Dana Dabelea
Colorado School of Public Health
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The Journal of Clinical Endocrinology and Metabolism | 2008
Robert E. Ratner; Costas A. Christophi; Boyd E. Metzger; Dana Dabelea; Peter H. Bennett; Xavier Pi-Sunyer; Sarah E. Fowler; Steven E. Kahn
CONTEXT A past history of gestational diabetes mellitus (GDM) confers a very high risk of postpartum development of diabetes, particularly type 2 diabetes. OBJECTIVE The Diabetes Prevention Program (DPP) sought to identify individuals with impaired glucose tolerance (IGT) and intervene in an effort to prevent or delay their progression to diabetes. This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM. DESIGN The DPP was a randomized, controlled clinical trial. SETTING The study was a multicenter, National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites. PATIENTS A total of 2190 women were randomized into the DPP and provided information for past history of GDM. This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM. INTERVENTIONS Subjects were randomized to either standard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention. MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing. Assessments of insulin secretion and insulin sensitivity were also performed. RESULTS Whereas entering the study with similar glucose levels, women with a history of GDM randomized to placebo had a crude incidence rate of diabetes 71% higher than that of women without such a history. Among women reporting a history of GDM, both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50% compared with the placebo group, whereas this reduction was 49 and 14%, respectively in parous women without GDM. These data suggest that metformin may be more effective in women with a GDM history as compared with those without. CONCLUSIONS Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline. Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM.
Diabetes Care | 2014
Richard F. Hamman; Ronny A. Bell; Dana Dabelea; Ralph B. D’Agostino; Lawrence M. Dolan; Giuseppina Imperatore; Jean M. Lawrence; Barbara Linder; Santica M. Marcovina; Elizabeth J. Mayer-Davis; Catherine Pihoker; Beatriz L. Rodriguez; Sharon Saydah
The SEARCH for Diabetes in Youth (SEARCH) study was initiated in 2000, with funding from the Centers for Disease Control and Prevention and support from the National Institute of Diabetes and Digestive and Kidney Diseases, to address major knowledge gaps in the understanding of childhood diabetes. SEARCH is being conducted at five sites across the U.S. and represents the largest, most diverse study of diabetes among U.S. youth. An active registry of youth diagnosed with diabetes at age <20 years allows the assessment of prevalence (in 2001 and 2009), annual incidence (since 2002), and trends by age, race/ethnicity, sex, and diabetes type. Prevalence increased significantly from 2001 to 2009 for both type 1 and type 2 diabetes in most age, sex, and race/ethnic groups. SEARCH has also established a longitudinal cohort to assess the natural history and risk factors for acute and chronic diabetes-related complications as well as the quality of care and quality of life of persons with diabetes from diagnosis into young adulthood. Many youth with diabetes, particularly those from low-resourced racial/ethnic minority populations, are not meeting recommended guidelines for diabetes care. Markers of micro- and macrovascular complications are evident in youth with either diabetes type, highlighting the seriousness of diabetes in this contemporary cohort. This review summarizes the study methods, describes key registry and cohort findings and their clinical and public health implications, and discusses future directions.
