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Barrio C, Fuentes D, Tibiriçá L, Hernandez M, Helu-Brown P, Golshan S, Palmer BW. Consent for Research Involving Spanish- and English-Speaking Latinx Adults With Schizophrenia. Schizophr Bull 2024; 50:673-683. [PMID: 37962384 PMCID: PMC11059799 DOI: 10.1093/schbul/sbad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Latinxs are vastly underrepresented in mental health research; one of many contributing factors may be complexities in the research consent process, including language preferences. We examined determinants of comprehension of research consent procedures and tested the effects of a preconsent research schema condition among 180 adults with schizophrenia (60 Latinx-English and 60 Latinx-Spanish preference, and 60 non-Latinx White). STUDY DESIGN Participants were randomly assigned (equal allocation) to an educational session regarding clinical research concepts and processes (schema condition) or to an attention control. Following a subsequent simulated consent procedure for a hypothetical drug trail, comprehension of consent disclosures was measured with 2 standard measures. STUDY RESULTS One-way ANOVAs showed significant medium effect size differences between ethnicity/language groups on both measures of comprehension (η2s = 0.066-0.070). The Latinx-Spanish group showed lower comprehension than non-Latinx White participants; differences between the 2 Latinx groups did not reach statistical significance. Group differences were not statistically significant after adjusting for differences in education, or on scores from structured measures of acculturation, health literacy, or research literacy. Two-way ANOVAs showed no significant main effects for consent procedure on either comprehension measure (Ps > .369; partial η2s < 0.006) and no significant group-by-consent interactions (Ps > .554; partial η2s < 0.008). CONCLUSIONS Although the preconsent procedure was not effective, the results suggest health and research literacy may be targets for reducing disparities in consent comprehension. The onus is on researchers to improve communication of consent information as an important step to addressing health care disparities.
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Affiliation(s)
- Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Dahlia Fuentes
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Lize Tibiriçá
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas, Austin, Austin, TX, USA
| | - Paula Helu-Brown
- Department of Psychology, Mount Saint Mary’s University, Los Angeles, CA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
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Fuller TJ, Lambert DN, DiClemente RJ, Wingood GM. Reach and Capacity of Black Protestant Health Ministries as Sites of Community-Wide Health Promotion: A Qualitative Social Ecological Model Examination. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01926-0. [PMID: 38319551 DOI: 10.1007/s40615-024-01926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/29/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Abstract
Black communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders' and members' perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the boundaries between their churches at the organizational level of the SEM and the broader Black community to be porous. Those who described their "community" as being broader than their congregation also tended to describe community-wide health promotion their church engaged in. They described church-based health fairs as a strategy to promote engagement in their communities. Some participants, particularly those in a health-related profession, discussed visions of how to utilize their church as a site for community-wide health promotion. We suggest these participants may be boundary leaders who can build relationships between public health professionals, pastors, and congregants. Based on the findings, we suggest that church-based health fairs may be effective sites of community-wide health promotion.
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Affiliation(s)
- Tyler J Fuller
- Graduate Program in Religion, Boston University, Boston, MA, USA.
| | - Danielle N Lambert
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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Gao Y, Tuokedaerhan Z, Zhang J, Yang L, Zhang Y, Cheng W, Zhao Y, Wang J. Comparative study of the vascular structures of the retina and choroid in Chinese Han and Uygur populations with proliferative diabetic retinopathy: An OCTA study. Photodiagnosis Photodyn Ther 2024; 45:103995. [PMID: 38286214 DOI: 10.1016/j.pdpdt.2024.103995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND To compare the vascular structures of the retina and choroid in Chinese Han and Uygur populations with proliferative diabetic retinopathy (PDR) using swept-source OCTA (SS-OCTA). METHODS Fifty-three eyes of 53 healthy volunteers (25 from Hans and 28 from Uygurs) and 40 eyes of 40 PDR patients (20 from Hans and 20 from Uygurs) were included. Retinal and choroidal parameters, including thickness, vessel flow density (VFD), foveal avascular zone (FAZ) area, choroidal vascularity volume and index (CVV and CVI) were evaluated. RESULTS Compared with the respective controls, superficial capillary plexus (SCP)-VFD and deep capillary plexus (DCP)-VFD, the areas of FAZ in SCP and DCP were significantly decreased in both Han and Uygur PDR patients. choroidal parameters analysis found that Uygur controls had substantially higher choroidal thickness (CT) than Han controls (p = 0.020) and PDR eyes showed significantly decreased CT. Both races with PDR exhibited significantly reduced choriocapillaris layer-VFD, large and medium choroidal vessel (LMCV) layer-VFD, CVV and CVI, however, Uygur PDR patients had significant lower LMCV layer-VFD, CVV and CVI compared to Han PDR patients. Diabetes duration was the most significant factor affecting CVV and CVI. CONCLUSION Both Han and Uygur PDR patients had significantly lower CT and decreased vessel densities compared to controls, but the Uygur PDR patients had more severe choroidal damage than Han PDR patients, which is most likely related to worse visual prognosis. These findings indicate that more frequent screenings and prompt therapy are urgent for Uygur PDR patients.
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Affiliation(s)
- Yunxian Gao
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Zhumahan Tuokedaerhan
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Jie Zhang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Lei Yang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Yani Zhang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Wanying Cheng
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Yong Zhao
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China.
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Schmidt BM, Keeney-Bonthrone TP, Hawes AM, Karmakar M, Frydrych LM, Cinti SK, Pop-Busui R, Delano MJ. Comorbid status in patients with osteomyelitis is associated with long-term incidence of extremity amputation. BMJ Open Diabetes Res Care 2023; 11:e003611. [PMID: 38164707 PMCID: PMC10729224 DOI: 10.1136/bmjdrc-2023-003611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Osteomyelitis is associated with significant morbidity, including amputation. There are limited data on long-term amputation rates following an osteomyelitis diagnosis. We sought to determine the incidence of amputation in patients with osteomyelitis over 2 years. RESEARCH DESIGN AND METHODS Observational cohort study of 1186 inpatients with osteomyelitis between 2004 and 2015 and stratified by osteomyelitis location status to evaluate the impact on amputation, mortality rates, readmission data, and inpatient days. RESULTS Persons with diabetes had 3.65 times greater probability of lower extremity amputation (p<0.001), readmission (p<0.001), and longer inpatient stay (p<0.001) and had higher 2-year mortality (relative risk (RR) 1.23, p=0.0027), adjusting for risk factors. Male gender (RR 1.57, p<0.001), black race (RR 1.41, p<0.05), former smoking status (RR 1.38, p<0.01), myocardial infarction (RR 1.72, p<0.001), congestive heart failure (RR 1.56, p<0.001), peripheral vascular disease (RR 2.25, p<0.001) and renal disease (RR 1.756, p<0.001) were independently associated with amputation. Male gender (RR 1.39, p<0.01), black race (RR 1.27, p<0.05), diabetes (RR 2.77, p<0.001) and peripheral vascular disease (RR 1.59, p<0.001) had increased risk of lower, not upper, extremity amputation. CONCLUSIONS Patients with osteomyelitis have higher rates of amputation and hospitalization. Clinicians must incorporate demographic and comorbid risk factors to protect against amputation.
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Affiliation(s)
- Brian M Schmidt
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Armani M Hawes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Karmakar
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn M Frydrych
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sandro K Cinti
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rodica Pop-Busui
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matthew J Delano
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Rony M, Quintero-Arias C, Osorio M, Ararso Y, Norman EM, Ravenell JE, Wall SP, Lee DC. Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes. J Racial Ethn Health Disparities 2023; 10:3150-3158. [PMID: 36520369 PMCID: PMC10267290 DOI: 10.1007/s40615-022-01488-z] [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: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system. RESEARCH DESIGN AND METHODS We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis. RESULTS Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans. CONCLUSION To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.
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Affiliation(s)
- Melissa Rony
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | | | - Marcela Osorio
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Yonathan Ararso
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Elizabeth M Norman
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, 10003, USA
| | - Joseph E Ravenell
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Stephen P Wall
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - David C Lee
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA.
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA.
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Sharma S, Hale JM, Myrskylä M, Kulu H. Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016. Demography 2023; 60:1441-1468. [PMID: 37638648 DOI: 10.1215/00703370-10941414] [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] [Indexed: 08/29/2023]
Abstract
Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.
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Affiliation(s)
- Shubhankar Sharma
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of St Andrews, St Andrews, Scotland
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Jo Mhairi Hale
- University of St Andrews, St Andrews, Scotland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Hill Kulu
- University of St Andrews, St Andrews, Scotland
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Tierney WM, Henning JM, Altillo BS, Rosenthal M, Nordquist E, Copelin K, Li J, Enriquez C, Lange J, Larson D, Burgermaster M. User-Centered Design of a Clinical Tool for Shared Decision-making About Diet in Primary Care. J Gen Intern Med 2023; 38:715-726. [PMID: 36127543 PMCID: PMC9971535 DOI: 10.1007/s11606-022-07804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. OBJECTIVE Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. DESIGN Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. PARTICIPANTS Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. MAIN MEASURES Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. KEY RESULTS Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. CONCLUSIONS Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice.
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Affiliation(s)
- William M Tierney
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA.
