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How Foods Affect Blood Glucose: Glycemic Impact


Oct 1, 2011; 29:161-161
Patient Information




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The Weighty Issue of Low-Carb Diets, or Is the Carbohydrate the Enemy?

Jennifer B. Marks
Oct 1, 2004; 22:155-156
Editorials




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Empowerment and Self-Management of Diabetes

Martha M. Funnell
Jul 1, 2004; 22:123-127
Feature Articles




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Case Study: New-Onset Diabetes: How to Tell the Difference Between Type 1 and Type 2 Diabetes

Joseph Largay
Jan 1, 2012; 30:25-26
Case Studies




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Hypoglycemia? Low Blood Glucose? Low Blood Sugar?


Jan 1, 2012; 30:38-38
Patient Information




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Good to Know: Factors Affecting Blood Glucose


Apr 1, 2018; 36:202-202
Patient Education




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Within-Trial Evaluation of Medical Resources, Costs, and Quality of Life Among Patients With Type 2 Diabetes Participating in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)

OBJECTIVE

To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs.

RESULTS

Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ~$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time.

CONCLUSIONS

Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated.




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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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Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries

OBJECTIVE

Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk.

RESEARCH DESIGN AND METHODS

We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR).

RESULTS

Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1–8.0) and of undiagnosed diabetes 4.9% (4.6–5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5–8.1), lower-middle-income economies (LMIs) 7.1% (6.6–7.6), and upper-middle-income economies (UMIs) 8.2% (7.5–9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22–1.78], LMIs 1.14 [1.06–1.23], and UMIs 1.28 [1.02–1.61]).

CONCLUSIONS

Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.




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Watch: Large flock of migrating birds shows up on Florida weather radar

A Florida TV station's weather radar detected a large mass between the state and Cuba that turned out to be something other than an unseasonable storm -- it was a flock of migrating birds.




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Iowa man receives postcard mailed 33 years earlier

An Iowa man who received a postcard from his sister said he was surprised to note the card had been mailed in 1987.




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Migration, Development, and Global Governance: From Crisis toward Consolidation

Migration and development policy discussions have edged closer to each other on the international stage. The adoption of the Global Compact for Migration in December 2018 marks an important milestone. As all eyes turn toward the compact’s implementation, this brief examines some of the key topics states have pledged to work more closely on—from labor migration and migrants’ rights, to returns and reintegration.




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Panthers' Derrick Brown to become first 2020 Round 1 pick to sign rookie deal

Former Auburn defensive tackle Derrick Brown agreed to his rookie contract with the Carolina Panthers on Friday.




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The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading

Roy W. Beck
Aug 1, 2017; 40:994-999
Perspectives in Care




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Lower Risk of Death With SGLT2 Inhibitors in Observational Studies: Real or Bias?

Samy Suissa
Jan 1, 2018; 41:6-10
Perspectives in Care




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A Low-Glycemic Load Diet Facilitates Greater Weight Loss in Overweight Adults With High Insulin Secretion but Not in Overweight Adults With Low Insulin Secretion in the CALERIE Trial

Anastassios G. Pittas
Dec 1, 2005; 28:2939-2941
BR Clinical Care/Education/Nutrition




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Beneficial Effect of Low-Glycemic Index Diet in Overweight NIDDM Subjects

Thomas M S Wolever
Apr 1, 1992; 15:562-564
Short Report




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Liraglutide, a Long-Acting Human Glucagon-Like Peptide-1 Analog, Given as Monotherapy Significantly Improves Glycemic Control and Lowers Body Weight Without Risk of Hypoglycemia in Patients With Type 2 Diabetes

Tina Vilsbøll
Jun 1, 2007; 30:1608-1610
BR Emerging Treatments and Technologies




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HbA1c Levels Are Significantly Lower in Early and Late Pregnancy

Lene R. Nielsen
May 1, 2004; 27:1200-1201
Brief Reports




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Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up

The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
May 1, 2016; 39:686-693
Cardiovascular Disease and Diabetes




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Chinese exports up in April, Beijing’s data show

China's exports rebounded in April, growing 3.5 percent, according to the latest data from Beijing's General Administration of Customs on Thursday.




