bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Adverse Pregnancy Outcomes among Women with Type 1 Diabetes
Authors: COSTACOU TINA , RUBINSTEIN DEBRA , ORCHARD TREVOR J. 
Published: June 2018

Women with type 1 diabetes are at a greater risk for adverse pregnancy outcomes (APO) compared with the general population, though factors relating to the occurrence of APO have not been well studied. We thus assessed predictors of APO among women with type 1 diabetes. Female participants (n=325; mean baseline age 28, duration 19 years) of a prospective cohort of childhood onset type 1 diabetes were selected for study. Among 320 with pregnancy data available, all pregnancies occurred after study entry (1986-88) for 61 (mean baseline age 21 and duration 14 years). APO were defined as tubal/ectopic pregnancies, spontaneous or induced abortions and stillbirths. Follow-up time was calculated as time in years from study entry to the date of the first adverse pregnancy outcome or date of last live birth for those with normal pregnancies. During 25 years of follow-up, 28 (45.9%) had at least one APO. With the exception of a greater number of total pregnancies in those with an APO (p=0.03), no other univariate differences were observed. In multivariable Cox models, a greater number of pregnancies (HR=1.49, p=0.03), log albumin excretion rate (HR=1.27, p=0.03) and proliferative retinopathy (HR=5.04, p=0.003) predicted APO. In multiple linear regression analyses, the number of pregnancies (β=0.58, p&lt;0.0001) and the presence of proliferative retinopathy (β=0.75, p=0.01) directly predicted number of APO. In analyses excluding induced abortions from the outcome definition (19 adverse events (31.1%)), glomerular filtration rate was the only predictor of any APO (HR=0.98, p=0.08). A greater number of pregnancies (β=0.48, p&lt;0.0001), non-HDL cholesterol (β=0.006, p=0.04), white blood cell count (β=-0.10, p=0.05) and proliferative retinopathy (β=0.74, p=0.02) predicted number of APO. Among women with type 1 diabetes, the presence of microvascular complications relates to both the occurrence and the number of subsequent adverse pregnancy outcomes.

Disclosure
T. Costacou: None. D. Rubinstein: None. T.J. Orchard: None.
Racial Patterns of Comorbidities in Patients with Cardiovascular Disease and Type 2 Diabetes
Authors: IGLAY KRISTY , HANNACHI HAKIMA , ENGEL SAMUEL S. , LI XUEYING , O'CONNELL DAVID J. , MOORE LORI M. , RAJPATHAK SWAPNIL 
Published: June 2018

Significant differences have been demonstrated in the risk of incident type 2 diabetes (T2D) and T2D-related complications by patient race. Because the presence of comorbidities can directly impact a physician’s selection of antidiabetic therapy, the current study sought to quantify differences in prevalence of diabetes-related comorbidities by race and cardiovascular disease (CVD) status in a large U.S. cohort. We conducted a retrospective study of T2D patients ≥18 years who had ≥1 encounter in the Quintiles Electronic Medical Record database from October 2014 to September 2015, as well as ≥1 year of medical history available. Of the 1,522,526 eligible patients, 54% were female, median age was 65 years, and median HbA1c was 6.7%. The cohort representation by race, and prevalence of comorbidities by CVD status, are shown in the table. Overall, 25% of patients had CVD, but this varied by race from 18.6% to 30.5%. The most prevalent comorbidities for all races included hypertension, hyperlipidemia, overweight/obesity, chronic kidney disease, neuropathy and heart failure, with rates generally higher among patients with CVD. Foot infections were also common for those with CVD across subgroups, but especially for Asian patients with CVD (36.9%).
In conclusion, patients with T2D and CVD had higher rates of common comorbidities vs. those without CVD, but rates varied by racial subgroups.

