Mechanisms and Potential Roles of Glucose-Lowering Agents in COVID-19: A Review.

OBJECTIVE: To explore mechanistic benefits of glucose-lowering agents that extend beyond glycemic control with the potential to mitigate coronavirus disease 2019 (COVID-19) complications. DATA SOURCES: The following PubMed literature search terms were used from July 2020 to January 2, 2021: diabetes, COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), glucose-lowering agents, and pharmacology. STUDY SELECTION AND DATA EXTRACTION: English-language studies reporting on the association between diabetes, COVID-19 adverse outcomes, and the potential roles of glucose-lowering agents were reviewed. DATA SYNTHESIS: Selected glucose-lowering agents have benefits beyond glycemic control, with the potential to reduce the risks of severe complications during SARS-CoV-2 infection. Key benefits include anti-inflammatory, anticoagulant, immune modulating, and enzyme/receptor effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review summarizes the current knowledge of glucose-lowering agents and their potential roles in COVID-19 outcomes. Considering beneficial mechanisms on COVID-19 outcomes that extend beyond glycemic control as well as safety profiles, current data suggest that dipeptidyl peptidase-IV (DPP-IV) inhibitors and metformin may have the most promise and warrant further investigation. CONCLUSIONS: Certain glucose-lowering agents may offer additional benefits beyond glucose control-namely, by modulating the mechanisms contributing to adverse outcomes related to COVID-19 in patients with diabetes. DPP-IV inhibitors and metformin appear to have the most promise. However, current published literature on diabetes medications and COVID-19 should be interpreted with caution. Most published studies are retrospective and consist of convenience samples, and some lack adequate analytical approaches with confounding biases. Ongoing trials aim to evaluate the effects of glucose-lowering agents in reducing the severity of COVID-19 outcomes.

Barriers and facilitators to perceived diabetes self-management in Arab American patients with diabetes.

AIMS: To assess perceptions surrounding diabetes self-management (DSM) behaviors in Arab American patients with diabetes. METHODS: A 39-item survey was constructed from focus group discussions designed to better understand the impact of Arab American culture on DSM behaviors. The survey assessed perceptions about diet, adherence to medications, exercise, healthy lifestyle, and family support. RESULTS: Two hundred Arab Americans with diabetes completed the survey via face-to-face interviews. Most patients were female (59%), over fifty years of age (79%), and immigrated from Lebanon (73%). Receiving instructions in Arabic, having family support, family understanding of food choices, and employment status were found to be important predictors of the perceived importance of DSM. CONCLUSIONS: Our findings suggest that there are multiple factors that dictate Arab American's perception of the importance of DSM. The survey that was constructed may serve as a valuable tool for providers to assess DSM perceptions in order to provide patient-centered care that will help to improve diabetes outcomes. This study supports the importance of integrating cultural influences into DSM education and support when providing care to a population with a strong cultural identity.

Safety and efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in type 1 diabetes: A systematic review and meta-analysis.

AIMS: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are currently FDA approved for the management of type 2 diabetes. Our objective was to review the available evidence of the effects of SGLT2 inhibitors on HbA1c, body weight, and total daily insulin dose, as well as their safety profile in patients with type 1 diabetes. METHODS: Four randomized controlled trials (RCTs) were identified by conducting a systematic search of PubMed, Embase, Web of Science, Scopus and Cochrane library databases through August 2017. Data on study design, sample size, mean ±â€¯standard deviation of HbA1c, body weight, and total daily insulin dose, as well as reported adverse events were extracted. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Relative to placebo, therapy with SGLT2 inhibitors led to significant reductions in HbA1c (WMD 0.39; 95% CI 0.27, 0.51), body weight (WMD 2.76; 95% CI 1.11, 4.40), and total daily insulin dose (WMD 5.03; 95% CI 1.83, 8.23). In addition, there was no significant difference in the rate of adverse events. CONCLUSIONS: The current study lends supports for the development of SGLT2 inhibitors in combination with insulin as a treatment option for patients with type 1 diabetes.

Association between haptoglobin gene and insulin resistance in Arab-Americans.

