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Fernández-Ramírez A, Olivas-Martinez A, Ruiz-Manriquez J, Kauffman-Ortega E, Moctezuma-Velázquez C, Marquez-Guillen E, Contreras AG, Vilatobá M, González-Flores E, Cruz-Martínez R, Flores-García NC, García-Juárez I. Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:249-257. [PMID: 37858455 DOI: 10.1016/j.rgmxen.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION AND AIMS Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD). METHODS A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM. RESULTS A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes. CONCLUSION The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.
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Affiliation(s)
- A Fernández-Ramírez
- Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Olivas-Martinez
- Departamento de Bioestadística, Universidad de Washington, Seattle, WA, United States
| | - J Ruiz-Manriquez
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E Kauffman-Ortega
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - C Moctezuma-Velázquez
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E Marquez-Guillen
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A G Contreras
- Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Vilatobá
- Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E González-Flores
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - R Cruz-Martínez
- Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - N C Flores-García
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - I García-Juárez
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Pai A, Santiago R, Glantz N, Bevier W, Barua S, Sabharwal A, Kerr D. Multimodal digital phenotyping of diet, physical activity, and glycemia in Hispanic/Latino adults with or at risk of type 2 diabetes. NPJ Digit Med 2024; 7:7. [PMID: 38212415 PMCID: PMC10784546 DOI: 10.1038/s41746-023-00985-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
Digital phenotyping refers to characterizing human bio-behavior through wearables, personal devices, and digital health technologies. Digital phenotyping in populations facing a disproportionate burden of type 2 diabetes (T2D) and health disparities continues to lag compared to other populations. Here, we report our study demonstrating the application of multimodal digital phenotyping, i.e., the simultaneous use of CGM, physical activity monitors, and meal tracking in Hispanic/Latino individuals with or at risk of T2D. For 14 days, 36 Hispanic/Latino adults (28 female, 14 with non-insulin treated T2D) wore a continuous glucose monitor (CGM) and a physical activity monitor (Actigraph) while simultaneously logging meals using the MyFitnessPal app. We model meal events and daily digital biomarkers representing diet, physical activity choices, and corresponding glycemic response. We develop a digital biomarker for meal events that differentiates meal events into normal and elevated categories. We examine the contribution of daily digital biomarkers of elevated meal event count and step count on daily time-in-range 54-140 mg/dL (TIR54-140) and average glucose. After adjusting for step count, a change in elevated meal event count from zero to two decreases TIR54-140 by 4.0% (p = 0.003). An increase in 1000 steps in post-meal step count also reduces the meal event glucose response by 641 min mg/dL (p = 0.0006) and reduces the odds of an elevated meal event by 55% (p < 0.0001). The proposed meal event digital biomarkers may provide an opportunity for non-pharmacologic interventions for Hispanic/Latino adults facing a disproportionate burden of T2D.
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Affiliation(s)
- Amruta Pai
- Electrical and Computer Engineering, Rice University, Houston, TX, USA.
| | - Rony Santiago
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Namino Glantz
- Santa Barbara County Education Office, Children & Family Resource Services, Santa Barbara, CA, USA
| | - Wendy Bevier
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Souptik Barua
- Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | | | - David Kerr
- Sutter Center for Health Systems Research, Santa Barbara, CA, USA
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Rawat P, Sehar U, Bisht J, Reddy AP, Reddy PH. Alzheimer's disease and Alzheimer's disease-related dementias in Hispanics: Identifying influential factors and supporting caregivers. Ageing Res Rev 2024; 93:102178. [PMID: 38154509 PMCID: PMC10807242 DOI: 10.1016/j.arr.2023.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD) are the primary public health concerns in the United States and around the globe. AD/ADRD are irreversible mental illnesses that primarily impair memory and thought processes and may lead to cognitive decline among older individuals. The prevalence of AD/ADRD is higher in Native Americans, followed by African Americans and Hispanics. Increasing evidence suggests that Hispanics are the fastest-growing ethnic population in the USA and worldwide. Hispanics develop clinical symptoms of AD/ADRD and other comorbidities nearly seven years earlier than non-Hispanic whites. The consequences of AD/ADRD can be challenging for patients, their families, and caregivers. There is a significant increase in the burden of illness, primarily affecting Hispanic/Latino families. This is partly due to their strong sense of duty towards family, and it is exacerbated by the inadequacy of healthcare and community services that are culturally and linguistically suitable and responsive to their needs. With an increasing age population, low socioeconomic status, low education, high genetic predisposition to age-related conditions, unique cultural habits, and social behaviors, Hispanic Americans face a higher risk of AD/ADRD than other racial/ethnic groups. Our article highlights the status of Hispanic older adults with AD/ADRD. We also discussed the intervention to improve the quality of life in Hispanic caregivers.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA
| | - Jasbir Bisht
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Arubala P Reddy
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Bukhbinder AS, Hinojosa M, Harris K, Li X, Farrell CM, Shyer M, Goodwin N, Anjum S, Hasan O, Cooper S, Sciba L, Vargas A, Hunter DH, Ortiz GJ, Chung K, Cui L, Zhang GQ, Fisher-Hoch SP, McCormick JB, Schulz PE. Population-Based Mini-Mental State Examination Norms in Adults of Mexican Heritage in the Cameron County Hispanic Cohort. J Alzheimers Dis 2023; 92:1323-1339. [PMID: 36872776 DOI: 10.3233/jad-220934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Accurately identifying cognitive changes in Mexican American (MA) adults using the Mini-Mental State Examination (MMSE) requires knowledge of population-based norms for the MMSE, a scale which has widespread use in research settings. OBJECTIVE To describe the distribution of MMSE scores in a large cohort of MA adults, assess the impact of MMSE requirements on their clinical trial eligibility, and explore which factors are most strongly associated with their MMSE scores. METHODS Visits between 2004-2021 in the Cameron County Hispanic Cohort were analyzed. Eligible participants were ≥18 years old and of Mexican descent. MMSE distributions before and after stratification by age and years of education (YOE) were assessed, as was the proportion of trial-aged (50-85- year-old) participants with MMSE <24, a minimum MMSE cutoff most frequently used in Alzheimer's disease (AD) clinical trials. As a secondary analysis, random forest models were constructed to estimate the relative association of the MMSE with potentially relevant variables. RESULTS The mean age of the sample set (n = 3,404) was 44.4 (SD, 16.0) years old and 64.5% female. Median MMSE was 28 (IQR, 28-29). The percentage of trial-aged participants (n = 1,267) with MMSE <24 was 18.6%; 54.3% among the subset with 0-4 YOE (n = 230). The five variables most associated with the MMSE in the study sample were education, age, exercise, C-reactive protein, and anxiety. CONCLUSION The minimum MMSE cutoffs in most phase III prodromal-to-mild AD trials would exclude a significant proportion of trial-aged participants in this MA cohort, including over half of those with 0-4 YOE.
