A Qualitative Study of Older Adult Perspectives on Continuous Glucose Monitoring for Type 2 Diabetes.

Background: Continuous glucose monitoring (CGM) may improve self-management and reduce hypoglycemia risk among individuals with diabetes. However, little is known about how older adults with insulin-treated type 2 diabetes (T2D) experience and incorporate this technology into their daily lives.

Objective: To explore experiences, preferences, barriers, and questions related to using CGM among older adults with insulin-treated T2D with and without experience using CGM.

Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study.

Background: Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of patients' self-reported perspectives with subsequent deprescribing of diabetes medications in older adults with type 2 diabetes.

Methods: Longitudinal cohort study of 1629 pharmacologically treated adults ages 65-100 years with type 2 diabetes who received care at Kaiser Permanente of Northern California (KPNC) and participated in the Diabetes Preferences and Self-Care survey (2019).

Type 2 Diabetes Health Care Outcomes for Patients with Alcohol Use Disorder Starting Addiction Treatment.

Background: Alcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment.

Objective: To examine diabetes-related health monitoring, clinical outcomes, and acute health care use among patients with T2DM and AUD newly accessing specialty addiction treatment.

Overcoming therapeutic inertia in newly diagnosed type 2 diabetes: Protocol of a randomized, quality improvement trial.

Therapeutic inertia, the delay in the appropriate initiation and intensification of recommended therapies, is a major contributor to the lack of improvement in type 2 diabetes outcomes over the past decade. Therapeutic inertia during the period following diagnosis, when improvements in glycemic control can have lasting benefits, is often overlooked. Technology and team-based care approaches can effectively address therapeutic inertia.

Risk of Infection in Older Adults With Type 2 Diabetes With Relaxed Glycemic Control.

Objective: To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control.

Research Design And Methods: This retrospective cohort study included adults age ≥65 years with type 2 diabetes from an integrated health care delivery system. Negative binomial models were used to estimate incidence rates and relative risk (RR) of hospitalization for infections (respiratory; genitourinary; skin, soft tissue, and bone; and sepsis), comparing two levels of relaxed (hemoglobin A1c [HbA1c] 7% to <8% and 8% to <9%) with intensive (HbA1c 6% to <7%) glycemic control from 1 January 2019 to 1 March 2020.

Continuous Glucose Monitor Metrics Are Associated with Emergency Department Visits and Hospitalizations for Hypoglycemia and Hyperglycemia, but Have Low Predictive Value.

Determine whether continuous glucose monitor (CGM) metrics can provide actionable advance warning of an emergency department (ED) visit or hospitalization for hypoglycemic or hyperglycemic (dysglycemic) events. Two nested case-control studies were conducted among insulin-treated diabetes patients at Kaiser Permanente, who shared their CGM data with their providers. Cases included dysglycemic events identified from ED and hospital records (2016-2021).

Quantification of risk factors for diabetic retinopathy progression.

Aims: To determine the importance of blood sugar control, blood pressure, and other key systemic factors on the risk of progression from no retinopathy to various stages of diabetic retinopathy.

Methods: Restrospective cohort analysis of patients (N = 99, 280) in the Kaiser Permanente Northern California healthcare system with a baseline retina photographic screening showing no evidence of retinopathy and a minimum follow-up surveillance period of 3 years from 2008 to 2019. We gathered longitudinal data on diabetic retinopathy progression provided by subsequent screening fundus photographs and data captured in the electronic medical record over a mean surveillance of 7.

Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes.

Importance: Continuous glucose monitoring (CGM) is recommended for patients with type 1 diabetes; observational evidence for CGM in patients with insulin-treated type 2 diabetes is lacking.

Objective: To estimate clinical outcomes of real-time CGM initiation.

Design, Setting, And Participants: Exploratory retrospective cohort study of changes in outcomes associated with real-time CGM initiation, estimated using a difference-in-differences analysis.

Clinical Response to Real-Time Patient-Reported Diabetic Peripheral Neuropathy Symptoms.

Introduction: To assess clinician response to real-time patient-reported data about diabetic peripheral neuropathy (DPN) symptoms, we analyzed DPN diagnosis and treatment patterns after administration of a 4-question symptom questionnaire in a large vertically integrated health care system.

