Diabetes Care最新文献

{"title":"Osteoprotegerin, Osteopontin, and Osteocalcin Are Associated With Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL","authors":"Ernesto Maddaloni, Maggie Nguyen, Svati H. Shah, Rury R. Holman","doi":"10.2337/dc24-1455","DOIUrl":"https://doi.org/10.2337/dc24-1455","url":null,"abstract":"OBJECTIVE To evaluate the association of four bone metabolism biomarkers (osteoprotegerin, osteopontin, sclerostin, and osteocalcin) with cardiovascular events in people with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS The Exenatide Study of Cardiovascular Event Lowering (EXSCEL) was a randomized clinical trial evaluating the cardiovascular (CV) safety and efficacy of once-weekly exenatide for patients with T2D. Candidate biomarker data were selected from proteomic profiling performed at baseline and 12 months after randomization samples by SomaScan assay in 5,473 trial participants. The primary composite outcome was the first occurrence of CV death, nonfatal myocardial infarction, or nonfatal stroke (major cardiovascular events [MACE]). Cox proportional hazards models controlling for confounders were used for time-to-event analyses to calculate hazard ratios (HRs) with 95% CI for a 1 SD increase in the biomarker concentrations. RESULTS The primary outcome occurred in 813 participants (14.9%). Higher levels of osteoprotegerin (HR 1.11; 95% CI 1.03–1.20; P = 0.0047) and osteopontin (HR 1.10; 95% CI 1.02–1.18; P = 0.0095) were associated with an increased risk of MACE. The addition of osteoprotegerin and osteopontin to a clinical predictive model containing traditional CV risk factors provided minimal incremental value for MACE prediction (C-index 0.629 vs. 0.638; likelihood ratio test P < 0.001). Osteocalcin and sclerostin were not associated with MACE. Osteocalcin had a nonlinear association with all-cause death and with CV death. CONCLUSIONS Higher levels of osteoprotegerin and osteopontin are associated with an increased risk of CV events in people with T2D, supporting the hypothesis that pathways involved in bone metabolism play a role in CV disease.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"66 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Insulin Resistance With Radiographic Lung Abnormalities and Incident Lung Disease: The Framingham Offspring Study","authors":"Sarath Raju, Paula Sierra, Vickram Tejwani, Kristen A. Staggers, Meredith McCormack, Dennis T. Villareal, Ivan O. Rosas, Nicola A. Hanania, Tianshi David Wu","doi":"10.2337/dc24-1754","DOIUrl":"https://doi.org/10.2337/dc24-1754","url":null,"abstract":"OBJECTIVE Insulin resistance (IR) may be a risk factor for lung disease, but objective evidence is limited. We sought to define the relationship of longitudinal IR with radiographic imaging outcomes and examiner-identified incident lung disease in the Framingham Offspring Study. RESEARCH DESIGN AND METHODS Participants without baseline lung disease underwent repeated measurements of fasting insulin and glucose levels over an average period of 13.6 years, from which time-weighted average HOMA-IR was calculated. Each participant then underwent a cardiac gated whole-lung computed tomography scan, which was analyzed for the presence of emphysema, interstitial lung abnormalities (ILAs), and quantitative airway features. Incident lung disease was determined by a study examiner. The relationship of HOMA-IR to these outcomes was estimated in models adjusted for demographics, BMI, and lifetime smoking. RESULTS A total of 875 participants with longitudinal IR data and outcomes were identified. Their mean age was 51.5 years, and BMI was 26.7 kg/m2. HOMA-IR was temporally unstable, with a within-person SD approximately two-thirds of the between-person SD. In adjusted models, a 1 SD increase in log(HOMA-IR) z score was associated with higher odds of qualitative emphysema (odds ratio [OR] 1.33; 95% CI 1.04–1.70), ILAs (OR 1.35; 95% CI 1.05–1.74), and modest increases in airway wall thickness and wall area percentage. These radiographic findings were corroborated by a positive association of HOMA-IR with incident lung disease. CONCLUSIONS IR is associated with radiographic lung abnormalities and incident lung disease. Deeper phenotyping is necessary to define mechanisms of IR-associated lung injury.