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Affiliation(s)
- Avram S Bukhbinder
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.,Division of Pediatric Neurology, Massachusetts General Hospital, Boston, MA
| | - Miriam Hinojosa
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kristofer Harris
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaojin Li
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christine M Farrell
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Madison Shyer
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nathan Goodwin
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sahar Anjum
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Omar Hasan
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Cooper
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lois Sciba
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Vargas
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David H Hunter
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guadalupe J Ortiz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karen Chung
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Licong Cui
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guo-Qiang Zhang
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.,School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan P Fisher-Hoch
- Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Brownsville, TX, USA
| | - Joseph B McCormick
- Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Brownsville, TX, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Rawat P, Sehar U, Bisht J, Reddy PH. Support Provided by Caregivers for Community-Dwelling Diabetic Hispanic Adults with Intellectual Disabilities and Comorbid Conditions. Int J Mol Sci 2023; 24:3848. [PMID: 36835260 PMCID: PMC9962604 DOI: 10.3390/ijms24043848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Diabetes is an age-related chronic health condition and a major public health concern. Diabetes is one of the significant causes of morbidity and mortality and a major contributing factor to dementia. Recent research reveals that Hispanic Americans are at an increased risk of chronic conditions such as diabetes, dementia, and obesity. Recent research also revealed that diabetes develops at least ten years earlier in Hispanics and Latinos than in neighboring non-Hispanic whites. Furthermore, the management of diabetes and providing necessary/timely support is a challenging task for healthcare professionals. Caregiver support is an emerging area of research for people with diabetes, mainly family caregiver support work for Hispanic and Native Americans. Our article discusses several aspects of diabetes, factors associated with diabetes among Hispanics, its management, and how caregivers can support individuals with diabetes.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jasbir Bisht
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Neurology Department, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Cincotta AH, Cersosimo E, Alatrach M, Ezrokhi M, Agyin C, Adams J, Chilton R, Triplitt C, Chamarthi B, Cominos N, DeFronzo RA. Bromocriptine-QR Therapy Reduces Sympathetic Tone and Ameliorates a Pro-Oxidative/Pro-Inflammatory Phenotype in Peripheral Blood Mononuclear Cells and Plasma of Type 2 Diabetes Subjects. Int J Mol Sci 2022; 23:ijms23168851. [PMID: 36012132 PMCID: PMC9407769 DOI: 10.3390/ijms23168851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Bromocriptine-QR is a sympatholytic dopamine D2 agonist for the treatment of type 2 diabetes that has demonstrated rapid (within 1 year) substantial reductions in adverse cardiovascular events in this population by as yet incompletely delineated mechanisms. However, a chronic state of elevated sympathetic nervous system activity and central hypodopaminergic function has been demonstrated to potentiate an immune system pro-oxidative/pro-inflammatory condition and this immune phenotype is known to contribute significantly to the advancement of cardiovascular disease (CVD). Therefore, the possibility exists that bromocriptine-QR therapy may reduce adverse cardiovascular events in type 2 diabetes subjects via attenuation of this underlying chronic pro-oxidative/pro-inflammatory state. The present study was undertaken to assess the impact of bromocriptine-QR on a wide range of immune pro-oxidative/pro-inflammatory biochemical pathways and genes known to be operative in the genesis and progression of CVD. Inflammatory peripheral blood mononuclear cell biology is both a significant contributor to cardiovascular disease and also a marker of the body’s systemic pro-inflammatory status. Therefore, this study investigated the effects of 4-month circadian-timed (within 2 h of waking in the morning) bromocriptine-QR therapy (3.2 mg/day) in type 2 diabetes subjects whose glycemia was not optimally controlled on the glucagon-like peptide 1 receptor agonist on (i) gene expression status (via qPCR) of a wide array of mononuclear cell pro-oxidative/pro-inflammatory genes known to participate in the genesis and progression of CVD (OXR1, NRF2, NQO1, SOD1, SOD2, CAT, GSR, GPX1, GPX4, GCH1, HMOX1, BiP, EIF2α, ATF4, PERK, XBP1, ATF6, CHOP, GSK3β, NFkB, TXNIP, PIN1, BECN1, TLR2, TLR4, TLR10, MAPK8, NLRP3, CCR2, GCR, L-selectin, VCAM1, ICAM1) and (ii) humoral measures of sympathetic tone (norepinephrine and normetanephrine), whole-body oxidative stress (nitrotyrosine, TBARS), and pro-inflammatory factors (IL-1β, IL-6, IL-18, MCP-1, prolactin, C-reactive protein [CRP]). Relative to pre-treatment status, 4 months of bromocriptine-QR therapy resulted in significant reductions of mRNA levels in PBMC endoplasmic reticulum stress-unfolded protein response effectors [GRP78/BiP (34%), EIF2α (32%), ATF4 (29%), XBP1 (25%), PIN1 (14%), BECN1 (23%)], oxidative stress response proteins [OXR1 (31%), NRF2 (32%), NQO1 (39%), SOD1 (52%), CAT (26%), GPX1 (33%), GPX4 (31%), GCH1 (30%), HMOX1 (40%)], mRNA levels of TLR pro-inflammatory pathway proteins [TLR2 (46%), TLR4 (20%), GSK3β (19%), NFkB (33%), TXNIP (18%), NLRP3 (32%), CCR2 (24%), GCR (28%)], mRNA levels of pro-inflammatory cellular receptor proteins CCR2 and GCR by 24% and 28%, and adhesion molecule proteins L-selectin (35%) and VCAM1 (24%). Relative to baseline, bromocriptine-QR therapy also significantly reduced plasma levels of norepinephrine and normetanephrine by 33% and 22%, respectively, plasma pro-oxidative markers nitrotyrosine and TBARS by 13% and 10%, respectively, and pro-inflammatory factors IL-18, MCP1, IL-1β, prolactin, and CRP by 21%,13%, 12%, 42%, and 45%, respectively. These findings suggest a unique role for circadian-timed bromocriptine-QR sympatholytic dopamine agonist therapy in reducing systemic low-grade sterile inflammation to thereby reduce cardiovascular disease risk.
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Affiliation(s)
- Anthony H. Cincotta
- VeroScience LLC, Tiverton, RI 02878, USA
- Correspondence: ; Tel.: +1-401-816-0525
| | - Eugenio Cersosimo
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Mariam Alatrach
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | | | - Christina Agyin
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - John Adams
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Robert Chilton
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Curtis Triplitt
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | | | | | - Ralph A. DeFronzo
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Zhang T, Tang JZ, Fei X, Li Y, Song Y, Qian Z, Peng Q. Can nanoparticles and nano‒protein interactions bring a bright future for insulin delivery? Acta Pharm Sin B 2021; 11:651-667. [PMID: 33777673 PMCID: PMC7982494 DOI: 10.1016/j.apsb.2020.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
Insulin therapy plays an essential role in the treatment of diabetes mellitus. However, frequent injections required to effectively control the glycemic levels lead to substantial inconvenience and low patient compliance. In order to improve insulin delivery, many efforts have been made, such as developing the nanoparticles (NPs)-based release systems and oral insulin. Although some improvements have been achieved, the ultimate results are still unsatisfying and none of insulin-loaded NPs systems have been approved for clinical use so far. Recently, nano‒protein interactions and protein corona formation have drawn much attention due to their negative influence on the in vivo fate of NPs systems. As the other side of a coin, such interactions can also be used for constructing advanced drug delivery systems. Herein, we aim to provide an insight into the advance and flaws of various NPs-based insulin delivery systems. Particularly, an interesting discussion on nano‒protein interactions and its potentials for developing novel insulin delivery systems is initiated. Insulin therapy plays essential roles in treating diabetes. Optimizing insulin delivery enhances insulin therapy. Nanoparticles are promising systems for delivery of insulin. Nano-protein interactions influence the delivery of nanoparticles. Nano-protein interactions can be used for advanced delivery of insulin.
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Affiliation(s)
- Ting Zhang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - James Zhenggui Tang
- Research Institute in Healthcare Science, Faculty of Science and Engineering, School of Pharmacy, University of Wolverhampton, Wolverhampton, WV1 1LY, UK
| | - Xiaofan Fei
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yanping Li
- Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yi Song
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhiyong Qian
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu 610041, China
| | - Qiang Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Corresponding author.
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Larsen BA, Benitez TJ, Mendoza-Vasconez AS, Hartman SJ, Linke SE, Pekmezi DJ, Dunsiger SI, Nodora JN, Gans KM, Marcus BH. Randomized Trial of a Physical Activity Intervention for Latino Men: Activo. Am J Prev Med 2020; 59:219-227. [PMID: 32448552 PMCID: PMC7375921 DOI: 10.1016/j.amepre.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Latino men experience disproportionately high rates of diseases related to low physical activity, yet they are poorly represented in physical activity intervention trials. Efforts to promote physical activity in Latina women show promising results, yet such interventions are yet to be extended to Latino men. This study tested a computer expert system‒tailored, text messaging-supported physical activity intervention for underactive Spanish-speaking Latino men compared with a control group matched for contact time. Potential predictors of intervention success were also explored. STUDY DESIGN Randomized trial. Participants were randomized to receive a Tailored Physical Activity Intervention (Intervention) or a Wellness Control (Control). Data were collected in 2015-2017 and analyzed in 2018-2019. SETTING/PARTICIPANTS Insufficiently active Latino men (n=46). INTERVENTION Intervention participants received a baseline counseling session and then, individually tailored print materials and text messages on a tapered schedule for 6 months. Control participants received printed wellness materials and text messages on the same schedule. MAIN OUTCOME MEASURES Primary outcome was a change in weekly moderate to vigorous physical activity from baseline to 6 months measured by accelerometers. Self-reported moderate to vigorous physical activity measured by the 7-day Physical Activity Recall Interview was a secondary outcome. RESULTS For Intervention participants, median accelerometer-measured moderate to vigorous physical activity increased from 10.0 minutes/week at baseline to 57.5 minutes/week at 6 months, whereas for Control participants, it increased from 21.0 minutes/week at baseline to 23.0 minutes/week at 6 months (p<0.05). Similar results were found for self-reported moderate to vigorous physical activity. At 6 months, 47% of Intervention participants met national guidelines of 150 minutes/week versus 25% of Control participants (p=0.15, not significant). CONCLUSIONS Findings suggest that an individually tailored intervention can successfully increase moderate to vigorous physical activity in underactive Latino men. Such technology-supported interventions have the potential for broad dissemination. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02512419.
