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In This Issue of JAMA |

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JAMA. 2014;311(22):2249-2251. doi:10.1001/jama.2013.279542.
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Anne R. Cappola, MD, and Edward H. Livingston, MD

Early exposure to complex dietary proteins may increase the risk of autoimmunity to pancreatic β cells in children at genetic risk of type 1 diabetes. In a study of 2159 at-risk infants who were randomly assigned to receive conventional formula or an extensively hydrolyzed casein-based formula, Knip and colleagues found that compared with conventional formula, the hydrolyzed formula did not decrease the incidence of diabetes-associated autoantibodies during a median follow-up of 7 years.

The preferred second-line treatment after metformin failure is not clear. In a retrospective cohort study that involved 14 616 patients initially treated with metformin and who subsequently added insulin (n = 2436) or a sulfonylurea (n = 12 180; propensity score–matched with the patients adding insulin), Roumie and colleagues found that compared with sulfonylurea, treatment intensification with insulin was associated with an increased risk of a composite of myocardial infarction, stroke, and death. In an Editorial, Safford discusses observational data analyses in comparative effectiveness research.

In an analysis of data from the Swedish Obese Subjects study—a prospective matched observational cohort study—Sjöström and colleagues examined long-term diabetes remission and diabetes complication rates among 343 of 2010 patients who had undergone bariatric surgery and 260 of 2037 control (usual care) patients who had type 2 diabetes at enrollment. The authors report that during a median follow-up of 10 years, bariatric surgery was associated with more frequent diabetes remission and fewer diabetes complications than usual care.

Latino populations have a high prevalence of type 2 diabetes. Florez and colleagues performed whole-exome sequencing on DNA samples from 3756 individuals of Mexican and US Latino ancestry (1794 with type 2 diabetes, 1962 controls) and identified a single low-frequency variant (p.E508K) in HNF1A—the maturity onset diabetes of the young type 3 gene—associated with type 2 diabetes in this population.

CLINICAL REVIEW & EDUCATION

To provide a current perspective on insulin use in patients with type 2 diabetes, Wallia and Molitch reviewed data from 100 studies of insulin therapy in this patient population. The authors discuss diabetes treatment goals, types of insulin, initiation and intensification of insulin therapy and review related challenges, including adverse effects of insulin therapy, patient preferences, and barriers to successful insulin use.

A recent article in JAMA Internal Medicine about a study involving patients with diabetes who were at risk of serious hypoglycemia by virtue of age, cognitive impairment, or renal disease reported that intensive glycemic control—representing possible overtreatment—was common. In this From the JAMA Network article, Andrews and O’Malley discuss factors contributing to diabetes overtreatment.

A 25-year-old woman with type 2 diabetes has a reddish-brown plaque on her shin that has gradually increased in size and tenderness over 3 years’ time. Central yellow deposits are noted on examination. What would you do next?

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