to As Millions Are Pushed from Jobs amid Pandemic, the Loss of Employer Health Coverage & Limited Access to Public Coverage for Many Immigrants Hold Major Implications for Them – and U.S. Overall By www.migrationpolicy.org Published On :: Thu, 07 May 2020 10:44:32 -0400 WASHINGTON – As more than 33 million U.S. workers have lost their jobs since March amid the pandemic-induced economic crisis, immigrants are among the most vulnerable: They are more likely than the U.S. born to be laid off and to live in communities with high COVID-19 infection rates, and less likely to have health insurance coverage and access to a doctor or other usual source of health care. Full Article
to How Does Immigration Fit into the Future of the U.S. Labor Market? By www.migrationpolicy.org Published On :: Thu, 08 Aug 2019 12:35:20 -0400 The U.S. economy is facing an uncertain future as an aging workforce, stagnating labor force participation, skill mismatches, and automation reshape the labor market. This issue brief explores these forces and the role that immigration could play in supporting future U.S. economic growth. It also examines how immigration affects workers already in the country, both native born and immigrant. Full Article
to Integrating Refugees and Asylum Seekers into the German Economy and Society: Empirical Evidence and Policy Objectives By www.migrationpolicy.org Published On :: Tue, 17 Dec 2019 10:32:57 -0500 As the top destination in Europe for asylum seekers in recent years, Germany has rolled out a number of integration policy changes. Based on an early look at how newcomers’ integration is progressing, the report finds the policies have had ambiguous implications. The report also provides insights into the demographic and socioeconomic characteristics of the asylum seeker and refugee population. Full Article
to An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA By www.migrationpolicy.org Published On :: Wed, 29 Jan 2020 13:09:18 -0500 Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, and areas where the law and state efforts to support English Learners can be improved. Full Article
to Moroccan chicken skewers with feta, pea and tomato tabbouleh By www.abc.net.au Published On :: Thu, 08 Oct 2015 14:47:00 +1000 1 onion, grated 1 cup Greek yoghurt 1/2 cup olive oil 1/2 lemon, juiced 2 cloves of garlic, crushed 1 tsp. smoked paprika 1/2 tsps. ground coriander 1/2 tsps. ground cumin 500g chicken thighs, cut in to 3 cm pieces 2 tbsps. sesame seeds, toasted tabbouleh 100g burghul 2 1/2 cups frozen peas 1 handful of flat leaf parsley, chopped 1 punnit of cherry tomatoes, halved 1 handful of mint leaves, lightly chopped 3 shallots, thinly sliced 200g Greek feta, crumbled 1/3 cup olive oil 1/2 lemon, juiced 1/2 tsp. ground cinnamon Good pinch of sea salt flakes and black pepper Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to Potato mushroom walnut sesame salad By www.abc.net.au Published On :: Tue, 27 Oct 2015 07:33:00 +0800 A new take on that old favourite, potato salad. The sesame and miso adds interest, while the walnuts add taste and crunch. So substantial it could be a meal in itself. Full Article ABC Local southwestwa Lifestyle and Leisure:Food and Cooking:All Australia:WA:Bunbury 6230
to Italian tomato, saffron and mozzarella arancini By www.abc.net.au Published On :: Fri, 26 Feb 2016 11:25:00 +1000 1/2 cup chicken stock 1 pinch of saffron olive oil, for cooking 1 small brown onion, diced 1 tbsp. tomato paste 150 g Carnaroli rice or Arborio rice Himalayan salt and freshly ground black pepper 100 ml white wine 60 g grated parmesan finely grated zest of 1 lemon 100 g grated mozzarella 3 eggs 125 ml (1/2 cup) milk 50 g plain flour 160 g panko breadcrumbs (see Note) vegetable oil, for deep-frying Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to Maggie Beer's Golden Chicken Stock By www.abc.net.au Published On :: Tue, 01 Mar 2016 14:56:00 +1100 Try your hand at this delicious Golden Chicken Stock creation from Maggie Beer. Full Article ABC Local sydney Human Interest:All:All Lifestyle and Leisure:Recipes:All Australia:NSW:Sydney 2000
