Scholars@Duke
Anastasia Stefania Alexopoulos

Anastasia Stefania Alexopoulos

Assistant Professor of Medicine
Medicine, Endocrinology, Metabolism, and Nutrition
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Selected Publications

Intervening on Metabolic Dysfunction-Associated Steatotic Liver Disease in Latino/a and Black Patients with Diabetes: A Feasibility Pilot.

Journal Article Diabetes Ther · September 14, 2024 INTRODUCTION: Patients with type 2 diabetes (T2D), particularly those from historically marginalized racial and ethnic groups, are at high risk of poor outcomes from metabolic dysfunction-associated steatotic liver disease (MASLD). Evidence-based managemen ... Full text Link to item Cite

Racial Disparities in Evidence-Based Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes.

Journal Article Endocr Pract · July 2024 OBJECTIVE: To assess frequency of evidence-based management (EBM) of metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes (T2D), and to examine for racial/ethnic disparities in the receipt of EBM. METHODS: We co ... Full text Link to item Cite

Evaluating Therapeutic Inertia in Two Telehealth Interventions for Type 2 Diabetes: Secondary Analyses of a Randomized Trial.

Journal Article Telemed J E Health · June 2024 Introduction: Although therapeutic inertia is a known driver of suboptimal type 2 diabetes control, little is known about how to combat this phenomenon. We analyzed randomized trial data to determine whether a comprehensive telehealth intervention was more ... Full text Link to item Cite

Prescribing of evidence-based diabetes pharmacotherapy in patients with metabolic dysfunction-associated steatohepatitis.

Journal Article BMJ Open Diabetes Res Care · November 29, 2023 INTRODUCTION: Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent in type 2 diabetes (T2D). Pioglitazone and glucagon-like peptide-1 receptor agonists (GLP-1RA) are medications used in T2D that can resolve MASH and should be conside ... Full text Link to item Cite

Specialist Perspectives on Delivering High-Quality Telemedicine for Diabetes: A Mixed Methods Survey Study.

Journal Article J Endocr Soc · March 6, 2023 BACKGROUND: Recent recommendations guiding appropriate use of telemedicine for endocrinology care have largely relied on expert opinion due to limited evidence on factors that increase quality of telemedicine care. In this study, we assessed the perspectiv ... Full text Open Access Link to item Cite

Simplifying therapy to assure glycemic control and engagement (STAGE) in poorly-controlled diabetes: A pilot study.

Journal Article J Diabetes Complications · January 2023 In this single-arm pilot study, we demonstrated feasibility and acceptability of an insulin simplification intervention in patients with persistent, poorly-controlled type 2 diabetes on complex insulin regimens. While not powered to assess clinical outcome ... Full text Link to item Cite

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review.

Journal Article J Med Internet Res · August 26, 2022 BACKGROUND: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of t ... Full text Link to item Cite

Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes.

Journal Article Chronic Illn · June 2022 OBJECTIVES: To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. METHODS: In this secondary analysis of a randomized trial in patient ... Full text Link to item Cite

Clinical associations of an updated medication effect score for measuring diabetes treatment intensity.

Journal Article Chronic Illn · December 2021 OBJECTIVES: The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effe ... Full text Link to item Cite

Underrecognition of Nonalcoholic Fatty Liver Disease in Poorly Controlled Diabetes: A Call to Action in Diabetes Care.

Journal Article J Endocr Soc · December 1, 2021 Individuals with type 2 diabetes (T2DM) are at high risk for nonalcoholic fatty liver disease (NAFLD), and evidence suggests that poor glycemic control is linked to heightened risk of progressive NAFLD. We conducted an observational study based on data fro ... Full text Link to item Cite

Deintensification of Treatment With Sulfonylurea and Insulin After Severe Hypoglycemia Among Older Adults With Diabetes.

