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Moving Beyond “Root Causes:” The Complicated Relationship between Development and Migration

Development assistance may be a blunt tool for reshaping migration patterns—and indeed one that could increase flows over the short term. Shifting the focus away from increasing individuals’ skills and assets toward investments in the broader economic or governance structures that are a prerequisite for growth and stability may offer more alternatives to emigration in the long run.




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Regional Enforcement: A Profile of Migrants Deported from the United States and Mexico to the Northern Triangle

Marking the release of an MPI report, speakers on this webinar present an overview of regional immigration enforcement trends, including U.S. and Mexican apprehensions and deportations of both children and adults, along with a demographic, socioeconomic, and criminal profile of child and adult deportees.




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Migrants Deported from the United States and Mexico to the Northern Triangle: A Statistical and Socioeconomic Profile

This report examines the rising numbers of apprehensions and deportations of Central American children and adults by the United States and Mexico, and provides a demographic, socioeconomic, and criminal profile of deportees to El Salvador, Guatemala, and Honduras. The report traces how rising Mexican enforcement is reshaping regional dynamics and perhaps ushering in changes to long-lasting trends in apprehensions.




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Regional Enforcement: A Profile of Migrants Deported from the United States and Mexico to the Northern Triangle

This webinar includes an overview of regional immigration enforcement trends, including U.S. and Mexican apprehensions and deportations of Central American migrants, along with a demographic, socioeconomic, and criminal profile of child and adult deportees.




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Mexican Immigrants in the United States

Mexican immigration to the United States has slowed in recent years, and since the Great Recession more Mexican immigrants have returned to Mexico than have migrated to the United States. Mexicans, however, remain the largest origin group in the country, accounting for 28 percent of all immigrants. See how Mexican immigrants compare to the overall foreign- and U.S.-born populations on key indicators with this Spotlight article.




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Temporary Protected Status at Risk: Implications for Central America and U.S. Policy

As the Trump administration weighs the future of Temporary Protected Status (TPS) for Salvadorans, this teleconference focuses on the legal framework for TPS (particularly for Hondurans and Salvadorans) and profile of current TPS holders; the capacity of El Salvador and Honduras to receive and meaningfully reintegrate returnees; and the implications of TPS termination for broader U.S. policy goals in Central America.




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Vanishing Frontiers: The Forces Driving Mexico and the United States Together

Marking the release of MPI President Andrew Selee's book, this discussion explores the emerging trends in migration, economic interdependence, technology innovation, and cultural exchange that are transforming the relationship between the United States and Mexico.




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Randomized Study to Evaluate the Impact of Telemedicine Care in Patients With Type 1 Diabetes With Multiple Doses of Insulin and Suboptimal HbA1c in Andalusia (Spain): PLATEDIAN Study

OBJECTIVE

To assess the impact of a telemedicine visit using the platform Diabetic compared with a face-to-face visit on clinical outcomes, patients’ health-related quality of life (HRQoL), and physicians’ satisfaction in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

PLATEDIAN (Telemedicine on Metabolic Control in Type 1 Diabetes Mellitus Andalusian Patients) (NCT03332472) was a multicenter, randomized, 6-month follow-up, open-label, parallel-group controlled study performed in patients with type 1 diabetes with suboptimal metabolic control (HbA1c <8% [<64 mmol/mol]), treated with multiple daily injections. A total of 388 patients were assessed for eligibility; 379 of them were randomized 1:1 to three face-to-face visits (control cohort [CC]) (n = 167) or the replacement of an intermediate face-to-face visit by a telemedicine visit using Diabetic (intervention cohort [IC]) (n = 163). The primary efficacy end point was the mean change of HbA1c levels from baseline to month 6. Other efficacy and safety end points were mean blood glucose, glucose variability, episodes of hypoglycemia and hyperglycemia, patient-reported outcomes, and physicians’ satisfaction.

RESULTS

At month 6, the mean change in HbA1c levels was –0.04 ± 0.5% (–0.5 ± 5.8 mmol/mol) in the CC and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the IC (P = 0.4941). The number of patients who achieved HbA1c <7% (<53 mmol/mol) was 73 and 78 in the CC and IC, respectively. Significant differences were not found regarding safety end points at 6 months. Changes in HRQoL between the first visit and final visit did not differ between cohorts, and, regarding fear of hypoglycemia (FH-15 score ≥28), statistically significant differences observed at baseline remained unchanged at 6 months (P < 0.05).

