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BACKGROUND: Both the incidence of diabetes mellitus and consumption of sugar-sweetened beverages are high in the Hispanic/Latino population in the United States. The associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers in the diverse Hispanic/Latino population in the United States are unknown. OBJECTIVES: The objective of this study was to examine the cross-sectional associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers such as fasting glucose and insulin, 2-h oral-glucose-tolerance test, HOMA-IR, HOMA index for β-cell function (HOMA-B), and glycated hemoglobin (HbA1c) among US Hispanic/Latino adults. METHODS: Using baseline data from the Hispanic Community Health Study/Study of Latinos (2008–2011), beverage consumption was ascertained using two 24-h dietary recalls and a food propensity questionnaire. Diabetes/prediabetes status was defined by self-report, antihyperglycemic medication use, and American Diabetes Association laboratory criteria. Among 9965 individuals without diabetes (5194 normoglycemia, 4771 prediabetes) aged 18–74 y, the associations of beverage consumption with prediabetes and glucose metabolism markers were analyzed using logistic and linear regressions, respectively, accounting for complex survey design. RESULTS: Compared with individuals who consumed 2 servings/d (>480 mL/d) had 1.3 times greater odds of having prediabetes (95% CI: 1.06, 1.61) and higher glucose metabolism markers including fasting glucose, fasting insulin, HOMA-IR, and HbA1c. Consumption of artificially sweetened beverages showed an inverse association with β-cell function (HOMA-B). Intake of 100% fruit juice was not significantly associated with prediabetes nor with glucose metabolism markers. CONCLUSIONS: Among US Hispanic/Latino adults, higher sugar-sweetened beverage consumption was associated with increased odds of prediabetes and higher glucose metabolism markers. Public health initiatives to decrease sugar-sweetened beverage consumption could potentially reduce the burden of diabetes among Hispanics/Latinos in the United States.

This was a cross-sectional study associating vitamin D, calcium, magnesium, and potassium intakes with markers of glucose metabolism in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is a multicenter, prospective, population-based cohort study on Hispanics/Latinos aged 18–74 years in the US. For this analysis, we included 10,609 participants who were free of diabetes. Analysis of covariance was used to assess associations of a range of micronutrient intake on the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Hemoglobin A1c (HbA1c), and 2-hour post-oral glucose tolerance test (2h-plasma glucose) separately for normoglycemic and with pre-diabetes, after controlling for important confounders. All analyses accounted for the complex sample design and sampling weights. HOMA-IR levels were significantly lower among adults with intakes in the highest quartile for vitamin D, magnesium, and potassium compared to the respective lowest quartiles, for those with normoglycemia and pre-diabetes, even after adjusting for confounders, such as diet quality (p

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.

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 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.

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.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.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).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.

OBJECTIVE To assess national changes in health insurance coverage and related costs before and after implementation of the Affordable Care Act (ACA) among U.S. adults with diabetes. RESEARCH DESIGN AND METHODS Data were cross-sectional from the 2009 and 2016 National Health Interview Surveys (NHIS). Participants were adults age ≥18 years with a previous diagnosis of diabetes who self-reported on their health insurance coverage, demographic information, diabetes-related factors, and amount spent on medical expenses and insurance premiums (N = 6,220). RESULTS Among adults with diabetes age 18–64 years, health insurance coverage increased from 84.7% in 2009 to 90.1% in 2016 (P < 0.001). Coverage remained near universal for those age ≥65 years (99.5%). For adults age 18–64 years, coverage increased for almost all subgroups and significantly for men; non-Hispanic whites, non-Hispanic blacks, and Hispanics; those who were married; those with less than or more than a high school education, family income 15 years; and those taking oral agents (P < 0.05 for all). Among adults age 18–64 years, Medicaid coverage significantly increased between 2009 and 2016 (19.4% vs. 24.3%, P = 0.006), and for those with private insurance, 7.8% acquired their plan through HealthCare.gov. For adults age ≥65 years, private insurance decreased and Medicare Part D increased (P < 0.007 for both). Among those age 18–64 years with an income CONCLUSIONS Health insurance coverage among adults with diabetes age 18–64 years increased significantly after implementation of the ACA, and medical costs to families decreased among those with lower incomes.