Disclosure
K. Iglay: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. S.S. Engel: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. X. Li: None. D.J. O'Connell: None. L.M. Moore: None. S. Rajpathak: Employee; Self; Merck & Co., Inc..
The Adiponectin-Mortality Paradox—A Systematic Review and Meta-analysis
Authors: SCARALE MARIA GIOVANNA , FONTANA ANDREA , TRISCHITTA VINCENZO , COPETTI MASSIMILIANO , MENZAGHI CLAUDIA 
Published: June 2018

Surprisingly, several, though not all, studies have shown a positive relationship between serum adiponectin (ADPN) and mortality rate. In order to deeply address direction and strength of this paradoxical association, we carried out a systematic review and meta-analysis (MA) of prospective studies present in MEDLINE, Cochrane Library and Scopus by December, 1st 2017, with ADPN being the exposure and all-cause (AC) and cardiovascular (CV) mortality the outcomes. We performed random effect MA to pool individual hazard ratios (HRs; 95% CIs). To address the role of Natriuretic Peptides (NPs), known to increase both ADPN expression and mortality rate, a MA focused only on studies reporting HRs before and after NPs adjustment was also carried out. We assessed study heterogeneity by Q statistic and then performed meta-regressions considering male percentage, age, BMI, eGFR and clinical setting (general population, type 2 diabetes, CV disease, dialysis) as study level covariates. We identified 56 (n=64,775 subjects) and 30 (n=48,439) studies for AC and CV mortality, respectively. Heterogeneity across studies was observed for both outcomes (Q-test p&lt;0.01). HRs, expressed as 1 SD increment of total ADPN, were 1.24 (1.17-1.30) and 1.28 (1.20-1.37) for AC and CV mortality, respectively. MA restricted to the 12 studies (n=19,010) reporting NPs data showed HRs for AC mortality equal to 1.24 (1.16-1.34) and 1.13 (1.06-1.21) without and with NPs adjustment, respectively (p&lt;0.between HRs, when their correlation was &gt;0.1). For CV mortality (6 studies, n=15,252), HRs were 1.21 (1.10-1.33) and 1.15 (1.06-1.24) without and with NPs adjustment, respectively (p&lt;0.between HRs, when their correlation was &gt;0.8). Male percentage, age, BMI, eGFR and clinical setting did not explain the observed heterogeneity among studies. Our results confirm the existence of a paradoxical association between high ADPN levels and increased mortality rate. Such paradox seems to be only partly explained by NPs levels.

Disclosure
M. Scarale: None. A. Fontana: None. V. Trischitta: None. M. Copetti: None. C. Menzaghi: None.
Fasting Plasma Mannose Level Is Associated with Insulin Sensitivity Independent of BMI in Japanese Individuals with Diabetes
Authors: AMANO ERI , FUNAKOSHI SHOGO , YOSHIMURA KUMIKO , HIRANO SEIKI , OHMI SATOKO , TERADA YOSHIO , FUJIMOTO SHIMPEI 
Published: June 2018

Recently, integrated network analysis has revealed dysregulation in the metabolism of mannose, an epimer of glucose, in individuals with severe obesity who do not have significant diabetes. It was also found that fasting plasma mannose levels (M0) are associated with insulin resistance independent of BMI. Since the association between mannose and insulin sensitivity (IS) in those with impaired glucose tolerance remains unknown, we aimed to investigate the association in individuals with varying degrees of glucose tolerance. Based on data of 75g OGTT in Japanese individuals without diabetic medication, individuals were classified as normal (NGT), impaired glucose tolerance (IGT), and diabetes (DM). In each group, 25 subjects were consecutively recruited [total 75 individuals, age: 65±11 (mean±SD); BMI: 24.9±3.8]. Matsuda index (MI) was calculated as an index of IS. M0 was assayed using HPLC. Normally-distributed loge-transformed (ln-) values were used for MI and leptin. Although fasting plasma glucose (G0), HbA1c, and ln-MI were significantly different among 3 groups, age, sex, BMI, and M0 were not different. In simple regression analysis, ln-MI was negatively correlated with BMI (NGT: r=-0.639, IGT: r=-0.466, DM: r=-0.613) and ln-leptin (NGT: r=-0.480, IGT: r=-0.447, DM: r=-0.593) in all 3 groups. Interestingly, although ln-MI was not significantly correlated with M0 in NGT (r=0.241, P=0.245) and IGT (r=-0.296, P=0.152), it was moderately and negatively correlated in DM (r=-0.626, P&lt;0.001). In DM, ln-MI was slightly correlated with G0 (r=-0.484, P=0.014). In multiple regression analysis in DM, ln-MI was independently predicted by BMI (β=-0.400) and M0 (β=-0.426), accounting for 51.2% (P&lt;0.001) of the variability, which was larger than that in the prediction by BMI alone (37.6%).
In conclusion, in our study, fasting plasma mannose was associated with insulin sensitivity independent of BMI in Japanese individuals with diabetes.