CONCLUSIONS

The use of telemedicine in patients with type 1 diabetes with HbA1c <8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits.




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Smartphone-Based Glucose Monitors and Applications in the Management of Diabetes: An Overview of 10 Salient "Apps" and a Novel Smartphone-Connected Blood Glucose Monitor

Joseph Tran
Oct 1, 2012; 30:173-178
Practical Pointers




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Elevated Liver Function Tests in Type 2 Diabetes

Elizabeth H. Harris
Jul 1, 2005; 23:115-119
Feature Articles




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Food, Culture, and Diabetes in the United States

Karmeen D. Kulkarni
Oct 1, 2004; 22:190-192
Practical Pointers




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Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

OBJECTIVE

Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises.

RESEARCH DESIGN AND METHODS

We analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality.

RESULTS

There were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P = 0.0019). In all groups, hypoglycemia (<40 mg/dL) during treatment was associated with a 4.8-fold increase in mortality (aOR 4.8; 95% CI 1.4, 16.8). Hypokalemia ≤3.5 mEq/L was frequent (55%). Severe hypokalemia (≤2.5 mEq/L) was associated with increased inpatient mortality (aOR 4.9; 95% CI 1.3, 18.8; P = 0.02).

CONCLUSIONS

Combined DKA-HHS is associated with higher mortality compared with isolated DKA or HHS. Severe hypokalemia and severe hypoglycemia are associated with higher hospital mortality in patients with hyperglycemic crises.




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Distinct Growth Phases in Early Life Associated With the Risk of Type 1 Diabetes: The TEDDY Study

OBJECTIVE

This study investigates two-phase growth patterns in early life and their association with development of islet autoimmunity (IA) and type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS

The Environmental Determinants of Diabetes in the Young (TEDDY) study followed 7,522 genetically high-risk children in Sweden, Finland, Germany, and the U.S. from birth for a median of 9.0 years (interquartile range 5.7–10.6) with available growth data. Of these, 761 (10.1%) children developed IA and 290 (3.9%) children were diagnosed with T1D. Bayesian two-phase piecewise linear mixed models with a random change point were used to estimate children’s individual growth trajectories. Cox proportional hazards models were used to assess the effects of associated growth parameters on the risks of IA and progression to T1D.

RESULTS

A higher rate of weight gain in infancy was associated with increased IA risk (hazard ratio [HR] 1.09 [95% CI 1.02, 1.17] per 1 kg/year). A height growth pattern with a lower rate in infancy (HR 0.79 [95% CI 0.70, 0.90] per 1 cm/year), higher rate in early childhood (HR 1.48 [95% CI 1.22, 1.79] per 1 cm/year), and younger age at the phase transition (HR 0.76 [95% CI 0.58, 0.99] per 1 month) was associated with increased risk of progression from IA to T1D. A higher rate of weight gain in early childhood was associated with increased risk of progression from IA to T1D (HR 2.57 [95% CI 1.34, 4.91] per 1 kg/year) in children with first-appearing GAD autoantibody only.

CONCLUSIONS

Growth patterns in early life better clarify how specific growth phases are associated with the development of T1D.




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Redesigning Primary Care to Improve Diabetes Outcomes (the UNITED Study)

OBJECTIVE

The effective redesign of primary care delivery systems to improve diabetes care requires an understanding of which particular components of delivery consistently lead to better clinical outcomes. We identified associations between common systems of care management (SysCMs) and the frequency of meeting standardized performance targets for Optimal Diabetes Care (NQF#0729) in primary care practices.

RESEARCH DESIGN AND METHODS

A validated survey of 585 eligible family or general internal medicine practices seeing ≥30 adult patients with diabetes in or near Minnesota during 2017 evaluated the presence of 62 SysCMs. From 419 (72%) practices completing the survey, NQF#0729 was determined in 396 (95%) from electronic health records, including 215,842 patients with type 1 or type 2 diabetes.

RESULTS

Three SysCMs were associated with higher rates of meeting performance targets across all practices: 1) a systematic process for shared decision making with patients (P = 0.001), 2) checklists of tests or interventions needed for prevention or monitoring of diabetes (P = 0.002), and 3) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (P = 0.002). When all three were in place, an additional 10.8% of the population achieved recommended performance measures. In subgroup analysis, 15 additional SysCMs were associated with better care in particular types of practices.

CONCLUSIONS

Diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions. Practice size and location are important considerations when redesigning delivery systems to improve performance.




