Faculty Bibliography

There is limited understanding of modifiable factors influencing health-related quality of life (HRQoL) among children living with type 1 diabetes (T1D). Executive function skills may be a relevant factor because they underpin the ability to successfully orchestrate T1D self-management. We examined the association between executive functioning and HRQoL among 10-17 year old children living with T1D for more than six months. Caregivers and children (n = 41) completed assessments to measure the child's executive function skills and child and caregiver HRQoL. Linear regression models estimated adjusted betas and 95% confidence intervals (CI) for associations between child executive functioning and child and caregiver HRQoL. In adjusted models, worse executive functioning skills were associated with worse HRQoL. This pattern was consistent across caregiver and child report of the child's executive functioning, caregiver and child report of the child's HRQoL, and caregiver report of their own HRQoL. Further investigation is needed to understand how executive functioning and HRQoL are related in this population, as well as whether educating families on the role of executive functioning in diabetes self-management could improve HRQoL within the family ecosystem.

BACKGROUND/UNASSIGNED:Fetal cardiomyopathy is a rare condition, often with an unknown cause and associated with high perinatal mortality. Recent years have seen improvement in fetal cardiac screening, genetic testing, and management. We sought to investigate genetic associations and clinical outcomes of fetal cardiomyopathy in the contemporary era. METHODS/UNASSIGNED:A single-arm (descriptive) retrospective cohort study of fetal cardiomyopathy cases diagnosed from January 2017 to December 2021 at 26 North American centers in the Fetal Heart Society Research Collaborative was undertaken. Cases attributable to maternal diabetes, extra-cardiac conditions, structural heart disease, or arrhythmias were excluded. Genetic testing results, extra-cardiac structural anomalies, and outcomes were collected. Logistic regression was performed to determine prenatal risk factors for death or cardiac transplantation by 1-year of age. Descriptive competing-risk analyses (cumulative incidence functions) and Kaplan-Meier survival estimates were used to describe outcomes. Multivariable logistic regression with 5 prespecified covariates was performed to identify prenatal factors associated with death or cardiac transplantation by 1-year of age. RESULTS/UNASSIGNED:≤0.001) were significantly associated with death or transplant by 1-year of age. CONCLUSIONS/UNASSIGNED:Fetal cardiomyopathy outcomes have improved in the current era, although only half achieve 1-year cardiac transplant-free survival. Genetic testing identifies a cause in one-third of cases. Hydrops at the time of fetal cardiomyopathy diagnosis and a prenatal diagnosis of extra-cardiac structural anomalies remain important risk factors for mortality.

IMPORTANCE/UNASSIGNED:Remote patient monitoring (RPM), including self-measured blood pressure monitoring with clinician review and telehealth-supported feedback, can support hypertension management. However, RPM use and related care continuity after switching from Medicare fee-for-service (FFS) to Medicare Advantage (MA) remain unclear. OBJECTIVE/UNASSIGNED:To compare RPM adoption, clinician continuity, and hypertension-related acute care utilization among beneficiaries who remained in Medicare FFS vs switched to MA plans, categorized as value-based contract (VBC) proxy or non-VBC. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study with an observational difference-in-differences design with propensity score matching used data from 2016 to 2022 Medicare enrollment, FFS claims, and MA encounter data. Beneficiaries were aged 65 years or older with prevalent diagnosed hypertension in 2018 and continuous enrollment in Parts A and B in 2018. Treated groups switched from FFS to MA in January 2019 and remained enrolled through 2022; comparators remained in FFS. Follow-up extended from January 1, 2019, through December 31, 2022. Data analysis was conducted from April to July 2025. EXPOSURE/UNASSIGNED:Switching from Medicare FFS to MA-VBC proxy or MA non-VBC in 2019. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was annual RPM adoption during hypertension-related visits; secondary outcomes included clinician loss without replacement, clinician switching or substitution, and hypertension-related emergency department (ED) visits and hospitalizations. RESULTS/UNASSIGNED:Matched samples included 281 620 beneficiaries, with 46 833 MA-VBC proxy plan switchers and 46 833 FFS comparators (27 920 [59.6%] aged 71 years or older and 27 685 female [59.1%] in each group) and 93 977 MA non-VBC switchers and 93 977 FFS comparators (67 188 [71.5%] aged 71 years or older; 53 122 female [56.5%] in each group). Common comorbidities included diabetes, chronic kidney disease, and heart failure. Switching to MA was associated with lower RPM adoption in 2022 (MA-VBC proxy: odds ratio [OR], 0.55; 95% CI, 0.42-0.72; -0.63 percentage points; non-VBC: OR, 0.73; 95% CI, 0.54-0.99; -0.52 percentage points), greater clinician loss without replacement (MA-VBC proxy: OR, 1.27; 95% CI, 1.23-1.32; 3.41 percentage points; MA non-VBC: OR, 1.09; 95% CI, 1.06-1.12; 0.83 percentage points), and higher hypertension-related hospitalizations (MA-VBC proxy: OR, 1.75; 95% CI, 1.48-2.06; MA non-VBC: OR, 1.94; 95% CI 1.71-2.19; 1.56 percentage points in both comparisons). Event-study analyses showed postswitch divergence through 2022. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cohort study of older Medicare beneficiaries with hypertension, switching from FFS to MA was associated with lower RPM adoption, greater clinician discontinuity, and higher hypertension-related acute care use. These findings suggest that continuity safeguards and clearer payment or quality incentives during MA transitions may support remote monitoring and clinician follow-up for hypertension.

