المؤلفون: Katharine C. Garvey, Jonathan A. Finkelstein, Fang Zhang, Robert LeCates, Lori Laffel, James F. Wharam

المصدر: Diabetes Care. 45:2509-2517

مصطلحات موضوعية: Adult, Advanced and Specialized Nursing, Transition to Adult Care, Adolescent, Endocrinology, Diabetes and Metabolism, Middle Aged, Patient Acceptance of Health Care, Hospitalization, Young Adult, Diabetes Mellitus, Type 1, Internal Medicine, Humans, Female, Child, Emergency Service, Hospital

الوصف: OBJECTIVE Lack of effective transition from pediatric to adult care may contribute to adverse outcomes in young adults with type 1 diabetes. The understanding of outpatient and acute care utilization patterns across the adolescent to young adult transition age in type 1 diabetes populations is suboptimal in the U.S. RESEARCH DESIGN AND METHODS We studied claims data from 14,616 individuals diagnosed with type 1 diabetes, aged 16–24 years, and enrolled in a large national health plan for ≥1 year from 2005 to 2012. Annual outpatient and emergency department visits and hospitalization rates were calculated at each age. Generalized estimating equations were used to assess the association of age-group (adolescents [age 16–18 years] vs. young adults [age 19–24 years]), outpatient visits, and sociodemographic variables with emergency department visit and hospitalization rates. RESULTS Endocrinologist visits declined from 2.3 per year at age 16 years to 1.5 per year by age 22. Emergency department rates increased per year from 45 per 100 at age 16 to 63 per 100 at age 20, then decreased to 60 per 100 by age 24. Hospitalizations per year climbed from 14 per 100 at age 16 to 21 per 100 at age 19, then decreased to 17 per 100 by age 24. In statistical models, young adults experienced higher rates of emergency department visits (incidence rate ratio [IRR] 1.24 [95% CI 1.18, 1.31]) and hospitalizations (IRR 1.25 [95% CI 1.15, 1.36]) than adolescents. Additional significant predictors of emergency department visits and hospitalizations included female sex and Black race. Individuals with two or more endocrinologist visits per year were less likely to have emergency department visits and hospitalizations; higher income was also protective. CONCLUSIONS Results highlight concerning increases in acute care utilization for young adults with type 1 diabetes who are less engaged with outpatient diabetes care and highlight socioeconomic risk factors that warrant further study.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8807e68ff2ff2571f9016092c2114fedTest
https://doi.org/10.2337/dc22-0152Test

المؤلفون: Tonet Serés-Noriega, Marga Giménez, Verónica Perea, Laura Boswell, Clara Viñals, Jesús Blanco, Irene Vinagre, Adriana Pané, Enric Esmatjes, Ignacio Conget, Antonio J. Amor

المصدر: Diabetes Care. 45:2412-2421

مصطلحات موضوعية: Adult, Male, Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Middle Aged, Atherosclerosis, Lipids, Risk Assessment, Diabetes Mellitus, Type 1, Cardiovascular Diseases, Risk Factors, Internal Medicine, Humans, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors

الوصف: OBJECTIVE To evaluate the concordance between the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (ESC/EASD-2019) and the Steno T1 Risk Engine (Steno-Risk) cardiovascular risk scales for individuals with type 1 diabetes (T1D) without cardiovascular disease (CVD) and to analyze the relationships of their use with identification of preclinical atherosclerosis. RESEARCH DESIGN AND METHODS We consecutively selected patients with T1D, without CVD, age ≥40 years, with nephropathy, and/or with ≥10 years of T1D evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated in accord with ESC/EASD-2019 risk groups (moderate/high/very high) and the Steno-Risk ( RESULTS We included 501 patients (53% men, mean age 48.8 years, median T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (κ = 0.19). A stepped increase in the presence of plaques according to Steno-Risk category was seen (18.4%, 38.2%, and 64.1%, for low, moderate, and high risk, respectively; P for trend CONCLUSIONS Among T1D patients undergoing primary prevention, use of Steno-Risk seems to result in better recognition of individuals with atherosclerosis in comparison with ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fa556d1cdaf286de5c156e565f9c983bTest
https://doi.org/10.2337/dc22-0118Test

المؤلفون: Yi-Sun Yang, Hsin-Hung Chen, Chien-Ning Huang, Chung Y. Hsu, Kai-Chieh Hu, Chia-Hung Kao

