Publications by authors named "Reaven P"
Objective: To determine the health care cost savings from the Wellth app, a mobile health intervention that uses financial incentives to increase medication adherence.
Study Design: An observational study of members in one of Arizona's Medicaid managed care plans, part of Arizona Health Care Cost Containment System (AHCCCS), using the Wellth app from March 28, 2020, to January 12, 2021. One-to-one matching was used to identify comparable nonparticipants, and a difference-in-differences approach was used to estimate the impact of the Wellth intervention on outcomes defined over the 9 months before and after using Wellth.
Objective: Higher truncated-to-native apolipoprotein (apo) C-I proteoform ratios (C-I'/C-I) are associated with favorable cardiometabolic risk profiles, but their relationship with longitudinal changes in insulin resistance (IR) and incident diabetes is unknown.
Research Design And Methods: Plasma apoC-I proteoforms were measured by mass spectrometry immunoassay at baseline in 4,742 nondiabetic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and 524 participants with prediabetes in the Actos Now for Prevention of Diabetes (ACT NOW) study. The primary outcome was incident diabetes (fasting glucose [FG] ≥7.
Article Synopsis
- Continuous glucose monitoring (CGM) can enhance diabetes management for patients on insulin, but our study found disparities in CGM prescriptions among different racial and ethnic groups among U.S. Veterans.
- Out of 368,794 patients, only 11.2% received a CGM prescription, with notably lower rates for Black or African American (9.2%) and Hispanic or Latino patients (8.3%) compared to White patients (11.8%).
- After adjusting for various factors, Black or African American patients had 38% lower odds and Hispanic patients had 21% lower odds of being prescribed CGM than their non-Hispanic White counterparts, highlighting ongoing racial disparities in healthcare access.
Article Synopsis
- The study aimed to create and validate algorithms that can effectively identify cases of diabetic retinopathy (DR) from electronic health records (EHRs) across three different healthcare systems.
- The algorithms were assessed based on specific criteria for identifying DR cases and diabetes controls, yielding high positive and negative predictive values (PPV and NPV) across the different systems tested.
- Results showed that while the algorithms performed well overall, there were some variances in their effectiveness, especially when comparing different healthcare systems, highlighting the need for further validation to enhance their reliability.
Article Synopsis
- Diabetes complications, like retinopathy and neuropathy, occur more frequently in individuals of African ancestry, partly due to G6PD deficiency which is associated with malaria resistance and lowers HbA1c levels by affecting red blood cell lifespan.
- A study discovered a specific variant (rs1050828-T) linked to G6PD deficiency that increases the risk of diabetes complications, showing that glucose levels influence retinopathy risk significantly.
- The findings suggest that adjusting diabetes management based on glucose levels or genetic factors could improve diagnosis and treatment, potentially reducing complications for those with G6PD deficiency.
Article Synopsis
- The study examined the relationship between different forms of Apolipoprotein C-III (apoC-III) and the risk of peripheral artery disease (PAD) in participants from a long-term study.
- Researchers measured various apoC-III forms in over 5,700 participants and assessed their ankle-brachial index (ABI) at multiple points over 17 years.
- They found that specific apoC-III proteoforms were associated with changes in ABI and a reduced risk of PAD, indicating that these proteoforms have unique effects on vascular health that aren't explained by total apoC-III levels alone.
Background: Intensive glycemic control reduced the risk of coronary artery disease (CAD) events among White ACCORD study participants with the haptoglobin (Hp)2-2 phenotype, and not among participants without the Hp2-2 phenotype. It is unknown whether these results persist in a population with more severe diabetes.
Methods: Haptoglobin phenotype was measured in 1746 (97 %) samples from the Veterans Affairs Diabetes Trial (VADT) randomized controlled trial.
Article Synopsis
- * The research evaluated how quickly patients started using CGM after receiving it, showing an average delay of 3 weeks that lessened over time, and confirmed consistent daily wear time of over 22 hours.
- * Findings revealed a strong agreement between CGM usage reported in EHRs and actual device data, demonstrating reliable integration and similar CGM usage patterns across different age and racial groups for both diabetes types.
Article Synopsis
- - Diabetes significantly raises the risk of heart and kidney diseases, particularly highlighting that those with kidney disease face even higher cardiovascular risks.
