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Glucagon-Like Peptide 1 Receptor Agonist or Bolus Insulin With Optimized Basal Insulin in Type 2 Diabetes

Michaela Diamant
Oct 1, 2014; 37:2763-2773
Emerging Technologies and Therapeutics




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Improved Glycemic Control in Poorly Controlled Patients with Type 1 Diabetes Using Real-Time Continuous Glucose Monitoring

Dorothee Deiss
Dec 1, 2006; 29:2730-2732
BR Emerging Treatments and Technologies




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International Consensus on Use of Continuous Glucose Monitoring

Thomas Danne
Dec 1, 2017; 40:1631-1640
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Evaluating Clinical Accuracy of Systems for Self-Monitoring of Blood Glucose

William L Clarke
Sep 1, 1987; 10:622-628
Technical Article




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Subdued ceremonies in Europe mark 75th anniversary of VE Day

French President Emanuel Macron led a series of events in Europe Friday that commemorate the 75th anniversary of Victory in Europe Day, with a small ceremony in Paris.




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Investigation of the Accuracy of 18 Marketed Blood Glucose Monitors

David C. Klonoff
Aug 1, 2018; 41:1681-1688
Emerging Technologies: Data Systems and Devices




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Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era

Kirstine J. Bell
Jun 1, 2015; 38:1008-1015
Type 1 Diabetes at a Crossroads




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Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring

Richard M. Bergenstal
Nov 1, 2018; 41:2275-2280
Perspectives in Care




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Long-Acting Glucagon-Like Peptide 1 Receptor Agonists: A review of their efficacy and tolerability

Alan J. Garber
May 1, 2011; 34:S279-S284
Diabetes Treatments




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Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital

Guillermo E. Umpierrez
Aug 1, 2018; 41:1579-1589
Diabetes Care Symposium




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International Consensus on Use of Continuous Glucose Monitoring

Thomas Danne
Dec 1, 2017; 40:1631-1640
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino
Aug 1, 2019; 42:1593-1603
International Consensus Report




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A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen (TWO2) Therapy in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study

OBJECTIVE

Topical oxygen has been used for the treatment of chronic wounds for more than 50 years. Its effectiveness remains disputed due to the limited number of robust high-quality investigations. The aim of this study was to assess the efficacy of multimodality cyclical pressure Topical Wound Oxygen (TWO2) home care therapy in healing refractory diabetic foot ulcers (DFUs) that had failed to heal with standard of care (SOC) alone.

RESEARCH DESIGN AND METHODS

Patients with diabetes and chronic DFUs were randomized (double-blind) to either active TWO2 therapy or sham control therapy—both in addition to optimal SOC. The primary outcome was the percentage of ulcers in each group achieving 100% healing at 12 weeks. A group sequential design was used for the study with three predetermined analyses and hard stopping rules once 73, 146, and ultimately 220 patients completed the 12-week treatment phase.

RESULTS

At the first analysis point, the active TWO2 arm was found to be superior to the sham arm, with a closure rate of 41.7% compared with 13.5%. This difference in outcome produced an odds ratio (OR) of 4.57 (97.8% CI 1.19, 17.57), P = 0.010. After adjustment for University of Texas Classification (UTC) ulcer grade, the OR increased to 6.00 (97.8% CI 1.44, 24.93), P = 0.004. Cox proportional hazards modeling, also after adjustment for UTC grade, demonstrated >4.5 times the likelihood to heal DFUs over 12 weeks compared with the sham arm with a hazard ratio of 4.66 (97.8% CI 1.36, 15.98), P = 0.004. At 12 months postenrollment, 56% of active arm ulcers were closed compared with 27% of the sham arm ulcers (P = 0.013).

CONCLUSIONS

This sham-controlled, double-blind randomized controlled trial demonstrates that, at both 12 weeks and 12 months, adjunctive cyclical pressurized TWO2 therapy was superior in healing chronic DFUs compared with optimal SOC alone.




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Free ADA webinar offers education on how to receive electronic funds transfer payments

Dentists who have had a dental plan payment check lost in the mail could consider a way to receive safe and secure payment through electronic funds transfer payments.




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April JADA compares zirconia-ceramic fixed dental prostheses with metal-ceramic

Posterior multiunit zirconia-ceramic restorations are slightly more susceptible to chipping of the veneering ceramic than metal-ceramic restorations, but they are considered a reliable treatment in the medium term, according to a systematic review and meta-analysis published in the April issue of The Journal of the American Dental Association.