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Affiliation(s)
- Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
| | - Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Andrea S Mendoza-Vasconez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Sarah E Linke
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Dori J Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, Alabama
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, Rhode Island
| | - Jesse N Nodora
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
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Marquez I, Calman N, Crump C. A Framework for Addressing Diabetes-Related Disparities in US Latino Populations. J Community Health 2020; 44:412-422. [PMID: 30264184 DOI: 10.1007/s10900-018-0574-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems.
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Affiliation(s)
- Ivan Marquez
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Suite L5-40, New York, NY, 10029, USA.
| | - Neil Calman
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Institute for Family Health, New York, NY, USA
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Smith-Miller CA, Berry DC, DeWalt D, Miller CT. Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants. J Immigr Minor Health 2018; 18:1392-1403. [PMID: 26547695 DOI: 10.1007/s10903-015-0271-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article describes the quantitative findings of a mixed-methods study that examined the relationship among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes self-management among recent Spanish-speaking, limited English proficient immigrants to the US. This population is at risk for both a higher incidence of disease and increased barriers to successful disease management compared to the general US population. Distinguishing aspects of this study compared to the available literature are the comprehensive nature of the data collected, the theoretical component, and the analysis and modeling approach. Social cognitive theory provides the framework for the study design and analysis. An innovative community-based recruiting strategy was used, a broad range of physiological measures related to health were observed, and instruments related to knowledge, self-efficacy, and healthy lifestyle behaviors were administered orally in Spanish to 30 participants. A broad range of statistical analysis methods was applied to the data, including a set of three structural equation models. The study results are consistent with the importance of education, health knowledge, and healthy lifestyle practices for type 2 diabetes self-management. With the usual cautions associated with applying structural equation modeling to modest sample sizes, multiple elements of the posited theoretical model were consistent with the data collected. The results of the investigation of this under-studied population indicate that, on average, participants were not effectively managing their disease. The results suggest that clinical interventions focused on improving knowledge, nutrition, and physical activity, reducing stress, and leveraging the importance of interpersonal relations could be effective intervention strategies to improve self-management among this population.
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Affiliation(s)
- Cheryl A Smith-Miller
- Nursing Quality and Research, University of North Carolina Hospital, Chapel Hill, NC, USA. .,School of Nursing, UNC-CH, Chapel Hill, NC, USA.
| | | | | | - Cass T Miller
- UNC Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
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11
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Nguyen AL, Sepulveda E, Angulo M. "It Feels Good to Know That Someone Cares". HISPANIC HEALTH CARE INTERNATIONAL 2017; 15:52-57. [PMID: 28558495 DOI: 10.1177/1540415317698701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diabetes is the leading cause of death in Hispanic communities. Self-management is an important part of diabetes care, and diabetes self-management education (DSME) aims to teach the skills necessary for preventing and delaying complication. However, DSME is underutilized. The purpose of this study was to explore Hispanic adults' motivations for attending a DSME class to identify effective strategies for promoting class participation and retention. METHOD Nineteen adults participated in seven focus groups conducted in Spanish. Discussions were audio-recorded, transcribed, and translated. Transcripts were content coded by two coders to create a thematic coding scheme. RESULTS Five main themes emerged as motivations for attendance: (1) frustration with physiological changes, (2) desire to "do better" because of family experience with death/complications from diabetes, (3) free access to information that is unattainable elsewhere, (3) a way to take control, and (4) group setting offered valued emotional and informational support as well as peer support for those who were uncomfortable discussing diabetes with family or lived with family who do not support lifestyle changes. CONCLUSIONS Gaining diabetes self-management knowledge only partly explains the perceived value of classes. Culturally relevant content and appealing to the social supportive aspects of groups may encourage participation.
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Affiliation(s)
| | | | - Marco Angulo
- 2 University of California, Irvine, Orange, CA, USA
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12
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Strizich G, Kaplan RC, González HM, Daviglus ML, Giachello AL, Teng Y, Lipton RB, Grober E. Glycemic control, cognitive function, and family support among middle-aged and older Hispanics with diabetes: The Hispanic Community Health Study/Study of Latinos. Diabetes Res Clin Pract 2016; 117:64-73. [PMID: 27329024 PMCID: PMC4918095 DOI: 10.1016/j.diabres.2016.04.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/02/2016] [Accepted: 04/30/2016] [Indexed: 12/20/2022]
Abstract
AIMS To examine among Hispanics in the U.S., a population with increased reliance on informal healthcare support structures, (1) the association between cognitive function and control of diabetes; and (2) whether this association is modified by family support. METHODS The Digit Symbol Substitution Test (DSST), word fluency, and learning and delayed recall components of the Spanish English Verbal Learning Test were administered to 1794 Hispanic adults aged 45-76years with diagnosed diabetes. An executive function index and global cognitive function index (GCFI) were derived. Uncontrolled diabetes (HbA1c⩾7% [53mmol/mol]) was compared across quartiles of cognitive function using multivariable logit models with interaction terms for cognitive function and family support. RESULTS After adjustment, lower DSST scores were associated with uncontrolled diabetes (P=0.03). Family support modified the relationship between other measures of cognition and diabetes control (Pinteraction: 0.002, 0.09). Among individuals with low family support, as cognitive function declined, the odds of uncontrolled diabetes increased (P-trend across quartiles of the GCFI, 0.015). Among those with low family support, persons in the lowest quartile of global cognitive function were more than twice as likely to have uncontrolled diabetes as those in the highest performing quartile (OR=2.31; 95% CI: 1.17, 4.55). There was no similar effect among those with high family support. CONCLUSIONS Family support may buffer the negative association between low cognitive functioning and diabetes control in US Hispanics/Latinos. Educational programs targeted at family members of middle-age and older persons with diabetes regardless of neurocognitive status may help improve population-level glycemic control.
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Affiliation(s)
- Garrett Strizich
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461
| | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, East Lansing, MI 48824
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk Street, Chicago, IL 60612
| | - Aida L Giachello
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Yanping Teng
- Collaborative Studies Coordinating Center, University of North Carolina, 137 East Franklin Street, Chapel Hill, NC 27514
| | - Richard B Lipton
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Kennedy Center Room 316, Bronx, NY 10461
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461
| | - Ellen Grober
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Kennedy Center Room 316, Bronx, NY 10461
- Corresponding author: Garrett Strizich, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Suite 1306, Bronx, NY 10461. Tel: 406-249-6387, Fax: 718.430.3588,
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Excess Weight Loss and Cardiometabolic Parameter Reduction Diminished among Hispanics Undergoing Bariatric Surgery: Outcomes in More than 2,000 Consecutive Hispanic Patients at a Single Institution. J Am Coll Surg 2016; 222:166-73. [DOI: 10.1016/j.jamcollsurg.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022]
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Rotberg B, Greene R, Ferez-Pinzon AM, Mejia R, Umpierrez G. Improving Diabetes Care in the Latino Population: The Emory Latino Diabetes Education Program. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2015.1111177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Type 2 diabetes (T2D) is a global health problem showing substantial ethnic disparity in disease prevalence. African Americans have one of the highest prevalence of T2D in the USA but little is known about their genetic risks. This review summarizes the findings of genetic regions and loci associated with T2D and related glycemic traits using linkage, admixture, and association approaches in populations of African ancestry. In particular, findings from genome-wide association and exome chip studies suggest the presence of both ancestry-specific and shared loci for T2D and glycemic traits. Among the European-identified loci that are transferable to individuals of African ancestry, allelic heterogeneity as well as differential linkage disequilibrium and risk allele frequencies pose challenges and opportunities for fine mapping and identification of causal variant(s) by trans-ancestry meta-analysis. More genetic research is needed in African ancestry populations including the next-generation sequencing to improve the understanding of genetic architecture of T2D.
