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PLoS Genet. Aug 2012; 8(8): e1002895.
Published online Aug 30, 2012. doi:  10.1371/journal.pgen.1002895
PMCID: PMC3431328
Genetic Modulation of Lipid Profiles following Lifestyle Modification or Metformin Treatment: The Diabetes Prevention Program
Toni I. Pollin,#1 Tamara Isakova,#2 Kathleen A. Jablonski,3 Paul I. W. de Bakker,4,5,6,7 Andrew Taylor,4,8 Jarred McAteer,4,8 Qing Pan,3 Edward S. Horton,9,10 Linda M. Delahanty,9,10,11 David Altshuler,4,5,8,10,12 Alan R. Shuldiner,1,13 Ronald B. Goldberg,14,15 Jose C. Florez,4,8,10,16 Paul W. Franks,#17,18*, for the Diabetes Prevention Program Research Group and Diabetes Prevention Program Research Group
1Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, and Program in Genetics and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
2Division of Nephrology and Hypertension, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
3The Biostatistics Center, George Washington University, Rockville, Maryland, United States of America
4Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
5Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
6Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
7Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
8Center for Human Genetic Research, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
9Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
10Diabetes Research Center (Diabetes Unit), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
11Diabetes Clinic, Massachusetts General Hospital, Boston, Massachusetts, United States of America
12Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
13Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland, United States of America
14Lipid Disorders Clinic, Division of Endocrinology, Diabetes, and Metabolism, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
15The Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
16Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
17Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
18Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
David B. Allison, Editor
University of Alabama at Birmingham, United States of America
#Contributed equally.
* E-mail: paul.franks/at/med.lu.se (PWF); dppmail/at/biostat.bsc.gwu.edu (DPPRG)
TIP has been a consultant for Isis Pharmaceuticals. TI has received a research grant from NIDDK and honoraria from Shire and Genzyme and has been a consultant for Shire. KAJ (the DPP Genetics Program) has a research grant from NIH. DA has received a research grant from Pfizer and honoraria from academic non-profit (e.g. talks) and has been a consultant for Eisai, MPM Capital, and NanoString. ARS has a NIH research grant. RBG has a research grant from NIH for this study; speaker honoraria from Merck; other research support from Bristol Myers Squibb, GSK, and Roche; and small consultant activities. JCF has received consulting honoraria from Daiichi-Sankyo and AstraZeneca. PWF has received speaking honoraria from Novo Nordisk and other academic/non-profit organisations.
Conceived and designed the experiments: TIP TI JCF PWF. Performed the experiments: ESH LMD ARS RBG. Analyzed the data: TIP KAJ. Contributed reagents/materials/analysis tools: ESH LMD ARS RBG KAJ AT JM QP DA PIWdB. Wrote the paper: TIP TI PWF. Critiqued and approved the manuscript: TIP TI KAJ PIWdB AT JM QP ESH LMD DA ARS RBG JCF PWF.
¶ Membership of the Diabetes Prevention Program Research Group is provided in the Acknowledgments.
Received March 26, 2012; Accepted June 26, 2012.
Weight-loss interventions generally improve lipid profiles and reduce cardiovascular disease risk, but effects are variable and may depend on genetic factors. We performed a genetic association analysis of data from 2,993 participants in the Diabetes Prevention Program to test the hypotheses that a genetic risk score (GRS) based on deleterious alleles at 32 lipid-associated single-nucleotide polymorphisms modifies the effects of lifestyle and/or metformin interventions on lipid levels and nuclear magnetic resonance (NMR) lipoprotein subfraction size and number. Twenty-three loci previously associated with fasting LDL-C, HDL-C, or triglycerides replicated (P = 0.04–1×10−17). Except for total HDL particles (r = −0.03, P = 0.26), all components of the lipid profile correlated with the GRS (partial |r| = 0.07–0.17, P = 5×10−5–1×10−19). The GRS was associated with higher baseline-adjusted 1-year LDL cholesterol levels (β = +0.87, SEE±0.22 mg/dl/allele, P = 8×10−5, Pinteraction = 0.02) in the lifestyle intervention group, but not in the placebo (β = +0.20, SEE±0.22 mg/dl/allele, P = 0.35) or metformin (β = −0.03, SEE±0.22 mg/dl/allele, P = 0.90; Pinteraction = 0.64) groups. Similarly, a higher GRS predicted a greater number of baseline-adjusted small LDL particles at 1 year in the lifestyle intervention arm (β = +0.30, SEE±0.012 ln nmol/L/allele, P = 0.01, Pinteraction = 0.01) but not in the placebo (β = −0.002, SEE±0.008 ln nmol/L/allele, P = 0.74) or metformin (β = +0.013, SEE±0.008 nmol/L/allele, P = 0.12; Pinteraction = 0.24) groups. Our findings suggest that a high genetic burden confers an adverse lipid profile and predicts attenuated response in LDL-C levels and small LDL particle number to dietary and physical activity interventions aimed at weight loss.
The study included 2,993 participants from the Diabetes Prevention Program, a randomized clinical trial of intensive lifestyle intervention, metformin treatment, and placebo control. We examined associations between 32 gene variants that have been reproducibly associated with dyslipidemia and concentrations of lipids and NMR lipoprotein particle sizes and numbers. We also examined whether genetic background influences a person's response to cardioprotective interventions on lipid levels. Our analysis, which focused on determining whether common genetic variants impact the effects of cardioprotective interventions on lipid and lipoprotein particle size, shows that in persons with a high genetic risk score the benefit of intensive lifestyle intervention on LDL and small LDL particle levels is substantially diminished; this information may be informative for the targeted prevention of dyslipidemia, as it suggests that genetics might help identify persons in whom lifestyle intervention is likely to be an effective treatment for elevated lipids and lipoproteins. The NMR subfraction analyses provide novel insight into the biology of dyslipidemia by illustrating how numerous genetic variants that have previously been associated with lipid levels also modulate NMR lipoprotein particle sizes and number. This information may be informative for the targeted prevention of cardiovascular disease.
Dyslipidemia is a strong risk factor for atherosclerotic heart disease [1][3], has a well-defined genetic basis [4], and is modifiable through therapeutic lifestyle changes and weight-loss interventions [5], [6]. Individuals at risk for diabetes are also at high risk of cardiovascular disease [7], and individualized lifestyle intervention programs, like the one incorporated into the Diabetes Prevention Program (DPP), have a salutary effect on dyslipidemia and cardiovascular disease risk in this population. However, the cost of widespread implementation of such interventions has been highlighted as a major limitation [8] and not all benefit equally from such interventions. Identifying persons most likely to benefit from intensive lifestyle modification could provide justification for targeting this subpopulation first, making the clinical translation of findings from studies such as the DPP more feasible.
Selection of persons whose dyslipidemia is likely to respond well to lifestyle interventions or pharmacotherapy could help target resources and optimize prevention strategies. To do so requires knowledge of the underlying risk factors for the trait and knowledge of how personal characteristics interact with exercise, diet, and weight loss. Although the heritability of polygenic dyslipidemia [9][11] and its sequelae [12] have been elucidated, little is known of how lifestyle interventions modify the effects of these loci, singly or in combination, on lipid profiles. Thus, learning how a person's genetic background modulates his or her response to therapeutic lifestyle changes and weight-loss interventions might help optimize the targeting of interventions designed to mitigate cardiovascular and metabolic disease risk.
The purpose of this study was to examine whether loci reliably associated with polygenic dyslipidemia modified the response to cardio-protective interventions in the DPP, a randomized clinical trial of intensive lifestyle modification, metformin treatment, or placebo with standard care. We hypothesized i) that the baseline lipid profiles of DPP participants would be associated with gene variants known to associate with polygenic dyslipidemia and ii) that improvement in lipidemia following treatment would depend on these same genetic variants. We also used NMR spectroscopy to characterize the associations of these previously reported loci with lipoprotein subfractions.
Table 1 shows participant characteristics stratified by DPP treatment arm. The effects of the DPP interventions on 1 yr changes in weight [14], insulin secretion [13], beta-cell function [13], and lipid traits [29] are reported in detail elsewhere.
Table 1
Table 1
Baseline Characteristics of the Study Population by Treatment Group [Quantitative Traits Are Shown as Median (Interquartile Range)].
Individual SNP Replication
Thirty-two SNPs previously associated with triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C) and/or high-density lipoprotein-cholesterol (HDL-C) levels were considered [10]. Thirty-one of these were successfully genotyped in the DPP, and two SNPs in CETP, serving as HapMap proxies (r2≥0.90) for rs173539, including rs247616, were subsequently successfully genotyped, with rs247616 retained as the replacement for rs173539. Twenty-three of these 32 non-redundant SNPs replicated with their respective traits in a directionally consistent manner (P≤0.05), including 8/11 for TG, 9/14 for HDL-C and 8/11 for LDL-C. Two of the SNPs, rs12678919 and rs964184, replicated for both HDL-C and TG (Table S1).
Association of Individual SNPs with All Four Lipid Traits and Ten Lipoprotein Traits
Additionally, we evaluated the associations of the 32 lipid loci with baseline lipids and nuclear magnetic resonance (NMR)-derived lipoprotein traits (Large HDL particles, Small HDL particles, Total HDL particles, HDL size, LDL size, Total LDL particles, Small LDL particles, Total VLDL particles, Large VLDL particles, VLDL size). Of all analyses of baseline traits, roughly one third of the tests were nominally significant associations, and 35 associations were significant after correcting for all 448 hypothesis tests; these involved 12 SNPs and 13 traits (Table S2). Interestingly, SNP rs10401969 did not replicate for LDL-C (C vs. T: β±SEM = −0.1±1.6 mg/dl, additive P = 0.94), but was associated with decreased large VLDL (mean 5.43, 4.26, 4.07 nmol/L for TT, TC, CC genotypes respectively, additive P = 4×10−5) and smaller VLDL size (53.18, 50.94, 49.55 nm, P = 2×10−6). SNP rs7679 did not quite reach nominal significance for decreased HDL-C (C vs. T: β ±SEM = −0.016±0.009 ln mg/dl, additive P = 0.07), but was very strongly associated with increased small HDL particle number (17.93, 20.14 and 21.89 µmol/L for TT, CT and CC genotypes respectively; additive P = 4×10−18) and consequently total HDL particle number (34.07, 35.10 and 36.78 µmol/L, P = 2×10−5).
