Melissa Glim

The latest United States Preventive Service Task Force screening guidelines for diabetes, released in October 2015, miss 55% of high-risk individuals with prediabetes or diabetes, a new 

The guidelines recommend doctors screen for diabetes in all patients between 40 and 70 years of age who are overweight or obese. While this represents a high-risk group, many people outside these age and weight ranges still develop diabetes, especially among certain racial and ethnic populations.

"We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites," said senior author, Matthew O’Brien, MD, assistant professor of medicine from Northwestern University Feinberg School of Medicine in Chicago.

O’Brien and colleagues looked at electronic health record data from 50,515 adults primary care patients at six community health centers in the Midwest and Southwest between 2008 and 2013. They excluded patients who already had diabetes at the beginning of the study. Using the guidelines, the identified those who should be screened. Then they looked at who actually developed diabetes.

The results showed that only 54 percent of white patients who developed dysglycemia fit well within the new screening guidelines. Worse yet, the guidelines only captured 50 percent of African Americans and 37 percent of Latinos.

“The screening criteria had lower sensitivity in all racial/ethnic minority groups compared to whites,” the researchers wrote in the report published online July 12 in PLoS Medicine.

By missing so many people at risk for diabetes, doctors lose an opportunity to advise patients on preventive measures such as improving their nutrition, exercising, and taking medications. Moreover, since the Affordable Care Act requires coverages of all services that are required by the USPST, those who fall outside the guideline parameters who want screening may have to pay out of pocket for the tests.

"Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly," said O'Brien. "If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes."

Articles

The latest United States Preventive Service Task Force screening guidelines for diabetes, released in October 2015, miss 55% of high-risk individuals with prediabetes or diabetes, a new study shows.

Task Force Screening Guidelines Missing Diabetes?

Studies have shown how the support of family members plays a role in outcomes for adults with diabetes. But how does living with or caring for someone with diabetes affect the family members?

To better understand the experiences and unmet needs of these families, an international team of researchers led by Heather Stuckey, D.Ed., assistant professor at Penn State College of Medicine in Harrisburg, PA, surveyed more than 2,057 adult families in which an adult member had diabetes.

The participants were registered with the second Diabetes Attitudes, Wishes, and Needs (DAWN2) study, a large-scale survey of family members of adults with diabetes in 17 countries. Participants responded via email, phone, and in person to open-ended questions about how living with a person with diabetes has impacted them and the ways they choose to be involved with that person’s care.

Overall, they found that having a family member with diabetes causes worry and can strain relationships for many of the respondents. They worry about issues like hypoglycemic attacks and job insecurity related to the illness. Although this group does believe support exists to deal with burdens and lifestyle changes necessitated by diabetes, many expressed a desire for more help. On the positive side, family members were inspired by their loved one with diabetes to make positive changes in their own lives, such as eating better and exercising.

"This research reveals the nature and extent of what it's like to live with a person with diabetes," said Stuckey. "The biggest challenge we identified for family members is that there's a constant worry about the person. It's in the background like an app that's always running."

She hopes these findings will support changes in health care policy. "For instance, in the U.S., we hope that the importance of including family members in educational sessions will be recognized and will be covered by medical insurance. This can help family members feel more informed and closer to their loved one who is living with diabetes,” she said.

In the absence of significant changes to the system, she recommends physicians will invite family members to come along to medical visits to learn more and find more support as a caregiver.

 appeared in the June 2016 issue of Diabetes Research and Clinical Practice. 

DAWN2 is a global partnership between the International Diabetes Federation in Brussels, the International Alliance of Patients’ Organizations in London, the Steno Diabetes Center in Gentofte, Denmark, and Novo Nordisk. 

Family members of diabetics can be stressed by worry, wondering what to do about a hypoglycemic attack or fretting over the patient's job security. A new study looks at the impact of diabetes on these caregivers. 

Diabetes Can Strain Relationships but Physicians Can Help

A less common procedure for coronary artery bypass grafting (CABG) may give diabetic patients longer life and long-term outcomes.

In an analysis of 63,000 cardiac surgery cases from the Australian and New Zealand Society of Cardiothoracic Surgeons (ANZSCTS) database, researchers found a statistically significant difference between those who had conventional bypass surgery and those who had total arterial revascularization (TAR) in which the surgeon uses only arteries to create the bypass. Conventional CABG generally uses one artery and veins to create the brief.