to Sad Vegetable Ratatouille By www.abc.net.au Published On :: Mon, 18 Apr 2016 14:00:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Cassie Duncan from Sustainable Table. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:VIC:Melbourne 3000
to Carrot Top Pesto By www.abc.net.au Published On :: Mon, 18 Apr 2016 14:03:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Cassie Duncan from Sustainable Table. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Galatopita By www.abc.net.au Published On :: Tue, 26 Apr 2016 14:02:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Kathy Tsaples. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Potatoes with Lemon and Oregano By www.abc.net.au Published On :: Tue, 26 Apr 2016 14:31:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Kathy Tsaples. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Thai Style Fried Chicken - Gai Tod Nahm Prik Pao By www.abc.net.au Published On :: Mon, 09 May 2016 09:53:00 +1000 A spicy Thai take on fried chicken, perfect as an entree to get the taste-buds sizzling or part of a main meal with rice and vegetables. Full Article ABC Local widebay Lifestyle and Leisure:Recipes:Entree Lifestyle and Leisure:Recipes:Main Australia:QLD:Bundaberg 4670
to Spinach and Sweet Potato Frittata By www.abc.net.au Published On :: Tue, 10 May 2016 14:38:00 +1000 The frittata has almost overtaken the classic quiche. It is a healthier option as it doesn't have the extra kilojoules of a pastry case. It's Italian in origin and a versatile dish as you can serve it hot or at room temperature for lunch or dinner, alone or with a salad or vegetables, as part of an Antipasto selection or cut in bite-size pieces to serve as a nibble with drinks. Full Article ABC Local shepparton goulburnmurray Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Australia:VIC:Shepparton 3630 Australia:VIC:Wodonga 3690
to Pumpkin soup with roasted almond pesto By www.abc.net.au Published On :: Mon, 23 May 2016 13:05:00 +0800 Pumpkin soup on it's own can be rather plain but with interesting garnishes, the ordinary becomes delicious. This variation on a classic pesto, which uses pine nuts, incorporates roasted almonds instead, giving this ubiquitous winter soup a greater depth of flavour and crunch. Full Article ABC Local southwestwa Lifestyle and Leisure:Recipes:Soups Australia:WA:Pemberton 6260
to Prosciutto and cheese croquettes By www.abc.net.au Published On :: Thu, 30 Jun 2016 10:41:00 +0800 75g butter 75g (1/2 cup) plain flour 500ml (2 cups) milk 75g finely grated parmesan 1 small red onion, finely diced 200g prosciutto, finely chopped 2 tablespoons chopped fresh parsley 3 eggs, lightly whisked 1 cup plain flour 270g (3 cups) dried breadcrumbs Vegetable oil, to deep-fry Full Article ABC Local wheatbelt Lifestyle and Leisure:Recipes:All Australia:WA:Geraldton 6530
to Chocolate Lamingtons By www.abc.net.au Published On :: Tue, 05 Jul 2016 13:21:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Kirsten Tibbals Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Crispy skinned Salmon, southern gold potatoes, sour cream, lemon, rye croutons and bottarga By www.abc.net.au Published On :: Mon, 11 Jul 2016 12:27:00 +1000 Salmon with a twist. Full Article ABC Local brisbane Lifestyle and Leisure:Recipes:All Australia:QLD:Brisbane 4000
to Six Simple Steps to Making Stock By www.abc.net.au Published On :: Tue, 12 Jul 2016 12:16:00 +1000 This recipe was featured on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Alice Zaslavsky. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Toasted Steak, onion and cheese sandwich, BBQ pickles By www.abc.net.au Published On :: Mon, 25 Jul 2016 11:21:00 +1000 Delicious gourmet steak, onion and cheese sandwich Full Article ABC Local brisbane Lifestyle and Leisure:Recipes:All Australia:QLD:All Australia:QLD:Brisbane 4000
to Beetroot and pinot risotto with king prawns By www.abc.net.au Published On :: Fri, 19 Aug 2016 10:37:00 +1000 Four of my favourite ingredients combined into one dish! Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
