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Introduction Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).Research design and methods GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017.Results Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes.Conclusions This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women.Trial registration number ClinicalTrials.gov (NCT01794143)

The affiliation details for Geltrude Mingrone are corrected below.

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.

The National Diabetes Education Program (NDEP) was established to translate findings from diabetes research studies into clinical and public health practice. Over 20 years, NDEP has built a program with partnership engagement that includes science-based resources for multiple population and stakeholder audiences. Throughout its history, NDEP has developed strategies and messages based on communication research and relied on established behavior change models from health education, communication, and social marketing. The program's success in continuing to engage diverse partners after 20 years has led to time-proven and high-quality resources that have been sustained. Today, NDEP maintains a national repository of diabetes education tools and resources that are high quality, science- and audience-based, culturally and linguistically appropriate, and available free of charge to a wide variety of audiences. This review looks back and describes NDEP's evolution in transforming and communicating diabetes management and type 2 diabetes prevention strategies through partnerships, campaigns, educational resources, and tools and identifies future opportunities and plans., (© 2018 by the American Diabetes Association.)

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus., (© 2015 by the American Diabetes Association and the American Heart Association, Inc.)

Despite current advances in engineering blood vessels over 1 mm in diameter and the existing wealth of knowledge regarding capillary bed formation, studies for the development of microvasculature, the connecting bridge between them, have been extremely limited so far. Here, we evaluate the use of 3-dimensional (3D) microfibers fabricated by hydrogel electrospinning as templates for microvascular structure formation. We hypothesize that 3D microfibers improve extracellular matrix (ECM) deposition from vascular cells, enabling the formation of freestanding luminal multicellular microvasculature. Compared to 2-dimensional cultures, we demonstrate with confocal microscopy and RT-PCR that fibrin microfibers induce an increased ECM protein deposition by vascular cells, specifically endothelial colony-forming cells, pericytes, and vascular smooth muscle cells. These ECM proteins comprise different layers of the vascular wall including collagen types I, III, and IV, as well as elastin, fibronectin, and laminin. We further demonstrate the achievement of multicellular microvascular structures with an organized endothelium and a robust multicellular perivascular tunica media. This, along with the increased ECM deposition, allowed for the creation of self-supporting multilayered microvasculature with a distinct circular lumen following fibrin microfiber core removal. This approach presents an advancement toward the development of human microvasculature for basic and translational studies., (© FASEB.)

Background: The increase in the prevalence of diabetes over the past few decades has coincided with an increase in certain risk factors for diabetes, such as a changing race/ethnicity distribution, an aging population, and a rising obesity prevalence., Objective: To determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults., Design: Cross-sectional, using data from 5 NHANES (National Health and Nutrition Examination Surveys): NHANES II (1976-1980), NHANES III (1988-1994), and the continuous NHANES 1999-2002, 2003-2006, and 2007-2010., Setting: Nationally representative samples of the U.S. noninstitutionalized civilian population., Patients: 23 932 participants aged 20 to 74 years., Measurements: Diabetes was defined as a self-reported diagnosis or fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or more., Results: Between 1976 to 1980 and 2007 to 2010, diabetes prevalence increased from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for trends for both groups < 0.001). After adjustment for age, race/ethnicity, and body mass index, diabetes prevalence increased in men (6.2% to 9.6%; P for trend < 0.001) but not women (7.6% to 7.5%; P for trend = 0.69). Body mass index was the greatest contributor among the 3 covariates to the change in prevalence estimates after adjustment., Limitation: Some possible risk factors, such as physical activity, waist circumference, and mortality, could not be studied because data on these variables were not collected in all surveys., Conclusion: The increase in the prevalence of diabetes was greater in men than in women in the U.S. population between 1976 to 1980 and 2007 to 2010. After changes in age, race/ethnicity, and body mass index were controlled for, the increase in diabetes prevalence over time was approximately halved in men and diabetes prevalence was no longer increased in women., Primary Funding Source: Centers for Disease Control and Prevention and National Institutes of Diabetes and Digestive and Kidney Diseases.

In microvascular vessels, endothelial cells are aligned longitudinally whereas several components of the extracellular matrix (ECM) are organized circumferentially. While current three-dimensional (3D) in vitro models for microvasculature have allowed the study of ECM-regulated tubulogenesis, they have limited control over topographical cues presented by the ECM and impart a barrier for the high-resolution and dynamic study of multicellular and extracellular organization. Here we exploit a 3D fibrin microfiber scaffold to develop a novel in vitro model of the microvasculature that recapitulates endothelial alignment and ECM deposition in a setting that also allows the sequential co-culture of mural cells. We show that the microfibers' nanotopography induces longitudinal adhesion and alignment of endothelial colony-forming cells (ECFCs), and that these deposit circumferentially organized ECM. We found that ECM wrapping on the microfibers is independent of ECFCs' actin and microtubule organization, but it is dependent on the curvature of the microfiber. Microfibers with smaller diameters (100-400 µm) guided circumferential ECM deposition, whereas microfibers with larger diameters (450 µm) failed to support wrapping ECM. Finally, we demonstrate that vascular smooth muscle cells attached on ECFC-seeded microfibers, depositing collagen I and elastin. Collectively, we establish a novel in vitro model for the sequential control and study of microvasculature development and reveal the unprecedented role of the endothelium in organized ECM deposition regulated by the microfiber curvature.