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.

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.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.The overall prevalence of A1c7.0% (53 mmol/mol), BP130/80 mm Hg, and LDL-C100 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 A1c7.0% (53 mmol/mol) or LDL-C100 mg/dL compared to those aged 65 to 74 years; younger adults were more likely to have BP130/80 mm Hg (P.05 for all). Individuals of Mexican heritage were significantly less likely to have A1c7.0% (53 mmol/mol) compared to those with Cuban heritage, but they were more likely to have BP130/80 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.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.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.

Previous evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease, for which persons with diabetes are at increased risk. We examined the association between heart rate and levels of glycemia in a nationally representative sample of U.S. adults. This study included 27,602 adults age ≥20 years from the 2011-2014 National Health and Nutrition Examination Surveys. Levels of glycemia were defined as: diagnosed diabetes (self-report); undiagnosed diabetes [fasting plasma glucose (FPG) ≥126mg/dL or A1c ≥6.5%]; prediabetes (FPG 100-125mg/dL or A1c 5.7%-6.4%); normoglycemia (FPG In conclusion, mean HR was higher among persons with diabetes and increased glycemia, which may reflect subtle autonomic and/or myocardial dysfunction among those with diabetes. Disclosure S. Casagrande: None. C.C. Cowie: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., Amgen Inc., Fresenius SE & Co. KGaA, General Electric, Johnson & Johnson, Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc. J.M. Sosenko: None. K.R. Mizokami-Stout: None. A.J. Boulton: None. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association. Funding National Institute of Diabetes and Digestive and Kidney Diseases

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

Diet modification is a mainstay of diabetes management. US Hispanics/Latinos are disproportionately affected by diabetes, but few studies have examined dietary intake among US Hispanics/Latinos with diabetes, and little is known regarding the influence of diabetes awareness on dietary intake.We evaluated macronutrient intake and its associations with diabetes awareness and glycemic control among US Hispanics/Latinos with diabetes.This analysis included 3310 diabetic adults aged 18–74 years from the Hispanic Community Health Study/Study of Latinos (2008–2011).Diabetes was defined as diagnosed (based on medical history or antihyperglycemic medication use) or undiagnosed diabetes (based on fasting glucose ≥ 126 mg/dL, glycated hemoglobin [HbA1c] ≥ 6.5%, or 2 h glucose ≥ 200 mg/dL in the absence of a physician diagnosis). Dietary intake was assessed using two 24-hour recalls.Among Hispanic/Latino adults with diabetes, 21.2%, 55.7%, and 71.2% met the American Diabetes Association recommendations for fiber (≥14 g per 1000 kcal), saturated fat (10% of total energy), and cholesterol intake (300 mg), respectively. Compared with those with undiagnosed diabetes, people with diagnosed diabetes consumed less carbohydrate (50.3 vs 52.4% of total energy; P = .017), total sugar (19.1 vs 21.5% of total energy; P = .002), added sugar (9.8 vs 12.1% of total energy; P.001), and more total fat (30.7 vs 29.3% of total energy; P = .048) and monounsaturated fat (11.5 vs 10.7% of total energy; P = .021). Association between diabetes awareness and low total and added sugar intake was observed in individuals of Mexican and Puerto Rican background but not in other groups (P for interaction.05). Among people with diagnosed diabetes, those with HbA1c of 7% or greater consumed more total fat, saturated fat, and cholesterol than those with HbA1c less than 7% (all P.05).Among US Hispanics/Latinos with diabetes, fiber intake is low, and diabetes awareness is associated with reduced carbohydrate and sugar intake and increased monounsaturated fat intake. Sugar intake may require special attention in certain Hispanic/Latino background groups.

IntroductionDefining 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 methodsThis 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.ResultsThe percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis 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.ConclusionsEstimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification.

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.

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 HbA1c , 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.

