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Women of reproductive age are less prone to cardiovascular disease than men. However, diabetes mellitus negates this female advantage. The prevalence change of prediabetes (prediabetes mellitus) and diabetes mellitus and diabetes mellitus‒associated cardiovascular risk factors have not been clearly described in women before menopause.Using National Health and Nutrition Examination Survey data (1999-2018), this study estimated the age-adjusted prevalence of prediabetes mellitus (2005-2018), diagnosed diabetes mellitus, and undiagnosed diabetes mellitus in premenopausal women. Logistic regression was used to examine cardiovascular risk factors, including obesity, central obesity, hypercholesterolemia, hypertension, and hypertriglyceridemia, associated with prediabetes mellitus, diagnosed diabetes mellitus, or undiagnosed diabetes mellitus in premenopausal women. The magnitude of the association among age-matched men and postmenopausal women was compared. The analysis was conducted in 2022.Premenopausal women experienced an increased prevalence of prediabetes mellitus and undiagnosed diabetes mellitus, contrasting with steady trends in all U.S. adults over the last 2 decades. Premenopausal women with prediabetes mellitus or diabetes mellitus (versus those with normoglycemia) have significant obesity risk, and the risk is equivalent to that among age-matched men and higher than that among postmenopausal women. The association between prediabetes mellitus and hypercholesterolemia or hypertriglyceridemia was significant in premenopausal women only. Hypercholesterolemia and hypertension associated with undiagnosed diabetes mellitus were significant in premenopausal women and men of the same age, respectively. Diagnosed and undiagnosed diabetes mellitus was associated with hypertriglyceridemia in men and postmenopausal women, respectively.Premenopausal women had increased prediabetes mellitus and undiagnosed diabetes mellitus in the past 2 decades. They face a considerable cardiovascular risk burden associated with prediabetes mellitus and diabetes mellitus. Cardiometabolic risk screening and patient education should be improved in young and early middle-aged adults, particularly in women.

Background: Diabetes (DM) diminishes female protection against cardiovascular disease (CVD). Women with DM face excess CVD risk than men partly due to women’s greater deterioration in risk factors before DM. In this study, we compared sex differences in biomarkers that reflect distinct pathophysiological pathways during the pre-diabetes (pre-DM) stage. Method: A cross-sectional analysis was performed based on pooled data from Atherosclerosis Risk in Communities Study and the Jackson Heart Study. We used multivariable linear regressions to examine the associations between sex and biomarkers (log-transformed) representative of inflammation, lipoprotein, adipokine, kidney function, cardiac injury/stress, and thrombosis, adjusted for age, race, and BMI, among CVD-free individuals with pre-DM. We validated the results in a sensitivity analysis, including those that eventually progressed into DM during the follow-up. We used the false discovery rate method to adjust multiple comparisons. Results: Among 5975 individuals with pre-DM, the mean age was 54.2 years, 2853 (48%) were women, and 2022 (34%) were non-Hispanic blacks. In the adjusted models, inflammatory biomarkers, including high-sensitivity c-reactive proteins (β coefficient 0.2, P=2.9 x 10 -9 ), fibrinogen (β 0.19, P=2.8E-12), and absolute lymphocyte (β 0.25, P=2.54 x 10 -7 ), and cardiac injury/stress biomarker, NT-proBNT (β 0.14, P=0.0002) were higher in women than men with pre-DM. Additionally, lipoprotein(a) (β 0.19, P=4.96 x 10 -13 ) and apolipoproteins A1 (β 0.61, P=2.81x 10 -120 ), and adipokines including leptin (β 1.1, P=2.62 x 10 -123 ) and adiponectin (β 0.56, P=1.94 x 10 -12 ) were all higher in women with pre-DM. In contrast, kidney function markers, albumin (β -0.24, P=2.79 x 10 -9 ) and creatinine (β -1.1, P=1x 10 -100 ), and thrombosis biomarker, homocysteine (β -0.5, P=9.09 x 10 -19 ) were higher in men with pre-DM than in their women counterparts. These sex differences remained generally unchanged among 2320 individuals that progressed into DM. Conclusion: Biomarkers differ significantly between sexes during the pre-DM state. The inflammatory, lipoprotein, adipokine, and cardiac stress biomarkers were higher in women with pre-DM, while kidney function and thrombosis biomarkers were higher in men with pre-DM. Future mechanistic studies are warranted to delineate pathophysiological pathways characterized by these biomarkers contributing to sex disparities of CVD risk in DM.

This study describes the results of an evaluation of a holistic defense model for juvenile clients. Longitudinal, retrospective analysis of de-identified data from clients (N = 308) measured individual variable outcomes, relationships, and project performance. Bivariate and multivariate analyses examined the strength of association and interrelationships among client and defense team variables. Findings indicate that holistic defense was significantly associated with improved outcomes among juvenile clients, including increased mental health assessment resulting in treatment, increased employment and educational attainment, and decreased odds of recidivism. Favorable court or dispositional outcomes, including lower adjudication or early termination from custody, were also reported. Further practice-level, controlled research is necessary to evaluate these models and offer comparison to other models for holistic defense.

