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Wang J, Casimiro-Garcia A, Johnson BG, Duffen J, Cain M, Savary L, Wang S, Nambiar P, Lech M, Zhao S, Xi L, Zhan Y, Olson J, Stejskal JA, Lin H, Zhang B, Martinez RV, Masek-Hammerman K, Schlerman FJ, Dower K. A protein kinase C α and β inhibitor blunts hyperphagia to halt renal function decline and reduces adiposity in a rat model of obesity-driven type 2 diabetes. Sci Rep 2023; 13:16919. [PMID: 37805649 PMCID: PMC10560236 DOI: 10.1038/s41598-023-43759-7] [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: 12/28/2022] [Accepted: 09/28/2023] [Indexed: 10/09/2023] Open
Abstract
Type 2 diabetes (T2D) and its complications can have debilitating, sometimes fatal consequences for afflicted individuals. The disease can be difficult to control, and therapeutic strategies to prevent T2D-induced tissue and organ damage are needed. Here we describe the results of administering a potent and selective inhibitor of Protein Kinase C (PKC) family members PKCα and PKCβ, Cmpd 1, in the ZSF1 obese rat model of hyperphagia-induced, obesity-driven T2D. Although our initial intent was to evaluate the effect of PKCα/β inhibition on renal damage in this model setting, Cmpd 1 unexpectedly caused a marked reduction in the hyperphagic response of ZSF1 obese animals. This halted renal function decline but did so indirectly and indistinguishably from a pair feeding comparator group. However, above and beyond this food intake effect, Cmpd 1 lowered overall animal body weights, reduced liver vacuolation, and reduced inguinal adipose tissue (iWAT) mass, inflammation, and adipocyte size. Taken together, Cmpd 1 had strong effects on multiple disease parameters in this obesity-driven rodent model of T2D. Further evaluation for potential translation of PKCα/β inhibition to T2D and obesity in humans is warranted.
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Affiliation(s)
- Ju Wang
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA.
| | | | - Bryce G Johnson
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Jennifer Duffen
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Michael Cain
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Mediar Therapeutics, Boston, MA, USA
| | - Leigh Savary
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Instem Life Science Systems Ltd, Mount Ida College, South Hadley, MA, USA
| | - Stephen Wang
- Pharmacokinetics and Drug Metabolism, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Novartis Gene Therapies, Novartis Institute for Biomedical Research, Cambridge, MA, USA
| | - Prashant Nambiar
- Drug Safety Research and Development, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Strand Therapeutics, Cambridge, MA, USA
| | - Matthew Lech
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Shanrong Zhao
- Clinical Genetics and Bioinformatics, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Amunix Pharmaceuticals, San Francisco, CA, USA
| | - Li Xi
- Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Yutian Zhan
- Drug Safety Research and Development, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Jennifer Olson
- Drug Safety Research and Development, Pfizer Worldwide Research and Development, Groton, CT, USA
| | - James A Stejskal
- Drug Safety Research and Development, Pfizer Worldwide Research and Development, Groton, CT, USA
- Charles River Laboratories, Shrewsbury, MA, USA
| | - Hank Lin
- Drug Safety Research and Development, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Baohong Zhang
- Clinical Genetics and Bioinformatics, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Data Sciences, Biogen, Cambridge, MA, USA
| | - Robert V Martinez
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
- Center for Technological Innovation, Pfizer Worldwide Research and Development, San Francisco, CA, USA
| | | | - Franklin J Schlerman
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Ken Dower
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, MA, USA.