The purposes of this study were to describe how medication prices are established, to explain why antihyperglycemic medications have become so expensive, to show trends in expenditures for antihyperglycemic medications, and to highlight strategies to control expenditures in the USA. In the U.S., pharmaceutical manufacturers set the prices for new products. Between 2002 and 2012, expenditures for antihyperglycemic medications increased from $10 billion to $22 billion. This increase was primarily driven by expenditures for insulin which increased sixfold. The increase in insulin expenditures may be attributed to several factors: the shift from inexpensive beef and pork insulins to more expensive genetically engineered human insulins and insulin analogs, dramatic price increases for the available insulins, physician prescribing practices, policies that limit payers’ abilities to negotiate prices, and nontransparent negotiation of rebates and discounts. The costs of antihyperglycemic medications, especially insulin, have become a barrier to diabetes treatment. While clinical interventions to shift physician prescribing practices towards lower cost drugs may provide some relief, we will ultimately need policy interventions such as more stringent requirements for patent exclusivity, greater transparency in medication pricing, greater opportunities for price negotiation, and outcomes-based pricing models to control the costs of antihyperglycemic medications.

Background Federal law requires certain private insurers to cover and waive patient cost sharing for preventive medical services that receive a grade of B or better from the U.S. Preventive Services Task Force (USPSTF). The USPSTF recommends that asymptomatic adults who have a blood pressure (BP) higher than 135/80 mmHg be screened for type 2 diabetes. Purpose The goals of this study were to determine the sensitivity and specificity of the USPSTF screening criteria and to determine the prevalence of cardiovascular risk factors and comorbidity among undiagnosed individuals by USPSTF criteria. Methods Data come from 7189 adults who participated in the 2003–2010 National Health and Nutrition Examination Survey; statistical analysis was conducted in 2011–2012. Participants with fasting plasma glucose ≥126 mg/dL or hemoglobin A1c (HbA1c) ≥6.5% who did not self-report a diagnosis of diabetes were categorized as having undiagnosed diabetes. Results Among people without diagnosed diabetes, 4.0% had undiagnosed diabetes. The proportion of adults with undiagnosed diabetes who were identified (sensitivity) using BP >135/80 mmHg as the screening standard was 44.4%; among individuals without undiagnosed diabetes, 74.8% had BP ≤135/80 mmHg (specificity). For those with undiagnosed diabetes, the prevalence of HbA1c 7.0%– 135/80 mmHg; and 12.8% and 9.4% for HbA1c ≥8.0%, respectively. Elevated low-density lipoprotein (100–160 mg/dL) was similar by BP cut-point (52%–53%). For those with BP ≤135/80 mmHg, 16.7% had a history of cardiovascular disease and 22.9% had chronic kidney disease. Conclusions The USPSTF screening recommendations result in missing more than half of those who have undiagnosed diabetes, and a substantial proportion of these people have increased low-density lipoprotein and other cardiovascular risk factors.

OBJECTIVE To determine the prevalence of people with diabetes who meet hemoglobin A1c (A1C), blood pressure (BP), and LDL cholesterol (ABC) recommendations and their current statin use, factors associated with goal achievement, and changes in the proportion achieving goals between 1988 and 2010. RESEARCH DESIGN AND METHODS Data were cross-sectional from the National Health and Nutrition Examination Surveys (NHANES) from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Participants were 4,926 adults aged ≥20 years who self-reported a previous diagnosis of diabetes and completed the household interview and physical examination (n = 1,558 for valid LDL levels). Main outcome measures were A1C, BP, and LDL cholesterol, in accordance with the American Diabetes Association recommendations, and current use of statins. RESULTS In 2007–2010, 52.5% of people with diabetes achieved A1C CONCLUSIONS Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups. Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes-related morbidity and mortality.

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.