Breast Cancer Research | 2011
Jennifer L Patnaik; Tim Byers; Carolyn DiGuiseppi; Dana Dabelea; Thomas D. Denberg
IntroductionMany women who survive breast cancer die of causes unrelated to their cancer diagnosis. This study was undertaken to assess factors that are related to breast cancer mortality versus mortality from other causes and to describe the leading causes of death among older women diagnosed with breast cancer.MethodsWomen diagnosed with breast cancer at age 66 or older between 1992 and 2000 were identified in the Surveillance, Epidemiology and End Results-Medicare linked database and followed through the end of 2005.ResultsA total of 63,566 women diagnosed with breast cancer met the inclusion criteria and were followed for a median of approximately nine years. Almost one-half (48.7%) were alive at the end of follow-up. Ages and comorbidities at the time of diagnosis had the largest effects on mortality from other causes, while tumor stage, tumor grade, estrogen receptor status, age and comorbidities at the time of diagnosis all had effects on breast cancer-specific mortality. Fully adjusted relative hazards of the effects of comorbidities on breast cancer-specific mortality were 1.24 (95% confidence interval (95% CI) 1.13 to 1.26) for cardiovascular disease, 1.13 (95% CI 1.13 to 1.26) for previous cancer, 1.13 (95% CI 1.05 to 1.22) for chronic obstructive pulmonary disease and 1.10 (95% CI 1.03 to 1.16) for diabetes. Among the total study population, cardiovascular disease was the primary cause of death in the study population (15.9% (95% CI 15.6 to 16.2)), followed closely by breast cancer (15.1% (95% CI 14.8 to 15.4)).ConclusionsComorbid conditions contribute importantly to both total mortality and breast cancer-specific mortality among breast cancer survivors. Attention to reducing the risk of cardiovascular disease should be a priority for the long-term care of women following the diagnosis and treatment of breast cancer.
The Journal of Pediatrics | 2009
Diana B. Petitti; Georgeanna J. Klingensmith; Ronny A. Bell; Jeanette S. Andrews; Dana Dabelea; Giuseppina Imperatore; Santica M. Marcovina; Catherine Pihoker; Debra Standiford; Beth Waitzfelder; Elizabeth J. Mayer-Davis
OBJECTIVE To assess correlates of glycemic control in a diverse population of children and youth with diabetes. STUDY DESIGN This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A(1c) (HbA(1c)) levels to assess glycemic control. RESULTS HbA(1c) levels reflecting poor glycemic control (HbA(1c) >or= 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA(1c) levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly associated with poorer glycemic control in youth with T1D and T2D. CONCLUSIONS The high percentage of US youth with HbA(1c) levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes.
The Journal of Maternal-fetal Medicine | 2000
Dana Dabelea; William C. Knowler; David J. Pettitt
OBJECTIVE To review data on the long-term effects of prenatal exposure to the diabetic intrauterine environment in the Pima Indians of Arizona. This population has high rates of Type 2 diabetes mellitus that has a strong genetic component and develops at young ages. METHODS Since 1965, Pima Indians at least 5 years old participated in a study of diabetes and its complications. This study consisted of biennial examinations with measurements of obesity and glucose tolerance and of glucose tolerance testing during pregnancy. The longitudinal nature of the study has permitted comparisons of data collected on children and young adults whose mothers were tested during pregnancy. RESULTS Offspring of women who had diabetes during pregnancy were more obese and had a higher prevalence of Type 2 diabetes. Exposure to the diabetic intrauterine environment was responsible for about 40% of Type 2 diabetes in 5-19-year-old children between 1987 and 1996--approximately twice the attributable risk found between 1967 and 1976. Over 70% of persons with prenatal exposure have Type 2 diabetes at 25-34 years of age. CONCLUSIONS The effects of the diabetic pregnancy can be thought of as a vicious cycle, with consequences for the offspring extending well beyond the neonatal period. The young woman whose mother had diabetes during pregnancy is at risk of perpetuating the cycle by developing diabetes by her childbearing years. In this population, much of the increase in childhood Type 2 diabetes can be attributed to the diabetic intrauterine environment, which may be a factor in the alarming rise of this disease nationally.