AIM: To analyze associations between variation in the HP gene and lipid and glucose-related measures in Arab-Americans. Secondary analyses were performed based on sex. PATIENTS & METHODS: Genomic DNA was extracted from samples obtained from a previous epidemiological study of diabetes in Arab-Americans. The HP 1 and 2 alleles were analyzed by polymerase chain reaction and gel electrophoresis. Associations were analyzed by linear regression. RESULTS & CONCLUSION: Associations were identified between the heterozygous haptoglobin 2-1 genotype and insulin resistance, fasting insulin and fasting c-peptide. The effect of sex did not remain significant after adjustment for relevant variables. HP genetic variation may have utility as a biomarker of insulin resistance and diabetes risk in Arab-Americans, however, future prospective studies are needed.

Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients.

IN BRIEF The purpose of this qualitative study was to examine providers' perspectives on cultural barriers and facilitators to diabetes self-management (DSM) in Arab Americans to identify factors to enhance DSM education in the Arab-American community. The main barriers to DSM from the providers' perspective were the disease itself and patients' denial or refusal to recognize it, reflecting the stigma of the disease. Cultural aspects also included overlapping themes that both facilitated and presented barriers to DSM. These results suggest that DSM education for Arab Americans will be most effective if developed and delivered in a manner consistent with the cultural facilitators and barriers noted by providers.

The Arab American experience with diabetes: Perceptions, myths and implications for culturally-specific interventions.

AIMS: Culturally-specific lifestyle diabetes prevention programs require an assessment of population disease perceptions and cultural influences on health beliefs and behaviors. The primary objectives were to assess Arab Americans' knowledge and perceptions of diabetes and their preferences for a lifestyle intervention. METHODS: Sixty-nine self-identified Arab or Arab Americans ≥30 years of age and without diabetes participated in 8 focus groups. RESULTS: Emerging themes from the data included myths about diabetes etiology, folk remedies, and social stigma. The main barrier to healthcare was lack of health insurance and/or cost of care. Intervention preferences included gender-specific exercise, group-delivered education featuring religious ideology, inclusion of the family, and utilization of community facilities. CONCLUSION: Lifestyle interventions for Arab Americans need to address cultural preferences, diabetes myths, and folk remedies. Interventions should incorporate Arabic cultural content and gender-specific group education and exercise. Utilization of family support and religious centers will enable culturally-acceptable and cost-effective interventions.

Diabetes self-management among Arab Americans: patient and provider perspectives.

BACKGROUND: Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. POPULATION: Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. METHODS: Qualitative content analysis was used to analyze five focus groups-two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients. RESULTS: Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships. CONCLUSIONS: Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

The Impact of Arab American Culture on Diabetes Self-management Education.

PURPOSE: The purpose of this study was to better understand barriers and facilitators of diabetes self-management education (DSME) among Arab American patients with diabetes. Little is known about the impact of Arab culture on DSME. METHODS: Arab American adults (N = 23) with medically managed diabetes participated in 1 of 3 focus groups. An Arabic-speaking, trained moderator conducted video-recorded sessions. Verbatim Arabic transcripts were translated into English. Transcripts underwent a qualitative content analysis approach. RESULTS: Arab American cultural traditions such as food sharing, religious beliefs, and gender roles both facilitated and at times impeded DSME. Patients also held conflicting views about their interactions with their providers; some participants praised the authoritative patient-physician relationship style while others perceived the gaps in communication to be a product of Arab culture. Participants expressed that lack of available educational and supportive resources are key barriers to DSME. CONCLUSION: Arab American culture affects DSM activities, and culturally sensitive educational resources are lacking. Development of DSME programs tailored to address relevant aspects of Arab culture might improve DSME outcomes in Arab American population.

Impact of an individualized type 2 diabetes education program on clinical outcomes during Ramadan.

