Yael Barer

Aims: Gestational diabetes (GDM) is the strongest known risk factor for maternal type 2 diabetes. However, little is known about type 2 diabetes risk in women with normal glucose challenge test (GCT) results during pregnancy. We investigated the association between GCT results in the normal range and type 2 diabetes risk, both overall and across pre‐pregnancy BMI categories. Materials and Methods: This retrospective cohort study identified pregnant women aged 20–50 who had normal (< 140 mg/dL) GCT results between 2004 and 2022. Follow‐up for type 2 diabetes extended from the date of the last documented GCT until 31 September 2024. Survival analyses examine GCT and combine BMI‐GCT exposures. Results: Among 249 190 eligible women (mean age 32.7 years), 1354 developed type 2 diabetes during a median follow‐up of 7 years. GCT results within the normal range were associated with the risk of type 2 diabetes, in a graded manner, without a clear threshold. Compared to women with normal pre‐pregnancy BMI and GCT of 70–89 mg/dL, women with a GCT of 130–140 mg/dL had adjusted hazard ratios for type 2 diabetes ranging from 14.7 (95% CI: 6.2–33.3) among women with normal BMI to 145 (95% CI: 67.7–309) among women with obesity. Conclusions: Pre‐pregnancy BMI and GCT values within the normal range can be used for further type 2 diabetes risk stratification, ranging from minimal risk among women with a GCT < 90 mg/dL and normal weight to substantially increased risk among women with pre‐pregnancy overweight or obesity.

Background/Objectives: While triptans remain the standard of care for moderate-to-severe migraine, the high discontinuation rates and remarkably low prescribing rates of triptans reflect suboptimal therapeutic optimization. Methods: This retrospective cohort study utilized data from Maccabi Healthcare Services (MHS), the second-largest healthcare provider in Israel, spanning 10 years (2012–2022). We identified naïve triptan users aged 21 years or older and evaluated triptan initiation and discontinuation patterns. Median time to discontinuation was assessed using Kaplan-Meier curves. Results: Of 2.8 million MHS members, 91,619 (3.4%) individuals had at least one triptan dispensation or prescription during the study period, including 41,297 triptan-naïve patients who met the study criteria. The median age at triptan initiation was 38.4 years (interquartile range: 28.2–48.0), and 75.6% were female. Overall, the median time to discontinuation was 7.7 months (95% confidence interval: 7.1–8.4). Discontinuation occurred in 70% of the cohort, with approximately 74% of triptan users purchasing only a single triptan formulation throughout the study period. Subgroup analyses by age, sex, socioeconomic status, and anxiety/depression prevalence demonstrated consistent discontinuation patterns across demographic and clinical characteristics, with median time to discontinuation remaining under 12 months in nearly all subgroups. Annual median time to discontinuation consistently remained under 12 months throughout the study period while showing a significant decreasing trend. Conclusions: The low rates of triptan use and high discontinuation rates suggest a possible undertreatment of migraine in Israel. These results highlight the need for improved patient and physician education, and enhanced follow-up protocols.

Aims/hypothesis: Gestational diabetes and abnormal 100‐g oral glucose tolerance test (OGTT) results in pregnancy are associated with type 2 diabetes, but their relationship with cardiovascular disease (CVD) is less clear. We evaluated the risk of CVD according to the number of abnormal OGTT values during pregnancy. Methods: This retrospective cohort study used data from a major Israeli healthcare provider. Pregnant individuals aged 20–50 years without a prior diagnosis of type 2 diabetes and CVD who had a complete 100‐g OGTT during their last pregnancy between January 2000 and December 2022 were included. The primary outcome was the development of a composite of CVD by September 2024. Risk was assessed using Cox proportional hazards models based on the number of abnormal OGTT values. Results: The study included 103 389 individuals with a mean age of 34 ± 5.2 years. Overall, the median follow‐up was 6.8 years (IQR, 3.4–12.9), totalling 886 955 person‐years. A composite of CVD developed in 641 individuals (a cumulative incidence of 0.62%). When compared to individuals with all OGTT values normal, individuals with one to three abnormal values had an adjusted hazard ratio (HR) of 1.2 (95% CI: 1.02–1.4) for CVD, reaching 2.41 (95% CI 1.44–4.05) in those with four abnormal OGTT values. Conclusions: A history of abnormal 100‐gram OGTT results during pregnancy, and specifically having four abnormal values, is associated with an elevated risk of CVD. These results underscore the need for early post‐partum identification and prevention strategies in this high‐risk population.

Introduction Early, simple predictors for long-term survival in Parkinson’s disease (PD) may help identify patients at elevated risk and are crucial for more personalized treatment. Methods This large, retrospective study examined whether higher levodopa equivalent daily dose (LEDD) a year after diagnosis predicts long-term survival. Results Mortality risk was increased among 292 patients receiving ≥ 600 mg LEDD versus 2233 patients receiving < 600 mg LEDD (hazard ratio 1.5; 95% confidence interval 1.3–1.7), particularly among patients aged < 75 years (1.8; 1.4–2.4). Conclusion In PD, higher LEDD can be an early risk marker of increased mortality, probably because it reflects more severe disease.