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Mora T, Roche D, Rodríguez-Sánchez B. Predicting the onset of diabetes-related complications after a diabetes diagnosis with machine learning algorithms. Diabetes Res Clin Pract 2023; 204:110910. [PMID: 37722566 DOI: 10.1016/j.diabres.2023.110910] [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: 04/12/2023] [Revised: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
AIMS Using machine learning algorithms and administrative data, we aimed to predict the risk of being diagnosed with several diabetes-related complications after one-, two- and three-year post-diabetes diagnosis. METHODS We used longitudinal data from administrative registers of 610,019 individuals in Catalonia with a diagnosis of diabetes and checked the presence of several complications after diabetes onset from 2013 to 2017: hypertension, renal failure, myocardial infarction, cardiovascular disease, retinopathy, congestive heart failure, cerebrovascular disease, peripheral vascular disease and stroke. Four different machine learning (ML) algorithms (logistic regression (LR), Decision tree (DT), Random Forest (RF), and Extreme Gradient Boosting (XGB)) will be used to assess their prediction performance and to evaluate the prediction accuracy of complications changes over the period considered. RESULTS 610,019 people with diabetes were included. After three years since diabetes diagnosis, the area under the curve values ranged from 60% (retinopathy) to 69% (congestive heart failure), whereas accuracy rates varied between 60% (retinopathy) to 75% (hypertension). RF was the most relevant technique for hypertension, myocardial and retinopathy, and LR for the rest of the comorbidities. The Shapley additive explanations values showed that age was associated with an elevated risk for all diabetes-related complications except retinopathy. Gender, other comorbidities, co-payment levels and age were the most relevant factors for comorbidity diagnosis prediction. CONCLUSIONS Our ML models allow for the identification of individuals newly diagnosed with diabetes who are at increased risk of developing diabetes-related complications. The prediction performance varied across complications but within acceptable ranges as prediction tools.
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Affiliation(s)
- Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Carrer de la Immaculada, 22, 08017 Barcelona, Spain
| | - David Roche
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Carrer de la Immaculada, 22, 08017 Barcelona, Spain
| | - Beatriz Rodríguez-Sánchez
- Applied Economics, Public Economics and Political Economy, Faculty of Law, Universidad Complutense de Madrid, Plaza Menéndez Pelayo, 4, 28040 Madrid, Spain.
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Lin Y, Jiang M. The Effect of Low-Dose Esketamine on Postoperative Neurocognitive Dysfunction in Elderly Patients Undergoing General Anesthesia for Gastrointestinal Tumors: A Randomized Controlled Trial [Letter]. Drug Des Devel Ther 2023; 17:2859-2860. [PMID: 37731480 PMCID: PMC10508585 DOI: 10.2147/dddt.s430847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Yongjian Lin
- Department of Gastrointestinal and Gland Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Mingyang Jiang
- Department of Orthopedics, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China
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Sit RW, Wang B, Ng WS, Abullah A, Isamail IZ, Goh LH, Wong SY. Prevalence and association of chronic musculoskeletal pain on self-management, glycemic control and quality of life among Chinese type 2 diabetes patients in primary care. Prim Care Diabetes 2022; 16:525-530. [PMID: 35487867 DOI: 10.1016/j.pcd.2022.04.004] [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: 01/11/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
AIMS To examine the prevalence of chronic musculoskeletal (MSK) pain and its association with diabetes self-management, glycemic control and health-related quality of life (HRQoL) in patients with diabetes mellitus (DM) in primary care. METHODS 329 patients with type 2 DM were recruited at public primary care clinics in Hong Kong. Chronic MSK pain was defined as having MSK pain ≥ 3 months, and the pain severity was measured by Brief Pain Inventory (BPI). Diabetes Management Self-Efficacy Scale (DMSES), hemoglobin A1c (HbA1c) and EuroQuol-5D (EQ5D) were collected. Multivariable regression was used to examine the association between the presence of chronic MSK pain with DMSES, HbA1c and EQ5D, adjusted for baseline confounders such as age, sex, BMI, duration of DM and comorbid depression. RESULTS Approximately 49.5% of respondents reported chronic MSK pain with a median BPI severity score of 3.5 (2.0-5.0). The presence of chronic MSK pain was associated with lower HRQoL (β = -0.053, 95% CI -0.087 to -0.018, P = 0.003), but was not associated with the diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management (β = -2.776, 95% CI -4.247 to -1.304, P < 0.001) and HRQoL.( β = -0.018,95% CI-0.025 to -0.012, P < 0.001). CONCLUSIONS Chronic MSK pain was present in nearly half of the diabetic patients in primary care; however, the degree of pain was mild and had not shown to affect diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management. Chronic MSK pain and depression were both associated with poorer HRQoL.
