Intensive Glucose Control in Patients with Type 2 Diabetes - 15-Year Follow-up.

Background: We previously reported that a median of 5.6 years of intensive as compared with standard glucose lowering in 1791 military veterans with type 2 diabetes resulted in a risk of major cardiovascular events that was significantly lower (by 17%) after a total of 10 years of combined intervention and observational follow-up. We now report the full 15-year follow-up.

Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes.

Background: The Veterans Affairs Diabetes Trial previously showed that intensive glucose lowering, as compared with standard therapy, did not significantly reduce the rate of major cardiovascular events among 1791 military veterans (median follow-up, 5.6 years). We report the extended follow-up of the study participants.

Blood pressure and pulse pressure effects on renal outcomes in the Veterans Affairs Diabetes Trial (VADT).

Objective: Blood pressure (BP) control for renal protection is essential for patients with type 2 diabetes. Our objective in this analysis of Veterans Affairs Diabetes Trial (VADT) data was to learn whether on-study systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) affected renal outcomes measured as albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).

Research Design And Methods: The VADT was a prospective, randomized study of 1,791 veterans with type 2 diabetes to determine whether intensive glucose control prevented major cardiovascular events.

Basic fibroblast growth factor predicts cardiovascular disease occurrence in participants from the veterans affairs diabetes trial.

Aim: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in adults with type 2 diabetes mellitus. The aim of the present study was to test whether plasma basic fibroblast growth factor (bFGF) levels predict future CVD occurrence in adults from the Veterans Affairs Diabetes Trial (VADT).

Methods: Nearly 400 veterans, 40 years of age or older having a mean baseline diabetes duration of 11.

The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial.

Background: The goal of the VA Diabetes Trial (VADT) was to determine the effect of intensive glucose control on macrovascular events in subjects with difficult-to-control diabetes. No significant benefit was found. This report examines predictors of the effect of intensive therapy on the primary outcome in this population.

Observation on renal outcomes in the Veterans Affairs Diabetes Trial.

Objective: The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, controlled trial of 1,791 patients with type 2 diabetes to determine whether intensive glycemic control would reduce cardiovascular events compared with standard control. The effect of intensive glycemic control and selected baseline variables on renal outcomes is reported.

Research Design And Methods: Baseline mean age was 60.

Insulin metabolism in human adipocytes from subcutaneous and visceral depots.

Subjects with the metabolic syndrome (insulin resistance, glucose intolerance, dyslipidemia, hypertension, etc.) have a relative increase in abdominal fat tissue compared to normal individuals and obesity has also been shown to be associated with a decrease in insulin clearance. The majority of the clearance of insulin is due to the action of insulin-degrading enzyme (IDE) and IDE is present throughout all tissues.

Rates and determinants of coronary and abdominal aortic artery calcium progression in the Veterans Affairs Diabetes Trial (VADT).

Objective: To determine the predictors of progression of calcified atherosclerosis and the effect of intensive glycemic control on this process in patients with type 2 diabetes.

Research Design And Methods: As part of the Risk Factors, Atherosclerosis, and Clinical Events in Diabetes (RACED) substudy of the Veterans Affairs Diabetes Trial (VADT), 197 and 189 individuals with type 2 diabetes received baseline and follow-up computed tomographic scans for measurement of coronary and abdominal artery calcium, respectively. Standard and novel risk factors were assessed at baseline, and progression of calcified atherosclerosis was determined by several methods.

Retinoblastoma protein co-purifies with proteasomal insulin-degrading enzyme: implications for cell proliferation control.

Previous investigations on proteasomal preparations containing insulin-degrading enzyme (IDE; EC 3.4.24.

Pioglitazone reduces inflammatory responses of human adipocytes to factors secreted by monocytes/macrophages.

Infiltration of monocyte-derived macrophages into adipose tissue may contribute to tissue and systemic inflammation and insulin resistance. We hypothesized that pioglitazone (Pio) could specifically reduce the inflammatory response of adipocytes to factors released by monocytes/macrophages. We show that macrophage factors (Mphi-factors) greatly increase expression levels of proinflammatory adipokines, chemokines, and adhesion molecules in human subcutaneous and visceral adipose tissue (SAT and VAT) as well as in adipocytes (up to several hundredfold of control).

Blood glucose monitoring is associated with better glycemic control in type 2 diabetes: a database study.

Background: The value of self-monitoring blood glucose (SMBG) in type 2 diabetes is controversial.

Objective: To determine SMBG testing rates are positively associated with glycemic control in veterans on oral hypoglycemic agents (OHA).

Design: Observational database study.

Regulation of protein degradation by insulin-degrading enzyme: analysis by small interfering RNA-mediated gene silencing.