to Brussels Sprout Caesar with Croutons, Borlotti Beans and Sunflower Seeds By www.abc.net.au Published On :: Tue, 06 Sep 2016 12:23:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Hetty McKinnon, founder of Surry Hills community kitchen Arthur Street Kitchen and author of 'Neighbourhood'. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Pho Noodle Salad with Tofu, Wombok and Broccolini By www.abc.net.au Published On :: Tue, 06 Sep 2016 12:32:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Hetty McKinnon, founder of Surry Hills community kitchen Arthur Street Kitchen and author of new cookbook 'Neighbourhood'. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Duck with scallop and potato salad By www.abc.net.au Published On :: Wed, 21 Sep 2016 14:38:00 +1000 2 duck breast, skin on. 2g five spice 2g dried ground ginger 5g salt flakes 4 scallops, roe on. sweet wasabi dressing potato salad Full Article ABC Local shepparton goulburnmurray Lifestyle and Leisure:Recipes:All Australia:VIC:Shepparton 3630 Australia:VIC:Wodonga 3690
to Potato Salad By www.abc.net.au Published On :: Wed, 21 Sep 2016 15:00:00 +1000 2 eggs 400g Kipfler potatoes 2 bacon rashers 1/2 bunch of spring onions Salt and pepper mayonnaise Full Article ABC Local shepparton goulburnmurray Lifestyle and Leisure:All:All Lifestyle and Leisure:Recipes:All Australia:VIC:Shepparton 3630 Australia:VIC:Wodonga 3690
to Medallions of Beef, with pan juice sauce, wilted cherry tomatoes, wine and basil By www.abc.net.au Published On :: Thu, 06 Oct 2016 10:07:00 +1100 Medallions of Beef, with pan juice sauce, wilted cherry tomatoes, any old wine and basil. Really nice with a potato salad, with fresh spring peas and crispy bacon pieces. Something I do very often is knock up quick tasty dinner utilising your favourite heavy-based frying pan. Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
to BBQ Moreton Bay bugs with asparagus, butter, lemon and capers By www.abc.net.au Published On :: Mon, 10 Oct 2016 10:56:00 +1000 A simple summer seafood dish! Full Article ABC Local brisbane Lifestyle and Leisure:Recipes:All Australia:QLD:Brisbane 4000
to MACADAMIA PESTO POTATO SALAD WITH CRISPY PROSCIUTTO AND MARKET CHERRY TOMATOES By www.abc.net.au Published On :: Tue, 25 Oct 2016 06:24:00 +1100 Love this time of year where our makers are abundant with the sweet aroma of fresh basil . Here is my take on a fancy potato salad of macadamia pesto , crispy prosciutto, sweet cherry tomatoes Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
to Bush food native tomato seasoned chicken with plum and chilli dip By www.abc.net.au Published On :: Fri, 28 Oct 2016 14:02:00 +1000 chicken thigh fillets, skinless and cut in to finger length strips 100g melted butter 1 tbsp. native tomato spice mix plum and chilli bottled sauce Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to Chicken and Asparagus Risotto By www.abc.net.au Published On :: Tue, 22 Nov 2016 15:37:00 +1100 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Glamingtons By www.abc.net.au Published On :: Wed, 23 Nov 2016 12:57:00 +1100 This recipe featured on 774 Drive with Raf Epstein, weekdays at 3.30PM, shared by Darren Purchese, Pastry Chef/Director of Burch & Purchese Sweet Studio. This is an edited extract from his book Lamingtons & Lemon Tart, published by Hardie Grant Books, and available nationally. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
to Chocolate and almond torte with amaretto cream and fresh market raspberries By www.abc.net.au Published On :: Thu, 08 Dec 2016 05:51:00 +1100 This is the biscuit base to sprinkle in top of the cake Make enough to accomodate 22 cm round tin 50 g Unsalted Butter 50 g Raw Sugar 50 g Almond Meal 8 g of Coco Powder Pinch of Salt 40 g plain Flour Beat all ingredients together in machine with k beater Roll into oblong wrap in glad and freeze Cake mix 250 g eggs or 5 x large eggs 75 g of local honey 125 g castor sugar beat all ingredients together 75 g Almond Meal 120 g plain Flour 25 g coco powder 8 g Baking powder sieve ingredients Add to egg mix then add 120 ml of double Cream Melt together 70 g 70% best quality chocolate 75 g unsalted butter Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