OBJECTIVE To compare health insurance coverage and type of coverage for adults with and without diabetes. RESEARCH DESIGN AND METHODS The data used were from 2,704 adults who self-reported diabetes and 25,008 adults without reported diabetes in the 2009 National Health Interview Survey. Participants reported on their current type of health insurance coverage, demographic information, diabetes-related factors, and comorbidities. If uninsured, participants reported reasons for not having health insurance. RESULTS Among all adults with diabetes, 90% had some form of health insurance coverage, including 85% of people 18–64 years of age and ∼100% of people ≥65 years of age; 81% of people without diabetes had some type of coverage (vs. diabetes, P < 0.0001), including 78% of people 18–64 years of age and 99% of people ≥65 years of age. More adults 18–64 years of age with diabetes had Medicare coverage (14% vs. no diabetes, 3%; P < 0.0001); fewer people with diabetes had private insurance (58% vs. no diabetes, 66%; P < 0.0001). People 18–64 years of age with diabetes more often had two health insurance sources compared with people without diabetes (13 vs. 5%, P < 0.0001). The most common private plan was a preferred provider organization (PPO) followed by a health maintenance organization/independent practice organization (HMO/IPA) plan regardless of diabetes status. For participants 18–64 years of age, high health insurance cost was the most common reason for not having coverage. CONCLUSIONS Two million adults

An improved understanding of which groups are more likely to be unaware of their diabetes may lead to more efficient screening, improved awareness, and overall better treatment for diabetes. Our objective was to investigate factors associated with being unaware of having diabetes among adults with diagnosed and undiagnosed diabetes. The 2011–2014 National Health and Nutrition Examination Survey (NHANES) is a stratified, multistage probability survey representative of the civilian, noninstitutionalized U.S. population (1). Data were collected during an in-home interview and a visit to a mobile examination center. We used data from 1,879 participants with either diagnosed or undiagnosed diabetes (based on a single measurement of A1C, fasting plasma glucose, or 2-h plasma glucose). Using logistic regression, we calculated odds ratios of being unaware of diabetes associated with age, race/ethnicity, sex, gestational diabetes mellitus (GDM), family history of diabetes, education, household income, smoking status, BMI, work-time activity, leisure-time activity, no health insurance, location of routine health …

To assess the effectiveness of an intervention to reduce the calorie content of meals served at two psychiatric rehabilitation programs. Intervention staff assisted kitchen staff with ways to reduce calories and improve the nutritional quality of meals. Breakfast and lunch menus were collected before and after a 6-month intervention period. ESHA software was used to determine total energy and nutrient profiles of meals. Total energy of served meals significantly decreased by 28% at breakfast and 29% at lunch for site 1 (P

ObjectiveTo study the association between the availability of healthy foods and BMI by neighbourhood race and socio-economic status (SES).DesignTrained staff collected demographic information, height, weight and 24 h dietary recalls between 2004 and 2008. Healthy food availability was determined in thirty-four census tracts of varying racial and SES composition using the Nutrition Environment Measures Survey–Stores in 2007. Multilevel linear regression was used to estimate associations between healthy food availability and BMI.SettingBaltimore City, Maryland, USA.SubjectsAdults aged 30–64 years (n 2616) who participated in the Healthy Aging in Neighborhoods of Diversity across the Life Span study.ResultsAmong individuals living in predominantly white neighbourhoods, high availability of healthy foods was associated with significantly higher BMI compared with individuals living in neighbourhoods with low availability of healthy food after adjustment for demographic variables (β = 3·22, P = 0·001). Associations were attenuated but remained significant after controlling for dietary quality (β = 2·81, P = 0·012).ConclusionsContrary to expectations, there was a positive association between the availability of healthy food and higher BMI among individuals living in predominantly white neighbourhoods. This result could be due to individuals in neighbourhoods with low healthy food availability travelling outside their neighbourhood to obtain healthy food.

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.

Diabetes and depression are common comorbid conditions. Although certain health behaviors and risk factors partially explain the association of depression and diabetes, other potential mechanisms have yet to be elucidated. Certain neuroendocrine alterations such as activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) may contribute to the association. Additionally, presence of a proinflammatory state shown in recent literature in both diabetes and depression may contribute to this as well. The objectives of this review are to summarize and review the recent evidence showing alterations of these three biological systems-HPA axis, SNS, and inflammatory cascade--in depression, diabetes, and diabetes-related risk factors.