The team identified 34,181 patients who underwent some form of CABG between 2001 and 2012. Of these, 11,642 (34.1%) had diabetes. Of this group, 3,785 (32.6%) had TAR and 7,847 (67.4%) had CABG. To do the analysis, they compared a subset of 2,017 patients who were diabetic and had CABG using only arteries and 1,967 patients who were diabetic and had conventional CABG.

After a mean follow-up of 4.9 years, they found perioperative mortality (including the 30 days after surgery) was similar for both groups (1.2% for TAR and 1.4% for non-TAR), but late mortality was lower among diabetic patients who had TAR (10.2% vs. 12.2%, which was statistically significant. Of every 100 patients, 4 more were alive at 10 years out when arteries are used (82% vs. 78%, respectively.

At the same time, no additional complications occurred when TAR/CABG was used compared with traditional CABG. Complications generally include angina, heart attack, heart failure, and hospital readmissions.

In the U.S., conventional CABG has been performed for more than 50 years. It is one of the most common surgeries, with about 400,000 performed each year according to the Centers for Disease Control and prevention. Currently only 5 percent of patients who undergo CABG receive multiple arterial grafts.

"With the incidence of diabetes increasing in the United States, happening together with the continued improvement in life expectancy, it is probable that there will be more and more diabetic patients requiring CABG surgery in the future," said James Tatoulis, MD, FRACS, Professor of Cardiothoracic Surgery at the Royal Melbourne Hospital in Australia in a statement, speaking about the applicability of the study in the U.S. "Thus, the superiority of TAR/CABG will assume progressive importance."

He predicted that more patients could benefit from this type of surgery and experience a longer life, a better quality of life, and lower medical costs. Moreover, he added, "TAR/CABG is definitely within each cardiothoracic surgeon's ability and should be part of their repertoire.”

The study was presented at the Fifty-Second Annual Meeting of The Society of Thoracic Surgeons, Phoenix, AZ, Jan 23—27, 2016 and 

in the Annals of Thoracic Surgeons online ahead of print July 14.

Diabetics who need CABG surgery have better outcomes when surgeons perform total arterial revascularization. 

Diabetics Do Better with Arteries-Only CABG

A simple new blood test can accurately predict Type 2 diabetes risk better than traditional glucose measures among women with gestational diabetes.

An estimated 3 to 14 percent of women develop gestational diabetes, a condition that can raise risk of developing type 2 diabetes within 5 years by 20 to 50 percent. A better predictive test can help health care providers identify those who have the highest risk and perhaps motivate them to make necessary lifestyle changes to stave off the disease.

Although diabetes is typically diagnosed by observing increases in blood glucose levels, other metabolites may also signify a higher risk of type 2 diabetes in the future. These changes appear before the rise in blood glucose levels occurs. The team identified 21 metabolites that were significantly different in people with type 2 diabetes.

To develop the new test, a team of researchers tested fasting blood samples for from 1,035 women who had experienced gestational diabetes 6 to 9 weeks after giving birth. They screened for diabetes with a fasting blood test followed by a 2-hour oral glucose test and also screened for other metabolites using a technique called targeted metabolomics. Of the 1,010 women who did not already have type 2 diabetes at the start, 113 developed it within 2 years and another 17 developed it between 2 and 4 years later.

The targeted metabolomics predicted diabetes risk with 83 percent accuracy, which was significantly better than the conventional test. It was also much more convenient.

"After delivering a baby, many women may find it very difficult to schedule two hours for another glucose test," said co-lead author Michael Wheeler, PhD, professor in the Department of Physiology at the University of Toronto and senior scientist at the Toronto General Research Institute. "What if we could create a much more effective test that could be given to women while they're still in the hospital? Once diabetes has developed, it's very difficult to reverse."

The new method may also be useful for predicting risk among people in the general population. The team plans to continue testing the technique to evaluate differences among people of different ethnicities and those who are already at high risk.

"Early prevention is the key to minimizing the devastating effects of diabetes on health outcomes," said co-lead author Erica Gunderson, PhD, senior research scientist with Kaiser Permanente Northern California Division of Research in Oakland, Calif. "By identifying women soon after delivery, we can focus our resources on those at greatest risk who may benefit most from concerted early prevention efforts." The study appeared online ahead of print on June 23 in the journal

Author | Melissa Glim

Articles

Task Force Screening Guidelines Missing Diabetes?

Diabetes Can Strain Relationships but Physicians Can Help

Diabetics Do Better with Arteries-Only CABG

How to Test for Gestational Diabetes the Easy Way