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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_449"
                     title="FDA Okays Statin for Primary Prevention"
                     score="0.015"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/18380?impressionId=1265804082714"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved rosuvastatin (Crestor) for primary prevention of cardiovascular disease, making it the first statin to receive this indication.&lt;/p&gt;
&lt;p&gt;The new labeling, recommended by an FDA advisory panel late last year, also marks the first time that a drug label will include an indication based on the biomarker highly-sensitive C-reactive protein, an inflammatory marker.&lt;/p&gt;
&lt;p&gt;The new indication would be for men 50 or older and women 60 or older who have fasting LDL of less than 130 mg/dL, a highly-sensitive CRP of 2.0 mg/L or greater, triglycerides of less than 500 mg/dL, and no prior history of heart attack or stroke, or coronary heart disease risk.&lt;/p&gt;
&lt;p&gt;The basis for the new labeling was the JUPITER trial, a randomized, placebo-controlled trial of 17,802 men and women with a mean age of 66 and no history of atherosclerosis. All participants had LDL of less than 130 mg/dL and a highly-sensitive C-reactive protein concentration of 2 mg/L or higher.&lt;/p&gt;
&lt;p&gt;Patients were randomized to 20 mg of rosuvastatin for 1.9 years, which reduced median LDL cholesterol to 55 mg/dL, down from a median of 108 mg/dL at baseline. The corresponding relative reduction in the rate of MI, stroke, arterial revascularization, or cardiovascular death was 44% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.00001).&lt;/p&gt;
&lt;p&gt;The number needed to treat to avoid one cardiovascular event was 25.&lt;/p&gt;
&lt;p&gt;Those results, according to Melvyn Rubenfire, MD, of the University of Michigan, were a &quot;home run for JUPITER,&quot; but it is not clear whether the results would be the same with another statin.&lt;/p&gt;
&lt;p&gt;And there were some risks associated with rosuvastatin, including 13 deaths due to gastrointestinal disorders in the rosuvastatin arm, and 18 patients reported experiencing a &quot;confused state&quot; while taking the drug.&lt;/p&gt;
&lt;p&gt;The most troubling adverse event, however, was an uptick in investigator-reported, new onset diabetes mellitus in the treatment arm, 2.8% versus 2.5%, for a hazard ratio of 1.27 (95% CI 1.05 to 1.53, &lt;em&gt;P&lt;/em&gt;=0.015).&lt;/p&gt;
&lt;p&gt;Rosuvastatin in marketed by AstraZeneca, which also sponsored the JUPITER trial.&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_409"
                     title="&apos;Artificial Pancreas&apos; Improves Glucose Control at Night (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18315?impressionId=1265804082714"
                     
      &lt;p&gt;Closed-loop insulin delivery systems can improve overnight blood sugar control and reduce hypoglycemia risk in young patients with type 1 diabetes, researchers have found.&lt;/p&gt;
&lt;p&gt;More patients with this &quot;artificial pancreas&quot; maintained target blood glucose levels over the course of the night than those on standard insulin pumps (60% versus 40%), according to Roman Hovorka, MD, of Addenbrooke&apos;s Hospital in Cambridge, England, and colleagues.&lt;/p&gt;
&lt;p&gt;They also avoided significant hypoglycemia events, while those on standard therapy had nine, the researchers reported online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Overnight closed-loop delivery is appealing because it addresses the issue of nocturnal hypoglycemia,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Two management strategies for type 1 diabetes  --  continuous glucose monitoring devices and insulin pumps  --  can be combined to form closed-loop systems. This enables delivery of insulin determined by an algorithm using real-time sensor glucose data, rather than preprogrammed rates.&lt;/p&gt;
&lt;p&gt;Unfortunately, few prototypes have been developed, the researchers wrote, because progress has been hindered by suboptimum accuracy and reliability of monitoring devices, slow absorption, and inadequate control algorithms.&lt;/p&gt;
&lt;p&gt;So, to test whether these devices were effective overnight, the researchers conducted three randomized crossover studies at the Wellcome Trust Clinical Research Facility at Addenbrooke&apos;s Hospital in Cambridge.&lt;/p&gt;
&lt;p&gt;They assessed 17 patients, ages 5 to 18, with type 1 diabetes. During 54 nights in the hospital (33 nights on closed-loop devices, and 21 on standard insulin pumps), they monitored three different crossover groups: standard versus closed-loop delivery, closed-loop delivery after rapidly or slowly absorbed meals, and standard versus closed-loop delivery after exercise.&lt;/p&gt;