Context An overall understanding of environmental factors that affect weight-related behaviors and outcomes in African American adults is limited. This article presents a summarization of the literature on the built environment and its association with physical activity, diet, and obesity among African Americans. Evidence acquisition A systematic review was conducted by searching the PubMed electronic database from inception to July 31, 2007, reviewing bibliographies of eligible articles, and searching authors' personal databases using various search terms for the built environment, physical activity, diet, and obesity. Eligible articles were observational studies that included a study population ≥90% African American (or subgroup analysis), adults (≥18 yrs), and were published in English; final article data abstraction occurred from October 2007 through February 2008. Evidence synthesis A total of 2797 titles were identified from the initial search, and 90 were deemed eligible for abstract review. Of these, 17 articles were eligible for full review and ten met all eligibility criteria. The median sample size was 761 (234 to 10,623), and half of the articles included only African Americans. Light traffic, the presence of sidewalks, and safety from crime were more often positively associated with physical activity, although associations were not consistent (OR range = 0.53–2.43). Additionally, perceived barriers to physical activity were associated with obesity. The presence of supermarkets and specialty stores was consistently positively associated with meeting fruit and vegetable guidelines. Conclusions With relatively few studies in the literature focused on African Americans, more research is needed to draw conclusions on features of the built environment that are associated with physical activity, diet, and obesity.

Previous research indicates that few Americans meet the United States Department of Agriculture (USDA) guidelines for fruit and vegetable consumption, and that adequate fruit and vegetable consumption may decrease the risk for chronic disease.Twenty-four-hour dietary recall data from NHANES III, 1988-1994 (n=14,997) and NHANES 1999-2002 (n=8910) were used to assess adult (equal to or more than 18 years) trends in daily fruit and vegetable consumption (number of servings and types).In 1988-1994, an estimated 27% of adults met the USDA guidelines for fruit (equal to or more than two servings) and 35% met the guidelines for vegetables (equal to or more than three servings). In 1999-2002, 28% and 32% of adults met fruit and vegetable guidelines, respectively. There was a significant decrease in vegetable consumption over time (p=0.026). Only 11% met USDA guidelines for both fruits and vegetables in 1988-1994 and 1999-2002, indicating no change in consumption (p=0.963). In both data sets, non-Hispanic blacks were less likely to meet USDA guidelines compared to non-Hispanic whites (p0.05). Higher income and greater education were significantly associated with meeting the guidelines in both data sets (p0.05).Despite the initiation of a national fruit and vegetable campaign in 1991, the findings indicated that Americans' fruit and vegetable consumption did not increase in 1999-2002, and only a small proportion met the related dietary recommendations. Greater public health efforts and approaches are needed to promote healthy eating in the United States.

Background Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities. Objective To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community. Design A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study. Participants Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md. Measurements An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care. Results For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR]=1.8, 2.6; OR=2.2, 3.3, respectively; all P

Early detection of type 2 diabetes has the potential to prevent complications, but the prevalence of opportunistic screening is unknown.To describe the prevalence of diabetes screening by demographic and diabetes-related factors and to determine predictors of screening among a representative U.S. population without self-reported diabetes.Cross-sectional data were obtained from the 2005-2010 National Health and Nutrition Examination Survey (n=15,125) and 2006 National Health Interview Survey (n=21,519). Participants were aged ≥20 years and self-reported having a diabetes screening test in the past 3 years. Diabetes screening prevalence was analyzed according to risk factors recommended by the American Diabetes Association. Logistic regression was used to determine significant predictors of diabetes screening. Analysis was conducted in 2012-2013.The prevalence of having a blood test for diabetes in the past 3 years was 42.1% in 2005-2006, 41.6% in 2007-2008, and 46.8% in 2009-2010. This prevalence increased with age and was higher for women, non-Hispanic whites, and those with more education and income (p0.001 for all). BMI ≥25, age ≥45 years, having a relative with diabetes, hypertension, glycosylated hemoglobin ≥5.7%, and cardiovascular disease history were significant predictors of screening. For each additional risk factor, the likelihood of screening increased by 51%.Nearly half of the adult population reported having a diabetes screening test. However, testing was less prevalent in minorities and those with lower socioeconomic status. Public health efforts to address these deficiencies in screening are needed.