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Digitizing financial services key to Africa's post-pandemic growth, experts say

As the COVID-19 pandemic begins to take root in Africa, experts say that digitizing financial services could help keep the continent safe




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HbA1c Levels Are Significantly Lower in Early and Late Pregnancy

Lene R. Nielsen
May 1, 2004; 27:1200-1201
Brief Reports




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Red and Processed Meats and Health Risks: How Strong Is the Evidence?

Frank Qian
Feb 1, 2020; 43:265-271
Perspectives in Care




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Leukocyte Telomere Length, DNA Oxidation, and Risk of Lower-Extremity Amputation in Patients With Long-standing Type 1 Diabetes

OBJECTIVE

Telomere shortening and DNA oxidation are associated with premature vascular aging, which may be involved in lower-extremity amputation (LEA). We sought to investigate whether leukocyte telomere length (LTL) and plasma 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of DNA oxidation, were associated with LEA in subjects with type 1 diabetes at high vascular risk.

RESEARCH DESIGN AND METHODS

LTL (quantitative PCR) and plasma 8-OHdG concentrations (immunoassay method) were assessed at baseline in the GENEDIAB (Génétique de la Néphropathie Diabétique) type 1 diabetes cohort. Logistic and Cox proportional hazards regression models were fitted to estimate odds ratio (OR) (at baseline) and hazard ratio (HR) (during follow-up), with related 95% CI, by increasing biomarker tertiles (T1, T2, T3).

RESULTS

Among 478 participants (56% male, mean ± SD age 45 ± 12 years and diabetes duration 29 ± 10 years), 84 patients had LEA at baseline. Baseline history of LEA was associated with shorter LTL (OR for T2 vs. T1 0.62 [95% CI 0.32–1.22] and for T3 vs. T1 0.41 [0.20–0.84]) but not with plasma 8-OHdG (1.16 [0.56–2.39] and 1.24 [0.61–2.55], respectively). New cases of LEA occurred in 34 (12.3%) participants during the 10-year follow-up. LTL were shorter (HR T2 vs. T1 0.25 [95% CI 0.08–0.67] and T3 vs. T1 0.29 [0.10–0.77]) and plasma 8-OHdG higher (2.20 [0.76–7.35] and 3.11 [1.07–10.32]) in participants who developed LEA during follow-up compared with others. No significant interaction was observed between biomarkers on their association with LEA.

CONCLUSIONS

We report the first independent association between LTL shortening and excess risk of LEA in type 1 diabetes. High plasma 8-OHdG was also associated with incident LEA but partly dependent on cofounding variables.




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As COVID-19 Slows Human Mobility, Can the Global Compact for Migration Meet the Test for a Changed Era?

The coronavirus pandemic dramatically reshaped how human mobility is managed just as the Global Compact for Safe, Orderly, and Regular Migration was beginning to move from paper to implementation. As governments face pressing public-health, economic, and other concerns in responding to COVID-19, this MPI Europe commentary explores whether the first comprehensive global agreement on migration can adjust to a changed reality.




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“Cubicle Activism”: Companies Face Growing Demands from Workers to Cut Ties with ICE and Others in Immigration Arena

From online petitions to organized walkouts, corporate America is facing increasing employee activism over its business involvement with agencies implementing the federal government's immigration policies. This "cubicle activism," seen at companies ranging from Amazon and Google to Bank of America and Wayfair, has garnered mixed success to date, forcing divestiture from private prison contractors but fewer results in other contexts, as this article explores.




