Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative

Synthesis of multi-responsive poly(NIPA-co-DMAEMA)-PBA hydrogel nanoparticles in aqueous solution for application as glucose-sensitive insulin-releasing nanoparticles

Objectives

This study aimed to present an innovative method for synthesizing pH-thermo-glucose responsive poly(NIPA-co-DMAEMA)-PBA hydrogel nanoparticles via single-step aqueous free radical polymerization.

Methods

The synthesis process involved free radical polymerization in an aqueous solution, and the resulting nanoparticles were characterized for their physical and chemical properties by 1H NMR, Dynamic Light Scattering (DLS) and Scanning Electron Microscopy (SEM). Insulin-loaded poly(NIPA-co-DMAEMA)-PBA hydrogel nanoparticles were prepared and evaluated for their insulin capture and release properties at different pH and temperature, in addition to different glucose concentrations, with the release profile of insulin quantitatively evaluated using the Bradford method.

Results

1H NMR results confirmed successful PBA incorporation, and DLS outcomes consistently indicated a transition to a more hydrophobic state above the Lower Critical Solution Temperature (LCST) of NIPA and DMAEMA. While pH responsiveness exhibited variation, insulin release generally increased with rising pH from acidic to neutral conditions, aligning with the anticipated augmentation of anionic PBA moieties and increased hydrogel hydrophilicity. Increased insulin release in the presence of glucose, particularly for formulations with the lowest mol % PBA, along with a slight increase for the highest mol % PBA formulation when increasing glucose from 1 to 4 mg/mL, supported the potential of this approach for nanoparticle synthesis tailored for glucose-responsive insulin release.

Conclusions

This work successfully demonstrates a novel method for synthesizing responsive hydrogel nanoparticles and underscores their potential for controlled insulin release in response to glucose concentrations. The observed pH-dependent insulin release patterns and the influence of PBA content on responsiveness highlight the versatility and promise of this nanoparticle synthesis approach for applications in glucose-responsive drug delivery systems.

Graphical abstract

Poly(NIPA) nanoparticles containing PBA moieties are normally synthesized in two or more steps in the presence of organic solvents. Here we propose a new method for the synthesis of multiresponsive hydrogel poly(NIPA-co-DMAEMA)-PBA nanoparticles in aqueous medium in a single reaction to provide a fast and effective strategy for the production of glucose-responsive multi-systems in aqueous media from free radical polymerization.

Multilevel perceptions of the virtual delivery of the University of California Diabetes Prevention Program on RE-AIM domains due to COVID-19 mandates

Background

The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented across all 10 UC campuses in 2018. The COVID-19 pandemic and accompanying mandates required swift changes to program delivery, including pivoting from in-person to virtual delivery (i.e., Zoom). Our goal was to assess multilevel constituent perceptions of the use of a virtual platform to deliver UC DPP due to COVID-19 mandates.

Methods

We conducted qualitative interviews with 68 UC DPP participants, coordinators, and leaders to examine the use of virtual platform delivery on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of UC DPP. Transcripts were analyzed using rapid qualitative analysis and emergent themes were categorized using domains corresponding to RE-AIM framework.

Results

Among UC DPP participants (n = 42), virtual delivery primarily impacted perceptions of UC DPP effectiveness and implementation. Some participants perceived program effectiveness to be negatively impacted, given their preference for in-person sessions, which they felt provided more engagement, peer support, and accountability. Implementation challenges included problems with virtual format (e.g., "Zoom fatigue"); however, several benefits were also noted (e.g., increased flexibility, maintenance of DPP connections during campus closures). UC DPP coordinators (n = 18) perceived virtual delivery as positively impacting UC DPP reach, since virtual platforms provided access for some who could not participate in-person, and negatively impacting effectiveness due to reduced engagement and lower peer support. UC leaders (n = 8) perceived that use of the virtual format had a positive impact on reach (e.g., increased availability, accessibility) and negatively impacted effectiveness (e.g., less intensive interactions on a virtual platform). Across constituent levels, the use of a virtual platform had little to no impact on perceptions of adoption and maintenance of UC DPP.

Conclusion

Perceptions of the reach, effectiveness, and implementation of UC DPP using a virtual platform varied across constituents, although all groups noted a potential negative impact on overall program effectiveness. Unanticipated program adaptations, including virtual delivery, present potential benefits as well as perceived drawbacks, primarily across the effectiveness domain. Understanding differential constituent perceptions of the impact of virtual delivery can help maximize RE-AIM and inform future UC DPP delivery strategies.