Disclosure
E. Amano: None. S. Funakoshi: None. K. Yoshimura: None. S. Hirano: None. S. Ohmi: None. Y. Terada: None. S. Fujimoto: None.
Sleep Disturbances Are Associated with Poorer Glycemia and Increased Obesity in Youth at Risk for or with Early Type 2 Diabetes (T2D)
Authors: MOKHLESI BABAK , TEMPLE KARLA A. , HOGAN ASHLEY N. , EDELSTEIN SHARON , NADEAU KRISTEN J. , SAM SUSAN , HANNON TAMARA , UTZSCHNEIDER KRISTINA , BARENGOLTS ELENA , MANCHANDA SHALINI , EHRMANN DAVID A. , CAUTER EVE VAN , CONSORTIUM RISE 
Published: June 2018

Poor sleep may be associated with an increased risk of obesity and T2D in youth. We explored whether subjective sleep duration, sleep quality or risk factors for obstructive sleep apnea (OSA) are associated with BMI, glycemia or blood pressure (BP) in youth. Between 2013 and 2016, 236 overweight and obese youth (10-19 years old) at risk for or with recently diagnosed T2D were screened for the Restoring Insulin Secretion (RISE) Study. Data from a 2 hour OGTT and validated Sleep Disturbances Scale and Cleveland Adolescent Sleepiness questionnaires were available for 214 youth. Regression models explored the independent association between sleep variables and outcomes of fasting glucose, 2-h glucose, HbA1c, BMI and BP. The cohort consisted of 67% females, 33% males; 26% white, 26% black, 33% hispanic; age 14.1±2.1 years and BMI 35.9±6.5 kg/m2 (mean±SD). Based on the ADA criteria, 20% had normal glucose tolerance, 60% had prediabetes and 20% had T2D. Sleep duration &lt;8 h and &lt;7 h was reported in 74% and 43% respectively; 51% reported daytime sleepiness; 26% reported poor sleep quality, and 30% high risk for OSA. 28% of the cohort was on metformin. After adjusting for age, sex, race/ethnicity, BMI and metformin use, the presence of daytime sleepiness was associated with 0.19% higher HbA1c (p=0.018) and higher 2-h glucose (13.3 mg/dl, p=0.05), but sleep duration, quality, and OSA risk were not associated with any of the outcomes. After adjusting for age, sex, race/ethnicity and metformin use, poor sleep quality was associated with 2.95 kg/m2 higher BMI (p=0.003), and high OSA risk with 2.81 kg/m2 higher BMI (p&lt;0.003). In these overweight and obese youth with or at risk for T2D, daytime sleepiness was associated with poorer glycemia, while poor sleep quality and high OSA risk were associated with higher BMI. These findings suggest that intervention studies aimed at improving sleep in youth are required to determine potential benefits on glycemia and weight.

Disclosure
B. Mokhlesi: None. K.A. Temple: None. A.N. Hogan: None. S. Edelstein: None. K.J. Nadeau: None. S. Sam: None. T. Hannon: Consultant; Self; Eli Lilly and Company. K. Utzschneider: Consultant; Self; Novo Nordisk Inc.. E. Barengolts: None. S. Manchanda: None. D.A. Ehrmann: None. E. Van Cauter: Research Support; Self; AstraZeneca. R. Consortium: None.
Self-Reported Sleep and Circadian Measures Are Not Associated with Glycemia in Adults with Prediabetes or Early Untreated Type 2 Diabetes (T2D)
Authors: MOKHLESI BABAK , TEMPLE KARLA A. , HOGAN ASHLEY N. , EDELSTEIN SHARON , UTZSCHNEIDER KRISTINA , NADEAU KRISTEN J. , HANNON TAMARA , SAM SUSAN , BARENGOLTS ELENA , MANCHANDA SHALINI , EHRMANN DAVID A. , CAUTER EVE VAN , CONSORTIUM RISE 
Published: June 2018

