% without diagnosed diabetes made <$35,000 annually between 2007 and 2010). Likewise, more adults with diabetes had a Poverty Income Ratio (PIR) <2.00 (49.1%, 38.4%, and 30.7%, respectively). Nearly 25% of non-Hispanic black, Hispanic, and non-Hispanic American Indian and Alaska Native adults lived below poverty (PIR <1.00) regardless of diabetes diagnosis. After considering family income within age and race/ethnicity groups, only adults age 45–64 years with diabetes diagnosed age ≥20 years had lower incomes than similar age adults without diabetes. In 2009–2010, a lower percentage of adults with diabetes diagnosed age ≥20 years reported working in the previous 12 months (43.3%) compared to adults without diabetes (71.8%) or adults in 2006–2010 with diabetes diagnosed age <20 years (53.7%). Over 70% of each group were employed in the private sector, and adults with diabetes diagnosed age ≥20 years had the largest percentage working for the government (21.5%). Being retired was the main reason for not working among adults with diabetes diagnosed age ≥20 years, adults without diabetes, and adults with diabetes diagnosed age <20 years (56.9%, 43.5%, and 38.7%, respectively); and being disabled was more frequently reported by adults in the diabetes groups (28.5%, 15.5%, and 37.2%, respectively). Men with diabetes diagnosed age ≥20 years were more often military veterans than men without diabetes (34.7% vs. 17.2%). Among adults with diabetes diagnosed age ≥20 years, 46.6% received Social Security or Railroad retirement benefits compared to 17.4% of adults without diabetes, and >7% of adults with diabetes received Supplemental Security Income usually due to a disability compared to 2.2% of adults without diabetes.
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- 2018
31. Diabetes in America
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Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, and Fradkin JE
- Abstract
Diabetes in America, 3rd Edition, is a compilation and assessment of epidemiologic, public health, clinical, and clinical trial data on diabetes and its complications in the United States. It was published by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, during 2016–2018. The intended audience is the wide range of individuals in the research community, clinicians, health policy makers, and individuals with diabetes, as well as their caregivers and family members. Diabetes in America, 3rd Edition, contains 42 chapters organized into three areas: Section I: Spectrum of Diabetes: Descriptive epidemiology of diabetes in the United States based on national surveys and community-based studies, including prevalence and incidence; sociodemographic, metabolic, and lifestyle characteristics; genetics and risk factors for developing diabetes; and unique aspects of diabetes in younger and older populations, and in pregnant women (chapters 1–16). Section II: Complications of Diabetes and Related Conditions: The myriad complications that affect patients with diabetes, including mortality (chapters 17–36). Section III: Prevention and Medical Care for Diabetes: Clinical trials and studies to prevent diabetes; medication use and self-care practices, health care utilization, and quality of care; and economic aspects including health insurance and health care costs (chapters 37–42).
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- 2018
32. Health Insurance and Diabetes
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Casagrande SS, Cowie CC, Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, and Fradkin JE
- Abstract
National data from 2009 indicate that among adults age ≥18 years with diabetes, 90.1% had some type of health insurance coverage, including 84.7% of those age 18–64 years and 99.7% of those age ≥65 years. An estimated 2.02 million adults with diabetes had no health insurance coverage, including 2.0 million adults age 18–64 years and 25,700 adults age ≥65 years. For adults without diabetes, 81.4% had health insurance coverage, including 78.3% at age 18–64 years and 99.2% at age ≥65 years. For adults with diabetes age 18–64 years, Hispanics had a significantly lower prevalence of health insurance coverage (72.0%) compared to non-Hispanic whites (87.6%), non-Hispanic blacks (85.4%), and non-Hispanic Asians (91.3%). The majority of adults age 18–64 years with diabetes had private insurance coverage (58.3%), 19.4% had Medicaid, 13.6% had Medicare, and 4.0% had military benefits; types of insurance coverage are not mutually exclusive. Compared to those without diabetes, significantly more adults age 18–64 years with diabetes had Medicare coverage, and fewer adults with diabetes had private insurance coverage. For adults age ≥65 years with diabetes, the majority had Medicare (95.2%), 50.6% had private insurance, 11.2% had Medicaid, and 11.0% had military benefits; results are again not mutually exclusive. For individuals age ≥65 years without diabetes, 94.6% had Medicare coverage, 58.6% had private insurance, 6.4% had Medicaid, and 7.0% had military benefits. For all adults, the prevalence of types of private health insurance plans was similar by diabetes status and age, with preferred provider organization plans being the most common followed by health maintenance organization/individual practice association plans. The majority of uninsured adults age 18–64 years with diabetes had been without health insurance for ≥3 years; these individuals were more often low-income earners, and high cost was the most common reason for not having insurance (51.5%). Persons with diabetes who had health insurance had greater health care utilization, better diabetes control, and less morbidity. Adults with diabetes age <65 years who had health insurance more often reported seeing a doctor in the past year (87.9%), including eye (58.5%) and foot (19.4%) specialists, compared to their counterparts without insurance (69.6%, 24.4%, 6.9%, respectively). In addition, those with insurance more often visited a regular doctor’s office and less frequently went to a clinic or health center for care compared to those without insurance. For adults age <65 years with diabetes, control of hemoglobin A1c, blood pressure, and cholesterol was better among those with insurance compared to those without insurance. Furthermore, adults age 18–64 years with diabetes who have health insurance were more likely to report having hypertension (65.2%) or heart disease (23.2%) compared to those without insurance (55.3% and 13.5%, respectively). Finally, the proportion of income spent on private insurance premiums and family medical care was inversely associated with family income, regardless of age or diabetes status.