المصدر: Diabetes Care. 45:1184-1192

مصطلحات موضوعية: Adult, Male, Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Middle Aged, Atherosclerosis, Glucagon-Like Peptide-1 Receptor, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Glucagon-Like Peptide 1, Ischemia, Internal Medicine, Humans, Hypoglycemic Agents, Female, Ischemic Stroke, Retrospective Studies

الوصف: OBJECTIVE We assessed the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on ischemic stroke prevention in the Asian population with type 2 diabetes (T2D) without established cardiovascular disease. RESEARCH DESIGN AND METHODS This retrospective cohort study examined data obtained from the Taiwan National Health Insurance Research Database for the period from 1998 to 2018. The follow-up ended upon the occurrence of hospitalization for ischemic stroke. The median follow-up period was 3 years. The effect of GLP-1RA exposure time on the development of hospitalization for ischemic stroke was assessed. RESULTS The GLP-1RA and non–GLP-1RA user groups both included 6,534 patients. Approximately 53% of the patients were women, and the mean age was 49 ± 12 years. The overall risk of ischemic stroke hospitalization for GLP-1RA users was not significantly lower than that for GLP-1RA nonusers (adjusted hazard ratio [HR] 0.69 [95% CI 0.47–1.00]; P = 0.0506), but GLP-1RA users with a >251-day supply during the study period had a significantly lower risk of ischemic stroke hospitalization than GLP-1RA nonusers (adjusted HR 0.28 [95% CI 0.11–0.71]). Higher cumulative dose of GLP-1 RAs (>1,784 mg) was associated with significantly lower risk of ischemic stroke hospitalization. The subgroup analyses defined by various baseline features did not reveal significant differences in the observed effect of GLP-1RAs. CONCLUSIONS Longer use and higher dose of GLP-1 RAs were associated with a decreased risk of hospitalization for ischemic stroke among Asian patients with T2D who did not have established atherosclerotic cardiovascular diseases, but who did have dyslipidemia or hypertension.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fc68df69e803a3c09d633dd591d21580Test
https://doi.org/10.2337/dc21-1993Test

المؤلفون: Amy Criego, Sarah A. Macleish, Jennifer L. Sherr, Jordan E. Pinsker, Ruth S. Weinstock, Anders L. Carlson, Anuj Bhargava, Richard M. Bergenstal, Thomas C. Jones, Daniel J. DeSalvo, Grazia Aleppo, Carol J. Levy, Bruce W. Bode, Sanjeev N. Mehta, Gregory P. Forlenza, Viral N. Shah, Bruce A. Buckingham, Irl B. Hirsch, David W Hansen, Sue A. Brown, Lori M. Laffel, Trang T. Ly

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Blood Glucose, medicine.medical_specialty, Adolescent, Diabetic ketoacidosis, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Hypoglycemia, Young Adult, 03 medical and health sciences, Insulin Infusion Systems, 0302 clinical medicine, Emerging Technologies: Data Systems and Devices, Internal medicine, Multicenter trial, Diabetes mellitus, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Insulin, Prospective Studies, 030212 general & internal medicine, Child, Prospective cohort study, Aged, Glycemic, Glycated Hemoglobin, Advanced and Specialized Nursing, Type 1 diabetes, business.industry, Incidence (epidemiology), Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, business

الوصف: OBJECTIVE Advances in diabetes technology have transformed the treatment paradigm for type 1 diabetes, yet the burden of disease is significant. We report on a pivotal safety study of the first tubeless, on-body automated insulin delivery system with customizable glycemic targets. RESEARCH DESIGN AND METHODS This single-arm, multicenter, prospective study enrolled 112 children (age 6–13.9 years) and 129 adults (age 14–70 years). A 2-week standard therapy phase (usual insulin regimen) was followed by 3 months of automated insulin delivery. Primary safety outcomes were incidence of severe hypoglycemia and diabetic ketoacidosis. Primary effectiveness outcomes were change in HbA1c and percent time in sensor glucose range 70–180 mg/dL (“time in range”). RESULTS A total of 235 participants (98% of enrolled, including 111 children and 124 adults) completed the study. HbA1c was significantly reduced in children by 0.71% (7.8 mmol/mol) (mean ± SD: 7.67 ± 0.95% to 6.99 ± 0.63% [60 ± 10.4 mmol/mol to 53 ± 6.9 mmol/mol], P < 0.0001) and in adults by 0.38% (4.2 mmol/mol) (7.16 ± 0.86% to 6.78 ± 0.68% [55 ± 9.4 mmol/mol to 51 ± 7.4 mmol/mol], P < 0.0001). Time in range was improved from standard therapy by 15.6 ± 11.5% or 3.7 h/day in children and 9.3 ± 11.8% or 2.2 h/day in adults (both P < 0.0001). This was accomplished with a reduction in time in hypoglycemia CONCLUSIONS This tubeless automated insulin delivery system was safe and allowed participants to significantly improve HbA1c levels and time in target glucose range with a very low occurrence of hypoglycemia.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9602f5bfa556f234a1c900cd9088422aTest
https://doi.org/10.2337/dc21-0172Test