PURPOSE OF REVIEW/OBJECTIVE:Diabetes care is characterized by the widespread use of plastics. With plastic-associated endocrine-disrupting chemicals (EDCs) implicated in diabetes pathogenesis, this review examines how medical plastics relate to diabetes and related disorders and proposes interventions to improve the situation. RECENT FINDINGS/RESULTS:Plastic-associated EDCs and micro-/nanoplastics (MNPs) are linked to metabolic dysfunction. Medical care exposes patients to these agents; however, the precise contribution of diabetes care to these exposures and their associated adverse health effects remains poorly defined. Diabetes care is an increasingly important contributor to plastic pollution and climate change, yet inadequate systems exist to mitigate its environmental impact. Plastic-associated EDCs and MNPs remain an underappreciated metabolic health threat. Mitigating the deleterious impacts of plastics on human and planetary health requires concerted actions from manufacturers, scientists, policymakers, professional organizations, healthcare providers, and patients. Doing so has the potential to improve metabolic health and promote health equity.

BACKGROUND:Over 90% of Asian American (AsA) adults are first- or second-generation immigrants, undergoing substantial environmental and sociocultural transitions; yet most environmental epidemiology cohorts have included few AsA participants. METHODS:The Food and Microbiome Longitudinal Investigation (FAMiLI) is an environmental health cohort enriched with AsA adults (predominantly Korean and Chinese American) and designed to capture environmental exposures, dietary acculturation, and sociocultural factors across immigration generations. Its biobank-including buccal and stool specimens-supports research on the oral and gut microbiomes, human genomics, and other multi-omics. RESULTS:Since its launch in 2018, FAMiLI has completed baseline recruitment and biospecimen collection for 13,183 adults aged 40-75 years. The cohort is now expanding to include an additional 3,000 Asian American adults, bringing the total to approximately 16,000 participants, with an expected distribution of ~50% Asian American and ~50% from other racial/ethnic groups. This expansion provides an opportunity to examine AsA environmental health experiences within the broader U.S. CONCLUSIONS:FAMiLI is a unique national resource to address priority questions in environmental health, including microbiome and exposome science, individual susceptibility, and large-scale data analytics. IMPACT/CONCLUSIONS:The cohort supports investigation of critical windows of environmental change across the immigration experience, racial and ethnic disparities, and drivers of emerging health outcomes, including cancer, cardiovascular disease, diabetes and other outcomes. This cohort offers essential data to inform prevention strategies and shape public health policy to improve health outcomes in AsA communities.

BACKGROUND:Improvements in cardiovascular health (CVH), an integral component of diabetes self-management, significantly reduce the risk of cardiovascular disease. OBJECTIVE:In this study, we aimed to compare CVH scores and explore barriers and facilitators to optimal CVH among 2 populations with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS:This is a secondary analysis from 2 parent-sequential explanatory mixed-methods studies: the first examined a subsample of emerging adults living with T1D; the second included emerging to middle-aged adults living with T2D. Participants' CVH was assessed using the American Heart Association's definition of CVH (Life's Simple 7). Semistructured interviews explored participants' achievement of CVH behaviors. An inductive content analysis method guided data analysis. RESULTS:The T1D sample (n1 = 50) consisted of 90% self-identifed White adults with a mean age of22 ± 2.4 years and 70% females. The T2D sample (n2 = 60) included adults who self-identifed as Black (63%) and Hispanic (47%), with a mean age of 34.4 ± 5.0 years and 75% females. The mean CVH scores for the T1D and T2D groups were 9.4 ± 2.1 and 8.6 ± 2.2, respectively. For the T1D group, barriers included knowledge deficits, whereas self-efficacy and diabetes technology facilitated self-management. For the T2D group, barriers consisted of unhealthy food convenience and limited space for physical activity, whereas access to healthcare services facilitated CVH behaviors. Shared barriers included time constraints/competing demands and financial burdens; facilitators were social support and individualized care. CONCLUSIONS:Our analysis highlights distinct and shared barriers and facilitators to CVH in 2 emerging adult populations with diabetes, emphasizing the need to assess age-specific factors and tailor clinical interventions accordingly.