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- 2018
33. Physical and Metabolic Characteristics of Persons With Diabetes and Prediabetes
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Menke A, Knowler WC, Cowie CC, Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, and Fradkin JE
- Abstract
This chapter provides a description of physical and metabolic characteristics of persons with diabetes and prediabetes and is based primarily on data from the National Health and Nutrition Examination Surveys 2005–2010. The 2010 American Diabetes Association guidelines were used to define undiagnosed diabetes and prediabetes. Among participants with diabetes, mean glycosylated hemoglobin (A1c) concentrations were highest in those with diagnosed diabetes treated by insulin or oral diabetes medication (7.4%), followed by undiagnosed diabetes defined by A1c or fasting plasma glucose (6.9%), and lowest among those with untreated diagnosed diabetes (6.3%) and undiagnosed diabetes defined by A1c, fasting plasma glucose, or 2-hour plasma glucose (6.3%). Mean fasting plasma glucose concentrations were highest in those with treated diabetes (153 mg/dL) and undiagnosed diabetes defined by A1c or fasting plasma glucose (149 mg/dL) and generally lower among those with untreated diagnosed diabetes (137 mg/dL) and undiagnosed diabetes defined by A1c, fasting plasma glucose, or 2-hour plasma glucose (130 mg/dL). Mean 2-hour plasma glucose concentrations were higher in those with undiagnosed diabetes (243 mg/dL for A1c and fasting plasma glucose definition; 235 mg/dL for A1c, fasting plasma glucose, and 2-hour plasma glucose definition) than in people with untreated diagnosed diabetes (183 mg/dL; 2-hour plasma glucose was not measured in participants with treated diagnosed diabetes). Participants with prediabetes by definition had lower A1c, fasting plasma glucose, and 2-hour plasma glucose concentrations than those with diabetes, and participants with normal glucose regulation had the lowest concentrations. Mean fasting insulin concentrations were generally higher in people with undiagnosed diabetes than in people with diagnosed diabetes (insulin users were excluded). Participants with prediabetes generally had lower fasting insulin concentrations than those with undiagnosed diabetes, and those with normal glucose regulation had the lowest fasting insulin concentrations. The prevalence of family history of diabetes was generally highest among people with diagnosed diabetes (69%), followed by undiagnosed diabetes (49% for A1c and fasting plasma glucose definition; 45% for A1c, fasting plasma glucose, and 2-hour plasma glucose definition), and was lowest in those with prediabetes (39%) and normal glucose regulation (33%). People with diabetes had higher mean body mass index and systolic blood pressure than people with prediabetes, and those with normal glucose regulation had the lowest means. The relationship between diabetes and cholesterol level differed by age group. Mean levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were generally higher in people with diabetes age 20–44 years than in people with prediabetes or normal glucose regulation. Conversely, mean levels of total cholesterol, LDL cholesterol, and triglycerides were generally lower in people with diabetes age 45–64 years than those with prediabetes or normal glucose regulation. The prevalence of C-reactive protein ≥10 mg/L was generally higher among people with diabetes than among people with prediabetes, and people with normal glucose regulation generally had the lowest prevalence. Women with diagnosed diabetes had a higher age-standardized mean number of live births than women who had not been diagnosed with diabetes. Individuals with diagnosed diabetes reported a higher prevalence of fair or poor health than those with prediabetes or normal glucose regulation.
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- 2018
34. Prevalence and Incidence of Type 2 Diabetes and Prediabetes
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Cowie CC, Casagrande SS, Geiss LS, Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, and Fradkin JE
- Abstract
Diabetes is a common condition in the United States and worldwide, associated with multiple complications and early mortality that result in costly use of health resources and lost productivity. This chapter reviews the prevalence and incidence of type 2 diabetes in terms of diagnosed and undiagnosed diabetes, as well as prediabetes. Variations in estimates are illustrated by age, sex, race/ethnicity, and over time. Data come primarily from analyses of two national health surveys: the National Health Interview Surveys (NHIS) 2011–2015, which include only an interview; and the National Health and Nutrition Examination Surveys (NHANES) 2011–2014, which include an interview and blood draw to detect undiagnosed diabetes by glycosylated hemoglobin (A1c), fasting plasma glucose (FPG), and/or 2-hour plasma glucose (2-hour PG) from an oral glucose tolerance test. While these data do not distinguish type 1 from type 2 diabetes, an estimated 90%–95% are from persons with type 2 diabetes. Data from the literature are used to describe type 2 diabetes in adolescents, Hispanic and Asian subgroups, and American Indians. Crude overall prevalence of diagnosed diabetes based on the NHIS 2011–2015 was 9.5% in adults age ≥20 years, translating to 21.8 million in the U.S. civilian noninstitutionalized population. Prevalence increased with age, ranging from 0.5% in youth age 12–19 years to about 20% in those age ≥65 years. Age-standardized prevalence was somewhat higher in adult men than women. Age- and sex-standardized prevalence was highest in non-Hispanic American Indian/Alaska Native adults (19.1%) and lowest in non-Hispanic whites (8.2%), with prevalences between these in non-Hispanic blacks, all Hispanics, and non-Hispanic Asians. Variability in prevalence was found across Hispanic and Asian subgroups. Prevalence of validated type 2 diabetes in adolescents age 10–19 years based on the SEARCH for Diabetes in Youth Study was 0.46 per 1,000 in 2009, which varied by age, sex, and race/ethnicity. Crude overall prevalence of undiagnosed diabetes in adults ≥20 years based on the NHANES 2011–2014 was 2.9% as detected by A1c/FPG; and when combined with diagnosed diabetes (9.6%), total diabetes prevalence was 12.5% or 28.2 million in the U.S. civilian noninstitutionalized population. Undiagnosed diabetes of 5.0% by A1c/FPG/2-hour PG resulted in total diabetes of 14.6% or 33.0 million. Prevalence of undiagnosed and total diabetes rose with age. The percent of total diabetes that was undiagnosed was highest (33.4%–41.5%) at age 20–44 years. Standardized prevalence of undiagnosed diabetes and total diabetes tended to be higher in men than women, as was the percent