Aim: Evaluate if cardiovascular (CV) risk factors increase at a greater rate during the prediabetes (preDM) stage rather than the diabetes (DM) stage by sex. Methods: We pooled data from the Atherosclerosis Risk in Communities Study and the Multi-Ethnic Study of Atherosclerosis. The CV risk outcome was the metabolic syndrome (MetS) severity z-score derived from components of waist circumference, HDL, triglycerides, SBP, and fasting glucose accounting for the weight of each component. The score was calculated for participants at visits 1 to 4 (3-year interval between visits) . We used linear mixed regressions to model the MetS z-score over time in men and women by levels of glucose (normal Results: Men and women had a greater rate of change in MetS severity during the preDM than the DM stage. Women had a significantly greater increase of MetS severity than men during the preDM stage, while men had a significantly greater increase in the DM stage than women. Conclusion: A more rapid increase in MetS severity occurred in preDM than in DM. Women exhibited a faster increase in MetS severity compared to men during the preDM stage. Greater attention should be given to CV risk in women with preDM. Disclosure Y.Yoshida: None. Z.Chen: n/a. R.L.Baudier: None. M.Krousel-wood: None. A.H.Anderson: None. V.Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. F.Mauvais-jarvis: Consultant; Mithra Pharmaceutical. Funding NIH K12HD043451

BACKGROUND AND AIMS: The effect of MHT on cardiovascular disease (CVD) risk among women with prediabetes or type 2 diabetes (PreDM or T2DM) is unclear. We examined the association between ever or early use MHT and CVD risk in postmenopausal women with PreDM or T2DM, and the potential modifying effect of race. METHODS: 2,917 postmenopausal women with PreDM or T2DM were pooled from 3 prospective CVD cohorts (the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study). Ever (yes vs no) or early use of MHT (MHT initiated ≤ 5 vs > 5 years since menopause), and their associations with ischemic stroke, coronary heart disease (CHD), and atherosclerotic cardiovascular disease (ASCVD) were assessed using Cox proportional hazards models. RESULTS: During a median follow-up of 15 years, 264 stroke, 484 CHD, and 659 ASCVD events were observed. In fully adjusted models, ever use of MHT was associated with reduced risk of stroke (hazard ratio 0.86, 95% CI 0.76–0.98), CHD (0.85, 0.74–0.98), and ASCVD (0.83, 0.73–0.95) in white women with PreDM or T2DM. Early use of MHT was associated with reduced risk of stroke (0.82, 0.72–0.95), CHD (0.85, 0.74–0.98), and ASCVD (0.82, 0.70–0.96) in the white group. No risk reduction with ever or early use of MHT was found for black women with PreDM or T2DM. CONCLUSIONS: MHT is associated with statistically reduced CVD risk among white but not black women with PreDM or DM. Race is an effect modifier in the association between MHT use and CVD.

Context: Lay advisor interventions improve hypertension outcomes, especially in vulnerable populations. However, the incremental benefit of adding these interventions, and factors that could inform their widespread implementation, are unknown. Objective: Inform real-world choices about implementation of lay advisor hypertension interventions. Methods: We systematically searched several databases, including Medline, CINAHL, SCOPUS, from January 1, 1980 to December 2020. We included all study designs of hypertension interventions delivered solely by a lay advisor. Search terms for lay advisors included peers, community health workers, barbers, and faith-based activists. Studies of lay advisor interventions combined with other health professional interventions were excluded. Two independent reviewers coded eligible articles using a validated data extraction tool based on the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: Of 5986 unique citations, 21 were eligible for inclusion. Most studies showed improvements in hypertension outcomes, but outcomes predominantly were measured shortly after intervention completion. Inclusion/exclusion criteria and lay advisor recruitment and training were usually well-described, and primary outcomes were reported. Participation rates were infrequently reported. None reported adverse outcomes. Only 14% (3 of 21) of studies reported qualitative assessments. External validity domains of adoption, implementation, and maintenance were rarely reported. In the adoption domain, no study reported comparisons of delivery and non-delivery settings or staff representativeness. Presence of previous lay advisor programs in the community improved adoption and implementation. One study mentioned costs of implementation for maintenance. Conclusion: Few studies have examined the incremental effectiveness of adding a lay advisor intervention for hypertension outcomes, most show improvement. Indicators of external validity of lay advisor interventions are not well-reported. Future research designs should improve reporting across RE-AIM dimensions, particularly indicators of external validity, including qualitative assessments.