المؤلفون: Kelly Rogers Keene, Farook Jahoor, Ruchi Gaba, Sanjeet Patel, Surya N. Mulukutla, Rasmus Bennet, Eunice I. Caducoy, Paras B. Mehta, Ashok Balasubramanyam, Åke Lernmark, W. Frank Peacock, Jean W. Hsu

المصدر: Diabetes

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, endocrine system diseases, Diabetic ketoacidosis, Endocrinology, Diabetes and Metabolism, Type 2 diabetes, Diabetic Ketoacidosis, chemistry.chemical_compound, Carnitine, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Metabolomics, Acetylcarnitine, Palmitoylcarnitine, Autoantibodies, Type 1 diabetes, business.industry, nutritional and metabolic diseases, Genetics/Genomes/Proteomics/Metabolomics, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Endocrinology, Diabetes Mellitus, Type 2, chemistry, Metabolome, Female, business, Amino Acids, Branched-Chain, Ketosis-prone diabetes, medicine.drug

الوصف: When stable and near-normoglycemic, patients with “A−β+” ketosis-prone diabetes (KPD) manifest accelerated leucine catabolism and blunted ketone oxidation, which may underlie their proclivity to develop diabetic ketoacidosis (DKA). To understand metabolic derangements in A−β+ KPD patients during DKA, we compared serum metabolomics profiles of adults during acute hyperglycemic crises, without (n = 21) or with (n = 74) DKA, and healthy control subjects (n = 17). Based on 65 kDa GAD islet autoantibody status, C-peptide, and clinical features, 53 DKA patients were categorized as having KPD and 21 type 1 diabetes (T1D); 21 nonketotic patients were categorized as having type 2 diabetes (T2D). Patients with KPD and patients with T1D had higher counterregulatory hormones and lower insulin-to-glucagon ratio than patients with T2D and control subjects. Compared with patients withT2D and control subjects, patients with KPD and patients with T1D had lower free carnitine and higher long-chain acylcarnitines and acetylcarnitine (C2) but lower palmitoylcarnitine (C16)-to-C2 ratio; a positive relationship between C16 and C2 but negative relationship between carnitine and β-hydroxybutyrate (BOHB); higher branched-chain amino acids (BCAAs) and their ketoacids but lower ketoisocaproate (KIC)-to-Leu, ketomethylvalerate (KMV)-to-Ile, ketoisovalerate (KIV)-to-Val, isovalerylcarnitine-to-KIC+KMV, propionylcarnitine-to-KIV+KMV, KIC+KMV-to-C2, and KIC-to-BOHB ratios; and lower glutamate and 3-methylhistidine. These data suggest that during DKA, patients with KPD resemble patients with T1D in having impaired BCAA catabolism and accelerated fatty acid flux to ketones—a reversal of their distinctive BCAA metabolic defect when stable. The natural history of A−β+ KPD is marked by chronic but varying dysregulation of BCAA metabolism.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2758a0d78c43e7f8562a1a2ccfb706d0Test
https://doi.org/10.2337/db21-0066Test

المؤلفون: Danielle Hessler, Lawrence Fisher, Lisa A. Strycker

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Blood Glucose, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Context (language use), Hypoglycemia, law.invention, Randomized controlled trial, law, Internal medicine, Diabetes mellitus, Internal Medicine, Humans, Insulin, Medicine, Glycemic, Glycated Hemoglobin, Advanced and Specialized Nursing, Blood glucose monitoring, Type 1 diabetes, medicine.diagnostic_test, business.industry, Blood Glucose Self-Monitoring, Clinical Care/Education/Nutrition/Psychosocial Research, Middle Aged, medicine.disease, Distress, Diabetes Mellitus, Type 1, business