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"198 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of the National Diabetes Prevention Program: A Real-World, 2-Year Prospective Study","authors":"Shihchen Kuo, Wen Ye, Di Wang, Laura N. McEwen, Claudia Villatoro Santos, William H. Herman","doi":"10.2337/dc24-1110","DOIUrl":"https://doi.org/10.2337/dc24-1110","url":null,"abstract":"OBJECTIVE We evaluated the real-world cost-effectiveness of the National Diabetes Prevention Program (NDPP) for people with prediabetes in a large workforce with employer-sponsored health insurance. RESEARCH DESIGN AND METHODS We performed difference-in-differences analyses using individual-level health insurance claims and survey data for 5,948 adults with prediabetes who enrolled (n = 575) or did not enroll (n = 5,373) in the NDPP to assess NDPP’s effects on health economic outcomes. We assessed direct medical costs for the year before the NDPP enrollment/index date and for 2 years thereafter; EuroQol 5-Dimension 5-level questionnaire (EQ-5D-5L) utility scores at baseline, 1 year, and 2 years; and quality-adjusted life-years (QALYs) over 2 years. We used propensity score weighting to adjust for potential bias due to self-selection for enrollment, multiple imputation to handle missing data, and bootstrapping to produce CIs. We adopted a health care sector perspective and discounted costs and QALYs at 3% annually. Costs were expressed in 2020 U.S. dollars. RESULTS Compared with nonenrollees, each NDPP enrollee had an average reduction of $4,552 (95% CI −13,231, 2,014) in 2-year total direct medical costs. Cost savings were primarily related to hospitalizations, outpatient visits, and emergency room visits. Compared with nonenrollees, each enrollee had no difference in EQ-5D-5L utility scores at 2 years or QALYs gained over 2 years. The uncertainty analyses found that enrollment in the NDPP had an 88% probability of saving money and 84% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY-gained over 2 years. CONCLUSIONS In this real-world population with prediabetes, enrollment in the NDPP was likely to provide cost savings.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and Excess Risk of Adverse Outcomes in Patients With Type 1 Diabetes Using KDIGO Classification: A National Cohort Study","authors":"Kianoush Makvandi, Björn Eliasson, Hanne Krage Carlsen, Seema Baid-Agrawal","doi":"10.2337/dc24-0908","DOIUrl":"https://doi.org/10.2337/dc24-0908","url":null,"abstract":"OBJECTIVE The widely adopted Kidney Disease: Improving Global Outcomes (KDIGO) classification system has been underused in assessing the burden and risk of adverse outcomes in type 1 diabetes. This observational study aimed to clarify how each KDIGO category correlates with outcomes, including mortality, in this patient group. RESEARCH DESIGN AND METHODS In 40,199 individuals with type 1 diabetes from the Swedish National Diabetes Register, we examined the 1) prevalence of different KDIGO categories at baseline; 2) incidence of adverse kidney and cardiovascular (CV) outcomes, including mortality, within each category; and 3) association of baseline category with excess risk of five outcomes: 40% decline in estimated glomerular filtration rate (eGFR), kidney failure, major adverse kidney/CV events, and all-cause mortality. Cox regression analyses were conducted using three different reference categories: 1) the conventional low-risk “combined G1A1 + G2A1”; 2) “G1A1” alone to assess whether G2A1 had excess risk; and 3) “G1bA1” alone to evaluate whether eGFR ≥105 mL/min/1.73 m2 had increased risk. RESULTS Among 39,067 included patients, with a mean follow-up of 9.1 years, 18.5% presented with chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2 and/or albuminuria. A progressive increase in the incidence and adjusted hazard ratio for all studied outcomes was found with advancing eGFR and albuminuria categories, including in G2A1 (non-CKD). A eGFR ≥105 