A provider toolkit with clinically relevant resources related to diagnosis and management of central precocious puberty.

CPP Provider Toolkit

A pair of experts in the management of diabetes review the role of insulin therapy and review the approval process for biosimilars, including the FDA's approval of the first interchangeable insulin biosimilar.

Interchangeable Insulin Biosimilars: A Game Changer in Diabetes Management

Podcast hosted by Diana Isaacs, PharmD, and Natalie Bellini, DNP aimed at providing real-world perspective on the latest advances in diabetes management.

 has served a key role in delivering topline news and expert-guided resources to every clinical stakeholder in the field of endocrinology. We’ve grown our audience, our offerings, and our very network of collaborative experts through an emphasis on the newest, most impactful and most-discussed subjects defining the field today—and potentially tomorrow.

We finish 2022 having accomplished many feats: a new record for site traffic, a bevy of new expert contributors and multimedia series, and a pronounced return to live, in-person meeting coverage and studio programs.

And best of all, we end the year with an exciting new partnership that allows us to expand our presence in endocrinology news.

 ®, will be officially merging with medical news site 

, becoming the longtime site’s representative endocrinology news source. Everything 

 has to offer—including its content, multimedia series, and teams of expert advisors—will be available on 

.com, among a growing network of specialty-focused site coverage.

Endocrinology, in each component of academic, research and clinical status, has become representative of great changes to modern health care. Our care teams are more diverse in specialty and capability; our drug classes are becoming multifactorial; our strategies are becoming more collaborative and comprehensive. We hope to reflect these changes in our own partnership with 

®, as our coverage will coexist—and, when relevant, overlap—with coverage from every other specialty.

Our site’s coverage, series and experts will begin to migrate to the 

 endocrinology section in the coming weeks, along with 

 in their respective specialty sections. We’re excited to be joining a growing team that shares our valuation of specialty medical news and insights from key opinion leaders, and our prioritization on FDA and pipeline news, multimedia expert interviews and in-depth meeting coverage.

. We’re excited to see how much more what we started can grow with 

Articles

Beginning January 1, 2023, all new content and insights from the editorial teams of Endocrinology Network, Practical Cardiology and Rheumatology Network will be hosted on HCPLive.Com.

Endocrinology Network to Join HCPLive Network in 2023

The American Diabetes Association (ADA) has released their updated Standards of Care for 2023 with the goal of providing the diabetes care team within an overview of diabetes management, including updates in diabetes technology, obesity, hypertension, heart failure medication, and lipid management.

The 2023 version of the living document, which has been updated annually since 1989, contains more than 100 updated recommendations within its 17 sections, with new updates highlighting the latest advances in clinical aspects of diabetes management, such as pharmacologic approaches to glycemic treatment, but also related to holistic diabetes management, including patient-first language and the influence of social determinants of health.

“ADA’s mission is to prevent and cure diabetes, a chronic illness that requires continuous medical care, and the release of ADA’s 

 is a critical part of that mission,” said Chuck Henderson, chief executive officer for the ADA, in 

. “This year’s annual report provides necessary guidance that considers the role health inequities play in the development of diabetes, particularly for vulnerable communities and communities of color disproportionately impacted by the disease. This guidance will ensure health care teams, clinicians and researchers treat the whole person.”

Published on December 12, the document was prepared for multiple audiences, including primary care physicians, endocrinologists, nurse practitioners, physician associates, pharmacists, dietitians, and diabetes care and education specialists as well as cardiologists, nephrologists, emergency physicians, internists, pediatricians, psychologists, neurologists, ophthalmologists, and podiatrists. The document’s recommendations encompass care throughout the lifespan, including youth, adults, and older adults with diabetes, and cover the management of type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus as well as other types of diabetes.

The updated Standards of Care in Diabetes—2023 also includes a 5-page summary of revisions. In this summary, the writing committee encapsulates relevant updates within the 17 sections of the document. Some of these revisions are highlighted below:

Emphasis on supporting higher weight loss (up to 15%) based on the efficacy of and access to newer medications when appropriate

New recommendations related to sleep health and physical activity in people with diabetes

Broad consideration of social determinants of health in guiding the design and delivery of care

New hypertension diagnosis cut-offs (hypertension is now defined as a systolic blood pressure at or exceeding 130 mmHg or a diastolic blood pressure ≥80 mmHg)

The expanded role of SGLT2 inhibitor use in preserved and reduced heart failure ejection fraction

The role of finerenone in individuals with diabetes and chronic kidney disease with albuminuria

New lipid management recommendations suggesting lower LDL goals for high-risk individuals

The document was composed by a multidisciplinary team of 20 experts from the US, including physicians, nurse practitioners, certified diabetes care and education specialists, registered dietitians, pharmacists, methodologists, and others.