Abnormal sleep and circadian misalignment (e.g., social jetlag, late chronotype, or shift work) have been associated with abnormal glucose metabolism. These associations have not been well established in adults who meet the ADA criteria for prediabetes. We hypothesized that self-reported short sleep, poor sleep quality or circadian misalignment are associated with worse glycemia, BP and BMI in adults with prediabetes or early untreated T2D. We screened 1,355 overweight/obese men and women age 20-65 y for the Restoring Insulin Secretion (RISE) Study. Completed data from a 2-h OGTT, HbA1c and sleep questionnaires were available for 704 adults with prediabetes and 258 with early untreated T2D. We used a modified Pittsburgh Sleep Quality Index to assess usual bedtime, wake time, and sleep duration on workdays and days off, and the Berlin questionnaire to assess the risk of obstructive sleep apnea (OSA). Regression models explored the independent associations of sleep variables with glycemic variables, BMI and BP. The cohort was 55% men, 45% women; 42% white, 36% black, 16% Hispanic; age 52.2±9.5 years and BMI 34.7±5.5 kg/m2 (mean±SD). Sleep duration was 6.6±1.3 h, poor sleep quality was reported by 54%, high risk for OSA in 64% and 20% did shift work. After adjusting for age, sex, and race/ethnicity, shift work was associated with 1.32 kg/m2 higher BMI (p=0.0043). After adjusting for age, sex, race/ethnicity and BMI, no sleep or circadian variables (sleep duration, sleep quality, OSA risk, shift work, social jetlag and chronotype) were associated with HbA1c, fasting or 2-h glucose, or BP. In this cohort with prediabetes or early untreated T2D, subjective measures of sleep duration, quality and circadian misalignment were not associated with measures of glycemia or BP. Shift workers were more obese. Further research using objective measures of sleep is needed to better delineate the relationship between sleep and glycemia.

Disclosure
B. Mokhlesi: None. K.A. Temple: None. A.N. Hogan: None. S. Edelstein: None. K. Utzschneider: Consultant; Self; Novo Nordisk Inc.. K.J. Nadeau: None. T. Hannon: Consultant; Self; Eli Lilly and Company. S. Sam: None. E. Barengolts: None. S. Manchanda: None. D.A. Ehrmann: None. E. Van Cauter: Research Support; Self; AstraZeneca. R. Consortium: None.
The Impact of Diabetes and Hyperglycemia in Patients Hospitalized for Dengue
Authors: BUENO COLMAN ELVIO D. , POZZO YESSIKA A. , UMPIERREZ GUILLERMO E. , MEDINA URSULA B. , BENITEZ ALDO , MARIN SUSANA N. 
Published: June 2018

Dengue is a potentially letal mosquito-borne flavivirus disease with about 390 million worldwide infections per year. We have experienced recurrent dengue epidemics in Brazil and Paraguay. We aimed to determine the impact and clinical outcome of diabetes (DM) and hyperglycemia during hospital admission in hospitalized patients for dengue. A total of 294 patients were admitted to a single medical center. Of them,47 (16%) patients had the previous diagnosis of DM (age: 62±12 years, blood glucose [BG]: 238±116 mg/dl), 44 (14.9%) patients had hyperglycemia (BG ≥180 mg/dl) without a prior diagnosis of DM (49±18 years, BG; 165±34 mg/dl) and 214 (73%) had normoglycemia (49±19 years, BG: 110±18 mg/dl). Patients with diabetes and hyperglycemia were older and were more likely to present with severe or hemorrhagic dengue, hemodynamic shock, acute kidney injury (AKI) requiring admission to the ICU and blood transfusion, and longer length of stay. There was a single death in a non-DM patient. Compared to patients with normoglycemia, non-DM patients with hyperglycemia (≥180 mg/dl) had more severe form of dengue with AKI (9.1% vs. 20.7%, OR: 2.61), hemodynamic shock (3.4% vs. 33.3%, OR: 2.61), ICU admission (4.4% vs. 33%, p=0.03) and longer length of hospital stay (4.7 days and 7.1 days, p=0.01).
Conclusion: Patients with DM and hyperglycemia were more likely to develop a more severe and hemorrhagic dengue compared to patients with normoglycemia. Because there is no specific dengue therapeutics, prevention is currently limited to vector control measures. A dengue vaccine program could represent a major advance in the control of the disease in patients with diabetes.