Context: Control of blood glucose levels, blood pressure, and cholesterol levels is proven to reduce the risk of vascular disease among individuals with diabetes mellitus; however, the current state of control of these risk factors among individuals in the United States is uncertain., Objectives: To examine 1999-2000 national data on control of risk factors for vascular disease among adults with previously diagnosed diabetes and to assess trends during the past decade., Design, Setting, and Participants: Review of data from the Third National Health and Nutrition Examination Survey (NHANES III, conducted 1988-1994) and NHANES 1999-2000, cross-sectional surveys of a nationally representative sample of the noninstitutionalized civilian US population. Participants were adults aged 20 years and older with previously diagnosed diabetes who participated in both the interview and examination in either NHANES III (n = 1265) or NHANES 1999-2000 (n = 441)., Main Outcome Measures: Levels of glycosylated hemoglobin (HbA1c), blood pressure, and total serum cholesterol in reference to target goals., Results: Compared with NHANES III, participants with previously diagnosed diabetes in NHANES 1999-2000 were similar by age and sex, were less likely to be non-Hispanic white, were diagnosed at an earlier age, had a higher body mass index, and were more likely to use insulin in combination with oral agents. In NHANES 1999-2000, only 37.0% of participants achieved the target goal of HbA1c level less than 7.0% and 37.2% of participants were above the recommended "take action" HbA1c level of greater than 8.0%; these percentages did not change significantly from NHANES III (P =.11 and P =.87, respectively). Only 35.8% of participants achieved the target of systolic blood pressure (SBP) less than 130 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg, and 40.4% had hypertensive blood pressure levels (SBP > or =140 or DBP > or =90 mm Hg). These percentages did not change significantly from NHANES III (P =.10 and P =.56, respectively). Over half (51.8%) of the participants in NHANES 1999-2000 had total cholesterol levels of 200 mg/dL or greater (vs 66.1% in NHANES III; P<.001). In total, only 7.3% (95% confidence interval, 2.8%-11.9%) of adults with diabetes in NHANES 1999-2000 attained recommended goals of HbA1c level less than 7%, blood pressure less than 130/80 mm Hg, and total cholesterol level less than 200 mg/dL (5.18 mmol/L)., Conclusion: Further public health efforts are needed to control risk factors for vascular disease among individuals with diagnosed diabetes.

Objective: There is some evidence to suggest that individuals with depression are at an almost twofold increased risk of developing type 2 diabetes mellitus, but results are far from conclusive. Therefore, to determine if depressive symptoms increased the risk of type 2 diabetes, we conducted longitudinal analyses using data from the NHANES I Epidemiologic Follow-up Survey (NHEFS)., Research Design and Methods: Participants included individuals who were white or African-American, did not report previous diagnosis of diabetes, and who completed the Centers for Epidemiologic Studies Depression (CES-D) questionnaire in the 1982-1984 study (n = 8870). Participants were followed up for incident-diagnosed diabetes through 1992 (mean follow-up 9.0 years)., Results: There were 1444 (15.9%) participants with high depressive symptoms in the 1982-1984 study (CES-D score > or = 16). During follow-up, there were 465 incident cases of diabetes. Incidence of diabetes was 6.9/1000 person years among those with high depressive symptoms, 6.0/1000 person years among those with moderate symptoms, and 5.0/1000 person years among those with no symptoms. After adjusting for age, sex, and race, the relative hazard (RH) of diabetes among those with high depressive symptoms was 1.27 (95% CI: 0.93 to 1.73) compared to those without symptoms. Further adjustment for education and known diabetes risk factors (body mass index and physical activity) further attenuated the relationship (RH 1.11, 95% CI: 0.79 to 1.56)., Conclusions: There was no increased incidence of diabetes for those with high or moderate depressive symptoms compared to those with no depressive symptoms. These results do not support the etiologic relationship of depression predisposing individuals to diabetes., (Copyright 2002 John Wiley & Sons, Ltd.)

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) actively supports technology-related research directed at development of new therapies for prevention and treatment of diabetes and its complications. Identification of the genetic and environmental contributors to diabetes and the molecular mechanisms through which they act will yield new targets for therapeutic development. Major efforts are also directed at development of beta-cell replacement therapy; improved methods for sensing glucose and delivering insulin; imaging technologies and other surrogate markers to detect disease progression; improved animal models for study of diabetes and its complications; and clinical trials to evaluate the safety and efficacy of new therapies. Application of genomic, proteomic and other new technologies to diabetes research, collaborations between diabetes researchers and researchers with technologies relevant to diabetes, and bench to bedside translational research are particularly encouraged. A variety of funding mechanisms are available to prospective researchers.

Three reported cases of Creutzfeldt-Jakob disease (CJD) in young adults who had received human growth hormone (hGH) raised concerns that pituitary-derived GH had been contaminated. Subsequently reported cases have confirmed this suspicion. The US Public Health Service is conducting an investigation to determine the extent of the problem of CJD in recipients of National Hormone Pituitary Program (NHPP) GH. In addition, other possible adverse effects of GH use including leukemia are being investigated. The design, conduct and current status of the study are the subject of this report. Interview data are now available on 5,240 of the 6,284 subjects treated by the NHPP for growth problems. Analysis is underway.