ObjectiveType 2 diabetes and gestational diabetes (GDM) disproportionately affect those of Hispanic/Latino heritage. This study examined the association between GDM and prevalent and incident ...diabetes in a community-based study of Hispanic/Latina women living in the USA.MethodsParticipants were women aged 18–74 years in the Hispanic Community Health Study/Study of Latinos who had at least one pregnancy and had information on self-reported history of GDM at baseline (n=6389). Logistic regression was used to determine the association between GDM and prevalent (2008–2011) and incident (2014–2017) diabetes and interactions between GDM and risk factors for incident diabetes.ResultsAt baseline, 8.7% of participants reported a history of GDM and 18.6% had prevalent diabetes. Women with Mexican heritage had the highest prevalence of GDM history (11.3%) vs women of Cuban (5.0%), Central American (4.9%), and South American (3.8%) heritage (p<0.001 for each comparison to Mexican heritage). Women with self-reported GDM were four times more likely to have prevalent diabetes compared with women without GDM, after adjusting for sociodemographic characteristics and cardiometabolic risk factors (adjusted OR (aOR)=3.94, 95% CI 2.75 to 5.64). Overall incidence of diabetes was 14.3/100 women. Women with GDM at baseline increased their odds of incident diabetes by threefold compared with women without GDM (aOR=3.25, 95% CI 2.09 to 5.05). Women with Cuban or Puerto Rican heritage and GDM had significantly higher odds of incident diabetes compared with women with Mexican heritage (aOR=2.15, 95% CI 1.17 to 3.95; aOR=1.95, 95% CI 1.07 to 3.55, respectively).ConclusionSelf-reported GDM was significantly associated with a threefold higher risk of incident diabetes among Hispanic/Latino women in the USA even after adjusting for several significant predictors of diabetes.
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 <30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/m2, 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.
Context:
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.
Objective:
We evaluated macronutrient intake and its associations with diabetes awareness and glycemic control among US Hispanics/Latinos with diabetes.
Participants:
This analysis included 3310 diabetic adults aged 18–74 years from the Hispanic Community Health Study/Study of Latinos (2008–2011).
Main Outcome Measures:
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.
Results:
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).
Conclusions:
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.
We evaluated dietary intake in US Hispanics/Latinos with diabetes, and found that diabetes awareness is associated with reduced carbohydrate and sugar intake, and increased monounsaturated fat intake.
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.
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.
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.
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.
Background
Dietary recommendations for adults with diabetes are to follow a healthy diet in appropriate portion sizes. We determined recent trends in energy and nutrient intakes among a nationally ...representative sample of US adults with and without type 2 diabetes.
Methods
Participants were adults aged ≥20 years from the cross‐sectional National Health and Nutrition Examination Surveys, 1988–2012 (N = 49 770). Diabetes was determined by self‐report of a physician's diagnosis (n = 4885). Intake of energy and nutrients were determined from a 24‐h recall by participants of all food consumed. Linear regression was used to test for trends in mean intake over time for all participants and by demographic characteristics.
Results
Among adults with diabetes, overall total energy intake increased between 1988–1994 and 2011–2012 (1689 kcal versus 1895 kcal; Ptrend < 0.001) with evidence of a plateau between 2003–2006 and 2011–2012. In 2007–2012, energy intake was greater for younger than older adults, for men than women, and for non‐Hispanic whites versus non‐Hispanic blacks. There was no change in the percentage of calories from carbohydrate, total fat or protein. Percentage of calories from saturated fat was similar across study periods but remained above recommendations (11.2% in 2011–2012). Fibre intake significantly decreased and remained below recommendations (Ptrend = 0.002). Sodium, cholesterol and calcium intakes increased. There was no change in energy intake among adults without diabetes and dietary trends were similar to those with diabetes.
Conclusions
Future data are needed to confirm a plateau in energy intake among adults with diabetes, although the opportunity exists to increase fibre and reduce saturated fat.
Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these ...potential measures of program quality.
Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.
Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p<0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p<0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.
Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.
ObjectiveA healthy diet is important for diabetes prevention and control; however, few studies have assessed dietary intake among US Hispanics/Latinos, a diverse population with a significant burden ...of diabetes. To address this gap in the literature, we determined intake of energy, macro/micronutrients, and vitamin supplements among Hispanics/Latinos by glycemic status and heritage.Research design and methodsCross-sectional study of adults aged 18–74 years from the Hispanic Community Health Study/Study of Latinos (2008–2011) with complete baseline data on glycemic status and two 24-hour dietary recalls (n=13 089). Age-adjusted and sex-adjusted and multivariable-adjusted measures of intake were determined by glycemic status and heritage.ResultsMean age-adjusted and sex-adjusted energy intake was significantly lower among Hispanics/Latinos with diagnosed diabetes compared with those with normal glycemic status (1665 vs 1873 kcal, P<0.001). Fiber intake was higher among those with diagnosed diabetes versus normal glycemic status (P<0.01). Among those with diagnosed diabetes, energy intake was highest among those with Cuban heritage compared with most other heritage groups (P<0.01 for all, except Mexicans), but there was no difference after additional adjustment. Fiber intake was significantly lower for those of Cuban heritage (vs Dominican, Central American, and Mexican), and sodium intake was significantly higher (vs all other heritage groups) (P<0.01 for all); findings were null after additional adjustment. There was no difference in supplemental intake of vitamin D, calcium, magnesium, or potassium by glycemic status.ConclusionsAs part of the care of Hispanics/Latinos with diabetes, attention should be made to fiber and sodium consumption.
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.
PDF