Disclosure
E.D. Bueno Colman: None. Y.A. Pozzo: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc.. U.B. Medina: None. A. Benitez: None. S.N. Marin: None.
Multiple Chronic Comorbidities in a T2DM Mediterranean Population
Authors: FRANCH-NADAL JOSEP , MATA-CASES MANEL , REAL JORDI , DE CAMPOS KARINE FERREIRA , CEDENILLA MARTA , GÓMEZ ANTÓN , MAURICIO DIDAC 
Published: June 2018

Objective: T2DM patients often have multiple comorbidities which may impact patients’ management approach and treatment selection. This is the first study examining the co-prevalence of comorbidities such as CVD and CKD (GFR &lt;60 ml/min and/or UACR ≥ 30 mg/g) across T2DM patients in Spain using a well-validated local database (DB).
Methods: Retrospective cross-sectional study using the Spanish local electronic records DB “Information System for the Development of Research in Primary Care”, SIDIAP. Adult patients with T2DM were included and comorbid conditions were assessed using all medical records available from full years 2015-2016. Patient characteristics, laboratory measures and comorbidities were summarized via descriptive analyses, overall and by subgroups of age, gender and HbA1c levels.
Results: From 373,185 T2DM identified patients (overall population, OP), 55% were men, their mean age was 70 years, the mean T2DM duration was 9 years and the mean HbA1c value was 7.12% (SD 1.32). The most common comorbid conditions were hypertension (HTN): 72% of patients; hyperlipidemia (HL): 60%; obesity: 39%, CKD: 33% and CVD: 23%. The highest co-prevalence was the combination of HTN/HL (45.2%), followed by HTN/CKD (28.3%), HTN/CVD (18.8%) and CVD/HL (15.1%). CVD was more frequent in older groups (32.3% in patients ³75 years-old) and in men (27.8% vs. 17.6%), while heart failure was more frequent in women (8.0% vs. 6.1%). CKD was found to increase with age, reaching 51.9% in patients ≥75 years. The coexistence of CKD and CVD in the whole population was 11.1%. Among T2DM patients with CVD and available GFR data (79,158, 91% of CVD patients), 57.6% had a GFR ≥ 60 ml/min (around 12% of OP), whereas 20.7% had GFR from 45 to &lt;60, 14.2% had GFR from 30 to &lt;45; 6.2% had GFR from 15 to &lt;30ml/min; and 1.3% had GFR &lt; 15ml/min.
Conclusion: The frequency of comorbidities in T2DM patients from a Mediterranean area is high, and both age and gender play a role in overall comorbidity burden. CKD and CVD are frequent comorbid conditions among T2DM patients.

Disclosure
J. Franch-Nadal: None. M. Mata-Cases: None. J. Real: None. K. Ferreira de Campos: Employee; Self; Merck Sharp & Dohme Corp. M. Cedenilla: Employee; Self; Merck Sharp & Dohme Corp. A. Gómez: Employee; Self; Merck Sharp & Dohme Corp. D. Mauricio: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Eli Lilly and Company, GlaxoSmithKline plc.. Research Support; Self; GlaxoSmithKline plc.. Advisory Panel; Self; Janssen-Cilag Pty Limited. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Board Member; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Sanofi.
Rate of Diabetes in Maricopa County, AZ
Authors: JAYCOX SHARON H. , PAGLIALUNGA SABINA 
Published: June 2018

