Author Interviews, JAMA, Surgical Research, Vitamin D / 19.02.2014

Sadeq A. Quraishi, MD, MHA Massachusetts General Hospital, Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with: Sadeq A. Quraishi, MD, MHA Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Quraishi: Our retrospective study suggests that there is an association between pre-operative 25-hydroxyvitamin D [25(OH)D] levels and the risk of hospital-acquired infections after gastric bypass surgery. In particular, patients with 25(OH)D levels <30 ng/ml before surgery were almost 4 times more likely to develop a surgical site infection within 30 days of surgery than patients with pre-operative 25(OH)D levels at 30 ng/ml or higher.
Alzheimer's - Dementia, Author Interviews, JAMA, Mental Health Research / 19.02.2014

Anton P. Porsteinsson M.D. William B. and Sheila Konar Professor of Psychiatry Director, Alzheimer's Disease Care, Research and Education Program (AD-CARE) University of Rochester School of Medicine and Dentistry Rochester, N.Y. 14620MedicalResearch.com Interview with: Anton P. Porsteinsson M.D. William B. and Sheila Konar Professor of Psychiatry Director, Alzheimer's Disease Care, Research and Education Program (AD-CARE) University of Rochester School of Medicine and Dentistry Rochester, N.Y. 14620 MedicalResearch.com: What are the main findings of the study? Dr. Porsteinsson: Identifying drugs outside the antipsychotic class with targeted anti-agitation effects that provide greater benefit or lower risk among patients with Alzheimer’s disease is a research priority.  Citalopram, a selective serotonin reuptake inhibitor (SSRI), is frequently used in older individualsand has been suggested as an alternative to antipsychotic drugs for agitation and aggression in dementia.  Among 186 patients with probable Alzheimer’s disease and agitation receiving psychosocial intervention, the addition of citalopram compared with placebo robustly and significantly reduced agitation and caregiver distress, but modest cognitive and cardiac adverse effects of citalopram may limit its practical application at the 30 mg/d dose studied in this trial. There are insufficient data on efficacy for agitation at lower doses of citalopram.
Author Interviews, Erasmus, JAMA, Stroke / 18.02.2014

dr_Arfan_IkramMedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD Departments of Radiology, Epidemiology, and Neurology Erasmus Medical Center, Rotterdam, the Netherlands MedicalResearch.com:  What are the main findings of the study? Dr. Ikram: The main finding of the study, carried out within the Rotterdam Study and led by drs. Daniel Bos and Arfan Ikram (both from the Erasmus Medical Center Rotterdam, the Netherlands), was that intracranial atherosclerosis is a major risk factor for stroke in the Western (white) population. Traditionally, intracranial atherosclerosis has not been considered of major importance to stroke risk in Western populations. In contrast, most research on intracranial atherosclerosis originates from Asian and African populations, where is was actually recognized as the most important risk factor of stroke. Our study demonstrates that also in the Western population intracranial atherosclerosis is a major risk factor for stroke and should get more focus in clinical practice. Moreover, our findings indicate that its contribution to the proportion of all strokes is greater than that of atherosclerosis in other vessel beds that are further away from the brain.
Author Interviews, Genetic Research, JAMA, Weight Research / 18.02.2014

Dr Clare Llewellyn PhD Cpsychol Lecturer in Behavioural Obesity Research Health Behaviour Research Centre Department of Epidemiology and Public Health University College London, LondonMedicalResearch.com Interview with: Dr Clare Llewellyn PhD Cpsychol Lecturer in Behavioural Obesity Research Health Behaviour Research Centre Department of Epidemiology and Public Health University College London, London  MedicalResearch.com: What are the main findings of the study? Dr. Llewellyn:This study indicated that appetite – and, in particular, satiety sensitivity (how quickly you feel full during eating, or how long you remain full after eating) – could be one of the mechanisms through which ‘obesity genes’ influence body weight. We know that body weight has a strong genetic basis, but the mechanisms through which ‘obesity genes’ influence weight are largely unknown. We showed that children with a higher genetic predisposition to obesity (estimated from a score comprising 28 known obesity-related genes) not only had more body fat (a larger BMI and waist circumference), but importantly they were also less sensitive to satiety.
Author Interviews, Dermatology, JAMA, University of Pennsylvania / 13.02.2014

