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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe role of low-dose aspirin as primary prevention among individuals who are at high risk for cardiovascular disease is controversial. Given the greater risk for cardiovascular events among individuals with diabetes, antiplatelet therapy has appeal as a way to reduce the risk of thrombi and subsequent ischemic events in both the primary and secondary setting.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe role of low-dose aspirin as primary prevention among individuals who are at high risk for cardiovascular disease (CVD) is controversial. Given the greater risk for cardiovascular (CV) events among individuals with diabetes, antiplatelet therapy has appeal as a way to reduce the risk of thrombi and subsequent ischemic events in both the primary and secondary setting.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAspirin for Primary Prevention\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe great interest\u2014and uncertainty\u2014about the role of aspirin as primary prevention has been demonstrated by the number of recent meta-analyses on aspirin trials, said Nilay Shah, MD, Mayo Clinic, Rochester, Minnesota, USA. In the most recent meta-analysis, aspirin decreased the risk for CV events and nonfatal myocardial infarction (MI), but there were no significant differences in the incidence of stroke, CV or all-cause mortality, or total coronary heart disease [Bartolucci AA et al. \u003Cem\u003EAm J Caridiol\u003C\/em\u003E 2011]. Five other meta-analyses that focused on patients with diabetes demonstrated a nonsignificant reduction in CV events (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12541\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12541\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12541\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ESummary of Evidence.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDespite the benefits that are associated with aspirin, the benefits must be weighed against the risk of excess bleeding. \u201cHeterogeneity exists in the risk-benefit tradeoff of aspirin,\u201d said Dr. Shah, increasing the challenge of decision-making.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EMost of the benefit of aspirin for men is derived from a reduction in MIs, whereas the greatest benefit for women is a reduction in strokes [Berger JS et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2006]. This difference in benefit is reflected in the United States Prevention Services Task Force guideline, which recommends aspirin for primary prevention for men aged 45 to 79 years and women aged 55 to 79 years when the CV risk outweighs harm; specific risks are defined for each gender and age group (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E) [Wolff T et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2009]. There is no differentiation in recommendations for individuals with diabetes.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12542\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12542\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12542\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EDefinitions of Risk in the US Preventive Services Task Force Recommendations for Aspirin as Primary Prevention.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe guidelines that were set forth by the American Diabetes Association (ADA)\/American Heart Association (AHA)\/American College of Cardiology Foundation (ACCF) in 2010 \u201care quite different than the 2002 guidelines,\u201d said Dr. Shah. The new guideline notes that aspirin therapy for primary prevention may be considered for individuals with type 1 or type 2 diabetes who are at increased CV risk, which is defined as a 10-year risk \u0026gt;10%. The guideline does not recommend aspirin for individuals with diabetes and a low CV risk (10-year risk \u0026lt;5%) and notes that clinical judgment is required for individuals with a 10-year CV risk of 5% to 10% [Pignone M et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. There is no differentiation according to gender.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThese risk thresholds raise several issues. At the population level, if the guideline thresholds are used, an estimated 54 million individuals who take preventive aspirin would benefit, with most of the benefit found among people with a 10-year risk \u0026gt;20% and little benefit found for individuals with a 6% to 10% risk [Sussman JB et al. \u003Cem\u003ECirc Cardiovasc Qual Outcomes\u003C\/em\u003E 2011]. Among the diabetes population, the greatest proportion of individuals (53%) has a CV risk of 10% to 20%, and approximately one-third has a risk \u0026gt;20%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EThe issue of risk is further complicated by the use of additional treatments, as people who are at high CV risk typically take antihypertensives and statins to reduce their risk. The unanswered question of the incremental benefit of aspirin adds complexity to the decision-making process about aspirin use.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EPatients with diabetes already face many challenges, with high numbers of diabetes-related medications, comorbidities, and health care visits. He encouraged clinicians to find ways to engage their patients in making an informed choice about aspirin use. Patients\u0027 preferences and how they value the risk-benefit ratio of aspirin are integral to the decision-making process about aspirin for primary prevention.