Association of Genetic Risk Score (GRS) with Baseline Lipid and Lipoprotein Traits
A lipid GRS was calculated for each individual by first replacing missing genotypes with ethnicity-specific imputed means and then adding up the number of risk alleles possessed for each of the 32 independent SNPs. Of the 32 SNPs evaluated, 11 were originally associated in the meta-analysis with LDL cholesterol, 10 with HDL cholesterol only, seven with triglycerides only, and four with both HDL cholesterol and triglycerides. A risk allele was defined as one associated with increased TG or LDL-C or decreased HDL in the original meta-analysis [10]. After adjustment for age, sex, ethnicity, and BMI, the GRS was significantly associated with all baseline traits evaluated except total HDL particles (P = 0.26, Table 2). The following are P-values for the effects of the GRS, as a quantitative covariate, and geometric means for the upper and lower ethnicity-specific GRS quartiles for each trait. A higher GRS was associated with elevated baseline levels of: total cholesterol (P = ×410−11, 206 vs. 195 mg/dl), LDL-C (P = ×910−8;, 129 vs. 121 mg/dl arithmetic means), TG (P = ×410−19, 160 vs. 127 mg/dl), total VLDL particles (P = ×610−14, 67 vs. 53 nmol/L), large VLDL particles (P = ×110−14, 6.57 vs. 4.21 nmol/L), total LDL particles (P = ×210−10, 1412 vs. 1262 nmol/L), small LDL particles (P = ×210−11, 743 vs. 543 nmol/L), small HDL particles (P = µ0.0005, 19.17 vs. 18.10 mol/L), and VLDL particle size (P = ×110−5, 53.86 vs. 51.84 nm). A higher GRS was also associated with lower baseline levels of: HDL-C (P = ×110−15, 43 vs. 47 mg/dl), LDL particle size (P = ×110−19, 0.256 vs. 0.269 nm), large HDL particles (P = ×210−8µ, 2.98 vs. 3.68 mol/L), and HDL particle size (P = 0.0003, 8.82 vs. 8.90 nm). All of these results are consistent with a greater number of risk alleles increasing the atherogenicity of the lipoprotein profile.
Table 2
Table 2
Association of 32-SNP GRS with Baseline Lipid and Lipoprotein Traits (n2,843).
GRS×Intervention Interactions of Baseline-Adjusted One-Year Traits
Two traits showed evidence of GRS×lifestyle interaction: LDL-C (P = 0.02) and small LDL particles (P = 0.01, Table 3; Figure 1; Figure S1a–S1f). For these two traits, there was a residual detrimental impact of GRS in the lifestyle (i.e., the GRS was associated with higher levels at one year even after adjusting for baseline levels) but not the metformin or placebo group, suggesting that the lifestyle intervention was less effective at lipid-lowering in those with a higher genetic burden. A unit (allele) GRS increase was associated with higher residual LDL-C levels in the lifestyle group (β+±0.087, SEE0.022 mg/dl, P = ×810−5) but not in the metformin (β−±0.03, SEE0.22 mg/dl, P = 0.90) or placebo (β+±0.20, SEE0.22 mg/dl, P = 0.35) groups (Figure 1). Similarly, the GRS was associated with higher residual ln-small LDL particles in the lifestyle group (β+±0.030, SEE0.0.012 ln nmol/L, P = 0.01), but not in the metformin (β−±0.013, SEE0.008 ln nm/L, P = 0.12) or placebo (β−±0.002, SEE0.008, P = 0.74) groups (Figure 1×). There were no metforminGRS interactions significant at the P = ×0.05 level. In addition to the three traits discussed, several traits showed residual detrimental effects of the GRS in one or more strata (total cholesterol, TG, LDL size, total VLDL particles, large HDL particles, and HDL size) without any statistical evidence of treatmentGRS interaction (Table 3).
Table 3
Table 3
Association of 32-SNP GRS with Baseline-Adjusted One-Year Lipid and Lipoprotein Traits (n2,686).
Figure 1
Figure 1
LDL-C levels.
In the present study, the majority of previously associated SNPs replicated for baseline lipid traits, and there was a statistically significant relationship between the GRS and the vast majority of standard lipid traits and NMR lipoprotein subfractions. Importantly, in several cases the evidence for association with NMR subfractions was much stronger than for the original standard lipid trait, which may be owing to the relative proximity of the subfractions to the genetic loci. For example, SNP rs7679, originally associated with total HDLC levels in previous GWASs, in the DPP was not significantly associated with HDL-C (P = 0.07) but was strongly associated with small HDL particle levels (P = ×410−18). This SNP is near PLTP, encoding phospholipid transfer protein, a molecule directly influencing HDL particle size [14]. Such findings extend our understanding of lipid biology and suggest that, compared to standard lipid levels, measurements of lipoprotein subfractions may provide a more effective way of capturing genetically influenced risk. This is particularly important, as recent studies have shown that HDL-C is a heterogeneous trait, which in the context of clinical use may benefit from sub-stratification by genotype [15].
We also observed that within the lifestyle group but not the placebo or metformin groups, the GRS was associated with higher LDL-C and small LDL particle levels after one year of intervention. These findings suggest that the genetic burden on these traits cannot be completely overcome by lifestyle modification. However, even those with the greatest genetic burden benefit to a limited extent from lifestyle intervention in terms of LDL-C reduction (Figure 1A), although the effect on LDL particle size reduction is almost completely ablated (Figure 1B'). Even a true residual effect of lifestyle on LDL-C in people with the highest GRS does not negate the clinical relevance of our findings in terms of potential to facilitate tailored treatment decisions. Seeing less of an effect of lifestyle in a particular patient subgroup indicates that these persons may benefit from more frequent surveillance, more intense lifestyle interventions, or aggressive pharmaceutical interventions to supplement lifestyle interventions. Conversely, knowing that lifestyle intervention is likely to be adequate in persons with the lowest genetic burden may maximize the patients diet adherence and potentially reduce the costs and side effects associated with prescribing lipid-lowering medications unnecessarily. The availability of information on genetic background may also facilitate patient-provider dialogue, owing to improved diagnostic accuracy. This is similar to the strategy used to control cholesterol levels in patients with a monogenic disorder such as familial hypercholesterolemia due to a severe loss of function mutation in LDLR, where lifestyle intervention combined with pharmacotherapy is needed to bring LDL-C levels within an acceptable range (Third Report of the NCEP-ATP III on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults).
×It is also important to bear in mind that the interaction effects may be underestimated in our paper. This is because the majority of SNPs included in the GRS are likely to be imperfect proxies for unobserved functional variants, resulting in some degree of genotype misclassification. Moreover, all 32 SNPs were included within the GRS, even though not all SNPs convey statistically significant effects in the DPP and do not individually modify the effects of the interventions. A parsimonious GRS including only those SNPs that are statistically significant in the DPP would likely be overfitted to our data, resulting in biased conclusions about the strength and magnitude of genetreatment interactions.
Dyslipidemia is a long-established risk factor for CVD [1][3]. Thus, the primary and secondary prevention of atherosclerotic CVD often involves intervening on lipid levels [16]. Lifestyle interventions [17] and metformin treatment [18]; that result in weight loss have the potential to improve lipid profiles nevertheless, as long recognized [19], changes in lipid profiles following interventions vary greatly from one person to the next. Some of the variability in response to interventions may be because genotypes modulate the effects of preventive interventions on lipid homeostasis and CVD risk [20].
Of the many known dyslipidemia-predisposing loci discovered so far [10]×, only a handful have been the focus of studies testing hypotheses of genetreatment interactions [21][28], and most of these studies are small (N<150), non-randomized trials of dietary intervention. Although some of these studies have focused on genomic regions that are confirmed to harbor dyslipidemia-predisposing loci, such as APOB, CETP, LIPC and LPL [21], [22], [24][28], no exhaustive studies testing whether GWAS-discovered loci [10], [29], [30] modify response to treatments have been previously reported.
The GRS used in this study attenuated the impact of the DPP lifestyle intervention on LDL levels and small LDL particle number. This suggests that a genetic predisposition to high LDL levels and more small LDL particles is difficult to overcome through lifestyle intervention alone. These data also unmask the effects of an underlying genetic defect of LDL levels and small LDL particles found in individuals with a high genetic burden, which becomes visible when adiposity and blood TG content are reduced through lifestyle intervention. This information may justify the combination of lifestyle and lipid lowering drug treatment from the outset in these individuals, rather than the usual approach of stepping from lifestyle to drug therapy when the former fails.
;The DPP lifestyle intervention prioritized weight loss, daily fat gram intake and physical activity goals over intake of saturated fat, cholesterol, viscous fiber and plant stanols/sterols this may have influenced the nature of the changes in the lipid profile. When compared to the metformin and placebo groups, the lifestyle intervention group reported improved physical activity levels and reductions in calorie intake, resulting in significantly greater weight losses [31], each of which has major influences on TG levels. The lifestyle intervention group reported significantly greater reductions in percent calories from total fat and saturated fat than the metformin and placebo groups [31]. However, they did not, on average, achieve the National Cholesterol Education Program target for saturated fat intake and did not focus on the other therapeutic lifestyle changes, such as the additional dietary changes mentioned above, that often have the largest effects on LDL concentrations. The ethnic diversity of the DPP cohort facilitates the generalizability of results, but may also lead to confounding by population stratification in genetic analyses. However, Sensitivity analyses in the European White sub-cohort of the DPP yielded comparable effect estimates to the results obtained in the entire DPP genetics cohort (results for baseline traits shown in Table S3), supporting the conclusion that confounding by population stratification is unlikely to explain our findings.
×Interestingly, no significant interaction was observed between the GRS and other biochemical components of the lipid profile in the present study. It is important to bear in mind, however, that despite being the largest clinical trial of its kind, the DPP is only moderately powered to detect genetreatment interactions [32];× it is likely, therefore, that genetreatment interactions that are small in magnitude will have been overlooked here. Moreover, during the course of writing this paper, many smaller impact lipid loci have been discovered [9], [11]. Thus, it is possible that with a larger sample size and the inclusion of some or all of these additional loci, we may have discovered interaction effects on other lipid traits.
In summary, we have shown that common genetic loci that influence polygenic dyslipidemia also modify the effects of clinical interventions designed to mitigate cardiovascular and metabolic risk. This report is the first comprehensive effort to examine validated lipid loci within the context of a large randomized clinical trial. The findings of this study may facilitate the implementation of complex trait genetics into the clinical setting.
Participants
The DPP was a multi-center randomized controlled trial that examined the effects of metformin or intensive lifestyle modification on the incidence of type 2 diabetes [33], [34]~~%%~– = . Briefly, overweight persons with elevated but non-diabetic fasting and post-challenge glucose levels were randomized to receive placebo, metformin (850 mg twice daily) or a program of intensive lifestyle modification. The lifestyle intervention was designed to achieve 150 min/wk of physical activity and 7 weight loss via focus on daily fat gram goals. Fat gram goals were based on initial weight and 25 of calories from fat using a calorie level estimate to produce a weight loss of 0.51 kg/wk. The principal endpoint was the development of diabetes by confirmed semi-annual fasting plasma glucose or annual oral glucose tolerance testing (OGTT). Other phenotypes, such as changes in weight, waist circumference, lipids, insulin and glucose, were also ascertained. Written, informed consent was obtained from each participant, and each of the 27 DPP centers obtained institutional review board approval prior to initiation of the study protocol. A total of 2,993 participants in the placebo, lifestyle and metformin groups had DNA available and provided consent for genetic analysis. Individuals taking lipid lowering medications at baseline (n145) were excluded from all analyses.
Measurements
≥[]All participants fasted for 12 hrs the night before blood was drawn from an antecubital vein. Standard blood lipid measurements (triglyceride TG, total cholesterol, HDL-C, calculated LDL-C) were performed at the DPP central biochemistry laboratory. TG and total cholesterol levels were measured using enzymatic methods standardized to the Centers for Disease Control and Prevention reference methods [35]. HDL fractions for cholesterol analysis were obtained by the treatment of whole plasma with dextran sulfate Mg+2 [36]. LDL cholesterol was calculated by the Friedewald equation [37]>β. In participants with TGs4.5 mmol/l, the lipoprotein fractions were separated using preparative ultracentrifugation of plasma by quantification [38]. Lipoprotein subclass particle concentrations and average VLDL, LDL, and HDL particle diameters were measured by NMR spectroscopy at LipoScience, Inc (Raleigh, NC) with modification of existing methods [39].