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Index shows that dentists slowly but surely embracing electronic means of doing business

Despite the ADA Council on Dental Benefits’ efforts, the practice of using automated electronic means for verifying eligibility and benefits, checking claim status or receiving and reconciling payment remains underutilized by many dental providers according to an index, said Dr. Randall Markarian, council chair.




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Performance of High-Sensitivity Cardiac Troponin Assays To Reflect Comorbidity Burden and Improve Mortality Risk Stratification in Older Adults With Diabetes

OBJECTIVE

Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification.

RESEARCH DESIGN AND METHODS

We used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67–89 years, 43% male, 31% black) at visit 5 (2011–2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels.

RESULTS

Elevations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio [HR] 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (HR 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality.

CONCLUSIONS

Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.




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Continuous Glucose Monitoring in Pregnancy: Importance of Analysing Temporal Profiles to Understand Clinical Outcomes

OBJECTIVE

To determine if temporal glucose profiles differed between 1) women who were randomized to real-time continuous glucose monitoring (RT-CGM) or self-monitored blood glucose (SMBG), 2) women who used insulin pumps or multiple daily insulin injections (MDIs), and 3) women whose infants were born large for gestational age (LGA) or not, by assessing CGM data obtained from the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT).

RESEARCH DESIGN AND METHODS

Standard summary metrics and functional data analysis (FDA) were applied to CGM data from the CONCEPTT trial (RT-CGM, n = 100; SMBG, n = 100) taken at baseline and at 24- and 34-weeks gestation. Multivariable regression analysis determined if temporal differences in 24-h glucose profiles occurred between comparators in each of the three groups.

RESULTS

FDA revealed that women using RT-CGM had significantly lower glucose (0.4–0.8 mmol/L [7–14 mg/dL]) for 7 h/day (0800 h–1200 h and 1600 h–1900 h) compared with those with SMBG. Women using pumps had significantly higher glucose (0.4–0.9 mmol/L [7–16 mg/dL]) for 12 h/day (0300 h to 0600 h, 1300 h to 1800 h, and 2030 h to 0030 h) at 24 weeks with no difference at 34 weeks compared with MDI. Women who had an LGA infant ran a significantly higher glucose by 0.4–0.7 mmol/L (7–13 mg/dL) for 4.5 h/day at baseline; by 0.4–0.9 mmol/L (7–16 mg/dL) for 16 h/day at 24 weeks; and by 0.4–0.7 mmol/L (7–13 mg/dL) for 14 h/day at 34 weeks.

CONCLUSIONS

FDA of temporal glucose profiles gives important information about differences in glucose control and its timing, which are undetectable by standard summary metrics. Women using RT-CGM were able to achieve better daytime glucose control, reducing fetal exposure to maternal glucose.




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Incidence of Type 2 Diabetes in Patients With Chronic Hepatitis C Receiving Interferon-Based therapy




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Novel Use of GLP-1 Receptor Agonist Therapy in HNF4A-MODY




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Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study

OBJECTIVE

To assess the association between use of glucagon-like peptide 1 (GLP-1) receptor agonists and risk of serious renal events in routine clinical practice.

RESEARCH DESIGN AND METHODS

This was a cohort study using an active-comparator, new-user design and nationwide register data from Sweden, Denmark, and Norway during 2010–2016. The cohort included 38,731 new users of GLP-1 receptor agonists (liraglutide 92.5%, exenatide 6.2%, lixisenatide 0.7%, and dulaglutide 0.6%), matched 1:1 on age, sex, and propensity score to a new user of the active comparator, dipeptidyl peptidase 4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years.

RESULTS

Mean (SD) age of the study population was 59 (10) years, and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP-1 receptor agonists (incidence rate 4.8 events per 1,000 person-years) and in 722 users of DPP-4 inhibitors (6.3 events per 1,000 person-years, HR 0.76 [95% CI 0.68–0.85], absolute difference –1.5 events per 1,000 person-years [–2.1 to –0.9]). Use of GLP-1 receptor agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62–0.87]) and hospitalization for renal events (HR 0.73 [0.65–0.83]) but not death from renal causes (HR 0.72 [0.48–1.10]). When we used an as treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49–0.74).

CONCLUSIONS

In this large cohort of patients seen in routine clinical practice in three countries, use of GLP-1 receptor agonists, as compared with DPP-4 inhibitors, was associated with a reduced risk of serious renal events.




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Predicting the Risk of Inpatient Hypoglycemia With Machine Learning Using Electronic Health Records

OBJECTIVE

We analyzed data from inpatients with diabetes admitted to a large university hospital to predict the risk of hypoglycemia through the use of machine learning algorithms.