to Upside down local tomato, goats cheese and onion tart By www.abc.net.au Published On :: Thu, 05 Jan 2017 10:24:00 +1100 Always a winner taking advantage of the local summer tomatoes . Who doesn't like flaky puff pastry? Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
to Poached eggs with corn, cottage cheese and sweet potato fritters By www.abc.net.au Published On :: Fri, 10 Feb 2017 10:58:00 +1000 Summer entertaining; breakfast/lunch Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to Greek Santorini tomato fritters with yogurt and dill dip By www.abc.net.au Published On :: Fri, 10 Feb 2017 11:15:00 +1000 400g ripe roma (plum) or pomodorino (baby plum) tomatoes 1 1/2 tablespoons chopped mint 1 teaspoon dried oregano 90g plain flour 1 teaspoon baking powder 1 teaspoon salt Light olive oil, or sunflower oil for pan-frying 250g Greek-style yogurt 1 tablespoon finely chopped dill Lemon wedges, to serve Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to Indian 5 spiced potatoes By www.abc.net.au Published On :: Wed, 12 Apr 2017 13:30:00 +1000 3 tbsps. coconut oil oil 2 tbsps. panch phoran spice mix 1 large onion, finely chopped 2 long green chillies, sliced lengthways 6 curry leaves 2 garlic cloves, crushed 1 tbsps. grated ginger 1 tsp. ground turmeric 4 large potatoes, peeled and diced Panch phoran spice mix: 3 tbsp. brown mustard seeds 3 tbsp. fennel seeds 3 tbsp. Nigella seeds 3 tbsp. cumin seeds salt, to taste chopped coriander leaves, to serve Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to Indian cauliflower rice and coriander pesto By www.abc.net.au Published On :: Thu, 20 Apr 2017 12:50:00 +1000 Cauliflower rice: 1 head cauliflower, cut into florets 2 tbsps. ghee Coriander pesto: 1 large bunch coriander 1 garlic clove 1/4 cup cashews 2 tbsps. parmesan, finely grated 1 lime, zested and juiced 3 tbsps. coconut oil Full Article ABC Local widebay Lifestyle and Leisure:Recipes:All Australia:QLD:Bundaberg 4670
to How to cook a leatherjacket By www.abc.net.au Published On :: Thu, 24 Aug 2017 10:37:00 +1000 This method is moist and magic! Throw out every notion you might have had about leatherjackets being anything other than juicy and flavoursome. This little trick cooks the fish from within. Usually salt draws but in this case its responsible for keeping every bit of moisture in the fish. Leatherjacket is an inexpensive fish, the presentation is great, and you'll bowl over your dinner guests every time. What's not to love? Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
to The Colombian Response to the Venezuelan Migration Crisis: A Dialogue with Colombia’s Migration Czar By www.migrationpolicy.org Published On :: Wed, 18 Sep 2019 15:40:54 -0400 Felipe Muñoz, Advisor to the President of Colombia for the Colombian-Venezuelan Border, discusses how Colombia is coping with the influx of Venezuelan migrants, plans for future policy decisions surrounding this migration, and developments in regional and international cooperation. Full Article
to Latin American Responses to the Venezuelan and Nicaraguan Migration Crises By www.migrationpolicy.org Published On :: Mon, 21 Oct 2019 12:56:39 -0400 Leading policymakers and key stakeholders from Latin America, as well as representatives of major international institutions, offer their views on the challenges ahead as Latin American governments seek to chart strategies for responding to large-scale forced migration flows, such as those from Venezuela and Nicaragua. Full Article
to Respuestas latinoamericanas a las crisis migratorias venezolanas y nicaragüenses By www.migrationpolicy.org Published On :: Fri, 01 Nov 2019 17:38:50 -0400 Responsables de políticos principales y partes interesadas de América Latina, así como representantes de instituciones internacionales claves, ofrecen sus puntos de vista sobre los desafíos futuros mientras gobiernos latinoamericanos buscan establecer las estrategias para responder a flujos migratorios forzados a gran escala, como los de Venezuela y Nicaragua. Full Article