Dr. Misha A. Rosenbach Assistant Professor of Dermatology Hospital of the University of Pennsylvania Section Editor, JAMA Dermatology Patient PageMedicalResearch.com Interview with: Dr. Misha A. Rosenbach Assistant Professor of Dermatology Hospital of the University of Pennsylvania Section Editor, JAMA Dermatology Patient Page MedicalResearch.com: What are the main findings of the study? Dr. Rosenbach: There is strong agreement between teledermatologists and in-person dermatologists when evaluating inpatients at a tertiary care academic hospital.  The primary aim of this study was to assess telederm as a triage tool.  Many dermatologists are not full-time hospitalists, but work in private practice or clinics which may be remote from affiliated hospitals.  The goal was to evaluate whether teledermatology could help those providers assess the acuity of inpatient consults.  There was strong concordance.
Author Interviews, HPV, JAMA, Karolinski Institute, Vaccine Studies / 12.02.2014

Lisen Arnheim Dahlström Associate Professor (Docent) Institutionen för medicinsk epidemiologi och biostatistik Department of Medical Epidemiology and Biostatistics Karolinska Institutet SwedenMedicalResearch.com Interview with: Lisen Arnheim Dahlström Associate Professor (Docent) Institutionen för medicinsk epidemiologi och biostatistik Department of Medical Epidemiology and Biostatistics Karolinska Institutet Sweden MedicalResearch.com: What are the main findings of the study? Answer: The main finding, when studying HPV vaccine effectiveness against condyloma by dose level is that 3 doses offered the maximum protection, although 2 doses also offered a substantial protection.
Author Interviews, JAMA, Menopause, Sexual Health, University of Pittsburgh / 11.02.2014

MedicalResearch.com Interview with: Holly Thomas, MD General Internal Medicine Fellow, Women's Health and Clinical Research University of Pittsburgh Pittsburgh, PA 15213 MedicalResearch.com: What are the main findings of the study? Dr. Thomas: We found that, despite popular perception, the majority of women (85%) who are sexually active at midlife will remain sexually active four years later. We also found that the majority of women score low on a measure of sexual function. However, low sexual function scores did not mean women stopped having sex. In fact, the score on the sexual function measure did not predict whether women maintained sexual activity. Finally, we found that importance of sex was a strong predictor of whether women remained sexually active. Women who felt sex was moderately to extremely important in their lives were 3 times more likely to maintain sexual activity.
Author Interviews, Heart Disease, JAMA, Nutrition, Sugar / 03.02.2014

MedicalReseach.com Interview with: Quanhe Yang, PhD Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, GA 30341 MedicalReseach.com: What are the main findings of the study? Dr. Yang: The majority of US adults consume more added sugar than is recommended for a healthy diet. On average, Americans consume about 15% of daily calories from added sugar.  About 70% of adults consume more than 10%of calories from added sugar and another 10% consume more than 25% of calories from added sugar. When you compare those who consume 7.5% (lowest quintile) of calories from added sugar with participants who consume between 17%-21% (quintile 4) of calories from added sugar, the latter group has a 38% higher risk of CVD mortality. But the risk of CVD death more than doubles  for those who consume  ≥21% (highest quintile) of calories from added sugar.
Author Interviews, Health Care Systems, JAMA, Primary Care / 26.01.2014

Dr. Lyndonna Marrast MD Fellow in General Internal Medicine Cambridge Health Alliance 1493 Cambridge Street Cambridge, MA 02139 MedicalResearch.com Interview with: Dr. Lyndonna Marrast MD Fellow in General Internal Medicine Cambridge Health Alliance Cambridge, MA 02139 MedicalResearch.com:   What are the main findings of the study? Dr. Marrast: We found that disadvantaged patients (categorized as racial and ethnic minorities, non-English home language speakers, being low income, having Medicaid, or reporting fair or poor health) were more likely than other patients to be cared for by a minority physician. A majority, 54%, of black, Hispanic and Asian patients received care from a minority doctor and the vast majority, 70%, of those who report not speaking English at home got care from a minority physician.
Author Interviews, FDA, JAMA, Yale / 23.01.2014