of total diabetes that was undiagnosed. Standardized prevalence of undiagnosed diabetes, total diabetes, and the percent of total diabetes that was undiagnosed were highest in non-Hispanic Asians and lowest in non-Hispanic whites, with prevalences for non-Hispanic blacks, all Hispanics, and Mexican Americans in between. Crude overall incidence of diagnosed diabetes based on the NHIS 2012 was 7.4 per 1,000 adults age 20–79 years. Incidence increased to age 65–74 years and then declined. It was higher in women than men, highest in Hispanics, followed by non-Hispanic blacks, and lowest in non-Hispanic whites. Over time, crude prevalence of diagnosed diabetes among all ages based on the NHIS has risen from 0.93% in 1958 to 7.40% in 2015. In adults age 20–74 years during 1980–2012, both age-adjusted prevalence and incidence rose particularly fast during 1990–2008, but may be leveling off or decreasing since 2008. Other data sources have corroborated this finding. An analysis of the NHANES during 1988–2012 found standardized prevalence of total diabetes increased across all subgroups of the U.S. population, due to an increase in diagnosed diabetes, while undiagnosed diabetes remained relatively constant. Both prevalence and incidence of type 2 diabetes in adolescents based on SEARCH have continued to increase significantly since the early 2000s across all age, sex, and race/ethnicity groups. Crude overall prevalence of prediabetes in adults age ≥20 years based on the NHANES 2011–2014 was 34.4% (77.9 million) by A1c/FPG and 36.9% (83.6 million) by A1c/FPG/2-hour PG. Prevalence of prediabetes rose with age. Standardized prevalence was significantly higher in men than women; and prevalences were higher in non-Hispanic blacks, all Hispanics, and Mexican Americans compared to non-Hispanic whites and non-Hispanic Asians. Prediabetes prevalence was fairly constant during 1999–2006, but significantly increased during 2007–2010. Diabetes remains a very prevalent condition, especially in American Indians, non-Hispanic blacks, and Hispanic groups. The long-term trend showing a persistent rise in occurrence, though a slowing in more recent years, needs continued surveillance. The fact that one-quarter to one-third of diabetes is undiagnosed and that another third of the total population has prediabetes emphasizes the importance of sustained monitoring and improvements in health care delivery.
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- 2018
35. Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women.
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Casagrande SS, Linder B, and Cowie CC
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- Adult, Female, Humans, Pregnancy, Prevalence, Risk Factors, United States, Young Adult, Diabetes Mellitus, Type 2 etiology, Diabetes, Gestational epidemiology, Obesity complications
- Abstract
Aims: The true prevalence of gestational diabetes (GDM) in the United States is unknown. This study determined the prevalence of GDM and a subsequent diagnosis of diabetes in a nationally representative sample of U.S. women., Methods: The crude and age-adjusted prevalence of GDM and subsequent diabetes were evaluated by sociodemographic and health-related characteristics among women age ≥20 years in the National Health and Nutrition Examination Surveys, 2007-2014 (N = 8185). Logistic regression analyzed independent factors associated with GDM and subsequent diabetes., Results: The prevalence of GDM was 7.6%. Women who were Mexican American (vs. non-Hispanic white), had ≥4 live births (vs. 1), had a family history of diabetes, or were obese (vs. normal weight) had a higher age-standardized prevalence of GDM (each p < 0.04). Among women with a history of GDM, 19.7% had a subsequent diagnosis of diabetes; subsequent diabetes diagnosis was higher for those with health insurance, more time since GDM diagnosis, greater parity, family history of diabetes, and obesity, and lower for those with higher education and income (all p ≤ 0.005). By logistic regression, significant factors associated with GDM were age at first birth, parity, family history of diabetes, and obesity; significant factors for subsequent diabetes were older age, greater years since GDM diagnosis, less education, family history of diabetes, and obesity (each p < 0.01)., Conclusions: The prevalence of GDM in the U.S. was 7.6%, with 19.7% of these women having a subsequent diabetes diagnosis. Women with a history of GDM, family history of diabetes, and obesity should be carefully monitored for dysglycemia., (Copyright © 2018 Elsevier B.V. All rights reserved.)
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- 2018
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36. Cardiovascular risk factors in adolescents with prediabetes.
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Casagrande SS, Menke A, Linder B, Osganian SK, and Cowie CC
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Aims: Adolescents with Type 2 diabetes are more likely to have cardiovascular disease (CVD) risk factors but there are few data available among adolescents with prediabetes. We characterized CVD risk factors among adolescents with prediabetes in the USA and compared levels of those risk factors with adolescents with normal glucose., Methods: The 2005-2014 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey, included 2843 adolescents aged 12-19 years after excluding those with diabetes. Prediabetes was based on an HbA
1c , a fasting plasma glucose or a 2-h plasma glucose. We determined cardiometabolic risk factors in adolescents using age-appropriate cut-off points. We calculated odds ratios (OR) and 95% confidence intervals (CI) of these outcomes associated with having prediabetes compared with normal glucose levels., Results: The weighted prevalence of prediabetes was 17.4%. After adjustment, prediabetes (vs. normal glucose) was associated with obesity (OR 1.86, 95% CI 1.35-2.55), low HDL-cholesterol (OR 1.62, 95% CI 1.08-2.44), high triglycerides (OR 1.61, 95% CI 1.12-2.30) and elevated liver transaminase (OR 2.09, 95% CI 1.19-3.67), but not with hypertension (OR 1.77, 95% CI 0.88-3.54), elevated total cholesterol (OR 1.30, 95% CI 0.82-2.06), elevated LDL-cholesterol (OR 1.59, 95% CI 0.88-2.88) or albuminuria (OR 1.24, 95% CI 0.76-2.02)., Conclusions: US adolescents with prediabetes are more likely to have obesity, low HDL-cholesterol, high triglycerides and elevated liver transaminase than adolescents with normal glucose. Addressing prediabetes in youth is important for the prevention of Type 2 diabetes and long-term comorbidity., (Published 2018. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)- Published
- 2018
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37. Prevalence of Diagnosed Diabetes in Adults by Diabetes Type - United States, 2016.