Journal Article JAMA Netw Open · November 1, 2021 IMPORTANCE: Practice guidelines recommend deintensification of hypoglycemic agents among older adults with diabetes who are at high risk of hypoglycemia, yet real-world treatment deintensification practices are not well characterized. OBJECTIVE: To examine ... Full text Link to item Cite

Glycemic Control Predicts Severity of Hepatocyte Ballooning and Hepatic Fibrosis in Nonalcoholic Fatty Liver Disease.

Journal Article Hepatology · September 2021 BACKGROUND AND AIMS: Whether glycemic control, as opposed to diabetes status, is associated with the severity of NAFLD is open for study. We aimed to evaluate whether degree of glycemic control in the years preceding liver biopsy predicts the histological ... Full text Open Access Link to item Cite

Duration of type 2 diabetes does not appear to moderate hypoglycaemia rate with insulin degludec versus insulin glargine U100.

Journal Article Diabetes Obes Metab · August 2021 In the DEVOTE and SWITCH 2 trials, insulin degludec 100 units/mL (degludec) was superior to insulin glargine 100 units/mL (glargine U100) with respect to the rates of severe (DEVOTE; across trial) and overall symptomatic (SWITCH 2; during the maintenance p ... Full text Link to item Cite

Racial Differences in the Effectiveness of a Multifactorial Telehealth Intervention to Slow Diabetic Kidney Disease.

Journal Article Med Care · November 2020 BACKGROUND: African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline. OBJECTIVE: The objective of this study was to ... Full text Open Access Link to item Cite

Newer second-line glucose-lowering drugs versus thiazolidinediones on cirrhosis risk among older US adult patients with type 2 diabetes.

Journal Article J Diabetes Complications · November 2020 AIMS: Type 2 diabetes (T2D) accelerates progression of chronic liver disease to cirrhosis, yet the effects of most glucose-lowering drugs (GLDs) on cirrhosis risk in T2D are unknown. To address this gap, we compared cirrhosis risk following initiation of n ... Full text Link to item Cite

Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review.

Journal Article Ann Intern Med · July 21, 2020 BACKGROUND: The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE: To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of ... Full text Link to item Cite

Intervening on Metabolic Dysfunction-Associated Steatotic Liver Disease in Latino/a and Black Patients with Diabetes: A Feasibility Pilot.

Journal Article Diabetes Ther · September 14, 2024 INTRODUCTION: Patients with type 2 diabetes (T2D), particularly those from historically marginalized racial and ethnic groups, are at high risk of poor outcomes from metabolic dysfunction-associated steatotic liver disease (MASLD). Evidence-based managemen ... Full text Link to item Cite

Racial Disparities in Evidence-Based Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes.

Journal Article Endocr Pract · July 2024 OBJECTIVE: To assess frequency of evidence-based management (EBM) of metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes (T2D), and to examine for racial/ethnic disparities in the receipt of EBM. METHODS: We co ... Full text Link to item Cite

Evaluating Therapeutic Inertia in Two Telehealth Interventions for Type 2 Diabetes: Secondary Analyses of a Randomized Trial.

Journal Article Telemed J E Health · June 2024 Introduction: Although therapeutic inertia is a known driver of suboptimal type 2 diabetes control, little is known about how to combat this phenomenon. We analyzed randomized trial data to determine whether a comprehensive telehealth intervention was more ... Full text Link to item Cite

Prescribing of evidence-based diabetes pharmacotherapy in patients with metabolic dysfunction-associated steatohepatitis.

Journal Article BMJ Open Diabetes Res Care · November 29, 2023 INTRODUCTION: Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent in type 2 diabetes (T2D). Pioglitazone and glucagon-like peptide-1 receptor agonists (GLP-1RA) are medications used in T2D that can resolve MASH and should be conside ... Full text Link to item Cite

Specialist Perspectives on Delivering High-Quality Telemedicine for Diabetes: A Mixed Methods Survey Study.

Journal Article J Endocr Soc · March 6, 2023 BACKGROUND: Recent recommendations guiding appropriate use of telemedicine for endocrinology care have largely relied on expert opinion due to limited evidence on factors that increase quality of telemedicine care. In this study, we assessed the perspectiv ... Full text Open Access Link to item Cite

Simplifying therapy to assure glycemic control and engagement (STAGE) in poorly-controlled diabetes: A pilot study.