“Evidence-based recommendations drive better care for all people with diabetes, including vulnerable communities and those at high risk. ADA’s 

 are the gold standard for diabetes care and prevention that allows clinicians around the world to remain abreast of the rapidly changing healthcare landscape,” said Robert Gabbay, MD, PhD chief scientific and medical officer for the ADA, in the aforementioned statement.

Published on December 12, the latest Standards of Care in Diabetes from the American Diabetes Association contain more than 100 new updates related to management and diagnosis of all types of diabetes.

American Diabetes Association Releases 2023 Standards of Care in Diabetes

The mental, emotional and physical toll of diabetes can drastically impact everyday life, especially for aspiring athletes. As a pediatric nurse living with type 1 diabetes (T1D) and an avid athlete myself, I’ve experienced this firsthand.

Following my diabetes diagnosis more than 27 years ago, I realized that my health and well-being depended on maintaining an active lifestyle. This led me to attend my first 

, where I was able to learn about diabetes and exercise, and train athletically with other people living with diabetes.

The experience opened my eyes to the benefits of having a network of people living with diabetes to support and learn from one another. It also showed me that the challenges and barriers we face are very similar – and for those who aspire to be physically active or compete at higher levels, diabetes can often prevent them from pursuing their dreams.

Unfortunately, these roadblocks appear as soon as a diagnosis is received. A recent survey found that nearly half of adults with T1D felt like quitting sports and physical activities because of their diagnosis

– and one in five adults said they stopped participating in sports or other physical activities altogether.

This underscores the crucial role that athletic trainers and healthcare professionals (HCPs) as well as coaches and teammates can play in the success of athletes living with diabetes. While a diabetes diagnosis can be harrowing and lonesome, with proper education, resources, and game plan, we can have a positive and lasting impact on people’s lives.

Here are three crucial tips that will help you effectively support athletes living with diabetes.

Diabetes is a chronic health condition that affects the body’s ability to produce insulin or make good use of the insulin it does produce, which impacts glucose levels in the blood.

 Varying intensities and types of exercise can also affect blood glucose in individuals with diabetes by lowering or raising glucose levels. Understanding the physical signs and symptoms of when glucose is going higher or lower than target range is important to determine what actions may need to be taken to help the athlete.

For example, a falling glucose level can respond quickly to fast-acting carbohydrates, so the athlete may not need more than a short break from activity. In cases where a person’s glucose levels are higher than their preferred range, they may need to administer insulin to bring their levels back within range. It’s critical to partner with the athlete to determine when it’s safe to resume play. Sidelining for longer than is necessary can be discouraging and frustrating for athletes eager and motivated to train with their team.

Everyone’s journey with diabetes is unique. Some athletes living with diabetes may be more comfortable than others speaking openly about their experience, while others may feel the need to hide their diagnosis, like almost half of adults with T1D surveyed.

 Depending on the age of the athlete and how recently they were diagnosed, they may lean on you for varying degrees of support, so it’s important to ask the athlete the right questions. This could include things like how involved they would like you to be in their diabetes management, how they check glucose levels, or what signs you should recognize when their glucose levels are too high or too low.

Remember that diabetes requires 24/7/365 management, and it takes time to find the best treatment plan for each person’s circumstances. By asking the right questions, you can help your player feel understood and encouraged, which in turn promotes good decision-making and motivation to persevere.

People with diabetes make countless additional decisions each day, which is especially cumbersome for athletes when they need to be in the zone and laser-focused on their performance. Modern technology can empower people with diabetes to pursue their goals by offering a reprieve from some of those minute-by-minute decisions. For me, diabetes technology meant I could run long distances for the first time completely aware of how my glucose was responding. If my glucose started to drop, I could consume carbs to return to target range without needing to take a break or completely end my run.