RESEARCH DESIGN AND METHODS

Four years of data were extracted from a hospital electronic health record system. This included laboratory and point-of-care blood glucose (BG) values to identify biochemical and clinically significant hypoglycemic episodes (BG ≤3.9 and ≤2.9 mmol/L, respectively). We used patient demographics, administered medications, vital signs, laboratory results, and procedures performed during the hospital stays to inform the model. Two iterations of the data set included the doses of insulin administered and the past history of inpatient hypoglycemia. Eighteen different prediction models were compared using the area under the receiver operating characteristic curve (AUROC) through a 10-fold cross validation.

RESULTS

We analyzed data obtained from 17,658 inpatients with diabetes who underwent 32,758 admissions between July 2014 and August 2018. The predictive factors from the logistic regression model included people undergoing procedures, weight, type of diabetes, oxygen saturation level, use of medications (insulin, sulfonylurea, and metformin), and albumin levels. The machine learning model with the best performance was the XGBoost model (AUROC 0.96). This outperformed the logistic regression model, which had an AUROC of 0.75 for the estimation of the risk of clinically significant hypoglycemia.

CONCLUSIONS

Advanced machine learning models are superior to logistic regression models in predicting the risk of hypoglycemia in inpatients with diabetes. Trials of such models should be conducted in real time to evaluate their utility to reduce inpatient hypoglycemia.




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Effects of Novel Dual GIP and GLP-1 Receptor Agonist Tirzepatide on Biomarkers of Nonalcoholic Steatohepatitis in Patients With Type 2 Diabetes

OBJECTIVE

To determine the effect of tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptors, on biomarkers of nonalcoholic steatohepatitis (NASH) and fibrosis in patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

Patients with T2DM received either once weekly tirzepatide (1, 5, 10, or 15 mg), dulaglutide (1.5 mg), or placebo for 26 weeks. Changes from baseline in alanine aminotransferase (ALT), aspartate aminotransferase (AST), keratin-18 (K-18), procollagen III (Pro-C3), and adiponectin were analyzed in a modified intention-to-treat population.

RESULTS

Significant (P < 0.05) reductions from baseline in ALT (all groups), AST (all groups except tirzepatide 10 mg), K-18 (tirzepatide 5, 10, 15 mg), and Pro-C3 (tirzepatide 15 mg) were observed at 26 weeks. Decreases with tirzepatide were significant compared with placebo for K-18 (10 mg) and Pro-C3 (15 mg) and with dulaglutide for ALT (10, 15 mg). Adiponectin significantly increased from baseline with tirzepatide compared with placebo (10, 15 mg).

CONCLUSIONS

In post hoc analyses, higher tirzepatide doses significantly decreased NASH-related biomarkers and increased adiponectin in patients with T2DM.




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Honey bees face chronic paralysis pandemic in Britain

The virus responsible for chronic bee paralysis is spreading rapidly among honey bee colonies in Britain, according to a new study.




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Can Return Migration Revitalize the Baltics? Estonia, Latvia, and Lithuania Engage Their Diasporas, with Mixed Results

Faced with high emigration rates and shrinking, aging populations, the Baltic states—Estonia, Latvia, and Lithuania—are exploring different ways to lure back nationals who have emigrated and establish or solidify ties with members of the diaspora. Of the three countries, Estonia is proving the most successful, while Latvia appears to be ignoring the looming demographic crisis and lacks an immigration plan.




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[ Polls & Surveys ] Open Question : Poll: Is it okay if I make love to my gin and tonic instead ?

It's lockdown after all. 




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Chronicling Migration in the 21st Century Through One Family&#039;s Journey

This event marked the launch of New York Times reporter Jason DeParle's book tracing the arc of migration as a phenomenon, witnessed through three decades observing a particular Filipino family moving from Manila to Texas. The conversation explored both the human and policy aspects of migration and development.




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In Face of Tragedy, 'Whodunit' Question Often Guides Moral Reasoning

When nearly 200 people in India were killed in terrorist attacks late last month, the carnage received saturation media coverage around the globe. When nearly 600 people in Zimbabwe died in a cholera outbreak a week ago, the international response was far more muted.





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Upside down local tomato, goats cheese and onion tart

Always a winner taking advantage of the local summer tomatoes . Who doesn't like flaky puff pastry?