OBJECTIVE: To determine if individualized education before Ramadan results in a safer fast for people with type 2 diabetes. METHODS: Patients with type 2 diabetes who received care from participating clinics in Egypt, Iran, Jordan and Saudi Arabia and intended to fast during Ramadan 2014 were prospectively studied. Twelve clinics participated. Individualized education addressed meal planning, physical activity, blood glucose monitoring and acute metabolic complications and when deemed necessary, provided an individualized diabetes treatment plan. RESULTS: 774 people met study criteria, 515 received individualized education and 259 received usual care. Those who received individualized education were more likely to modify their diabetes treatment plan during Ramadan (97% vs 88%, p<0.0001), to perform self-monitoring of blood glucose at least twice daily during Ramadan (70% vs 51%, p<0.0001), and to have improved knowledge about hypoglycemic signs and symptoms (p=0.0007). Those who received individualized education also reduced their body mass index (-1.1±2.4 kg/m(2) vs -0.2±1.7 kg/m(2), p<0.0001) and glycated haemoglobin (-0.7±1.1% vs -0.1±1.3%, p<0.0001) during Ramadan compared those who received usual care. There were more mild (77% vs 67%, p=0.0031) and moderate (38% vs 19%, p<0.0001) hypoglycemic events reported by participants who received individualized education than those who received usual care, but fewer reported severe hypoglycemic events during Ramadan (23% vs 34%, p=0.0017). CONCLUSIONS: This individualized education and diabetes treatment program helped patients with type 2 diabetes lose weight, improve glycemic control and achieve a safer fast during Ramadan.

Insulin sensitivity and secretion in Arab Americans with glucose intolerance.

BACKGROUND: This study examined the pathophysiological abnormalities in Arab Americans with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). SUBJECTS AND METHODS: Homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of insulin secretion (HOMA-%ß), and the Matsuda Insulin Sensitivity Index composite (ISIcomposite) were calculated from the fasting and stimulated glucose and insulin concentrations measured during the oral glucose tolerance test in a population-based, representative, cross-sectional sample of randomly selected Arab Americans. RESULTS: In total, 497 individuals (42±14 years old; 40% males; body mass index [BMI], 29±6 kg/m(2)) were studied. Multivariate linear regression models were performed to compare HOMA-IR, HOMA-%ß, and ISIcomposite among individuals with normal glucose tolerance (NGT) (n=191) versus isolated IFG (n=136), isolated IGT (n=22), combined IFG/IGT (n=43), and diabetes (n=105). Compared with individuals with NGT (2.9±1.6), HOMA-IR progressively increased in individuals with isolated IFG (4.8±2.7, P<0.001), combined IFG/IGT (6.0±4.3, P<0.001), and diabetes (9.7±8.3, P<0.001) but not in those with isolated IGT (3.0±1.7, P=0.87). After adjustment for sex and BMI, these associations remained unchanged. Whole-body insulin sensitivity as measured by ISIcomposite was significantly lower in individuals with isolated IFG (3.9±2.3, P<0.001), isolated IGT (2.8±1.5, P<0.001), combined IFG/IGT (1.9±1.1, P<0.001), and diabetes (1.6±1.1, P<0.001) compared with those with NGT (6.1±3.5). HOMA-%ß was significantly lower in diabetes (113.7±124.9, P<0.001) compared with NGT (161.3±92.0). After adjustment for age, sex, and BMI, isolated IFG (146.6±80.2) was also significantly associated with a decline in HOMA-%ß relative to NGT (P=0.005). CONCLUSIONS: This study suggests that differences in the underlying metabolic defects leading to diabetes in Arab Americans with IFG and/or IGT exist and may require different strategies for the prevention of diabetes.

Sensitivity and specificity of glycated hemoglobin as a diagnostic test for diabetes and prediabetes in Arabs.

