Faculty Bibliography

Despite immense strides in therapeutic advances, clinical outcomes continue to be less than ideal for people with type 1 diabetes. This discrepancy has prompted an outpouring of quality improvement (QI) initiatives to address the medical, psychosocial, and health equity challenges that complicate ideal type 1 diabetes care and outcomes. This article reviews a framework for QI in diabetes care that guided the development of the T1D Exchange Quality Improvement Collaborative to improve care delivery and health outcomes in type 1 diabetes. Evaluation of the methodology, outcomes, and knowledge gained from these initiatives will highlight the importance of continued QI initiatives in diabetes care.

PURPOSE OF REVIEW/OBJECTIVE:The goal of this article is to review recent research of technology use, including insulin pumps, continuous glucose monitors, and smartpens, for pregnant women with preexisting type 1 diabetes. RECENT FINDINGS/RESULTS:Recent research shows that there may be benefits from technology use in type 1 diabetes pregnancies given the changes in insulin sensitivity throughout the span of pregnancy as well as allowing for more monitoring to allow for sooner titration of insulin doses. SUMMARY/CONCLUSIONS:There may be utility in incorporation of technology during pregnancy with appropriate medical guidance. Additional research would be helpful to further assess the ability of newer automated insulin systems to aid in tight glucose management goals during pregnancy and show value in receiving FDA approval.

CONTEXT:Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there are few data focusing on outcomes in people with type 1 diabetes. OBJECTIVE:The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. DESIGN:An observational multisite cross-sectional study was performed. Diabetes care providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between glycated hemoglobin (HbA1c), age, and comorbidities and hospitalization. SETTING:Cases were submitted from 52 US sites between March and August 2020. PATIENTS OR OTHER PARTICIPANTS:Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. INTERVENTIONS:None. MAIN OUTCOME MEASURES:Hospitalization for COVID-19 infection. RESULTS:A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and 5 patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (odds ratio 1.42, 95% confidence interval 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. CONCLUSIONS:Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.

BACKGROUND:levels among young adults with type 1 diabetes (T1D) and whether this association differed by age or exposure to adverse childhood experiences (ACEs). METHODS:levels were abstracted from medical records. Respondents were categorized by age, high and low dispositional mindfulness (median split on Cognitive and Affective Mindfulness Scale-Revised), and exposure to any of 10 ACEs. RESULTS:levels. CONCLUSIONS:only among 27- to 31-year-olds. In early adulthood, the impact of mindfulness-based interventions on glycemic control may vary by age and childhood trauma history.

PURPOSE OF REVIEW/OBJECTIVE:The increasing prevalence of type 2 diabetes is driving the boundaries of clinical diabetes care outside of the traditional office setting. The purpose of this paper will be to review recent technological advances in the medical management of people with type 2 diabetes, spanning the spectrum of care from access to healthcare providers/educators, to continual virtual support methods, on-line management tools, and technologically integrated medication delivery systems. RECENT FINDINGS/RESULTS:Recent findings support a potential positive impact of technology on access to care, clinical outcomes, convenience, patient well-being, and patient acceptance. This includes the use of Bluetooth-enabled glucose meters, continuous glucose monitors, mHealth apps, smartpens, and insulin pumps. However, there are impediments to the implementation of some technologies due to cost and lack of insurance coverage. There is evidence to support the use of technology to improve the management and treatment of people with type 2 diabetes. Further research is required to demonstrate the long-term clinical benefit and financial viability of technology in the management of type 2 diabetes.

Spinal muscular atrophy is an autosomal recessive neurodegenerative disease caused by homozygous mutation to the survival motor neuron 1 (SMN1) gene. Historically, spinal muscular atrophy has been considered to almost exclusively affect the function and survival of alpha motor neurons of the spinal cord and brainstem. With the development of animal models of spinal muscular atrophy, the presence of widespread systemic abnormalities affecting the brain, heart, and pancreas has been repeatedly noted among animals with diminished survival motor neuron protein expression. While these observations suggest similar possible effects in humans, reports of primary systemic disease manifestations among humans affected by spinal muscular atrophy are strikingly lacking. Here we report a case of a 29-year-old man with genetically confirmed spinal muscular atrophy type II who presented with new onset diabetes mellitus and diabetic ketoacidosis.

OBJECTIVE:The purpose of this study was to determine whether metformin promotes weight loss in overweight outpatients with chronic schizophrenia or schizoaffective disorder. METHOD/METHODS:In a double-blind study, 148 clinically stable, overweight (body mass index [BMI] ≥27) outpatients with chronic schizophrenia or schizoaffective disorder were randomly assigned to receive 16 weeks of metformin or placebo. Metformin was titrated up to 1,000 mg twice daily, as tolerated. All patients continued to receive their prestudy medications, and all received weekly diet and exercise counseling. The primary outcome measure was change in body weight from baseline to week 16. RESULTS:Fifty-eight (77.3%) patients who received metformin and 58 (81.7%) who received placebo completed 16 weeks of treatment. Mean change in body weight was -3.0 kg (95% CI=-4.0 to -2.0) for the metformin group and -1.0 kg (95% CI=-2.0 to 0.0) for the placebo group, with a between-group difference of -2.0 kg (95% CI=-3.4 to -0.6). Metformin also demonstrated a significant between-group advantage for BMI (-0.7; 95% CI=-1.1 to -0.2), triglyceride level (-20.2 mg/dL; 95% CI=-39.2 to -1.3), and hemoglobin A1c level (-0.07%; 95% CI=-0.14 to -0.004). Metformin-associated side effects were mostly gastrointestinal and generally transient, and they rarely led to treatment discontinuation. CONCLUSIONS:Metformin was modestly effective in reducing weight and other risk factors for cardiovascular disease in clinically stable, overweight outpatients with chronic schizophrenia or schizoaffective disorder over 16 weeks. A significant time-by-treatment interaction suggests that benefits of metformin may continue to accrue with longer treatment. Metformin may have an important role in diminishing the adverse consequences of obesity and metabolic impairments in patients with schizophrenia.