OBJECTIVE Early menopause may be associated with higher cardiovascular disease (CVD) risk. Type 2 diabetes mellitus (T2DM), coupled with early menopause, may result in even greater CVD risk in women. We examined CVD risk in women with early compared with normal-age menopause, with and without T2DM overall, and by race/ethnicity. RESEARCH DESIGN AND METHODS We pooled data from the Atherosclerosis Risk in Communities study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. We included women with data on menopausal status, menopausal age, and T2DM, excluding pre- or perimenopausal women and those with prevalent CVD. Outcomes included incident coronary heart disease (CHD), stroke, heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD) (CHD or stroke). We estimated the risk associated with early ( RESULTS We included 9,374 postmenopausal women for a median follow-up of 15 years. We observed 1,068 CHD, 659 stroke, 1,412 HF, and 1,567 ASCVD events. T2DM significantly modified the effect of early menopause on CVD risk. Adjusted hazard ratios for early menopause and the outcomes were greater in women with T2DM versus those without (CHD 1.15 [95% CI 1.00, 1.33] vs. 1.09 [1.03, 1.15]; stroke 1.21 [1.04, 1.40] vs. 1.10 [1.04, 1.16]; ASCVD 1.29 [1.09, 1.51] vs. 1.10 [1.04, 1.17]; HF 1.18 [1.00, 1.39] vs. 1.09 [1.03, 1.16]). The modifying effect of T2DM on the association between early menopause and ASCVD was only statistically significant in Black compared with White women. CONCLUSIONS Early menopause was associated with an increased risk for CVD in postmenopausal women. T2DM may further augment the risk, particularly in Black women.

The effect of Glucagon-like peptide 1 receptor agonists (GLP1 RA) on diabetic retinopathy (DR) remains controversial. Previous reviews combined data from randomized clinical trials (RCTs) with or without cardiovascular (CV) benefits and did not address confounders, therefore may have generated misleading results. The study aimed to examine the effect of GLP1RA on DR in type 2 diabetes (T2DM) in RCTs with or without CV benefits and distinguish the effect by major confounders.We conducted electronic searches of multiple databases and a manual search using references lists. We included 13 RCTs examining the effect of GLP1 RA on health outcomes/adverse events including DR or DR complications in T2DM. We performed a random-effects model meta-analysis.GLP1RA was associated with an elevated risk of rapidly worsening DR in four major RCTs with CV benefits in T2DM (OR 1.23, 95 % CI 1.05-1.44). The association between GLP1 RA and DR was significant in subgroups of RCTs with length over 52 weeks (1.2, 1.00-1.43), using placebo as a comparator (1.22, 1.05-1.42). In subgroups with patients who had T2DM ≥10 years (1.19, 0.99-1.42) or with subjects enrolled from multiple countries (1.2, 0.99-1.46), the association appeared to be evident but did not reach statistical significance.GLP1 RA including liraglutide, semaglutide, and dulaglutide are associated with an increased risk of rapidly worsening DR in RCTs with CV benefits. Further data from clinical studies with longer follow-up purposefully designed for DR risk assessment, particularly including patients of established DR are warranted.

Background: Early menopause may be associated with higher cardiovascular disease (CVD) risk due to the early cessation of estrogens protection. The presence of diabetes (DM) coupled with early menopause may result in even greater CVD risk in postmenopausal women. We compared CVD risk in women with early vs. normal age menopause with and without DM. Methods: We pooled data from the Atherosclerosis Risk in Communities Study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. Women with data on menopausal status, age at menopause and DM (yes/no) were included. We excluded pre- or peri-menopausal women, those with hysterectomy/oophorectomy or prevalent CVD. Outcomes were incident coronary heart disease (CHD), ischemic or hemorrhagic stroke, heart failure (HF), and a composite CVD outcome (CHD, stroke or HF). Cox models examined the risk associated with early ( Results: During a median follow-up of 15 yrs for 5964 postmenopausal women, 684 CHD, 434 stroke, 962 HF and 1535 CVD events occurred. In adjusted models, women with early menopause had elevated risk of CHD (Hazard ratio 1.12, 95% CI 1.03-1.22), stroke (1.09, 1.01-1.18) and HF (1.09, 1.00-1.19) compared to those with normal age menopause. DM was a significant effect modifier to the relationship between early menopause and CHD, stroke or CVD (P for interaction ≤0.05). HRs for early menopause and the outcomes were greater in diabetic than nondiabetic women (CHD 1.34, 1.02-1.78 vs. 1.10, 1.00-1.20; stroke 1.26, 0.98-1.61 vs. 1.07, 0.98-1.16; CVD 1.41, 1.01-1.95 vs. 1.04, 0.94-1.14). Conclusion: Early menopause increases risk for CVD in postmenopausal women; DM places this group at even higher CVD risk. Attention to CVD risk monitoring and management in women with early menopause, with and without diabetes, should be considered. Disclosure Y. Yoshida: None. Z. Chen: None. R. L. Baudier: None. M. Krousel-wood: None. A. H. Anderson: None. V. Fonseca: Consultant; Self; Abbott Diabetes, Asahi Kasei Corporation, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. F. Mauvais-jarvis: None. Funding National Institutes of Health (K12HD043451)

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces more severe symptoms and a higher mortality in men than in women. The role of biological sex in the immune response to SARS-CoV-2 is believed to explain this sex disparity. However, the contribution of gender factors that influence health protective behaviors and therefore health outcomes, remains poorly explored.MethodsWe assessed the contributions of gender in attitudes towards the COVID-19 pandemic, using a hypothetical influenza pandemic data from the 2014 Taiwan Social Change Survey. Participants were selected through a stratified, three-stage probability proportional-to-size sampling from across the nation, to fill in questionnaires that asked about their perception of the hypothetical pandemic, and intention to adopt health protective behaviors.ResultsA total of 1,990 participants (median age 45.92 years, 49% women) were included. Significant gender disparities (pConclusionThis study unveils gender differences in risk perception, health protective behaviors, vaccine hesitancy, and compliance with contact-tracing using a hypothetical viral pandemic. Gender-specific health education raising awareness of health protective behaviors may be beneficial to prevent future pandemics.