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Diabetic Neuropathy Is a Substantial Burden in People With Type 1 Diabetes and Is Strongly Associated With Socioeconomic Disadvantage: A Population-Representative Study From Scotland

OBJECTIVE

To assess the contemporaneous prevalence of diabetic peripheral neuropathy (DPN) in people with type 1 diabetes (T1D) in Scotland and study its cross-sectional association with risk factors and other diabetic complications.

RESEARCH DESIGN AND METHODS

We analyzed data from a large representative sample of adults with T1D (N = 5,558). We assessed the presence of symptomatic neuropathy using the dichotomized (≥4) Michigan Neuropathy Screening Instrument Patient Questionnaire score. Logistic regression models were used to investigate associations between DPN and risk factors, as well as with other complications.

RESULTS

The burden of DPN is substantial with 13% prevalence overall. Adjusting for attained age, diabetes duration, and sex, the odds of DPN increased mainly with waist-to-hip ratio, lipids, poor glycemic control (odds ratio 1.51 [95% CI 1.21–1.89] for levels of 75 vs. 53 mmol/mol), ever versus never smoking (1.67 [1.37–2.03]), and worse renal function (1.96 [1.03–3.74] for estimated glomerular filtration rate levels <30 vs. ≥90 mL/min/1.73 m2). The odds significantly decreased with higher HDL cholesterol (0.77 [0.66–0.89] per mmol/L). Living in more deprived areas was associated with DPN (2.17 [1.78–2.65]) for more versus less deprived areas adjusted for other risk factors. Finally, individuals with prevalent DPN were much more likely than others to have other diabetes complications.

CONCLUSIONS

Diabetic neuropathy remains substantial, particularly affecting those in the most socioeconomically deprived groups. Those with clinically manifest neuropathy also have a higher burden of other complications and elevated levels of modifiable risk factors. These data suggest that there is considerable scope to reduce neuropathy rates and narrow the socioeconomic differential by better risk factor control.




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Watch: Girl, 14, accepted into eight California universities

A California 14-year-old who graduated high school at the age of 13 said she has now been accepted into the music programs at eight California universities.




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Watch: Utah man reunited with class ring 38 years after it was lost in Germany

A Utah man who lost his high school class ring in Germany in 1982 was reunited with the ring thanks to a man who found it on a beach in the United States.




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Evidence-Informed Clinical Practice Recommendations for Treatment of Type 1 Diabetes Complicated by Problematic Hypoglycemia

Pratik Choudhary
Jun 1, 2015; 38:1016-1029
Type 1 Diabetes at a Crossroads




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Kidney Disease and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Ian H. de Boer
Jan 1, 2014; 37:24-30
DCCT/EDIC 30th Anniversary Summary Findings




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Feasibility of Outpatient Fully Integrated Closed-Loop Control: First studies of wearable artificial pancreas

Boris P. Kovatchev
Jul 1, 2013; 36:1851-1858
Diabetes Care Symposium




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Phase 3 Trial of Transplantation of Human Islets in Type 1 Diabetes Complicated by Severe Hypoglycemia

Bernhard J. Hering
Jul 1, 2016; 39:1230-1240
Emerging Technologies and Therapeutics




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Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Catherine L. Martin
Jan 1, 2014; 37:31-38
DCCT/EDIC 30th Anniversary Summary Findings




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Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial

Saila B. Koivusalo
Jan 1, 2016; 39:24-30
Considerations in the Management of Gestational Diabetes Mellitus




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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

Kellee M. Miller
Jun 1, 2015; 38:971-978
Type 1 Diabetes at a Crossroads




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Report: South Korea tested new ballistic missile with larger warhead

South Korea's military tested a ballistic missile capable of carrying a 2-ton warhead in March, according to local reports on Thursday.




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Google-related company pulls plug on Toronto 'smart city' project

A Google-related company has pulled the plug on its ambitious high-tech waterfront city project in Toronto, citing financial strains from the coronavirus, but the project had also run into local opposition.




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DoD releases name of soldier who died in 'non-combat-related' incident in Iraq

The Pentagon announced Tuesday that Sgt. Christopher Wesley Curry died Monday in Iraq in what officials describe as a non-combat-related incident.