Genotyping
Thirty-two SNPs previously associated with lipid concentrations in GWAS meta-analyses [10] were selected. DNA was extracted from peripheral blood leukocytes using standard methods. Genotyping was performed by allele-specific primer extension of multiplex amplified products and detection using matrix-assisted laser desorption ionization time-of-flight mass spectrometry on a Sequenom iPLEX platform [40]%%. The mean genotyping success rate was 96.7. The minimum call rate was 94.0. All SNPs were in Hardy-Weinberg equilibrium within each self-reported ethnic group.
Statistical Analysis
The SAS software v9.2 (SAS, Carey, NC) was used for analyses. Baseline total cholesterol, HDL-C, TG and all lipoprotein sub-fraction levels were natural log transformed for non-normality, and LDL-C was evaluated directly. For replicating the previously reported associations of SNPs with baseline traits and evaluating the association of the individual SNPs with NMR lipoprotein particle sizes and numbers, measurements were compared across genotypic groups by ANCOVA (general model, 2 df F test for three possible genotypes), and evidence for an additive effect of genotype was also evaluated using the measured genotype approach, in which each genotype was assigned a value of 0, 1 or 2 according to the number of minor alleles. Analyses of baseline traits were adjusted for age, sex, self-reported ethnicity (to minimize confounding due to potential differences in both allele frequency and lipid traits across ethnicities) and BMI. For the individual SNP analyses, the Bonferroni-corrected P-value for significance was set at P = ; = 0.0001 to account for multiple comparisons (32 SNPs14 traits448 tests 0.05/4480.0001).
A genetic risk score (GRS) was calculated from the 32 SNPs using the direction of association from the initial association seen in the published meta-analysis [10]; for each SNP, an allele was designated as a risk allele if it was associated with higher TG or LDL-C and/or lower HDL-C. In order to be able to incorporate all individuals in the analysis, including those missing genotypes at one or more loci, a simple imputation procedure within each self-reported ethnic group was implemented (in order to account for allele frequency differences across ethnicities) prior to score calculation. First, after coding the genotype as the number of minor alleles (0, 1 or 2), an ethnicity-specific mean genotype was calculated and rounded to the nearest whole number. Missing genotypes were replaced by the appropriate rounded mean genotype [41]%××. We calculated a GRS for each individual by adding up the number of risk alleles for each of the 32 tested SNPs, where a risk allele was defined as one associated with increased TG or LDL-C or decreased HDL. The GRS was then included as a quantitative independent variable in a multiple regression model for each baseline lipid/lipoprotein trait to test for association, adjusted for age, sex, self-reported ethnicity, and BMI. GRS quartiles were constructed separately within each self-reported ethnicity prior to calculating quartile-specific arithmetic means or geometric means and 95 confidence intervals. To test for interaction of the risk score with treatment, a multiple regression model was constructed with the 1 year value as the outcome variable and including GRS, lifestyle and metformin treatment and GRSlifestyle and GRSmetformin terms, along with adjustments for the corresponding baseline trait, baseline age, sex and self-reported ethnicity.
Sample Size and Power
A priori power calculations are an important study-planning tool, providing relevant information on likely effect sizes and variances is accessible. It is possible to obtain a broad understanding of the power constraints of our study by extrapolating results from other experimental settings (as described in detail in [42]), but specific a priori× power calculations could not be performed for the current study because reliable effect estimates and variances for tests of genetreatment interactions for the index genotypes and phenotypes were unavailable in the published literature at the time this study was planned. Post-hoc' power calculations were not performed, as these are well known to cause bias when interpreting a studys results [43][46]. However, confidence intervals are included in the figures, which give insight into the precision of the GRS effect estimates and hence the power to detect those estimates in the DPP cohort.
Figure S1
a: Box plots for Small LDL particles measured at baseline in the placebo arm of the Diabetes Prevention Program stratified by level of the genetic risk score. b: Box plots for Small LDL particles measured at baseline in the metformin arm of the Diabetes Prevention Program stratified by level of the genetic risk score. c: Box plots for Small LDL particles measured at baseline in the lifestyle arm of the Diabetes Prevention Program stratified by level of the genetic risk score. d: Box plots for Small LDL particles measured at 1 yr follow-up in the placebo arm of the Diabetes Prevention Program stratified by level of the genetic risk score. e: Box plots for Small LDL particles measured at 1 yr follow-up in the metformin arm of the Diabetes Prevention Program stratified by level of the genetic risk score. f: Box plots for Small LDL particles measured at 1 yr follow-up in the lifestyle arm of the Diabetes Prevention Program stratified by level of the genetic risk score.
(PPTX)
Table S1
≤Details of individual SNP replication results (n2,843). The table compares results for each of the SNP loci in published meta-analysis and elsewhere with those reported here in the DPP. Analyses and means adjusted for age, sex, ethnicity and BMI.
(DOCX)
Table S2
<Associations of individual SNPs with lipid or lipoprotein traits significant at the Bonferroni-significant p-value of 0.0001 for additive model (see Table 1 for units). Shown are geometric means for all traits except LDL-C, for which arithmetic means are shown. All analyses and means adjusted for age, sex, ethnicity and BMI.
(DOCX)
Table S3
 = Associations of individual SNPs with lipid or lipoprotein traits measured at baseline in White participants from the DPP (n1,565). Analyses were performed to determine whether population stratification owing to the mutliethnic nature of the DPP is likely to confound the associations reported in the main analyses. The comparability of the results in White DPP participants with the main analyses indicates that confoudning by population stratification is unlikely to underly the main results reported here. Analyses and means adjusted for age, sex, and BMI.
(DOCX)
Acknowledgments
The Investigators gratefully acknowledge the commitment and dedication of the participants of the DPP.
List of all DPP staff:
Pennington Biomedical Research Center (Baton Rouge, LA)
George A. Bray, MD*
Iris W. Culbert, BSN, RN, CCRC**
Catherine M. Champagne, PhD, RD
Barbara Eberhardt, RD, LDN
Frank Greenway, MD
Fonda G. Guillory, LPN
April A. Herbert, RD
Michael L. Jeffirs, LPN
Betty M. Kennedy, MPA
Jennifer C. Lovejoy, PhD
Laura H. Morris, BS
Lee E. Melancon, BA, BS
Donna Ryan, MD
Deborah A. Sanford, LPN
Kenneth G. Smith, BS, MT
Lisa L. Smith, BS
Julia A. St.Amant, RTR
Richard T. Tulley, PhD
Paula C. Vicknair, MS, RD
Donald Williamson, PhD
Jeffery J. Zachwieja, PhD
University of Chicago (Chicago, IL)
Kenneth S. Polonsky, MD*
Janet Tobian, MD, PhD*
David Ehrmann, MD*
Margaret J. Matulik, RN, BSN**
Bart Clark, MD
Kirsten Czech, MS
Catherine DeSandre, BA
Ruthanne Hilbrich, RD
Wylie McNabb, EdD
Ann R. Semenske, MS, RD
Jefferson Medical College (Philadelphia, PA)
Jose F. Caro, MD*
Pamela G. Watson, RN, ScD*
Barry J. Goldstein, MD, PhD*
Kellie A. Smith, RN, MSN**
Jewel Mendoza, RN, BSN**
Renee Liberoni, MPH
Constance Pepe, MS, RD
John Spandorfer, MD
University of Miami (Miami, FL)
Richard P. Donahue, PhD*
Ronald B. Goldberg, MD*
Ronald Prineas, MD, PhD*
Patricia Rowe, MPA**
Jeanette Calles, MSEd
Paul Cassanova-Romero, MD
Hermes J. Florez, MD
Anna Giannella, RD, MS
Lascelles Kirby, MS
Carmen Larreal
Valerie McLymont, RN
Jadell Mendez
Juliet Ojito, RN
Arlette Perry, PhD
Patrice Saab, PhD
The University of Texas Health Science Center (San Antonio, TX)
Steven M. Haffner, MD, MPH*
Maria G. Montez, RN, MSHP, CDE**
Carlos Lorenzo, MD, PhD
Arlene Martinez, RN, BSN, CDE
University of Colorado (Denver, CO)
Richard F. Hamman, MD, DrPH*
Patricia V. Nash, MS**
Lisa Testaverde, MS**
Denise R. Anderson, RN, BSN
Larry B. Ballonoff, MD
Alexis Bouffard, MA,
B. Ned Calonge, MD, MPH
Lynne Delve
Martha Farago, RN
James O. Hill, PhD
Shelley R. Hoyer, BS
Bonnie T. Jortberg, MS, RD, CDE
Dione Lenz, RN, BSN
Marsha Miller, MS, RD
David W. Price, MD
Judith G. Regensteiner, PhD
Helen Seagle, MS, RD
Carissa M. Smith, BS
Sheila C. Steinke, MS
Brent VanDorsten, PhD
Joslin Diabetes Center (Boston, MA)
Edward S. Horton, MD*
Kathleen E. Lawton, RN**
Ronald A. Arky, MD
Marybeth Bryant
Jacqueline P. Burke, BSN
Enrique Caballero, MD
Karen M. Callaphan, BA
Om P. Ganda, MD
Therese Franklin
Sharon D. Jackson, MS, RD, CDE
Alan M. Jacobsen, MD
Lyn M. Kula, RD
Margaret Kocal, RN, CDE
Maureen A. Malloy, BS
Maryanne Nicosia, MS, RD
Cathryn F. Oldmixon, RN
Jocelyn Pan, BS, MPH
Marizel Quitingon
Stacy Rubtchinsky, BS
Ellen W. Seely, MD
Dana Schweizer, BSN
Donald Simonson, MD
Fannie Smith, MD
Caren G. Solomon, MD, MPH
James Warram, MD
VA Puget Sound Health Care System and University of Washington (Seattle, WA)
Steven E. Kahn, MB, ChB*
Brenda K. Montgomery, RN, BSN, CDE**
Wilfred Fujimoto, MD
Robert H. Knopp, MD
Edward W. Lipkin, MD
Michelle Marr, BA
Dace Trence, MD
University of Tennessee (Memphis, TN)