Previous studies have found a positive association between psoriasis and diabetes/diabetes-related complications, but the association has not been studied in a nationally representative U.S. sample. Our analysis of NHANES data indicated that psoriasis was not associated with diabetes but was positively associated with hypertension, overweight/obesity and waist circumference.

Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness.We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months.Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was -3.2 kg (-7.0 lb, P=0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P=0.009). There were no significant between-group differences in adverse events.A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694.).

OBJECTIVE We examined the prevalence of knowledge of A1C, blood pressure, and LDL cholesterol (ABC) levels and goals among people with diabetes, its variation by patient characteristics, and whether knowledge was associated with achieving levels of ABC control recommended for the general diabetic population. RESEARCH DESIGN AND METHODS Data came from 1,233 adults who self-reported diabetes in the 2005–2008 National Health and Nutrition Examination Survey. Participants reported their last ABC level and goals specified by their physician (not validated by medical record data). Analysis included descriptive statistics and logistic regression. RESULTS Among participants tested in the past year, 48% stated their last A1C level. Overall, 63% stated their last blood pressure level and 22% stated their last LDL cholesterol level. Knowledge of ABC levels was greatest in non-Hispanic whites, lowest in Mexican Americans, and higher with more education and income (all P ≤ 0.02). Demographic associations were similar for those reporting physician-specified ABC goals at the American Diabetes Association–recommended levels (A1C CONCLUSIONS Ample opportunity exists to improve ABC knowledge. Diabetes education should include behavior change components in addition to information on ABC clinical measures.

Objectives. To investigate the association between walkability and obesity, we studied adults residing in Baltimore City, Maryland, in neighborhoods of varying racial and socioeconomic composition. Methods. We conducted a cross-sectional study of 3493 participants from the study Healthy Aging in Neighborhoods of Diversity across the Life Span. We used the Pedestrian Environment Data Scan to measure neighborhood walkability in 34 neighborhoods of diverse racial and socioeconomic composition in which the study participants lived. Confirmatory factor analysis was used to determine walkability scores. Multilevel modeling was used to determine prevalence ratios for the association between walkability and obesity. Results. Among individuals living in predominately White and high-socioeconomic status (SES) neighborhoods, residing in highly walkable neighborhoods was associated with a lower prevalence of obesity when compared with individuals living in poorly walkable neighborhoods, after adjusting for individual-level demographic variables (prevalence ratio–[PR] = 0.58; P = Conclusions. Future research is needed to determine how differences in associations by neighborhood characteristics may contribute to racial disparities in obesity.

OBJECTIVE: Suboptimal diet may be related to the high prevalence of obesity and cardiovascular disease (CVD) in persons with serious mental illnesses, but few studies have characterized dietary intake in this population. METHODS: Participants were 102 overweight/obese adults with serious mental illnesses who were being screened for a weight loss trial in psychiatric rehabilitation centers. Direct observation of participant meals was completed using a standardized measurement form. RESULTS: CVD risk factors were common: mean body mass index was 35.7 kg/m(2); 30% had diabetes. Participants consumed 100% of caloric beverages served (7.2 oz/meal) but consumption was significantly less than served for fruits (difference of 0.12 cups/meal, p=0.003) and vegetables (0.14 cups/meal, p=0.02i). The majority (56%) of meat consumed was high fat. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Interventions designed to improve dietary intake of persons with serious mental illnesses are needed to improve health in this population at high risk for CVD.

Publisher Summary A lack of an improvement in Fruit and Vegetable (FV eating out is common and convenient but facilitates consumption of larger portion sizes with extra energy and fat content; advertising for nutritionally poor foods is much more widespread than for the promotion of FV access to fruits and vegetables may be limited in disadvantaged neighborhoods. Third, confusion over implementing the Dietary Guidelines into daily practice deters individuals from trying to meet F&V recommendations. Without formal education or access to pertinent information, many Americans are missing important messages about the health benefits of including F&V in their daily diet. Consumption of fruits and vegetables among US adults is below United States Department of Agriculture (USDA) recommended servings. Low consumption has a negative effect on a healthy diet. A healthy diet that includes a variety of fruits and vegetables may protect against preventable chronic diseases including cardiovascular disease and diabetes. To increase consumption, concerted efforts must address individual behaviors and the social and physical environments in which individuals interact and obtain fruits and vegetables.

