Background Trends in the prevalence and control of diabetes defined by hemoglobin A1c (HbA1c) are important for health care policy and planning. Objective To update trends in prevalence of diabetes, pre-diabetes, and glycemic control in persons with diagnosed diabetes over the past two decades in U.S. adults. Design Cross-sectional. Setting The National Health and Nutrition Examination Surveys 1988-1994 and 1999-2010. Participants Adults 20 years or older. Measurements We used calibrated HbA1c to define undiagnosed diabetes (≥6.5%), pre-diabetes (5.7-6.4%), and, among persons with diagnosed diabetes, glycemic control (<7.0% or <8.0%). Trends in HbA1c categories were compared to fasting glucose (≥7.0 and 5.6-6.9 mmol/l [≥126 and 100-125 mg/dL]). Results In 2010, there were ~21 million adults aged 20 years or older with total confirmed diabetes (self-reported diabetes or diagnostic values for both fasting glucose and calibrated HbA1c) in the U.S. The prevalence of total confirmed diabetes increased but the prevalence of undiagnosed diabetes has remained fairly stable, reducing the proportion of total diabetes cases that are undiagnosed to 11% in 2005-10. The prevalence of pre-diabetes was lower when defined by calibrated HbA1c compared to when defined by fasting glucose but has increased from 5.8% in 1988-1994 to 12.4% in 2005-2010 when defined by HbA1c. Glycemic control has improved overall but total diabetes prevalence was higher and diabetes was less controlled among non-Hispanic blacks and Mexican Americans compared to non-Hispanic whites. Limitations Cross-sectional design. Conclusions Over the past two decades, the prevalence of total diabetes has increased substantially. However, the proportion of diabetes cases that are undiagnosed has decreased suggesting improvements in screening and diagnosis. Among the growing number of persons with diagnosed diabetes, glycemic control improved but remains a challenge, particularly among non-Hispanic blacks and Mexican Americans.

Purpose To examine the association of psychosocial stress with obesity, adiposity, and dietary intake in a diverse sample of Hispanic/Latino adults. Methods Participants were 5077 men and women, 18–74 years old, from diverse Hispanic/Latino ethnic backgrounds. Linear regression models were used to assess the association of ongoing chronic stressors and recent perceived stress with measures of adiposity (waist circumference and percentage body fat) and dietary intake (total energy, saturated fat, alternative healthy eating index [AHEI-2010]). Multinomial logistic models were used to describe the odds of obesity or overweight relative to normal weight. Results Greater number of chronic stressors and greater perceived stress were associated with higher total energy intake. Greater recent perceived stress was associated with lower diet quality as indicated by AHEI-2010 scores. Compared to no stressors, reporting ≥ 3 chronic stressors was associated with higher odds of being obese (OR = 1.5, 95%CI 1.01–2.1), greater waist circumference (β = 3.3, 95%CI 1.0–5.5) and percentage body fat (β = 1.5, 95%CI 0.4, 2.6). Conclusions The study found an association between stress and obesity and adiposity measures, suggesting that stress management techniques may be useful in obesity prevention and treatment programs that target Hispanic/Latino populations.

Fasting glucose and hemoglobin A1c (HbA1c) are the standard measures for diagnosis and monitoring of diabetes. There has been recent interest in nontraditional markers of hyperglycemia, including fructosamine, glycated albumin and 1,5-anhydroglucitol (1,5-AG), as alternatives or adjuncts to standard measures. There is a growing literature linking these nontraditional markers with microvascular and macrovascular complications. Fructosamine and glycated albumin have also been shown to improve identification of persons with diabetes. However, long-term prospective studies with clinical outcomes are lacking. Some modern laboratory assays for fructosamine, glycated albumin and 1,5-AG have excellent performance. Expanded use of these tests has the potential to improve diabetes care as these measures may overcome limitations of HbA1c in certain patients, complement traditional measures by providing additional information on shorter-term glycemic control, and improve risk stratification for diabetes and its complications. Nonetheless, studies are needed to demonstrate if their routine use will benefit patients and improve outcomes.