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Bullard KM, Cowie CC, Lessem SE, Saydah SH, Menke A, Geiss LS, Orchard TJ, Rolka DB, and Imperatore G
- Subjects
- Adolescent, Adult, Aged, Diabetes Mellitus, Type 1 diagnosis, Diabetes Mellitus, Type 2 diagnosis, Female, Health Surveys, Humans, Male, Middle Aged, Prevalence, United States epidemiology, Young Adult, Diabetes Mellitus, Type 1 epidemiology, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Currently 23 million U.S. adults have been diagnosed with diabetes (1). The two most common forms of diabetes are type 1 and type 2. Type 1 diabetes results from the autoimmune destruction of the pancreas's beta cells, which produce insulin. Persons with type 1 diabetes require insulin for survival; insulin may be given as a daily shot or continuously with an insulin pump (2). Type 2 diabetes is mainly caused by a combination of insulin resistance and relative insulin deficiency (3). A small proportion of diabetes cases might be types other than type 1 or type 2, such as maturity-onset diabetes of the young or latent autoimmune diabetes in adults (3). Although the majority of prevalent cases of type 1 and type 2 diabetes are in adults, national data on the prevalence of type 1 and type 2 in the U.S. adult population are sparse, in part because of the previous difficulty in classifying diabetes by type in surveys (2,4,5). In 2016, supplemental questions to help distinguish diabetes type were added to the National Health Interview Survey (NHIS) (6). This study used NHIS data from 2016 to estimate the prevalence of diagnosed diabetes among adults by primary type. Overall, based on self-reported type and current insulin use, 0.55% of U.S. adults had diagnosed type 1 diabetes, representing 1.3 million adults; 8.6% had diagnosed type 2 diabetes, representing 21.0 million adults. Of all diagnosed cases, 5.8% were type 1 diabetes, and 90.9% were type 2 diabetes; the remaining 3.3% of cases were other types of diabetes. Understanding the prevalence of diagnosed diabetes by type is important for monitoring trends, planning public health responses, assessing the burden of disease for education and management programs, and prioritizing national plans for future type-specific health services., Competing Interests: No conflicts of interest were reported.
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- 2018
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38. Variations of dietary intake by glycemic status and Hispanic/Latino heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
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Casagrande SS, Sotres-Alvarez D, Avilés-Santa L, O'Brien MJ, Palacios C, Pérez CM, Reina SA, Wang X, Qi Q, Giachello AL, Espinoza Giacinto RA, and Cowie CC
- Abstract
Objective: A healthy diet is important for diabetes prevention and control; however, few studies have assessed dietary intake among US Hispanics/Latinos, a diverse population with a significant burden of diabetes. To address this gap in the literature, we determined intake of energy, macro/micronutrients, and vitamin supplements among Hispanics/Latinos by glycemic status and heritage., Research Design and Methods: Cross-sectional study of adults aged 18-74 years from the Hispanic Community Health Study/Study of Latinos (2008-2011) with complete baseline data on glycemic status and two 24-hour dietary recalls (n=13 089). Age-adjusted and sex-adjusted and multivariable-adjusted measures of intake were determined by glycemic status and heritage., Results: Mean age-adjusted and sex-adjusted energy intake was significantly lower among Hispanics/Latinos with diagnosed diabetes compared with those with normal glycemic status (1665 vs 1873 kcal, P<0.001). Fiber intake was higher among those with diagnosed diabetes versus normal glycemic status (P<0.01). Among those with diagnosed diabetes, energy intake was highest among those with Cuban heritage compared with most other heritage groups (P<0.01 for all, except Mexicans), but there was no difference after additional adjustment. Fiber intake was significantly lower for those of Cuban heritage (vs Dominican, Central American, and Mexican), and sodium intake was significantly higher (vs all other heritage groups) (P<0.01 for all); findings were null after additional adjustment. There was no difference in supplemental intake of vitamin D, calcium, magnesium, or potassium by glycemic status., Conclusions: As part of the care of Hispanics/Latinos with diabetes, attention should be made to fiber and sodium consumption., Competing Interests: Competing interests: None declared.
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- 2018
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39. Diabetes based on 2-h plasma glucose among those classified as having prediabetes based on fasting plasma glucose or A1c.
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Menke A, Rust KF, and Cowie CC
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- Alanine Transaminase blood, Albuminuria diagnosis, Albuminuria epidemiology, Biomarkers blood, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus blood, Diabetes Mellitus epidemiology, Dyslipidemias blood, Dyslipidemias diagnosis, Dyslipidemias epidemiology, Female, Humans, Hypertension diagnosis, Hypertension epidemiology, Lipids blood, Logistic Models, Male, Middle Aged, Nutrition Surveys, Odds Ratio, Prediabetic State blood, Prediabetic State epidemiology, Predictive Value of Tests, Prevalence, Risk Factors, Time Factors, United States epidemiology, Blood Glucose metabolism, Diabetes Mellitus diagnosis, Fasting blood, Glucose Tolerance Test, Glycated Hemoglobin metabolism, Prediabetic State diagnosis
- Abstract
Objective: Determine the prevalence of diabetes using 2-h plasma glucose among people who otherwise would be categorized as having prediabetes based on A1c and fasting glucose, and to determine whether those people were more likely to have cardiometabolic risk factors., Methods: Among 3644 adults with prediabetes based on A1c and fasting glucose in the 2005-2014 National Health and Nutrition Examination Survey, a cross-sectional survey of the US general population, we estimated the percentage who would be categorized as having diabetes based on having a 2-h plasma glucose ⩾200 mg/dL. We calculated odds ratios of cardiometabolic risk factors associated with having 2-h plasma glucose ⩾200 mg/dL., Results: A total of 6.9% would be categorized as having diabetes based on 2-h plasma glucose. The adjusted odds ratios (95% confidence interval) associated with having 2-h plasma glucose ⩾200 mg/dL were significant for total hypertension (2.06, 1.35-3.14), high triglycerides (1.64, 1.10-2.44), low high-density lipoprotein cholesterol (1.55, 1.01-2.39), albuminuria (2.05, 1.33-3.14) and elevated alanine aminotransferase (1.78, 1.09-2.91), but not for other cardiometabolic risk factors., Conclusion: A total of 6.9% of people categorized as having prediabetes based on A1c and fasting glucose would be categorized as having diabetes based on 2-h plasma glucose. They were more likely to have hypertension, high triglycerides, low high-density lipoprotein cholesterol, albuminuria and elevated alanine aminotransferase.