- - The study found that higher levels of apolipoprotein C3 (APOC3) in patients with type 2 diabetes predict worse kidney function, suggesting it plays a role in diabetic kidney disease and atherosclerosis.
- - By silencing APOC3 in diabetic mice, researchers observed reduced kidney damage and atherosclerosis, indicating that targeting APOC3 could be a promising strategy for treating these diabetes-related complications.
Objective: To characterize high type 1 diabetes (T1D) genetic risk in a population where type 2 diabetes (T2D) predominates.
Research Design And Methods: Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program participants with adult-onset diabetes, 2011-2021, who had T1D genetic risk scores (GRS) defined as low (0 to <45%), medium (45 to <90%), high (90 to <95%), or highest (≥95%).
Results: T1D characteristics increased progressively with higher genetic risk (P < 0.
Objectives: To develop, validate and implement algorithms to identify diabetic retinopathy (DR) cases and controls from electronic health care records (EHR)s. : We developed and validated EHR-based algorithms to identify DR cases and individuals with type I or II diabetes without DR (controls) in three independent EHR systems: Vanderbilt University Medical Center Synthetic Derivative (VUMC), the VA Northeast Ohio Healthcare System (VANEOHS), and Massachusetts General Brigham (MGB). Cases were required to meet one of three criteria: 1) two or more dates with any DR ICD-9/10 code documented in the EHR, or 2) at least one affirmative health-factor or EPIC code for DR along with an ICD9/10 code for DR on a different day, or 3) at least one ICD-9/10 code for any DR occurring within 24 hours of an ophthalmology exam.
View Article and Find Full Text PDFPurpose: To provide a systematic review and meta-analysis synthesizing the findings of randomized controlled trials (RCTs) of continuous glucose monitors (CGMs) in the management of adults with type 2 diabetes mellitus (T2DM) on glucose control and clinical outcomes.
Methods: MEDLINE, Embase, and Cochrane were searched for RCTs that assessed the effectiveness of real-time CGM (rt-CGM) or flash CGM (FGM) in adults (≥18 years) with T2DM that reported on at least 1 of the following outcomes: hemoglobin A1c (HbA1c), time in range, time in hyperglycemia, or time in hypoglycemia. The GRADE approach was used to assess certainty of evidence for primary outcomes.
Article Synopsis
- The study focused on the effects of long-term and short-term glycemic variability on kidney complications in type 2 diabetes, measured during a clinical trial.
- It found that both high visit-to-visit fasting plasma glucose variability (CV-FPG) and low levels of a short-term marker (1,5-AG) were linked to microalbuminuria, a type of kidney damage.
- However, after considering average HbA1c levels, only long-term glycemic variability remained a significant predictor for both microalbuminuria and macroalbuminuria, suggesting its importance in assessing renal risk in diabetic patients.
Background And Aims: Higher truncated-to-native proteoform ratios of apolipoproteins (apo) C-I (C-I'/C-I) and C-II (C-II'/C-II) are associated with less atherogenic lipid profiles. We examined prospective relationships of C-I'/C-II and C-II'/C-II with coronary heart disease (CHD) and coronary artery calcium (CAC).
Methods: ApoC-I and apoC-II proteoforms were measured by mass spectrometry immunoassay in 5790 MESA baseline plasma samples.
Article Synopsis
- The study aimed to find new uses for existing drugs to help manage diabetes while controlling blood sugar levels, using a low-cost method for drug discovery.
- Researchers developed a drug-repurposing pipeline that identified and validated 20 drug-gene pairs linked to diabetes, showing that certain medications, especially calcium channel blockers, effectively reduce blood glucose levels.
- The findings suggest that calcium channel blockers are promising candidates for managing both blood glucose and cardiovascular health, highlighting the potential for this approach in repurposing drugs for other medical conditions.
Apo CIII Proteoforms, Plasma Lipids, and Cardiovascular Risk in MESA.
Arterioscler Thromb Vasc Biol
August 2023
Background: Apo CIII (apolipoprotein CIII) is an important regulator of triglyceride metabolism and was associated with cardiovascular risk in several cohorts. It is present in 4 major proteoforms, a native peptide (CIII), and glycosylated proteoforms with zero (CIII), 1 (CIII, most abundant), or 2 (CIII) sialic acids, which may differentially modify lipoprotein metabolism. We studied the relationships of these proteoforms with plasma lipids and cardiovascular risk.