CONTEXT: Glycated hemoglobin (A1C) has been recommended by the American Diabetes Association for the diagnosis of diabetes and prediabetes. The diagnostic utility of A1C has not been evaluated in Arabs, a population at increased risk for developing diabetes. OBJECTIVE: Our objective was to examine the sensitivity and specificity of A1C for the diagnosis of diabetes and prediabetes in Arabs. DESIGN & SETTING: In this cross-sectional study, glucose tolerance was classified by the American Diabetes Association diagnostic criteria specified for A1C, fasting plasma glucose, and 75-g oral glucose tolerance test. PARTICIPANTS: A population-based representative sample of 482 randomly selected adult Arabs without known diabetes was studied. MAIN OUTCOME MEASURES: Sensitivity, specificity, and area under the receiver operating characteristic curve of A1C diagnostic cutpoints for diabetes and prediabetes were calculated. κ Coefficients were used to test for agreement between A1C categorization and glucose-based diagnoses. RESULTS: A1C testing correctly identified 5% of individuals diagnosed with diabetes by oral glucose tolerance test, 13% by fasting plasma glucose, and 41% by both criteria. A1C alone identified 14% of individuals diagnosed with impaired glucose tolerance, 9% with impaired fasting glucose, and 33% with both abnormalities. Sensitivity, specificity, and area under the receiver operating characteristic curve were 19% (16-23%), 100% (99-100%), and 77% (69-85%) for diabetes A1C cutpoint and 14% (11-17%), 91% (89-94%), and 57% (52-62%) for prediabetes A1C range. A1C cutpoint of 6.2% for diabetes and 5.1% for prediabetes yielded the highest accuracy but still missed 73% of those with diabetes and 31% with prediabetes. Agreement between A1C and diabetes (κ = 0.2835) or prediabetes (κ = 0.0530) was low. CONCLUSIONS: A1C-based criteria yield a high proportion of false-negative tests for diabetes and prediabetes in Arabs. SUMMARY: Racial/ethnic differences in A1C performance for diagnosis and prediction of diabetes exist. This paper examines its utility against glucose measurements in an at-risk Arab population.

Practices of Arab American patients with type 2 diabetes mellitus during Ramadan.

AIMS: To examine practices and complications among Arab Americans observing fasting during Ramadan. METHODS: Adults with type 2 diabetes mellitus, of native Arab ancestry, and observing fasting were invited to complete an interview. Changes made to behavioral characteristics or diabetes management during Ramadan and consequences of fasting were assessed. RESULTS: Twenty-seven patients (60.1 ± 9.8 years, 51.9% male) participated. Majority reported exercising less frequently during Ramadan. Modifications in home blood glucose monitoring (HBGM) were observed in 48% of patients, of these 25% and 17% decreased frequency or had not tested at all, respectively. Consultation with providers prior to Ramadan was reported by 67%. Education regarding medications, risks of fasting, indications to break fasting, meal plans, and exercise were not provided in the majority. Therapeutic changes were made in 50% and 46% of insulin and oral medication users, respectively. Excessive thirst was the most commonly reported symptom. The overall frequency of hypoglycemia and hyperglycemia was low. One patient stopped fasting during Ramadan due to uncontrolled hyperglycemia. Hospitalization or emergency room visits were not reported. CONCLUSIONS: Lack of patient education prior to Ramadan may contribute to the suboptimal practices reported. Pharmacists may be able to ensure safe fasting practices among Arab Americans by providing patient-specific education.

Antidiabetic prescribing trends and predictors of thiazolidinedione discontinuation following the 2007 rosiglitazone safety alert.

This study aimed to examine the change in antidiabetic medication prescribing trends and predictors of thiazolidinedione (TZD) discontinuation six months after the 2007 rosiglitazone safety alert. We performed a retrospective cohort analysis. Patients with two prescriptions for a TZD between 1 January and 21 May 2007, including one covering 21 May 2007, and continuous enrolment during 2006-2007 were identified from the MarketScan database. Multivariate logistic regression analysis was used to compare characteristics between patients who continued and discontinued each TZD. We identified 40,836 and 37,183 individuals with a current prescription for rosiglitazone and pioglitazone, respectively. Significantly more rosiglitazone (53.5%) compared to pioglitazone users (21.4%) discontinued initial therapy six months after the alert (p<0.001). Approximately 23% of patients who discontinued rosiglitazone were switched to pioglitazone, while <1% was switched from pioglitazone to rosiglitazone. Notably, 19.4% of patients who discontinued rosiglitazone and 36.1% of those who discontinued pioglitazone did not have evidence of any antidiabetic drug at follow-up. There was a significant decrease in metformin and an increase in sitagliptin prescribing in patients who discontinued TZDs. Age, sex, region, cardiovascular comorbidities and physician specialty predicted TZD discontinuation. These findings suggest that FDA advisories may be associated with substantial changes in medication use.