Methods: Retrospective cohort study to analyze data from 160,852 patients screened for DPN symptoms from April 2012 to March 2014. Electronic medical record data were used to study changes in DPN diagnosis, treatment initiation, and treatment intensification.

Albuminuria according to status of autoimmunity and insulin sensitivity among youth with type 1 and type 2 diabetes.

Objective: To evaluate whether etiologic diabetes type is associated with the degree of albuminuria in children with diabetes. RESEARCH DESIGN AND METHODS SEARCH: is an observational, longitudinal study of children with diabetes. Youth with newly diagnosed diabetes were classified according to diabetes autoantibody (DAA) status and presence of insulin resistance.

Prevalence, characteristics and clinical diagnosis of maturity onset diabetes of the young due to mutations in HNF1A, HNF4A, and glucokinase: results from the SEARCH for Diabetes in Youth.

Aims: Our study aims were to determine the frequency of MODY mutations (HNF1A, HNF4A, glucokinase) in a diverse population of youth with diabetes and to assess how well clinical features identify youth with maturity-onset diabetes of the young (MODY).

Methods: The SEARCH for Diabetes in Youth study is a US multicenter, population-based study of youth with diabetes diagnosed at age younger than 20 years. We sequenced genomic DNA for mutations in the HNF1A, HNF4A, and glucokinase genes in 586 participants enrolled in SEARCH between 2001 and 2006.

Digenic heterozygous HNF1A and HNF4A mutations in two siblings with childhood-onset diabetes.

Monogenic diabetes due to mutations in the transcription factor genes hepatocyte nuclear factor 1A (HNF1A) and HNF4A is characterized by islet cell antibody negative, familial diabetes with residual insulin secretion. We report two sisters with childhood onset diabetes who are both heterozygous for the most common mutation in each of two transcription factors, HNF1A, and HNF4A. The proband was diagnosed with diabetes at 7 yr of age and treated with insulin for 4 yr.

Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence.

Objective: Youth with type 1 diabetes mellitus are at risk for poor glycemic control as they age into adulthood. The aim of this study was to describe sociodemographic and clinical correlates of poor glycemic control associated with the transfer of care from pediatric to adult diabetes providers among a cohort of youth with type 1 diabetes diagnosed in adolescence.

Methods: Analyses included 185 adolescent participants with recently diagnosed type 1 diabetes in the SEARCH for Diabetes in Youth Study with pediatric care at baseline who were age ≥18 years at follow-up.

High titers of autoantibodies to glutamate decarboxylase in type 1 diabetes patients: epitope analysis and inhibition of enzyme activity.

Objective: Autoantibodies to glutamate decarboxylase (GAD65Ab) are found in patients with autoimmune neurological disorders or type 1 diabetes. The correct diagnosis of GAD65Ab-associated neurological disorders is often delayed by the variability of symptoms and a lack of diagnostic markers. We hypothesized that the frequency of neurological disorders with high GAD65Ab titers is significantly higher than currently recognized.

Permanent neonatal diabetes mellitus: prevalence and genetic diagnosis in the SEARCH for Diabetes in Youth Study.

Background: Neonatal diabetes mellitus (NDM) is defined as diabetes with onset before 6 months of age. Nearly half of individuals with NDM are affected by permanent neonatal diabetes mellitus (PNDM). Mutations in KATP channel genes (KCNJ11, ABCC8) and the insulin gene (INS) are the most common causes of PNDM.

Sustained benefit of continuous glucose monitoring on A1C, glucose profiles, and hypoglycemia in adults with type 1 diabetes.

Objective: To evaluate long-term effects of continuous glucose monitoring (CGM) in intensively treated adults with type 1 diabetes.

Research Design And Methods: We studied 83 of 86 individuals >or=25 years of age with type 1 diabetes who used CGM as part of a 6-month randomized clinical trial in a subsequent 6-month extension study. RESULTS After 12 months, median CGM use was 6.

Practical aspects of real-time continuous glucose monitoring.

The advent of commercially available real-time (rt) continuous glucose monitoring (CGM) is revolutionizing diabetes care. This technology, which allows patients to view an approximation of their blood glucose (BG) levels every 5 min, permits fine-tuning of a patient's glycemic control that is not possible with self-monitoring of BG. While at first glance this technology seems too good to be true, it is still early in its development, and thus some practical aspects of its use must be considered before recommending rt-CGM to every patient with diabetes.