Journal Article J Diabetes Complications · January 2023 In this single-arm pilot study, we demonstrated feasibility and acceptability of an insulin simplification intervention in patients with persistent, poorly-controlled type 2 diabetes on complex insulin regimens. While not powered to assess clinical outcome ... Full text Link to item Cite

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review.

Journal Article J Med Internet Res · August 26, 2022 BACKGROUND: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of t ... Full text Link to item Cite

Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes.

Journal Article Chronic Illn · June 2022 OBJECTIVES: To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. METHODS: In this secondary analysis of a randomized trial in patient ... Full text Link to item Cite

Clinical associations of an updated medication effect score for measuring diabetes treatment intensity.

Journal Article Chronic Illn · December 2021 OBJECTIVES: The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effe ... Full text Link to item Cite

Underrecognition of Nonalcoholic Fatty Liver Disease in Poorly Controlled Diabetes: A Call to Action in Diabetes Care.

Journal Article J Endocr Soc · December 1, 2021 Individuals with type 2 diabetes (T2DM) are at high risk for nonalcoholic fatty liver disease (NAFLD), and evidence suggests that poor glycemic control is linked to heightened risk of progressive NAFLD. We conducted an observational study based on data fro ... Full text Link to item Cite

Deintensification of Treatment With Sulfonylurea and Insulin After Severe Hypoglycemia Among Older Adults With Diabetes.

Journal Article JAMA Netw Open · November 1, 2021 IMPORTANCE: Practice guidelines recommend deintensification of hypoglycemic agents among older adults with diabetes who are at high risk of hypoglycemia, yet real-world treatment deintensification practices are not well characterized. OBJECTIVE: To examine ... Full text Link to item Cite

Glycemic Control Predicts Severity of Hepatocyte Ballooning and Hepatic Fibrosis in Nonalcoholic Fatty Liver Disease.

Journal Article Hepatology · September 2021 BACKGROUND AND AIMS: Whether glycemic control, as opposed to diabetes status, is associated with the severity of NAFLD is open for study. We aimed to evaluate whether degree of glycemic control in the years preceding liver biopsy predicts the histological ... Full text Open Access Link to item Cite

Duration of type 2 diabetes does not appear to moderate hypoglycaemia rate with insulin degludec versus insulin glargine U100.

Journal Article Diabetes Obes Metab · August 2021 In the DEVOTE and SWITCH 2 trials, insulin degludec 100 units/mL (degludec) was superior to insulin glargine 100 units/mL (glargine U100) with respect to the rates of severe (DEVOTE; across trial) and overall symptomatic (SWITCH 2; during the maintenance p ... Full text Link to item Cite

Racial Differences in the Effectiveness of a Multifactorial Telehealth Intervention to Slow Diabetic Kidney Disease.

Journal Article Med Care · November 2020 BACKGROUND: African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline. OBJECTIVE: The objective of this study was to ... Full text Open Access Link to item Cite

Newer second-line glucose-lowering drugs versus thiazolidinediones on cirrhosis risk among older US adult patients with type 2 diabetes.

Journal Article J Diabetes Complications · November 2020 AIMS: Type 2 diabetes (T2D) accelerates progression of chronic liver disease to cirrhosis, yet the effects of most glucose-lowering drugs (GLDs) on cirrhosis risk in T2D are unknown. To address this gap, we compared cirrhosis risk following initiation of n ... Full text Link to item Cite

Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review.

Journal Article Ann Intern Med · July 21, 2020 BACKGROUND: The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE: To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of ... Full text Link to item Cite

Hospital admissions for hyperglycemic emergencies in young adults at an inner-city hospital.