Continuous glucose monitors or CGM devices are small wearable sensors that track glucose levels continuously throughout the day and night. Glucose readings are then sent directly to a smart device or receiver, and some CGM systems like Dexcom G6, can connect to additional technologies such as Apple or Garmin smartwatches – giving athletes options to seamlessly manage their diabetes during even the most strenuous activities.

Remote monitoring capabilities that CGM systems also offer are also a game-changer for athletes with diabetes, with the ability to share their glucose levels in real time with their trainers and parents.

HCPs can have an enormous impact on athletes’ lives

Whether you’re an athletic trainer, HCP, or coach, you play a crucial role in ensuring that individuals with diabetes don’t give up on athletics. While living with diabetes can be challenging at times, it does not limit anyone’s ability to perform optimally. No matter what age or level of competition your athlete is, remember you can be a supporting partner to help them achieve or surpass their goals.

By being thoughtful in your approach, you can build trust with your athlete and help them reach their full potential. For more about diabetes, exercise, and how to support the athlete in your life, the website 

 contains multiple valuable educational resources and more.

Fran Damian, MS, RN, is a pediatric nurse specializing in emergency care at Boston Children’s Hospital with more than 40 years of experience. For the past nine years, she has been part of the lead medical staff at Diabetes Training Camp and recently became the director of their teen boot camp, which works with teen athletes with diabetes as well as their parents.

T1 Aspirations & Physical Activity research, dQ&A Market Research Inc., September 2022

Centers for Disease Control and Prevention, What is Diabetes? https://www.cdc.gov/diabetes/basics/diabetes.html

A recent survey found that most people with type 1 diabetes felt their coaches, trainers, and teachers treated them differently after learning about their diagnosis. In this column, Fran Damian, MS, RN, provides 3 simple steps to better support athletes with diabetes.

How to Best Support Young Athletes with Type 1 Diabetes, with Fran Damian, MS, RN

Dexcom has announced their Dexcom G7 Continuous Glucose Monitoring (CGM) system has received clearance from the US Food and Drug Administration for people with all types of diabetes aged 2 years and older.

Announced on December 8, the Dexcom G7 boasts an overall MARD of 8.2% and is billed by the company as the most covered CGM on the market.

“G7 isn’t just great for people with diabetes, it’s great for healthcare professionals as well,” said Thomas Grace, MD, a primary care physician in Findlay, Ohio, in 

. "The integration of Dexcom Clarity into the mobile app provides easy access to retrospective insights about a patient’s glycemic management during in person or telehealth appointments. With its exceptional accuracy and ease of use, I’m confident G7 will be a game changer for my patients.”

The Dexcom G7 carries over several key features from the previous generation system, including the lack of need for fingersticks, scanning, or calibration, the ability to send real-time glucose readings automatically every 5 minutes to a compatible device, and the ability to share glucose data with up to 10 followers. Within their aforementioned release, Dexcom lists notable differences between the Dexcom G7 CGM system and the previous generation G6 system. Some of these key differences are highlighted below:

60% smaller, all-in-one discreet wearable, with fewer components

12-hour grace period to replace finished sensors

Indicated for wear on the back of the upper arm for ages 2 years and older or the upper buttocks for ages 2-17

Further in their announcement, Dexcom noted they expect a US launch of the Dexcom G7 CGM system in early 2023. Additionally, in order to facilitate immediate access, the company will offer accessible cash pay options as the company transitions coverage availability.

“There’s a reason Dexcom has the best-selling real-time CGM on the market,” said Kevin Sayer, chairman, president and CEO of Dexcom. “For more than a decade, we’ve pioneered generation after generation of sensing technology that consistently delivers improved accuracy, reliability and a simpler user experience, giving people greater control of their diabetes.”

Find more news on the Dexcom G7 system, including a study comparing ease of uptake compared with the Dexcom G6 in older, CGM-naive patients, by clicking here!

On December 8, Dexcom announced their Dexcom G7 CGM system had received US FDA clearance for use in people with all types of diabetes aged 2 years and older. 

Dexcom G7 CGM System Receives FDA Clearance

The Endocrine Society has released a new clinical practice guideline aimed at outlining optimal evidence-based strategies for management of 

 considered to be at high risk for hypoglycemia.

Released on December 7, the guideline, which was created by a multidisciplinary, 10-person team, is expected to be published in the March 2023 print issue of 

Journal of Clinical Endocrinology & Metabolism 

and is cosponsored by major organizations, including the American Association of Clinical Endocrinology (AACE) and the American Diabetes Association (ADA).