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
| | - Jacqueline M Henning
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Brandon S Altillo
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Lone Star Circle of Care, Georgetown, TX, USA
| | - Madalyn Rosenthal
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Eric Nordquist
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Ken Copelin
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Jiaxin Li
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | | | - Jordan Lange
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Dagny Larson
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Marissa Burgermaster
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
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Mendivil CO, Amaya-Montoya M, Hernández-Vargas JA, Ramírez-García N, Herrera-Parra LJ, Guatibonza-García V, Romero-Díaz C, Pérez-Londoño A, Acuña-Merchán L. Impact of metabolic control on all-cause mortality in a nationwide cohort of patients with diabetes from Colombia. Front Endocrinol (Lausanne) 2023; 14:1073833. [PMID: 36742410 PMCID: PMC9892640 DOI: 10.3389/fendo.2023.1073833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Objective The magnitude of the mortality benefit conferred by good integral metabolic control in diabetes in not sufficiently known, especially among Latin American patients. We prospectively studied the association between sustained control of blood glucose (HbA1c<7%), systolic blood pressure (SBP) (<130 mmHg) and LDL (LDLc, <100mg/dL) and non-HDL (non-HDLc, <130 mg/dL) cholesterol, and death from any cause among all adult patients with diagnosed diabetes in Colombia. Methods We retrospectively analyzed data from a nationwide, centralized, mandatory registry of all patients with diagnosed diabetes assisted by the Colombian health system between July 1, 2015, and June 30, 2019. We estimated the associations of sustained achievement of each goal, and of the joint triple goal (HbA1c + SBP + LDLc) with all-cause death. Associations were assessed after adjustment for sex, age, race, insurance type and BMI in multivariable logistic models. Results We studied 1 352 846 people with diabetes. Sustained SBP (OR 0.42 [0.41-0.43]), HbA1c (OR 0.25 [0.24-0.26]) and LDLc (OR 0.28 [0.27-0.29]) control had strong negative associations with death. Moreover, among the 5.4% of participants who achieved joint, sustained metabolic control, the OR for death was 0.19 (0.18-0.21). Importantly, the impact of sustained, joint metabolic control was significantly smaller for patients of black race compared to other races (OR 0.31 [0.23-0.43] versus 0.18 [0.17-0.20], p-value for interaction <0.001), mostly at the expense of a smaller impact of LDLc control. The results were similar across body-mass index categories. Conclusions Sustained and simultaneous metabolic control was associated with remarkably lower odds of death.
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Affiliation(s)
- Carlos O. Mendivil
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Endocrinology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | | | | | | | | | | | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, Colombia
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Kindratt TB, Dallo FJ, Zahodne LB, Ajrouch KJ. Cognitive Limitations Among Middle Eastern and North African Immigrants. J Aging Health 2022; 34:1244-1253. [PMID: 35606926 PMCID: PMC9633450 DOI: 10.1177/08982643221103712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate and compare the prevalence of cognitive limitations among Middle Eastern and North African (MENA) immigrants compared to US- and foreign-born non-Hispanic Whites from Europe (including Russia/former USSR) and examine differences after controlling for risk factors. METHODS Cross-sectional data using linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages >=65 years, n = 24,827) were analyzed. RESULTS The prevalence of cognitive limitations was 17.3% among MENA immigrants compared to 9.6% and 13.6% among US- and foreign-born non-Hispanic Whites from Europe. MENA immigrants had higher odds (OR = 1.88; 95% CI = 1.06-3.34) of reporting a cognitive limitation than US-born non-Hispanic Whites after controlling for age, sex, education, hearing loss, hypertension, depression, social isolation, and diabetes. DISCUSSION To further examine cognitive health among the MENA aging population, policy changes are needed to identify this group that is often absent from research because of their federal classification as non-Hispanic Whites.
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Affiliation(s)
- Tiffany B. Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Florence J. Dallo
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Laura B. Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristine J. Ajrouch
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University, Ypsilanti, MI, USA
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10
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Nuhoglu İ, Deger O, Topbaş M, Erem C. The prevalence of diabetes and associated risk factors among adult population in a Turkish population (Trabzon city). Prim Care Diabetes 2022; 16:549-554. [PMID: 35697629 DOI: 10.1016/j.pcd.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 04/15/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objectives of this study were to determine the prevalence of diagnosed and undiagnosed diabetes mellitus (DM) and prediabetes, and to evaluate the associated risk factors in a sample of adult Turkish population. METHODS A total of 4000 eligible study subjects, aged 20 years or older, chosen by multistage sampling on a field were considered. Of those 3721 subjects (2139 women and 1582 men) participated in the study. RESULTS The prevalence of prediabetes and DM were found to be as 6.4% and 10.4% (3.6% being newly diagnosed by this study), respectively. In multivariate logistic regression analysis, advanced age (OR:26.7, p < 0.0005 in the group 70 years and over), marriage (OR:2.05, p = 0.047), housewives (OR:1.34, p = 0.003), family history of diabetes (OR:2.84, p < 0.0005), overweight (OR:1.61, p = 0.026), obesity (OR:2.25, p < 0.0005), hypertension (OR:1.42, p = 0.007) and dyslipidemia (OR:1.38, p = 0.028) were independent risk factors for being diabetic. CONCLUSIONS DM is an important health problem in the adult population of Trabzon city. Newly diagnosed diabetic patients who were unaware of their status are at high risk. To control DM and associated risk factors, effective public health education and taking urgent steps are needed.
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Affiliation(s)
- İrfan Nuhoglu
- Department of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon 61080, Turkey
| | - Orhan Deger
- Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey
| | - Murat Topbaş
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey
| | - Cihangir Erem
- Department of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon 61080, Turkey
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Martin KE, Thomas BS, Greenberg KI. The expanding role of primary care providers in care of individuals with kidney disease. J Natl Med Assoc 2022; 114:S10-S19. [DOI: 10.1016/j.jnma.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fleary SA, Gonçalves C, Joseph PL, Baker DM. Census Tract Demographics Associated with Libraries' Social, Economic, and Health-Related Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6598. [PMID: 35682183 PMCID: PMC9180538 DOI: 10.3390/ijerph19116598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
Background: Public libraries can contribute to reducing economic, social, and health inequities through their programming and practices. However, the extent to which libraries regularly provide programming that improve the social determinants of health (SDH) in underserved communities is unclear. Objective: This study explored the relationship between census tract demographic characteristics and library programming implicated in the SDH for underserved groups at risk for health disparities. Method: A stratified random sample of libraries (n = 235) who completed the 2017 Public Libraries Survey were recruited. Librarians completed surveys about their libraries' economic, social, and health-related programming. Libraries' census tract demographic characteristics were taken from the 2013-2017 American Community Survey. Linear regressions were estimated to determine the relationship between relevant census tract demographic characteristics and programming offered at libraries in the census tracts. Results: Higher proportions of racial and ethnic minorities were associated with more frequent economic and social programs, but results were mixed for health-related programs. Lower proportions of populations with no more than a high school diploma or GED were related to more frequent economic, social, and health-related programs. Conclusions: The inequitable distribution of SDH-related library programming highlights gaps in libraries' responsiveness to community needs. Libraries' programming likely perpetuate systemic inequities.
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Affiliation(s)
- Sasha A. Fleary
- Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY 10027, USA
| | - Carolina Gonçalves
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, MA 02155, USA;
| | - Patrece L. Joseph
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA;
| | - Dwayne M. Baker
- Urban Studies Department, CUNY Queens College, Queens, NY 11367, USA;
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13
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Austin J, Delgado P, Gatewood A, Enmeier M, Frantz B, Greiner B, Hartwell M. Cervical cancer screening among women with comorbidities: a cross-sectional examination of disparities from the behavioral risk factor surveillance system. J Osteopath Med 2022; 122:359-365. [PMID: 35285219 DOI: 10.1515/jom-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist. OBJECTIVES This study aims to analyze whether CC screening rates differ among women with comorbidities-body mass index (BMI) ≥30 kg/m2, diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer-compared to women without these comorbidities. METHODS Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2-4, 5+). Confidence intervals (CIs) were reported at 95%. RESULTS Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83-0.97) as were those with COPD (AOR: 0.77; CI: 0.67-0.87) and kidney disease (AOR: 0.81; CI: 0.67-0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05-1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities. CONCLUSIONS Women with BMI ≥30 kg/m2, COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures.
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Affiliation(s)
- Jordyn Austin
- Center for Health Sciences, Office of Medical Student Research, Oklahoma State University, Tulsa, OK, USA.,College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Oklahoma State University, Tahlequah, OK, USA
| | - Paul Delgado
- Center for Health Sciences, Office of Medical Student Research, Oklahoma State University, Tulsa, OK, USA
| | - Ashton Gatewood
- Center for Health Sciences, Office of Medical Student Research, Oklahoma State University, Tulsa, OK, USA.,College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Oklahoma State University, Tahlequah, OK, USA
| | - Mackenzie Enmeier
- Center for Health Sciences, Office of Medical Student Research, Oklahoma State University, Tulsa, OK, USA.,College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Oklahoma State University, Tahlequah, OK, USA
| | - Brooke Frantz
- OU College of Medicine, Department of Women's Health at Oklahoma City Indian Clinic, Oklahoma City, OK, USA
| | - Benjamin Greiner
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Micah Hartwell
- Center for Health Sciences, Office of Medical Student Research, Oklahoma State University, Tulsa, OK, USA.,Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Oklahoma State University, Tulsa, OK, USA
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14
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Johnson-Agbakwu CE, Ali NS, Oxford CM, Wingo S, Manin E, Coonrod DV. Racism, COVID-19, and Health Inequity in the USA: a Call to Action. J Racial Ethn Health Disparities 2022; 9:52-58. [PMID: 33197038 PMCID: PMC7668281 DOI: 10.1007/s40615-020-00928-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path forward to address structural racism and advance health equity for Black Americans through anti-racism, implicit bias, and cultural competency training; capacity building; community-based participatory research (CBPR) initiatives; validated metrics for longitudinal monitoring of efforts to address health disparities and the evaluation of those interventions; and advocacy for and empowerment of vulnerable communities. This necessitates a multi-pronged, coordinated approach led by clinicians; public health professionals; researchers; social scientists; policy-makers at all governmental levels; and local community leaders and stakeholders across the education, legal, social service, and economic sectors to proactively and systematically advance health equity for Black Americans across the USA.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, Phoenix, AZ, USA.
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Creighton University School of Medicine, Phoenix, AZ, USA.