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Chronicling Migration in the 21st Century Through One Family’s Journey

Marking the launch of New York Times reporter Jason DeParle's book tracing the arc of migration and its impacts through the life of an extended family of Filipino migrants over a three-decade period, from Manila and through Dubai to the Houston area, this conversation with MPI's Andrew Selee and the World Bank's Dilip Ratha explores migration at both a global and very personal level.




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Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain

Lorenzo Rinaldo
Jul 1, 2017; 35:126-131
Feature Articles




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Self-Monitoring of Blood Glucose: The Basics

Evan M. Benjamin
Jan 1, 2002; 20:
Practical Pointers




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Persistence of Continuous Glucose Monitoring Use in a Community Setting 1 Year After Purchase

James Chamberlain
Jul 1, 2013; 31:106-109
Feature Articles




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Diabetes Management Issues for Patients With Chronic Kidney Disease

Kerri L. Cavanaugh
Jul 1, 2007; 25:90-97
Feature Articles




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How women are revolutionizing Rwanda | Agnes Binagwaho

In 1996, Agnes Binagwaho returned home to Rwanda in the aftermath of its genocide. She considered leaving amid the overwhelming devastation, but women in her community motivated her to stay and help rebuild -- and she's glad she did. In an inspiring talk, Binagwaho reflects on her work as Rwanda's former Minister of Health and discusses her new women's education initiative for the country, which strives to create one of the greatest levels of gender equality worldwide.




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How menopause affects the brain | Lisa Mosconi

Many of the symptoms of menopause -- hot flashes, night sweats, insomnia, memory lapses, depression and anxiety -- start in the brain. How exactly does menopause impact cognitive health? Sharing groundbreaking findings from her research, neuroscientist Lisa Mosconi reveals how decreasing hormonal levels affect brain aging -- and shares simple lifestyle changes you can make to support lifelong brain health.




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How to make pandemics optional, not inevitable | Sonia Shah

What can past pandemics teach us how to tackle the current one? Tracing the history of contagions from cholera to Ebola and beyond, science journalist Sonia Shah explains why we're more vulnerable to outbreaks now than ever before, what we can do to minimize the spread of coronavirus and how to prevent future pandemics. (This virtual conversation is part of the TED Connects series, hosted by science curator David Biello and current affairs curator Whitney Pennington Rodgers. Recorded March 31, 2020)




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Clark County School District postpones graduation ceremonies




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Iconic Teacher Leader on Coronavirus Response

"Educators are completely redesigning instructional delivery while constantly being thrown new rules. It's like 'flying the plane as you build it,'" says Maddie Fennell.




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Minnesota bans large-scale high school graduation ceremonies




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When Will The Birds Fly Free?: Education as Colonialism

The play made me ask the terrifying question that every educator asks themselves at some point: Am I actually helping my students?




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Casindra lost : the Paradisi Chronicles / Marti Ward.

A 3.5 year mission from which they'll never return, a 2.5 million lightyear journey to another galaxy, 1.5 crew members comprising a solitary captain and a half-baked AI... Captain Sideris is a loner and knows LETO ships like nobody else, having risen to command the Lunar-Earth construction fleet, as they build ships to mine asteroids and colonize Mars. Suddenly he finds the colonization effort is for another planet, in another galaxy, and he's the sole human guinea pig being gated through a wormhole with an AI playing Noah to LETO SS Casindra's ark. Everything goes well as he starts to survey four planets they plan to exploit, as he gets to know emergent AI 'Al', as he discovers he's building a special relationship with empathic cat 'Simba'. Problem is message drones gated home are not being returned per protocol, with little explanation, no supplies, and some cryptic and disturbing messages. This full length novel is set in the multi-author multi-genre Paradisi universe. Casindra Lost opens the Lost Mission Series to explain what happened to some of the early missions that underlie the various colonization and post-colonization stories.




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Cooking my books : what the fork to cook tonight / Yvette Hewett.




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Spaghetti madness : inspired by Great Food / by Louie Laudonia.

Annotation. Spaghetti Cook Book.




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Colours of Impressionism : masterpieces from the Musée d'Orsay / [curators: Marine Kisiel, Paul Perrin].

Musée d'Orsay -- Exhibitions.




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Imagined homelands : British poetry in the colonies / Jason R. Rudy.

Commonwealth poetry (English) -- History and criticism.




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The fragments / Toni Jordan.

Authors -- Fiction.




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Is it okay to sell the Monet? : the age of deaccessioning in museums / edited by Julia Courtney.

Museums -- Deaccessioning.




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In good faith : questioning religion and atheism / Scott A. Shay.

Faith and reason.