mL/min/1.73 m2 without albuminuria was not associated with increased risk. CONCLUSIONS A progressively increasing burden of all studied adverse outcomes was observed with advancing KDIGO categories. Even individuals with preserved eGFR and normoalbuminuria (G2A1) conventionally perceived as non-CKD, had an excess risk for all outcomes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"3 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced Aqueous Retinol-Binding Protein 3 Concentration Is Associated With Diabetic Macular Edema and Progression of Diabetic Retinopathy","authors":"Tanvi Chokshi, Ward Fickweiler, Surya Jangolla, Kyoungmin Park, I-Hsien Wu, Hetal Shah, Jennifer K. Sun, Lloyd Paul Aiello, George L. King","doi":"10.2337/dc24-1260","DOIUrl":"https://doi.org/10.2337/dc24-1260","url":null,"abstract":"OBJECTIVE To evaluate the association of aqueous retinol-binding protein 3 (RBP3) with history of diabetic macular edema (DME) and diabetic retinopathy (DR) progression. RESEARCH DESIGN AND METHODS RBP3 concentration was measured by ELISA in aqueous from patients undergoing cataract surgery at Joslin Diabetes Center. DR progression was defined as two-step or more worsening on the Early Treatment Diabetic Retinopathy Study severity scale, and DME history was determined by clinical diagnosis. RESULTS In 153 eyes (31 with type 1 and 122 with type 2 diabetes; n = 149 patients), 37% had no signs of DR, 40% had mild nonproliferative DR (NPDR), and 23% had moderate NPDR. Aqueous RBP3 decreased from a median of 2.1 nmol/L (interquartile range 0.8–3.4) in eyes with no DR to 1.5 nmol/L (0.8–3.8) in eyes with mild-to-moderate NPDR (P = 0.047). The difference between aqueous RBP3 levels in those with type 1 or type 2 diabetes was not significant. Elevated RBP3 (β = −0.701, 95% CI −1.151 to 0.250, P = 0.002) was associated with no DME history. With a mean follow-up of 5.5 ± 3.6 years, elevated RBP3 at baseline was associated with less subsequent DR progression (odds ratio 0.51, 95% CI 0.28–0.93, P = 0.03). In multivariable analyses, RBP3 remained significantly associated with a DR progression and history of DME. A 5% improvement was seen in the area under the curve when RBP3 was added to clinical models for predicting DR progression (P < 0.05). CONCLUSIONS This study suggests that aqueous RBP3 may be an important protective factor, the first neuroretinal-specific biomarker of DME or DR progression, and a possible therapeutic target.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"52 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life Course Associations Between Ambient Fine Particulate Matter and the Prevalence of Prediabetes and Diabetes: A Longitudinal Cohort Study in Taiwan and Hong Kong","authors":"Yuanyuan Yi, Cui Guo, Yiling Zheng, Siyi Chen, Changqing Lin, Alexis K. H. Lau, Martin C. S. Wong, David M. Bishai","doi":"10.2337/dc24-1041","DOIUrl":"https://doi.org/10.2337/dc24-1041","url":null,"abstract":"OBJECTIVE Both air pollution and diabetes are key urban challenges. The association between particulate matter with a diameter of <2.5 μm (PM2.5) exposure and prediabetes/diabetes in adults is well documented, but the health effects of life course exposure remain unclear. This study evaluated the impact of PM2.5 exposure throughout various life stages on the prevalence of prediabetes/diabetes in adulthood. RESEARCH DESIGN AND METHODS We included 4,551 individuals with 19,593 medical visits from two open cohorts in Taiwan and Hong Kong between 2000 and 2018. Ambient PM2.5 exposure was assessed using a satellite-based model, delivering a 2-year average exposure at a resolution of 1 km2. Logistic mixed-effects models were used to investigate longitudinal associations between PM2.5 exposure and the prevalence of prediabetes/diabetes. Life course models were used to examine the impact of PM2.5 exposure at different life stages on prediabetes/diabetes in adulthood. RESULTS Over an average follow-up period of 9.93 years, 1,660 individuals with prediabetes/diabetes were observed. For the longitudinal association, every 10 μg/m3 increase in PM2.5 was associated with an increased odds of having prediabetes/diabetes (odds ratio 1.32, 95% CI 1.13, 1.54). The odds of adulthood prediabetes/diabetes increased by 15%, 18%, and 29% for each 10 μg/m3 increase in PM2.5 exposure during school age, adolescence, and adulthood, respectively. CONCLUSIONS Our findings suggest a link between PM2.5 exposure during each life stage and the prevalence of prediabetes/diabetes in adulthood, with the health impacts of exposure during adulthood being slightly greater. This study underscores the need for life course air pollution control strategies to mitigate the substantial disease burden of diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"72 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Care in the School Setting: A Statement of the American Diabetes Association","authors":"Fran Cogen, Henry Rodriguez, Christine A. March, Cynthia E. Muñoz, Jacqueline McManemin, Margaret Pellizzari, Janet Rodriguez, Leah Wycoff, Alan L. Yatvin, Torie Atkinson, Nuha A. ElSayed, Raveendhara R. Bannuru, Elizabeth J. Pekas, Crystal Woodward, Jennifer Sherman","doi":"10.2337/dci24-0082","DOIUrl":"https://doi.org/10.2337/dci24-0082","url":null,"abstract":"Diabetes is a prevalent chronic disease in school-age children. To keep students with diabetes safe at school, support their long-term health, prevent complications, and ensure full participation in all school activities, proper monitoring of and response to glucose levels must be attended to throughout the school day and during all school-sponsored activities. Care coordination among the family, school, and diabetes health care professionals is critical. With proper planning, including the education and training of school staff, children and youth with diabetes can fully and safely participate in school. In this statement, we review the legal framework for diabetes care in schools, the core components of school-based diabetes care, the responsibilities of various stakeholders, and special circumstances.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"211 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus Considerations and Good Practice Points for Use of Continuous Glucose Monitoring Systems in Hospital Settings","authors":"Julie L.V. Shaw, Raveendhara R. Bannuru, Lori Beach, Nuha A. ElSayed, Guido Freckmann, Anna K. Füzéry, Angela W.S. Fung, Jeremy Gilbert, Yun Huang, Nichole Korpi-Steiner, Samantha Logan, Rebecca Longo, Dylan MacKay, Lisa Maks, Stefan Pleus, Kendall Rogers, Jane Jeffrie Seley, Zachary Taxin, Fiona Thompson-Hutchison, Nicole V. Tolan, Nam K. Tran, Guillermo E. Umpierrez, Allison A. Venner","doi":"10.2337/dci24-0073","DOIUrl":"https://doi.org/10.2337/dci24-0073","url":null,"abstract":"Continuous glucose monitoring (CGM) systems provide frequent glucose measurements in interstitial fluid and have been used widely in ambulatory settings for diabetes management. During the coronavirus disease 2019 (COVID-19) pandemic, regulators in the U.S. and Canada temporarily allowed for CGM systems to be used in hospitals with the aim of reducing health care professional COVID-19 exposure and limiting use of personal protective equipment. As such, studies on hospital CGM system use have been possible. With improved sensor accuracy, there is increased interest in CGM usage for diabetes management in hospitals. Laboratorians and health care professionals must determine how to integrate CGM usage into practice. The aim of this consensus guidance document is to provide an update on the application of CGM systems in hospital, with insights and opinions from laboratory medicine, endocrinology, and nursing.