Objectives Determine if sex differences exist in clinical characteristics and outcomes of adults hospitalized for coronavirus disease 2019 (COVID-19) in a US healthcare system. Design Case series study. Setting and participants Sequentially hospitalized adults admitted for COVID-19 at two tertiary care academic hospitals in New Orleans, LA, between 27 February and 15 July 2020. Measures and outcomes Measures included demographics, comorbidities, presenting symptoms, and laboratory results. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), and in-hospital death. Results We included 776 patients (median age 60.5 years; 61.4% women, 75% non-Hispanic Black). Rates of ICU, IMV, and death were similar in both sexes. In women versus men, obesity (63.8 vs 41.6%, P < 0.0001), hypertension (77.6 vs 70.1%, P = 0.02), diabetes (38.2 vs 31.8%, P = 0.06), chronic obstructive pulmonary disease (COPD, 22.1 vs 15.1%, P = 0.015), and asthma (14.3 vs 6.9%, P = 0.001) were more prevalent. More women exhibited dyspnea (61.2 vs 53.7%, P = 0.04), fatigue (35.7 vs 28.5%, P = 0.03), and digestive symptoms (39.3 vs 32.8%, P = 0.06) than men. Obesity was associated with IMV at a lower BMI (> 35) in women, but the magnitude of the effect of morbid obesity (BMI ≥ 40) was similar in both sexes. COPD was associated with ICU (adjusted OR (aOR), 2.6; 95%CI, 1.5–4.3) and IMV (aOR, 1.8; 95%CI, 1.2–3.1) in women only. Diabetes (aOR, 2.6; 95%CI, 1.2–2.9), chronic kidney disease (aOR, 2.2; 95%CI, 1.3–5.2), elevated neutrophil-to-lymphocyte ratio (aOR, 2.5; 95%CI, 1.4–4.3), and elevated ferritin (aOR, 3.6; 95%CI, 1.7–7.3) were independent predictors of death in women only. In contrast, elevated D-dimer was an independent predictor of ICU (aOR, 7.3; 95%CI, 2.7–19.5), IMV (aOR, 6.5; 95%CI, 2.1–20.4), and death (aOR, 4.5; 95%CI, 1.2–16.4) in men only. Conclusions This study highlights sex disparities in clinical determinants of severe outcomes in COVID-19 patients that may inform management and prevention strategies to ensure gender equity.

IntroductionThe prevalence of diabetes self-management education and support (DSME/S) use among patients with newly diagnosed type 2 diabetes mellitus (T2DM) and patients with insulin prescription has not been evaluated. It is also unclear what demographic, behavioral, and clinical factors associated with use of DSME/S.Research design and methodsThis retrospective analysis was based on electronic health records from the Research Action for Health Network (2013–2019). Patients with newly diagnosed T2DM were identified as 35–94 year-olds diagnosed with T2DM≥1 year after the first recorded office visit. Patients with insulin were identified by the first insulin prescription records. DSME/S (Healthcare Common Procedure Coding System G0108 and G0109) codes that occurred from 2 months before the ‘new diagnosis date’ or first insulin prescription date through 1 year after were defined as use of DSME/S. Age-matched controls (non-users) were identified from the Electronic Health Records (EHR). The date of first DSME/S record was selected as the index date. Logistic regression was used to estimate the associations between patient factors and use of DSME/S.ResultsThe prevalence of DSME/S use was 6.5% (8909/137 629) among patients with newly diagnosed T2DM and 32.7% (13,152/40,212) among patients with diabetes taking insulin. Multivariable analysis found that among patients with newly diagnosed T2DM, black and male patients were less likely to use DSME/S, while in patients with insulin, they were more likely to use the service compared with white and female counterparts, respectively. Among patients taking insulin, those with private insurance or self-pay status were significantly less likely, while those with Medicaid were more likely to use the service compared with their Medicare counterparts. A strong positive association was found between HbA1c, obesity, and DSME/S use in both cohorts, while hypertension was negatively associated with DSME/S in both cohorts.ConclusionWe showed a low rate of DSME/S use in Louisiana, especially in patients with newly diagnosed T2DM. Our findings demonstrated heterogeneity in factors influencing DSME/S use between patients with newly diagnosed T2D and patients with insulin.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces more severe symptoms and a higher mortality in men than in women. The role of biological sex in the immune response to SARS-CoV-2 is believed to explain this sex disparity. However, the contribution of gender factors that influence health protective behaviors and therefore health outcomes, remains poorly explored. Methods: We assessed the contributions of gender in attitudes towards the COVID-19 pandemic, using a hypothetical influenza pandemic data from the 2014 Taiwan Social Change Survey. Participants were selected through a stratified, three-stage probability proportional-to-size sampling from across the nation, to fill in questionnaires that asked about their perception of the hypothetical pandemic, and intention to adopt health protective behaviors. Results: A total of 1,990 participants (median age 45·92 years, 49% women) were included. Significant gender disparities (p