“CGMs and insulin pumps have been much more commonly used in the last decade among people with diabetes including children, and there are new forms of glucagon available. We had to update our guideline to match these developments in the diabetes field,” said chair of the guideline writing committee Anthony L. McCall, MD, PhD, professor of endocrinology and metabolism at the University of Virginia, in 

At 34 pages in length and citing 256 references, the guideline represents an update to the Endocrine Society’s 2009 recommendations, which included 7 recommendations. In the current guidelines, the guideline writing committee created the guideline after identifying 10 clinical questions related to hypoglycemia in people living with diabetes, with a focus on use of 

, insulin pumps, insulin analogs, glucagon use, and patient education. Upon identifying these questions, investigators performed systematic reviews for each and used GRADE methodology to assess the certainty of evidence and create their recommendations.

In addition to these recommendations, the writing committee detailed future research considerations for each of the 10 questions. The writing committee also provided a review of the recently updated definitions of hypoglycemia levels, which were presented in a 2018 consensus statement. Of note, DiabetesSisters, the Pediatric Endocrine Society, and the Society for Hospital Medicine joined the AACE and ADA in cosponsorship of the document.

In their release, the Endocrine Society highlighted this guideline is a product of its 

, which was created with the intent of providing endocrinologists and other clinicians with evidence-based recommendations in the diagnosis, treatment, and management of endocrine-related conditions.

“People with diabetes, their caregivers and diabetes specialists will all benefit from our guideline with a better understanding of best practices and interventions,” McCall added.

Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline,

The Journal of Clinical Endocrinology & Metabolism.

The Endocrine Society has released updated guidance for management of hypoglycemia in people with diabetes, which represents their first guidance on the topic since 2009 and places a new emphasis on the role of diabetes technology, insulin analogs, and glucagon use. 

Endocrine Society Releases Updated Guidance for Management of Hypoglycemia

Despite advances in care and pushes for more equitable access to care, a new study suggests racial disparities in glycemic control and severe hyperglycemia among people with 

 in the US have worsened over the last 3 decades.

An analysis of data from the National Health and Nutrition Examination Survey (NHANES), results of the Johns Hopkins-led study indicate the portion of patients with diabetes who received insulin and achieved glycemic control did not change over the study period, but racial disparities in both of these that existed in 1988 persisted or increased through 2020, particularly among Mexican American individuals.

“Few population-based studies have examined glycemic control among patients using insulin,” wrote investigators. “Previous work showed that the prevalence of glycemic control did not change among US adults with diabetes using insulin from 1988 to 2012, averaging 33% throughout the study period. Our updated results, based on nationally representative data collected from 1988 to 2020, extend this work and show that glycemic control continued to stagnate among insulin users. Our results also establish that the prevalence of severe hyperglycemia did not decrease over time.”

For decades, affordability of insulin and the importance of glycemic control have been at the forefront of diabetes management. In the US and other areas across the globe, systemic inequities have resulted in reduced access to many therapies for minority and other underserved populations. A team from Johns Hopkins University School of Medicine undertook the current research endeavor with the intent of exploring trends and disparities in glycemic control and severe hyperglycemia in adults with diabetes using insulin in the US.

With this in mind, investigators designed their analyses as a serial population-based, cross-sectional study of data recorded in survey cycles of NHANES from 1998-1994 and from 1999-2020. Limiting their analyses to non-pregnant US adults aged 20 years or older with a diagnosis of diabetes and reporting current insulin use, investigators identified 2482 individuals for inclusion in their analyses. This cohort had a manage of 59.8 (SD, 0.4) years, 51.3% were men, 7.0% were Mexican American individuals, 17.9% were non-Hispanic Black individuals, and 65.2% were non-Hispanic White individuals. From the periods ranging from 1988-1994, 1999-2004, 2005-2012, and 2013-2020, investigators obtained data from 475, 388, 755, and 864 individuals, respectively.

The primary outcomes of interest for the study were trends in glycemic control and severe hyperglycemia overall and among subgroups stratified by age, race and ethnicity, and indicators of socioeconomic status. Investigators noted these were assessed using logistic regression. For the purpose of analysis, glycemic control was defined as an HbA1c less than 7% and severe hyperglycemia was defined as an HbA1c level greater than 10%.