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Affiliation(s)
- Maggie C Y Ng
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA,
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Kilpadi KL, Eldabaje R, Schmitz JE, Ehler B, Thames TA, Joshi AP, Simmons JW, Michalek JE, Fajardo RJ. Type 2 diabetes is associated with vertebral fractures in a sample of clinic- and hospital-based Latinos. J Immigr Minor Health 2015; 16:440-9. [PMID: 23636465 DOI: 10.1007/s10903-013-9833-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Latinos are the fastest growing ethnic population in the United States and type 2 diabetes is a major health burden in this population, but little effort has been made to study the prevalence of diabetic vertebral fragility in Latinos. We performed a cross-sectional study to determine vertebral fracture prevalence in a hospital-based population of South Texas residents (N = 296). We defined fractures in X-rays as a >20% reduction in vertebral body height. Numerous variables were recorded, including age, body mass index, indicators of diabetes management and others. 71% of the sample (N = 296) was Latino. The prevalence of vertebral fracture was increased in diabetic subjects relative to non-diabetic subjects (diabetic 27.9%, non-diabetic 13.8%) and, regardless of sex and diabetics status, decreased in Latinos relative to non-Latinos (Latino 16.7%, non-Latino 26.4%). These data suggest that vertebral fractures may be a growing concern for diabetic Latinos as well as diabetics of any racial/ethnic background.
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Affiliation(s)
- K L Kilpadi
- Department of Orthopaedics MSC-7774, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX, 78229, USA
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Williams JP, Schroeder D. Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review. JMIR Mhealth Uhealth 2015; 3:e84. [PMID: 26307533 PMCID: PMC4705030 DOI: 10.2196/mhealth.3986] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/02/2015] [Accepted: 05/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs. mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos. OBJECTIVE The objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US. METHODS Our study consisted of two parts. First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities. Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents' use of diabetes apps. RESULTS Approximately one-third of apps reviewed were available in Spanish. The most common features were blood glucose recording/annotation and activity logs. The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account. Twenty percent of apps reviewed could connect directly with a glucometer, and 30% had reminder functionalities prompting patients to take medications or check blood glucose levels. Over 1600 online surveys were completed during the second half of April 2014. More than 90% of respondents were from the United States, including Puerto Rico. The majority of respondents used a device running on an Android platform while only a quarter used an iPhone. Use of diabetes apps was approximately 3% among diabetic respondents and 3.6% among diabetic respondents who also had a smartphone. Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used. A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor. CONCLUSIONS Latino diabetics have unique needs and this should be reflected in diabetes apps designed for this population. Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps. We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish.
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Affiliation(s)
- John Patrick Williams
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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18
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Zeki Al Hazzouri A, Haan MN, Robinson WR, Gordon-Larsen P, Garcia L, Clayton E, Aiello AE. Associations of intergenerational education with metabolic health in U.S. Latinos. Obesity (Silver Spring) 2015; 23:1097-104. [PMID: 25809593 PMCID: PMC4414717 DOI: 10.1002/oby.21051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/21/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the association of intergenerational education and country of birth with waist circumference, metabolic syndrome, and type 2 diabetes among older adult Latinos in the United States. METHODS We used cross-sectional data from the Sacramento Area Latino Study on Aging, a cohort of older adult Mexican-American Latinos (mean age = 70 years). At baseline, we measured waist circumference and assessed metabolic syndrome and diabetes according to established guidelines (N = 1,789). Participants were classified as US-born or foreign-born based on self-reported birth country. Participants reported their parents' education level (≥6 vs. <6 years) and their own educational attainment (≥12 vs. <12 years). RESULTS US-born participants who achieved high adult education, regardless of their parents' education, had 37% lower odds of type 2 diabetes compared to US-born participants with both low parental and personal education levels [e.g., multivariable-adjusted OR (parental low/adult high) = 0.63; 95% CI = 0.40, 0.99]. Among the foreign-born, only those with both high parental and high personal education levels had 55% lower odds of large waist circumference (OR = 0.45; 95% CI = 0.23, 0.88) compared to foreign-born participants with both low parental and personal education levels. CONCLUSIONS Intergenerational exposure to low education levels may increase central obesity and type 2 diabetes differentially among US-born and foreign-born Latinos.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Division of Epidemiology and Population Health, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
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Ross MC, Muzny DM, McCormick JB, Gibbs RA, Fisher-Hoch SP, Petrosino JF. 16S gut community of the Cameron County Hispanic Cohort. MICROBIOME 2015; 3:7. [PMID: 25763184 PMCID: PMC4355967 DOI: 10.1186/s40168-015-0072-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/03/2015] [Indexed: 05/05/2023]
Abstract
BACKGROUND Obesity and type 2 diabetes (T2D) are major public health concerns worldwide, and their prevalence has only increased in recent years. Mexican Americans are disproportionately afflicted by obesity and T2D, and rates are even higher in the United States-Mexico border region. To determine the factors associated with the increased risk of T2D, obesity, and other diseases in this population, the Cameron County Hispanic Cohort was established in 2004. RESULTS In this study, we characterized the 16S gut community of a subset of 63 subjects from this unique cohort. We found that these communities, when compared to Human Microbiome Project subjects, exhibit community shifts often observed in obese and T2D individuals in published studies. We also examined microbial network relationships between operational taxonomic units (OTUs) in the Cameron County Hispanic Cohort (CCHC) and three additional datasets. We identified a group of seven genera that form a tightly interconnected network present in all four tested datasets, dominated by butyrate producers, which are often increased in obese individuals while being depleted in T2D patients. CONCLUSIONS Through a combination of increased disease prevalence and relatively high gut microbial homogeneity in the subset of CCHC members we examined, we believe that the CCHC may represent an ideal community to dissect mechanisms underlying the role of the gut microbiome in human health and disease. The lack of CCHC subject gut community segregation based on all tested metadata suggests that the community structure we observe in the CCHC likely occurs early in life, and endures. This persistent 'disease'-related gut microbial community in CCHC subjects may enhance existing genetic or lifestyle predispositions to the prevalent diseases of the CCHC, leading to increased attack rates of obesity, T2D, non-alcoholic fatty liver disease, and others.
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Affiliation(s)
- Matthew C Ross
- />Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX USA
- />Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX USA
| | - Donna M Muzny
- />Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | | | - Richard A Gibbs
- />Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | | | - Joseph F Petrosino
- />Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX USA
- />Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX USA
- />Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
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Prezio EA, Pagán JA, Shuval K, Culica D. The Community Diabetes Education (CoDE) program: cost-effectiveness and health outcomes. Am J Prev Med 2014; 47:771-9. [PMID: 25455119 DOI: 10.1016/j.amepre.2014.08.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/08/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limited evidence exists regarding the long-term effects of community health worker-led diabetes management programs on health outcomes and cost-effectiveness, particularly in low-income, ethnic minority populations. PURPOSE To examine the long-term cost-effectiveness and improvements in diabetes-related complications of a diabetes education and management intervention led by community health workers among uninsured Mexican Americans. METHODS Clinical data, changes in hemoglobin A1c over 12 months, and costs from an RCT of 180 uninsured Mexican Americans with type 2 diabetes conducted in 2006 were utilized for secondary analyses in 2012. Simulation modeling was used to estimate long-term cost and health outcomes using the validated Archimedes Model. The absolute differences for the incremental cost-effectiveness ratios and cumulative incidence of diabetes-related complications were derived by comparing intervention and control groups. RESULTS During a 20-year time horizon, participants who received the intervention would be expected to have significantly lower hemoglobin A1c levels (p<0.001), fewer foot ulcers (p<0.001), and a reduced number of foot amputations (p=0.005) in comparison with a control group receiving usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life year gained was estimated for intervention participants during the same time period. CONCLUSIONS A simulated clinical trial suggests that a community health worker-led diabetes intervention is a cost-effective way to reduce diabetes-related complications for uninsured Mexican Americans during a 20-year horizon in comparison to usual medical care.