- District Medical Group, Phoenix, AZ, USA.
| | - Nyima S Ali
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Creighton University School of Medicine, Phoenix, AZ, USA
- District Medical Group, Phoenix, AZ, USA
| | - Corrina M Oxford
- Maternal Fetal Medicine/Critical Care Medicine, NewYork-Presbyterian Hospital, Clinical Obstetrics and Gynecology-Weill Cornell Medical College, Cornell University, New York City, NY, USA
| | | | - Emily Manin
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, Phoenix, AZ, USA
| | - Dean V Coonrod
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Creighton University School of Medicine, Phoenix, AZ, USA
- District Medical Group, Phoenix, AZ, USA
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15
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Jeong D, Karim ME, Wong S, Wilton J, Butt ZA, Binka M, Adu PA, Bartlett S, Pearce M, Clementi E, Yu A, Alvarez M, Samji H, Velásquez García HA, Abdia Y, Krajden M, Janjua NZ. Impact of HCV infection and ethnicity on incident type 2 diabetes: findings from a large population-based cohort in British Columbia. BMJ Open Diabetes Res Care 2021; 9:9/1/e002145. [PMID: 34099439 PMCID: PMC8186745 DOI: 10.1136/bmjdrc-2021-002145] [Citation(s) in RCA: 4] [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: 01/22/2021] [Accepted: 05/09/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Increasing evidence indicates that chronic hepatitis C virus (HCV) infection is associated with higher risk of diabetes. Previous studies showed ethnic disparities in the disease burden of diabetes, with increased risk in Asian population. We described the incidence of type 2 diabetes related to HCV infection and assessed the concurrent impact of HCV infection and ethnicity on the risk of diabetes. RESEARCH DESIGN AND METHODS In British Columbia Hepatitis Testers Cohort, individuals were followed from HCV diagnosis to the earliest of (1) incident type 2 diabetes, (2) death or (3) end of the study (December 31, 2015). Study population included 847 021 people. Diabetes incidence rates in people with and without HCV were computed. Propensity scores (PS) analysis was used to assess the impact of HCV infection on newly acquired diabetes. PS-matched dataset included 117 184 people. We used Fine and Gray multivariable subdistributional hazards models to assess the effect of HCV and ethnicity on diabetes while adjusting for confounders and competing risks. RESULTS Diabetes incidence rates were higher among people with HCV infection than those without. The highest diabetes incidence rate was in South Asians with HCV (14.7/1000 person-years, 95% CI 12.87 to 16.78). Compared with Others, South Asians with and without HCV and East Asians with HCV had a greater risk of diabetes. In the multivariable stratified analysis, HCV infection was associated with increased diabetes risk in all subgroups: East Asians, adjusted HR (aHR) 3.07 (95% CI 2.43 to 3.88); South Asians, aHR 2.62 (95% CI 2.10 to 3.26); and Others, aHR 2.28 (95% CI 2.15 to 2.42). CONCLUSIONS In a large population-based linked administrative health data, HCV infection was associated with higher diabetes risk, with a greater relative impact in East Asians. South Asians had the highest risk of diabetes. These findings highlight the need for care and screening for HCV-related chronic diseases such as type 2 diabetes among people affected by HCV.
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Affiliation(s)
- Dahn Jeong
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stanley Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James Wilton
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Zahid Ahmad Butt
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mawuena Binka
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Prince Asumadu Adu
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sofia Bartlett
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Margo Pearce
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Emilia Clementi
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Younathan Abdia
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
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16
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Fathi M, Vakili K, Sayehmiri F, Mohamadkhani A, Hajiesmaeili M, Rezaei-Tavirani M, Eilami O. The prognostic value of comorbidity for the severity of COVID-19: A systematic review and meta-analysis study. PLoS One 2021; 16:e0246190. [PMID: 33592019 PMCID: PMC7886178 DOI: 10.1371/journal.pone.0246190] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES With the increase in the number of COVID-19 infections, the global health apparatus is facing insufficient resources. The main objective of the current study is to provide additional data regarding the clinical characteristics of the patients diagnosed with COVID-19, and in particular to analyze the factors associated with disease severity, lack of improvement, and mortality. METHODS 102 studies were included in the present meta-analysis, all of which were published before September 24, 2020. The studies were found by searching a number of databases, including Scopus, MEDLINE, Web of Science, and Embase. We performed a thorough search from early February until September 24. The selected papers were evaluated and analyzed using Stata software application version 14. RESULTS Ultimately, 102 papers were selected for this meta- analysis, covering 121,437 infected patients. The mean age of the patients was 58.42 years. The results indicate a prevalence of 79.26% for fever (95% CI: 74.98-83.26; I2 = 97.35%), 60.70% for cough (95% CI: 56.91-64.43; I2 = 94.98%), 33.21% for fatigue or myalgia (95% CI: 28.86-37.70; I2 = 96.12%), 31.30% for dyspnea (95% CI: 26.14-36.69; I2 = 97.67%), and 10.65% for diarrhea (95% CI: 8.26-13.27; I2 = 94.20%). The prevalence for the most common comorbidities was 28.30% for hypertension (95% CI: 23.66-33.18; I2 = 99.58%), 14.29% for diabetes (95% CI: 11.88-16.87; I2 = 99.10%), 12.30% for cardiovascular diseases (95% CI: 9.59-15.27; I2 = 99.33%), and 5.19% for chronic kidney disease (95% CI: 3.95-6.58; I2 = 96.42%). CONCLUSIONS We evaluated the prevalence of some of the most important comorbidities in COVID-19 patients, indicating that some underlying disorders, including hypertension, diabetes, cardiovascular diseases, and chronic kidney disease, can be considered as risk factors for patients with COVID-19 infection. Furthermore, the results show that an elderly male with underlying diseases is more likely to have severe COVID-19.
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Affiliation(s)
- Mobina Fathi
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Kimia Vakili
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Sayehmiri
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ashraf Mohamadkhani
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammadreza Hajiesmaeili
- Anesthesia and Critical Care Department, Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Faculty of Paramedical Sciences, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Owrang Eilami
- Department of Family Medicine, Shiraz University of Medical Science, Fars, IR Iran
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17
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Sudre C, Duplan H, Bukasakakamba J, Nacher M, Peyre-Costa P, Sabbah N. Diabetes Care in French Guiana: The Gap Between National Guidelines and Reality. Front Endocrinol (Lausanne) 2021; 12:789391. [PMID: 34917037 PMCID: PMC8670498 DOI: 10.3389/fendo.2021.789391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION French Guiana is a multicultural overseas territory in the Amazon, where precariousness and difficulties in access to care are widespread. The prevalence of diabetes is double that of other French departments, and cardiovascular morbidity and mortality is high. The objective of the study was to analyze the biological, clinical and therapeutic follow-up of patients with diabetes mellitus using exhaustive data and to correlate it with national and European recommendations. MATERIAL AND METHODS Using the national health insurance data, 9079 and 10075 patients with diabetes mellitus were analyzed in 2018 and 2019, respectively. We analyzed antidiabetic treatments, medical, dental, and podiatric consultations, examinations prescribed as part of the annual follow-up, and home nursing care. RESULTS There was a significant increase over one year in the number of patients (+10%) with diabetes, mainly women (60%), and 31% were under 54 years of age, with a disparity depending on the area of the territory, the most isolated having less access to screening. Less than 56% of patients had HbA1c measurements twice a year, less than 43% had an annual renal check-up, only 19% had an ophthalmic check-up at least every two years, less than 25% had an annual dental check-up, and less than 4% had an annual follow-up with the podiatrist. CONCLUSIONS Substandard diabetes monitoring is a major problem likely to increase morbidity and mortality. Adapting health care to the specificities of the territory is crucial, notably by formalizing the delegation of care to advanced practice nurse and non-healthcare professionals in precarious or geographically isolated areas.
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Affiliation(s)
- Christine Sudre
- Regional Office of the Medical Service and Directorate of Risk Management Coordination of French Guiana, Cayenne, French Guiana
| | - Hélène Duplan
- Regional Office of the Medical Service and Directorate of Risk Management Coordination of French Guiana, Cayenne, French Guiana
| | - John Bukasakakamba
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center, West Indies, French Guiana (INSERM CIC 14 24), Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pascale Peyre-Costa
- Regional Office of the Medical Service and Directorate of Risk Management Coordination of French Guiana, Cayenne, French Guiana
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- Clinical Investigation Center, West Indies, French Guiana (INSERM CIC 14 24), Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- *Correspondence: Nadia Sabbah,
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18
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Sidhu GS, Ward C, Ferdinand KC. Racial disparity in atherosclerotic cardiovascular disease in hospitalized patients with diabetes 2005-2015: Potential warning signs for future U.S. public health. Am J Prev Cardiol 2020; 4:100095. [PMID: 34327471 PMCID: PMC8315432 DOI: 10.1016/j.ajpc.2020.100095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction The pattern of atherosclerotic cardiovascular disease (ASCVD) and diabetes driven hospitalizations in the United States (U.S.) is unclear. We attempted to identify the disparate outcome in race related ASCVD hospitalizations with comorbid diabetes. Methods Adults aged ≥40 years old with ASCVD (acute coronary syndrome (ACS), coronary artery disease (CAD), stroke, or peripheral arterial disease (PAD)) as the first-listed diagnosis with comorbid diabetes as a secondary diagnosis were determined using the U.S. 2005-2015 National (Nationwide) Inpatient Sample (NIS) data. The incidence of other modifiable cardiovascular risk factors (hypertension, dyslipidemia, smoking/substance abuse, obesity, and renal failure), in hospital procedures and outcomes was estimated. Complex samples multivariate regression was used to determine the odds ratio (OR) with 95% confidence Interval (CI) of risk associations and to determine patient comorbidity adjusted ASCVD related in-hospital mortality rate. Results The rate of total ASCVD hospitalizations with comorbid diabetes adjusted to the U.S. census population increased by 5.7% for black men compared to 4% for black women. There was a higher odd of an ASCVD hospitalization if there was comorbid hypertension (Odds Ratio (OR 1.29; 95% CI 95% 1.28-1.31), dyslipidemia (OR 2.03; 95% CI 2.01-2.05), renal failure (OR 1.84; 95% CI 1.82-1.86), and smoking/substance use disorder (OR 1.31; 95% CI 1.29-1.33). White Women had the highest risk-adjusted incidence of ASCVD related in-hospital mortality (4.2%) relative to black women (3.9%), compared to white men (3.6%) and black men (3.5%) respectively. Conclusions Despite improving treatment options for ASCVD in the diabetic population, blacks with diabetes continue to have a higher hospitalization burden with a concomitant disparity in comorbid presentation and outcome. Further evaluation is the need to understand these associations.