PURPOSE OF REVIEW:Despite advances in type 1 diabetes (T1D) management, mortality is still increased, with cardiovascular disease (CVD) as the leading cause. Dyslipidemia is a highly prevalent modifiable CVD risk factor. We reviewed the existing literature on CVD mortality in T1D to highlight CVD risk in pediatric patients with T1D. RECENT FINDINGS:Pathophysiology of T1D and premature CVD risk is still not fully understood. Dyslipidemia remains a highly prevalent and undertreated CV risk factor in T1D. Statins have been shown to be safe and effective to improve CVD risk in adults with T1D, and in children with familial hypercholesterolemia, in addition to improving lipids levels in children with T1D. SUMMARY:T1D is associated with premature CVD mortality, and dyslipidemia is still a highly prevalent and undertreated CVD risk factor. We aim to educate and empower pediatric providers to optimize management of dyslipidemia in pediatric patients with T1D to potentially decrease the CVD risk.

Prader-Willi syndrome (PWS) is a rare genetic disorder marked by metabolic, endocrine, and behavioral challenges, with hyperphagia as a central feature contributing to significant health risks. Diazoxide choline extended-release (DCCR; VYKAT™ XR) is a once-daily adenosine triphosphate (ATP)-sensitive potassium channel activator recently approved for the treatment of hyperphagia in individuals with genetically confirmed PWS aged 4 years and older. As this novel therapy enters clinical practice, clinicians require practical guidance on appropriate use. This manuscript provides actionable recommendations for patient selection, baseline assessments, and strategies for optimizing comorbid conditions prior to initiation. Structured, weight-based dosing and titration protocols are outlined, along with recommendations for monitoring glycemia and edema and managing common adverse events (AEs), including hyperglycemia, peripheral edema, and rash. Special considerations are discussed for patients with diabetes, cardiopulmonary risk factors, and those on concomitant medications with potential drug-drug interactions. The guidance is informed by data from the phase 3 DESTINY-PWS program, long-term extension studies, and real-world clinical experience. Emphasis is placed on early identification and management of AEs and the importance of a multidisciplinary approach to care. These recommendations aim to support clinicians in safely and effectively incorporating DCCR into the management of PWS, improving outcomes for affected individuals. Ongoing research and real-world evidence will continue to refine best practices and address remaining gaps in knowledge.

AIMS/OBJECTIVE:Rural communities experience a higher prevalence of type 2 diabetes and diabetes-related mortality than urban populations. This study sought to disaggregate the influences of demographic and socioeconomic factors, food environment, diet quality, and dietary chemical exposures on diabetes risk in rural areas. MATERIALS AND METHODS/METHODS:We enrolled participants from rural Sullivan County in an observational cohort study involving surveys and biospecimen collection measuring bisphenols and phthalates. We measured these endocrine disrupting chemicals found in food packaging, as rural residents generally consume canned foods and other shelf-stable foods more frequently than their urban counterparts. We used LASSO regression to compare the relative influence of these factors had on rural diabetes risk. RESULTS:Based on values for LASSO regression coefficients among 276 participants, the strongest risk factors for diagnosed diabetes included: older age (+0.486), lower household income (+0.172), Hispanic ethnicity (+0.124), red meat intake (+0.093), proportion of fast food restaurants among nearby restaurants (+0.071), and two phthalates (+0.149 and + 0.107). Among study participants without a history of diabetes, high HbA1c levels were associated with older age (+0.106), being non-Hispanic Black (+0.064), more trans-fat and red meat intake (+0.044 and +0.028), higher BMI (+0.014), higher levels of total bisphenols (+0.005), and higher levels of high-molecular weight phthalates (+0.002). CONCLUSIONS:Demographic and socioeconomic factors were the strongest predictors of rural diabetes risk; however, diet quality, food environment, and dietary chemical exposures also each played a key role. Our study identified modifiable risk factors, which could help reduce the burden of rural diabetes.

OBJECTIVE:Exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of gestational diabetes mellitus (GDM), with adverse consequences for pregnant women and their offspring. However, epidemiologic studies have shown inconsistent results. We addressed this question in a large, pooled sample of U.S. women. RESEARCH DESIGN AND METHODS/METHODS:Participants (n = 5,229) from 16 cohorts had singleton pregnancies. PFAS were quantified in a single plasma or serum sample during pregnancy (1999-2021); six PFAS detected in ≥60% of participants were analyzed. The primary outcome was GDM diagnosis based on self-report or medical record documentation. The secondary outcome, among 1,213 participants, was fasting glucose. We estimated associations between each PFAS and GDM using generalized estimating equations models with Poisson distribution and robust variance, and estimated associations between each PFAS and fasting glucose using generalized estimating equations models for linear regression. Effect modification by prepregnancy BMI or race and ethnicity was evaluated via interaction terms and stratification. We quantified the combined effect of the PFAS mixture using quantile-based g-computation. RESULTS:Associations between individual PFAS and GDM were null or weakly inverse; the association with the six-PFAS mixture was negative (prevalence ratio [95% CI] per quartile increase: 0.75 [0.58, 0.96]). Certain PFAS were more strongly negatively associated with GDM among participants with BMI <25 kg/m2. Associations between PFAS and fasting glucose were largely null, although both positive and negative associations were observed in specific race and ethnicity strata. CONCLUSIONS:In a large, pooled sample of U.S. pregnant women, greater concentrations of PFAS were not associated with higher prevalence of GDM.