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Affiliation(s)
- Elizabeth A Prezio
- Department of Epidemiology, University of Texas Health Science Center, Dallas.
| | - José A Pagán
- Center for Health Innovation, The New York Academy of Medicine, New York, New York; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kerem Shuval
- Intramural Research Department, Economics and Health Policy Research Program, American Cancer Society, Atlanta, Georgia
| | - Dan Culica
- TMF Health Quality Institute, Austin, Texas
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Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Klein E, Coppola G, Ringman J. Younger age of dementia diagnosis in a Hispanic population in southern California. Int J Geriatr Psychiatry 2014; 29:586-93. [PMID: 24478258 PMCID: PMC4013239 DOI: 10.1002/gps.4040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/23/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Prior studies of US Hispanics, largely performed on the East Coast, have found a younger age of dementia onset than in White non-Hispanics. We performed a cross-sectional study to examine clinical and sociodemographic variables associated with age of dementia diagnosis in older Hispanics and White, non-Hispanics in southern California. METHODS Two hundred ninety (110 Hispanic and 180 White non-Hispanic) community dwelling, cognitively symptomatic subjects, aged 50 years and older, were assessed and diagnosed with probable Alzheimer's disease or probable vascular dementia. Apolipoprotein E (APOE) genotype was assessed in a subset of cases. Analysis of variance and multiple stepwise linear regression were used to assess main effects and interactions of ethnicity with dementia severity (indexed by mini mental state examination scores) and other sociodemographic and clinical variables on age of dementia diagnosis. RESULTS Hispanics were younger by an average of 4 years at the time of diagnosis, regardless of dementia subtype, despite a similar prevalence of the APOE ε4 genotype. The earlier age at diagnosis for Hispanics was not explained by gender, dementia severity, years of education, history of hypercholesterolemia, hypertension, or diabetes. Only ethnicity was significantly associated with age of onset. CONCLUSIONS These findings confirm that US Hispanics living in the southwestern USA tend to be younger at the time of dementia diagnosis than their White non-Hispanic counterparts. As this is not explained by the presence of the APOE ε4 genotype, further studies should explore other cultural, medical, or genetic risk factors influencing the age of dementia onset in this population.
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Affiliation(s)
- L. Jaime Fitten
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Greater Los Angeles Veterans Affairs Healthcare System, Sepulveda Campus,Department of Psychiatry Olive View-UCLA Medical Center,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - Freddy Ortiz
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Greater Los Angeles Veterans Affairs Healthcare System, Sepulveda Campus,Department of Psychiatry Olive View-UCLA Medical Center,Department of Neurology, David Geffen School of Medicine at UCLA,Corresponding Author: L. Jaime Fitten, MD, Greater Los Angeles VA Healthcare System, Sepulveda Campus, 16111 Plummer St. (116A-9), Los Angeles, CA. 91343, Telephone: (818) 895-9541, Fax:(818) 895-9515,
| | - Lynn Fairbanks
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - George Bartzokis
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - Po Lu
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA,Department of Neurology, David Geffen School of Medicine at UCLA
| | - Eric Klein
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - Giovanni Coppola
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - John Ringman
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Neurology, David Geffen School of Medicine at UCLA
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Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:671-8. [PMID: 24745315 DOI: 10.1016/j.jse.2014.01.046] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty, its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored. The purpose of the study was to determine the association of diabetes with in-hospital death, complications, length of stay, non-homebound disposition, and cost in patients undergoing shoulder arthroplasty. METHODS By use of the Nationwide Inpatient Sample database for the year 2011, an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with (21%) and without (79%) diabetes mellitus. Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling. RESULTS Diabetes mellitus was independently associated with in-hospital death, a number of perioperative complications, prolonged hospital stay, and increased non-homebound disposition after shoulder arthroplasty. The presence of diabetes was not associated with increased hospital cost. CONCLUSION Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty. Future prospective research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes.
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Zeki Al Hazzouri A, Haan MN, Deng Y, Neuhaus J, Yaffe K. Reduced heart rate variability is associated with worse cognitive performance in elderly Mexican Americans. Hypertension 2013; 63:181-7. [PMID: 24144650 DOI: 10.1161/hypertensionaha.113.01888] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Reduced heart rate variability is a strong predictor of cardiovascular risk factors, cardiovascular events, and mortality and thus may be associated with cognitive neurodegeneration. Yet, this has been relatively unexplored, particularly in minority populations with high cardiovascular burden. We used data from the Sacramento Area Latino Study on Aging to examine the cross-sectional association of reduced heart rate variability with cognitive function among elderly Mexican Americans. A total of 869 participants (mean age, 75 years; 59% women) had their 6-minute heart rate variability measured using an ECG monitor and respiration pacer in response to deep breathing. We used the mean circular resultant, known as R bar, as a measure of heart rate variability and categorized it into quartiles (Q1 to Q4 of R bar: reduced to high heart rate variability). Cognitive function was assessed using the modified Mini-Mental State Examination, a 100-point test of global cognitive function, and the Spanish and English verbal learning test, a 15-point test of verbal memory recall. In fully adjusted linear regression models, participants in quartile 1 had a 4-point lower modified Mini-Mental State Examination score (P<0.01), those in quartile 2 had a 2-point lower score (P=0.04), and those in quartile 3 had a 1-point lower score (P=0.35) compared with those in the highest quartile of R bar. Reduced R bar was not associated with verbal memory. Our results suggest that reduced heart rate variability is associated with worse performance on the test of global cognitive function, above and beyond traditional cardiovascular risk factors.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 185 Berry St, Lobby 5, Suite 5700, San Francisco, CA 94107.
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Zhao X. Relationships between sources of health information and diabetes knowledge in the U.S. Hispanic population. HEALTH COMMUNICATION 2013; 29:574-585. [PMID: 24131235 DOI: 10.1080/10410236.2013.784937] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Data from the 2007 Hispanic Healthcare Survey were analyzed to examine the relationship between health information use and diabetes knowledge in the U.S. Hispanic population. A nationally representative sample of 4,013 adults self-identified as Hispanics or Latinos was generated through stratified random digit dialing (RDD) and interviewed using Computer Assisted Telephone Interviewing (CATI). Results showed that receiving health information from health care providers, family and friends, newspapers and magazines, and the Internet was positively associated with diabetes knowledge. Getting health information from churches and community organizations, however, was negatively associated with diabetes knowledge. Use of television as a source of health information showed mixed results. Implications of these findings for diabetes interventions targeting the Hispanic population in the United States are discussed.
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Affiliation(s)
- Xiaoquan Zhao
- a Department of Communication , George Mason University
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Dinwiddie GY, Zambrana RE, Garza MA. Exploring risk factors in Latino cardiovascular disease: the role of education, nativity, and gender. Am J Public Health 2013; 104:1742-50. [PMID: 24028268 DOI: 10.2105/ajph.2013.301280] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We examined 3 cardiovascular disease risk factors by nativity and gender, evaluating evidence for education and health behaviors in explaining the "Hispanic Health Paradox." METHODS We analyzed 2001-2008 National Health and Nutrition Examination Survey data for adults (n = 6032) to compare hypertension, high waist circumference, and diabetes for US- and foreign-born Mexican men and women. We controlled for age, depression, and health insurance. RESULTS Cardiovascular disease risk factors differed by education, nativity, and gender. Higher education was associated with higher odds of hypertension and high waist circumference for men and women regardless of nativity. As education increased, the odds of diabetes increased for US-born women, showing a gradient for this population. Finally, foreign-born Mexican women with 5 to 19 years in the United States conferred the highest odds of having diabetes, whereas foreign-born men with less than 5 years in the United States had the lowest odds for high waist circumference and presence of diabetes. CONCLUSIONS Results contest assumptions of the Hispanic Health Paradox and suggest new approaches. New research can yield accurate information to ensure the development of appropriate interventions, decreasing health disparities endemic to a subgroup of Latinos.
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Affiliation(s)
- Gniesha Y Dinwiddie
- Gniesha Y. Dinwiddie is with the African American Studies Department and the Maryland Population Research Center, University of Maryland, College Park. Ruth E. Zambrana is with the Department of Women's Studies and the Consortium on Race, Gender and Ethnicity, University of Maryland, College Park. Mary A. Garza is with the Department of Behavioral and Community Health and the Maryland Center for Health Equity, University of Maryland, College Park
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Tucker CM, Arthur TM, Roncoroni J, Wall W, Sanchez J. Patient-Centered, Culturally Sensitive Health Care. Am J Lifestyle Med 2013. [DOI: 10.1177/1559827613498065] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In recent years, there have been increasing national calls for patient-centered, culturally sensitive health care (PC-CSHC). The impetus for these calls include (a) the reality that health care providers are increasingly having to provide health care to a more culturally diverse patient population without the necessary training to do so effectively, (b) the growing evidence that culturally insensitive health care is a major contributor to the costly health disparities that plague our nation, and (c) the fact that racial/ethnic minorities and individuals with low household incomes are more likely than their non-Hispanic white and higher-income counterparts to experience culturally insensitive health care and dissatisfaction with health care—health care experiences that have been linked to poorer health outcomes. This article (a) presents literature on the definition of PC-CSHC and the need for this care, (b) presents research on assessing and promoting this care, and (c) offers research-informed strategies and future directions for customizing and institutionalizing this care.