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Affiliation(s)
| | - Charisse Ward
- Cardiovascular Institute of the South, New Orleans, LA, USA
| | - Keith C Ferdinand
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, LA, USA
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19
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Hermans MP, Ahn SA, Sadikot S, Rousseau MF. Established and novel gender dimorphisms in type 2 diabetes mellitus: Insights from a multiethnic cohort. Diabetes Metab Syndr 2020; 14:1503-1509. [PMID: 32795742 DOI: 10.1016/j.dsx.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS In type 2 diabetes mellitus (T2DM), sexual dimorphisms modulate the natural histories of hyperglycemia, anthropophysical/cardiometabolic phenotype, and susceptibility to chronic micro and macrovascular complications. The purpose of this work was to revisit known or new dimorphisms within a multiethnic cohort. METHODS Among 1238 T2DM patients, men (63%) were compared to women (37%), including leading ethnicities: Whites (67.4%; 542 men; 293 women); Maghrebians (9.4%; 62 men; 54 women); and Blacks (12.5%; 92 men; 63 women). RESULTS Age, BMI, diabetes duration, insulin sensitivity, B-cell function loss, HbA1c, and hyperglycemia index were similar in both genders. All-cause microangiopathy and cerebrovascular disease did not differ between sexes. Women had significantly more retinopathy (27% vs. 21%) and men more microalbuminuria (25% vs. 19%), all-cause macroangiopathy (40% vs. 26%), CAD (29% vs. 17%) and PAD (11% vs. 6%). Among Blacks, sexual dimorphism in terms of retinopathy was more pronounced (24% in women vs. 11%), while there was no sexual dimorphism in all-cause macroangiopathy, CAD or PAD. B-cell function loss was faster among North African men (+15%), who also had more hepatic steatosis (+27%) than women. CONCLUSIONS T2DM abolishes the CV protection provided by the female gender in Blacks. In White women, the loss of CV protection in diabetes is limited to cerebrovascular disease. In Black women, a markedly increased risk of retinopathy is present, despite glycemic exposure similat to men. Sexual dimorphisms do not affect glucose homeostasis and metabolic control in all ethnicities, except for lesser B-cell function loss in Maghrebian women.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Sylvie A Ahn
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Michel F Rousseau
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
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20
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Liu J, Tarasenko L, Pong A, Huyck S, Patel S, Hickman A, Mancuso JP, Ellison MC, Gantz I, Terra SG. Efficacy and safety of ertugliflozin in Hispanic/Latino patients with type 2 diabetes mellitus. Curr Med Res Opin 2020; 36:1097-1106. [PMID: 32324065 DOI: 10.1080/03007995.2020.1760227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: To assess the efficacy and safety of ertugliflozin in Hispanic/Latino patients with type 2 diabetes (T2DM).Methods: Analysis of data from Hispanic/Latino patients who participated in randomized, double-blind phase III studies. Ertugliflozin efficacy was evaluated when initiated as a single agent (as monotherapy or add-on therapy) and when initiated in combination with sitagliptin. Least-squares mean change from baseline was calculated for glycated hemoglobin (HbA1c), body weight (BW), and systolic blood pressure (SBP). Safety evaluation included overall and prespecified adverse events (AEs).Results: Analyses included 1178 Hispanic/Latino patients. In a pooled analysis of three placebo-controlled studies where ertugliflozin was initiated as a single agent, the placebo-corrected change from baseline in HbA1c at week 26 for ertugliflozin 5 and 15 mg was -0.8 and -1.0%, respectively. In an active-comparator study, when initiated as a single agent, the change from baseline in HbA1c at week 52 was -0.5, -0.7, and -0.5% for ertugliflozin 5 mg, ertugliflozin 15 mg, and glimepiride, respectively. In a placebo-controlled study, when initiated in combination with sitagliptin, the placebo-corrected change from baseline in HbA1c at week 26 for ertugliflozin 5 mg/sitagliptin and ertugliflozin 15 mg/sitagliptin was -1.3 and -1.6%, respectively. In an active-comparator study, when initiated in combination with sitagliptin, the change from baseline in HbA1c at week 26 was -1.4, -1.6, and -0.9 for ertugliflozin 5 mg/sitagliptin, ertugliflozin 15 mg/sitagliptin, and sitagliptin alone, respectively. Reductions in BW and SBP were observed with ertugliflozin as a single agent or combined with sitagliptin. The incidences of overall and prespecified AEs in Hispanic/Latino patients were generally consistent with the known safety profile of ertugliflozin.Conclusion: Ertugliflozin, administered as a single agent or as a combination with sitagliptin, improved HbA1c, BW, and SBP. Ertugliflozin was generally well-tolerated in Hispanic/Latino patients with T2DM. Clinicaltrials.gov identifiers: NCT01986855, NCT01999218, NCT01958671, NCT02099110, NCT02036515, NCT02033889, and NCT02226003.
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Affiliation(s)
- Jie Liu
- Merck & Co., Inc, Kenilworth, NJ, USA
| | | | | | | | | | | | | | | | - Ira Gantz
- Merck & Co., Inc, Kenilworth, NJ, USA
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Cordero DM, Davis DL. Communication for Equity in the Service of Patient Experience: Health Justice and the COVID-19 Pandemic. J Patient Exp 2020; 7:279-281. [PMID: 32821779 PMCID: PMC7410125 DOI: 10.1177/2374373520933110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Xiao K, Liu F, Liu J, Xu J, Wu Q, Li X. The effect of metformin on lung cancer risk and survival in patients with type 2 diabetes mellitus: A meta-analysis. J Clin Pharm Ther 2020; 45:783-792. [PMID: 32406122 DOI: 10.1111/jcpt.13167] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Metformin has received increasing attention owing to its potential protective effect against cancer. We aimed to summarize evidence regarding the association between metformin and the risk or survival in lung cancer patients with type 2 diabetes. METHODS We selected observational studies examining the association between exposure to metformin and the risk or survival in lung cancer. Available publications were searched in PubMed, Cochrane Library, ScienceDirect, Wiley and SpringerLink databases. Meta-analysis was performed with hazard ratios (HRs) and 95% confidence intervals (95% CIs) as effect measures for risk or survival in lung cancer. RESULTS Eighteen studies (eight on lung cancer risk and ten on lung cancer survival) were included. Metformin treatment was associated with decreased lung cancer incidence (HR 0.78; 95% CI 0.70-0.86) and increased lung cancer survival (HR 0.65; 95% CI 0.55-0.77). In the subgroup analysis by ethnicity, a significant protective effect of metformin use on lung cancer risk was observed among Asian patients (HR 0.66; 95% CI 0.56-0.76), but not in European patients. On the other hand, the protective effect of metformin use on lung cancer survival was observed in both Asian (HR 0.57; 95% CI 0.49-0.66) and non-Asian (HR 0.79; 95% CI 0.71-0.88) patients. In the subgroup analysis by histology, a protective effect of metformin on lung cancer survival was observed in both non-small-cell lung cancer (HR 0.68; 95% CI 0.54-0.84) and small-cell lung cancer (HR 0.52; 95% CI 0.39-0.69). Funnel plot showed that no significant publication bias existed. CONCLUSIONS Our findings demonstrate that metformin is significantly associated with a decreased risk and increased survival in lung cancer.
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Affiliation(s)
- Kang Xiao
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.,Department of Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Fengxi Liu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.,Department of Clinical pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Juan Liu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Jiwei Xu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Qiuyun Wu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Xiao Li
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.,Department of Clinical pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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23
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Nabulsi NA, Yan CH, Tilton JJ, Gerber BS, Sharp LK. Clinical pharmacists in diabetes management: What do minority patients with uncontrolled diabetes have to say? J Am Pharm Assoc (2003) 2020; 60:708-715. [PMID: 32115392 DOI: 10.1016/j.japh.2020.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Clinical pharmacist support for patients with type 2 diabetes mellitus (T2DM) can optimize patient outcomes and medication adherence. However, there is limited understanding of what pharmacist roles patients perceive as most helpful in T2DM management interventions. This study describes experiences of minority patients with uncontrolled T2DM in terms of perceived pharmacist helpfulness and specific roles found to be most helpful within diabetes management. DESIGN A secondary analysis of a 2-year randomized, crossover trial was conducted. SETTING AND PARTICIPANTS This study included 244 African American and Hispanic adults with uncontrolled T2DM who received clinical pharmacist support within a team-based model. OUTCOME MEASURES The patients completed a mixed-methods survey regarding their experience with the intervention that included a general helpfulness rating on a 10-point unipolar Likert scale and described the support qualitatively, including their perception of the pharmacist roles. Thematic analysis guided coding of the responses. RESULTS One hundred forty-seven (60%) patients completed the survey and had at least 1 encounter with a clinical pharmacist. Of these, 108 (74%) were African American, 39 (27%) were Hispanic, and 101 (69%) were women. The median rating of clinical pharmacist helpfulness was 10 (very helpful). Only 10 (7%) participants rated pharmacist helpfulness as 1 (not at all helpful). "Medication education and management" was the most frequently perceived supportive role of the clinical pharmacists, followed by "non-medication-related patient education," "social support," and "care coordination." Miscommunication related to scheduling was the most common reason cited for not meeting with the clinical pharmacist. CONCLUSION This sample of minority patients with uncontrolled T2DM recognized many roles outlined within the American Pharmacists Association Medication Therapy Management framework. Patient experiences with clinical pharmacist T2DM support are crucial for developing effective programs, maximizing patient engagement, satisfying patient needs, and ensuring that a program's intended purpose aligns with the patient perspective.