The prevalence of type 2 diabetes mellitus (T2DM) is well documented at the national, state, and even county level. Results are captured in the Behavior Risk Factor Surveillance System (BRFSS), a U.S. survey that collects data on disease rates and health-related risk behavior. The 2015 BRFSS audit revealed Arizona has an overall adult T2DM prevalence of 9.1%. Further, in Maricopa County, the region which includes the greater Phoenix area, the T2DM prevalence is higher at 10.8%. Conversely, there is limited data available on prediabetes rates in Maricopa County; therefore, we examined the rate of diabetes and prediabetes during community-partnered events as part of an educational “A1C initiative.” Basic demographic data as well as a fingerstick blood sample were obtained. HbA1c was measured with a hand-held monitor. 794 participants (272 men) were screened at 15 events from April 2016 to Sept 2017. The majority of participants were of Hispanic descent (54%). HbA1c results were categorized according to the ADA guidelines; normal (&lt; 5.7%), prediabetes (5.7-6.4%) and diabetes (≥6.5%) ranges. Mean HbA1c for all participants was 6.0% +1.2%, with 16% and 35% falling in the diabetes and prediabetes ranges respectively. Diabetes and prediabetes rates for males and females were similar. By ethnicity, prediabetes was highest among African Americans (AA) (41%), followed by white non-Hispanics (35%) then Hispanics (33%). Despite AA having a higher diabetes rate at 21%, HbA1c was significantly higher in Hispanics vs. AA diabetes only subjects (8.6% +2.0 vs. 7.4% +1.4, p&lt;0.001), suggesting worse glycemic control for the Hispanic group. In line with the national average of prediabetes prevalence at 33.9%, the overall rate we observed was similar, yet higher in certain groups. Notably, the diabetes rate was nearly double than that of the BRFSS report. The initiative provided vital (pre)diabetes awareness to Maricopa County residents. These findings were shared with our community partners, to aid in developing strategies to best assist those at risk of developing T2DM.

Disclosure
S.H. Jaycox: None. S. Paglialunga: Employee; Self; Celerion.
High-Risk Medication Use to Achieve Tight Glycemic Control among U.S. Adults with Serious Chronic Conditions
Authors: MCCOY ROZALINA G. , HOUTEN HOLLY VAN , LIPSKA KASIA J. , SHAH NILAY 
Published: June 2018

For patients with serious comorbidities, diabetes management guidelines recommend more relaxed glycemic targets (glycosylated hemoglobin [HbA1c] &lt;8-8.5% rather than &lt;7%) and cautious use of agents known to cause hypoglycemia. We examined glycemic control and use of insulin and/or sulfonylureas among commercially insured and Medicare Advantage beneficiaries with serious comorbidities. Using OptumLabs Data Warehouse, we identified adults ≥18 years with diabetes and ≥1 of the following conditions (all identified by the guidelines) in 2014: dementia, end stage renal disease (ESRD), stages 3-4 chronic kidney disease (CKD), myocardial infarction (MI), heart failure (HF), cerebrovascular disease (CVD), chronic obstructive pulmonary disease (COPD), cancer, arthritis, urinary incontinence, falls, depression, hypertension, cirrhosis, proliferative retinopathy, peripheral neuropathy, and recent emergency department or hospital visit for hypoglycemia. We then identified their last available HbA1c in 2015 and the medications filled within 100 days of this HbA1c. There were 216,839 adults (mean age 65.5 years, 50.5% women, 58.6% white) with diabetes included in the study. The proportion of patients with HbA1c &lt;7% was lowest among patients with retinopathy (28.9%), hypoglycemia (33.4%), and neuropathy (48.4%); it was highest among patients with dementia (59.1%). The majority (between 51.5% and 58.6%) of patients with the remaining conditions also had HbA1c &lt;7%. The plurality of patients in each disease cohort was treated insulin and/or sulfonylurea, including 66.9% of patients with hypoglycemia, 54.4% with ESRD, 51.9% with CKD, 51.1% with cirrhosis, 46.8% with MI, 48% with HF, and 43% with dementia. Sulfonylureas were used in combination with insulin by nearly 6% of patients with ESRD, CKD, and cirrhosis. Thus, despite efforts to individualize therapy, the majority of patients with chronic conditions achieve HbA1c &lt;7% and the plurality do so using high risk drugs.

Disclosure
R.G. McCoy: None. H. Van Houten: None. K.J. Lipska: Other Relationship; Self; Centers for Medicare and Medicaid Services. Research Support; Self; National Institutes of Health. N. Shah: None.