Effect of administration time of exenatide on satiety responses, blood glucose, and adverse events in healthy volunteers.

The objective was to investigate whether varying administration time of exenatide affects the magnitude of satiety responses, blood glucose, and adverse events in healthy volunteers. In this randomized, single-blind, placebo-controlled, 4-period crossover, single-dose study, the authors measured satiety responses, blood glucose, and adverse events in 20 participants receiving exenatide (10 µg) at either -60 minutes, -30 minutes, or -15 minutes or placebo at -30 minutes relative to a standardized test meal. Compared with placebo, exenatide reduced caloric intake (P = .0059), food intake (P = .0032), and glucose concentrations at 60 (P < .001) and 120 minutes after meals (P = .015). Nausea (63% vs 20%), reduced appetite (43% vs 10%), and vomiting (18% vs 0%) occurred more frequently in exenatide-treated subjects compared with placebo (P < .05). Significant differences were noted in caloric intake (P = .0149) and food intake (P = .0205) based on the administration time of exenatide, with doses given further from meals producing reduced feeding responses. No such difference was found in postprandial glucose concentrations or adverse events based on timing of exenatide administration. Single-dose exenatide administered further from mealtime had an increased magnitude on satiety responses in healthy volunteers. Postprandial glucose concentrations and the frequency of adverse events did not differ by the administration time of exenatide.

Family support is associated with success in achieving weight loss in a group lifestyle intervention for diabetes prevention in Arab Americans.

OBJECTIVE: We have recently shown the feasibility of a community-based, culturally-specific, Diabetes Prevention Program-adapted, goal-oriented group lifestyle intervention targeting weight loss in Arab Americans. The objective of this study was to examine factors associated with weight-loss goal attainment at 24-weeks of the lifestyle intervention. METHODS: We assessed the relationship among demographic, psychosocial, and behavioral measures and the attainment of > or =7% decrease of initial body weight among 71 lifestyle intervention participants. RESULTS: Weight loss goal of > or = 7% of body weight was achieved by 44% of study participants. Demographic and psychosocial factors were not associated with weight loss. Individuals attaining the weight loss goal were more likely to have family support during the core curriculum sessions (70% vs 30%; P=.0023). Decrease in body weight was positively correlated with attendance at sessions (r=.46; P=.0016) and physical activity minutes (r=.66; P<.0001) and negatively correlated with reported caloric intake (r=-.49; P=.0023), fat intake (r=-.52; P=.0010), and saturated fat intake (r=-.39; P=.0175) in women; these trends were similar but not significant in men. CONCLUSIONS: Family support was an important predictor of attainment of the weight loss goal. Family-centered lifestyle interventions are likely to succeed in curtailing the rising epidemic of diabetes in the Arab-American Community.

Feasibility of group lifestyle intervention for diabetes prevention in Arab Americans.

AIMS: To assess the feasibility and acceptability of a community-based, culturally-specific, Diabetes Prevention Program (DPP)-adapted, group lifestyle intervention in Arab-Americans. METHODS: Overweight (BMI ≥ 27 kg/m(2)) Arab-Americans aged ≥ 30 years and without a history of diabetes were recruited to participate in a 24-week group lifestyle intervention. The DPP core-curriculum was culturally rewritten, translated into Arabic, and delivered in weekly sessions over a 12-week period. Follow-up was performed at week-24. The primary goals were to achieve ≥ 7% weight loss and ≥ 150 min/week of physical activity. An intent-to-treat analysis was performed. RESULTS: Of the 71 participants (mean age ± SD 47 ± 10 years, 38% males), 44% achieved ≥ 7% weight loss, 59% achieved ≥ 5% reduction in weight, and 78% reached the physical activity goal of ≥ 150-min/week. The mean ± SD weight loss was 5.2 ± 4.4 kg at week-24 (p<0.0001), Marked reduction in body measurements, daily energy and fat intake were noted. Retention was high with 86% completing the intervention. CONCLUSIONS: This trial demonstrates that a culturally-specific, DPP-adapted, group lifestyle intervention implemented in a community setting is feasible and effective in Arab-Americans.