Additional file 1: eFigure 1.A. Multivariable Analysis of Comorbidities and ICU by Race. eFigure 1.B. Multivariable Analysis of Comorbidities and IMV by Race. eFigure 1.C. Multivariable Analysis of Comorbidities and Death by Race. eFigure 2.A. Multivariable Analysis of Biomarkers and ICU by Race. eFigure 2.B. Multivariable Analysis of Biomarkers and IMV by Race. eFigure 2.C. Multivariable Analysis of Biomarkers and Death by Race. eTable 1. Demographic Characteristics and comorbidities prior to admission– Blacks vs. non-Blacks. eTable 2. Clinical symptoms and biomarkers at admission – Blacks vs. non-Blacks.

Background: This study examined the moderating role of social support in the acculturation-obesity/central obesity relationship in Mexican American (MA) men and women. Methods: Data from NHANES 1999-2008 were used. Acculturation derived from language use, country of birth and length of residence in the U.S. Social support assessed emotional and financial support. BMI (≥30) and waist circumference (≥88 cm for women; ≥102 cm for men) measured obesity and central obesity, respectively. Weighted multivariate logistic regression models were used to describe associations. Results: Compared to less acculturation, more acculturation was associated with higher odds of obesity (ORs 2.48; 95% CI 1.06-5.83) and central obesity (2.90; 1.39-6.08) among MA men with low/no social support, but not among MA men reporting high social support. The modifying effects was not observed among women. Conclusion: Higher amounts of social support appeared to attenuate the risk of obesity/central obesity associated with acculturation. Interventions enhancing social support maybe effective among acculturated MAs, particularly among men.

U.S. veterans have a high prevalence of post-traumatic stress disorder (PTSD), for which no effective psychotropic medications are indicated. Nearly 25% of veterans have diabetes, for which metformin is a first line treatment. Although metformin is associated with improved neurodegenerative outcomes, there is no evidence on the association between metformin and PTSD-related symptom relief. This study aimed to examine whether metformin was associated with a clinically meaningful reduction in PTSD symptoms (≥20 points reduction PTSD checklist for DSM-5 {PCL-5}) score)) among veterans with PTSD using data from Veterans Health Administration. The metformin cohort was defined as first metformin use after a recorded PTSD diagnosis with a PCL-5 score ≥33 (i.e., clinical cut-score). The control cohort (never used metformin) was selected by propensity score 1:1 matching on the likelihood of initiating metformin with the covariates of age, gender, race, durations of PTSD, diabetes, and depression, and baseline CCI, PCL-5, and PHQ-9 scores. Multivariable Cox proportional regression was used to assess the association between metformin exposure and improvement in the PCL-5 scores. A total of 7950 veterans (mean age: 51.9 ± 13.6 years, male: 85%, white: 61.4%, African American: 28.8%) with confirmed PTSD were comparable on the baseline demographics and medical conditions between metformin and control PSM-matched cohorts with a median follow-up 1.2 years in both cohorts. The baseline PCL-5 score was 56.2±11.6 and 56.5±11.7 in metformin and control cohort, respectively. The metformin-treated cohort was more likely to have a clinically meaningful reduction in PTSD symptoms (adjusted hazard ratio (aHR): 1.31, 95%CI: 1.16-1.48), compared the control cohort. Furthermore, patients on metformin ≥2 years were 22% more likely to reduce PTSD symptoms (aHR: 1.22, 95%CI: 1.04-1.43), compared with metformin exposure Disclosure S. Liu: None. A.M. Raines: None. Y. Yoshida: None. W. Tang: None. J.I. Constans: None. V. Fonseca: Consultant; Self; Abbott, Asahi Kasei Corporation, AstraZeneca, Bayer Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Stock/Shareholder; Self; Amgen, Bravo4health. L. Shi: None.