An overall understanding of environmental factors that affect weight-related behaviors and outcomes in African American adults is limited. This article presents a summarization of the literature on the built environment and its association with physical activity, diet, and obesity among African Americans.A systematic review was conducted by searching the PubMed electronic database from inception to July 31, 2007, reviewing bibliographies of eligible articles, and searching authors' personal databases using various search terms for the built environment, physical activity, diet, and obesity. Eligible articles were observational studies that included a study populationor=90% African American (or subgroup analysis), adults (or=18 yrs), and were published in English; final article data abstraction occurred from October 2007 through February 2008.A total of 2797 titles were identified from the initial search, and 90 were deemed eligible for abstract review. Of these, 17 articles were eligible for full review and ten met all eligibility criteria. The median sample size was 761 (234 to 10,623), and half of the articles included only African Americans. Light traffic, the presence of sidewalks, and safety from crime were more often positively associated with physical activity, although associations were not consistent (OR range = 0.53-2.43). Additionally, perceived barriers to physical activity were associated with obesity. The presence of supermarkets and specialty stores was consistently positively associated with meeting fruit and vegetable guidelines.With relatively few studies in the literature focused on African Americans, more research is needed to draw conclusions on features of the built environment that are associated with physical activity, diet, and obesity.

Previous studies have shown increasing prevalence of diabetes in the United States. New US data are available to estimate prevalence of and trends in diabetes.To estimate the recent prevalence and update US trends in total diabetes, diagnosed diabetes, and undiagnosed diabetes using National Health and Nutrition Examination Survey (NHANES) data.Cross-sectional surveys conducted between 1988-1994 and 1999-2012 of nationally representative samples of the civilian, noninstitutionalized US population; 2781 adults from 2011-2012 were used to estimate recent prevalence and an additional 23,634 adults from 1988-2010 were used to estimate trends.The prevalence of diabetes was defined using a previous diagnosis of diabetes or, if diabetes was not previously diagnosed, by (1) a hemoglobin A1c level of 6.5% or greater or a fasting plasma glucose (FPG) level of 126 mg/dL or greater (hemoglobin A1c or FPG definition) or (2) additionally including 2-hour plasma glucose (2-hour PG) level of 200 mg/dL or greater (hemoglobin A1c, FPG, or 2-hour PG definition). Prediabetes was defined as a hemoglobin A1c level of 5.7% to 6.4%, an FPG level of 100 mg/dL to 125 mg/dL, or a 2-hour PG level of 140 mg/dL to 199 mg/dL.In the overall 2011-2012 population, the unadjusted prevalence (using the hemoglobin A1c, FPG, or 2-hour PG definitions for diabetes and prediabetes) was 14.3% (95% CI, 12.2%-16.8%) for total diabetes, 9.1% (95% CI, 7.8%-10.6%) for diagnosed diabetes, 5.2% (95% CI, 4.0%-6.9%) for undiagnosed diabetes, and 38.0% (95% CI, 34.7%-41.3%) for prediabetes; among those with diabetes, 36.4% (95% CI, 30.5%-42.7%) were undiagnosed. The unadjusted prevalence of total diabetes (using the hemoglobin A1c or FPG definition) was 12.3% (95% CI, 10.8%-14.1%); among those with diabetes, 25.2% (95% CI, 21.1%-29.8%) were undiagnosed. Compared with non-Hispanic white participants (11.3% [95% CI, 9.0%-14.1%]), the age-standardized prevalence of total diabetes (using the hemoglobin A1c, FPG, or 2-hour PG definition) was higher among non-Hispanic black participants (21.8% [95% CI, 17.7%-26.7%]; P .001), non-Hispanic Asian participants (20.6% [95% CI, 15.0%-27.6%]; P = .007), and Hispanic participants (22.6% [95% CI, 18.4%-27.5%]; P .001). The age-standardized percentage of cases that were undiagnosed was higher among non-Hispanic Asian participants (50.9% [95% CI, 38.3%-63.4%]; P = .004) and Hispanic participants (49.0% [95% CI, 40.8%-57.2%]; P = .02) than all other racial/ethnic groups. The age-standardized prevalence of total diabetes (using the hemoglobin A1c or FPG definition) increased from 9.8% (95% CI, 8.9%-10.6%) in 1988-1994 to 10.8% (95% CI, 9.5%-12.0%) in 2001-2002 to 12.4% (95% CI, 10.8%-14.2%) in 2011-2012 (P .001 for trend) and increased significantly in every age group, in both sexes, in every racial/ethnic group, by all education levels, and in all poverty income ratio tertiles.In 2011-2012, the estimated prevalence of diabetes was 12% to 14% among US adults, depending on the criteria used, with a higher prevalence among participants who were non-Hispanic black, non-Hispanic Asian, and Hispanic. Between 1988-1994 and 2011-2012, the prevalence of diabetes increased in the overall population and in all subgroups evaluated.