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- 2018
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40. Cardiometabolic health in Asians with diabetes in the US.
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Menke A, Casagrande S, and Cowie CC
- Subjects
- Adult, Asian People, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, United States, Cardiovascular Diseases epidemiology, Diabetes Mellitus ethnology
- Abstract
Aims: Asians develop diabetes at lower levels of adiposity than people of other race/ethnicities. However, there is limited data investigating the health of US Asians with diabetes. We compared cardiovascular risk factors in US Asians to other race/ethnicities stratified by diabetes status., Methods: Among 4645 adults in the 2011-2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of the US population, odds ratios were calculated for obesity, hypertension, and elevated low-density lipoprotein (LDL) cholesterol associated with race/ethnicity after adjustment for age, sex, income, education, smoking, alcohol consumption, and health insurance., Results: Overall and stratified by diabetes status, non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans were significantly more likely to be obese compared to non-Hispanic Asians after adjustment. Overall and stratified by diabetes status, adjusted levels of hypertension compared to non-Hispanic Asians was generally similar for non-Hispanic whites and Mexican-Americans and generally more common among non-Hispanic blacks; among those with diagnosed diabetes, the adjusted odds ratios (95% confidence interval) were 1.48 (0.79-2.77), 2.54 (1.49-4.30), and 1.38 (0.73-2.60) for non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans, respectively. Overall and stratified by diabetes status, elevated LDL cholesterol levels were generally similar between non-Hispanic Asians and other race/ethnicities; among those with diagnosed diabetes, the adjusted odds ratios (95% confidence interval) were 0.88 (0.32-2.43), 0.58 (0.24-1.42), and 1.15 (0.29-4.58) for non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans, respectively., Conclusions: Although non-Hispanic Asians had lower levels of adiposity compared to other race/ethnicities with diabetes, their adjusted levels of hypertension and LDL cholesterol were generally more comparable., (Copyright © 2017 Elsevier B.V. All rights reserved.)
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- 2017
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41. HEMOGLOBIN A1C, BLOOD PRESSURE, AND LDL-CHOLESTEROL CONTROL AMONG HISPANIC/LATINO ADULTS WITH DIABETES: RESULTS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL).
- Author
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Casagrande SS, Aviles-Santa L, Corsino L, Daviglus ML, Gallo LC, Espinoza Giacinto RA, Llabre MM, Reina SA, Savage PJ, Schneiderman N, Talavera GA, and Cowie CC
- Subjects
- Adolescent, Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus blood, Diabetes Mellitus physiopathology, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prevalence, United States epidemiology, Young Adult, Blood Pressure, Cholesterol, LDL blood, Diabetes Mellitus ethnology, Glycated Hemoglobin metabolism, Hispanic or Latino statistics & numerical data
- Abstract
Objective: To determine the prevalence of Hispanic/Latino adults with diabetes who meet target hemoglobin A1c, blood pressure (BP), and low-density-lipoprotein cholesterol (LDL-C) recommendations, and angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blocker (ARB) and statin medication use by heritage and sociodemographic and diabetes-related characteristics., Methods: Data were cross-sectional, collected between 2008 and 2011, and included adults age 18 to 74 years who reported a physician diagnosis of diabetes in the Hispanic Community Health Study/Study of Latinos (N = 2,148). Chi-square tests compared the prevalence of hemoglobin A1c, BP, and LDL-C targets and ACE/ARB and statin use across participant characteristics. Predictive margins regression was used to determine the prevalence adjusted for sociodemographic characteristics., Results: The overall prevalence of A1c <7.0% (53 mmol/mol), BP <130/80 mm Hg, and LDL-C <100 mg/dL was 43.0, 48.7, and 36.6%, respectively, with 8.4% meeting all three targets. Younger adults aged 18 to 39 years with diabetes were less likely to have A1c <7.0% (53 mmol/mol) or LDL-C <100 mg/dL compared to those aged 65 to 74 years; younger adults were more likely to have BP <130/80 mm Hg (P<.05 for all). Individuals of Mexican heritage were significantly less likely to have A1c <7.0% (53 mmol/mol) compared to those with Cuban heritage, but they were more likely to have BP <130/80 mm Hg compared to those with Dominican, Cuban, or Puerto Rican heritage (P<.05 for all); there was no difference in LDL-C by heritage. Overall, 38.2% of adults with diabetes were taking a statin, and 50.5% were taking ACE/ARB medications., Conclusion: Hemoglobin A1c, BP, and LDL-C control are suboptimal among Hispanic/Latinos with diabetes living in the U.S. With 8.4% meeting all three recommendations, substantial opportunity exists to improve diabetes control in this population., Abbreviations: A1c = hemoglobin A1c; ABC = hemoglobin A1c, blood pressure, low-density-lipoprotein cholesterol; ACE = angiotensin-converting enzyme; ADA = American Diabetes Association; ARB = angiotensin receptor blocker; BMI = body mass index; BP = blood pressure; CHD = coronary heart disease; CVD = cardiovascular disease; HCHS/SOL = Hispanic Community Health Study/Study of Latinos; LDL-C = low-density-lipoprotein cholesterol; NHANES = National Health and Nutrition Examination Survey; PAD = peripheral artery disease.