&lt;p&gt;In the closed-loop scenario, glucose measurements were fed to a control algorithm every 15 minutes, and a nurse adjusted the insulin pump.&lt;/p&gt;
&lt;p&gt;In the first group, the researchers found no significant differences for time in the targeted glucose range or hypoglycemic events (&amp;lt;3.90 mmol/l) between closed-loop and standard delivery (52% versus 39% and 1% versus 2%, respectively).&lt;/p&gt;
&lt;p&gt;Nor were there differences in maintaining the targeted range for closed-loop patients after they ate their meals rapidly or slowly (53% versus 55%).&lt;/p&gt;
&lt;p&gt;&quot;In our studies, postprandial glucose concentrations were increased after large evening meals, but overall glucose control was unaffected and risk of hypoglycemia was low, documenting effective, nonaggressive insulin delivery,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Patients in the closed-loop delivery group who did early-evening exercises spent the greatest percentage of time in the target blood glucose range, but the improvement was not significant at the corrected level, the researchers said (78% versus 43%).&lt;/p&gt;
&lt;p&gt;&quot;Moderate-intensity, late-afternoon or early-evening exercise in young people is a frequent occurrence and increases glucose requirements in the early morning, exacerbating the risk of nocturnal hypoglycemia,&quot; they wrote. &quot;Our closed-loop algorithm ameliorated this risk and maintained good glucose control.&quot;&lt;/p&gt;
&lt;p&gt;A secondary analysis of pooled data showed increased time in the target range and reduced hypoglycemia episodes for patients with the &quot;artificial pancreas,&quot; compared with those on the regular insulin pump (60% versus 40%, &lt;em&gt;P&lt;/em&gt;=0.002, and 2.1% versus 4.1%, &lt;em&gt;P&lt;/em&gt;=0.03, respectively).&lt;/p&gt;
&lt;p&gt;The closed-loop device also completely prevented blood glucose levels from falling below 3.0 mmol/l, which represents &quot;significant hypoglycemia,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;There were nine such events in the control group.&lt;/p&gt;
&lt;p&gt;They acknowledged that adoption of closed-loop devices is &quot;likely to be gradual,&quot; but &quot;advancements in glucose-sensing technologies could further improve the performance of closed-loop systems.&quot;&lt;/p&gt;
&lt;p&gt;In the future, fully automated closed-loop insulin delivery will &quot;need wireless data transmission to replace manual control of the pump by nurses.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Eric Renard, MD, of the Center Hospitalier Universitaire de Montpellier in France, called the findings a &quot;milestone in the quest for an artificial pancreatic beta-cell that started almost 50 years ago.&quot;&lt;/p&gt;
&lt;p&gt;But he cautioned that glucose control at mealtimes &quot;will now be the challenge for Hovorka and co-workers and other research groups who adopted model predictive control algorithms.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Because of the more complex effects that need to be considered for meal coverage, including the cephalic phase of insulin secretion, incretin&apos;s effects, and the variability of gut glucose absorption from mixed meals, model predictive control algorithms could offer more flexibility than do proportional-integral-derivative algorithms.&quot;&lt;/p&gt;
&lt;p&gt;Meanwhile, Renard wrote, &quot;Overnight closed-loop insulin delivery will hopefully be implemented at home.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Juvenile Diabetes Research Foundation, Abbott Diabetes Care, the European Foundation for the Study of Diabetes, Medical Research Council Center for Obesity and Related Metabolic Diseases, and the National Institute for Health Research Cambridge Biomedical Research Center.&lt;/p&gt;&lt;p&gt;Hovorka reported relationships with Minimed Medtronic, Abbott Diabetes Care, Lifescan, Novo Nordisk, and BBraun.&lt;/p&gt;&lt;p&gt;A co-author reported relationships with Novo Nordisk and Medtronic International Trading Sarl.&lt;/p&gt;&lt;p&gt;Renard reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_394"
                     title="Even Normal Glucose in Kids Could Predict Diabetes Later (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18291?impressionId=1265804082714"
                     
      Increases in fasting plasma glucose during childhood  --  even though levels remain in the normal range  --  can predict adult prediabetes and type 2 diabetes later in life, a retrospective cohort study showed.&lt;br&gt;
&lt;br&gt;Among individuals with a fasting plasma glucose of less than 100 mg/dL as children, increasing levels were associated with greater risks of prediabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and type 2 diabetes (&lt;em&gt;P&lt;/em&gt;=0.03) in adulthood, according to Gerald Berenson, MD, of Tulane University Health Sciences Center in New Orleans, and colleagues.&lt;br&gt;