Objective Several studies have found a U-shaped association between body mass index (BMI) and mortality in the general population. In similar studies among people with diabetes, the shape of the association is inconsistent. We investigated the relationship of BMI and waist circumference with mortality among people with diabetes. Setting The Third National Health and Nutrition Examination Survey (NHANES III) and the 1999–2004 NHANES Mortality Studies were designed to be representative of the US general population. Baseline data were collected in 1988–2004. Participants 2607 adults ≥20 years of age with diabetes. Primary Outcome Measure Participants were followed through 31 December 2006 for mortality (n=668 deaths). Results Compared with people with a BMI 18.5–24.9 kg/m2, the HRs (95% CI) of mortality were 0.85 (0.60 to 1.21) for 25–29.9 kg/m2, 0.87 (0.57 to 1.33) for 30–34.9 kg/m2 and 1.05 (0.72 to 1.53) for ≥35 kg/m2 after adjustment for age, sex, race-ethnicity, smoking status, education, income and diabetes duration. Compared with people in the lowest sex-specific quartile of waist circumference, the adjusted HRs (95% CI) of mortality were 1.03 (0.77 to 1.37) for the second quartile, 1.02 (0.73 to 1.42) for the third quartile and 1.12 (0.77 to 1.61) for the highest quartile of waist circumference. When modelled as a restricted quadratic spline with knots at the 10th, 50th and 90th centiles, BMI and waist circumference were not associated with mortality. Several sensitivity analyses were conducted and most found no significant association between measures of adiposity and mortality, but there were significant results suggesting a U-shaped association among people in the highest tertile of glycated haemoglobin (≥7.1%), and there was an inverse association between BMI and mortality among people 20–44 years of age. Conclusions In a nationally representative sample of the non-institutionalised US population with diabetes, BMI and waist circumference were not associated with risk of mortality.

Background Studies investigating the association between telomere length and diabetes have been inconsistent, and there are few data available investigating the associations of telomere length with diabetes duration and control. We evaluated the relationship of leukocyte telomere length with diabetes, and the relationship of leukocyte telomere length with diabetes duration and poor glucose control among people with diabetes. Methods We used data from the 1999–2002 National Health and Nutrition Examination Survey, a representative sample of the US civilian non-institutionalized population. In 3921 participants, leukocyte telomere length was measured and diabetes status was determined based on a previous diagnosis, hemoglobin A1c ≥6.5 %, or fasting glucose ≥126 mg/dL. Results The odds ratios (95 % confidence intervals) of diabetes associated with the first, second, and third quartile of leukocyte telomere length, compared to the highest quartile, was 2.09 (1.46–2.98), 1.74 (1.30–2.31), and 1.08 (0.76–1.54), respectively (p-trend 0.05). Conclusions In this study of the US general population, leukocyte telomere length was not associated with diabetes status, diabetes duration, or diabetes control.

Background Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group. Methods/Design A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months. Discussion Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness. Trial Registration Clinical Trials.gov NCT00902694