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Affiliation(s)
- Carolyn M. Tucker
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Tya M. Arthur
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Julia Roncoroni
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Whitney Wall
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Jackeline Sanchez
- Department of Psychology, University of Florida, Gainesville, Florida
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Gucciardi E, Chan VWS, Manuel L, Sidani S. A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity. PATIENT EDUCATION AND COUNSELING 2013; 92:235-245. [PMID: 23566428 DOI: 10.1016/j.pec.2013.03.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/01/2013] [Accepted: 03/09/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This systematic literature review aims to identify diabetes self-management education (DSME) features to improve diabetes education for Black African/Caribbean and Hispanic/Latin American women with Type 2 diabetes mellitus. METHODS We conducted a literature search in six health databases for randomized controlled trials and comparative studies. Success rates of intervention features were calculated based on effectiveness in improving glycosolated hemoglobin (HbA1c), anthropometrics, physical activity, or diet outcomes. Calculations of rate differences assessed whether an intervention feature positively or negatively affected an outcome. RESULTS From 13 studies included in our analysis, we identified 38 intervention features in relation to their success with an outcome. Five intervention features had positive rate differences across at least three outcomes: hospital-based interventions, group interventions, the use of situational problem-solving, frequent sessions, and incorporating dietitians as interventionists. Six intervention features had high positive rate differences (i.e. ≥50%) on specific outcomes. CONCLUSION Different DSME intervention features may influence broad and specific self-management outcomes for women of African/Caribbean and Hispanic/Latin ethnicity. PRACTICAL IMPLICATIONS With the emphasis on patient-centered care, patients and care providers can consider options based on DSME intervention features for its broad and specific impact on outcomes to potentially make programming more effective.
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Umstattd Meyer MR, Sharkey JR, Patterson MS, Dean WR. Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: a descriptive study. BMC Public Health 2013; 13:14. [PMID: 23297793 PMCID: PMC3558355 DOI: 10.1186/1471-2458-13-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing numbers of colonias along the U.S.-Mexico border are characterized by disproportionately poor families of Mexican-origin, limited access to resources and health services, and heightened risk for obesity and diabetes. Despite consistent evidence supporting physical activity (PA) in prevention of chronic diseases, many individuals of Mexican-origin, including children, fail to meet PA recommendations. Environmental influences on PA, founded in ecological and social cognitive perspectives, have not been examined among children living in colonias. The purpose of this study was to identify and better understand (1) household and neighborhood environmental PA resources/supports, (2) perceived barriers to engaging in PA, and (3) PA offerings, locations, and transportation characteristics for Mexican-origin children living in colonias. METHODS Data for this study were collected by promotora-researchers (indigenous community health workers trained in research methods) using face-to-face interviews conducted in Spanish. The sample consists of 94 mother-child dyads from Texas border colonias in Hidalgo County. Interviews included questionnaire items addressing PA barriers, household and neighborhood environmental support assessments conducted with each dyad, and open-ended questions that were coded to identify availability and locations of PA opportunities and transportation options. Descriptive statistics were calculated and differences between genders, birth countries, and BMI categories of children were determined using chi-square tests. RESULTS All children were of Mexican-origin. The most frequently reported barriers were unleashed dogs in the street, heat, bad weather, traffic, no streetlights, and no place like a park to exercise. Prominent locations for current PA included schools, home, and parks. Common PA options for children were exercise equipment, running, playing, and sports. Environmental assessments identified exercise equipment (bicycles/tricycles, balls, etc.…), paved/good streets, yard/patio space, and social norms as the most frequent household or neighborhood resources within these colonias. Differences in PA barriers, options, and environmental resources for genders, birth countries, and BMI categories were detected. CONCLUSIONS This study suggests that PA environmental resources, barriers, and opportunities for colonias children are similar to previous studies and distinctively unique. As expected, built resources in these communities are limited and barriers exist; however, knowledge of PA opportunities and available PA resources within colonias households and neighborhoods offers insight to help guide future research, policy, and PA initiatives.
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Affiliation(s)
- M Renée Umstattd Meyer
- Baylor University, Department of Health, Human Performance, and Recreation, One Bear Place 97313, Waco, TX, 76798, USA
| | - Joseph R Sharkey
- Program for Research in Nutrition and Health Disparities, Department of Health Promotion and Community Health Sciences, Texas A&M School of Rural Public Health, TAMU, 1266, College Station, TX, 77843-1266, USA
| | - Megan S Patterson
- Baylor University, Department of Health, Human Performance, and Recreation, One Bear Place 97313, Waco, TX, 76798, USA
| | - Wesley R Dean
- Program for Research in Nutrition and Health Disparities, Department of Health Promotion and Community Health Sciences, Texas A&M School of Rural Public Health, TAMU, 1266, College Station, TX, 77843-1266, USA
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Briggs Early K, Armstrong Shultz J, Evans M, Corbett CF, Nicholson Butkus S, Massey L. Dietary goal attainment measures and psychosocial factors among Mexican Americans and non-Hispanic whites with type 2 diabetes. Ecol Food Nutr 2012; 51:227-46. [PMID: 22632062 DOI: 10.1080/03670244.2012.674446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Diabetes education programs need improved measures of goal setting for dietary control of diabetes. Additionally, measures of patient experiences with dietary goal setting are needed to better prepare patients for diabetes self-management. Measures of dietary goals and strategies were investigated via survey of 100 Mexican Americans and non-Hispanic whites with type 2 diabetes at a community clinic. Analyses tested novel goal measures as stages of change and goal attainment with a food plan compared to a traditional measure of food plan adherence. Ethnic groups varied in some reported experiences with goal setting education and goal attainment, but did not differ in most clinical characteristics of diabetes. Results indicated that different measures of goal setting vary in their psychosocial predictors, suggesting changes in how health care providers use and monitor goal setting for patients. At the time this research was conducted, Dr. Briggs Early was a doctoral candidate in the Department of Food Science and Human Nutrition at Washington State University. She is currently an Assistant Professor of Biochemistry and Nutrition at Pacific Northwest University of Health Sciences - College of Osteopathic Medicine, and a certified diabetes educator, and insulin pump trainer in Yakima, Washington.
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Affiliation(s)
- Kathaleen Briggs Early
- Pacific Northwest University of Health Sciences - College of Osteopathic Medicine, Yakima, WA 98901, USA.
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Obese minorities have a higher prevalence of H. pylori than do whites, but nonsignificant differences in upper gastrointestinal tract findings, before laparoscopic adjustable gastric banding. J Clin Gastroenterol 2012; 46:431-2. [PMID: 22476044 DOI: 10.1097/mcg.0b013e31824c0f45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Genetic polymorphisms of the transcription factor NFATc4 and development of new-onset diabetes after transplantation in Hispanic kidney transplant recipients. Transplantation 2012; 93:325-30. [PMID: 22234350 DOI: 10.1097/tp.0b013e31823f7f26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transcription factors of the nuclear factor of activated T cells (NFAT) family regulate both immune activation and insulin production. Calcineurin inhibitors (CNIs) target NFAT activation. Hence, CNIs not only prevent organ transplant rejection but also contribute to the development of new-onset diabetes after transplantation (NODAT). Given individual variation in the susceptibility to NODAT, we hypothesized that polymorphisms in the cytoplasmic NFAT (NFATc)4 gene, which is expressed in pancreatic islets, may be associated with NODAT. Haplotype-tagging single-nucleotide polymorphisms (SNPs) of the NFATc4 gene were genotyped in Hispanic renal transplant patients. Cumulative incidences of NODAT were compared between recipients of different NFATc4 genotypes and haplotypes. The Cox proportional hazard model was used to examine risks for NODAT. Nongenetic and genetic characteristics were included in the multivariate risk model. The SNP (rs10141896) T allele was associated with a lower cumulative incidence of NODAT (P=0.02). This is a tagging SNP for one of the five dominant NFATc4 haplotypes, T-T-T-T-G, and CNI-treated recipients with this haplotype had a reduced adjusted risk for NODAT (hazard ratio: 0.45; 95% confidence interval: 0.19-1.01). Conversely, patients homozygous for the C-C-C-G-G haplotype were at an increased risk (hazard ratio: 2.13; 95% confidence interval: 1.01-4.46) for NODAT in subanalysis. Of the nongenetic factors, use of tacrolimus, sirolimus, and older age were associated with increased risk for NODAT. Polymorphisms in the NFATc4 gene may confer certain protection or predisposition for NODAT.