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On the Move in a War Zone: Mixed Migration Flows to and through Yemen

War and impending famine in Yemen have captured significant attention. Yet often overlooked is the country’s role as the epicenter of one of the world’s busiest mixed migration routes, linking Africa, Asia, and Europe. This article examines the migration pathways to and through the country, push and pull factors, and the impact of civil war on human movement.




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Policy Solutions to Address Crisis at Border Exist, But Require Will and Staying Power to Execute

Closing the U.S.-Mexico border and cutting off aid to Central America would only feed the crisis unfolding at key points along the U.S.-Mexico border. This commentary outlines a range of immediate and long-term policy responses that would more effectively address the complex mix of factors fueling rising Central American migration to the United States.




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Policy Options for Responding to Changing Migration Flows at the Southwest Border

Testimony of Andrew Selee, President of MPI, before Senate Committee on Homeland Security and Governmental Affairs on April 4, 2019 regarding response to changing migration flows at the Southwest border.




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Free ADA webinar offers education on how to receive electronic funds transfer payments

Dentists who have had a dental plan payment check lost in the mail could consider a way to receive safe and secure payment through electronic funds transfer payments.




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New HPI Industry Report now available

Dental spending reached $136 billion in 2018 — 3.7% of all health spending — and what the ADA Health Policy Institute is calling a “historic high” in the new HPI Industry Report released Feb. 4.




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World Oral Health Day calls for pledges to show unity

Pledge to celebrate World Oral Health Day on March 20 with the rest of the sphere.




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Howard dental school celebrates GKAS

The Howard University College of Dentistry treated 35 students from Washington’s Raymond Elementary School at a Feb. 7 Give Kids A Smile event.




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ADA urges Congress to increase relief for small businesses, dentist owners

As Congress works on a third legislation package in response to the coronavirus pandemic, the ADA is asking lawmakers to include provisions on how to assist dental practices and other small businesses facing economic burdens.




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How dentists can keep the lights on during economic downturn

The ADA is streaming a free practice management webinar March 25 designed to help dentists predict short- and long-term impacts on their business operations during tough economic times and teach them how taking the right steps now can minimize their risk during the COVID-19 outbreak and its aftermath.




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Dr. Glick to step down March 31 as JADA editor

Dr. Michael Glick, professor in oral diagnostic sciences at the University at Buffalo School of Dental Medicine, is stepping down as editor of The Journal of the American Dental Association effective March 31.




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Second week of HPI polling shows dentists’ response to COVID-19

The second round of results from the ADA Health Policy Institute poll on the impact of COVID-19 on dental practices showed significant financial impact, with collections for the vast majority of dentists less than 5% of what is typical in their practice.




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Index shows that dentists slowly but surely embracing electronic means of doing business

Despite the ADA Council on Dental Benefits’ efforts, the practice of using automated electronic means for verifying eligibility and benefits, checking claim status or receiving and reconciling payment remains underutilized by many dental providers according to an index, said Dr. Randall Markarian, council chair.




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ADA advises dentists to follow science-backed guidance regarding COVID-19 testing, avoid 'gray market'

The ADA is urging dentists to be cautious about using novel coronavirus diagnostic tests before they have been properly evaluated and made available for dentists.




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Third wave of HPI polling shows dentists’ response to COVID-19

The third round of results from the ADA Health Policy Institute poll on the impact of COVID-19 on dental practices was released April 27, with 79% of dentists reporting their practices are closed except for emergencies and 17% are closed completely.




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Dow, Total part of group that raised $1B to clean plastic in ocean

Some 30 companies including Dow, Total and other big makers of plastic raised $1 billion to contribute to cleaner ocean waters.




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Crude oil prices drop after API reported lower-than-expected draw

Oil prices fell early Wednesday, likely a result of lower-than-expected draws in an API with traders awaiting official EIA inventory data later in the day.




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EIA sees fuel prices below 2018 average for the next two years

U.S. retail fuel prices will drop this year and in 2020 from 2018, but in both cases higher than January levels due to mandated lower sulfur in marine fuel.




