{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:59:34Z","timestamp":1787507974388,"version":"build-2736575974"},"reference-count":26,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2018,3,20]],"date-time":"2018-03-20T00:00:00Z","timestamp":1521504000000},"content-version":"vor","delay-in-days":41,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["R01-DK-091437"],"award-info":[{"award-number":["R01-DK-091437"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["R21-DK-106574"],"award-info":[{"award-number":["R21-DK-106574"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["UL1-RR-025764"],"award-info":[{"award-number":["UL1-RR-025764"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["C06-RR-11234"],"award-info":[{"award-number":["C06-RR-11234"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Improved blood pressure control and use of renin-angiotensin-aldosterone system blockers have altered the clinical presentation or phenotype of chronic kidney disease (CKD) in U.S. adults with diabetes. These changes may influence mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Data from the National Health and Nutrition Examination Surveys (NHANES) 1988\u20132006 were used to examine mortality trends in adults with diabetes, defined as physician diagnosis, fasting glucose \u2265126 mg\/dL, HbA1c &amp;gt;6.5% (48 mmol\/mol), or use of glucose-lowering medications. Mortality trends by CKD phenotype (estimated glomerular filtration rate [eGFR] and urine albumin-to-creatinine ratio [ACR] level) were obtained via linkage with the National Death Index through 31 December 2011 while accounting for the complex survey design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>From 1988 to 2006, adults with an eGFR &amp;lt;60 mL\/min\/1.73 m2 and an ACR &amp;lt;30 mg\/g increased from \u223c0.9 million (95% CI 0.7, 1.1) or 6.6% of the total population with diabetes during years 1988\u20131994 to 2.4 million (95% CI 1.9, 2.9) or 10.1% of the total population with diabetes during years 2007\u20132010. Mortality rates generally trended downward for adults with diabetes and an ACR \u226530 mg\/g but increased in those with eGFR &amp;lt;60 mL\/min\/1.73 m2 and an ACR &amp;lt;30 mg\/g from 35 deaths per 1,000 person-years (95% CI 22, 55) during years 1988\u20131994 to 51 deaths per 1,000 person-years (95% CI 33, 83) during years 2003\u20132006.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>ACR values are decreasing in U.S. adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR &amp;lt;30 mg\/g.<\/jats:p>\n                  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E.","family":"Boucher","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Leehey","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Loyola University Chicago, Maywood, IL"},{"name":"Hines Veterans Affairs Medical Center, Hines, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Fried","sequence":"additional","affiliation":[{"name":"Veterans Affairs Pittsburgh Healthcare System and Division of Nephrology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Greene","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia E.","family":"Rosas","sequence":"additional","affiliation":[{"name":"Joslin Diabetes Center and Division of Nephrology, Department of Medicine, Beth Israel Deaconess Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Loyola University Chicago, Maywood, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guichan","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Loyola University Chicago, Maywood, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivasan","family":"Beddhu","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT"},{"name":"Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2018,2,7]]},"reference":[{"key":"2022031301471915100_B1","first-page":"918","article-title":"Increasing prevalence of diagnosed diabetes\u2013United States and Puerto Rico, 1995-2010","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022031301471915100_B2","doi-asserted-by":"crossref","first-page":"e0170219","DOI":"10.1371\/journal.pone.0170219","article-title":"Deaths attributable to diabetes in the United States: comparison of data sources and estimation 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