Journal Article Diabetes Res Clin Pract · November 2019 AIMS: There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emerge ... Full text Link to item Cite

Management of Preexisting Diabetes in Pregnancy: A Review

Journal Article Obstetrical and Gynecological Survey · October 1, 2019 Preexisting diabetes complicates 0.9% of pregnancies in the US and increases the risk of adverse maternal and neonatal outcomes, specifically linked to preeclampsia, congenital anomalies, preterm delivery, and stillbirth. With type 1 and type 2 diabetes be ... Full text Cite

Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin.

Journal Article Metabolism · September 2019 Managing type 2 diabetes is complex and necessitates careful consideration of patient factors such as engagement in self-care, comorbidities and costs. Since type 2 diabetes is a progressive disease, many patients will require injectable agents, usually in ... Full text Link to item Cite

Management of Preexisting Diabetes in Pregnancy: A Review.

Journal Article JAMA · May 14, 2019 IMPORTANCE: The presence of preexisting type 1 or type 2 diabetes in pregnancy increases the risk of adverse maternal and neonatal outcomes, such as preeclampsia, cesarean delivery, preterm delivery, macrosomia, and congenital defects. Approximately 0.9% o ... Full text Link to item Cite

Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes.

Journal Article Curr Diab Rep · February 26, 2019 PURPOSE OF REVIEW: Moderate hypertriglyceridemia is exceedingly common in diabetes, and there is growing evidence that it contributes to residual cardiovascular risk in statin-optimized patients. Major fibrate trials yielded inconclusive results regarding ... Full text Link to item Cite

Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study.

Journal Article PLoS One · 2019 OBJECTIVE: Patients with persistent poorly-controlled diabetes mellitus (PPDM) despite engagement in clinic-based care are at particularly high risk for diabetes complications and costs. Understanding this population's demographics, comorbidities and care ... Full text Open Access Link to item Cite

Impact of obesity on hospital complications and mortality in hospitalized patients with hyperglycemia and diabetes

Journal Article BMJ Open Diabetes Research and Care · July 1, 2016 Objective: Obesity is associated with increased risk of diabetes, hypertension and cardiovascular mortality. Several studies have reported increased length of hospital stay and complications; however, there are also reports of obesity having a protective e ... Full text Cite

Report on Racial Disparities in Hospitalized Patients with Hyperglycemia and Diabetes.

Journal Article J Clin Endocrinol Metab · March 2016 CONTEXT: A higher prevalence of diabetes-related complications is reported in minority populations; however, it is not known if there are racial disparities in diabetes care and outcomes in hospitalized patients. OBJECTIVE: Our objective was to determine t ... Full text Link to item Cite

Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis

Journal Article Case Reports in Medicine · January 1, 2015 Levamisole is a known immunomodulating agent frequently used as a cutting agent in cocaine consumed in the United States today. Numerous cases of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis connected with the use of levamisole-Adulterated cocain ... Full text Cite

The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients.

Journal Article J Diabetes Complications · 2015 BACKGROUND: The impact of obesity on clinical outcomes and hospitalization costs in general surgery patients with and without diabetes (DM) is unknown. MATERIALS AND METHODS: We reviewed medical records of 2451 patients who underwent gastrointestinal surge ... Full text Link to item Cite

Teaching skills training for medical students.

Journal Article Clin Teach · June 2013 BACKGROUND:   The UK General Medical Council has recommended that medical students be taught how to teach; however, the current state of teaching skills training in England has not yet been investigated. AIMS:   To explore the current state of undergraduat ... Full text Link to item Cite

Time to internal fixation of femoral neck fractures in patients under sixty years--does this matter in the development of osteonecrosis of femoral head?

Conference Int Orthop · October 2012 PURPOSE: Osteonecrosis of femoral head remains a major complication of femoral neck fractures. It has been postulated that early internal fixation drastically reduces the incidence of osteonecrosis of the femoral head. However, there is a paucity of litera ... Full text Link to item Cite

Junior tutor programme--benefits and risks.

Journal Article Ir J Med Sci · March 2011 Full text Link to item Cite

The need for more teaching-skills training for medical students

Journal Article Academic Medicine · January 1, 2011 Full text Cite