Background and objective: Chronic cough (CC) is a prevalent yet underexplored medical condition, with limited real-world data regarding its healthcare burden. This study investigates the epidemiology, associated comorbidities, and healthcare service utilization among patients with CC. Methods: In this retrospective cohort study, adult patients with at least 3 physician diagnoses of cough over a period spanning a minimum of 8 weeks and a maximum of 12 months anytime between 2009 and 2018, were defined as patients with CC (PwCC). The reference group were adults without cough matched in a 1:1 ratio for age, sex, and place of residence. Results: The study included 91,757 PwCC, reflecting a prevalence of 5.5%. Of those, 59,296 patients (mean [SD] age, 53.9 [16.8] years; 59.6% females) were first diagnosed with CC during the study period, representing a 10-year incidence rate of 3.26% (95%CI: 3.24–3.29%). Diseases associated with the highest OR for CC included lung cancer (OR = 3.32; 95%CI: 2.90–4.25), whooping cough (OR = 3.04; 95%CI: 2.70–3.60), and respiratory infections (OR = 2.81; 95%CI: 2.74–2.88). Furthermore, PwCC demonstrated increased healthcare service utilization, leading to a higher adjusted annual estimated mean cost (USD 4038 vs. USD 1833, p < 0.001). Conclusions: Chronic cough emerges as a relatively prevalent complaint within community care, exerting a considerable economic burden. This study underscores the need for heightened awareness, comprehensive management strategies, and resource allocation to address the multifaceted challenges associated with chronic cough.

Background: Progressive supranuclear palsy (PSP) is a rare and fatal neurodegenerative movement disorder with no disease modifying therapy currently available. Data on the costs associated with PSP are scarce. This study aims to assess the direct medical expenditure of patients with PSP (PwPSP) throughout disease course. Methods: This retrospective cohort study is based on the data of a large state-mandated health provider in Israel. We identified PwPSP who were initially diagnosed between 2000 and 2017. Each PwPSP was randomly matched to three health-plan members without PSP by birth-year, sex, and socioeconomic status. Healthcare resources’ utilization and related costs were assessed. Results: We identified 88 eligible PwPSP and 264 people in the reference group; mean age at diagnosis was 72.6 years (SD = 8.4) and 53.4% were female. The annual direct costs of PwPSP have risen over time, reaching US$ 21,637 in the fifth year and US$ 36,693 in the tenth year of follow-up vs US$ 8910 in the year prior diagnosis. Compared to people without PSP, PwPSP had substantially higher medical expenditure during the years prior- and post-index date. Conclusion: The present study demonstrates higher economic burden, which increases with time, in PwPSP as compared to those without.

Progressive supranuclear palsy (PSP) is a rare and fatal neurodegenerative movement disorder and no disease modifying therapy (DMT) is currently available. This study aims to assess the epidemiology of PSP in Israel and to describe its clinical features. This retrospective analysis identified patients with PSP between 2000 and 2018 over the age of 40 years at first diagnosis (index date). We identified 209 patients with ≥1 diagnosis of PSP. Of those, 88 patients satisfied the inclusion criteria with a mean age at diagnosis of 72 years (SD = 8) and 53% were female. The 2018 prevalence and incidence rates were 5.3 and 1 per 100,000 persons, respectively. Median survival time was 4.9 years (95% CI 3.6–6.1) and median time from initial symptom to diagnosis was 4.2 years. The most common misdiagnoses were Parkinson’s disease, cognitive disorder and depression. The present study demonstrates that the clinic-epidemiological features of PSP in Israel are similar to PSP worldwide. In light of PSP’s rarity, investigation of PSP cohorts in different countries may create a proper platform for upcoming DMT trials.

Purpose/Background: Tardive dyskinesia (TD) is a hyperkinetic movement disorder caused by exposure to dopamine-receptor blockers. Data on TD burden in Israel are scarce. This analysis assesses the clinical and economic burden of TD in Israeli patients. Methods/Procedures: This retrospective analysis used a national health plan database (Maccabi Healthcare Services), representing 25% of the Israeli population. The study included adults alive at index date with an International Classification of Diseases, Ninth Revision, Clinical Modification TD diagnosis before 2018 and more than or equal to 1-year enrollment before diagnosis. Tardive dyskinesia patients were matched to non-TD patients (1:3) by underlying psychiatric condition, birth year, and sex. Treatment patterns and 2018 annual health care resource utilization and costs were assessed. Findings/Results: Of 454 TD patients alive between 2013 and 2018, 333 alive on January 1, 2018, were matched to 999 non-TD patients. At baseline, TD patients had lower socioeconomic status and higher proportion of chronic kidney disease and antipsychotic medication use; all analyses were adjusted accordingly. Tardive dyskinesia patients had significantly more visits to general physicians, neurologists, psychiatrists, physiotherapists, and emergency departments versus non-TD patients (all P < 0.05). Tardive dyskinesia patients also had significantly longer hospital stays than non-TD patients (P = 0.003). Total healthcare and medication costs per patient were significantly higher in the TD versus non-TD population (US $11,079 vs US $7145, P = 0.018). Implications/Conclusions: Israeli TD patients have higher clinical and economic burden than non-TD patients. Understanding real-world health care resource utilization and costs allows clinicians and decision makers to quantify TD burden and prioritize resources for TD patients' treatment.