Effectiveness and cost-effectiveness of diabetes prevention among adherent participants.

Objectives: We report the 10-year effectiveness and within-trial cost-effectiveness of the Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) interventions among participants who were adherent to the interventions.

Study Design: DPP was a 3-year randomized clinical trial followed by 7 years of open-label modified intervention follow-up.

Methods: Data on resource utilization, cost, and quality of life were collected prospectively.

Impact of lifestyle intervention and metformin on health-related quality of life: the diabetes prevention program randomized trial.

Background: Adults at high risk for diabetes may have reduced health-related quality of life (HRQoL).

Objective: To assess changes in HRQoL after interventions aimed at diabetes risk reduction.

Design, Setting, And Participants: A randomized clinical trial, the Diabetes Prevention Program, was conducted in 27 centers in the United States, in 3,234 non-diabetic persons with elevated fasting and post-load plasma glucose, mean age 51 years, mean BMI 34 Kg/m(2); 68 % women, and 45 % members of minority groups.

Parental longevity and diabetes risk in the Diabetes Prevention Program.

Background: Longevity clusters in families, and parental longevity may be associated with lower risk of chronic diseases in their children. It is unknown if diabetes risk is associated with parental longevity.

Methods: We evaluated participants in the Diabetes Prevention Program with a parental history questionnaire at study entry.

Glucose and insulin measurements from the oral glucose tolerance test and relationship to muscle mass.

Background: Diabetes is associated with decreased muscle mass. The effect of higher levels of glucose and insulin on muscle mass has not been studied in individuals without diabetes. We sought to determine the relationship of insulin and glucose measurements from the oral glucose tolerance test (OGTT) with muscle mass in persons without diabetes.

Evaluation of a novel isotope biomarker for dietary consumption of sweets.

Carbon isotopic signatures ("δ¹³C") might reflect consumption of corn- and cane-based sweeteners. The authors hypothesized that the δ¹³C value of human serum is higher for individuals with high versus low intakes of corn- and cane-based sweeteners (measured as sweetened beverage intake). They conducted a cross-sectional study within the Atherosclerosis Risk in Communities Magnetic Resonance Imaging study (Maryland, 2005-2006).

Increased expression of beta-N-acetylglucosaminidase in erythrocytes from individuals with pre-diabetes and diabetes.

Objective: O-linked beta-N-acetylglucosamine (O-GlcNAc) plays an important role in the development of insulin resistance and glucose toxicity. O-GlcNAcylation is regulated by O-GlcNAc transferase (OGT), which attaches O-GlcNAc to serine and/or threonine residues of proteins and by O-GlcNAcase, which removes O-GlcNAc. We investigated the expression of these two enzymes in erythrocytes of human subjects with diabetes or pre-diabetes.

Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey (NHANES), 1999-2006.

Objective: To examine the relationship of diabetes and functional disability in older adults and the possible mediating roles of comorbidities and A1C.

Research Design And Methods: We analyzed data from a nationally representative sample of 6,097 participants aged >or=60 years in the National Health and Nutrition Examination Survey, 1999-2006. Diabetes was defined by self-report.

The clinical use of hemoglobin A1c.

Hemoglobin A1c (HbA1c) has been accepted as an index of glycemic control since the mid-1970s and is the best marker for diabetic microvascular complications. Clinically, it is now used to assess glycemic control in people with diabetes. Assays are most reliable when certified by the National Hemoglobin Standardization Program but are subject to confounders and effect modifiers, particularly in the setting of hematologic abnormalities.

A randomized comparison of the terms estimated average glucose versus hemoglobin A1C.

Purpose: The purpose of this study was to evaluate the hypothesis that using estimated average glucose (eAG) while instructing patients yields better knowledge retention than using the term hemoglobin A1C (A1C).

Methods: Patients with diabetes who had poor baseline understanding of A1C (determined by a 4-question survey) were randomized into 1 of 2 groups: A1C or eAG. Depending on randomization, providers discussed patients' current status and personal targets for glycemic control using either the term A1C or estimated average glucose.

Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma.

Purpose: Hyperglycemia has been associated with poor outcomes in many disease states. This retrospective study assessed the association between hyperglycemia and survival in patients with newly diagnosed glioblastoma multiforme (GBM). PATIENTS AND METHODS; Between 1999 and 2004, before the standard use of temozolomide, 191 patients were accrued onto New Approaches to Brain Tumor Therapy CNS Consortium trials with similar eligibility criteria.

Site-specific GlcNAcylation of human erythrocyte proteins: potential biomarker(s) for diabetes.

Objective: O-linked N-acetylglucosamine (O-GlcNAc) is upregulated in diabetic tissues and plays a role in insulin resistance and glucose toxicity. Here, we investigated the extent of GlcNAcylation on human erythrocyte proteins and compared site-specific GlcNAcylation on erythrocyte proteins from diabetic and normal individuals.

Research Design And Methods: GlcNAcylated erythrocyte proteins or GlcNAcylated peptides were tagged and selectively enriched by a chemoenzymatic approach and identified by mass spectrometry.

Clinical-scale investigation of stable isotopes in human blood: delta13C and delta15N from 406 patients at the Johns Hopkins Medical Institutions.

Objective chemical biomarkers are needed in clinical studies of diet-related diseases to supplement subjective self-reporting methods. We report on several critical experiments for the development of clinically legitimate dietary stable isotope biomarkers within human blood. Our examination of human blood revealed the following: (1) Within blood clot and serum from anonymous individuals (201 males, 205 females) we observed: mean serum delta13C = -19.

Therapeutic potential of dipeptidyl peptidase-IV inhibitors in patients with diabetes mellitus.

Dipeptidyl peptidase-IV (DPP-IV) inhibitors are a new class of oral antidiabetic agents for the treatment of patients with type 2 diabetes. Inhibition of the enzyme DPP-IV results in increased activity of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), the incretin hormones. Through the action of GLP-1 and GIP, DPP-IV inhibitors improve preprandial and postprandial glucose by enhancing insulin secretion and reducing postprandial concentrations of glucagon.

Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation.

Objective: To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection.

Research Design And Methods: This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection before neutropenia during BMT.

The implantable peritoneal pump--a patient's perspective.

A participant in a study of implantable insulin pump therapy recounts his experiences with on-and-off use of the pump over the past 18 years. Christopher Witkowski, 55, first had a pump implanted in 1990. Despite occasional difficulties over the years, Witkowski reports that his overall experience has been extremely positive.

A new look at screening and diagnosing diabetes mellitus.

Objective: Diabetes is underdiagnosed. About one third of people with diabetes do not know they have it, and the average lag between onset and diagnosis is 7 yr. This report reconsiders the criteria for diagnosing diabetes and recommends screening criteria to make case finding easier for clinicians and patients.

An isotopic method for quantifying sweeteners derived from corn and sugar cane.

Background: Consumption of high-fructose corn syrup, as well as cane sugar, has been implicated in the rise of the obesity and diabetes epidemics. To date, however, no reliable biomarker for the consumption of these sweeteners is available.

Objective: The objective of the study was to determine the natural abundance stable-carbon-isotope signature of commonly consumed foods of plant origin.

Implantable insulin pump therapy: an unusual presentation of a catheter-related complication.

We report the case of a 63-year-old man who has a 19-year history of involvement in the implantable insulin pump program at Johns Hopkins University. After his most recent pump implantation in February 2004, his 24-h insulin requirement gradually increased from a baseline of 75 units to a peak of almost 500 units in June 2005. Surprisingly, insulin delivery from the pump and glycemic control remained satisfactory despite the dramatic change in insulin requirement.