MedicalResearch.com Interview with: Nicholas S. Downing, AB Yale University School of Medicine New Haven, Connecticut MedicalResearch.com: What are the main findings of the study? Answer: In our systematic review of all new drugs approved by the FDA over an 8 year period, we found that there was real variability in the quality and quantity of clinical trial evidence used as the basis of the agency’s approval decisions. Some drugs were studied in multiple randomized, double-blinded, controlled clinical trials that provide very helpful information for patients and physicians. However, other drugs were studied in clinical trials that did not produce as much information about their safety and effectiveness.
Author Interviews, Brain Injury, JAMA / 22.01.2014

John W. O'Kane M.D. Associate Professor Family Medicine and Orthopaedics and Sports Medicine Medical Coordinator, U.W. Intercollegiate Athletics University of Washington Sports Medicine Clinic, SeattleMedicalResearch.com Interview with: John W. O'Kane M.D. Associate Professor Family Medicine and Orthopaedics and Sports Medicine Medical Coordinator, U.W. Intercollegiate Athletics University of Washington Sports Medicine Clinic, Seattle MedicalResearch.com: What are the main findings of the study? Dr. O’Kane:  In 11 to 14 year old female elite soccer players the concussion incidence was 13% with a rate of 1.2 per 1000 athletic exposures.   Symptoms lasted a median of 4 days and players with light or noise sensitivity, emotional lability, memory loss, nausea, and concentration problems took significantly longer to recover.  Heading the ball accounted for 30.5% of concussions and the vast majority of concussions (86%) occurred in games.  The majority of players (58.6%) reported playing with symptoms and less than half (44.1%) sought medical attention for their symptoms.  Those seeking medical attention were symptomatic longer and were less likely to play with symptoms.
Author Interviews, Baylor College of Medicine Houston, JAMA, Outcomes & Safety, Surgical Research / 17.01.2014

MedicalResearch.com Interview with: Daniel A. Anaya, MD, FACS Associate Professor of Surgery - Surgical Oncology Michael E. DeBakey Department of Surgery Baylor College of Medicine Chief, General Surgery & Surgical Oncology SectionDirector, Liver Tumor Program Michael E. DeBakey VA Medical Center Houston, TX 77030 and Dr. Courtney J. Balentine, MD First author and surgical resident at Baylor College of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Anaya:  That a good proportion of patients having colorectal operations will need additional assistance to recover during the postoperative period, resulting in being discharged to other facilities (nursing facilities, skilled care, etc) after surgery, and that hospitals where a higher-volume of colorectal operations are performed are more likely to discharge patients back to home after surgery.
Author Interviews, Brigham & Women's - Harvard, Health Care Systems, JAMA, Medical Research Centers, Outcomes & Safety / 17.01.2014

Elliot Wakeam MD Center for Surgery and Public Health Brigham and Women's Hospital Boston MA 02115MedicalResearch.com Interview with Elliot Wakeam MD Center for Surgery and Public Health Brigham and Women's Hospital Boston MA 02115 MedicalResearch.com: What are the main findings of the study? Dr. Wakeam: Our study examined failure to rescue (FTR), or death after postoperative complications, in safety net hospitals. Prior work has shown that hospital clinical resources can improve rescue rates, however, despite having higher levels of technology and other clinical resources that should lead to better rates of patient rescue, safety net hospitals still had greater rates of death after major complications.
Author Interviews, Gastrointestinal Disease, JAMA, Nutrition, Pediatrics / 14.01.2014

Flavia Indrio, MD Department of Pediatrics Aldo Moro University of Bari Bari, ItalyMedicalResearch.com Interview with: Flavia Indrio, MD Department of Pediatrics Aldo Moro University of Bari Bari, Italy MedicalResearch.com: What are the main findings of the study? Answer: The main finding is that for the first time the use in prevention instead of treatment with a probiotic for the colic regurgitation and constipation.
Author Interviews, JAMA, Ophthalmology, Smoking / 14.01.2014