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Al Hazzouri AZ, Haan MN, Whitmer RA, Yaffe K, Neuhaus J. Central obesity, leptin and cognitive decline: the Sacramento Area Latino Study on Aging. Dement Geriatr Cogn Disord 2012; 33:400-9. [PMID: 22814127 PMCID: PMC3483312 DOI: 10.1159/000339957] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS Central obesity is a risk factor for cognitive decline. Leptin is secreted by adipose tissue and has been associated with better cognitive function. Aging Mexican Americans have higher levels of obesity than non-Hispanic Whites, but no investigations examined the relationship between leptin and cognitive decline among them or the role of central obesity in this association. METHODS We analyzed 1,480 dementia-free older Mexican Americans who were followed over 10 years. Cognitive function was assessed every 12-15 months with the Modified Mini Mental State Exam (3MSE) and the Spanish and English Verbal Learning Test (SEVLT). RESULTS For females with a small waist circumference (≤35 inches), an interquartile range difference in leptin was associated with 35% less 3MSE errors and 22% less decline in the SEVLT score over 10 years. For males with a small waist circumference (≤40 inches), an interquartile range difference in leptin was associated with 44% less 3MSE errors and 30% less decline in the SEVLT score over 10 years. There was no association between leptin and cognitive decline among females or males with a large waist circumference. CONCLUSION Leptin interacts with central obesity in shaping cognitive decline. Our findings provide valuable information about the effects of metabolic risk factors on cognitive function.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States,Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Mary N. Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Rachel A. Whitmer
- Kaiser Permanente, Northern California Division of Research, Oakland, CA, United States
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States,Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States
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Abstract
The prevalence of type 2 diabetes mellitus is higher in Hispanic/Latino individuals living in the United States compared with their non-Hispanic white counterparts. Many factors contribute to the increased prevalence of type 2 diabetes, including biological characteristics, socioeconomic conditions, and cultural aspects. The contribution of genetics to the risk of type 2 diabetes in Hispanic/Latino patients is becoming increasingly clear, but this inherent risk factor cannot be modified. However, certain socioeconomic and cultural factors, such as reduced access to healthcare, language barriers, cultural beliefs, and lack of cultural competence by the healthcare provider, are modifiable and should be overcome in order to improve the management of type 2 diabetes in Hispanic/Latino patients. At the healthcare system level, policies should be put into place to reduce disparities between Hispanics/Latinos and non-Hispanic whites regarding health insurance coverage and access to healthcare. At the healthcare provider and patient level, cultural beliefs should be taken into consideration when selecting adequate treatment. Overall, type 2 diabetes management should be individualized by identifying the preferred language and level of acculturation for each patient. These considerations are necessary to further improve communication through culturally appropriate educational materials and programs. These strategies may help to overcome the barriers in the treatment of type 2 diabetes in Hispanic/Latino patients.
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Affiliation(s)
- Eugenio Cersosimo
- Texas Diabetes Institute, University of Texas Health Science Center, San Antonio, TX 78284, USA.
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Abstract
In the United States, the prevalence of adults who are overweight or obese is higher in Hispanics/Latinos compared with non-Hispanic whites. In addition, data from the National Health and Nutrition Examination Survey (NHANES) indicate that the prevalence of type 2 diabetes mellitus is consistently greater in racial/ethnic minority groups, such as Hispanics/Latinos, compared with non-Hispanic whites. In fact, data from the Centers for Disease Control and Prevention (CDC) from 2007 to 2009 suggest that the prevalence of type 2 diabetes is almost twice as high in Hispanics/Latinos compared with non-Hispanic whites (11.8% vs. 7.1%, respectively). Although genetics plays a role in the increased prevalence of type 2 diabetes in Hispanics/Latinos, cultural and environmental factors also contribute. In addition to the increased prevalence of type 2 diabetes in Hispanics/Latinos, evidence suggests that the patients in this population are often undertreated and, therefore, less likely to achieve control of their glucose, blood pressure, and lipid levels. Because individuals with type 2 diabetes have a 2- to 4-fold increased risk of cardiovascular disease compared with individuals with normal glucose levels, there is consensus that targeting environmental factors, particularly the development of obesity at an early age, is the most cost-effective approach to prevent the development of type 2 diabetes and its broad spectrum of complications, including cardiovascular disease. Cultural and socioeconomic barriers, such as language, cost, and access to goods and services, must be overcome to improve management of type 2 diabetes in this high-risk population. By increasing healthcare provider awareness and the availability of programs tailored to Hispanic/Latino individuals, the current treatment gap among ethnic minorities in the United States will progressively narrow, and eventually, disappear.
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Restrepo BI, Camerlin AJ, Rahbar MH, Wang W, Restrepo MA, Zarate I, Mora-Guzmán F, Crespo-Solis JG, Briggs J, McCormick JB, Fisher-Hoch SP. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bull World Health Organ 2011; 89:352-9. [PMID: 21556303 PMCID: PMC3089389 DOI: 10.2471/blt.10.085738] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To estimate the contribution of clinically-confirmed diabetes mellitus to tuberculosis (TB) rates in communities where both diseases are prevalent as a way to identify opportunities for TB prevention among diabetic patients. METHODS This is a prospective study in which TB patients ≥ 20 years old at TB clinics in the Texas-Mexico border were tested for diabetes. The risk of tuberculosis attributable to diabetes was estimated from statistics for the corresponding adult population. FINDINGS The prevalence of diabetes among TB patients was 39% in Texas and 36% in Mexico. Diabetes contributed 25% of the TB cases studied, whereas human immunodeficiency virus (HIV) infection contributed 5% or fewer. Among TB patients, fewer Mexicans than Texans were aware that they had diabetes before this study (4% and 19%, respectively). Men were also less frequently aware than women that they had diabetes (P = 0.03). Patients who knew that they had diabetes before the study had an 8-year history of the disease, on average, before being diagnosed with TB. CONCLUSION Patients with diabetes are at higher risk of contracting TB than non-diabetic patients. Integrating TB and diabetes control programmes worldwide would facilitate TB prevention among diabetes patients and increase the number of diabetics who learn of their condition, particularly among males. Such a strategy would lead to earlier case detection and improve the management of both TB and diabetes.
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Affiliation(s)
- Blanca I Restrepo
- School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, 78520, USA.
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Vella CA, Ontiveros D, Zubia RY, Dalleck L. Physical activity recommendations and cardiovascular disease risk factors in young Hispanic women. J Sports Sci 2011; 29:37-45. [PMID: 21086215 DOI: 10.1080/02640414.2010.520727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the benefits associated with regular physical activity, there is little epidemiological evidence to support positive health outcomes when meeting physical activity guidelines in high-risk ethnic groups, such as Hispanic women. We compared cardiovascular disease risk factors between young Hispanic women who meet and those who do not meet current physical activity guidelines. Height, weight, waist circumference, and blood pressure were measured in 60 Hispanic women aged 20-39 years. Lipids, C-reactive protein, insulin, and glucose were assessed. Body composition and cardiovascular fitness were assessed by BodPod and maximal oxygen uptake (VO₂(max)) respectively. Participants wore an accelerometer and average minutes (assessed in 10-min bouts) spent in light, moderate, and hard daily activity for weekdays and weekends was determined. Seventy percent of participants did not meet the recommended physical activity guidelines, whereas 30% did so. Following current physical activity guidelines was associated with significantly lower mean cholesterol (mean ± s: 4.2 ± 0.8 vs. 4.7 ± 0.9 mmol · l⁻¹) and triglycerides (0.7 ± 0.3 vs. 1.1 ± 0.6 mmol · l⁻¹), and higher fat-free mass (43.3 ± 3.8 vs. 40.2 ± 5.1 kg) and relative (40.4 ± 7.6 vs. 35.6 ± 7.0 ml · kg⁻¹ · min⁻¹) and absolute (2.5 ± 0.3 vs. 2.1 ± 0.4 litres · min⁻¹) VO₂(max) (P < 0.05). These findings suggest an improved health status in women who meet versus those who did not meet current physical activity guidelines.
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Affiliation(s)
- Chantal A Vella
- Department of Health, Physical Education, Recreation and Dance, University of Idaho, Moscow, ID 83804-3150, USA.