Upon analysis, results indicated the portion of patients with diabetes who received insulin and achieved glycemic control did not significantly change from 1988-1994 to 2013-2020, with rates of 29.2% (95% CI, 22.6-36.8) and 27.5% (95% CI, 21.7-34.2), respectively, during those periods (

=.87 for trend). Similarly, there was no significant change in the rate of severe hypoglycemia, with rates of 18.2% (95% CI, 13.0-24.8%) in the period lasting from 1998-1994 to 14.6% (95% CI, 12.0-17.5) from 2013-2020 (

Further analysis indicated trends in glycemic control were consistent across subgroups with the exception of race and ethnicity. Specifically, rates of control decreased significantly for Mexican American adults using insulin from 25.1% (95% CI, 17.2-35.1) in 1988-1994 to 9.9% (95% CI, 5.4-17.4) in 2013-2020 (

=.004 for trend). Among the other various findings from their study, investigators highlighted the prevalence of severe hyperglycemia was roughly twice as high for Mexican Americans (23.9% [95% CI, 13.6-38.7]) and non-Hispanic Black adults (22.7% [95% CI, 17.4-29.0) than it was for non-Hispanic White adults (9.1% [95% CI, 6.0-13.7]) in 2013-2020.

“This serial cross-sectional study of NHANES data from 1988 to 2020 demonstrated that despite advancements in insulin formulations and diabetes management strategies, glycemic control and severe hyperglycemia among adults using insulin did not improve in the general US adult population with diabetes,” investigators concluded. “Racial and ethnic disparities in glycemic control among adults with type 2 diabetes persisted and increased. Current rates of glycemic control in minority groups, especially Mexican American individuals, remain unacceptably low.”

Trends and Disparities in Glycemic Control and Severe Hyperglycemia Among US Adults With Diabetes Using Insulin, 1988-2020

An analysis of NHANES data spanning more than 3 decades provides an overview of trends in glycemic control and severe hyperglycemia among people with diabetes using insulin, including racial and ethnic disparities.

Despite Advances, Decades-Old Racial Disparities Persist in Glycemic Control in the US

A retrospective analysis of more than 40,000 patients suggests use of metformin was associated with a significant reduction in total joint replacements among a cohort of aging adults.

Comparing data from 20,000 patients treated with metformin and 20,000 patients treated without metformin, results of the study suggest adherence to metformin was associated with a 30% reduction in risk of total knee or total hip replacement.

"We found that metformin use in patients with type 2 diabetes mellitus was associated with a significantly reduced risk of joint replacement, suggesting a potential therapeutic effect of metformin in patients with osteoarthritis," said Changhai Ding, Clinical Research Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China, 

As populations across the globe begin to age, a better understanding of optimization practices for overall health and well-being of older patients becomes of the utmost importance. With this in mind, Ding and a team of colleagues from institutions in Taiwan, China, and Australia designed the current research endeavor to explore whether metformin use was associated with a reduced risk of total knee replacement or total hip placement.

To do so, the investigators’ analyses leveraged the Taiwan National Health Insurance Research database to identify patients with type 2 diabetes diagnosed between 2000-2012. A total of 85,455 participants with a new diagnosis of type 2 diabetes were identified for potential inclusion. Using prescription time-distribution matching, a total of 20,347 participants who were not treated with metformin and 20,347 participants treated with metformin for inclusion in their analyses. This cohort had a mean age of 63 (SD, 11) years and 49.8% were women.

For further analysis, investigators used propensity-score matching to identify 10,163 matched pairs of metformin users and nonusers. Investigators planned to use Cox proportional hazards regression to estimate associations of metformin use with risk of total knee replacement or total hip replacement as a composite and as individual end points.

Upon analysis, results indicated found use of metformin was associated with a lower risk of total knee replacement or total hip replacement (aHR, 0.70 [95% CI, 0.60-0.81]). When assessing individual components of the primary end point results demonstrated use of metformin was associated with a reduction in risk for both total knee replacement (aHR, 0.71 [95% CI, 0.61-0.84]) and total hip replacement (aHR, 0.61 [95% CI, 0.41-0.92]). Investigators pointed out similar trends were observed in In propensity-score matching and sensitivity analyses using inverse probability of treatment weighting and competing risk regression.

“Given our findings and those of a previous observational study, a randomized trial of the efficacy of metformin in patients with [osteoarthritis] is indicated,” wrote investigators.

Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based matched cohort study

An analysis of a national health insurance database provides insight into the risk of total knee or total hip replacement based on use of metformin among a cohort of older adults. 

Metformin Linked to Lower Risk of Total Joint Replacement in Older Adults

An analysis of data from Medicare Advantage beneficiaries with type 1 or type 2 diabetes is providing an overview of trends in incidence of glycemic emergencies in the US from 2011-2020.

Results of the study, which included more than 2.5 million adults with diabetes, results indicate rates of incidence for both severe hypoglycemia and hyperglycemia among people with type 1 diabetes had increased during the study period, while rates of severe hypoglycemia decreased among those with type 2 diabetes.

“Our findings underscore the importance of preventing severe hypoglycemia and hyperglycemia, closely monitoring patients who experience them, and intervening to prevent recurrence,” wrote investigators.

Since the landmark Diabetes Control and Complications trial indicated optimal glycemic control was associated with a reduction in adverse outcomes, the diabetes community has experienced a revolution in therapy and management. The current research endeavor was launched by a team of collaborators from the Mayo Clinic and Yale School of Medicine with an interest in exploring trends in hospitalizations for glycemic emergencies in the US. With this in mind, investigators designed their study as an analysis of claims data from Medicare Advantage beneficiaries with type 1 or type 2 diabetes using OptumLabs Data Warehouse, with a period of interest defined as January 1, 2011-December 31, 2020.

The primary endpoints of interest for the analyses were rate of hypoglycemia- and hyperglycemia-related emergency department visits or hospitalizations among those with type 1 and type 2 diabetes, which was expressed as number of events per 1000 person-years and adjusted for patient age, sex, race, ethnicity, and region.

Investigators identified a total of 67,901 adults with type 1 diabetes and 2,483,951 adults with type 2 diabetes for inclusion in their analyses. The cohort of people with type 1 diabetes had a mean age of 43.2 (SD, 16.1) years, 52.8% were male, and 71.8% were non-Hispanic White. The cohort of people with type 2 diabetes had a mean age of 62.6 (SD, 12.5) years, 50.5% were males, and 56.3% were non-Hispanic White.

Among those with type 1 diabetes, adjusted rates of severe hypoglycemia increased from 25.7 per 1000 person-years in 2011 to 32.9 per 1000 person-years in 2019 and then decreased to 25.6 per 1000 person-years in 2020 (

=.87). The adjusted rates of severe hyperglycemia increased from 30.0 per 1000 person-years in 2011 to 47.2 per 1000 person-years in 2019 and then decreased to 44.5 per 1000 person-years in 2020 (

Among those with type 2 diabetes, adjusted rates of severe hypoglycemia decreased from 9.6 per 1000 person-years in 2011 to 8.6 per 1000 person-years in 2019 and then declined further to 7.0 per 1000 person-years in 2020 (

=.02). The adjusted rates of severe hyperglycemia increased from 2.6 per 1000 person-years in 2011 to 3.3 per 1000 person-years in 2019 and remained consistent at 3.2 per 1000 person-years in 2020 (

“Further research is needed to probe for the reasons for the observed deterioration of glycemic management among people with type 1 diabetes, with higher rates of both severe hypoglycemia and hyperglycemia, and why people with type 2 diabetes who saw improvements in the rates of severe hypoglycemia did not see similar declines in severe hyperglycemia,” investigators concluded.

Rates of Hypoglycemic and Hyperglycemic Emergencies Among U.S. Adults With Diabetes, 2011–2020

Using data from Medicare Advantage beneficiaries from 2011-2020, investigators provide an overview of trends of severe hyperglycemic- and hypoglycemic-related hospitalizations and emergency department visits among those with type 1 or type 2 diabetes. 

Study Details Rates of Glycemic Emergencies Among Medicare Beneficiaries from 2011-2020

New research suggests 3-in-4 children with 

A systematic review and meta-analysis of 53 studies incorporating nearly 9000 participants suggests 75% of children with type 2 diabetes also had obesity, with more than 75% of this group having a diagnosis of obesity at time of diagnosis for type 2 diabetes. Results of the study also shed light into potential risk factors for obesity in this cohort, including male sex and race.

