Concurrent diagnoses of treatment-induced neuropathy of diabetes and restless leg syndrome

Background: To describe the clinical manifestations, treatment, and prognosis of a patient with type 1 diabetes (T1D) and concurrent diagnoses of painful treatment-induced neuropathy of diabetes (TIND) and restless leg syndrome (RLS). Case report: A 36-year-old man with newly diagnosed T1D experienced the onset of painful lower extremity neuropathy symptoms after a hemoglobin A1C drop from 15% to 6.6% over 1 month upon initiation of insulin pump therapy. His pain was refractory to conventional diabetic neuropathy management, and TIND was diagnosed given the rapid A1C reduction. He was later found to have anemia and diagnosed with concurrent RLS, for which he was treated with carbidopa-levodopa and later pramipexole. Over the course of 18 months, his neuropathic symptoms resolved completely. Discussion: TIND and RLS are both small fiber neuropathies with some shared clinical symptoms, including worsening symptoms at night. Sleep disturbance and the urge to move legs are more characteristic of RLS. Rapid A1C lowering, which may occur in patients with newly diagnosed T1D, may provoke TIND, while underlying iron-deficiency anemia is a risk factor for RLS. TIND may be poorly responsive to conventional diabetic neuropathy treatment and may take months to improve or resolve, while RLS is responsive to treatment with dopamine agonists. Conclusion: TIND should be suspected in T1D patients who have rapid A1C lowering (more than 2% drop in 3 months). In patients with refractory symptoms who have underlying iron deficiency anemia, sleep disturbance, and the urge to move their legs, RLS should be considered in the differential

sj-docx-1-dst-10.1177_19322968231223726 – Supplemental material for Machine Learning Models for Prediction of Diabetic Microvascular Complications

Supplemental material, sj-docx-1-dst-10.1177_19322968231223726 for Machine Learning Models for Prediction of Diabetic Microvascular Complications by Sarah Kanbour, Catharine Harris, Benjamin Lalani, Risa M. Wolf, Hugo Fitipaldi, Maria F. Gomez and Nestoras Mathioudakis in Journal of Diabetes Science and Technology</p

Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients with Type 1 Diabetes in a U.S. Academic Medical Center

   Objective: Recent studies highlight racial disparities in insulin pump (PUMP) and continuous glucose monitor (CGM) use in children and adolescents with type 1 diabetes (T1D). This study explored racial disparities in diabetes technology among adult patients with T1D. Research Design and Methods: Retrospective clinic-based cohort study of adult patients with T1D seen consecutively from April 2013 to January 2020. Race was categorized into non-Black (reference group) and Black. The primary outcomes were baseline and prevalent technology use, rates of diabetes technology discussions (CGMdiscn, PUMPdiscn), and prescribing (CGMrx, PUMPrx). Multivariable logistic regression analysis evaluated the association of technology discussions and prescribing with race, adjusting for social determinants of health and diabetes outcomes.  Results:  Among 1,528 adults with T1D, baseline technology use was significantly lower for Black compared to non-Black patients (7.9% vs. 30.3% for CGM; 18.7% vs. 49.6% for pump), as was prevalent use (43.6% vs. 72.1% for CGM; 30.7% vs. 64.2% for pump). Black patients had adjusted odds ratios (aORs) of 0.51 (95% CI, 0.29, 0.90) and 0.61 (95% CI, 0.41, 0.93) for CGMdiscn and CGMrx, respectively. Black patients had aORs of 0.74 (95% CI, 0.44, 1.25) and 0.40 (95% CI, 0.22, 0.70), for PUMPdiscn and PUMPrx, respectively. Neighborhood context, insurance, marital and employment status, and number of clinic visits were also associated with the outcomes. Conclusions and Relevance: Significant racial disparities were observed in discussions, prescribing, and use of diabetes technology. Further research is needed to identify the causes behind these disparities and develop and evaluate strategies to reduce them.</p

Precision Prognostics for Cardiovascular Disease in Type 2 Diabetes : A Systematic Review and Meta-analysis

BACKGROUND: Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with type 2 diabetes (T2D).METHODS: We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that could improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies.Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination on internal validation, with lower performance on external validation.CONCLUSIONS: Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.PLAIN LANGUAGE SUMMARY: Patients with T2D are at high risk for CVD but predicting who will experience a cardiac event is challenging. Current risk tools and prognostic factors, such as laboratory tests, may not accurately predict risk in different patient populations. There is a need for personalized risk prediction tools to identify patients more accurately so that CVD prevention can be targeted to those who need it most. This study examined novel biomarkers, genetic markers, and risk scores on the prediction of CVD in individuals with T2D. We found that four laboratory markers and a genetic risk score for CHD had high predictive utility beyond traditional CVD risk factors and that risk scores had modest predictive utility when tested in diverse populations, but more studies are needed to determine their usefulness in clinical practice. The highest strength of evidence was observed for NT-proBNP, a laboratory test currently used to monitor patients with heart failure but not currently used in clinical practice for the purpose of CVD prediction in T2D

Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Abstract: Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine. A systematic review of evidence, across the key pillars of prevention, diagnosis, treatment and prognosis, outlines milestones that need to be met to enable the broad clinical implementation of precision medicine in diabetes care

Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.</p