Abbas E. Kitabchi, PhD, MD, FACP*
Mary E. Murphy, RN, MS, CDE, MBA**
William B. Applegate, MD, MPH
Michael Bryer-Ash, MD
Sandra L. Frieson, RN
Raed Imseis, MD
Helen Lambeth, RN, BSN
Lynne C. Lichtermann, RN, BSN
Hooman Oktaei, MD
Lily M.K. Rutledge, RN, BSN
Amy R. Sherman, RD, LD
Clara M. Smith, RD, MHP, LDN
Judith E. Soberman, MD
Beverly Williams-Cleaves, MD
Northwestern University's Feinberg School of Medicine (Chicago, IL)
Boyd E. Metzger, MD*
Mariana K. Johnson, MS, RN**
Catherine Behrends
Michelle Cook, MS
Marian Fitzgibbon, PhD
Mimi M. Giles, MS, RD
Deloris Heard, MA
Cheryl K.H. Johnson, MS, RN
Diane Larsen, BS
Anne Lowe, BS
Megan Lyman, BS
David McPherson, MD
Mark E. Molitch, MD
Thomas Pitts, MD
Renee Reinhart, RN, MS
Susan Roston, RN, RD
Pamela A. Schinleber, RN, MS
Massachusetts General Hospital (Boston, MA)
David M. Nathan, MD*
Charles McKitrick, BSN**
Heather Turgeon, BSN**
Kathy Abbott
Ellen Anderson, MS, RD
Laurie Bissett, MS, RD
Enrico Cagliero, MD
Jose C. Florez, MD, PhD+
Linda Delahanty, MS, RD
Valerie Goldman, MS, RD
Alexandra Poulos
University of California-San Diego (San Diego, CA)
Jerrold M. Olefsky, MD*
Mary Lou Carrion-Petersen, RN, BSN**
Elizabeth Barrett-Connor, MD
Steven V. Edelman, MD
Robert R. Henry, MD
Javiva Horne, RD
Simona Szerdi Janesch, BA
Diana Leos, RN, BSN
Sundar Mudaliar, MD
William Polonsky, PhD
Jean Smith, RN
Karen Vejvoda, RN, BSN, CDE, CCRC
St. Luke's-Roosevelt Hospital (New York, NY)
F. Xavier Pi-Sunyer, MD*
Jane E. Lee, MS**
David B. Allison, PhD
Nancy J. Aronoff, MS, RD
Jill P. Crandall, MD
Sandra T. Foo, MD
Carmen Pal, MD
Kathy Parkes, RN
Mary Beth Pena, RN
Ellen S. Rooney, BA
Gretchen E.H. Van Wye, MA
Kristine A. Viscovich, ANP
Indiana University (Indianapolis, IN)
David G. Marrero, PhD*
Melvin J. Prince, MD*
Susie M. Kelly, RN, CDE**
Yolanda F. Dotson, BS
Edwin S. Fineberg, MD
John C. Guare, PhD
Angela M. Hadden
James M. Ignaut, MA
Marcia L. Jackson
Marion S. Kirkman, MD
Kieren J. Mather, MD
Beverly D. Porter, MSN
Paris J. Roach, MD
Nancy D. Rowland, BS, MS
Madelyn L. Wheeler, RD
Medstar Research Institute (Washington, DC)
Robert E. Ratner, MD*
Gretchen Youssef, RD, CDE**
Sue Shapiro, RN, BSN, CCRC**
Catherine Bavido-Arrage, MS, RD, LD
Geraldine Boggs, MSN, RN
Marjorie Bronsord, MS, RD, CDE
Ernestine Brown
Wayman W. Cheatham, MD
Susan Cola
Cindy Evans
Peggy Gibbs
Tracy Kellum, MS, RD, CDE
Claresa Levatan, MD
Asha K. Nair, BS
Maureen Passaro, MD
Gabriel Uwaifo, MD
University of Southern California/UCLA Research Center (Alhambra, CA)
Mohammed F. Saad, MD*
Maria Budget**
Sujata Jinagouda, MD**
Khan Akbar, MD
Claudia Conzues
Perpetua Magpuri
Kathy Ngo
Amer Rassam, MD
Debra Waters
Kathy Xapthalamous
Washington University (St. Louis, MO)
Julio V. Santiago, MD (deceased)*
Samuel Dagogo-Jack, MD, MSc, FRCP, FACP*
Neil H. White, MD, CDE*
Samia Das, MS, MBA, RD, LD**
Ana Santiago, RD**
Angela Brown, MD
Edwin Fisher, PhD
Emma Hurt, RN
Tracy Jones, RN
Michelle Kerr, RD
Lucy Ryder, RN
Cormarie Wernimont, MS, RD
Johns Hopkins School of Medicine (Baltimore, MD)
Christopher D. Saudek, MD*
Vanessa Bradley, BA**
Emily Sullivan, MEd, RN**
Tracy Whittington, BS**
Caroline Abbas
Frederick L. Brancati, MD, MHS
Jeanne M. Clark, MD
Jeanne B. Charleston, RN, MSN
Janice Freel
Katherine Horak, RD
Dawn Jiggetts
Deloris Johnson
Hope Joseph
Kimberly Loman
Henry Mosley
Richard R. Rubin, PhD
Alafia Samuels, MD
Kerry J. Stewart, EdD
Paula Williamson
University of New Mexico (Albuquerque, NM)
David S. Schade, MD*
Karwyn S. Adams, RN, MSN**
Carolyn Johannes, RN, CDE**
Leslie F. Atler, PhD
Patrick J. Boyle, MD
Mark R. Burge, MD
Janene L. Canady, RN, CDE
Lisa Chai, RN
Ysela Gonzales, RN, MSN
Doris A. Hernandez-McGinnis
Patricia Katz, LPN
Carolyn King
Amer Rassam, MD
Sofya Rubinchik, MD
Willette Senter, RD
Debra Waters, PhD
Albert Einstein College of Medicine (Bronx, NY)
Harry Shamoon, MD*
Janet O. Brown, RN, MPH, MSN**
Elsie Adorno, BS
Liane Cox, MS, RD
Jill Crandall, MD
Helena Duffy, MS, C-ANP
Samuel Engel, MD
Allison Friedler, BS
Crystal J. Howard-Century, MA
Stacey Kloiber, RN
Nadege Longchamp, LPN
Helen Martinez, RN, MSN, FNP-C
Dorothy Pompi, BA
Jonathan Scheindlin, MD
Elissa Violino, RD, MS
Elizabeth Walker, RN, DNSc, CDE
Judith Wylie-Rosett, EdD, RD
Elise Zimmerman, RD, MS
Joel Zonszein, MD
University of Pittsburgh (Pittsburgh, PA)
Trevor Orchard, MD*
Rena R. Wing, PhD*
Gaye Koenning, MS, RD**
M. Kaye Kramer, BSN, MPH**
Susan Barr, BS
Miriam Boraz
Lisa Clifford, BS
Rebecca Culyba, BS
Marlene Frazier
Ryan Gilligan, BS
Susan Harrier, MLT
Louann Harris, RN
Susan Jeffries, RN, MSN
Andrea Kriska, PhD
Qurashia Manjoo, MD
Monica Mullen, MHP, RD
Alicia Noel, BS
Amy Otto, PhD
Linda Semler, MS, RD
Cheryl F. Smith, PhD
Marie Smith, RN, BSN
Elizabeth Venditti, PhD
Valarie Weinzierl, BS
Katherine V. Williams, MD, MPH
Tara Wilson, BA
University of Hawaii (Honolulu, HI)
Richard F. Arakaki, MD*
Renee W. Latimer, BSN, MPH**
Narleen K. Baker-Ladao, BS
Ralph Beddow, MD
Lorna Dias, AA
Jillian Inouye, RN, PhD
Marjorie K. Mau, MD
Kathy Mikami, BS, RD
Pharis Mohideen, MD
Sharon K. Odom, RD, MPH
Raynette U. Perry, AA
;Southwest American Indian Centers (Phoenix, AZ Shiprock, ;NM Zuni, NM)
William C. Knowler, MD, DrPH+*
Norman Cooeyate**
Mary A. Hoskin, RD, MS**
Carol A. Percy, RN, MS**
Kelly J. Acton, MD, MPH
Vickie L. Andre, RN, FNP
Rosalyn Barber
Shandiin Begay, MPH
Peter H. Bennett, MB, FRCP
Mary Beth Benson, RN, BSN
Evelyn C. Bird, RD, MPH
Brenda A. Broussard, RD, MPH, MBA, CDE
Marcella Chavez, RN, AS
Tara Dacawyma
Matthew S. Doughty, MD
Roberta Duncan, RD
Cyndy Edgerton, RD
Jacqueline M. Ghahate
Justin Glass, MD
Martia Glass, MD
Dorothy Gohdes, MD
Wendy Grant, MD
Robert L. Hanson, MD, MPH
Ellie Horse
Louise E. Ingraham, MS, RD, LN
Merry Jackson
Priscilla Jay
Roylen S. Kaskalla
David Kessler, MD
Kathleen M. Kobus, RNC-ANP
Jonathan Krakoff, MD
Catherine Manus, LPN
Sara Michaels, MD
Tina Morgan
Yolanda Nashboo (deceased)
Julie A. Nelson, RD
Steven Poirier, MD
Evette Polczynski, MD
Mike Reidy, MD
Jeanine Roumain, MD, MPH
Debra Rowse, MD
Sandra Sangster
Janet Sewenemewa
Darryl Tonemah, PhD
Charlton Wilson, MD
Michelle Yazzie
George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Raymond Bain, PhD*
Sarah Fowler, PhD*
Tina Brenneman**
Solome Abebe
Julie Bamdad, MS
Jackie Callaghan
Sharon L. Edelstein, ScM
Yuping Gao
Kristina L. Grimes
Nisha Grover
Lori Haffner, MS
Steve Jones
Tara L. Jones
Richard Katz, MD
John M. Lachin, ScD
Pamela Mucik
Robert Orlosky
James Rochon, PhD
Alla Sapozhnikova
Hanna Sherif, MS
Charlotte Stimpson
Marinella Temprosa, MS
Fredricka Walker-Murray
Central Biochemistry Laboratory (Seattle, WA)
Santica Marcovina, PhD, ScD*
Greg Strylewicz, PhD**
F. Alan Aldrich
Carotid Ultrasound
Dan O'Leary, MD*
CT Scan Reading Center
Elizabeth Stamm, MD*
Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
Pentti Rautaharju, MD, PhD*
Ronald J. Prineas, MD, PhD*/*
Teresa Alexander
Charles Campbell, MS
Sharon Hall
Yabing Li, MD
Margaret Mills
Nancy Pemberton, MS
Farida Rautaharju, PhD
Zhuming Zhang, MD
Nutrition Coding Center (Columbia, SC)
Elizabeth Mayer-Davis, PhD*
Robert R. Moran, PhD**
Quality of Well-Being Center (La Jolla, CA)
Ted Ganiats, MD*
Kristin David, MHP*
Andrew J. Sarkin, PhD*
NIH/NIDDK (Bethesda, MD)
R. Eastman, MD
Judith Fradkin, MD
Sanford Garfield, PhD
&Centers for Disease Control Prevention (Atlanta, GA)
Edward Gregg, PhD
Ping Zhang, PhD
University of Michigan (Ann Arbor, MI)
William Herman, MD, MPH
Genetics Working Group
Jose C. Florez, MD, PhD1, 2
David Altshuler, MD, PhD1, 2
Paul I.W. de Bakker, PhD2
Paul W. Franks, PhD, MPhil, MS6, 7
Robert L. Hanson, MD, MPH3
Kathleen Jablonski, PhD5
William C. Knowler, MD, DrPH3
Jarred B. McAteer, AB1, 2
Toni I. Pollin, PhD4
Alan R. Shuldiner, MD4
1 Massachusetts General Hospital, Boston, Massachusetts, United States of America,
2 Broad Institute, Cambridge, Massachusetts, United States of America,
3 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America,
4 University of Maryland, College Park, Maryland, United States of America,
5 Coordinating Center, Millersville, Maryland, United States of America,
6 Lund University, Lund, Sweden,
7 Harvard School of Public Health, Boston, Massachusetts, United States of America
Funding Statement
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health provided funding to the clinical centers and the Coordinating Center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. The Southwestern American Indian Centers were supported directly by the NIDDK and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, supported data collection at many of the clinical centers. Funding for data collection and participant support was also provided by the Office of Research on Minority Health, the National Institute of Child Health and Human Development, the National Institute on Aging, the Centers for Disease Control and Prevention, the Office of Research on Women's Health, and the American Diabetes Association. Bristol-Myers Squibb and Parke-Davis provided medication. This research was also supported, in part, by the intramural research program of the NIDDK. LifeScan, Health O Meter, Hoechst Marion Roussel, Merck-Medco Managed Care, Merck, Nike Sports Marketing, Slim Fast Foods, and Quaker Oats donated materials, equipment, or medicines for concomitant conditions. McKesson BioServices, Matthews Media Group, and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center. The opinions expressed are those of the investigators and do not necessarily reflect the views of the Indian Health Service or other funding agencies. A complete list of centers, investigators, and staff is shown in the Acknowledgments. Genetics research in the DPP and the work reported in this manuscript was supported in part by R01 DK072041 to DA, JCF, KAJ, TIP, and ARS (PWF was an unpaid co-investigator) and by a Doris Duke Charitable Foundation Distinguished Scientist Clinical Award to DA. TI was supported by NIH grant K23DK087858. JCF is supported by a Physician Scientist Development Award by theMassachusetts General Hospital and a Clinical Scientist Development Award from the Doris Duke Charitable Foundation. PWF was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, Påhlssons Foundation, and Novo Nordisk Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Contributor Information