الوصف: OBJECTIVE To explore associations between reductions in diabetes distress (DD) and improvements in glycemic outcomes among adults with type 1 diabetes (T1D) in the context of a DD randomized clinical trial. RESEARCH DESIGN AND METHODS Adults with T1D (N = 301) participated in a two-arm trial aimed at reducing DD (DD-focused OnTrack group vs. education-oriented KnowIt group). Mean age was 45.1 years; mean baseline HbA1c was 8.8% (73 mmol/mol). Individuals were assessed at baseline and 9 months later on DD, self-care, HbA1c, and frequency of hypoglycemia. Structural equation models evaluated hypothesized pathways among changes in DD, self-care, and glycemic outcomes in the total sample and by intervention group. RESULTS Reductions in DD were significantly and independently associated with better self-care, including fewer missed insulin boluses, more frequent insulin adjustment, improved problem-solving skills, more blood glucose monitoring, and greater adoption of continuous glucose monitoring (all P < 0.05). In turn, better self-care was linked with better glycemic outcomes, including fewer episodes of hypoglycemia and improved HbA1c over time. Fit indices indicated good fit of the model to the data (confirmatory fit index = 0.94, root mean square error of approximation = 0.05), with stronger and more meaningful associations for OnTrack than for KnowIt. CONCLUSIONS In the context of an intervention to reduce DD for adults with T1D, results indicate that reductions in DD do not affect glycemic outcomes directly but through improvements in self-care behavior. Findings support the importance of integrating disease management with DD interventions to maximize improvements in glycemic outcomes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4a61778bbe6ae851f533704b0ee3d4aeTest
https://doi.org/10.2337/dc20-2724Test

المؤلفون: Richard J MacIsaac, Jordan T. Kamel, Sabine Braat, Leslie Roberts, Laura E Downie, Jennifer P. Craig, Alexis Ceecee Britten-Jones

المصدر: Diabetes. 70:1794-1806

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Placebo-controlled study, Nerve fiber, Placebo, Gastroenterology, law.invention, Cornea, Double-Blind Method, Randomized controlled trial, law, Diabetes mellitus, Internal medicine, Fatty Acids, Omega-3, Internal Medicine, medicine, Humans, Adverse effect, Aged, Type 1 diabetes, business.industry, Diabetic retinopathy, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Neuroprotective Agents, medicine.anatomical_structure, Dietary Supplements, Female, business

الوصف: This randomized, double-masked, placebo-controlled trial evaluated the effects of oral omega-3 (n-3) fatty acid supplementation on peripheral nerves in type 1 diabetes. Participants with type 1 diabetes were assigned (1:1) to n-3 (1,800 mg/day fish oil) or placebo (600 mg/day olive oil) supplements for 180 days. The primary outcome was change from baseline in central corneal nerve fiber length (CNFL) at day 180. Secondary outcomes included change in other corneal nerve parameters, corneal sensitivity, peripheral small and large nerve fiber function, and ocular surface measures. Efficacy was analyzed according to the intention-to-treat principle. Safety assessments included diabetic retinopathy grade and adverse events. Between July 2017 and September 2019, 43 participants received n-3 (n = 21) or placebo (n = 22) supplements. All participants, except for two assigned to placebo, completed the trial. At day 180, the estimated increase in CNFL in the n-3 group, compared with placebo, was 2.70 mm/mm2 (95% CI 1.64, 3.75). The Omega-3 Index increased relative to placebo (3.3% [95% CI 2.4, 4.2]). There were no differences in most small or large nerve fiber functional parameters. Adverse events were similar between groups. In conclusion, we found in this randomized controlled trial that long-chain n-3 supplements impart corneal neuroregenerative effects in type 1 diabetes, indicating a role in modulating peripheral nerve health.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::908e3d12acb6e619dfdd9a7be74a7cb0Test
https://doi.org/10.2337/db21-0136Test

المؤلفون: Gina Aulisio, Sarah C. Westen, Brian C. Fitzgerald, Claudia Anez-Zabala, Jason Konopack, Stephanie L. Filipp, Xanadu Roque, Ananta Addala, Korey K. Hood, Katarina Yabut, David M. Maahs, Diana Naranjo, Jennifer Maizel, Elvira Mercado, Nicolas Cuttriss, Sydney Look, Matthew J. Gurka, Ashby F. Walker, Michael J. Haller