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- 2017
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42. Trends in dietary intake among adults with type 2 diabetes: NHANES 1988-2012.
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Casagrande SS and Cowie CC
- Subjects
- Adult, Aged, Cross-Sectional Studies, Diet Records, Dietary Carbohydrates administration & dosage, Dietary Fats administration & dosage, Dietary Fiber administration & dosage, Dietary Proteins administration & dosage, Female, Humans, Male, Micronutrients administration & dosage, Middle Aged, Nutrition Surveys, Portion Size trends, Young Adult, Diabetes Mellitus, Type 2, Diet trends, Recommended Dietary Allowances
- Abstract
Background: Dietary recommendations for adults with diabetes are to follow a healthy diet in appropriate portion sizes. We determined recent trends in energy and nutrient intakes among a nationally representative sample of US adults with and without type 2 diabetes., Methods: Participants were adults aged ≥20 years from the cross-sectional National Health and Nutrition Examination Surveys, 1988-2012 (N = 49 770). Diabetes was determined by self-report of a physician's diagnosis (n = 4885). Intake of energy and nutrients were determined from a 24-h recall by participants of all food consumed. Linear regression was used to test for trends in mean intake over time for all participants and by demographic characteristics., Results: Among adults with diabetes, overall total energy intake increased between 1988-1994 and 2011-2012 (1689 kcal versus 1895 kcal; P
trend < 0.001) with evidence of a plateau between 2003-2006 and 2011-2012. In 2007-2012, energy intake was greater for younger than older adults, for men than women, and for non-Hispanic whites versus non-Hispanic blacks. There was no change in the percentage of calories from carbohydrate, total fat or protein. Percentage of calories from saturated fat was similar across study periods but remained above recommendations (11.2% in 2011-2012). Fibre intake significantly decreased and remained below recommendations (Ptrend = 0.002). Sodium, cholesterol and calcium intakes increased. There was no change in energy intake among adults without diabetes and dietary trends were similar to those with diabetes., Conclusions: Future data are needed to confirm a plateau in energy intake among adults with diabetes, although the opportunity exists to increase fibre and reduce saturated fat., (© 2017 The British Dietetic Association Ltd.)- Published
- 2017
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43. Intensive glycemic control in younger and older U.S. adults with type 2 diabetes.
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Casagrande S, Cowie CC, and Fradkin JE
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- Adult, Aged, Diabetes Complications epidemiology, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 complications, Drug Therapy, Combination adverse effects, Female, Glycated Hemoglobin analysis, Humans, Hyperglycemia epidemiology, Hypoglycemia chemically induced, Hypoglycemia epidemiology, Hypoglycemic Agents adverse effects, Male, Middle Aged, Nutrition Surveys, Practice Guidelines as Topic, Precision Medicine, Risk, Self Report, United States epidemiology, Aging, Diabetes Complications prevention & control, Diabetes Mellitus, Type 2 drug therapy, Hyperglycemia prevention & control, Hypoglycemia prevention & control, Hypoglycemic Agents therapeutic use, Practice Patterns, Physicians'
- Abstract
Aims: To determine the extent to which older vs. younger adults with diabetes intensively control glycemia., Methods: Participants were age≥40years who self-reported a physician diagnosis of diabetes in the 2009-2014 National Health and Nutrition Examination Surveys (N=1554). Intensive glycemic control was defined as A1c<7.0% and taking insulin, sulfonylureas, or ≥2 glycemic medications. Logistic regression was used to determine the adjusted odds of intensive control in older (≥65years) vs. younger adults (age 40-64years)., Results: The prevalence of intensive control was greater for older (33.4%) vs. younger (21.3%) adults (p<0.001). In logistic regression, intensive control was significantly higher in older vs. younger adults after fully adjusting for sociodemographics, diabetes duration, comorbidities, disability, use of multiple medications, and depression (OR=1.72, 1.09-2.69). The multivariable adjusted prevalence of intensive control was 40% higher in adults ≥75years (35.6%) compared to adults 40-49years (21.7%)., Conclusions: Older adults are being treated more aggressively than younger adults to achieve A1c<7.0% despite the presence of comorbidities, duration of diabetes, disability, and depression. Glycemic guidelines for individualized therapy are not being widely followed., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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44. Factors Associated With Being Unaware of Having Diabetes.
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Menke A, Casagrande S, Avilés-Santa ML, and Cowie CC
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- 2017
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45. Glucocorticoid use and its association with skeletal health among U.S. adults with diabetes.