Diabetes Care | 2008
Dana Dabelea; Elizabeth J. Mayer-Davis; Archana P. Lamichhane; Ralph B. D'Agostino; Angela D. Liese; Kendra S. Vehik; K.M. Venkat Narayan; P. Zeitler; Richard F. Hamman
OBJECTIVE—Limited data exist on the association between in utero exposure to maternal diabetes and obesity and type 2 diabetes in diverse youth. These associations were explored in African-American, Hispanic, and non-Hispanic white youth participating in the SEARCH Case-Control Study. RESEARCH DESIGN AND METHODS—A total of 79 youth with type 2 diabetes and 190 nondiabetic control youth aged 10–22 years attended a research visit. In utero exposures to maternal diabetes and obesity were recalled by biological mothers. RESULTS—Youth with type 2 diabetes were more likely to have been exposed to maternal diabetes or obesity in utero than were nondiabetic control youth (P < 0.0001 for each). After adjusting for offspring age, sex, and race/ethnicity, exposure to maternal diabetes (odds ratio [OR] 5.7 [95% CI 2.4–13.4]) and exposure to maternal obesity (2.8 [1.5–5.2]) were independently associated with type 2 diabetes. Adjustment for other perinatal and socioeconomic factors did not alter these associations. When offspring BMI was added, the OR for the association between in utero exposure to obesity and type 2 diabetes was attenuated toward the null (OR 1.1 [0.5–2.4]). Overall, 47.2% (95% CI 30.9–63.5) of type 2 diabetes in youth could be attributed to intrauterine exposure to maternal diabetes and obesity. CONCLUSIONS—Intrauterine exposures to maternal diabetes and obesity are strongly associated with type 2 diabetes in youth. Prevention efforts may need to target, in addition to childhood obesity, the increasing number of pregnancies complicated by obesity and diabetes.
Journal of Pediatric Endocrinology and Metabolism | 2001
Dana Dabelea; David J. Pettitt
Abstract Numerous studies have reported that offspring whose mothers had type 2 diabetes mellitus (DM) are more likely to develop type 2 DM, impaired glucose tolerance, and obesity at an early age than offspring whose fathers had DM. Exposure to the diabetic intrauterine environment has been shown to be an important risk factor for all these conditions. To what extent transmission of type 2 DM from mother to offspring is the effect of genetic inheritance and to what extent it is the long-term consequence of exposure to maternal hyperglycemia is still uncertain. There are, of course, interactions between the diabetic intrauterine environment and genetics. Several data in experimental animals as well as in humans suggest, however, that exposure of the fetus to the mother’s DM confers a risk for type 2 DM and obesity that is above any genetically transmitted susceptibility. In the Pima Indian population much of the increase in childhood type 2 DM can be attributed to the diabetic intrauterine environment. This suggests that intensive glucose control during pregnancy might have extended beneficial effects, contributing to a decrease in the prevalence of childhood type 2 DM.
Diabetes Care | 2012
Giuseppina Imperatore; James P. Boyle; Theodore J. Thompson; Doug Case; Dana Dabelea; Richard F. Hamman; Jean M. Lawrence; Angela D. Liese; Lenna L. Liu; Elizabeth J. Mayer-Davis; Beatriz L. Rodriguez; Debra Standiford
OBJECTIVE To forecast the number of U.S. individuals aged <20 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) through 2050, accounting for changing demography and diabetes incidence. RESEARCH DESIGN AND METHODS We used Markov modeling framework to generate yearly forecasts of the number of individuals in each of three states (diabetes, no diabetes, and death). We used 2001 prevalence and 2002 incidence of T1DM and T2DM from the SEARCH for Diabetes in Youth study and U.S. Census Bureau population demographic projections. Two scenarios were considered for T1DM and T2DM incidence: 1) constant incidence over time; 2) for T1DM yearly percentage increases of 3.5, 2.2, 1.8, and 2.1% by age-groups 0–4 years, 5–9 years, 10–14 years, and 15–19 years, respectively, and for T2DM a yearly 2.3% increase across all ages. RESULTS Under scenario 1, the projected number of youth with T1DM rises from 166,018 to 203,382 and with T2DM from 20,203 to 30,111, respectively, in 2010 and 2050. Under scenario 2, the number of youth with T1DM nearly triples from 179,388 in 2010 to 587,488 in 2050 (prevalence 2.13/1,000 and 5.20/1,000 [+144% increase]), with the greatest increase in youth of minority racial/ethnic groups. The number of youth with T2DM almost quadruples from 22,820 in 2010 to 84,131 in 2050; prevalence increases from 0.27/1,000 to 0.75/1,000 (+178% increase). CONCLUSIONS A linear increase in diabetes incidence could result in a substantial increase in the number of youth with T1DM and T2DM over the next 40 years, especially those of minority race/ethnicity.