Background Previous data showed that metabolic syndrome (MS) and its components are associated with cancer mortality. However, whether the association varies by race is unclear. To examine the association between metabolic risk factors and cancer death in non-Hispanic whites (whites) and non-Hispanic blacks (blacks) in the US. Methods We used data from National Health and Nutrition Examination Survey III (NHANES III) [1988–1994], a nationwide survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention in the US. We included a total of 18,001 participants aged ≥20 years in the study. We ascertained cancer death from NHANES III mortality follow-up study, which linked with the National Death Index and provides follow-up from the date of baseline NHANES III [1988–1994] through December 2006. MS was defined as the presence of at least three of five risk factors [i.e., elevated triglycerides (TG) (≥150 mg/dL), impaired fasting blood glucose (≥100 mg/dL), increased waist circumference (≥88 cm for women and ≥102 cm for men), elevated blood pressure (BP) (≥130 mmHg systolic BP or ≥85 mmHg diastolic BP) and, reduced high density lipoprotein (HDL) cholesterol (

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved class of drugs (since 2012) for type 2 diabetes mellitus (T2DM), but their economic merits have yet been fully confirmed. The objective of this review was to evaluate the most updated evidence that examined the cost-effectiveness of SGLT2i for T2DM. We systematically searched Medline (PubMed), EMBASE, and Web of Science for eligible articles from January 1, 2011, to October 31, 2019, using combinations of search words. A supplementary search using reference lists of eligible articles and other review articles was also performed. A multistage screening process was carried out with duplicates removal, abstract screening, and full-text reading to confirm eligibility. Two reviewers independently screened the eligible articles and assessed reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. A total of 24 studies were included in the final review. All studies showed good quality according to the CHEERS checklist (scored 21–24). Seven studies compared SGLT2i vs. dipeptidyl peptidase-4 inhibitors (DPP-4i), 3 studies compared SGLT2i vs. sulfonylureas (SU), 3 compared SGLT2i vs. glucagon-like peptide-1 receptor agonist (GLP-1 RA), 2 compared SGLT2i vs. SGLT2i, 3 compared SGLT2i vs. other antidiabetic therapies including thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI) or insulin, and 5 compared SGLT2i vs. standard care/metformin. Most studies concluded SGLT2i was cost-effective relative to its comparator except GLP-1 RA, where two studies suggested GLP-1 RA was the favorable treatment option relative to SGLT2i. The literature demonstrated that SGLT2i may be cost-effective compared to many antidiabetic therapies including DPP-4i, SU, TZD, AGI, insulin, and standard care .

Objectives Population-based evidence regarding impact of cancer screenings and cancer rates in Missouri is lacking. This study examined whether screenings of breast cancer, cervical cancer, and colorectal cancer impact early-stage cancer incidence and mortality in Missouri. Study design This is an ecological study based on county-specific estimates of selected cancer screening prevalence and early-stage cancer incidence and cancer mortality. Methods County-specific prevalence of clinical breast examination, mammography, Pap test, sigmoidoscopy or colonoscopy, and fecal occult blood test (FOBT) were generated from Missouri County-Level Study (2003, 2007, and 2011). County-specific crude incidence and mortality were calculated (2004–2013). Pearson's correlation and Poisson regression were used to test association between cancer rate and screening prevalence. Covariates included county-level mean age, percentage of whites, percentage with low income, percentage with less than high school education high school, percentage with no insurance, and percentage having difficulties accessing care. Results In the adjusted model, ‘ever had Pap test’ was significantly associated with an increase of 8% in early-stage cervical cancer incidence. Having clinical breast examination or Pap test in the past was also associated with decreases in mortality by 3% and 4%, respectively, although the association was not significant for Pap test. In addition, having mammography was statistically significantly associated with early-stage breast cancer incidence, and having FOBT or sigmoidoscopy or colonoscopy was associated with decreased colorectal cancer mortality; however, magnitude for these associations was only around 1%. Conclusions This study provides ecological evidence of the effectiveness of screening services in predicting early stage cancer incidence and in reducing mortality across Missouri counties. Further incentive to promote these screenings in Missouri is needed.

Objective We evaluated the extent to which studies that tested short message service (SMS)– and application (app)-based interventions for diabetes self-management education and support (DSMES) report on factors that inform both internal and external validity as measured by the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. Materials and Methods We systematically searched PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and IEEE Xplore Digital Library for articles from January 1, 2009, to February 28, 2019. We carried out a multistage screening process followed by email communications with study authors for missing or discrepant information. Two independent coders coded eligible articles using a 23-item validated data extraction tool based on the RE-AIM framework. Results Twenty studies (21 articles) were included in the analysis. The comprehensiveness of reporting on the RE-AIM criteria across the SMS- and app-based DSMES studies was low. With respect to internal validity, most interventions were well described and primary clinical or behavioral outcomes were measured and reported. However, gaps exist in areas of attrition, measures of potential negative outcomes, the extent to which the protocol was delivered as intended, and description on delivery agents. Likewise, we found limited information on external validity indicators across adoption, implementation, and maintenance domains. Conclusions Reporting gaps were found in internal validity but more so in external validity in the current SMS- and app-based DSMES literature. Because most studies in this review were efficacy studies, the generalizability of these interventions cannot be determined. Future research should adopt the RE-AIM dimensions to improve the quality of reporting and enhance the likelihood of translating research to practice.