MedicalResearch.com Interview with: Birgitta Ejdervik Lindblad, MD PhD Department of Ophthalmology Örebro University Hospital Örebro, Sweden MedicalResearch.com: What are the main findings of the study? Answer: We have investigated the association between smoking cessation and risk of having a cataract extraction among 44 371 Swedish men aged 45-79 years. During 12 years of follow up we identified 5713 incident cases of cataract extraction. Smoking cessation significantly decreased the risk with time. Men who currently smoked more than 15 cigarettes per day had a 42 % increased risk of cataract extraction compared with men who had never smoked. More than 20 years since quitting smoking, men who had smoked more than 15 cigarettes per day had a 21% increased risk of  having a cataract extraction compared with men who had never smoked. The effect of smoking cessation was observed earlier among men who smoked less than 15 cigarettes per day but more than 2 decades since smoking cessation the risk had not decreased to the level of never smokers.
Author Interviews, JAMA, Nutrition, Pediatrics, University of Michigan / 14.01.2014

Yvonne M. Terry-McElrath, MSA Institute for Social Research, University of Michigan, Ann ArborMedicalResearch.com Interview with: Yvonne M. Terry-McElrath, MSA Institute for Social Research, University of Michigan, Ann Arbor MedicalResearch.com: What are the main findings of the study? Answer: This study examined 2007-2012 commercialism trends in schools attended by nationally representative samples of US elementary and secondary students. While some measures showed significant decreases over time (especially beverage vending measures), most students at both elementary and secondary school levels continued to be exposed to school-based commercialism. Commercialism increased significantly with grade level. The most frequent type of commercialism varied by school level:  food coupons used as incentives was most common at the elementary school level, while exclusive beverage contracts were the most prevalent type of commercialism for middle and high school students.
Alzheimer's - Dementia, Author Interviews, JAMA / 10.01.2014

Maurice Dysken, MD Professor, School of Medicine Department of Psychiatry Minneapolis VA Health Care System, Minneapolis, MinnesotaMedicalResearch.com Interview Invitation Maurice Dysken, MD Professor, School of Medicine Department of Psychiatry Minneapolis VA Health Care System, Minneapolis, Minnesota MedicalResearch.com: What are the main findings of the study? Dr. Dysken: In patients with mild-to-moderate Alzheimer’s disease who were taking an acetylcholinesterase inhibitor, a dosage of 2000 IU/d of vitamin E significantly slowed functional decline compared to placebo by 6.2 months over the mean follow-up period of 2.27 years.  Over this period of time caregiver time increased least in the vitamin E group compared to the other three groups (memantine alone, vitamin E plus memantine, and placebo) although the only statistically significant difference was between vitamin E alone and memantine alone.  There were no significant safety concerns for vitamin E compared to placebo and mortality was lowest in the vitamin E alone group.  It should be noted that patients who were on warfarin were excluded from the study because of a possible interaction with vitamin E that could have possibly increased bleeding events.
Addiction, Author Interviews, JAMA, Mental Health Research / 10.01.2014

Sarah M. Hartz, MD, PhD Assistant Professor of Psychiatry Washington University in St. Louis, MissouriMedicalResearch.com Interview with: Sarah M. Hartz, MD, PhD Assistant Professor of Psychiatry Washington University in St. Louis, Missouri MedicalResearch.com: What are the main findings of this study? Dr. Hartz: This is the first large-scale study to comprehensively evaluate substance use in people with schizophrenia, bipolar disorder, and other severe mental illness.We found that people with severe mental illness have rates of smoking, alcohol use, and other substance use that are 3 to 5 times higher than people in the general population.
Author Interviews, Depression, JAMA, Johns Hopkins, Mental Health Research, Pain Research / 07.01.2014