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24
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Alvarez C, Cleveland RJ, Schwartz TA, Renner JB, Murphy LB, Jordan JM, Callahan LF, Golightly YM, Nelson AE. Comorbid conditions and the transition among states of hip osteoarthritis and symptoms in a community-based study: a multi-state time-to-event model approach. Arthritis Res Ther 2020; 22:12. [PMID: 31959228 PMCID: PMC6972032 DOI: 10.1186/s13075-020-2101-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). Methods This longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in North Carolina, USA, with 18.4 ± 1.5 years of follow-up. Transitions across the following states were modeled: development of radiographic HOA (rHOA; Kellgren-Lawrence grade [KLG] of< 2); development of hip symptoms (self-reported hip pain, aching, or stiffness on most days) or symptomatic HOA (sxHOA; rHOA and symptoms in the same hip), and resolution of symptoms. Obesity (body mass index ≥ 30 kg/m2) and self-reported DM and CVD were the time-dependent comorbid conditions of interest. Markov multi-state models were used to estimate adjusted hazard ratios and 95% confidence intervals to describe the associations between the conditions and HOA states. Results The sample included 33% African Americans, 39% men, with a mean (SD) age of 62.2 (9.8) years; the frequencies of the comorbidities increased substantially over time. When considered individually, obesity was associated with incident hip symptoms, while CVD and DM were associated with reduced symptom resolution. For those with > 1 comorbidity, the likelihood of incident sxHOA increased, while that of symptom resolution significantly decreased. When stratified by sex, the association between obesity and incident symptoms was only seen in women; among men with DM versus men without, there was a significant (~ 75%) reduction in symptom resolution in those with rHOA. When stratified by race, African Americans with DM, versus those without, were much more likely to develop sxHOA. Conclusions Comorbid chronic conditions are common in individuals with OA, and these conditions have a significant impact on the persistence and progression of HOA. OA management decisions, both pharmacologic and non-pharmacologic, should include considerations of the inter-relationships between OA and common comorbidities such as DM and CVD.
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Affiliation(s)
- Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3106E McGavran-Greenberg Hall, Campus Box #7420, Chapel Hill, NC, 27599-7420, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Radiology, University of North Carolina at Chapel Hill, 509 Old Infirmary Bldg, Campus Box #7510, Chapel Hill, NC, 27599-7510, USA
| | - Louise B Murphy
- Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-7, Atlanta, GA, 30341, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Division of Physical Therapy, Department of Allied Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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25
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Simeni Njonnou SR, Boombhi J, Etoa Etoga MC, Tiodoung Timnou A, Jingi AM, Nkem Efon K, Mbono Samba Eloumba EA, Ntsama Essomba MJ, Kengni Kebiwo O, Tsitsol Meke AN, Talbit Ndjonya S, Dehayem Yefou M, Sobngwi E. Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison. J Diabetes Res 2020; 2020:5016327. [PMID: 32047824 PMCID: PMC7003275 DOI: 10.1155/2020/5016327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa. METHODS A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention. RESULTS We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (. CONCLUSION Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.
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Affiliation(s)
- Sylvain Raoul Simeni Njonnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jérôme Boombhi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé General Hospital, Yaoundé, Cameroon
| | - Martine Claude Etoa Etoga
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Aimée Tiodoung Timnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ahmadou Musa Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Kevin Nkem Efon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Prison, Yaoundé, Cameroon
| | | | - Marie-Josiane Ntsama Essomba
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Odette Kengni Kebiwo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Alice Ninon Tsitsol Meke
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Stéphane Talbit Ndjonya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mesmin Dehayem Yefou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eugène Sobngwi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
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Morieri ML, Avogaro A, Fadini GP. Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice. Diabetes Metab Syndr Obes 2020; 13:4221-4234. [PMID: 33204129 PMCID: PMC7665457 DOI: 10.2147/dmso.s216054] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022] Open
Abstract
Randomized controlled trials (RCTs) have consistently shown glycemic and extra-glycemic benefits of long-acting injectable glucagon-like-peptide-1 receptor agonists (GLP-1RAs, liraglutide, albiglutide, exenatide once-weekly, dulaglutide, and semaglutide) in terms of reduction in the rates of cardiovascular events and mortality among patients with type 2 diabetes. Recently, the analyses of large datasets collecting routinely-accumulated data from clinical practice (ie, real-world studies, RWS) have provided new opportunities to complement the information obtained from RCTs. In this narrative review, we addressed clinically relevant questions that might be answered by well-conducted RWS: are subjects treated with GLP-1RAs in the "real-world" similar to those included in RCTs? Is the performance of GLP-1RA observed in the RWS (effectiveness) similar to that described in RCTs (efficacy)? Is the effectiveness similar in population of patients generally under-represented in RCTs? Are the cardiovascular benefits of GLP-1RAs confirmed in RWS? We also describe a few comparisons currently un-explored by specific RCTs, such as direct comparison between different administration strategies (eg, fixed- versus flexible-combination with basal-insulin) or between GLP-1RAs versus dipeptidyl-peptidase-4 inhibitor (DDP4i) or versus sodium/glucose cotransporter-2 inhibitors (SGLT-2i) on hard cardio-renal outcomes. Altogether, RWS provide highly informative information on treatment with GLP-1RAs. On the one side, RWS showed different clinical characteristics between subjects enrolled in RCTs versus those attending real-world clinics and receiving a GLP-1RA. On the other hand, RWS showed that GLP-1RA effectiveness is overall consistent in subgroups of patients less represented in RCTs. In addition, RWS allowed the identification of modifiable factors (eg, titration or adherence) that might guide physicians towards better GLP-1RAs use. Finally, multiple RWS reported better cardio-renal outcomes with GLP-1RAs than with DPP-4i, while initial findings from RWS described a weaker cardiovascular protection compared to SGLT-2i. Therefore, there is the need for further RWS and RCTs comparing these different classes of glucose lowering medications.
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Affiliation(s)
- Mario Luca Morieri
- Department of Medicine, University of Padova, Padova35128, Italy
- Correspondence: Mario Luca Morieri Department of Medicine, University of Padova, Via Giustiniani 2, Padova35128, ItalyTel +39 049 8217094 Email
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova35128, Italy
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Thomas DD, Stockman MC, Yu L, Meshulam T, McCarthy AC, Ionson A, Burritt N, Deeney J, Cabral H, Corkey B, Istfan N, Apovian CM. Effects of medium chain triglycerides supplementation on insulin sensitivity and beta cell function: A feasibility study. PLoS One 2019; 14:e0226200. [PMID: 31869355 PMCID: PMC6927614 DOI: 10.1371/journal.pone.0226200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Medium chain triglycerides (MCT) have unique metabolic properties which may improve insulin sensitivity (Si) and beta cell function but data in humans are limited. We conducted a 6-week clinical trial of MCT oil supplementation. Methods 22 subjects without diabetes (8 males, 14 females, mean ± standard error age 39±2.9 years, baseline BMI 27.0±1.4 kg/m2) were counseled to maintain their body weight and physical activity (PA) during the trial. Dietary intake, PA data, body composition, and resting energy expenditure (REE) were obtained through dietary recall, international PA questionnaire, dual x-ray absorptiometry, and indirect calorimetry, respectively. MCT prescriptions were given based on REE and PA to replace part of dietary fat with 30 grams of MCT per 2000 kcal daily. Insulin-modified frequently sampled intravenous glucose tolerance tests were performed before and after MCT to measure changes in Si, acute insulin response (AIR), disposition index (DI), and glucose effectiveness (Sg). Results MCT were well tolerated and weight remained stable (mean change 0.3 kg, p = 0.39). Fasting REE, respiratory quotient, and body composition were stable during the intervention. There were no significant changes in mean fasting glucose, insulin, insulin resistance, fasting total ketones, Si, AIR, DI, Sg, leptin, fructosamine, and proinsulin. The mean change in Si was 0.5 10−4 min-1 per mU/L (95% CI: -1.4, 2.4), corresponding to a 12% increase from baseline, and the range was -4.7 to 12.9 10−4 min-1 per mU/L. Mean total adiponectin decreased significantly from 22925 ng/mL at baseline to 17598 ng/mL at final visit (p = 0.02). The baseline clinical and laboratory parameters were not significantly associated with the change in Si. Discussion There were a wide range of changes in the minimal model parameters of glucose and insulin metabolism in subjects following 6 weeks of MCT as an isocaloric substitution for part of usual dietary fat intake. Since this was a single-arm non-randomized study without a control group, it cannot be certain whether these changes were due to MCT so further randomized controlled trials are warranted.
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Affiliation(s)
- Dylan D. Thomas
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Mary-Catherine Stockman
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Liqun Yu
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Tova Meshulam
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Ashley C. McCarthy
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Annaliese Ionson
- Boston University School of Medicine, Boston, MA, United States of America
| | - Nathan Burritt
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Jude Deeney
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Barbara Corkey
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Nawfal Istfan
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Caroline M. Apovian
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
- * E-mail:
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Sargis RM, Simmons RA. Environmental neglect: endocrine disruptors as underappreciated but potentially modifiable diabetes risk factors. Diabetologia 2019; 62:1811-1822. [PMID: 31451869 PMCID: PMC7462102 DOI: 10.1007/s00125-019-4940-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/14/2019] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes prevalence is increasing dramatically across the globe, imposing a tremendous toll on individuals and healthcare systems. Reversing these trends requires comprehensive approaches to address both classical and emerging diabetes risk factors. Recently, environmental toxicants acting as endocrine-disrupting chemicals (EDCs) have emerged as novel metabolic disease risk factors. EDCs implicated in diabetes pathogenesis include various inorganic and organic molecules of both natural and synthetic origin, including arsenic, bisphenol A, phthalates, polychlorinated biphenyls and organochlorine pesticides. Indeed, evidence implicates EDC exposures across the lifespan in metabolic dysfunction; moreover, specific developmental windows exhibit enhanced sensitivity to EDC-induced metabolic disruption, with potential impacts across generations. Importantly, differential exposures to diabetogenic EDCs likely also contribute to racial/ethnic and economic disparities. Despite these emerging links, clinical practice guidelines fail to address this underappreciated diabetes risk factor. Comprehensive approaches to stem the tide of diabetes must include efforts to address its environmental drivers.