Diabetes Prevention Program Research Group:
MD George A. Bray, BSN, RN, CCRC Iris W. Culbert, PhD, RD Catherine M. Champagne, RD, LDN Barbara Eberhardt, MD Frank Greenway, LPN Fonda G. Guillory, RD April A. Herbert, LPN Michael L. Jeffirs, MPA Betty M. Kennedy, PhD Jennifer C. Lovejoy, BS Laura H. Morris, BA, BS Lee E. Melancon, MD Donna Ryan, LPN Deborah A. Sanford, BS, MT Kenneth G. Smith, BS Lisa L. Smith, RTR Julia A. St. Amant, PhD Richard T. Tulley, MS, RD Paula C. Vicknair, PhD Donald Williamson, PhD Jeffery J. Zachwieja, MD Kenneth S. Polonsky, MD, PhD Janet Tobian, MD David Ehrmann, RN, BSN Margaret J. Matulik, MD Bart Clark, MS Kirsten Czech, BA Catherine DeSandre, RD Ruthanne Hilbrich, EdD Wylie McNabb, MS, RD Ann R. Semenske, MD Jose F. Caro, RN, ScD Pamela G. Watson, MD, PhD Barry J. Goldstein, RN, MSN Kellie A. Smith, RN, BSN Jewel Mendoza, MPH Renee Liberoni, MS, RD Constance Pepe, MD John Spandorfer, PhD Richard P. Donahue, MD Ronald B. Goldberg, MD, PhD Ronald Prineas, MPA Patricia Rowe, MSEd Jeanette Calles, MD Paul Cassanova-Romero, MD Hermes J. Florez, RD, MS Anna Giannella, MS Lascelles Kirby, Carmen Larreal, RN Valerie McLymont, Jadell Mendez, RN Juliet Ojito, PhD Arlette Perry, PhD Patrice Saab, MD, MPH Steven M. Haffner, RN, MSHP, CDE Maria G. Montez, MD, PhD Carlos Lorenzo, RN, BSN, CDE Arlene Martinez, MD, DrPH Richard F. Hamman, MS Patricia V. Nash, MS Lisa Testaverde, RN, BSN Denise R. Anderson, MD Larry B. Ballonoff, MA Alexis Bouffard, MD, MPH B. Ned Calonge, Lynne Delve, RN Martha Farago, PhD James O. Hill, BS Shelley R. Hoyer, MS, RD, CDE Bonnie T. Jortberg, RN, BSN Dione Lenz, MS, RD Marsha Miller, MD David W. Price, PhD Judith G. Regensteiner, MS, RD Helen Seagle, BS Carissa M. Smith, MS Sheila C. Steinke, PhD Brent VanDorsten, MD Edward S. Horton, RN Kathleen E. Lawton, MD Ronald A. Arky, Marybeth Bryant, BSN Jacqueline P. Burke, MD Enrique Caballero, BA Karen M. Callaphan, MD Om P. Ganda, Therese Franklin, MS, RD, CDE Sharon D. Jackson, MD Alan M. Jacobsen, MD Alan M. Jacobsen, RD Lyn M. Kula, RN, CDE Margaret Kocal, BS Maureen A. Malloy, MS, RD Maryanne Nicosia, RN Cathryn F. Oldmixon, BS, MPH Jocelyn Pan, Marizel Quitingon, BS Stacy Rubtchinsky, MD Ellen W. Seely, BSN Dana Schweizer, MD Donald Simonson, MD Fannie Smith, MD, MPH Caren G. Solomon, MD James Warram, MB, ChB Steven E. Kahn, RN, BSN, CDE Brenda K. Montgomery, MD Wilfred Fujimoto, MD Robert H. Knopp, MD Edward W. Lipkin, BA Michelle Marr, MD Dace Trence, PhD, MD, FACP Abbas E. Kitabchi, RN, MS, CDE, MBA Mary E. Murphy, MD, MPH William B. Applegate, MD Michael Bryer-Ash, RN Sandra L. Frieson, MD Raed Imseis, RN, BSN Helen Lambeth, RN, BSN Lynne C. Lichtermann, MD Hooman Oktaei, RN, BSN Lily M.K. Rutledge, RD, LD Amy R. Sherman, RD, MHP, LDN Clara M. Smith, MD Judith E. Soberman, MD Beverly Williams-Cleaves, MD Boyd E. Metzger, MS, RN Mariana K. Johnson, Catherine Behrends, MS Michelle Cook, PhD Marian Fitzgibbon, MS, RD Mimi M. Giles, MA Deloris Heard, MS, RN Cheryl K.H. Johnson, BS Diane Larsen, BS Anne Lowe, BS Megan Lyman, MD David McPherson, MD Mark E. Molitch, MD Thomas Pitts, RN, MS Renee Reinhart, RN, RD Susan Roston, RN, MS Pamela A. Schinleber, MD David M. Nathan, BSN Charles McKitrick, BSN Heather Turgeon, Kathy Abbott, MS, RD Ellen Anderson, MS, RD Laurie Bissett, MD Enrico Cagliero, MD, PhD Jose C. Florez, MS, RD Linda Delahanty, MS, RD Valerie Goldman, Alexandra Poulos, MD Jerrold M. Olefsky, RN, BSN Mary Lou Carrion-Petersen, MD Elizabeth Barrett-Connor, MD Steven V. Edelman, MD Robert R. Henry, RD Javiva Horne, BA Simona Szerdi Janesch, RN, BSN Diana Leos, MD Sundar Mudaliar, PhD William Polonsky, RN Jean Smith, RN, BSN, CDE, CCRC Karen Vejvoda, MD F. Xavier Pi-Sunyer, MS Jane E. Lee, PhD David B. Allison, MS, RD Nancy J. Aronoff, MD Jill P. Crandall, MD Sandra T. Foo, MD Carmen Pal, RN Kathy Parkes, RN Mary Beth Pena, BA Ellen S. Rooney, MA Gretchen E.H. Van Wye, ANP Kristine A. Viscovich, PhD David G. Marrero, MD Melvin J. Prince, RN, CDE Susie M. Kelly, BS Yolanda F. Dotson, MD Edwin S. Fineberg, PhD John C Guare, Angela M. Hadden, MA James M. Ignaut, Marcia L. Jackson, MD Marion S. Kirkman, MD Kieren J. Mather, MSN Beverly D. Porter, MD Paris J. Roach, BS, MS Nancy D. Rowland, RD Madelyn L. Wheeler, MD Robert E. Ratner, RD, CDE Gretchen Youssef, RN, BSN, CCRC Sue Shapiro, MS, RD, LD Catherine Bavido-Arrage, MSN, RN Geraldine Boggs, MS, RD, CDE Marjorie Bronsord, Ernestine Brown, MD Wayman W. Cheatham, Susan Cola, Cindy Evans, Peggy Gibbs, MS, RD, CDE Tracy Kellum, MD Claresa Levatan, BS Asha K. Nair, MD Maureen Passaro, MD Gabriel Uwaifo, MD Mohammed F. Saad, Maria Budget, MD Sujata Jinagouda, MD Khan Akbar, Claudia Conzues, Perpetua Magpuri, Kathy Ngo, MD Amer Rassam, Debra Waters, Kathy Xapthalamous, MD Julio V. Santiago, MD, MSc, FRCP, FACP Samuel Dagogo-Jack, MD, CDE Neil H. White, MS, MBA, RD, LD Samia Das, RD Ana Santiago, MD Angela Brown, PhD Edwin Fisher, RN Emma Hurt, RN Tracy Jones, RD Michelle Kerr, RN Lucy Ryder, MS, RD Cormarie Wernimont, MD Christopher D. Saudek, BA Vanessa Bradley, MEd, RN Emily Sullivan, BS Tracy Whittington, Caroline Abbas, MD, MHS Frederick L. Brancati, MD Jeanne M. Clark, RN, MSN Jeanne B. Charleston, Janice Freel, RD Katherine Horak, Dawn Jiggetts, Deloris Johnson, Hope Joseph, Kimberly Loman, Henry Mosley, PhD Richard R. Rubin, MD Alafia Samuels, EdD Kerry J. Stewart, Paula Williamson, MD David S. Schade, RN, MSN Karwyn S. Adams, RN, CDE Carolyn Johannes, PhD Leslie F. Atler, MD Patrick J. Boyle, MD Mark R. Burge, RN, CDE Janene L. Canady, RN Lisa Chai, RN, MSN Ysela Gonzales, Doris A. Hernandez-McGinnis, LPN Patricia Katz, Carolyn King, MD Amer Rassam, MD Sofya Rubinchik, RD Willette Senter, PhD Debra Waters, MD Harry Shamoon, RN, MPH, MSN Janet O. Brown, BS Elsie Adorno, MS, RD Liane Cox, MD Jill Crandall, MS, C-ANP Helena Duffy, MD Samuel Engel, BS Allison Friedler, MA Crystal J. Howard-Century, RN Stacey Kloiber, LPN Nadege Longchamp, RN, MSN, FNP-C Helen Martinez, BA Dorothy Pompi, MD Jonathan Scheindlin, RD, MS Elissa Violino, RN, DNSc, CDE Elizabeth Walker, EdD, RD Judith Wylie-Rosett, RD, MS Elise Zimmerman, MD Joel Zonszein, MD Trevor Orchard, PhD Rena R. Wing, MS, RD Gaye Koenning, BSN, MPH M. Kaye Kramer, BS Susan Barr, Miriam Boraz, BS Lisa Clifford, BS Rebecca Culyba, Marlene Frazier, BS Ryan Gilligan, MLT Susan Harrier, RN Louann Harris, RN, MSN Susan Jeffries, PhD Andrea Kriska, MD Qurashia Manjoo, MHP, RD Monica Mullen, BS Alicia Noel, PhD Amy Otto, Linda Semler, PhD Cheryl F. Smith, RN, BSN Marie Smith, PhD Elizabeth Venditti, BS Valarie Weinzierl, MD, MPH Katherine V. Williams, BA Tara Wilson, MD Richard F. Arakaki, BSN, MPH Renee W. Latimer, BS Narleen K. Baker-Ladao, MD Ralph Beddow, AA Lorna Dias, RN, PhD Jillian Inouye, MD Marjorie K. Mau, BS, RD Kathy Mikami, MD Pharis Mohideen, RD, MPH Sharon K. Odom, AA Raynette U. Perry, MD, DrPH William C. Knowler, Norman Cooeyate, RD, MS Mary A. Hoskin, RN, MS Carol A. Percy, MD, MPH Kelly J. Acton, RN, FNP Vickie L. Andre, Rosalyn Barber, MPH Shandiin Begay, MB, FRCP Peter H. Bennett, RN, BSN Mary Beth Benson, RD, MPH Evelyn C. Bird, RD, MPH, MBA, CDE Brenda A. Broussard, RN, AS Marcella Chavez, Tara Dacawyma, MD Matthew S. Doughty, RD Roberta Duncan, RD Cyndy Edgerton, Jacqueline M. Ghahate, MD Justin Glass, MD Martia Glass, MD Dorothy Gohdes, MD Wendy Grant, MD, MPH Robert L. Hanson, Ellie Horse, MS, RD, LN Louise E. Ingraham, Merry Jackson, Priscilla Jay, Roylen S. Kaskalla, MD David Kessler, RNC-ANP Kathleen M. Kobus, MD Jonathan Krakoff, LPN Catherine Manus, MD Sara Michaels, Tina Morgan, Yolanda Nashboo, RD Julie A. Nelson, MD Steven Poirier, MD Evette Polczynski, MD Mike Reidy, MD, MPH Jeanine Roumain, MD Debra Rowse, Sandra Sangster, Janet Sewenemewa, PhD Darryl Tonemah, MD Charlton Wilson, Michelle Yazzie, PhD Raymond Bain, PhD Sarah Fowler, Tina Brenneman, Solome Abebe, MS Julie Bamdad, Jackie Callaghan, ScM Sharon L. Edelstein, Yuping Gao, Kristina L. Grimes, Nisha Grover, MS Lori Haffner, Steve Jones, Tara L. Jones, MD Richard Katz, ScD John M. Lachin, Pamela Mucik, Robert Orlosky, PhD James Rochon, Alla Sapozhnikova, MS Hanna Sherif, Charlotte Stimpson, MS Marinella Temprosa, Fredricka Walker-Murray, Santica Santica Marcovina, PhD Greg Strylewicz, F. Alan Aldrich, MD Dan O'Leary, Elizabeth Elizabeth Stamm, MD, PhD Pentti Rautaharju, MD, PhD Ronald J. Prineas, Teresa Alexander, MS Charles Campbell, Sharon Hall, MD Yabing Li, Margaret Mills, MS Nancy Pemberton, PhD Farida Rautaharju, MD Zhuming Zhang, PhD Elizabeth Mayer-Davis, PhD Robert R. Moran, MD Ted Ganiats, MHP Kristin David, PhD Andrew J. Sarkin, MD R. Eastman, MD Judith Fradkin, PhD Sanford Garfield, PhD Edward Gregg, Ping Ping Zhang, MD, MPH William Herman, MD, PhD Jose C. Florez, MD, PhD David Altshuler, PhD Paul I.W. de Bakker, PhD, MPhil, MS Paul W. Franks, MD, MPH Robert L. Hanson, PhD Kathleen Jablonski, MD, DrPH William C. Knowler, AB Jarred B. McAteer, PhD Toni I. Pollin, and MD Alan R. Shuldiner