Twelve-Month Reach and Effectiveness of a University-Based Diabetes Prevention Initiative

INTRODUCTION

The University of California (UC) implemented the Diabetes Prevention Program (DPP) to address diabetes and obesity risk. This project examined the reach and effectiveness of this university-based DPP delivery approach.

METHODS

This project compared 12-month weight change among three groups of UC beneficiaries with overweight/obesity: (1) those who received invitation letters and enrolled in UC DPP, (2) those mailed invitation letters but did not enroll, and (3) those who were not mailed letters and did not enroll (controls). Using 2012-2022 EHR, administrative and DPP cohort data, an interrupted time series was conducted in 2022-2023 to compare group differences in rate of weight change.

RESULTS

Among 6,231 beneficiaries (132 UC DPP aware enrollees, 1,750 DPP aware non-enrollees, 4,349 controls), UC DPP enrollees were older (mean age 49), mostly women (76%), and more diverse (33% Asian, 8% Black, 20% Hispanic, 4% Multi/Other). Over 12 months of follow-up, UC DPP enrollee postenrollment rate of weight loss was -0.68 lbs./month. UC DPP enrollees had significantly greater weight change from pre- to post-enrollment than DPP aware non-enrollees (adjusted Δ-1.02 vs. Δ-0.07 lbs./month, difference= -0.95, p<0.001). Weight change among all participants who received letters with/without DPP enrollment was similar to controls.

CONCLUSIONS

UC DPP reached a diverse group and was effective for weight loss at 12-month follow-up. However, UC DPP invitation letters to raise prediabetes and DPP awareness were not associated with significant weight change in the absence of DPP enrollment. University-based approaches to DPP delivery are effective and may enhance reach of DPP among at-risk adults.

Discrepancy in diagnoses of diabetes and prediabetes using fasting plasma glucose and glycosylated hemoglobin and the underdiagnosis by ICD-10 coding: data from a tertiary hospital in Thailand

Background

Early detection of prediabetes and diabetes better prevents long-term health complications. FPG and HbA1c levels are some common laboratory tests utilized as tools to diagnose diabetes and prediabetes, but the agreement rate between these two diagnostic tests varies, which could lead to underdiagnosis and thus undertreatment. This study aimed to analyze the agreement rate between FPG and HbA1c, as well as the physicians' accuracy of using these results to make a prediabetes or diabetes diagnosis through ICD-10 coding at a tertiary care hospital in Bangkok, Thailand.

Methods

A cross-sectional descriptive study was conducted using secondary data collected in a tertiary hospital's check-up clinic from August 16, 2019 to June 30, 2022 to study the prevalence and diagnosis of diabetes and prediabetes, determined through FPG and HbA1c laboratory results. We analyzed the two laboratory tests' diagnosis agreement rate and the physicians' accuracy of diagnosing diabetes and prediabetes in ICD-10 coding using the FPG and HbA1c results.

Results

Among 8,024 asymptomatic participants, the period prevalence diagnosed through laboratory results was 5.8% for diabetes and 19.8% for prediabetes. Diabetes and prediabetes prevalence based on laboratory data differs from that of ICD-10 coding data. Specifically, 79.6% of diabetes patients and 32.3% of prediabetes patients were coded using the ICD-10 coding system. 4,094 individuals had both FPG and HbA1c data. The agreement rate for diagnosing diabetes and prediabetes between the two laboratory results is 89.5%, with Kappa statistics of 0.58. Using only one of the two laboratory results would have missed a substantial number of patients.

Conclusion

Our findings highlight screening test discrepancies and underdiagnosis issues that impede diagnostic accuracy enhancement and refined patient management strategies. Early diagnoses of prediabetes and diabetes, especially before symptoms arise, could increase health consciousness in individuals, thereby enabling the implementation of lifestyle modifications and prevention of serious health complications. We emphasize the importance of diagnosing these conditions using both FPG and HbA1c, along with subsequent accurate ICD-10 coding. Even though some hospitals lack certified HbA1c testing, we suggest enhancing the availability of HbA1c testing, which could benefit many people in Thailand.Clinical trial registration:https://www.thaiclinicaltrials.org, identifier [TCTR20230824003].