to Is the Door Closing? Latin American and Caribbean Responses to Venezuelan Migration By www.migrationpolicy.org Published On :: Fri, 31 Jan 2020 16:30:49 -0500 This webinar marks the release of MPI's Latin American and Caribbean Migration Portal that offers up-to-date, authoritative research and data on migration trends and policies, and a report examining the policy responses of 11 countries in Latin America and the Caribbean to increased Venezuelan and Nicaraguan migration. Full Article
to An Uneven Welcome: Latin American and Caribbean Responses to Venezuelan and Nicaraguan Migration By www.migrationpolicy.org Published On :: Mon, 03 Feb 2020 17:19:48 -0500 Large-scale displacement from Venezuela and Nicaragua is reshaping the migration landscape in much of Latin America and the Caribbean. This report, accompanied by the launch of a new Migration Portal offering research and analysis on the region, examines the immigration and integration policy responses of 11 countries, including pathways to legal status and measures to integrate newcomers into schools, health-care systems, and labor markets. Full Article
to Federer charges to fifth Basel title By www.abc.net.au Published On :: Mon, 07 Nov 2011 09:09:00 +1100 Roger Federer has returned to winning mode 10 months after his last title, as the home tennis hero schooled Japanese wild card Kei Nishikori 6-1, 6-3 to win a fifth Swiss Indoors title in Basel. Full Article
to Rugby returns to Christchurch By www.abc.net.au Published On :: Tue, 08 Nov 2011 12:00:00 +1100 A 17,000-seat temporary stadium will host rugby union matches, including an All Blacks v Ireland Test, in earthquake-hit Christchurch next year, Prime Minister John Key said. Full Article
to Williams apologises to Tiger for slur By www.abc.net.au Published On :: Tue, 08 Nov 2011 13:09:00 +1100 Tiger Woods says he was hurt by a racist slur from his former caddie Steve Williams, who referred to him as a "black arsehole". Full Article
to Warne returns to big stage By www.abc.net.au Published On :: Tue, 08 Nov 2011 12:22:00 +1100 Champion leg spinner Shane Warne has signed on to play with Melbourne Stars in the inaugural Big Bash League Twenty20 tournament at the end of the year. Full Article
to Microvascular and Cardiovascular Outcomes According to Renal Function in Patients Treated With Once-Weekly Exenatide: Insights From the EXSCEL Trial By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE To evaluate the impact of once-weekly exenatide (EQW) on microvascular and cardiovascular (CV) outcomes by baseline renal function in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL). RESEARCH DESIGN AND METHODS Least squares mean difference (LSMD) in estimated glomerular filtration rate (eGFR) from baseline between the EQW and placebo groups was calculated for 13,844 participants. Cox regression models were used to estimate effects by group on incident macroalbuminuria, retinopathy, and major adverse CV events (MACE). Interval-censored time-to-event models estimated effects on renal composite 1 (40% eGFR decline, renal replacement, or renal death) and renal composite 2 (composite 1 variables plus macroalbuminuria). RESULTS EQW did not change eGFR significantly (LSMD 0.21 mL/min/1.73 m2 [95% CI –0.27 to 0.70]). Macroalbuminuria occurred in 2.2% of patients in the EQW group and in 2.5% of those in the placebo group (hazard ratio [HR] 0.87 [95% CI 0.70–1.07]). Neither renal composite was reduced with EQW in unadjusted analyses, but renal composite 2 was reduced after adjustment (HR 0.85 [95% CI 0.74–0.98]). Retinopathy rates did not differ by treatment group or in the HbA1c-lowering or prior retinopathy subgroups. CV outcomes in those with eGFR <60 mL/min/1.73 m2 did not differ by group. Those with eGFR ≥60 mL/min/1.73 m2 had nominal risk reductions for MACE, all-cause mortality, and CV death, but interactions by renal function group were significant for only stroke (HR 0.74 [95% CI 0.58–0.93]; P for interaction = 0.035) and CV death (HR 1.08 [95% CI 0.85–1.38]; P for interaction = 0.031). CONCLUSIONS EQW had no impact on unadjusted retinopathy or renal outcomes. CV risk was modestly reduced only in those with eGFR ≥60 mL/min/1.73 m2 in analyses unadjusted for multiplicity. Full Article