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- The study aimed to evaluate the advantages of continuous glucose monitoring (CGM) for adults with type 1 and type 2 diabetes, focusing on long-term glucose control and emergency healthcare events.
- Researchers conducted a retrospective observational study within the Veterans Affairs Health Care System, comparing CGM users to nonusers over 12 months.
- Results showed significant improvements in glucose control (lower HbA1c levels) for CGM users and reduced risks of hospital admissions related to blood sugar issues in both types of diabetes.
Article Synopsis
- The paper investigates how to track the onset and progression of diseases over time by focusing on data from the UK Biobank and the use of algorithms to identify risk factors that change over time.
- Researchers developed a method to consolidate health data, specifically targeting diabetes complications like cardiovascular disease, kidney disease, and retinopathy, while ensuring relevant definitions and expert validation in the phenotyping process.
- The study successfully identified tens of thousands of diabetes patients and demonstrated reliable risk prediction for various complications, emphasizing the importance of a comprehensive approach to understanding disease progression.
Elevated body mass index (BMI) is heritable and associated with many health conditions that impact morbidity and mortality. The study of the genetic association of BMI across a broad range of common disease conditions offers the opportunity to extend current knowledge regarding the breadth and depth of adiposity-related diseases. We identify 906 (364 novel) and 41 (6 novel) genome-wide significant loci for BMI among participants of European (N~1.
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- The study investigates the relationship between different antidiabetic medications (ADMs) and the risk of dementia in patients with type 2 diabetes (T2D), specifically comparing sulfonylurea (SU), thiazolidinedione (TZD), and metformin (MET).
- Using a large dataset from the Veterans Affairs Healthcare System, researchers analyzed dementia onset in a cohort of over 559,000 veterans aged 60 and older who were free of dementia at the start of treatment.
- Results showed that TZD treatment was linked to a 22% lower risk of developing all-cause dementia compared to MET, while SU treatment was associated with a 12% higher risk than MET, indicating significant differences in dementia risk
Apolipoproteins (apo) C-I and C-II are key regulators of triglyceride and HDL metabolism. Both exist as full-size native and truncated (apoC-I'; apoC-II') posttranslational proteoforms. However, the determinants and the role of these proteoforms in lipid metabolism are unknown.
View Article and Find Full Text PDFWe report a genome-wide association study (GWAS) of coronary artery disease (CAD) incorporating nearly a quarter of a million cases, in which existing studies are integrated with data from cohorts of white, Black and Hispanic individuals from the Million Veteran Program. We document near equivalent heritability of CAD across multiple ancestral groups, identify 95 novel loci, including nine on the X chromosome, detect eight loci of genome-wide significance in Black and Hispanic individuals, and demonstrate that two common haplotypes at the 9p21 locus are responsible for risk stratification in all populations except those of African origin, in which these haplotypes are virtually absent. Moreover, in the largest GWAS for angiographically derived coronary atherosclerosis performed to date, we find 15 loci of genome-wide significance that robustly overlap with established loci for clinical CAD.
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- Researchers studied the rs35705950-T genetic variant to see how it affects the risk of severe outcomes in COVID-19 patients, particularly in the Million Veteran Program (MVP) participants.
- The study found that those with the rs35705950-T allele had fewer hospitalizations due to COVID-19 but did not show significant differences in overall positivity rates for the virus.
- The variant was linked to reduced rates of post-COVID-19 pneumonia among individuals of European ancestry, suggesting potential protective effects against certain complications of the disease.
Article Synopsis
- Sickle cell trait (SCT) affects millions in the US, especially among African and Hispanic populations, but its link to COVID-19 remains uncertain.* -
- The study analyzed data from the Million Veteran Program, comparing 2,729 SCT-positive individuals, 353 of whom had COVID-19, to SCT-negative individuals to understand COVID-19 outcomes.* -
- Results showed that SCT is associated with higher COVID-19 mortality among individuals of African ancestry and linked to various chronic health conditions before the pandemic.*
Article Synopsis
- * The genome-wide association study (GWAS) identified 77 significant genetic loci linked to NAFLD, with 25 of these being newly discovered, demonstrating the complexity of its genetic basis across different ancestries.
- * Further validation in other cohorts confirmed 17 specific single-nucleotide polymorphisms (SNPs) related to NAFLD, highlighting their relationships with metabolic and inflammatory traits, thus