Madhav Goyal MD, MPH Assistant Professor General Internal Medicine Johns Hopkins School of MedicineMedicalResearch.com Interview with: Madhav Goyal MD, MPH  Assistant Professor General Internal Medicine Johns Hopkins School of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Goyal:
  • The evidence is moderately strong that there is a small but consistent benefit for mindfulness meditation programs to improve 3 symptoms: anxiety, depression, and pain.  We found low level evidence that mindfulness meditation helps with symptoms of stress and distress, as well as with the mental health dimension of quality of life.
  • For the symptoms of anxiety and depression for which we find moderate evidence of benefit, we need to keep in mind that most of the trials didn't study people with a clinical diagnosis of anxiety or depression (although a few did).  Most were studying diverse patient populations who may have had a low level of these symptoms, such as those with  breast cancer, fibromyalgia, organ transplant recipients, and caregivers of people with dementia.
  • We found about a 5-10% improvement in anxiety symptoms compared to placebo groups.  For depression, we found a roughly 10-20% improvement in depressive symptoms compared to the placebo groups. This is similar to the effects that other studies have found for the use of antidepressants in similar populations.
  • While we found that the evidence was moderately strong that mindfulness meditation programs may improve pain, there weren't as many trials evaluating chronic pain, and so we don't understand what kinds of pain this type of meditation may be most useful for.
Alzheimer's - Dementia, Author Interviews, JAMA, Lipids / 02.01.2014

MedicalResearch.com Interview with: Dr. Bruce Reed PhD Professor of Neurology, Associate Director UC Davis Alzheimer's Disease Center Davis, CA 95616 Dr. Bruce Reed PhD Professor of Neurology, Associate Director UC Davis Alzheimer's Disease Center Davis, CA 95616 MedicalResearch.com: What are the main findings of the study? Dr. Reed: We found that high LDL cholesterol and low HDL cholesterol in blood  were both associated with higher amyloid deposition in the brain.  This is potentially very important because the deposition of amyloid seems to be a critical step that kicks off a whole chain of events that eventually lead to Alzheimer's disease.  It is widely believed (although not proven) that if this deposition of amyloid could be blocked that we could greatly decrease the incidence of Alzheimer's.  The connection to cholesterol is exciting because we know a fair amount about how to change cholesterol levels.  A great deal more research needs to be done, but this does suggest a potential new path toward trying to prevent AD.
Author Interviews, Duke, JAMA, Pediatrics, Sexual Health / 31.12.2013

Stewart C. Alexander, PhD Department of Medicine Duke University Medical Center Durham, North CarolinaMedicalResearch.com Interview with: Stewart C. Alexander, PhD Department of Medicine Duke University Medical Center Durham, North Carolina MedicalResearch.com: What are the main findings of the study? Dr. Alexander: Adolescents are reluctant to talk about sex with their doctors and won't raise the topic with their doctors. For physicians, there are common and valid barriers to talking about sexuality with adolescents, including time pressures and discomfort with the topic. Two-thirds of adolescents in our study had some sexuality talk during their annual visit, lasting 36 seconds long. Girls, African Americans, and older teens were more likely to receive sexuality talk. Additionally, longer visits and visits where the physician talked confidentially with their adolescent patient were more likely to have sexuality talk. Our study suggest that sexuality conversations in annual visits can be improved.
Author Interviews, Cognitive Issues, JAMA, Mayo Clinic, Thyroid Disease / 31.12.2013

Ajay K Parsaik, MD, MS Department of Psychiatry and Behavior Sciences The University of Texas Medical School, Houston Department of Neurology and Mayo Alzheimer’s Disease Research Center, Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with: Ajay K Parsaik, MD, MS Department of Psychiatry and Behavior Sciences The University of Texas Medical School, Houston Department of Neurology and Mayo Alzheimer’s Disease Research Center, Mayo Clinic, Rochester, Minnesota MedicalResearch.com: What are the main findings of the study? Dr. Parsaik: Main findings of our study are that clinical and subclinical hypothyroidism is not associated with mild cognitive impairment in an elderly population after accounting for possible confounding factors and interactions.
Allergies, Author Interviews, JAMA, OBGYNE / 29.12.2013

MedicalResearch.com Interview with: Michael C. Young, M.D. Associate Clinical Professor of Pediatrics Harvard Medical School Division of Allergy & Immunology Children's Hospital Boston MedicalResearch.com: What are the main findings of the study? Dr. Young: We found an association between increased maternal peripregnancy consumption of peanuts/ tree nuts and reduced risk of nut allergies in the offspring.
Author Interviews, JAMA, Ophthalmology / 29.12.2013