MD George A. Bray, Pennington Biomedical Research Center (Baton Rouge, LA)
BSN, RN, CCRC Iris W. Culbert, Pennington Biomedical Research Center (Baton Rouge, LA)
PhD, RD Catherine M. Champagne, Pennington Biomedical Research Center (Baton Rouge, LA)
RD, LDN Barbara Eberhardt, Pennington Biomedical Research Center (Baton Rouge, LA)
MD Frank Greenway, Pennington Biomedical Research Center (Baton Rouge, LA)
LPN Fonda G. Guillory, Pennington Biomedical Research Center (Baton Rouge, LA)
RD April A. Herbert, Pennington Biomedical Research Center (Baton Rouge, LA)
LPN Michael L. Jeffirs, Pennington Biomedical Research Center (Baton Rouge, LA)
MPA Betty M. Kennedy, Pennington Biomedical Research Center (Baton Rouge, LA)
PhD Jennifer C. Lovejoy, Pennington Biomedical Research Center (Baton Rouge, LA)
BS Laura H. Morris, Pennington Biomedical Research Center (Baton Rouge, LA)
BA, BS Lee E. Melancon, Pennington Biomedical Research Center (Baton Rouge, LA)
MD Donna Ryan, Pennington Biomedical Research Center (Baton Rouge, LA)
LPN Deborah A. Sanford, Pennington Biomedical Research Center (Baton Rouge, LA)
BS, MT Kenneth G. Smith, Pennington Biomedical Research Center (Baton Rouge, LA)
BS Lisa L. Smith, Pennington Biomedical Research Center (Baton Rouge, LA)
RTR Julia A. St. Amant, Pennington Biomedical Research Center (Baton Rouge, LA)
PhD Richard T. Tulley, Pennington Biomedical Research Center (Baton Rouge, LA)
MS, RD Paula C. Vicknair, Pennington Biomedical Research Center (Baton Rouge, LA)
PhD Donald Williamson, Pennington Biomedical Research Center (Baton Rouge, LA)
PhD Jeffery J. Zachwieja, Pennington Biomedical Research Center (Baton Rouge, LA)
MD Kenneth S. Polonsky, University of Chicago (Chicago, IL)
MD, PhD Janet Tobian, University of Chicago (Chicago, IL)
MD David Ehrmann, University of Chicago (Chicago, IL)
RN, BSN Margaret J. Matulik, University of Chicago (Chicago, IL)
MD Bart Clark, University of Chicago (Chicago, IL)
MS Kirsten Czech, University of Chicago (Chicago, IL)
BA Catherine DeSandre, University of Chicago (Chicago, IL)
RD Ruthanne Hilbrich, University of Chicago (Chicago, IL)
EdD Wylie McNabb, University of Chicago (Chicago, IL)
MS, RD Ann R. Semenske, University of Chicago (Chicago, IL)
MD Jose F. Caro, Jefferson Medical College (Philadelphia, PA)
RN, ScD Pamela G. Watson, Jefferson Medical College (Philadelphia, PA)
MD, PhD Barry J. Goldstein, Jefferson Medical College (Philadelphia, PA)
RN, MSN Kellie A. Smith, Jefferson Medical College (Philadelphia, PA)
RN, BSN Jewel Mendoza, Jefferson Medical College (Philadelphia, PA)
MPH Renee Liberoni, Jefferson Medical College (Philadelphia, PA)
MS, RD Constance Pepe, Jefferson Medical College (Philadelphia, PA)
MD John Spandorfer, Jefferson Medical College (Philadelphia, PA)
PhD Richard P. Donahue, University of Miami (Miami, FL)
MD Ronald B. Goldberg, University of Miami (Miami, FL)
MD, PhD Ronald Prineas, University of Miami (Miami, FL)
MPA Patricia Rowe, University of Miami (Miami, FL)
MSEd Jeanette Calles, University of Miami (Miami, FL)
MD Paul Cassanova-Romero, University of Miami (Miami, FL)
MD Hermes J. Florez, University of Miami (Miami, FL)
RD, MS Anna Giannella, University of Miami (Miami, FL)
MS Lascelles Kirby, University of Miami (Miami, FL)
Carmen Larreal, University of Miami (Miami, FL)
RN Valerie McLymont, University of Miami (Miami, FL)
Jadell Mendez, University of Miami (Miami, FL)
RN Juliet Ojito, University of Miami (Miami, FL)
PhD Arlette Perry, University of Miami (Miami, FL)
PhD Patrice Saab, University of Miami (Miami, FL)
MD, MPH Steven M. Haffner, The University of Texas Health Science Center (San Antonio, TX)
RN, MSHP, CDE Maria G. Montez, The University of Texas Health Science Center (San Antonio, TX)
MD, PhD Carlos Lorenzo, The University of Texas Health Science Center (San Antonio, TX)
RN, BSN, CDE Arlene Martinez, The University of Texas Health Science Center (San Antonio, TX)
MD, DrPH Richard F. Hamman, University of Colorado (Denver, CO)
MS Patricia V. Nash, University of Colorado (Denver, CO)
MS Lisa Testaverde, University of Colorado (Denver, CO)
RN, BSN Denise R. Anderson, University of Colorado (Denver, CO)
MD Larry B. Ballonoff, University of Colorado (Denver, CO)
MA Alexis Bouffard, University of Colorado (Denver, CO)
MD, MPH B. Ned Calonge, University of Colorado (Denver, CO)
Lynne Delve, University of Colorado (Denver, CO)
RN Martha Farago, University of Colorado (Denver, CO)
PhD James O. Hill, University of Colorado (Denver, CO)
BS Shelley R. Hoyer, University of Colorado (Denver, CO)
MS, RD, CDE Bonnie T. Jortberg, University of Colorado (Denver, CO)
RN, BSN Dione Lenz, University of Colorado (Denver, CO)
MS, RD Marsha Miller, University of Colorado (Denver, CO)
MD David W. Price, University of Colorado (Denver, CO)
PhD Judith G. Regensteiner, University of Colorado (Denver, CO)
MS, RD Helen Seagle, University of Colorado (Denver, CO)
BS Carissa M. Smith, University of Colorado (Denver, CO)
MS Sheila C. Steinke, University of Colorado (Denver, CO)
PhD Brent VanDorsten, University of Colorado (Denver, CO)
MD Edward S. Horton, Joslin Diabetes Center (Boston, MA)
RN Kathleen E. Lawton, Joslin Diabetes Center (Boston, MA)
MD Ronald A. Arky, Joslin Diabetes Center (Boston, MA)
Marybeth Bryant, Joslin Diabetes Center (Boston, MA)
BSN Jacqueline P. Burke, Joslin Diabetes Center (Boston, MA)
MD Enrique Caballero, Joslin Diabetes Center (Boston, MA)
BA Karen M. Callaphan, Joslin Diabetes Center (Boston, MA)
MD Om P. Ganda, Joslin Diabetes Center (Boston, MA)
Therese Franklin, Joslin Diabetes Center (Boston, MA)
MS, RD, CDE Sharon D. Jackson, Joslin Diabetes Center (Boston, MA)
MD Alan M. Jacobsen, Joslin Diabetes Center (Boston, MA)
MD Alan M. Jacobsen, Joslin Diabetes Center (Boston, MA)
RD Lyn M. Kula, Joslin Diabetes Center (Boston, MA)
RN, CDE Margaret Kocal, Joslin Diabetes Center (Boston, MA)
BS Maureen A. Malloy, Joslin Diabetes Center (Boston, MA)
MS, RD Maryanne Nicosia, Joslin Diabetes Center (Boston, MA)
RN Cathryn F. Oldmixon, Joslin Diabetes Center (Boston, MA)
BS, MPH Jocelyn Pan, Joslin Diabetes Center (Boston, MA)
Marizel Quitingon, Joslin Diabetes Center (Boston, MA)
BS Stacy Rubtchinsky, Joslin Diabetes Center (Boston, MA)
MD Ellen W. Seely, Joslin Diabetes Center (Boston, MA)
BSN Dana Schweizer, Joslin Diabetes Center (Boston, MA)
MD Donald Simonson, Joslin Diabetes Center (Boston, MA)
MD Fannie Smith, Joslin Diabetes Center (Boston, MA)
MD, MPH Caren G. Solomon, Joslin Diabetes Center (Boston, MA)
MD James Warram, Joslin Diabetes Center (Boston, MA)
MB, ChB Steven E. Kahn, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
RN, BSN, CDE Brenda K. Montgomery, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
MD Wilfred Fujimoto, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
MD Robert H. Knopp, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
MD Edward W. Lipkin, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
BA Michelle Marr, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
MD Dace Trence, VA Puget Sound Health Care System and University of Washington (Seattle, WA)
PhD, MD, FACP Abbas E. Kitabchi, University of Tennessee (Memphis, TN)
RN, MS, CDE, MBA Mary E. Murphy, University of Tennessee (Memphis, TN)
MD, MPH William B. Applegate, University of Tennessee (Memphis, TN)
MD Michael Bryer-Ash, University of Tennessee (Memphis, TN)
RN Sandra L. Frieson, University of Tennessee (Memphis, TN)
MD Raed Imseis, University of Tennessee (Memphis, TN)
RN, BSN Helen Lambeth, University of Tennessee (Memphis, TN)
RN, BSN Lynne C. Lichtermann, University of Tennessee (Memphis, TN)
MD Hooman Oktaei, University of Tennessee (Memphis, TN)
RN, BSN Lily M.K. Rutledge, University of Tennessee (Memphis, TN)
RD, LD Amy R. Sherman, University of Tennessee (Memphis, TN)
RD, MHP, LDN Clara M. Smith, University of Tennessee (Memphis, TN)
MD Judith E. Soberman, University of Tennessee (Memphis, TN)
MD Beverly Williams-Cleaves, University of Tennessee (Memphis, TN)
MD Boyd E. Metzger, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MS, RN Mariana K. Johnson, Northwestern University's Feinberg School of Medicine (Chicago, IL)
Catherine Behrends, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MS Michelle Cook, Northwestern University's Feinberg School of Medicine (Chicago, IL)
PhD Marian Fitzgibbon, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MS, RD Mimi M. Giles, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MA Deloris Heard, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MS, RN Cheryl K.H. Johnson, Northwestern University's Feinberg School of Medicine (Chicago, IL)
BS Diane Larsen, Northwestern University's Feinberg School of Medicine (Chicago, IL)
BS Anne Lowe, Northwestern University's Feinberg School of Medicine (Chicago, IL)
BS Megan Lyman, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MD David McPherson, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MD Mark E. Molitch, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MD Thomas Pitts, Northwestern University's Feinberg School of Medicine (Chicago, IL)
RN, MS Renee Reinhart, Northwestern University's Feinberg School of Medicine (Chicago, IL)
RN, RD Susan Roston, Northwestern University's Feinberg School of Medicine (Chicago, IL)
RN, MS Pamela A. Schinleber, Northwestern University's Feinberg School of Medicine (Chicago, IL)
MD David M. Nathan, Massachusetts General Hospital (Boston, MA)
BSN Charles McKitrick, Massachusetts General Hospital (Boston, MA)
BSN Heather Turgeon, Massachusetts General Hospital (Boston, MA)
Kathy Abbott, Massachusetts General Hospital (Boston, MA)