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Investigation of the Accuracy of 18 Marketed Blood Glucose Monitors

David C. Klonoff
Aug 1, 2018; 41:1681-1688
Emerging Technologies: Data Systems and Devices




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Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial

Jordi Salas-Salvadó
May 1, 2019; 42:777-788
Continuing Evolution of Nutritional Therapy for Diabetes




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Efficacy and Safety of Liraglutide 3.0 mg in Individuals With Overweight or Obesity and Type 2 Diabetes Treated With Basal Insulin: The SCALE Insulin Randomized Controlled Trial

W. Timothy Garvey
May 1, 2020; 43:1085-1093
Emerging Therapies: Drugs and Regimens




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Redefining Hypoglycemia in Clinical Trials: Validation of Definitions Recently Adopted by the American Diabetes Association/European Association for the Study of Diabetes

OBJECTIVE

To determine if the International Hypoglycaemia Study Group (IHSG) level 2 low glucose definition can identify clinically relevant hypoglycemia in clinical trials and offer value as an end point for future trials.

RESEARCH DESIGN AND METHODS

A post hoc analysis was performed of the SWITCH (SWITCH 1: n = 501, type 1 diabetes; SWITCH 2: n = 721, type 2 diabetes) and DEVOTE (n = 7,637, type 2 diabetes) trials utilizing the IHSG low glucose definitions. Patients in all trials were randomized to either insulin degludec or insulin glargine 100 units/mL. In the main analysis, the following definitions were compared: 1) American Diabetes Association (ADA) 2005 (plasma glucose [PG] confirmed ≤3.9 mmol/L with symptoms); and 2) IHSG level 2 (PG confirmed <3.0 mmol/L, independent of symptoms).

RESULTS

In SWITCH 2, the estimated rate ratios of hypoglycemic events indicated increasing differences between treatments with decreasing PG levels until 3.0 mmol/L, following which no additional treatment differences were observed. Similar results were observed for the SWITCH 1 trial. In SWITCH 2, the IHSG level 2 definition produced a rate ratio that was lower than the ADA 2005 definition.

CONCLUSIONS

The IHSG level 2 definition was validated in a series of clinical trials, demonstrating its ability to discriminate between basal insulins. This definition is therefore recommended to be uniformly adopted by regulatory bodies and used in future clinical trials.




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European Immigrants in the United States

European immigrants in the United States have largely dwindled in number since 1960, after historically making up the bulk of immigration to the country. Today, immigrants from Eastern Europe account for the largest share of European arrivals, and Europeans overall are much older and more educated than the total foreign- and native-born populations. This article explores the data on Europeans in the United States.




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Vietnamese Immigrants in the United States

The Vietnamese immigrant population in the United States has grown significantly since the end of the Vietnam War, making it the sixth-largest foreign-born population in the country. The main modes of arrival for the Vietnamese have shifted over the years, from refugee protection to family reunification. This article explores the characteristics of Vietnamese immigrants, including their incomes, education, English proficiency, and more.




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Mexican Immigrants in the United States

For decades, Mexicans have been the largest immigrant group in the United States. While this is still the case, the Mexican immigrant population is no longer growing at the rate it once was. In fact, between 2010 and 2017, the number of Mexicans in the country first leveled off and then began to decline. This article explores the latest data on Mexican immigrants in the United States.




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South American Immigrants in the United States

South Americans represent a small, but growing share of immigrants in the United States, composing 7 percent of country’s total foreign-born population. Recent growth has been marked by an uptick in arrivals from increasingly failing Venezuela, with an increase of 61,000 Venezuelan immigrants from 2016 to 2017. This article offers an interesting data snapshot of South American immigrants in the United States.




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Immigrants from New Origin Countries in the United States

The national origins of new arrivals to the United States are shifting, in ways not always fully appreciated. Recent newcomers are more likely to come from Asia, Central America, and Africa, and less likely to be from Mexico. This article offers key demographic information about the 15 immigrant groups that have experienced the largest growth since 2010, including Indians, Chinese, Colombians, Nigerians, and Bangladeshis.




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Caribbean Immigrants in the United States

Caribbean immigrants represent 10 percent of the 44.5 million immigrants in the United States, with the vast majority coming from just five countries: Cuba, the Dominican Republic, Jamaica, Haiti, and Trinidad and Tobago. Depending on their origin country and period of arrival, immigrants from the Caribbean have varying skill levels, racial composition, language background, and motivations for migration, as this article explores.




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Korean Immigrants in the United States

Approximately 1 million Korean immigrants—the vast majority from South Korea—resided in the United States in 2017. Korean immigrants tend to be highly educated and of high socioeconomic standing. Get the latest data on this population, including flows over time, geographic distribution, employment, and more in this Spotlight.