- Author
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Casagrande SS, Cowie CC, and Malozowski S
- Subjects
- Adult, Aged, Bone Density Conservation Agents therapeutic use, Cross-Sectional Studies, Diabetes Complications drug therapy, Diabetes Complications epidemiology, Diphosphonates therapeutic use, Female, Humans, Logistic Models, Male, Middle Aged, Nutrition Surveys, Osteoporosis complications, Osteoporosis drug therapy, Osteoporosis epidemiology, Osteoporotic Fractures epidemiology, Osteoporotic Fractures prevention & control, Risk, Self Report, Sex Factors, United States epidemiology, Bone and Bones drug effects, Diabetes Complications chemically induced, Glucocorticoids adverse effects, Osteoporosis chemically induced, Osteoporotic Fractures etiology
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Aims: Determine the prevalence of glucocorticoid use in U.S. adults with diabetes and whether prevalence is associated with reduced skeletal health, as measured by fracture history and bisphosphonate use., Methods: Participants were age≥20years from the cross-sectional National Health and Nutrition Examination Survey (1999-2010; N=15,661). Diabetes was determined by self-report, fasting plasma glucose ≥126mg/dL (≥6.99mmol/L), or A1c ≥6.5% (≥47.5mmol/mol) (n=4539). Prevalences of fractures and bisphosphonate use were determined by diabetes status and glucocorticoid use. Logistic regression was stratified by sex and assessed the effect of glucocorticoid use and diabetes associated with fractures and bisphosphonates., Results: The age-standardized prevalence of glucocorticoid use was higher among persons with diabetes (3.2% vs. 2.0% without diabetes, p=0.001). Among adults with diabetes, the prevalence of fractures was significantly higher among those taking glucocorticoids vs. those not (38.3% vs. 26.1%, p=0.048). The prevalences of fractures and bisphosphonate use were generally similar in those with and without diabetes when stratified by glucocorticoid use. In logistic regression analysis among men, the combination of diabetes and glucocorticoid use (compared to those with neither) was highly associated with bisphosphonate use, while adjusting for demographic factors. Among women, having diabetes and glucocorticoid use increased the odds of fractures, while adjusting for demographic factors and menopause., Conclusions: The prevalence of fractures was greater for those with diabetes taking glucocorticoids versus those not taking glucocorticoids. This study provides a national framework for further research on elucidating these associations., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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46. Detecting prediabetes among Hispanics/Latinos from diverse heritage groups: Does the test matter? Findings from the Hispanic Community Health Study/Study of Latinos.
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Avilés-Santa ML, Pérez CM, Schneiderman N, Savage PJ, Kaplan RC, Teng Y, Suárez EL, Cai J, Giachello AL, Talavera GA, and Cowie CC
- Subjects
- Cross-Sectional Studies, Diabetes Mellitus, Type 2 epidemiology, Glycated Hemoglobin analysis, Humans, Hypertension, Prevalence, Risk Factors, Surveys and Questionnaires, Culture, Glucose Tolerance Test methods, Hispanic or Latino, Prediabetic State blood
- Abstract
The objectives of this analysis were to compare the ability of fasting plasma glucose (FPG), post oral load plasma glucose (2hPG), and hemoglobin A
1c (HbA1c ) to identify U.S. Hispanic/Latino individuals with prediabetes, and to assess its cardiovascular risk factor correlates. This is a cross-sectional analysis of baseline data from 15,507 adults without self-reported diabetes mellitus from six Hispanic/Latino heritage groups, enrolled in the Hispanic Community Health Study/Study of Latinos, which takes place in four U.S. communities. The prevalence of prediabetes was determined according to individual or combinations of ADA-defined cut points: FPG=5.6-7.0mmol/L, 2hPG=7.8-11.1mmol/L, and HbA1c =5.7%-6.4% (39-46mmol/mol). The sensitivity of these criteria to detect prediabetes was estimated. The prevalence ratios (PRs) for selected cardiovascular risk factors were compared among alternative categories of prediabetes versus normoglycemia [FPG<5.6mmol/L and 2hPG<7.8mmol/L and HbA1c <5.7% (39mmol/mol)]. Approximately 36% of individuals met any of the ADA prediabetes criteria. Using 2hPG as the gold standard, the sensitivity of FPG was 40.1%, HbA1c was 45.6%, and that of HbA1c +FPG was 62.2%. The number of significant PRs for cardiovascular risk factors was higher among individuals with isolated 2hPG=7.8-11.1mmol/L, FPG=5.6-7.0mmol/L+HbA1c =5.7%-6.4%, or those who met the three prediabetes criteria. Assessing FPG, HbA1c , and cardiovascular risk factors in Hispanics/Latinos at risk might enhance the early prevention of diabetes mellitus and cardiovascular complications in this young and growing population, independent of their heritage group., Competing Interests: The authors do not have conflicts to declare., (Published by Elsevier Inc.)- Published
- 2017
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47. Risk Factors for Hearing Impairment among Adults with Diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
- Author
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Bainbridge KE, Cowie CC, Gonzalez F 2nd, Hoffman HJ, Dinces E, Stamler J, and Cruickshanks KJ
- Abstract
Aim: The aim was to examine risk factors for hearing impairment among Hispanic/Latino adults with diabetes., Methods: Findings are based on 3384 participants aged 18-76 years with diagnosed or previously undetected diabetes who completed audiometric testing as part of the Hispanic Community Health Study/Study of Latinos. We defined hearing impairment as the pure-tone average (PTA) >25 decibels hearing level [dB HL] of pure-tone thresholds at high frequencies (3000, 4000, 6000, and 8000 Hz) in the worse ear and defined a second hearing impairment outcome with the additional requirement of PTA >25 dB HL of low/mid-frequency (500, 1000, and 2000 Hz) thresholds in the worse ear. We identified independent associations using logistic regression., Results: Controlling for age and Hispanic/Latino background, prevalence ratios for hearing impairment in the high plus low/mid frequencies were 1.35 (95% CI 1.07, 1.71) for current smoking, 1.64 (1.14, 2.38) for alcohol consumption (≥ 14 drinks/week for men or ≥ 7 drinks/week for women), and 1.29 (1.06, 1.56) for triglycerides ≥ 150 mg/dL. For high-frequency only hearing impairment, the prevalence ratio for estimated glomerular filtration rate 30-59 mL/min/1.73m
2 was 1.23 (1.03, 1.47) adjusted for age and sex. People with family income less than $20,000 had almost twice the prevalence of hearing impairment (PR=1.93 (1.34, 2.78)) as people with income over $40,000., Conclusions: Current smoking, alcohol consumption, high triglycerides, and chronic kidney disease are potentially preventable correlates of hearing impairment for persons with diabetes. Low income is a marker of increased likelihood of hearing impairment.- Published
- 2016
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48. IDENTIFYING PROBABLE DIABETES MELLITUS AMONG HISPANICS/LATINOS FROM FOUR U.S. CITIES: FINDINGS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS.