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Oil prices led lower by rising U.S. production, inventories

Oil prices fell early Thursday despite an OPEC report confirming a sizable cut due to bearishness related to rising United States production and inventories.




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IEA: Greater use of rail would save energy, lower emissions

Increased railway use would save energy, help the environment, and also be safer, according to reports prepared by international environmental experts.




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Arctic bird turns down immune system to conserve energy in winter

To survive the Arctic's frigid temperatures, animals must use their energy efficiently. According to a new study, one Arctic bird species, the Svalbard rock ptarmigan, utilizes a previously unknown energy-saving method.




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Arthritis drug shows promise against respiratory distress caused by COVID-19

Anakinra, a drug developed to treat rheumatoid arthritis might help patients who have developed acute respiratory distress syndrome caused by COVID-19, a small study published by The Lancet Rheumatology has found.




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Effects of Low-Energy Diet or Exercise on Cardiovascular Function in Working-Age Adults With Type 2 Diabetes: A Prospective, Randomized, Open-Label, Blinded End Point Trial

OBJECTIVE

To confirm the presence of subclinical cardiovascular dysfunction in working-age adults with type 2 diabetes (T2D) and determine whether this is improved by a low-energy meal replacement diet (MRP) or exercise training.

RESEARCH DESIGN AND METHODS

This article reports on a prospective, randomized, open-label, blinded end point trial with nested case-control study. Asymptomatic younger adults with T2D were randomized 1:1:1 to a 12-week intervention of 1) routine care, 2) supervised aerobic exercise training, or 3) a low-energy (~810 kcal/day) MRP. Participants underwent echocardiography, cardiopulmonary exercise testing, and cardiac magnetic resonance (CMR) at baseline and 12 weeks. The primary outcome was change in left ventricular (LV) peak early diastolic strain rate (PEDSR) as measured by CMR. Healthy volunteers were enrolled for baseline case-control comparison.

RESULTS

Eighty-seven participants with T2D (age 51 ± 7 years, HbA1c 7.3 ± 1.1%) and 36 matched control participants were included. At baseline, those with T2D had evidence of diastolic dysfunction (PEDSR 1.01 ± 0.19 vs. 1.10 ± 0.16 s–1, P = 0.02) compared with control participants. Seventy-six participants with T2D completed the trial (30 routine care, 22 exercise, and 24 MRP). The MRP arm lost 13 kg in weight and had improved blood pressure, glycemia, LV mass/volume, and aortic stiffness. The exercise arm had negligible weight loss but increased exercise capacity. PEDSR increased in the exercise arm versus routine care (β = 0.132, P = 0.002) but did not improve with the MRP (β = 0.016, P = 0.731).

CONCLUSIONS

In asymptomatic working-age adults with T2D, exercise training improved diastolic function. Despite beneficial effects of weight loss on glycemic control, concentric LV remodeling, and aortic stiffness, a low-energy MRP did not improve diastolic function.




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The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and All-Cause Mortality in Type 2 Diabetes

OBJECTIVE

To examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP), a two-by-two factorial randomized controlled trial, examined effects of SBP (<120 vs. <140 mmHg) and glycemic (HbA1c <6% vs. 7.0–7.9% [<42 vs. 53–63 mmol/mol]) control on cardiovascular events in T2DM (N = 4,731). We examined whether effects of SBP control on cardiovascular composite were modified by baseline DBP and glycemic control.

RESULTS

Intensive SBP lowering decreased the risk of the cardiovascular composite (hazard ratio [HR] 0.76 [95% CI 0.59–0.98]) in the standard glycemic arm but not in the intensive glycemic arm (HR 1.06 [95% CI 0.81–1.40]). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite three-way interaction (P = 0.83).

CONCLUSIONS

In persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite end point irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in patients with T2DM treated with guidelines recommending standard glycemic control.