MedicalResearch.com Interview with: Dr. Yang Liu MedicalResearch.com Interview with: Dr. Yang Liu Preceptor and David A. Sullivan, MS, PhD, FARVO Senior Scientist, Schepens Eye Research Institute Associate Professor, Department of Ophthalmology Harvard Medical School Boston, MA, USA 02114 Founder, Tear Film & Ocular Surface SocietyDr. David A. Sullivan, MS, PhD, FARVO Senior Scientist, Schepens Eye Research Institute, Associate Professor, Department of Ophthalmology Harvard Medical School Boston, MA, USA  02114 MedicalResearch.com: What is the main finding of the study? Answer: We discovered that azithromycin (AZM) can directly stimulate the function of human meibomian gland epithelial cells. Given this finding, it is possible that this antibiotic may prove beneficial as a treatment for meibomian gland dysfunction (MGD), which is the leading cause of dry eye disease in the world.
Author Interviews, JAMA, Pain Research, Pediatrics / 26.12.2013

Scott W. Powers, PhD APBB Division of Behavioral Medicine and Clinical Psychology and Division of Neurology, Cincinnati Children’s Hospital Medical Center Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OhioMedicalResearch.com Interview with: Scott W. Powers, PhD APBB Division of Behavioral Medicine and Clinical Psychology and Division of Neurology, Cincinnati Children’s Hospital Medical Center Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio MedicalResearch.com: What are the main findings of the study? Dr. Powers: Cognitive behavioral therapy plus amitriptyline resulted in greater reductions in days with headache and migraine-related disability compared with the use of headache education plus amitriptyline.  Children and adolescents with chronic migraine began the study with an average of 21 days with headache per 28 days and disability measured in the severe range.  After 20 weeks of treatment, 2 out of 3 participants in the CBT group had a 50% or greater reduction in headache days and 3 out of 4 had a reduction in disability to the mild to none range.
Author Interviews, Gastrointestinal Disease, JAMA, Johns Hopkins, Surgical Research / 22.12.2013

Nita Ahuja, MD Departments of Surgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MarylandMedicalResearch.com Interview with: Nita Ahuja, MD Departments of Surgery and Oncology, Johns Hopkins University School of Medicine Baltimore, Maryland MedicalResearch.com: What are the main findings of the study? Dr. Ahuja: Across the nation, laparoscopic colectomy is performed about as frequently as open colectomy, despite being associated with a lower complication rate and a lower overall hospital cost. On the other hand,  an exponentially growing prevalence was found with robotic colectomy, a procedure that has so far demonstrated only equivalent outcomes with laparoscopic colectomy but a higher overall cost.
Author Interviews, Cost of Health Care, Education, JAMA, University of Pennsylvania / 19.12.2013

Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical CenterMedicalResearch.com Interview with: Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Patel: We evaluated survey responses from nearly 300 internal medicine residency programs directors to assess whether residency programs were teaching residents the fundamental concepts of practicing high-value, cost-conscious care.  We found that 85% of program directors feel that graduate medical education has a responsibility to help curtail the rising costs of health care.  Despite this, about 6 out of every 7 internal medicine residency programs have not yet adopted a formal curriculum teaching new physicians these important concepts.
Author Interviews, Diabetes, JAMA / 18.12.2013

Elbert S. Huang, MD MPH FACP Associate Professor of Medicine University of Chicago 5841 S. Maryland Ave., MC 2007 Chicago, IL 60637MedicalResearch.com Interview with: Elbert S. Huang, MD MPH FACP Associate Professor of Medicine University of Chicago 5841 S. Maryland Ave., MC 2007 Chicago, IL 60637 MedicalResearch.com: What did you find most surprising in these results? Dr. Huang: We did not expect hypoglycemia to rank as highly as it did among the diabetes complications. We were also surprised to find that the rates of cardiovascular and microvascular complications are all dramatically lower than they were in the 1990s.