&lt;br&gt;There appeared to be a threshold  --  85 mg/dL  --  above which the risk of adult problems began to increase, the researchers reported in the February issue of &lt;em&gt;Archives of Pediatrics and Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;It is not surprising that a higher fasting glucose level in childhood predicts prediabetes and diabetes in adulthood,&quot; Matthew Gillman, MD, of Harvard, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;More surprising, he said, was the existence of the apparent threshold, although &quot;the authors are appropriately circumspect about recommending lowering glucose cutoff points to diagnose children at risk of developing prediabetes or diabetes.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Even if there is a threshold over which children are at substantially higher risk of later prediabetes, it is unclear exactly how high the risk should be to make changing guidelines a good thing,&quot; he wrote. &quot;After all, the right interventions for individuals with prediabetes are still obscure, so identifying more of them may be more trouble than it&apos;s worth.&quot;&lt;/p&gt;
&lt;p&gt;According to Berenson and colleagues, 19 million U.S. adults have type 2 diabetes. More common is a prediabetic state of impaired fasting glucose, affecting about 54 million.&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that higher plasma glucose levels, even if still in the normal range, might be a predictor of diabetes.&lt;/p&gt;
&lt;p&gt;Berenson&apos;s group wanted to see whether elevated fasting plasma glucose in childhood would predict prediabetes or type 2 diabetes in adulthood.&lt;/p&gt;
&lt;p&gt;To find out, they turned to the Bogalusa Heart Study, which began tracking children from that Louisiana town in 1978. All had a fasting plasma glucose lower than 100 mg/dL.&lt;/p&gt;
&lt;p&gt;The current analysis included those same individuals assessed as adults after a mean follow-up of 21 years  --  1,723 were normoglycemic (99 mg/dL or lower), 79 were prediabetic (100 to 125 mg/dL), and 47 had type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Using a childhood fasting plasma glucose of 86 mg/dL or higher as a predictor for prediabetes yielded a 76.9% sensitivity and 85.2% specificity. For diabetes, sensitivity was 75% and specificity was 76%.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis controlling for anthropometric, hemodynamic, and metabolic variables from childhood to adulthood, as well as baseline fasting plasma glucose level, those individuals who had a childhood level 86 mg/dL or higher had increased risks of both prediabetes (OR 3.40, 95% CI 1.87 to 6.18) and type 2 diabetes (OR 2.06, 95% CI 1.01 to 4.23) as adults.&lt;/p&gt;
&lt;p&gt;The authors acknowledged some limitations of the study, including the lack of data on postchallenge glucose, in vivo insulin action and secretion, and glycosylated hemoglobin in childhood.&lt;/p&gt;
&lt;p&gt;Gillman, the editorialist, also noted that the findings&apos; generalizability to children today is unclear because obesity was much less prevalent when the adults in this study were children.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute on Aging and the American Heart Association.&lt;/p&gt;&lt;p&gt;The editorial was supported by a grant from the NIH.&lt;/p&gt;&lt;p&gt;Neither the study authors nor the editorialist reported any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_391"
                     title="Rare Genetic Deletion Linked to Morbid Obesity (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Genetics/GeneralGenetics/tb/18286?impressionId=1265804082714"
                     
      &lt;p&gt;Missing sections of DNA may have a powerful impact on weight for a small segment of the population, researchers said.&lt;/p&gt;
&lt;p&gt;Nearly all teens and adults found to have a particular deletion of roughly 30-genes on chromosome 16p11.2 were obese  --  most morbidly so  --  with a body mass index of at least 40 kg/m&lt;sup&gt;2&lt;/sup&gt;, Philippe Froguel, MD, PhD, of Imperial College London, and colleagues reported in &lt;em&gt;Nature&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;While the variant appeared to explain only a small proportion of morbid obesity  --  0.7% in the study population  --  it was never present in healthy, normal-weight controls.&lt;/p&gt;
&lt;p&gt;&quot;Although the recent rise in obesity in the developed world is down to an unhealthy environment, with an abundance of unhealthy food and many people taking very little exercise, the difference in the way people respond to this environment is often genetic,&quot; Froguel said in a prepared statement.&lt;/p&gt;