Perceived risk and the willingness to enroll in a diabetes prevention lifestyle intervention in Arab-Americans.

The purpose was to examine whether self-reported perceived risk predicts willingness to enroll in DPP-adapted lifestyle intervention in Arab-Americans. Results document a positive relationship between perceived risk and willingness to engage in diabetes prevention activities. These findings imply that educational interventions communicating risk may improve adoption of diabetes preventative efforts.

Serum 25-hydroxy vitamin d and insulin resistance, metabolic syndrome, and glucose intolerance among Arab Americans.

OBJECTIVE: To describe 25-hydroxy vitamin D (25-OH-D) levels and examine associations between 25-OH-D levels and insulin resistance (IR), metabolic syndrome (MS), and glucose intolerance in Arab Americans. RESEARCH DESIGN AND METHODS: Serum 25-OH-D levels were measured in a representative, cross-sectional sample of 542 Arab Americans with IR (46%), MS (33%), and glucose intolerance (42%). RESULTS: Vitamin D insufficiency (5 to <20 ng/ml) was present in 75% and hypovitaminosis D (20 to <40 ng/ml) in 24% of participants. In men, 25-OH-D levels were lower in those with glucose intolerance than normoglycemia (P = 0.01). No such difference was found in women. In men, 25-OH-D was negatively correlated with homeostasis model assessment of insulin resistance (r = -0.19; P = 0.0043), triglycerides (r = -0.18; P = 0.0069), fasting plasma glucose (r = -0.15; P = 0.027), and A1C (r = -0.14; P = 0.038). In women, 25-OH-D was positively correlated with HDL (r = 0.19; P = 0.0008). CONCLUSIONS: Vitamin D insufficiency and hypovitaminosis D are extremely common among Arab Americans, and they are associated with IR, components of the MS, and glucose intolerance in men.

Risk perception for developing diabetes among pharmacists.

BACKGROUND: Emerging evidence implies that differences in risk perception between healthcare professionals and the lay public exist. OBJECTIVE: To compare the actual risk status versus the personal risk perceptions for developing diabetes among pharmacists. METHODS: Perceived risk was measured in this cross-sectional study with the validated Risk Perception Survey for Developing Diabetes (RPS-DD). The RPS-DD has 4 main subscales aimed at capturing multiple dimensions of perceived risk and is scored on the following scale: 1 (almost no risk), 2 (slight risk), 3 (moderate risk), and 4 (high risk). Actual risk was assigned according to the American Diabetes Association (ADA) Diabetes Risk Test. Differences between higher and lower ADA risk participants were analyzed. Regression analyses were conducted to examine risk factors associated with pharmacists' self-reported perception for developing diabetes. RESULTS: Pharmacists (N = 218, 46.2 +/- 12.2 years [mean +/- SD], 47.7% male, 85.9% white) completed the survey. The Comparative Disease and Environmental Risk mean subscale scores were 1.98 +/- 0.43 and 1.86 +/- 0.41, indicating slight risk perceptions for the subscales, respectively. The single-item self-reported perceived risk for developing diabetes was 2.25 +/- 0.90, indicating a slight to moderate perceived risk for this disease. The Optimistic Bias score was 2.60 +/- 0.64, suggesting a trend toward more optimistic bias and a lower perceived risk for the development of diabetes. The Personal Control score was 3.38 +/- 0.47, illustrating that pharmacists endorsed personal control over the development of diabetes. Higher ADA risk participants reported less optimistic bias compared with lower risk respondents (p = 0.005). Comparative disease risk perception (correlation [r] = 0.38; p < 0.0001) and degree of optimistic bias (r = -0.49; p < 0.0001) emerged as the only predictors for diabetes related risk perception CONCLUSIONS: Pharmacists exhibited a slight to moderate risk perception for developing diabetes, reported a trend toward more optimistic bias, and demonstrated personal control over developing diabetes. Significant comparisons between higher and lower risk respondents were observed only with the optimistic bias subscale.