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Affiliation(s)
- Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625; M/C 640, Chicago, IL, 60612, USA.
- ChicAgo Center for Health and EnvironmenT (CACHET), University of Illinois at Chicago, Chicago, IL, USA.
| | - Rebecca A Simmons
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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29
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Margolis SA, Sears MZ, Daiello LA, Solon C, Nakhutina L, Hoogendoorn CJ, Gonzalez JS. Anticholinergic/sedative drug burden predicts worse memory acquisition in older racially/ethnically diverse patients with type 2 diabetes mellitus. Int J Geriatr Psychiatry 2019; 34:1545-1554. [PMID: 31313847 PMCID: PMC8807032 DOI: 10.1002/gps.5173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), is linked to cognitive impairment in older adults. Yet, studies on the DBI's association with neuropsychological functioning are lacking, especially in underserved groups at increased risk of cognitive impairment. We examined cross-sectional relationships between total DBI (DBIT ) and an age-adjusted analogue (Adj DBIT ) with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in diverse adults with type 2 diabetes mellitus (T2DM). Based on results of a prior study, we anticipated higher DBIs would be associated with worse memory at older ages. METHODS One hundred five adults with T2DM (age = 57 ± 9 years, 65% female, 62% Black, 27% Hispanic/Latino, HbA1c = 7.8 ± 1.8) participated. Although memory outcomes were normally distributed, DBIT values were positively skewed. Spearman correlations assessed their bivariate relationships with RBANS. Adjusting for comorbidities, polypharmacy, HbA1c , and education, we tested the moderating effect of age on DBI-RBANS associations at mean ±1 standard deviations of age. RESULTS One third of the participants endorsed current sedative/anticholinergic use. Mean DBIT was 0.385, and mean Adj DBIT was 0.393 (ranges = 0.00-4.22). Drug burden negatively correlated with RBANS Immediate Memory (DBIT rs = -0.237, P = .013; Adj DBIT rs = -0.239, P = .014) but no other indices. There was a significant DBI*Age interaction; the negative effect of drug burden on Immediate Memory was significant for ages greater than or equal to 55 years old. CONCLUSIONS Sedative/anticholinergic drug exposure was prevalent in these diverse T2DM patients. Adjusting for covariates, greater drug burden was associated with worse memory acquisition among older adults only. Prospective studies should examine these relationships over time and assess whether dementia biomarkers affect the interaction.
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Affiliation(s)
- Seth A. Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI,The Miriam Hospital, Providence, RI
| | | | - Lori A. Daiello
- Rhode Island Hospital, Providence, RI,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Carly Solon
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY
| | | | | | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY,Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY,New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, New York, NY,The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, NY
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Jiménez-Osorio AS, Aguilar-Lucio AO, Cárdenas-Hernández H, Musalem-Younes C, Solares-Tlapechco J, Costa-Urrutia P, Medina-Contreras O, Granados J, Rodríguez-Arellano ME. Polymorphisms in Adipokines in Mexican Children with Obesity. Int J Endocrinol 2019; 2019:4764751. [PMID: 31354816 PMCID: PMC6634012 DOI: 10.1155/2019/4764751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/10/2019] [Accepted: 04/16/2019] [Indexed: 12/22/2022] Open
Abstract
The high prevalence of childhood obesity in Mexico is alarming in the health-science field. We propose to investigate the contribution of adipokines and cytokines polymorphisms and common BMI/obesity-associated loci, revealed in genome-wide association studies in Caucasian adult cohorts, with childhood obesity. This study included 773 Mexican-Mestizo children (5-15 years old) in a case-control study. The polymorphisms included were ADIPOQ (rs6444174), TNF-α (rs1800750), IL-1β (rs1143643), IL-6 (rs1524107; rs2069845), NEGR1 (rs34305371), SEC16B-RASAL2 (rs10913469), TMEM18 (rs6548238; rs7561317), GNPDA2 (rs16857402), LEP (rs2167270), MTCH2 (rs10838738), LGR4-LIN7C-BDNF (rs925946), BCDIN3D-FAIM2 (rs7138803), FTO (rs62033400), MC4R (rs11872992), MC4R (rs17782313), and KCTD15 (rs29942). No significant contribution was found with adipokines and cytokines polymorphisms in this study. Only both TMEM18 (rs6548238; rs7561317) polymorphisms were found associated with obesity (OR=0.5, P=0.008) and were in linkage disequilibrium (r2=0.87). The linear regression showed that the rs7561317 polymorphism of TMEM18 is negatively associated with obesity. This report highlights the influence of TMEM18 in Mexican-Mestizo children obesity, while adipokine and cytokine polymorphisms were not associated with it.
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Affiliation(s)
- Angélica Saraí Jiménez-Osorio
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
| | - Alma Olivia Aguilar-Lucio
- Servicio de Neonatología del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
| | - Helios Cárdenas-Hernández
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
| | - Claudette Musalem-Younes
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
| | - Jacqueline Solares-Tlapechco
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
| | - Paula Costa-Urrutia
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
| | - Oscar Medina-Contreras
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Julio Granados
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
- División de Inmunogenética, Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, C.P. 14080, Mexico City, Mexico
| | - Martha Eunice Rodríguez-Arellano
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, C.P. 01030, Álvaro Obregón, Mexico City, Mexico
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Mannino GC, Andreozzi F, Sesti G. Pharmacogenetics of type 2 diabetes mellitus, the route toward tailored medicine. Diabetes Metab Res Rev 2019; 35:e3109. [PMID: 30515958 PMCID: PMC6590177 DOI: 10.1002/dmrr.3109] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease that has reached the levels of a global epidemic. In order to achieve optimal glucose control, it is often necessary to rely on combination therapy of multiple drugs or insulin because uncontrolled glucose levels result in T2DM progression and enhanced risk of complications and mortality. Several antihyperglycemic agents have been developed over time, and T2DM pharmacotherapy should be prescribed based on suitability for the individual patient's characteristics. Pharmacogenetics is the branch of genetics that investigates how our genome influences individual responses to drugs, therapeutic outcomes, and incidence of adverse effects. In this review, we evaluated the pharmacogenetic evidences currently available in the literature, and we identified the top informative genetic variants associated with response to the most common anti-diabetic drugs: metformin, DPP-4 inhibitors/GLP1R agonists, thiazolidinediones, and sulfonylureas/meglitinides. Overall, we found 40 polymorphisms for each drug class in a total of 71 loci, and we examined the possibility of encouraging genetic screening of these variants/loci in order to critically implement decision-making about the therapeutic approach through precision medicine strategies. It is possible then to anticipate that when the clinical practice will take advantage of the genetic information of the diabetic patients, this will provide a useful resource for the prevention of T2DM progression, enabling the identification of the precise drug that is most likely to be effective and safe for each patient and the reduction of the economic impact on a global scale.
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Affiliation(s)
- Gaia Chiara Mannino
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Francesco Andreozzi
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Giorgio Sesti
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
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Jiménez-Osorio AS, Musalem-Younes C, Cárdenas-Hernández H, Solares-Tlapechco J, Costa-Urrutia P, Medina-Contreras O, Granados J, López-Saucedo C, Estrada-Garcia T, Rodríguez-Arellano ME. Common Polymorphisms Linked to Obesity and Cardiovascular Disease in Europeans and Asians are Associated with Type 2 Diabetes in Mexican Mestizos. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E40. [PMID: 30764545 PMCID: PMC6410269 DOI: 10.3390/medicina55020040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023]
Abstract
Background and objectives: Type 2 diabetes (T2D) is a major problem of public health in Mexico. We investigated the influence of five polymorphisms, previously associated with obesity and cardiovascular disease in Europeans and Asians, on T2D in Mexican Mestizos. Materials and Methods: A total of 1358 subjects from 30 to 85 years old were genotyped for five loci: CXCL12 rs501120; CDNK2A/B rs1333049; HNF-1α rs2259816; FTO rs9939609; and LEP rs7799039. We used logistic regressions to test the effect of each locus on T2D in two case⁻control groups with obesity and without obesity. Also, linear regression models on glucose and glycated hemoglobin (HbA1c) were carried out on the whole sample, adjusted by age, gender, and body mass index. Results: The CXCL12 rs501120 C allele (OR = 1.96, p = 0.02), the FTO rs9939609 A allele (OR = 2.20, p = 0.04) and the LEP rs7799039 A allele (OR = 0.6, p = 0.03) were significantly associated with T2D in obesity case⁻control group. No significant association was found in the non-obesity case⁻control group. The linear regression model showed that CDNK2A/B rs1333049 C allele (β = 0.4, p = 0.03) and FTO rs9939609 A allele (β = 0.5, p = 0.03), were significantly associated with HbA1c, but no association was found among the loci with the glucose levels. Conclusions: Polymorphisms previously linked with obesity and cardiovascular events were also associated with T2D and high levels of HbA1c. Furthermore, we must point at the fact that this is the first report where polymorphisms CXCL12 rs501120 and LEP rs7799039 are associated with T2D in subjects with obesity.
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Affiliation(s)
| | - Claudette Musalem-Younes
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
| | - Helios Cárdenas-Hernández
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
| | | | - Paula Costa-Urrutia
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
| | - Oscar Medina-Contreras
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico.
| | - Julio Granados
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
- División de Inmunogenética, Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Catalina López-Saucedo
- Department of Molecular Biomedicine, CINVESTAV-IPN, Av. IPN #2508, Col. Zacatenco, Mexico City 07360, Mexico.
| | - Teresa Estrada-Garcia
- Department of Molecular Biomedicine, CINVESTAV-IPN, Av. IPN #2508, Col. Zacatenco, Mexico City 07360, Mexico.