Proteins are vital to the overall structure of cells and to the function of cells in the form of enzymes. Thus the control of protein metabolism is among the most important aspects of cellular metabolism. Insulin's major effect on protein metabolism in the adult animal is inhibition of protein degradation.

Adoption of a new technology in a Veterans Affairs national formulary system with local implementation: the insulin glargine example.

A study group gathered by the Pharmacy & Therapeutics Society reviewed data on the Department of Veterans Affairs (VA) health care system's implementation of a new technology (insulin glargine) for patients with diabetes. It examined local implementation of VA criteria for nonformulary use of insulin glargine in 21 VA treatment facilities that were surveyed about the issue. The examination found differences in the use of insulin glargine across the 21 treatment facilities and in the approach to implementing the criteria for nonformulary use of insulin glargine used at the individual VA treatment facility level.

Baseline achievement of lipid goals and usage of lipid medications in patients with diabetes mellitus (from the Veterans Affairs Diabetes Trial).

The American Diabetes Association has established lipid goals for patients with diabetes. Although diabetic populations historically have poor low-density lipoprotein (LDL) cholesterol goal adherence, little is known about adherence to triglyceride and high-density lipoprotein (HDL) cholesterol goals. To determine the degree of lipid goal attainment among patients with diabetes, and to characterize the patterns of lipid medication use, we evaluated the baseline data from 1,742 enrollees of the national Veterans Affairs Diabetes Trial.

Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study.

Background: Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes.

Methods: We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest.

Control of cardiovascular risk factors in the Veterans Affairs Diabetes Trial in advanced type 2 diabetes.

Objective: To present a status report on the Veterans Affairs Diabetes Trial (VADT), a multisite long-term study examining the effect of glucose control on cardiovascular (CV) complications in older patients with established, poorly controlled type 2 diabetes.

Methods: We review the rationale, objectives, and design of the VADT and summarize the baseline data and the results achieved thus far.

Results: The main objective of this 20-site, 1,792-patient study is to ascertain whether intensive glucose control can reduce major CV events in patients with difficult-to-control type 2 diabetes.

Reliability and validity of the DCP among hispanic veterans.

The Diabetes Care Profile (DCP) was designed to measure psychosocial factors related to diabetes and its treatment. This study sought to determine the reliability and validity of the DCP in Hispanic veterans with Type 2 diabetes. Hispanic (n=81) and non-Hispanic White (n=238) patients were recruited at three southwestern VA hospitals.

Hypoglycemia in stable, insulin-treated veterans with type 2 diabetes: a prospective study of 1662 episodes.

Unlabelled: We evaluated the incidence, severity, and predisposing risk factors for hypoglycemic episodes in subjects with type 2 diabetes.

Methods: We conducted a prospective observational study of Southwest veterans with stable, insulin-treated type 2 diabetes who were randomly selected from pharmacy databases. Electronically recorded self-monitored blood glucose (SMBG) results were collected during 12 months of routine monitoring.

Hypoglycemia in type 2 diabetes: a critical review.

Hypoglycemia is the most important barrier to tight glycemic control. Although severe hypoglycemia is uncommon, milder events can occur so often that they represent a deterrent to intensifying treatment. High-risk patient behaviors are the most important cause for episodes for which a cause can be identified.

Food frequency questionnaire results correlate with metabolic control in insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study.

Objective: To validate food frequency analysis as a predictor of metabolic status in persons with type 2 diabetes and to identify psychosocial factors affecting dietary adherence.

Methods: Three hundred forty-seven subjects with stable, insulin-treated type 2 diabetes completed a food frequency questionnaire and six instruments measuring different psychosocial attributes. Eight metabolic parameters were used as principal endpoints.

Reduced action of insulin glargine on protein and lipid metabolism: possible relationship to cellular hormone metabolism.

Insulin analogues are used in the treatment of diabetes to mimic physiological insulin secretion. Glargine is used to provide basal insulin levels. Previous work has shown no differences in glucose uptake when glargine was compared to native insulin.

A probabilistic model for predicting hypoglycemia in type 2 diabetes mellitus: The Diabetes Outcomes in Veterans Study (DOVES).

Background: To develop and validate a method for estimating hypoglycemia risk in stable, insulin-treated subjects with type 2 diabetes mellitus.

Methods: Subjects (n = 195) monitored their blood glucose levels 4 times daily for 8 weeks. An 8-week mean blood glucose value (GLUMEAN) with standard deviation (GLUSD) was derived for each patient.

Contributions of weekly mean blood glucose values to hemoglobin A1c in insulin-treated type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).

Background: Daily self-monitored blood glucose testing is recommended for patients with insulin-treated type 2 diabetes. However, most patients do not test frequently enough for optimal glycemic control. Less frequent testing may be sufficient for assessing glycemic control among stable patients as well as improving patient compliance.