المصدر: Diabetes Care

مصطلحات موضوعية: Research design, Adult, Blood Glucose, medicine.medical_specialty, Technology, Diabetic ketoacidosis, Adolescent, Endocrinology, Diabetes and Metabolism, Psychological intervention, Ethnic group, Endocrinology, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Socioeconomic status, Advanced and Specialized Nursing, Type 1 diabetes, business.industry, Blood Glucose Self-Monitoring, Clinical Care/Education/Nutrition/Psychosocial Research, Middle Aged, medicine.disease, Focus group, Diabetes Mellitus, Type 1, business

الوصف: OBJECTIVE Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited. RESEARCH DESIGN AND METHODS To better understand barriers, focus groups were conducted in Florida and California with adults ≥18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre–focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included 1) provider level (negative provider encounters), 2) system level (financial coverage), and 3) individual level (preferences). RESULTS Over 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P = 0.02 in FL; P = 0.08 in CA) and race/ethnicity (P = 0.01 in FL; P = 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P = 0.05 in CA; P = 0.56 in FL) and education level (P = 0.02 in CA; P = 0.90 in FL). CONCLUSIONS These findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0a0d34899da97935c1f3e95f2161e12fTest
http://europepmc.org/articles/PMC8323174Test

المؤلفون: Priyanka Mathias, Lakshmi Priyanka Mahali, Shivani Agarwal

المصدر: Diabetes Care

مصطلحات موضوعية: Advanced and Specialized Nursing, Adult, Blood Glucose, Technology, Young Adult, Diabetes Mellitus, Type 1, Endocrinology, Diabetes and Metabolism, Blood Glucose Self-Monitoring, Internal Medicine, Humans, Erratum, Middle Aged

الوصف: Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. We were interested in examining whether addressing structural health care barriers would change provider prescribing behaviors to make CGM access more equitable.From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations targeted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Transformations were prioritized based on feasibility, acceptability, and sustainability. To examine effect on prescribing behaviors, we collected monthly aggregate data from the electronic medical record and performed multiple linear regression to examine and compare change in CGM prescriptions over the 3 years of transformation.In total, we included 1,357 adults with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P0.001). Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053).Diabetes practice transformations that target equity, offload provider burdens, and focus on feasible sustainable stakeholder-driven solutions can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream determinants of downstream CGM use.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::85da92fbe862f8dd7f2c50d4c642ef4cTest
https://europepmc.org/articles/PMC9797642Test/

المؤلفون: Medha Munshi, Christine Slyne, Atif Adam, Dai’Quann Davis, Amy Michals, Astrid Atakov-Castillo, Katie Weinger, Elena Toschi

المصدر: Diabetes Care

مصطلحات موضوعية: Aged, 80 and over, Diabetes Complications, Novel Communications in Diabetes, Advanced and Specialized Nursing, Aging, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Endocrinology, Diabetes and Metabolism, Internal Medicine, Humans, Middle Aged, Hypoglycemia, Aged

الوصف: OBJECTIVE Adults with type 1 diabetes (T1D) are aging successfully. The impact of diabetes duration on clinical and functional status as people age with T1D is not well known. RESEARCH DESIGN AND METHODS We performed a cross-sectional study of older adults (age ≥65 years) with T1D. RESULTS We evaluated 165 older adults, mean age 70 ± 10 years. After adjustment for age, sex, and A1C, longer duration of T1D, ≥50 years, was associated with a higher likelihood of depression (odds ratio [OR] 2.8; P = 0.008), hypoglycemia unawareness (OR 2.6; P = 0.01), lower scores on 6-Minute Walk Test (OR 0.99; P = 0.01) and the Physical Component Summary (PCS) of Short Form-36 (SF-36) (OR 0.96; P = 0.02), and greater daily medication use (OR 1.1; P = 0.004) compared with those with duration CONCLUSIONS In older adults with T1D, duration of diabetes impacts clinical and functional status, independent of age and glycemic control, and should be considered in development of management strategies for safety and success.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::013c7aed1be5e60261d91f38d8c65da6Test
https://doi.org/10.2337/dc21-2000Test