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Immigrant Veterans in the United States

Approximately 530,000 foreign-born veterans of the U.S. armed forces resided in the United States in 2018, accounting for 3 percent of the 18.6 million veterans nationwide. Immigrant veterans tend to have higher education levels and household incomes compared to native-born veterans, and the vast majority are naturalized citizens, as this data-rich article explores.




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Refugees and Asylees in the United States

The United States has historically been the top country for refugee resettlement, but was surpassed in 2018 by Canada amid record cuts to admissions by the Trump administration. Approximately 22,500 refugees were resettled in the United States during fiscal year 2018, as well as 26,500 asylees. This article examines where these newcomers came from and many other characteristics, including religious affiliation, age, and gender.




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Naturalization Trends in the United States

Nearly 22 million immigrants—about half of the overall immigrant population—were naturalized U.S. citizens in fiscal year 2017. In the same year, more than 707,000 immigrants became U.S. citizens. Naturalized citizens tend to have higher incomes and educational attainment compared to other immigrants, as this data-rich article explores.




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Central American Immigrants in the United States

While much attention has been paid to recent Central American arrivals at the U.S.-Mexico border, nearly half of the approximately 3.5 million Central Americans resident in the United States in 2017 arrived before 2000. About one-third are naturalized U.S. citizens, and they tend to participate in the labor force at a higher rate than foreign- and U.S.-born adults. Discover more about this population in this data-rich article.




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Brazilian Immigrants in the United States

Approximately 450,000 Brazilian immigrants resided in the United States in 2017, an increase of nearly one-third since 2010. Representing 1 percent of the nation's 44.5 million immigrants, Brazilians tend to have higher educational attainment and household incomes compared to the overall foreign-born population. Get the latest data on Brazilians immigrants, including flows over time, geographic distribution, and more in this Spotlight.




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Sub-Saharan African Immigrants in the United States

The sub-Saharan African immigrant population in the United States is a small, but quickly growing, one. Between 2010 and 2018, the size of the sub-Saharan African population increased 52 percent, far outpacing the overall rise in the foreign born. Immigrants coming from the 51 sub-Saharan countries, including Nigeria, Ghana, Ethiopia, and Somalia, are diverse in their origins and socioeconomic characteristics, as this Spotlight explores.




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Immigrant Women and Girls in the United States

Immigrant women and girls constituted slightly more than half of the 44.7 million immigrants in the United States in 2018. This is higher than the global average, likely because immigrants are more likely to enter the United States through family reunification channels rather than labor migration ones (which globally are predominantly male). This article offers a rich data profile on immigrant women and girls in the United States including age, education, employment, and poverty levels.




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As the United States Resettles Fewer Refugees, Some Countries and Religions Face Bigger Hits than Others

Even as refugee admissions have dropped sharply during the Trump administration, some countries and religions have been significantly more affected than others, as this commentary explores. In fiscal year 2019, 79 percent of refugees were Christian and 16 percent Muslim—as compared to 44 percent Christian and 46 percent Muslim in fiscal year 2016, which was the last full year of the Obama administration.




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USCIS Fee Increase Proposed Rule Could Represent the Latest Step in Reshaping Immigration to United States

While much attention has been given to the move by U.S. Citizenship and Immigration Services to raise its application fees—including an 83 percent hike to apply for U.S. citizenship—the policy changes embedded in the proposed rule have been less scrutinized. The changes, including the elimination of most fee waivers for lower-income applicants, would likely reduce the number and shift the profile of those getting a green card or other immigration status.




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Explainer: Illegal Immigration in the United States

How has the size of the unauthorized population in the United States changed over time? How is illegal immigration changing, and where do unauthorized immigrants come from? This explainer answers basic questions about illegal immigration, the changing patterns from Mexico, and more.




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Strategic Solutions for the United States and Mexico to Manage the Migration Crisis

Amid surging migration from Central America, the United States and Mexico in June 2019 agreed to a series of enforcement measures. Yet these near-term efforts will be difficult to maintain given chronic institutional weaknesses and poorly thought-out policy structures in both countries. This commentary, by the presidents of MPI and El Colegio de México, offers a set of long-term, collaborative solutions to dissuade illegal migration while ensuring fairness to those seeking protection.




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Member review, comment solicited for changes to CDT Code

The 2021 Code on Dental Procedures and Nomenclature — better known as the CDT Code — could include changes or additions to codes regarding oral/oropharyngeal cancer, caries management by risk assessment, laboratory surface scanning for diagnostic purposes, and counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use.