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Salinas J, McCormick JB, Rentfro A, Hanis C, Hossain MM, Fisher-Hoch SP. The missing men: high risk of disease in men of Mexican origin. Am J Mens Health 2010; 5:332-40. [PMID: 20930218 DOI: 10.1177/1557988310379390] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The present study sought to determine gender- and age-specific prevalences of chronic diseases in an urban Mexican American border community. The Cameron County Hispanic Cohort (CCHC; n = 2,000) was selected using a multistaged cluster design. Sociodemographics, anthropometric measures, and blood samples were collected on each participant. More women were obese (55.1%) than men (44.8%). Men had significantly higher rates of diabetes (20.4% for men vs. 15.8% for women, p < .05) and undiagnosed diabetes (6.2% for men vs. 2.4% for women, p < .01); the prevalence of diabetes rose steeply between the ages of 40 and 49 years. Men were significantly more likely to have serum cholesterol levels of 200 mg/dL and elevated low-density lipoprotein levels (22.6% vs. 26.1%, p < .01). Mexican American males in the U.S./Mexico border region have a high prevalence of obesity in younger men and higher overall rates of diabetes, including undiagnosed diabetes, and significantly higher serum cholesterol levels than women.
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Affiliation(s)
- Jennifer Salinas
- University of Texas, Houston Health Science Center, Houston, TX 78520, USA.
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Chen J, Pasricha PJ, Yin J, Lin L, Chen JDZ. Hepatic electrical stimulation reduces blood glucose in diabetic rats. Neurogastroenterol Motil 2010; 22:1109-e286. [PMID: 20618834 DOI: 10.1111/j.1365-2982.2010.01556.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to investigate the feasibility and mechanisms of controlling blood glucose using hepatic electrical stimulation (HES). METHODS The study was performed in regular Sprague-Dawley (SD) rats, streptozotocin-induced type 1 diabetic rats and Zucker diabetic fatty (ZDF) rats chronically implanted with one pair of stimulation electrodes on two lobes of the liver tissues. KEY RESULTS (i) Hepatic electrical stimulation was effective in reducing blood glucose by 27%-31% at time points 60, 75 and 90 min after oral glucose in normal rats; (ii) HES reduced blood glucose in both fasting and fed states in both type 1 and type 2 diabetic rats; (iii) Chronic HES decreased the blood glucose level, and, delayed gastric empty and increased plasma glucagon-like peptide-1 (GLP-1) level; and (iv) No adverse events were noted in any rats during HES. Histopathological analyses and liver function tests revealed no electrode dislodgement, tissue damages or liver enzyme changes with HES. CONCLUSIONS & INFERENCES Hepatic electrical stimulation is capable of reducing both fasting and fed blood glucose in normal, and type 1 and type 2 diabetic rats and the effect may be partially mediated via an increase in GLP-1 release.
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Affiliation(s)
- J Chen
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX 77555-0655, USA.
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Martyn-Nemeth PA, Vitale GA, Cowger DR. A culturally focused exercise program in Hispanic adults with type 2 diabetes: a pilot study. DIABETES EDUCATOR 2010; 36:258-67. [PMID: 20103618 DOI: 10.1177/0145721709358462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this pilot study was to examine the feasibility and effectiveness of a community-based, culturally focused, exercise program for adults in the Hispanic community with type 2 diabetes. METHODS A pretest/posttest design using a culturally designed exercise program through dance was used. A total of 19 Mexican American men and women (39 to 64 years of age) with type 2 diabetes were recruited. Mean preprogram and postprogram differences were examined in hemoglobin A1C, lipid panel, body mass index (BMI), and psychological well-being. RESULTS Feasibility was demonstrated by exceeding our recruitment goal and achieving an 84% completion rate and 75% attendance rate for the exercise sessions. Mean hemoglobin A1C, lipids, and psychological well-being demonstrated trends toward improvement from the beginning of the program to the end. BMI remained unchanged. Physical activity increased and all participants met the physical activity goals from the national physical activity guidelines for Americans by the end of the program. CONCLUSIONS The culturally focused exercise program detailed here is effective in promoting regular physical activity among Hispanic adults with type 2 diabetes.
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Affiliation(s)
- Pamela A Martyn-Nemeth
- Lewis University, College of Nursing and Health Professions, Romeoville, Illinois (Dr Martyn-Nemeth, Ms Vitale),The University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, Illinois (Dr Martyn-Nemeth)
| | - Gail A Vitale
- Lewis University, College of Nursing and Health Professions, Romeoville, Illinois (Dr Martyn-Nemeth, Ms Vitale)
| | - Debra R Cowger
- The Will Grundy Medical Clinic, Joliet, Illinois (Ms Cowger)
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Neumiller JJ, Sclar DA, Robison LM, Maldonado AL, Setter SM, Skaer TL. Ethnicity/race and the extent of physician-ordered hemoglobin A1C during US office-based visits by patients with diabetes mellitus. THE DIABETES EDUCATOR 2010; 36:65-6. [PMID: 20067945 DOI: 10.1177/0145721709358463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joshua J Neumiller
- The Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane (Dr Neumiller, Dr Maldonado, Dr Setter)
| | - David A Sclar
- Department of Pharmacotherapy, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Pullman, Washington (Dr Sclar, Ms Robison, Dr Skaer)
| | - Linda M Robison
- Department of Pharmacotherapy, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Pullman, Washington (Dr Sclar, Ms Robison, Dr Skaer)
| | - Angela L Maldonado
- The Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane (Dr Neumiller, Dr Maldonado, Dr Setter)
| | - Stephen M Setter
- The Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane (Dr Neumiller, Dr Maldonado, Dr Setter)
| | - Tracy L Skaer
- Department of Pharmacotherapy, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Pullman, Washington (Dr Sclar, Ms Robison, Dr Skaer)
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Bosi PL, Carvalho AM, Contrera D, Casale G, Pereira MA, Gronner MF, Diogo TM, Torquarto MTDCG, Oishi J, Leal AMDO. Prevalência de diabetes melito e tolerância à glicose diminuída na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo. ACTA ACUST UNITED AC 2009; 53:726-32. [DOI: 10.1590/s0004-27302009000600006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Accepted: 03/29/2009] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Estimar a prevalência de diabetes melito (DM) e tolerância à glicose diminuída (TGD) na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo. MÉTODOS: Foi realizado estudo de base populacional entre agosto de 2007 e junho de 2008. Todos os indivíduos, exceto mulheres grávidas, não diabéticos e aqueles com glicemia capilar em jejum < 199 mg/dl foram submetidos a teste oral de tolerância à glicose e classificados em diabéticos, com TGD ou com tolerância normal à glicose. RESULTADOS: Participaram da pesquisa 1.116 voluntários. As prevalências gerais de DM e TGD foram 13,5% e 5%, respectivamente. Houve associação entre DM e TGD e as variáveis "idade", "escolaridade", "índice de massa corpórea" e "circunferência abdominal". Não houve associação entre DM ou TGD e as variáveis "gênero", "cor da pele" e "rendimento mensal". CONCLUSÕES: Houve aumento na prevalência de DM em comparação a estudos anteriores no Brasil e na região. Embora tenha havido avanços no diagnóstico, o tratamento do DM requer otimização.
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ELL KATHLEEN, KATON WAYNE, CABASSA LEOPOLDOJ, XIE BIN, LEE PEYJIUAN, KAPETANOVIC SUAD, GUTERMAN JEFFRY. Depression and diabetes among low-income Hispanics: design elements of a socioculturally adapted collaborative care model randomized controlled trial. Int J Psychiatry Med 2009; 39:113-32. [PMID: 19860071 PMCID: PMC3387981 DOI: 10.2190/pm.39.2.a] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations. METHODS The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of > or = 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management. RESULTS Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels > or = 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life. CONCLUSION Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.
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Affiliation(s)
| | | | | | - BIN XIE
- University of Southern California, Los Angeles
| | | | | | - JEFFRY GUTERMAN
- University of Southern California, Los Angeles, and Los Angeles County Department of Health Services
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Abstract
The purpose of this article was to review physical activity interventions done with Hispanic American girls and women that were published between 1994 and 2007, and suggest ways of enhancing these interventions. A total of 12 such interventions were found. Majority of the interventions focused on both physical activity and nutrition behaviours. Only half of the interventions were based on a behavioural theory. Social cognitive theory was the most popular theory, which was operationalized by four interventions. The interventions ranged from 3 weeks to 2 years in duration. The impact was not necessarily linked to the length of the intervention. The most popular physical activity that was promoted was walking, which was utilized by four interventions. Most of the interventions utilized a classroom format for imparting instruction in being physically active. All the interventions utilized individual-level behaviour change as an approach, and none tried to address broader policy and environmental-level changes. Process evaluation was done by very few interventions and must be done more systematically. In terms of the impact, half of the interventions were successful in influencing the outcomes. Recommendations for enhancing the effectiveness of physical activity interventions in Hispanic American girls and women are presented.
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Affiliation(s)
- M Sharma
- Health Promotion & Education, University of Cincinnati, Cincinnati, OH 45221-0068, USA.
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