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Kelley AT, Mizokami-Stout K, O'Brien MJ, Bowen ME, Sussman J. Hispanic representation in diabetes cardiovascular outcomes trials. BMJ Open Diabetes Res Care 2019; 7:e000656. [PMID: 31245007 PMCID: PMC6557465 DOI: 10.1136/bmjdrc-2019-000656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/22/2019] [Accepted: 04/12/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine Hispanic/Latino representation in diabetes cardiovascular outcomes trials for novel antidiabetic drugs. RESEARCH DESIGN AND METHODS We compared Hispanic/Latino representation, age, gender and body mass index in diabetes cardiovascular outcomes trials published from January 2008 to October 2018 to Hispanic adults with diabetes in the National Health Examination and Nutrition Survey over the same time period. RESULTS Hispanics/Latinos comprised 18.5 % of trial subjects, which was similar to the proportion of US adults with diabetes who identify as Hispanic. Trial subjects were significantly younger, more likely to be female, and more obese than US Hispanics/Latinos. At least 10 different Latin American countries and territories were represented across the 10 trials. CONCLUSIONS US Hispanics/Latinos differ from subjects in diabetes cardiovascular outcomes trials, which may limit generalizability of trial results.
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Affiliation(s)
- A. Taylor Kelley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
- National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan, United States
| | - Kara Mizokami-Stout
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
- National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan, United States
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, United States
| | - Matthew J. O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael E. Bowen
- Departments of Internal Medicine, Pediatrics and Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeremy Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
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Beeri MS, Lin HM, Sano M, Ravona-Springer R, Liu X, Bendlin BB, Gleason CE, Guerrero-Berroa E, Soleimani L, Launer LJ, Ehrenberg S, Lache O, Seligman YK, Levy AP. Association of the Haptoglobin Gene Polymorphism With Cognitive Function and Decline in Elderly African American Adults With Type 2 Diabetes: Findings From the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Study. JAMA Netw Open 2018; 1:e184458. [PMID: 30646354 PMCID: PMC6324406 DOI: 10.1001/jamanetworkopen.2018.4458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE African American individuals have higher dementia risk than individuals of white race/ethnicity. They also have higher rates of type 2 diabetes, which may contribute to this elevated risk. This study examined the association of the following 2 classes of alleles at the haptoglobin (Hp) locus that are associated with poor cognition, cardiovascular disease, and mortality: Hp 1-1 (associated with poor cognition and cerebrovascular disease) and Hp 2-1 and Hp 2-2 (associated with greater risk of myocardial infarction and mortality). An additional polymorphism in the promoter region of the Hp 2 allele, restricted to individuals of African descent, yields a fourth genotype, Hp 2-1m. African American adults have a higher prevalence of Hp 1-1 (approximately 30%) compared with individuals of white race/ethnicity (approximately 14%), but the potential role of the Hp genotype in cognition among elderly African American individuals with type 2 diabetes is unknown. OBJECTIVE To assess the association of the Hp genotypes with cognitive function and decline in elderly African American adults with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used publicly available data and specimens from the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study to investigate the association of the Hp genotypes with cognitive function and decline in 466 elderly African American participants with type 2 diabetes. The hypothesis was that the Hp 1-1 genotype compared with the other genotypes would be associated with more cognitive impairment and faster cognitive decline in elderly African American adults with type 2 diabetes. The initial ACCORD trial was performed from October 28, 1999, to September 15, 2014. This was a multicenter clinical study performed in an academic setting. EXPOSURES The Hp genotypes were determined from serum samples by polyacrylamide gel electrophoresis and by enzyme-linked immunosorbent assay. MAIN OUTCOMES AND MEASURES The Mini-Mental State Examination (MMSE) was used to measure cognitive function and change after 40 months. The MMSE score ranges from 0 to 30 points; higher scores represent better cognition. Associations were examined with analysis of covariance and linear regression, adjusting for age, sex, education, baseline glycated hemoglobin level, systolic blood pressure, diastolic blood pressure, cholesterol level, creatinine level, and treatment arm (intensive vs standard). The cognitive change model adjusted also for the baseline MMSE score. RESULTS Among 466 African American study participants (mean [SD] age, 62.3 [5.7] years), 64.8% were women, and the genotype prevalences were 29.4% (n = 137) for Hp 1-1, 36.1% (n = 168) for Hp 2-1, 10.9% (n = 51) for Hp 2-1m, and 23.6% (n = 110) for Hp 2-2. The groups differed in their baseline MMSE scores (P = .006): Hp 1-1 had the lowest MMSE score (mean [SE], 25.68 [0.23]), and Hp 2-1m had the highest MMSE score (mean [SE], 27.15 [0.36]). Using the least squares method, the 40-month decline was significant for Hp 1-1 (mean [SE], -0.41 [0.19]; P = .04) and for Hp 2-2 (mean [SE], -0.68 [0.21]; P = .001). However, the overall comparison across the 4 groups did not reach statistical significance for the fully adjusted model. The interaction of age with the Hp 1-1 genotype on MMSE score decline estimate per year change was significant (mean [SE], -0.87 [0.37]; P = .005), whereas it was not significant for Hp 2-1 (mean [SE], 0.06 [0.37]; P = .85), Hp 2-1m (mean [SE], -0.06 [0.51]; P = .89), and Hp 2-2 (mean [SE], -0.44 [0.41]; P = .29), indicating that cognitive decline in Hp 1-1 carriers was accentuated in older ages, whereas it was not significant for the other Hp genotypes. CONCLUSIONS AND RELEVANCE In this study, the Hp 1-1 genotype, which is 2-fold (approximately 30%) more prevalent among African American individuals than among individuals of white race/ethnicity, was associated with poorer cognitive function and greater cognitive decline than the other Hp genotypes. The Hp gene polymorphism may explain the elevated dementia risk in African American adults. The neuropathological substrates and mechanisms for these associations merit further investigation.
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Affiliation(s)
- Michal S. Beeri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hung-Mo Lin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- The Memory and Psychogeriatric Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Xiaoyu Liu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara B. Bendlin
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Carey E. Gleason
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Elizabeth Guerrero-Berroa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychology, Lehman College, The City University of New York, Bronx
| | - Laili Soleimani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Scott Ehrenberg
- currently a student at Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Orit Lache
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaakov K. Seligman
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Andrew P. Levy
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Lam C, Cronin K, Ballard R, Mariotto A. Differences in cancer survival among white and black cancer patients by presence of diabetes mellitus: Estimations based on SEER-Medicare-linked data resource. Cancer Med 2018; 7:3434-3444. [PMID: 29790667 PMCID: PMC6051153 DOI: 10.1002/cam4.1554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/28/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023] Open
Abstract
Diabetes prevalence and racial health disparities in the diabetic population are increasing in the US. Population‐based cancer‐specific survival estimates for cancer patients with diabetes have not been assessed. The Surveillance, Epidemiology, and End Results (SEER)‐Medicare linkage provided data on cancer‐specific deaths and diabetes prevalence among 14 separate cohorts representing 1 068 098 cancer patients ages 66 + years diagnosed between 2000 and 2011 in 17 SEER areas. Cancer‐specific survival estimates were calculated by diabetes status adjusted by age, stage, comorbidities, and cancer treatment, and stratified by cancer site and sex with whites without diabetes as the reference group. Black patients had the highest diabetes prevalence particularly among women. Risks of cancer deaths were increased across most cancer sites for patients with diabetes regardless of race. Among men the largest effect of having diabetes on cancer‐specific deaths were observed for black men diagnosed with Non‐Hodgkin lymphoma (NHL) (HR = 1.53, 95%CI = 1.33‐1.76) and prostate cancer (HR = 1.37, 95%CI = 1.32‐1.42). Diabetes prevalence was higher for black females compared to white females across all 14 cancer sites and higher for most sites when compared to white and black males. Among women the largest effect of having diabetes on cancer‐specific deaths were observed for black women diagnosed with corpus/uterus cancer (HR = 1.66, 95%CI = 1.54‐1.79), Hodgkin lymphoma (HR = 1.62, 95%CI = 1.02‐2.56) and breast ER+ (HR = 1.39, 95%CI = 1.32‐1.47). The co‐occurrence of diabetes and cancer significantly increases the risk of cancer death. Our study suggests that these risks may vary by cancer site, and indicates the need for future research to address racial and sex disparities and enhance understanding how prevalent diabetes may affect cancer deaths.
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Affiliation(s)
- Clara Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kathleen Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachel Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Rockville, MD, USA
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Race, insurance status, and traumatic brain injury outcomes before and after enactment of the Affordable Care Act. Surgery 2018; 163:251-258. [DOI: 10.1016/j.surg.2017.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/03/2017] [Accepted: 09/08/2017] [Indexed: 11/18/2022]
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Ferdinand KC, Seman L, Salsali A. Design of a 24-week trial of empagliflozin once daily in hypertensive black/African American patients with type 2 diabetes mellitus. Curr Med Res Opin 2018; 34:361-367. [PMID: 29139301 DOI: 10.1080/03007995.2017.1405800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Black/African American individuals have a higher prevalence of type 2 diabetes mellitus (T2DM), diabetes-related complications and hypertension, but they are often underrepresented in clinical trials. The sodium-glucose co-transporter 2 inhibitor, empagliflozin, was associated with significant improvements in glucose control (via hemoglobin [Hb] A1c) and reductions in blood pressure (BP; via office and ambulatory BP monitoring) in a primarily white population with T2DM and hypertension. The aim of this ongoing study is to assess the safety and efficacy of empagliflozin in terms of glucose- and BP-lowering in a self-identified black/African American population with T2DM and hypertension. METHODS This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 3b study carried out at 85 centers in the USA. It was designed to assess the safety and efficacy of empagliflozin (10 or 25 mg/day) versus placebo in black/African American patients with uncontrolled T2DM and hypertension. Patients receiving stable glucose-lowering therapy prestudy continued at the same dose during the trial; BP-lowering medication was also held stable. The primary endpoint was the change from baseline in HbA1c at Week 24. Key secondary endpoints were change from baseline in: mean 24-hour ambulatory systolic BP (SBP) at Week 12, mean trough ambulatory SBP at Week 12, body weight at Week 24 and trough seated SBP at Week 12. RESULTS The study will report final data in 2018. CONCLUSIONS Results of this study will add to our understanding of the efficacy and safety of empagliflozin in self-identified black/African American patients with T2DM and hypertension. (ClinicalTrials.gov identifier: NCT02182830.).