&lt;p&gt;But with further findings like these, it may be possible to identify such individuals through genetic testing, he said.&lt;/p&gt;
&lt;p&gt;If so, &quot;We can then offer them appropriate support and medical interventions, such as the option of weight-loss surgery, to improve their long-term health,&quot; Froguel declared.&lt;/p&gt;
&lt;p&gt;Although researchers speculate that one in 20 cases of obesity may have a genetic cause, the genetic component remains largely elusive.&lt;/p&gt;
&lt;p&gt;Even accounting for such a small fraction of cases, the newly discovered 16p11.2 variant would be the second most frequent known genetic cause of obesity, Froguel&apos;s group said.&lt;/p&gt;
&lt;p&gt;Extensive genome-wide association studies have linked numerous single nucleotide polymorphisms (SNPs) to obesity, but added all together they account for only a small fraction of the known heritable component, the researchers said.&lt;/p&gt;
&lt;p&gt;&quot;The &apos;common disease, common variant&apos; hypothesis is increasingly coming under challenge,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Their team first identified the genetic deletion in teen and adults with learning difficulties or delayed development.&lt;/p&gt;
&lt;p&gt;Because the 31 individuals who had the nearly identical deletions of at least 593 kilobases at chromosome 16p11.2 in one copy of their DNA all had a BMI of over 30 kg/m&lt;sup&gt;2&lt;/sup&gt;, the researchers decided to dig a little deeper.&lt;/p&gt;
&lt;p&gt;&quot;Cohorts with extreme phenotypes that include obesity may be enriched for rare but very potent risk variants,&quot; making them easier to discover, they wrote.&lt;/p&gt;
&lt;p&gt;So they undertook a case-control study among 312 patients at three centers in Britain and France who presented with congenital malformations, developmental delay, or both, in addition to obesity.&lt;/p&gt;
&lt;p&gt;The same deletions were seen in 2.9% of these individuals.&lt;/p&gt;
&lt;p&gt;The function of the missing genes are not well known, but some have previously been associated with delayed development, autism, and schizophrenia.&lt;/p&gt;
&lt;p&gt;Notably, though, the frequency of deletion of these genes in the obese case-control cohort was &quot;appreciably higher&quot; than the less than 1% seen in the autism and other studies that didn&apos;t include obesity as an inclusion criteria, the researchers said.&lt;/p&gt;
&lt;p&gt;A second independent survey of genetic data at eight cytogenetic centers in France, Switzerland, and Estonia turned up a 0.6% rate among 3,947 people with developmental delay, malformations, or both, but who were not selected for obesity (&lt;em&gt;P&lt;/em&gt;=0.00022 versus the cohort selected for obesity).&lt;/p&gt;
&lt;p&gt;Analysis of those with the missing genes revealed an age-dependent link to weight: All four teens and adults were obese. Children were often obese (four of 15) or overweight (two of 15). Children under 2 years all had normal weight.&lt;/p&gt;
&lt;p&gt;So to see whether the deletion was independent of neurodevelopmental problems, Froguel&apos;s group examined genome-wide association study data from general population cohorts totaling 11,856 individuals along with 2,772 from childhood obesity and adult morbid obesity case-control studies, 931 in an extreme early-onset obesity study, and 141 who had bariatric weight-loss surgery.&lt;/p&gt;
&lt;p&gt;All adult carriers of the deletion were obese with the exception of one who was apparently diabetic. Each of the seven children and adolescents who carried the variant had a BMI in the top 0.1% for their age and gender.&lt;/p&gt;
&lt;p&gt;None had any reported developmental or cognitive problems. Four had reported hyperphagia with excessive hunger and food intake.&lt;/p&gt;
&lt;p&gt;Altogether, the 16p11.2 deletions predicted 29.8-fold elevated risk of obesity (&lt;em&gt;P&lt;/em&gt;=0.00000058) and 43.0-fold elevated risk of morbid obesity (&lt;em&gt;P&lt;/em&gt;=0.000000064) compared with lean or normal weight.&lt;/p&gt;
&lt;p&gt;By extrapolation, the researchers extrapolated that about 0.4% of all morbidly obese cases are attributable to an inherited 16p11.2 deletion, with 0.3% arising from a de novo deletion in the same genetic region.&lt;/p&gt;
&lt;p&gt;&quot;Although they may be heterogeneous in nature, these deletions are highly likely to be the causal variants,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by &quot;Le Conseil Regional Nord Pas de Calais/FEDER&quot; along with various governmental and industry supporters for the various component studies.&lt;/p&gt;&lt;p&gt;The researchers reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_383"
                     title="Primary Concerns of MDs, Diabetics Not Always the Same (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18274?impressionId=1265804082714"
                     
