OBJECTIVELittle is known concerning the primary cause(s) of mortality in type 1 diabetes responsible for the excess mortality seen in this population.RESEARCH DESIGN AND METHODSThe Allegheny County (Pennsylvania) childhood-onset (age <18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965 to 1979 was used to explore patterns in cause-specific mortality. Cause of death was determined by a mortality classification committee of at least three physician epidemiologists, based on the death certificate and additional records surrounding the death.RESULTSVital status for 1,043 (97%) participants was ascertained as of 1 January 2008, revealing 279 (26.0%) deaths overall (141 females and 138 males). Within the first 10 years after diagnosis, the leading cause of death was acute diabetes complications (73.6%), while during the next 10 years, deaths were nearly evenly attributed to acute (15%), cardiovascular (22%), renal (20%), or infectious (18%) causes. After 20 years' duration, chronic diabetes complications (cardiovascular, renal, or infectious) accounted for >70% of all deaths, with cardiovascular disease as the leading cause of death (40%). Women (P < 0.05) and African Americans (P < 0.001) have significantly higher diabetes-related mortality rates than men and Caucasians, respectively. Standardized mortality ratios (SMRs) for non–diabetes-related causes do not significantly differ from the general population (violent deaths: SMR 1.2, 95% CI 0.6–1.8; cancer: SMR 1.2, 0.5–2.0).CONCLUSIONSThe excess mortality seen in type 1 diabetes is almost entirely related to diabetes and its comorbidities but varies by duration of diabetes and particularly affects women and African Americans.

Aims/hypothesis The FinnDiane Study has reported that mortality in type 1 diabetes is not increased over a 7 year follow-up in the absence of renal disease (RD). Using the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study population (n= 658) of childhood-onset type 1 diabetes (age <17 years), the present study sought to replicate and expand these findings to a 20 year follow-up (as of 1 January 2008) and examine cause of death by renal status. Methods At baseline (1986)(1987)(1988), mean age and duration of diabetes were 28 and 19 years, respectively. RD was defined as an albumin excretion rate ≥20 μg/min from multiple samples and grouped as microalbuminuria (MA; 20-200 μg/min), overt nephropathy (ON; >200 μg/min), or end stage renal disease (ESRD; dialysis or renal transplantation). Results At baseline, 311 (47.3%) individuals had RD (MA 21.3%, ON 22.2% and ESRD 3.8%). During a median 20 year follow-up, there were 152 deaths (23.1%). Mortality was 6.2 (95% CI 5.2-7.2) times higher than expected, with standardised mortality ratios of 2.0 (1.2-2.8) for normoalbuminuria (NA); 6.4 (4.4-8.4) for MA; 12.5 (9.5-15.4) for ON; and 29.8 (16.8-42.9) for ESRD. Excluding those (n=64) with NA who later progressed to RD, no significant excess mortality was observed in the remaining NA group (1.2, 0.5-1.9), whose deaths were largely unrelated to diabetes.

Survival in type 1 diabetes has improved, but the impact on life expectancy in the U.S. type 1 diabetes population is not well established. Our objective was to estimate the life expectancy of the Pittsburgh Epidemiology of Diabetes Complications (EDC) study cohort and quantify improvements by comparing two subcohorts based on year of diabetes diagnosis (1950–1964 [n = 390] vs. 1965–1980 [n = 543]). The EDC study is a prospective cohort study of 933 participants with childhood-onset (aged <17 years) type 1 diabetes diagnosed at Children’s Hospital of Pittsburgh from 1950 to 1980. Mortality ascertainment was censored 31 December 2009. Abridged cohort life tables were constructed to calculate life expectancy. Death occurred in 237 (60.8%) of the 1950–1964 subcohort compared with 88 (16.2%) of the 1965–1980 subcohort. The life expectancy at birth for those diagnosed 1965–1980 was ∼15 years greater than participants diagnosed 1950–1964 (68.8 [95% CI 64.7–72.8] vs. 53.4 [50.8–56.0] years, respectively) (P < 0.0001); this difference persisted regardless of sex or pubertal status at diagnosis. This improvement in life expectancy emphasizes the need for insurance companies to update analysis of the life expectancy of those with childhood-onset type 1 diabetes because weighting of insurance premiums is based on outdated estimates.