Diabetes | 2011
Dana Dabelea; Tessa L. Crume
The prevalence of obesity continues to increase worldwide and represents one of the most pressing public health issues due to its associated morbidity, mortality, and health care costs. Novel research is demonstrating that alterations of the maternal environment can impact the intrauterine development of the fetus and influence the offspring’s risk for obesity and type 2 diabetes over the lifecourse. This article reviews the epidemiological evidence with a focus on the fetal overnutrition hypothesis. We discuss potential mechanisms and suggest future directions for research. While postnatal lifestyle is the most immediate cause of obesity, the influence of the maternal in utero environment is evidenced in the U- or J-shaped relationship between birth weight and adult obesity and metabolic disease demonstrating that both a nutritionally limited or excessive in utero environment can lead to postnatal obesity and related chronic diseases. Developmental biology has taught us about the role of a mismatch between a constrained prenatal and a plentiful postnatal environment in the pathogenesis of obesity, i.e., a so-called thrifty obesity pathway (1). This is likely operating in developing countries and populations undergoing rapid transition. Another developmental pathway to obesity, which is likely more important in Western societies, is the fetal overnutrition pathway. This pathway reflects the effects of hypernutrition during fetal life and creates the conditions for the later pathophysiological effects of an obesogenic environment (1). Although these developmental mechanisms are likely distinct, they are both associated with an increased risk of obesity later in life. This article focuses on the fetal overnutrition pathway. Research in this field started with the hypothesis of fuel-mediated teratogenesis (2) and clinical studies suggesting that offspring exposed to diabetes in utero have greater birth weight and greater weight for length during childhood. Animal studies have demonstrated that the metabolic imprinting caused by the obese and …
Journal of the National Cancer Institute | 2011
Jennifer L Patnaik; Tim Byers; Carolyn DiGuiseppi; Thomas D. Denberg; Dana Dabelea
BACKGROUND Previous studies have shown that summary measures of comorbid conditions are associated with decreased overall survival in breast cancer patients. However, less is known about associations between specific comorbid conditions on the survival of breast cancer patients. METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to identify primary breast cancers diagnosed from 1992 to 2000 among women aged 66 years or older. Inpatient, outpatient, and physician visits within the Medicare system were searched to determine the presence of 13 comorbid conditions present at the time of diagnosis. Overall survival was estimated using age-specific Kaplan-Meier curves, and mortality was estimated using Cox proportional hazards models adjusted for age, race and/or ethnicity, tumor stage, cancer prognostic markers, and treatment. All statistical tests were two-sided. RESULTS The study population included 64,034 patients with breast cancer diagnosed at a median age of 75 years. None of the selected comorbid conditions were identified in 37,306 (58%) of the 64,034 patients in the study population. Each of the 13 comorbid conditions examined was associated with decreased overall survival and increased mortality (from prior myocardial infarction, adjusted hazard ratio [HR] of death = 1.11, 95% CI = 1.03 to 1.19, P = .006; to liver disease, adjusted HR of death = 2.32, 95% CI = 1.97 to 2.73, P < .001). When patients of age 66-74 years were stratified by stage and individual comorbidity status, patients with each comorbid condition and a stage I tumor had similar or poorer overall survival compared with patients who had no comorbid conditions and stage II tumors. CONCLUSIONS In a US population of older breast cancer patients, 13 individual comorbid conditions were associated with decreased overall survival and increased mortality.