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"236 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Plasma Apolipoprotein C-I Truncation With Risk of Diabetes in the Multi-Ethnic Study of Atherosclerosis and the Actos Now for the Prevention of Diabetes Study","authors":"Juraj Koska, Yueming Hu, Jeremy Furtado, Dean Billheimer, Dobrin Nedelkov, Dawn Schwenke, Matthew J. Budoff, Alain G. Bertoni, Robyn L. McClelland, Peter D. Reaven","doi":"10.2337/dc24-1462","DOIUrl":"https://doi.org/10.2337/dc24-1462","url":null,"abstract":"OBJECTIVE Higher truncated-to-native apolipoprotein (apo) C-I proteoform ratios (C-I′/C-I) are associated with favorable cardiometabolic risk profiles, but their relationship with longitudinal changes in insulin resistance (IR) and incident diabetes is unknown. RESEARCH DESIGN AND METHODS Plasma apoC-I proteoforms were measured by mass spectrometry immunoassay at baseline in 4,742 nondiabetic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and 524 participants with prediabetes in the Actos Now for Prevention of Diabetes (ACT NOW) study. The primary outcome was incident diabetes (fasting glucose [FG] ≥7.0 mmol/L or hypoglycemic medication use in MESA; FG ≥7.0 mmol/L or 2-h glucose ≥11.1 mmol/L in an oral glucose tolerance test [OGTT] in ACT NOW). Secondary outcomes were changes in FG and HOMA-IR in MESA, and OGTT-glucose area under the curve (AUCglucose) and Matsuda insulin sensitivity index (ISI) in ACT NOW. RESULTS In MESA, a higher C-I′/C-I was associated with lower risk of diabetes (n = 564 events; HR 0.87 [95% CI 0.79, 0.95] per SD; P = 0.0036; median follow-up, 9 years), and smaller increases (follow-up adjusted for baseline) in FG (−0.5%; P < 0.0001) and HOMA-IR (−2.9%; P = 0.011) after adjusting for baseline clinical and demographic covariates, including plasma triglycerides and HDL cholesterol. Total apoC-I concentrations were not associated with changes in FG, HOMA-IR, or incident diabetes. In ACT NOW, higher C-I′/C-I was associated with smaller increases in AUCglucose (−1.8%; P = 0.0052), greater increases in ISI (7.2%; P = 0.0095), and lower risk of diabetes (n = 59 events; 0.66 [95% CI 0.48, 0.91]; P = 0.004; median follow-up, 2.5 years) after adjusting for treatment group and diabetes risk factors, including plasma lipids. CONCLUSIONS Our results indicate that apoC-I truncation may contribute to changes in glucose levels, IR, and risk of diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"15 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Infection in Older Adults With Type 2 Diabetes With Relaxed Glycemic Control","authors":"Kasia J. Lipska, Lisa K. Gilliam, Catherine Lee, Jennifer Y. Liu, Vincent X. Liu, Howard H. Moffet, Melissa M. Parker, Heidi Zapata, Andrew J. Karter","doi":"10.2337/dc24-1612","DOIUrl":"https://doi.org/10.2337/dc24-1612","url":null,"abstract":"OBJECTIVE To compare the risk of hospitalization for infection among patients who achieve intensive versus relaxed glycemic control. RESEARCH DESIGN AND METHODS This retrospective cohort study included adults age ≥65 years with type 2 diabetes from an integrated health care delivery system. Negative binomial models were used to estimate incidence rates and relative risk (RR) of hospitalization for infections (respiratory; genitourinary; skin, soft tissue, and bone; and sepsis), comparing two levels of relaxed (hemoglobin A1c [HbA1c] 7% to <8% and 8% to <9%) with intensive (HbA1c 6% to <7%) glycemic control from 1 January 2019 to 1 March 2020. RESULTS Among 103,242 older patients (48.5% with HbA1c 6% to <7%, 35.3% with HbA1c 7% to <8%, and 16.1% with HbA1c 8% to <9%), the rate of hospitalization for infections was 51.3 per 1,000 person-years. Compared with HbA1c 6% to <7%, unadjusted risk of hospitalization for infections was significantly elevated among patients with HbA1c 8% to <9% (RR 1.25; 95% CI 1.13, 1.39) but not among patients with HbA1c 7% to <8% (RR 0.99; 95% CI 0.91, 1.08), and the difference became nonsignificant after adjustment. Across categories of infections, the adjusted RR of hospitalization was significantly higher among patients with HbA1c 8% to <9% only for skin, soft tissue, and bone infection (RR 1.33; 95% CI 1.05, 1.69). CONCLUSIONS Older patients with type 2 diabetes who achieve relaxed glycemic control levels endorsed by clinical guidelines are not at significantly increased risk of hospitalization for most infections, but HbA1c 8% to <9% is associated with an increased risk of hospitalization for skin, soft tissue, and bone infections.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"225 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}