OBJECTIVEAlthough management of type 1 diabetes improved dramatically in the 1980s, the effect on mortality is not clear.RESEARCH DESIGN AND METHODSWe report trends in 30-year mortality using the Allegheny County (Pennsylvania) childhood-onset (age <18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965–1979, by dividing the cohort into three diagnosis year cohorts (1965–1969, 1970–1974, and 1975–1979). Local (Allegheny County) mortality data were used to calculate standardized mortality ratios (SMRs).RESULTSAs of 1 January 2008, vital status was ascertained for 97.0% of participants (n = 1,043) when mean age ± SD and duration of diabetes were 42.8 ± 8.0 and 32.0 ± 7.6 years, respectively. The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1–7.7]). An improving trend in SMR was seen by diagnosis cohort at 30 years of diabetes duration (9.3 [7.2–11.3], 7.5 [5.8–9.2], and 5.6 [4.0–7.2] for 1965–1969, 1970–1974, and 1975–1979, respectively). Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7–15.7]), much higher than the SMR for men (5.0 [4.0–6.0]). Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race.CONCLUSIONSAlthough survival has clearly improved, those with diabetes diagnosed most recently (1975–1979) still had a mortality rate 5.6 times higher than that seen in the general population, revealing a continuing need for improvements in treatment and care, particularly for women and African Americans with type 1 diabetes.

RAPD can be performed with safety and oncologic outcomes comparable to open or laparoscopic approaches. Results of this early series suggest that the robot-assisted approach holds promise. Larger, more mature multi-institutional cohorts will be needed to explore potential benefits over open and laparoscopic techniques.

Purpose To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study. Methods Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24–32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential, and minimize the effect of advanced diabetes complications on SES. Results The incidences over 1–20 years follow-up of end-stage renal disease (ESRD) and coronary artery disease (CAD) were 2–3 times higher for T1D individuals without, compared to those with a college degree (p<0.05 for both), while autonomic neuropathy (AN) incidence was significantly higher for low income and/or non-professional participants (p<0.05 for both). HbA1c was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted ESRD (HR=2.9, 95% CI, 1.1–7.7) and CAD (HR=2.5, 1.3–4.9), whereas lower income predicted AN (HR=1.7, 1.0–2.9) and lower extremity arterial disease (HR=3.7, 1.1–11.9). Conclusions These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, more diabetes complications.

Teledermatology is an effective method for delivering health care, with strong evidence supporting its use, yet barriers have stalled implementation, including lack of reimbursement, liability concerns, and licensing restrictions. 1,2 The coronavirus disease 2019 (COVID-19) pandemic crisis led to rapid adoption of telemedicine to continue care while minimizing in-person contact. 3 Historically, most teledermatology studies have focused on store-and-forward models, whereas during the COVID-19 pandemic, regulatory changes from the US Centers for Medicare and Medicaid Services prompted an increase in live-interactive video visits. These changes granted parity in reimbursements between video and in-person visits, removing eligibility and geographic restrictions. 4,5 We sought to assess dermatologists' perceptions of and experiences with teledermatology in the context of the COVID-19 pandemic and these new changes.Methods | In May and June 2020, an American Academy of Dermatology (AAD) Teledermatology Task Force subgroup surveyed AAD members regarding the effects of COVID-19 on teledermatology. Topics included modes used; situational appropriateness; and opinions regarding reimbursement, perceived need, barriers, and anticipated future use. Questions were tested for face validity and readability and approved by the Task Force and AAD representatives (see Supplement for detailed methods). The AAD administered the survey via email, collected and maintained data, and provided deidentified data for analysis. Participant representativeness based on age, sex,

IMPORTANCE Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied.OBJECTIVE To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists.