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This Week in JAMA
May 15, 2002

This Week in JAMA

JAMA. 2002;287(19):2461. doi:10.1001/jama.287.19.2461

Edited by David S. Cooper, MD, and Catherine D. DeAngelis, MD, MPH

Predictors of Acute Complications of Diabetes in Children

Diabetic ketoacidosis and severe hypoglycemia are acute life-threatening complications of type 1 diabetes mellitus. In this analysis of prospectively collected data from a large cohort of children with type 1 diabetes, Rewers and colleagues found that the incidence of ketoacidosis was 8 episodes per 100 person-years and of severe hypoglycemia, 19 episodes per 100 person-years. Potentially modifiable risk factors for these complications included underinsurance, the presence of psychiatric disorders, and extremes of the hemoglobin A1C distribution.

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Ethnic Disparities in Incidence of Diabetic Complications

Higher rates of microvascular complications of diabetes mellitus have been reported for blacks and Hispanics relative to whites. Karter and colleagues assessed ethnic differences in the incidence of 5 major diabetic complications in a 3-year longitudinal study of adults with diabetes who had uniform health care coverage through enrollment in a prepaid health care organization. Patterns of ethnic differences were not consistent across complications. The incidence of end-stage renal disease was elevated among ethnic minorities compared with whites, consistent with previous studies, but rates of the other complications were similar or lower.

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Retinal Arteriolar Narrowing and Risk of Diabetes

Previous studies suggest that microvascular abnormalities may play a role in the pathogenesis of type 2 diabetes mellitus. In this report from the Atherosclerosis Risk in Communities study, a prospective cohort study of adults aged 49 to 73 years without diabetes, Wong and colleagues found that retinal arteriolar narrowing as measured on digitized retinal photographs was independently associated with risk of incident diabetes after a median follow-up of 3.5 years.

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Birth Weight and Eventual Risk of Gestational Diabetes

Reduced fetal growth has been associated with subsequent risk for type 2 diabetes mellitus among older adults. In this case-control study of healthy women completing a first pregnancy, Innes and colleagues found that a woman's own birth weight was strongly and inversely related to her risk of gestational diabetes, which is a major predictor of type 2 diabetes.

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Cost-effectiveness of Interventions for Type 2 Diabetes

The CDC Diabetes Cost-effectiveness Group used data from the United Kingdom Prospective Diabetes Study and other studies to estimate the incremental cost-effectiveness of 3 medical interventions for patients with type 2 diabetes mellitus. In a hypothetical cohort of adults aged 25 years or older with newly diagnosed type 2 diabetes, intensified hypertension control was found to reduce costs and improve health outcomes compared with moderate hypertension control. Intensive glycemic control and reduction of serum cholesterol level were also found to improve health outcomes, but at increased costs.

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Therapeutic Footwear in Patients With Diabetes

Therapeutic footwear is often dispensed to patients with diabetes mellitus to prevent foot ulcers. In this randomized clinical trial, Reiber and colleagues compared therapeutic shoes with customized cork inserts, therapeutic shoes with prefabricated polyurethane inserts, and usual footwear in patients with diabetes who had a history of foot ulcer but who did not have severe foot deformity. All patients continued to receive regular health care and foot care. The 2-year cumulative reulceration incidence was low (14% to 17%) and not significantly different in the 3 study groups.

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Medical News & Perspectives

Research is helping to uncover the molecular miscues that can cause neural tube defects in infants of diabetic women, and advances in prevention and therapy may mitigate the risk heart disease carries for patients with diabetes.

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Alcohol Intake and Insulin Sensitivity

In a randomized crossover trial, daily moderate alcohol intake reduced fasting insulin levels and improved insulin sensitivity in postmenopausal women without diabetes.

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Intensive Therapy for Type 1 Diabetes

In the Diabetes Control and Complications Trial, risk of microvascular complications of type 1 diabetes mellitus was significantly reduced with intensive therapy compared with conventional therapy. This risk reduction has persisted through 7 years of observational follow-up even though the difference in mean HbA1C levels in the 2 former randomized treatment groups progressively decreased and became nonsignificant.

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Clinician's corner

A review of atherosclerosis and diabetes mellitus stresses the importance of aggressive treatment of dyslipidemia, hypertension, and hypercoagulability, in addition to glycemic control, to reduce the risk of cardiovascular morbidity and mortality in patients with diabetes.

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JAMA Patient Page

For your patients: Information about diabetes.

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