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Affiliation(s)
- Regina Ws Sit
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong.
| | - Bo Wang
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong
| | - Wing-Sze Ng
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong
| | - Adina Abullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Irmi Zb Isamail
- Department of Family Medicine, Universiti Putra Malaysia, Malaysia
| | - Lay-Hoon Goh
- Department of Family Medicine, National University Health System, Singapore
| | - Samuel Ys Wong
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong
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Comer-HaGans D, Austin S, Ramamonjiarivelo Z, Sherman LD. Preventative diabetes self-care management practices among individuals with diabetes and mental health stress. J Affect Disord 2022; 298:24-34. [PMID: 34780862 DOI: 10.1016/j.jad.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/09/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress. METHODS Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors. RESULTS Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior. LIMITATIONS Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional. CONCLUSIONS Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.
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Affiliation(s)
- DeLawnia Comer-HaGans
- Governors State University, Health Administration, 1 University Parkway, University Park, IL 60484-0975, United States.
| | - Shamly Austin
- Gateway Health, Four Gateway Center, Research Development and Analytics, 444 Liberty Avenue -1222, Pittsburgh, PA 15222, United States.
| | - Zo Ramamonjiarivelo
- Texas State University, School of Health Administration, University Drive, Encino Hall, Suite 250, Office 254, 601, San Marcos, TX 78666, United States.
| | - Ledric D Sherman
- Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX 77843, United States.
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Khadilkar A, Oza C. Glycaemic Control in Youth and Young Adults: Challenges and Solutions. Diabetes Metab Syndr Obes 2022; 15:121-129. [PMID: 35046683 PMCID: PMC8759988 DOI: 10.2147/dmso.s304347] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 04/20/2023] Open
Abstract
Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care team. The increasing prevalence of T1D in the adolescent age group and deteriorating glycaemic control from childhood to adolescence and youth, as well as the secular trend of worsening glycaemic control in youth and young adults with T1D, are a matter of real concern. Lack of monitoring, insufficient self-control, psychosocial factors, lack of family support and parental supervision, inadequate adherence to treatment, pubertal increase in insulin resistance and incompetent transition from paediatric to adult care are likely causes of deteriorating glycaemic control in youth. Efforts to improve insulin sensitivity by using pharmacological agents such as metformin are insufficient in resolving this problem. Interventions such as structured intervention, motivational interviews, development of youth friendly services and organization of diabetes camps for peer support can improve adherence in these individuals. Innovative technologies such as continuous subcutaneous insulin infusion and continuous glucose monitoring, comprehensive multidisciplinary teams with effective communication, parental support and supervision with planned transition from paediatric to adult care will not only reduce the risk of micro- and macrovascular complications in young adults with T1D but will also cause significant improvement in their quality of life.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
- Correspondence: Anuradha Khadilkar Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, 411001, IndiaTel +91 206057004 Email
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
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Kahkoska AR, Dabelea D. Diabetes in Youth: A Global Perspective. Endocrinol Metab Clin North Am 2021; 50:491-512. [PMID: 34399958 PMCID: PMC8374087 DOI: 10.1016/j.ecl.2021.05.007] [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: 01/09/2023]
Abstract
Diabetes is a common disease among pediatric populations in the United States and worldwide. The incidence of type 1 and type 2 diabetes is increasing, with disproportional increases in racial/ethnic subpopulations. As the prevalence of obesity continue to increase, type 2 diabetes now represents a major form of pediatric diabetes. The management of diabetes in youth centers on maintaining glycemic control to prevent acute and chronic complications. This article summarizes the epidemiology, etiology, management, and complications of type 1 and type 2 diabetes in youth, as well as future directions and opportunities.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall 2205A, Chapel Hill, NC 27599, USA.
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 East 17th Avenue, Box B119, Room W3110, Aurora, CO 80045, USA
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Verma AK, Goyal Y, Bhatt D, Dev K, Alsahli MA, Rahmani AH, Almatroudi A. A Compendium of Perspectives on Diabetes: A Challenge for Sustainable Health in the Modern Era. Diabetes Metab Syndr Obes 2021; 14:2775-2787. [PMID: 34168477 PMCID: PMC8216699 DOI: 10.2147/dmso.s304751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a chronic illness. Hyperglycemia is the characteristic of this disorder. Diabetes is a global crisis which affects the economy and health of all nations. Over the last decades, the number of individuals living with diabetes has significantly increased worldwide. Asia is a key epicenter of the emerging diabetes epidemic, with China and India the two nations having the highest number of diabetic people. Economic development, modernization, unhealthy diet, population aging, and sedentary lifestyles are the major factors responsible for the increasing diabetes epidemic. Diabetes is associated with several complications, and cardiovascular disease is the most important cause of morbidity and mortality among people with diabetes. These life-threatening problems can be prevented or delayed by proper management of diabetes. Lifestyle modification is an important factor to decrease the diabetes risk. The frequency of diabetic complications will rise if there is a lack of cost-effective and sustainable interventions. Hence, prevention of diabetes and its complications such as diabetic retinopathy and cardiovascular disease should be a crucial part of all future health-related public policies among all nations. This review summarizes current epidemiological aspects of diabetes in the world along with its complications, preventive measures, and treatment.