MS, RD Ellen Anderson, Massachusetts General Hospital (Boston, MA)
MS, RD Laurie Bissett, Massachusetts General Hospital (Boston, MA)
MD Enrico Cagliero, Massachusetts General Hospital (Boston, MA)
MD, PhD Jose C. Florez, Massachusetts General Hospital (Boston, MA)
MS, RD Linda Delahanty, Massachusetts General Hospital (Boston, MA)
MS, RD Valerie Goldman, Massachusetts General Hospital (Boston, MA)
Alexandra Poulos, Massachusetts General Hospital (Boston, MA)
MD Jerrold M. Olefsky, University of California-San Diego (San Diego, CA)
RN, BSN Mary Lou Carrion-Petersen, University of California-San Diego (San Diego, CA)
MD Elizabeth Barrett-Connor, University of California-San Diego (San Diego, CA)
MD Steven V. Edelman, University of California-San Diego (San Diego, CA)
MD Robert R. Henry, University of California-San Diego (San Diego, CA)
RD Javiva Horne, University of California-San Diego (San Diego, CA)
BA Simona Szerdi Janesch, University of California-San Diego (San Diego, CA)
RN, BSN Diana Leos, University of California-San Diego (San Diego, CA)
MD Sundar Mudaliar, University of California-San Diego (San Diego, CA)
PhD William Polonsky, University of California-San Diego (San Diego, CA)
RN Jean Smith, University of California-San Diego (San Diego, CA)
RN, BSN, CDE, CCRC Karen Vejvoda, University of California-San Diego (San Diego, CA)
MD F. Xavier Pi-Sunyer, St. Luke's-Roosevelt Hospital (New York, NY)
MS Jane E. Lee, St. Luke's-Roosevelt Hospital (New York, NY)
PhD David B. Allison, St. Luke's-Roosevelt Hospital (New York, NY)
MS, RD Nancy J. Aronoff, St. Luke's-Roosevelt Hospital (New York, NY)
MD Jill P. Crandall, St. Luke's-Roosevelt Hospital (New York, NY)
MD Sandra T. Foo, St. Luke's-Roosevelt Hospital (New York, NY)
MD Carmen Pal, St. Luke's-Roosevelt Hospital (New York, NY)
RN Kathy Parkes, St. Luke's-Roosevelt Hospital (New York, NY)
RN Mary Beth Pena, St. Luke's-Roosevelt Hospital (New York, NY)
BA Ellen S. Rooney, St. Luke's-Roosevelt Hospital (New York, NY)
MA Gretchen E.H. Van Wye, St. Luke's-Roosevelt Hospital (New York, NY)
ANP Kristine A. Viscovich, St. Luke's-Roosevelt Hospital (New York, NY)
PhD David G. Marrero, Indiana University (Indianapolis, IN)
MD Melvin J. Prince, Indiana University (Indianapolis, IN)
RN, CDE Susie M. Kelly, Indiana University (Indianapolis, IN)
BS Yolanda F. Dotson, Indiana University (Indianapolis, IN)
MD Edwin S. Fineberg, Indiana University (Indianapolis, IN)
PhD John C Guare, Indiana University (Indianapolis, IN)
Angela M. Hadden, Indiana University (Indianapolis, IN)
MA James M. Ignaut, Indiana University (Indianapolis, IN)
Marcia L. Jackson, Indiana University (Indianapolis, IN)
MD Marion S. Kirkman, Indiana University (Indianapolis, IN)
MD Kieren J. Mather, Indiana University (Indianapolis, IN)
MSN Beverly D. Porter, Indiana University (Indianapolis, IN)
MD Paris J. Roach, Indiana University (Indianapolis, IN)
BS, MS Nancy D. Rowland, Indiana University (Indianapolis, IN)
RD Madelyn L. Wheeler, Indiana University (Indianapolis, IN)
MD Robert E. Ratner, Medstar Research Institute (Washington, DC)
RD, CDE Gretchen Youssef, Medstar Research Institute (Washington, DC)
RN, BSN, CCRC Sue Shapiro, Medstar Research Institute (Washington, DC)
MS, RD, LD Catherine Bavido-Arrage, Medstar Research Institute (Washington, DC)
MSN, RN Geraldine Boggs, Medstar Research Institute (Washington, DC)
MS, RD, CDE Marjorie Bronsord, Medstar Research Institute (Washington, DC)
Ernestine Brown, Medstar Research Institute (Washington, DC)
MD Wayman W. Cheatham, Medstar Research Institute (Washington, DC)
Susan Cola, Medstar Research Institute (Washington, DC)
Cindy Evans, Medstar Research Institute (Washington, DC)
Peggy Gibbs, Medstar Research Institute (Washington, DC)
MS, RD, CDE Tracy Kellum, Medstar Research Institute (Washington, DC)
MD Claresa Levatan, Medstar Research Institute (Washington, DC)
BS Asha K. Nair, Medstar Research Institute (Washington, DC)
MD Maureen Passaro, Medstar Research Institute (Washington, DC)
MD Gabriel Uwaifo, Medstar Research Institute (Washington, DC)
MD Mohammed F. Saad, University of Southern California/UCLA Research Center (Alhambra, CA)
Maria Budget, University of Southern California/UCLA Research Center (Alhambra, CA)
MD Sujata Jinagouda, University of Southern California/UCLA Research Center (Alhambra, CA)
MD Khan Akbar, University of Southern California/UCLA Research Center (Alhambra, CA)
Claudia Conzues, University of Southern California/UCLA Research Center (Alhambra, CA)
Perpetua Magpuri, University of Southern California/UCLA Research Center (Alhambra, CA)
Kathy Ngo, University of Southern California/UCLA Research Center (Alhambra, CA)
MD Amer Rassam, University of Southern California/UCLA Research Center (Alhambra, CA)
Debra Waters, University of Southern California/UCLA Research Center (Alhambra, CA)
Kathy Xapthalamous, University of Southern California/UCLA Research Center (Alhambra, CA)
MD Julio V. Santiago, Washington University (St. Louis, MO)
MD, MSc, FRCP, FACP Samuel Dagogo-Jack, Washington University (St. Louis, MO)
MD, CDE Neil H. White, Washington University (St. Louis, MO)
MS, MBA, RD, LD Samia Das, Washington University (St. Louis, MO)
RD Ana Santiago, Washington University (St. Louis, MO)
MD Angela Brown, Washington University (St. Louis, MO)
PhD Edwin Fisher, Washington University (St. Louis, MO)
RN Emma Hurt, Washington University (St. Louis, MO)
RN Tracy Jones, Washington University (St. Louis, MO)
RD Michelle Kerr,
RN Lucy Ryder, Washington University (St. Louis, MO)
MS, RD Cormarie Wernimont, Washington University (St. Louis, MO)
MD Christopher D. Saudek, Johns Hopkins School of Medicine (Baltimore, MD)
BA Vanessa Bradley, Johns Hopkins School of Medicine (Baltimore, MD)
MEd, RN Emily Sullivan, Johns Hopkins School of Medicine (Baltimore, MD)
BS Tracy Whittington, Johns Hopkins School of Medicine (Baltimore, MD)
Caroline Abbas, Johns Hopkins School of Medicine (Baltimore, MD)
MD, MHS Frederick L. Brancati, Johns Hopkins School of Medicine (Baltimore, MD)
MD Jeanne M. Clark, Johns Hopkins School of Medicine (Baltimore, MD)
RN, MSN Jeanne B. Charleston, Johns Hopkins School of Medicine (Baltimore, MD)
Janice Freel, Johns Hopkins School of Medicine (Baltimore, MD)
RD Katherine Horak, Johns Hopkins School of Medicine (Baltimore, MD)
Dawn Jiggetts, Johns Hopkins School of Medicine (Baltimore, MD)
Deloris Johnson, Johns Hopkins School of Medicine (Baltimore, MD)
Hope Joseph, Johns Hopkins School of Medicine (Baltimore, MD)
Kimberly Loman, Johns Hopkins School of Medicine (Baltimore, MD)
Henry Mosley, Johns Hopkins School of Medicine (Baltimore, MD)
PhD Richard R. Rubin, Johns Hopkins School of Medicine (Baltimore, MD)
MD Alafia Samuels, Johns Hopkins School of Medicine (Baltimore, MD)
EdD Kerry J. Stewart, Johns Hopkins School of Medicine (Baltimore, MD)
Paula Williamson, Johns Hopkins School of Medicine (Baltimore, MD)
MD David S. Schade, University of New Mexico (Albuquerque, NM)
RN, MSN Karwyn S. Adams, University of New Mexico (Albuquerque, NM)
RN, CDE Carolyn Johannes, University of New Mexico (Albuquerque, NM)
PhD Leslie F. Atler, University of New Mexico (Albuquerque, NM)
MD Patrick J. Boyle, University of New Mexico (Albuquerque, NM)
MD Mark R. Burge, University of New Mexico (Albuquerque, NM)
RN, CDE Janene L. Canady, University of New Mexico (Albuquerque, NM)
RN Lisa Chai, University of New Mexico (Albuquerque, NM)
RN, MSN Ysela Gonzales, University of New Mexico (Albuquerque, NM)
Doris A. Hernandez-McGinnis, University of New Mexico (Albuquerque, NM)
LPN Patricia Katz, University of New Mexico (Albuquerque, NM)
Carolyn King, University of New Mexico (Albuquerque, NM)
MD Amer Rassam, University of New Mexico (Albuquerque, NM)
MD Sofya Rubinchik, University of New Mexico (Albuquerque, NM)
RD Willette Senter, University of New Mexico (Albuquerque, NM)
PhD Debra Waters, University of New Mexico (Albuquerque, NM)
MD Harry Shamoon, Albert Einstein College of Medicine (Bronx, NY)
RN, MPH, MSN Janet O. Brown, Albert Einstein College of Medicine (Bronx, NY)
BS Elsie Adorno, Albert Einstein College of Medicine (Bronx, NY)
MS, RD Liane Cox, Albert Einstein College of Medicine (Bronx, NY)
MD Jill Crandall, Albert Einstein College of Medicine (Bronx, NY)
MS, C-ANP Helena Duffy, Albert Einstein College of Medicine (Bronx, NY)
MD Samuel Engel, Albert Einstein College of Medicine (Bronx, NY)
BS Allison Friedler, Albert Einstein College of Medicine (Bronx, NY)
MA Crystal J. Howard-Century, Albert Einstein College of Medicine (Bronx, NY)
RN Stacey Kloiber, Albert Einstein College of Medicine (Bronx, NY)
LPN Nadege Longchamp, Albert Einstein College of Medicine (Bronx, NY)
RN, MSN, FNP-C Helen Martinez, Albert Einstein College of Medicine (Bronx, NY)
BA Dorothy Pompi, Albert Einstein College of Medicine (Bronx, NY)
MD Jonathan Scheindlin, Albert Einstein College of Medicine (Bronx, NY)
RD, MS Elissa Violino, Albert Einstein College of Medicine (Bronx, NY)
RN, DNSc, CDE Elizabeth Walker, Albert Einstein College of Medicine (Bronx, NY)
EdD, RD Judith Wylie-Rosett, Albert Einstein College of Medicine (Bronx, NY)
RD, MS Elise Zimmerman, Albert Einstein College of Medicine (Bronx, NY)
MD Joel Zonszein, Albert Einstein College of Medicine (Bronx, NY)
MD Trevor Orchard, University of Pittsburgh (Pittsburgh, PA)
PhD Rena R. Wing, University of Pittsburgh (Pittsburgh, PA)
MS, RD Gaye Koenning, University of Pittsburgh (Pittsburgh, PA)
BSN, MPH M. Kaye Kramer, University of Pittsburgh (Pittsburgh, PA)
BS Susan Barr, University of Pittsburgh (Pittsburgh, PA)
Miriam Boraz, University of Pittsburgh (Pittsburgh, PA)
BS Lisa Clifford, University of Pittsburgh (Pittsburgh, PA)