      Diabetic patients aren&apos;t as concerned about their hypertension as their physicians are, researchers found.&lt;br&gt;
&lt;br&gt;In a prospective cohort study, 38% of physicians ranked hypertension as one of their most important concerns for their diabetic patients, while only 18% of those patients ranked hypertension among their most important, Donna M. Zulman, MD, of the University of Michigan Medical School and the Ann Arbor VA, and colleagues reported online in the&lt;em&gt; Journal of General Internal Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;If a patient and their doctor do not agree on which of these issues should be prioritized, it will be difficult for them to come up with an effective treatment plan together,&quot; Zulman said in a statement.&lt;/p&gt;
&lt;p&gt;Generally, however, patients&apos; health concerns were similar to their physicians&apos;, as 60% of patient-provider pairs listed the same top three heath concerns.&lt;/p&gt;
&lt;p&gt;On average, diabetics have at least three other chronic health conditions, which can affect treatment, the researchers said.&lt;/p&gt;
&lt;p&gt;To assess concordance of patient and physician priorities, they surveyed 1,169 patients with a primary care visit at any of nine Veterans Affairs facilities in three Midwestern states. They also surveyed the patients&apos; 92 physicians.&lt;/p&gt;
&lt;p&gt;They found that 4% had no matching health concerns, 25% had one matching concern, 55% had two, and 16% had three matches.&lt;/p&gt;
&lt;p&gt;Both patients and providers ranked diabetes and hypertension most frequently in their top three concerns.&lt;/p&gt;
&lt;p&gt;The most obvious disconnect: 38% of physicians ranked hypertension as the most important factor, compared with 18% of patients.&lt;/p&gt;
&lt;p&gt;&quot;This is consistent with previous findings that many diabetic patients are unaware of the importance of blood pressure control despite evidence and guidelines that emphasize the critical importance of this issue,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Patients were more likely than providers to list losing weight or being more active in their top three concerns (35% versus 21%, respectively).&lt;/p&gt;
&lt;p&gt;They were also more likely to prioritize pain and depression than their doctors were.&lt;/p&gt;
&lt;p&gt;The researchers characterized this finding as &quot;concerning&quot; because it suggests that providers aren&apos;t aware of how seriously these conditions affect their patients. Also, pain and depression can be barriers to effective diabetes self-management, they noted.&lt;/p&gt;
&lt;p&gt;&quot;Both sets of priorities are valid,&quot; Zulman said in a statement. &quot;However, we know from previous studies that issues like pain interfere with a person&apos;s ability to manage their diabetes. So putting these types of symptomatic problems on the back-burner might lead to worse outcomes in diabetes and other chronic conditions.&quot;&lt;/p&gt;
&lt;p&gt;While 60% of patient-provider pairs listed the same top three heath concerns, 28% had much lower concordance. The discord was strongest among the sickest patients, the researchers said, and the probability of concordance decreased significantly when a patient reported competing demands or poor health status (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;&quot;One possible explanation for this is that patients with poor health or competing demands may be more likely to face functional limitations, financial stress, and other barriers to care,&quot; Zulman added. &quot;For these patients, symptomatic problems might be of utmost importance because they exacerbate their existing challenges.&quot;&lt;/p&gt;
&lt;p&gt;The disconnect may also reflect a breakdown in communication, as the physician may not fully realize how conditions affect health and well-being and may not effectively communicate morbidity and mortality risks, the researchers suggested.&lt;/p&gt;
&lt;p&gt;The study was limited because all participants were aware of diabetes and hypertension status, so it may not be unexpected that the majority of participants ranked both conditions among their top three concerns. The researchers cautioned that this could limit the study&apos;s ability to fully evaluate concordance patterns.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Robert Wood Johnson Clinical Scholars Program and an associated VA Advanced Fellowship, as well as grants from the US Department of Veterans Affairs Health Services Research and Development Service and the Michigan Diabetes Research and Training Center.&lt;/p&gt;&lt;p&gt;A co-author is supported by an award from the American Cancer Society.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
