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OBJECTIVEWomen with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. RESEARCH DESIGN AND METHODSWe performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. RESULTSThe age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). CONCLUSIONSThe incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.Diabetes in pregnancy is becoming an increasingly growing concern as the prevalence of diabetes continues to rise (1). Women with diabetes who become pregnant have an increased risk of pregnancy complications (2-7), including serious perinatal outcomes such as stillbirth, perinatal mortality, and major congenital malformations. Hyperglycemia in the period around conception and the first weeks

ARDIOVASCULAR DISEASE IS AN important cause of morbidity and mortality among persons with type 2 diabetes mellitus. 1-3 The thiazolidinediones (TZDs), rosiglitazone and pioglitazone, are oral hypoglycemic agents that have been shown to improve glycemic control and may act to slow the progression of beta cell failure. 4 While improved glycemic control has been linked to better clinical outcomes in diabetes 5-7 and TZDs have been suggested as having potential cardiovascular benefits, 8-11 recent concerns have arisen regarding adverse cardiac effects of these drugs. Use of TZDs is associated with weight gain and edema, 12 and evidence suggests that both rosiglitazone and pioglitazone increase the risk of congestive heart failure (CHF). 8,10,13-19 A recent boxed warning for CHF was added for these agents recommending against the use of TZDs in persons with preexisting CHF. 20 Two meta-analyses have also suggested that rosiglitazone may be associated with an increased risk of acute myocardial infarction (AMI) and death. 18,21 These findings prompted a hearing by a US Food and Drug Administration advisory panel regarding the safety of rosiglitazone; however, the panel voted against removing rosiglitazone from the market because of insufficient data. 22 Most studies to date far have examined adverse cardiovascular outcomes associated with TZDs among clinical trial samples. However, the extent to which these adverse effects apply to real-world populations is less clear. In addition, older persons are traditionally underrepresented in clinical

Increased cumulative duration of metformin exposure after PC diagnosis was associated with decreases in both all-cause and PC-specific mortality among diabetic men.

Substantial evidence suggests that people with type 2 diabetes have an increased risk of developing several types of cancers. These associations may be due to a number of direct and indirect mechanisms. Observational studies of these associations, including the potential role for glucoselowering therapy, are being increasingly reported, but face a number of methodological challenges. This paper is the first of two review papers addressing methodological aspects underpinning the interpretations of links between diabetes and cancer, and suggests potential approaches to study designs to be considered in observational studies. This paper reviews factors related to cancer incidence in the diabetic population; the second paper relates to studies of cancer mortality.

Healthy behaviour interventions should be initiated in people newly diagnosed with type 2 diabetes.• In people with type 2 diabetes with A1C <1.5% above the person's individualized target, antihyperglycemic pharmacotherapy should be added if glycemic targets are not achieved within 3 months of initiating healthy behaviour interventions.• In people with type 2 diabetes with A1C ≥1.5% above target, antihyperglycemic agents should be initiated concomitantly with healthy behaviour interventions, and consideration could be given to initiating combination therapy with 2 agents.• Insulin should be initiated immediately in individuals with metabolic decompensation and/or symptomatic hyperglycemia.• In the absence of metabolic decompensation, metformin should be the initial agent of choice in people with newly diagnosed type 2 diabetes, unless contraindicated.• Dose adjustments and/or additional agents should be instituted to achieve target A1C within 3 to 6 months. Choice of second-line antihyperglycemic agents should be made based on individual patient characteristics, patient preferences, any contraindications to the drug, glucose-lowering efficacy, risk of hypoglycemia, affordability/access, effect on body weight and other factors.• In people with clinical cardiovascular (CV) disease in whom A1C targets are not achieved with existing pharmacotherapy, an antihyperglycemic agent with demonstrated CV outcome benefit should be added to antihyperglycemic therapy to reduce CV risk.• In people without clinical CV disease in whom A1C target is not achieved with current therapy, if affordability and access are not barriers, people with type 2 diabetes and their providers who are concerned about hypoglycemia and weight gain may prefer an incretin agent (DPP-4 inhibitor or GLP-1 receptor agonist) and/or an SGLT2 inhibitor to other agents as they improve glycemic control with a low risk of hypoglycemia and weight gain.• In people receiving an antihyperglycemic regimen containing insulin, in whom glycemic targets are not achieved, the addition of a GLP-1 receptor agonist, DPP-4 inhibitor or SGLT2 inhibitor may be considered before adding or intensifying prandial insulin therapy to improve glycemic control with less weight gain and comparable or lower hypoglycemia risk.