BS Rebecca Culyba, University of Pittsburgh (Pittsburgh, PA)
Marlene Frazier, University of Pittsburgh (Pittsburgh, PA)
BS Ryan Gilligan, University of Pittsburgh (Pittsburgh, PA)
MLT Susan Harrier, University of Pittsburgh (Pittsburgh, PA)
RN Louann Harris, University of Pittsburgh (Pittsburgh, PA)
RN, MSN Susan Jeffries, University of Pittsburgh (Pittsburgh, PA)
PhD Andrea Kriska, University of Pittsburgh (Pittsburgh, PA)
MD Qurashia Manjoo, University of Pittsburgh (Pittsburgh, PA)
MHP, RD Monica Mullen, University of Pittsburgh (Pittsburgh, PA)
BS Alicia Noel, University of Pittsburgh (Pittsburgh, PA)
PhD Amy Otto, University of Pittsburgh (Pittsburgh, PA)
Linda Semler, University of Pittsburgh (Pittsburgh, PA)
PhD Cheryl F. Smith, University of Pittsburgh (Pittsburgh, PA)
RN, BSN Marie Smith, University of Pittsburgh (Pittsburgh, PA)
PhD Elizabeth Venditti, University of Pittsburgh (Pittsburgh, PA)
BS Valarie Weinzierl, University of Pittsburgh (Pittsburgh, PA)
MD, MPH Katherine V. Williams, University of Pittsburgh (Pittsburgh, PA)
BA Tara Wilson, University of Pittsburgh (Pittsburgh, PA)
MD Richard F. Arakaki, University of Hawaii (Honolulu, HI)
BSN, MPH Renee W. Latimer, University of Hawaii (Honolulu, HI)
BS Narleen K. Baker-Ladao, University of Hawaii (Honolulu, HI)
MD Ralph Beddow, University of Hawaii (Honolulu, HI)
AA Lorna Dias, University of Hawaii (Honolulu, HI)
RN, PhD Jillian Inouye, University of Hawaii (Honolulu, HI)
MD Marjorie K. Mau, University of Hawaii (Honolulu, HI)
BS, RD Kathy Mikami, University of Hawaii (Honolulu, HI)
MD Pharis Mohideen, University of Hawaii (Honolulu, HI)
RD, MPH Sharon K. Odom, University of Hawaii (Honolulu, HI)
AA Raynette U. Perry, University of Hawaii (Honolulu, HI)
MD, DrPH William C. Knowler, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Norman Cooeyate, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RD, MS Mary A. Hoskin, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RN, MS Carol A. Percy, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD, MPH Kelly J. Acton, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RN, FNP Vickie L. Andre, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Rosalyn Barber, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MPH Shandiin Begay, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MB, FRCP Peter H. Bennett, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RN, BSN Mary Beth Benson, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RD, MPH Evelyn C. Bird, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RD, MPH, MBA, CDE Brenda A. Broussard, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RN, AS Marcella Chavez, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Tara Dacawyma, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Matthew S. Doughty, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RD Roberta Duncan, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RD Cyndy Edgerton, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Jacqueline M. Ghahate, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Justin Glass, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Martia Glass, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Dorothy Gohdes, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Wendy Grant, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD, MPH Robert L. Hanson, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Ellie Horse, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MS, RD, LN Louise E. Ingraham, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Merry Jackson, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Priscilla Jay, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Roylen S. Kaskalla, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD David Kessler, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RNC-ANP Kathleen M. Kobus, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Jonathan Krakoff, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
LPN Catherine Manus, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Sara Michaels, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Tina Morgan, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Yolanda Nashboo, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
RD Julie A. Nelson, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Steven Poirier, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Evette Polczynski, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Mike Reidy, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD, MPH Jeanine Roumain, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Debra Rowse, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Sandra Sangster, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Janet Sewenemewa, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
PhD Darryl Tonemah, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
MD Charlton Wilson, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
Michelle Yazzie, Southwest American Indian Centers (Phoenix, AZ; Shiprock, NM; Zuni, NM)
PhD Raymond Bain, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
PhD Sarah Fowler, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Tina Brenneman, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Solome Abebe, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
MS Julie Bamdad, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Jackie Callaghan, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
ScM Sharon L. Edelstein, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Yuping Gao, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Kristina L. Grimes, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Nisha Grover, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
MS Lori Haffner, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Steve Jones, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Tara L. Jones, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
MD Richard Katz, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
ScD John M. Lachin, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Pamela Mucik, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Robert Orlosky, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
PhD James Rochon, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Alla Sapozhnikova, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
MS Hanna Sherif, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Charlotte Stimpson, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
MS Marinella Temprosa, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Fredricka Walker-Murray, George Washington University Biostatistics Center (DPP Coordinating Center Rockville, MD)
Santica Santica Marcovina, Central Biochemistry Laboratory (Seattle, WA)
PhD Greg Strylewicz, Central Biochemistry Laboratory (Seattle, WA)
F. Alan Aldrich, Central Biochemistry Laboratory (Seattle, WA)
MD Dan O'Leary, Carotid Ultrasound.
Elizabeth Elizabeth Stamm, CT Scan Reading Center.
MD, PhD Pentti Rautaharju, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
MD, PhD Ronald J. Prineas, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
Teresa Alexander, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
MS Charles Campbell, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
Sharon Hall, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
MD Yabing Li, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
Margaret Mills, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
MS Nancy Pemberton, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
PhD Farida Rautaharju, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
MD Zhuming Zhang, Epidemiological Cardiology Research Center- Epicare (Winston-Salem, NC)
PhD Elizabeth Mayer-Davis, Nutrition Coding Center (Columbia, SC)
PhD Robert R. Moran, Nutrition Coding Center (Columbia, SC)
MD Ted Ganiats, Quality of Well-Being Center (La Jolla, CA)
MHP Kristin David, Quality of Well-Being Center (La Jolla, CA)
PhD Andrew J. Sarkin, Quality of Well-Being Center (La Jolla, CA)
MD R. Eastman, NIH/NIDDK (Bethesda, MD)
MD Judith Fradkin, NIH/NIDDK (Bethesda, MD)
PhD Sanford Garfield, NIH/NIDDK (Bethesda, MD)
PhD Edward Gregg, Centers for Disease Control & Prevention (Atlanta, GA)
Ping Ping Zhang, Centers for Disease Control & Prevention (Atlanta, GA)
MD, MPH William Herman, University of Michigan (Ann Arbor, MI)
MD, PhD Jose C. Florez, Massachusetts General Hospital, Boston, Massachusetts, United States of America. Broad Institute, Cambridge, Massachusetts, United States of America.
MD, PhD David Altshuler, Massachusetts General Hospital, Boston, Massachusetts, United States of America. Broad Institute, Cambridge, Massachusetts, United States of America.
PhD Paul I.W. de Bakker, Broad Institute, Cambridge, Massachusetts, United States of America.
PhD, MPhil, MS Paul W. Franks, Lund University, Lund, Sweden. Harvard School of Public Health, Boston, Massachusetts, United States of America.
MD, MPH Robert L. Hanson, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
PhD Kathleen Jablonski, Coordinating Center, Millersville, Maryland, United States of America.
MD, DrPH William C. Knowler, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
AB Jarred B. McAteer, Massachusetts General Hospital, Boston, Massachusetts, United States of America. Broad Institute, Cambridge, Massachusetts, United States of America.
PhD Toni I. Pollin, University of Maryland, College Park, Maryland, United States of America.
MD Alan R. Shuldiner, University of Maryland, College Park, Maryland, United States of America.
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