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERole of Intensive Platelet Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-12\u0022\u003ECan the benefit of aspirin as primary prevention be improved with the addition of another antiplatelet drug? \u201cThere is no evidence for improved efficacy beyond aspirin,\u201d said Stephen D. Wiviott, MD, Cardiovascular Division, Brigham and Women\u0027s Hospital, Boston, Massachusetts, USA. He pointed to the results of the CHARISMA trial, in which low-dose aspirin plus clopidogrel was not more effective than aspirin alone in reducing the rate of MI, stroke, or CV deaths among participants who had either stable CVD or multiple CV risk factors (including type 1 and type 2 diabetes) [Bhatt DL et al. \u003Cem\u003ENEJM\u003C\/em\u003E 2006]. In the group of subjects with multiple risk factors, there was a trend that favored aspirin alone, with increased bleeding and higher mortality rates associated with dual antiplatelet therapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAlthough intensive therapy may not be beneficial as primary prevention, \u201cthe net benefit may be greater in patients with ACS [acute coronary syndrome] and diabetes,\u201d said Dr. Wiviott. \u201cPatients with diabetes have higher event rates with similar or greater reductions in ischemic events with intensive platelet therapy,\u201d he added, discussing the findings of several landmark trials to support the statement.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EFor example, a pooled analysis of data on patients with ACS showed significantly higher all-cause mortality through 1 year after ACS for patients with diabetes compared with patients without diabetes [Donahoe SM et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007]. Rates of stent thrombosis have also been substantially higher among patients with diabetes, with rates 2 to 3 times higher than those among patients without diabetes [Kuchulakanti PK et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2006]. Dr. Wiviott emphasized the importance of this finding, noting that stent thrombosis is the \u201cmost dreaded complication\u201d of percutaneous coronary interventions (PCIs) and is associated with higher mortality among all groups of patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EIntensive antiplatelet therapy has been shown to reduce the risk of these events among all patients (with and without diabetes). For example, in the CURE trial, when compared with aspirin plus placebo, aspirin plus clopidogrel was associated with lower rates of CV death\/MI\/stroke after many types of intervention\u2014medical therapy alone, PCI, or coronary artery bypass grafting [Fox KA et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004]. When the results were compared for patients with and without diabetes, the number of CV events was higher in both treatment groups.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EBecause of the great variability in response to clopidogrel, other, more potent thienopyridines have been developed and compared with clopidogrel. One of these newer agents, prasugrel, was compared with clopidogrel in the TRITON-TIMI 38 trial, which enrolled patients with ACS and a scheduled PCI. Prasugrel was associated with significantly lower rates of CV death\/MI\/stroke (p\u0026lt;0.001) but an increase in major bleeding (p=0.03) [Wiviott SD et al. \u003Cem\u003ENEJM\u003C\/em\u003E 2007]. Again, when the data for patients with and without diabetes were compared, the event rate was higher and the benefit was greater in the diabetic subgroup, with an absolute benefit of 5% (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Wiviott SD et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. There was no increase in bleeding events, granting a greater net benefit to prasugrel.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022TRITON-TIMI 38 Trial: Diabetic Subgroup.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-459493359\u0022 data-figure-caption=\u0022TRITON-TIMI 38 Trial: Diabetic Subgroup.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12539\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-17\u0022 class=\u0022first-child\u0022\u003ETRITON-TIMI 38 Trial: Diabetic Subgroup.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from Wolters Kluwer Health; Greater Clinical Benefit of More Intensive Oral Antiplatelet Therapy With Prasugrel in Patients With Diabetes Mellitus in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38; Wiviott SD et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008;118:1626\u20131636.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EWhen another agent, ticagrelor, was compared with clopidogrel among patients with ACS in the PLATO trial, ticagrelor significantly lowered rates of MI (p=0.005) and death from vascular causes (p=0.001) [Wallentin L et al. \u003Cem\u003ENEJM\u003C\/em\u003E 2009]. Subsequent analysis indicated that ticagrelor was superior to clopidogrel in reducing CV events among the subgroup of patients with diabetes (14.1% vs 16.2%) [Ferreiro JL et al. \u003Cem\u003ECirculation\u003C\/em\u003E in press].\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EOngoing trials, such as the ASCEND (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00135226\u0026amp;atom=%2Fspmdc%2F11%2F8%2F16.atom\u0022\u003ENCT00135226\u003C\/a\u003E) and ACCEPT-D (\u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN48110081\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN48110081\u003C\/a\u003E) trials, will help to better define the benefit of aspirin as primary prevention, specifically among patients with diabetes. In addition, researchers are continuing to explore alternate pathways of platelet inhibition to develop potent antiplatelet drugs with minimal risk of bleeding.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the American Diabetes Association 71st Scientific Sessions presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-459493359\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;The editors would like to thank the many members of the American Diabetes Association 71\u0026amp;lt;sup\u0026amp;gt;st\u0026amp;lt;\/sup\u0026amp;gt; Scientific Sessions presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/16\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12540\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the American Diabetes Association 71\u003Csup\u003Est\u003C\/sup\u003E Scientific Sessions presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/8\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn1i1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn1i1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn1i1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}