Asian Americans (AA) are disproportionately affected by diabetes (DM) and its complications than non-Hispanic whites (whites). We examined white-AA disparities in glycemic, cholesterol and blood pressure control, known as 'ABCs of DM', and evaluated if acculturation plays a role in DM control in AA with DM. Using data from NHANES 2011-2016, we found AA patients were significantly less likely to meet glycemic, cholesterol and the collective 'ABCs' goals than their white counterparts. Acculturation was positively associated with glycemic goal achievement in AA patients. This study identified disparities and pointed to strategies related to acculturation to improve DM control for AA.

Objective: After almost three decades of U.S. surveillance in fruit and vegetable (F&V) intake and obesity, it is important to evaluate their usefulness for monitoring prevention and health promotion efforts in public health. We used U.S. surveillance data to evaluate whether the 16-year trends of F&V intake, measured by the prevalence of eating five or more servings of fruits and vegetables a day (FV5/day) is related to obesity trend as measured by its prevalence in the same period. We also evaluated whether trends in the prevalence of FV5/day by important sociodemographic factors (age, race/ethnicity, etc.) could explain the findings. Study design: A secondary analysis of U.S. adults (≥ 18 years) from the Behavioral Risk Factor Surveillance System (BRFSS) (1994–2009). Methods: We categorized survey subjects for their F&V intake derived from the BRFSS six-question food frequency questionnaire into two groups: < FV5/day vs. ≥ FV5/day. Obesity was defined as BMI ≥ 30. We used logistic regressions to compute predicted prevalence of FV5/day and obesity, and to estimate the odds ratio of FV5/day by obesity and levels of sociodemographic, stratified by year. Results: Between 1994 and 2009, the prevalence of FV5/day hovered around 25% among U.S. adults, while the obesity prevalence steadily increased from 14.8% to 27.4%. As measured through odds ratio, an inverse association between FV5/day and obesity was only observed in 55+, but not in other age, racial/ethnic or education groups. Conclusions: Between 1994 and 2009, we could not confirm a decrease in the prevalence of FV5/day associated with an increase in obesity prevalence, except for age 55+ group. Known disparities in FV5/day and obesity across sociodemographic factors persisted over the study period. FV5/day may be an inappropriate measure of total calories derived from eating fruits and vegetables. Its use to measure impact of public health strategies to improve nutrition and prevent obesity may be questionable.

Purpose of Review To identify a common effect of health information technologies (HIT) on the management of cardiovascular disease (CVD) risk factors among people with type 2 diabetes (T2D) across randomized control trials (RCT). Recent Findings CVD is the most frequent cause of morbidity and mortality among patients with diabetes. HIT are effective in reducing HbA1c; however, their effect on cardiovascular risk factor management for patients with T2D has not been evaluated. Summary We identified 21 eligible studies (23 estimates) with measurement of SBP, 20 (22 estimates) of DBP, 14 (17 estimates) of HDL, 14 (17 estimates) of LDL, 15 (18 estimates) of triglycerides, and 10 (12 estimates) of weight across databases. We found significant reductions in SBP, DBP, LDL, and TG, and a significant improvement in HDL associated with HIT. As adjuvants to standard diabetic treatment, HIT can be effective tools for improving CVD risk factors among patients with T2D, especially in those whose CVD risk factors are not at goal. Electronic supplementary material The online version of this article (10.1007/s11892-019-1152-3) contains supplementary material, which is available to authorized users.

We evaluated relative survival (RS) for ovarian cancer (OC) overall, by demographic and by clinicopathological characteristics in Missouri. Survival data from the Missouri Cancer Registry were obtained for cases diagnosed 1996–2014. An improved OC survival, especially in late stage, was observed in the study period. Our findings showed demographic, especially race-associated, and geographical variations of OC survival. OC survival also differed by first course treatment received and histology. These differences indicate disparities in OC care.

Purpose of Review This study was to present meta-analysis findings across selected clinical trials for the effect of health information technologies (HITs) on glycemic control among patients with type 2 diabetes. Recent Findings HITs may be promising in diabetes management. However, findings on effect size of glycated hemoglobin level (HbA1c) yielded from HITs varied across previous studies. This is likely due to heterogeneity in sample size, adherence to standard quantitative method, and/or searching criteria (e.g., type of HITs, type of diabetes, specification of patient population, randomized vs. nonrandomized trials). Summary We systematically searched Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Cochrane Library for peer-reviewed randomized control trials that studied the effect of HITs on HbA1c reduction. We also used Google Scholar and a hand search to identify additional studies. Thirty-four studies (40 estimates) met the criteria and were included in the analysis. Overall, introduction of HITs to standard diabetes treatment resulted in a statistically and clinically reduced HbA1c. The bias adjusted HbA1c reduction due to the combined HIT interventions was − 0.56 [Hedges’ g = − 0.56 (− 0.70, − 0.43)]. The reduction was significant across each of the four types of HIT intervention under review, with mobile phone-based approaches generating the largest effects [Hedges’ g was − 0.67 (− 0.90, − 0.45)]. HITs can be an effective tool for glycemic control among patients with type 2 diabetes. Future studies should examine long-term effects of HITs and explore factors that influence their effectiveness. Electronic supplementary material The online version of this article (10.1007/s11892-018-1105-2) contains supplementary material, which is available to authorized users.

Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives. Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.

Age and acculturation may play a role in diet quality among Mexican Americans. This study examined diet quality in Mexican Americans by age and whether acculturation influences diet quality across different age groups, using data from the National Health and Nutrition Examination Survey (NHANES). Diet quality, measured by the Healthy Eating Index 2010, improved with age except in categories of dairy, sodium, and refined grains. More acculturation was associated with lower scores in overall diet quality and categories of vegetables, fruits, and sodium and empty calories across almost all ages, but higher scores in grain categories, especially in younger groups. A diet rich in fruits and vegetables but low in fat and sodium should be promoted among more acculturated Mexican Americans, and whole-grain foods should be promoted among young but less acculturated Mexican Americans.

ObjectiveUsing the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women.DesignCross-sectional data from NHANES 1999–2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity.SettingNational Health and Nutrition Examination Survey (NHANES) 1999–2012.SubjectsA total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status.ResultsHigher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women.ConclusionsHEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity.

Background The clinical phenotype and complications of sickle cell disease (SCD) are heterogeneous and disease outcomes are influenced by both genetic and non-genetic factors, including geography, socioeconomic and educational status and access to health care. These factors serve a role in the quality of life and overall survival in the SCD population. Prior studies have sought to characterize the genotype-phenotype relationship and geographic clustering of SCD with distinct clinical differences found between the African and Asian SCD subtypes. The Central Missouri SCD Cohort (MU-SCD Cohort) has a heterogeneous population of SCD patients who seek medical care from University of Missouri. The clinical characteristics and frequency of SCD-related complications in this group have not yet been defined. This is a retrospective cohort analysis of patients HbSS, HbSC, and HbS/b-thalassemia in central Missouri, ranging in age from the first through the sixth decade of life. We hypothesize that SCD patients from central Missouri, with its mix of African American, Congolese, Nigerian, Kenyan, Southeast Asian and other refugee populations, will have clinical complications distinct from the previously described North American Sickle Cell Disease series and needs further characterization. Objective To survey the SCD phenotype by evaluating complications of patients in the MU-Sickle Cell Disease Cohort. Methods We retrospectively reviewed clinical and laboratory data for pediatric and adult SCD patients who were treated at the University of Missouri between 2002 to 2018. Prevalence of major vaso-occlusive, hemolytic and renal complications by decade was estimated. Results A total of 81 patients were reviewed, with five excluded due to insufficient clinical data. The sample size for prevalence estimation was 76, 61, 30, 14 and 8 for first to fifth decade, respectively. In this cohort, 60.5% were male with average age of 21.2 years. Genotypes represented included 52.6% HbSS, 38.2% HbSC, and 7.9% HbS/b-thalassemia. A total of 94.7% of patients identified as African American. Clinical features of vaso-occlusive complications predominated in the first two decades of life. The frequency of acute chest syndrome for patients ages ≤10 years and 11-20 years of age were 23.7% and 21.3%, respectively (Table 1). Seven children (9.2%) developed overt stroke by age 10 years. Greater than one vaso-occlusive pain crisis occurred in 46% of patients in the first decade of life and thereafter declined with age (Figure 1). In contrast, the MU-SCD Cohort exhibited increasing frequency of hemolytic complications with advancing age. The peak prevalence of pulmonary hypertension occurred between the ages of 21-30 years (13.3%). In congruence, only 4% of patients aged ≤10 years were diagnosed with gallstones requiring cholecystectomy, which increased to 57.1% at age 31-40 years. Reticulocytopenia was noted in the fourth decade with further decline in the fifth decade of life (Figure 2). Renal evaluation revealed an average estimated glomerular filtration rate (eGFR) of 149.9 ± 43 in patients ≤10 years, with progressive decline to 117.3 ± 25 in SCD patients aged 41-50 years (Figure 3). The average serum creatinine demonstrated an increasing trend with advancing age. There was a prevalence of persistent proteinuria in patients older than 11 years. Disease modifying agents were assessed, in which only 21% of patients ≤10 years, 25% of patients aged 11-20 years, and 15.8% of patients aged 21-30 years received therapy with hydroxyurea (Table 1). The use of exchange transfusion or packed red blood cell (pRBC) transfusion for anemia was predominant in SCD patients aged ≤20 years. Conclusions This is the first report describing prevalence of SCD-related complications in the MU-SCD Cohort. We identified this population to have an increasing frequency of hemolytic complications and sickle cell nephropathy with advancing age. Onset of persistent proteinuria occurred in the second decade of life, followed by renal insufficiency or end stage renal disease in subsequent decades. As previously demonstrated in the Cooperative Study of Sickle Cell Disease and the Jamaican SCD Cohort study, renal insufficiency was a significant risk factor for early mortality. Further studies are required for identification of biomarkers and institution of early intervention strategies to prevent end-organ damage and decrease mortality in SCD. Disclosures No relevant conflicts of interest to declare.