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Objective We expanded the previous assessment of a mortality variable suited for real‐world evidence‐focused oncology research. Data source We used a nationwide electronic health record (EHR)‐derived de‐identified database. Data collection We included patients with at least 1 of 18 cancer types between January 1, 2011 and December 31, 2017. Patient‐level structured data (EHRs, obituaries, and Social Security Death Index) and unstructured EHR data (abstracted) were linked to generate a composite mortality variable. Study design We benchmarked sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ±15‐day agreement against the National Death Index (NDI). Real‐world overall survival (rwOS) was estimated using the Kaplan‐Meier method. We performed sensitivity analyses using a smaller patient cohort that underwent next‐generation sequencing testing. Principal findings Compared with the NDI across 18 cancer types (overall N = 160 436): sensitivity, 83.9%‐91.5% (17/18 cancer types had sensitivity ≥85.0%); specificity, 93.5%‐99.7%; PPV, 96.3%‐98.3%; NPV, 75.0%‐98.7%; ±15‐day agreement, 95.6%‐97.6%; and median rwOS estimates ranging from 2.8% to 12.7% greater. Sensitivity analysis results (n = 17 540) were consistent with the main analysis. Conclusions Across all cancer types analyzed, this composite mortality variable showed high sensitivity, specificity, PPV, NPV, and ±15‐day agreement, and yielded median rwOS values modestly overestimated when compared to NDI‐based results.

Objectives HIV disease is associated with increased arterial stiffness, which may be related to inflammation provoked by HIV-related immune perturbation. We assessed the association of T cell markers of immune activation and immunosenescence with carotid artery stiffness among HIV-infected women. Methods Among 114 HIV-infected and 43 HIV-uninfected women, we measured CD4+ and CD8+ T cell populations expressing activation (CD38+HLA-DR+) and senescence (CD28-CD57+) markers. We then related these measures of immune status with parameters of carotid artery stiffness, including decreased distensibility, and increased Young’s elastic modulus, as assessed by B-mode ultrasound. Results HIV infection was associated with increased CD4+ T cell activation, CD8+ T cell activation and CD8+ T cell senescence. Among HIV-infected women, adjusted for age, HIV medications, and vascular risk factors, higher CD4+CD38+HLA-DR+ T cell frequency was associated with decreased carotid artery distensibility (β= −2.00, 95% confidence interval [CI]= −3.86,−0.14, P=0.04) and increased Young’s modulus (β=1.00, 95% CI=0.03,1.97, P=0.04). These associations were affected little by further adjustment for CD4+ T cell count and viral load. Among HIV-infected women, higher frequencies of immunosenescent T cells, including CD4+CD28-CD57+ and CD8+CD28-CD57+ T cells, were also associated with decreased arterial distensibility. Among HIV-uninfected women, frequencies of activated or senescent T cells were not significantly associated with measures of carotid stiffness. Discussion T cell activation and senescence are associated with arterial stiffness, suggesting that pro-inflammatory populations of T cells may produce functional or structural vascular changes in HIV-infected women.

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Background Equivalence of laboratory tests over time is important for longitudinal studies. Even a small systematic difference (bias) can result in substantial misclassification. Methods We selected 200 Atherosclerosis Risk in Communities Study participants attending all 5 study visits over 25 years. Eight analytes were re-measured in 2011–13 from stored blood samples from multiple visits: creatinine, uric acid, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and high-sensitivity C-reactive protein. Original values were recalibrated to re-measured values using Deming regression. Differences >10% were considered to reflect substantial bias, and correction equations were applied to affected analytes in the total study population. We examined trends in chronic kidney disease (CKD) pre- and post-recalibration. Results Repeat measures were highly correlated with original values (Pearson’s r>0.85 after removing outliers [median 4.5% of paired measurements]), but 2 of 8 analytes (creatinine and uric acid) had differences >10%. Original values of creatinine and uric acid were recalibrated to current values using correction equations. CKD prevalence differed substantially after recalibration of creatinine (visits 1, 2, 4 and 5 pre-recalibration: 21.7%, 36.1%, 3.5%, 29.4%; post-recalibration: 1.3%, 2.2%, 6.4%, 29.4%). For HDL-cholesterol, the current direct enzymatic method differed substantially from magnesium dextran precipitation used during visits 1–4. Conclusions Analytes re-measured in samples stored for ~25 years were highly correlated with original values, but two of the 8 analytes showed substantial bias at multiple visits. Laboratory recalibration improved reproducibility of test results across visits and resulted in substantial differences in CKD prevalence. We demonstrate the importance of consistent recalibration of laboratory assays in a cohort study.