to Glycated Hemoglobin, Prediabetes, and the Links to Cardiovascular Disease: Data From UK Biobank By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE HbA1c levels are increasingly measured in screening for diabetes; we investigated whether HbA1c may simultaneously improve cardiovascular disease (CVD) risk assessment, using QRISK3, American College of Cardiology/American Heart Association (ACC/AHA), and Systematic COronary Risk Evaluation (SCORE) scoring systems. RESEARCH DESIGN AND METHODS UK Biobank participants without baseline CVD or known diabetes (n = 357,833) were included. Associations of HbA1c with CVD was assessed using Cox models adjusting for classical risk factors. Predictive utility was determined by the C-index and net reclassification index (NRI). A separate analysis was conducted in 16,596 participants with known baseline diabetes. RESULTS Incident fatal or nonfatal CVD, as defined in the QRISK3 prediction model, occurred in 12,877 participants over 8.9 years. Of participants, 3.3% (n = 11,665) had prediabetes (42.0–47.9 mmol/mol [6.0–6.4%]) and 0.7% (n = 2,573) had undiagnosed diabetes (≥48.0 mmol/mol [≥6.5%]). In unadjusted models, compared with the reference group (<42.0 mmol/mol [<6.0%]), those with prediabetes and undiagnosed diabetes were at higher CVD risk: hazard ratio (HR) 1.83 (95% CI 1.69–1.97) and 2.26 (95% CI 1.96–2.60), respectively. After adjustment for classical risk factors, these attenuated to HR 1.11 (95% CI 1.03–1.20) and 1.20 (1.04–1.38), respectively. Adding HbA1c to the QRISK3 CVD risk prediction model (C-index 0.7392) yielded a small improvement in discrimination (C-index increase of 0.0004 [95% CI 0.0001–0.0007]). The NRI showed no improvement. Results were similar for models based on the ACC/AHA and SCORE risk models. CONCLUSIONS The near twofold higher unadjusted risk for CVD in people with prediabetes is driven mainly by abnormal levels of conventional CVD risk factors. While HbA1c adds minimally to cardiovascular risk prediction, those with prediabetes should have their conventional cardiovascular risk factors appropriately measured and managed. Full Article
to Visit-to-Visit HbA1c Variability Is Associated With Cardiovascular Disease and Microvascular Complications in Patients With Newly Diagnosed Type 2 Diabetes By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE To investigate the association between visit-to-visit HbA1c variability and cardiovascular events and microvascular complications in patients with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS This retrospective cohort study analyzed patients from Tayside and Fife in the Scottish Care Information–Diabetes Collaboration (SCI-DC) who were observable from the diagnosis of diabetes and had at least five HbA1c measurements before the outcomes were evaluated. We used the previously reported HbA1c variability score (HVS), calculated as the percentage of the number of changes in HbA1c >0.5% (5.5 mmol/mol) among all HbA1c measurements within an individual. The association between HVS and 10 outcomes was assessed using Cox proportional hazards models. RESULTS We included 13,111–19,883 patients in the analyses of each outcome. The patients with HVS >60% were associated with elevated risks of all outcomes compared with the lowest quintile (for example, HVS >80 to ≤100 vs. HVS ≥0 to ≤20, hazard ratio 2.38 [95% CI 1.61–3.53] for major adverse cardiovascular events, 2.4 [1.72–3.33] for all-cause mortality, 2.4 [1.13–5.11] for atherosclerotic cardiovascular death, 2.63 [1.81–3.84] for coronary artery disease, 2.04 [1.12–3.73] for ischemic stroke, 3.23 [1.76–5.93] for heart failure, 7.4 [3.84–14.27] for diabetic retinopathy, 3.07 [2.23–4.22] for diabetic peripheral neuropathy, 5.24 [2.61–10.49] for diabetic foot ulcer, and 3.49 [2.47–4.95] for new-onset chronic kidney disease). Four sensitivity analyses, including adjustment for time-weighted average HbA1c, confirmed the robustness of the results. CONCLUSIONS Our study shows that higher HbA1c variability is associated with increased risks of all-cause mortality, cardiovascular events, and microvascular complications of diabetes independently of high HbA1c. Full Article