- Author
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Avilés-Santa ML, Schneiderman N, Savage PJ, Kaplan RC, Teng Y, Pérez CM, Suárez EL, Cai J, Giachello AL, Talavera GA, and Cowie CC
- Subjects
- Adolescent, Adult, Aged, Cardiovascular Diseases ethnology, Cities epidemiology, Community Health Services, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Prevalence, Risk Factors, United States epidemiology, Young Adult, Diabetes Mellitus diagnosis, Diabetes Mellitus ethnology, Hispanic or Latino statistics & numerical data
- Abstract
Objective: The aim of this study was to compare the ability of American Diabetes Association (ADA) diagnostic criteria to identify U.S. Hispanics/Latinos from diverse heritage groups with probable diabetes mellitus and assess cardiovascular risk factor correlates of those criteria., Methods: Cross-sectional analysis of data from 15,507 adults from 6 Hispanic/Latino heritage groups, enrolled in the Hispanic Community Health Study/Study of Latinos. The prevalence of probable diabetes mellitus was estimated using individual or combinations of ADA-defined cut points. The sensitivity and specificity of these criteria at identifying diabetes mellitus from ADA-defined prediabetes and normoglycemia were evaluated. Prevalence ratios of hypertension, abnormal lipids, and elevated urinary albumin-creatinine ratio for unrecognized diabetes mellitus-versus prediabetes and normoglycemia-were calculated., Results: Among Hispanics/Latinos (mean age, 43 years) with diabetes mellitus, 39.4% met laboratory test criteria for probable diabetes, and the prevalence varied by heritage group. Using the oral glucose tolerance test as the gold standard, the sensitivity of fasting plasma glucose (FPG) and hemoglobin A1c-alone or in combination-was low (18, 23, and 33%, respectively) at identifying probable diabetes mellitus. Individuals who met any criterion for probable diabetes mellitus had significantly higher (P<.05) prevalence of most cardiovascular risk factors than those with normoglycemia or prediabetes, and this association was not modified by Hispanic/Latino heritage group., Conclusion: FPG and hemoglobin A1c are not sensitive (but are highly specific) at detecting probable diabetes mellitus among Hispanics/Latinos, independent of heritage group. Assessing cardiovascular risk factors at diagnosis might prompt multitarget interventions and reduce health complications in this young population., Abbreviations: 2hPG = 2-hour post-glucose load plasma glucose ADA = American Diabetes Association BMI = body mass index CV = cardiovascular FPG = fasting plasma glucose HbA1c = hemoglobin A1c HCHS/SOL = Hispanic Community Health Study/Study of Latinos HDL-C = high-density-lipoprotein cholesterol NGT = normal glucose tolerance NHANES = National Health and Nutrition Examination Survey OGTT = oral glucose tolerance test TG = triglyceride UACR = urine albumin-creatinine ratio.
- Published
- 2016
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49. Cardiovascular Risk Factors of Adults Age 20-49 Years in the United States, 1971-2012: A Series of Cross-Sectional Studies.
- Author
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Casagrande SS, Menke A, and Cowie CC
- Subjects
- Adult, Age Factors, Cardiovascular Diseases history, Comorbidity, Cross-Sectional Studies, Female, History, 20th Century, History, 21st Century, Humans, Male, Middle Aged, Odds Ratio, Population Surveillance, Prevalence, Risk Assessment, Risk Factors, Socioeconomic Factors, Spatio-Temporal Analysis, United States epidemiology, Young Adult, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology
- Abstract
Background: The health of younger adults in the U.S. has important public health and economic-related implications. However, previous literature is insufficient to fully understand how the health of this group has changed over time. This study examined generational differences in cardiovascular risk factors of younger adults over the past 40 years., Methods: Data were from 6 nationally representative cross-sectional National Health and Nutrition Examination Surveys (1971-2012; N = 44,670). Participants were adults age 20-49 years who self-reported sociodemographic characteristics and health conditions, and had examination/laboratory measures for hypertension, hyperlipidemia, diabetes, obesity, and chronic kidney disease. Prevalences of sociodemographic characteristics and health status were determined by study period. Logistic regression was used to determine the odds [odds ratio (OR), 95% confidence interval] of health conditions by study period: models adjusted only for age, sex, and race, and fully adjusted models additionally adjusted for socioeconomic characteristics, smoking, BMI, diabetes, and/or hypertension (depending on the outcome) were assessed., Results: Participants in 2009-2012 were significantly more likely to be obese and have diabetes compared to those in 1971-1975 (OR = 4.98, 3.57-6.97; OR = 3.49, 1.59-7.65, respectively, fully adjusted). Participants in 2009-2012 vs. 1988-1994 were significantly more likely to have had hypertension but uncontrolled hypertension was significantly less likely (OR = 0.67, 0.52-0.86, fully adjusted). There was no difference over time for high cholesterol, but uncontrolled high cholesterol was significantly less likely in 2009-2012 vs. 1988-1994 (OR = 0.80, 0.68-0.94, fully adjusted). The use of hypertensive and cholesterol medications increased while chronic kidney and cardiovascular diseases were relatively stable., Conclusions: Cardiovascular risk factors of younger U.S. adults have worsened over the past 40 years, but treatment for hypertension and high cholesterol has improved. The sub-optimal and worsening health in younger adults may have a substantial impact on health care utilization and costs, and should be considered when developing health care practices., Competing Interests: The affiliation between the National Institute of Diabetes and Digestive and Kidney Diseases and Social & Scientific Systems, Inc. does not alter our adherence to the PLOS ONE policies on sharing data and materials.
- Published
- 2016
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50. Prevalence of Diabetes in Adolescents Aged 12 to 19 Years in the United States, 2005-2014.
- Author
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Menke A, Casagrande S, and Cowie CC
- Subjects
- Adolescent, Child, Female, Humans, Male, Nutrition Surveys statistics & numerical data, Prevalence, United States epidemiology, Diabetes Mellitus epidemiology
- Published
- 2016
- Full Text
- View/download PDF
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