OBJECTIVE -Compared with men and women without diabetes, individuals with type 2 diabetes have higher bone mineral density (BMD). However, they may still be at increased risk for hip fractures. Using population-based Ontario health care data, we compared the risk of hip fractures among men and women with and without diabetes.RESEARCH DESIGN AND METHODS -Using a retrospective cohort design, we identified Ontario residents aged Ն66 years with diabetes from a validated registry from 1994 to 1995 (n ϭ 197,412) and followed them for their first hip fracture until 31 March 2003 (mean 6.1-year follow-up). Hip fracture rates were compared with those of age-matched Ontario residents without diabetes (n ϭ 401,400), and results were stratified by sex and adjusted for age and other covariates.RESULTS -Compared with individuals without diabetes, individuals with diabetes had greater comorbidity, were less likely to have had a BMD test, and were more likely to be taking medications that increase risk of falling and decrease BMD. After adjusting for these differences and age, we found that diabetes increased fracture risk in both men (hazard ratio 1.18 [95% CI 1.12-1.24], P Ͻ 0.0001) and women (1.11 [1.08 -1.15], P Ͻ 0.0001).CONCLUSIONS -Men and women with diabetes have a higher risk of hip fractures compared with individuals without diabetes. Further research to elucidate the mechanisms underlying this increased risk of fracture is needed, as well as increased attention to fracture prevention strategies in patients with diabetes. Diabetes Care 30:835-841, 2007O steoporotic fractures, such as hip and vertebral fractures, are a major source of morbidity and mortality for both men and women. In the 1st year after a hip fracture, there is a 20% increase in mortality, and an estimated 50% of women who sustain a hip fracture do not return to their previous level of function (1).An association between diabetes and hip fractures is becoming increasingly recognized. Both cross-sectional and prospective studies have shown that type 1 diabetes is associated with a decrease in bone mineral density (BMD) (2,3) and an increased risk of osteoporotic hip and other fractures (2,4 -7). In contrast, studies in patients with type 2 diabetes have demonstrated that these patients have higher BMD, probably due to increased body weight (8 -10), but have found inconsistent associations between type 2 diabetes and fractures. Some studies have shown no association (11), whereas other cross-sectional studies have demonstrated a decreased risk of fractures in this population (9,12). However, prospective studies have demonstrated that individuals with type 2 diabetes have an increased risk of osteoporotic fractures, particularly of the hip, despite having higher BMD (4 -6,13-16).Most of these findings have been documented in women (5,6,15). With respect to type 2 diabetes and fracture in men, studies either did not find an association (4,5) or did not specifically examine fracture risk by sex (14,16). Prior studies are also limited by modest sample sizes ...

BackgroundHealth care data allow for the study and surveillance of chronic diseases such as diabetes. The objective of this study was to identify and validate optimal algorithms for diabetes cases within health care administrative databases for different research purposes, populations, and data sources.MethodsWe linked health care administrative databases from Ontario, Canada to a reference standard of primary care electronic medical records (EMRs). We then identified and calculated the performance characteristics of multiple adult diabetes case definitions, using combinations of data sources and time windows.ResultsThe best algorithm to identify diabetes cases was the presence at any time of one hospitalization or physician claim for diabetes AND either one prescription for an anti-diabetic medication or one physician claim with a diabetes-specific fee code [sensitivity 84.2%, specificity 99.2%, positive predictive value (PPV) 92.5%]. Use of physician claims alone performed almost as well: three physician claims for diabetes within one year was highly specific (sensitivity 79.9%, specificity 99.1%, PPV 91.4%) and one physician claim at any time was highly sensitive (sensitivity 93.6%, specificity 91.9%, PPV 58.5%).ConclusionsThis study identifies validated algorithms to capture diabetes cases within health care administrative databases for a range of purposes, populations and data availability. These findings are useful to study trends and outcomes of diabetes using routinely-collected health care data.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3148-0) contains supplementary material, which is available to authorized users.