“In this study, while obesity was an important risk factor for the development of [type 2 diabetes] in children, not all patients with [type 2 diabetes] had obesity. Screening for and diagnosing [type 2 diabetes] may consider obesity as a risk factor for [type 2 diabetes] but not a prerequisite to screening when other risk factors are present,” wrote investigators.

Few public health issues carry the same societal level burden as those of type 2 diabetes and obesity. Citing the belief that childhood obesity epidemic is driving increases in rates of pediatric type 2 diabetes, a team of investigators from McMaster University along with other collaborators from international institutions sought to investigate trends in prevalence of obesity in pediatric type 2 diabetes through a systematic review and meta-analysis of published works within the MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science databases database inception to June 16, 2022.

For the purpose of analysis, investigators only included observational studies with at least 10 participants reporting prevalence of obesity in pediatric type 2 diabetes. The primary outcome of interest for the analysis was the pooled prevalence of obesity in type 2 diabetes. The analysis’s multiple secondary outcomes of interest included pooled prevalence rates by sex and race and associations between obesity and glycemic control and dyslipidemia.

In total, investigators identified 57 articles for inclusion in the systematic review and 53 articles, with a population of 8942 participants, for inclusion in the meta-analysis. Of the 57 studies identified by investigators, 26 had a cross-sectional design, 23 were retrospective cohort studies, and 6 were prospective cohort studies. Of note, 12 of the 57 studies did not report specific diabetes diagnostic criteria.

Results of the investigators’ analysis suggested the overall prevalence of obesity among those with pediatric type 2 diabetes was 75.27% (95% CI, 70.47-79.78). Further analysis indicated the prevalence of obesity at diabetes diagnosis among 4688 participants was 77.24% (95% CI, 70.55-83.34). When assessing factors associated with increased odds of obesity, results indicated male participants had higher odds of obesity than their female counterparts (OR, 2.10 [95% CI, 1.33-3.31]). When evaluating the influence of race or ethnicity, results suggested Asian participants had the lowest prevalence of obesity (64.50% [95% CI, 53.28-74.99]), and White participants had the highest prevalence of obesity (89.86% [95% CI, 71.50-99.74]) among racial groups. Investigators noted high heterogeneity was observed across studies as well as varying degrees of glycemic control and dyslipidemia.

“Understanding the causes of T2D in children without obesity is crucial to define the etiology of their diabetes and to create effective management strategies for this cohort,” concluded investigators. “Further research is needed to evaluate the causes of sex- and race and ethnicity–based associations of diabetes with obesity and explore additional factors that may affect the risk of developing T2D apart from obesity in children.”

The Prevalence of Obesity Among Children With Type 2 Diabetes

A systematic review and meta-analysis of studies reporting the pooled prevalence of obesity in pediatric type 2 diabetes suggest 75% of these patients had obesity. 

Report: 3-in-4 Children with Type 2 Diabetes Also Have Obesity

Each year, the American Diabetes Association (ADA)’s Standards of Care in Diabetes serve as a guiding document for many in the community, providing updates on the latest in clinical management of diabetes and beyond.

, which was initially published on December 12, 2022, clinicians and people with diabetes were provided with more than 100 revisions to the previous document. Among the more than 100 revisions included in this year’s document is a new emphasis on expanding access of diabetes technologies and a multitude of updates pertaining to inpatient management of diabetes.

 are the gold standard for diabetes care and prevention that allows clinicians around the world to remain abreast of the rapidly changing healthcare landscape,” said Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA,

The weekend preceding the release of the latest iteration of the ADA’s Standard of Care in Diabetes, the hosts of 

Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives

 were on site for the Association of Diabetes Care and Education Specialists (ADCES) Diabetes Technology Conference 2022. The meeting, which offers an opportunity to disseminate and discuss the latest in diabetes technology for the benefit of people with diabetes, served as a timely ground for discussion around the role of diabetes technology, including continuous glucose monitoring systems and insulin pumps, in different care settings.

A co-member of Isaacs on the writing committee for the Standards of Care in Diabetes—2023, Jane Jeffrie Seley, DNP, MPH, assistant professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at Weill Cornell Medicine, joined our hosts during the ADCES DTC meeting to impart perspective on the guidelines, with a specific focus on changes made within the sections pertaining to inpatient diabetes management. In the episode, Seley highlights 4 specific changes within this portion of the document, why they are relevant, and how the determination to make these revisions were made based on contemporary data.