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Affiliation(s)
| | - Leo Seman
- b Boehringer Ingelheim Pharmaceuticals, Inc. , Ridgefield , CT , USA
| | - Afshin Salsali
- b Boehringer Ingelheim Pharmaceuticals, Inc. , Ridgefield , CT , USA
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Heitkemper EM, Mamykina L, Tobin JN, Cassells A, Smaldone A. Baseline Characteristics and Technology Training of Underserved Adults With Type 2 Diabetes in the Mobile Diabetes Detective (MoDD) Randomized Controlled Trial. THE DIABETES EDUCATOR 2017; 43:576-588. [PMID: 29059017 PMCID: PMC5759770 DOI: 10.1177/0145721717737367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose The purpose of this study is to describe the characteristics and technology training needs of underserved adults with type 2 diabetes mellitus (T2DM) who participated in a health information technology (HIT) diabetes self-management education (DSME) intervention. Methods The baseline physiological, psychosocial, and technology use characteristics for 220 adults with poorly controlled T2DM were evaluated. Intervention participants received a 1-time intervention training, which included basic technology help, introduction to the Mobile Diabetes Detective (MoDD) website and text message features, and account activation that included subject-specific tailoring. Four additional on-site sessions for participants needing computer or Internet access or technology support were made available based on need. Data regarding on-site visits for usual care were collected. Data were analyzed using descriptive statistics and bivariate analysis. Results The participants were predominately Hispanic and female with a baseline mean A1C of 10% (86 mmol/mol). Only half of the participants regularly used computers or text messages in daily life. The average introductory MoDD training session lasted 73.6 minutes. Following training, approximately one-third (35%) of intervention participants returned for basic and MoDD-specific technology assistance at their federally qualified health center. The most frequently reported duration for the extra training sessions was 30 to 45 minutes. Conclusions Training and support needs were greater than anticipated. Diabetes educators should assess technology abilities prior to implementing health information technology (HIT) diabetes self-management education (DSME) in underserved adults. Future research must invest resources in technology access, anticipate subject training, and develop new training approaches to ensure HIT DSME use and engagement.
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Affiliation(s)
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University Medical Center, New York, NY
| | - Jonathan N. Tobin
- Clinical Directors Network (CDN), Inc., New York, NY
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY
| | | | - Arlene Smaldone
- School of Nursing, Columbia University Medical Center, New York, NY
- Department of Dental Behavioral Sciences, College of Dental Medicine, Columbia University Medical Center, New York, NY
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Davidson JA, Jones-Leone A, Wilson TH, Nino A, Forero-Schwanhaeuser S, Reinhardt RR. Albiglutide efficacy and safety in the Latino/Hispanic subpopulation for the integrated phase III program. Postgrad Med 2017; 129:849-857. [PMID: 29083275 DOI: 10.1080/00325481.2017.1387473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE to evaluate the efficacy and safety of albiglutide compared with placebo and active comparators from an integrated trial subpopulation of Latino/Hispanic patients whose type 2 diabetes mellitus (T2DM) was inadequately controlled on their current regimen of diet and exercise, with or without oral antidiabetic drugs (OADs) and/or insulin. METHODS Latino/Hispanic patient subpopulations (N = 1204) across 7 phase III albiglutide studies (N = 4400) were evaluated post-hoc for efficacy and safety. Comparators were placebo, sulfonylureas, insulin, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors. Glycatedhemoglobin (HbA1c) change from baseline to the time of the primary endpoint assessment (from 26 to 104 weeks) was evaluated in patients on diet and exercise and/or OADs, with or without insulin. Patients were allowed to continue in the study if hyperglycemic rescue was required, according to a prespecified algorithm and at the discretion of the investigator. RESULTS At baseline in the Latino/Hispanic subpopulation, the mean HbA1c was 8.3%, mean age was 53 years, mean body mass index was 32 kg/m2, and mean duration of T2DM was 8.0 years. The primary endpoint of mean HbA1c difference (albiglutide - placebo) was -0.94% for the Latino/Hispanic subpopulation and -0.86% (p < 0.001) for the overall phase III population. Changes in fasting plasma glucose mirrored those of HbA1c. Weight loss with albiglutide was numerically greater than with OADs and insulin in both populations, but it was smaller than with liraglutide. Within the Latino/Hispanic subpopulation, more injection-site reactions were reported with albiglutide vs all comparators, while gastrointestinal and hypoglycemic adverse events were comparable between the two groups, and the latter was uncommon when used without insulin and/or a sulfonylurea. CONCLUSIONS In the Latino/Hispanic population, albiglutide resulted in effective lowering of glucose and modest weight loss, and it was generally well tolerated.
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Affiliation(s)
- Jaime A Davidson
- a Touchstone Diabetes Center , UT Southwestern Medical Center , Dallas , TX , USA
| | | | | | - Antonio Nino
- d Research and Development, GlaxoSmithKline , Collegeville , PA , USA
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Kountz DS. The use of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and hypertension: a focus on African-American populations. Postgrad Med 2017; 129:421-429. [DOI: 10.1080/00325481.2017.1313074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David S. Kountz
- Medical and Academic Affairs, Jersey Shore University Medical Center, Neptune, NJ, USA
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Bowes A, Begley J, Kerr D. Lifestyle change reduces cardiometabolic risk factors and glucagon-like peptide-1 levels in obese first-degree relatives of people with diabetes. J Hum Nutr Diet 2017; 30:490-498. [DOI: 10.1111/jhn.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Bowes
- Bournemouth Diabetes and Endocrine Centre; Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Bournemouth UK
- Intermediate Dietetics Department; Dorset Healthcare University NHS Foundation Trust; Diabetes Centre; Poole UK
| | - J. Begley
- Bournemouth Diabetes and Endocrine Centre; Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Bournemouth UK
| | - D. Kerr
- Research and Innovation; William Sansum Diabetes Center; Santa Barbara CA USA
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Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, Partridge JC, Rogers EE, Keller RL. Persistent Pulmonary Hypertension of the Newborn in Late Preterm and Term Infants in California. Pediatrics 2017; 139:peds.2016-1165. [PMID: 27940508 DOI: 10.1542/peds.2016-1165] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are limited epidemiologic data on persistent pulmonary hypertension of the newborn (PPHN). We sought to describe the incidence and 1-year mortality of PPHN by its underlying cause, and to identify risk factors for PPHN in a contemporary population-based dataset. METHODS The California Office of Statewide Health Planning and Development maintains a database linking maternal and infant hospital discharges, readmissions, and birth and death certificates from 1 year before to 1 year after birth. We searched the database (2007-2011) for cases of PPHN (identified by International Classification of Diseases, Ninth Revision codes), including infants ≥34 weeks' gestational age without congenital heart disease. Multivariate Poisson regression was used to identify risk factors associated with PPHN; results are presented as risk ratios, 95% confidence intervals. RESULTS Incidence of PPHN was 0.18% (3277 cases/1 781 156 live births). Infection was the most common cause (30.0%). One-year mortality was 7.6%; infants with congenital anomalies of the respiratory tract had the highest mortality (32.0%). Risk factors independently associated with PPHN included gestational age <37 weeks, black race, large and small for gestational age, maternal preexisting and gestational diabetes, obesity, and advanced age. Female sex, Hispanic ethnicity, and multiple gestation were protective against PPHN. CONCLUSIONS This risk factor profile will aid clinicians identifying infants at increased risk for PPHN, as they are at greater risk for rapid clinical deterioration.
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Affiliation(s)
| | - Laura L Jelliffe-Pawlowski
- Epidemiology and Biostatistics, and.,California Preterm Birth Initiative, University of California, San Francisco, California; and
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California, San Francisco, California; and.,Department of Pediatrics, University of California, San Diego, California
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Rodríguez JE, Campbell KM. Racial and Ethnic Disparities in Prevalence and Care of Patients With Type 2 Diabetes. Clin Diabetes 2017; 35:66-70. [PMID: 28144049 PMCID: PMC5241767 DOI: 10.2337/cd15-0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Objective To update clinicians with an overview of empagliflozin for the treatment of type 2 diabetes mellitus (T2DM), with focus on use in combination regimens. Methods Keyword searches were conducted in the Medline database to identify literature reporting clinical trials of at least 12 weeks’ duration using empagliflozin treatment in patients with T2DM. Results When given as monotherapy or in combination therapy (as add-on or single-pill therapy) with metformin, pioglitazone, sulfonylurea, linagliptin, and insulin, empagliflozin produced clinically meaningful reductions in glycated hemoglobin levels, plasma glucose concentrations, bodyweight, and blood pressure. These changes were sustained during long-term treatment. In a dedicated cardiovascular event trial, empagliflozin on top of standard of care demonstrated a significant reduction in the risk of cardiovascular mortality and all-cause mortality. Across the clinical trials, empagliflozin combination therapies were well tolerated, and empagliflozin used alone was not associated with increased risk of hypoglycemia versus placebo. Indeed, the combination of empagliflozin and metformin had a significantly reduced rate of hypoglycemia compared with the combination of metformin and a sulfonylurea. On the other hand, empagliflozin treatment did have increased risk of genital infections compared with placebo. In clinical trials to date, diabetic ketoacidosis was not seen more frequently with empagliflozin than with placebo, but physicians should be alert to the possibility of this rare event. Conclusion Empagliflozin has the potential to make an important contribution to the treatment of patients with T2DM. In some patients, empagliflozin may be used as monotherapy, but it is most likely to be used in combination with other therapies. Given the reduced risk of mortality seen when empagliflozin was added to standard care in patients at high cardiovascular risk, as well as the lack of alternative options for patients at lower cardiovascular risk, empagliflozin may be added to ongoing regimens for a significant proportion of patients.
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Affiliation(s)
- Kenneth S Hershon
- North Shore Diabetes and Endocrine Associates, New Hyde Park, NY, USA; Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA
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