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Affiliation(s)
- Amit K Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Yamini Goyal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Deepti Bhatt
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Mohammed A Alsahli
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
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Heisler M, Kullgren J, Richardson C, Stoll S, Alvarado Nieves C, Wiley D, Sedgwick T, Adams A, Hedderson M, Kim E, Rao M, Schmittdiel JA. Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART). Contemp Clin Trials 2020; 95:106048. [PMID: 32497783 PMCID: PMC8059966 DOI: 10.1016/j.cct.2020.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). METHODS In this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. RESULTS At least 296 participants and approximately 75 peer supporters will be enrolled. DISCUSSION Despite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03689530.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
| | - Jeffrey Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America.
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Cristina Alvarado Nieves
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology and Diabetes, United States of America.
| | - Deanne Wiley
- Kaiser Permanente Northern California, United States of America.
| | - Tali Sedgwick
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Alyce Adams
- Kaiser Permanente Northern California, United States of America.
| | | | - Eileen Kim
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Megan Rao
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Julie A Schmittdiel
- Kaiser Permanente Northern California Division of Research, United States of America.
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Campbell MD, Sathish T, Zimmet PZ, Thankappan KR, Oldenburg B, Owens DR, Shaw JE, Tapp RJ. Benefit of lifestyle-based T2DM prevention is influenced by prediabetes phenotype. Nat Rev Endocrinol 2020; 16:395-400. [PMID: 32060416 DOI: 10.1038/s41574-019-0316-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2019] [Indexed: 01/11/2023]
Abstract
The prevention of type 2 diabetes mellitus (T2DM) is a target priority for the WHO and the United Nations and is a key priority in the 2018 Berlin Declaration, which is a global call for early actions related to T2DM. Health-care policies advocate that individuals at high risk of developing T2DM undertake lifestyle modification, irrespective of whether the prediabetes phenotype is defined by hyperglycaemia in the postprandial state (impaired glucose tolerance) and/or fasting state (impaired fasting glucose) or by intermediate HbA1c levels. However, current evidence indicates that diabetes prevention programmes based on lifestyle change have not been successful in preventing T2DM in individuals with isolated impaired fasting glucose. We propose that further research is needed to identify effective lifestyle interventions for individuals with isolated impaired fasting glucose. Furthermore, we call for the identification of innovative approaches that better identify people with impaired glucose tolerance, who benefit from the currently available lifestyle-based diabetes prevention programmes.
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Affiliation(s)
- Matthew D Campbell
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- School of Food Science and Bioengineering, Zhejiang Gongshang University, Hangzhou, China
| | - Thirunavukkarasu Sathish
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Paul Z Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, Australia
| | | | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - David R Owens
- Diabetes Research Unit Cymru, Swansea University, Swansea, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robyn J Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
- Population Health Research Institute, St George's, University of London, London, UK.
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Myneni S, Lewis B, Singh T, Paiva K, Kim SM, Cebula AV, Villanueva G, Wang J. Diabetes Self-Management in the Age of Social Media: Large-Scale Analysis of Peer Interactions Using Semiautomated Methods. JMIR Med Inform 2020; 8:e18441. [PMID: 32602843 PMCID: PMC7367515 DOI: 10.2196/18441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/14/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Online communities have been gaining popularity as support venues for chronic disease management. User engagement, information exposure, and social influence mechanisms can play a significant role in the utility of these platforms. OBJECTIVE In this paper, we characterize peer interactions in an online community for chronic disease management. Our objective is to identify key communications and study their prevalence in online social interactions. METHODS The American Diabetes Association Online community is an online social network for diabetes self-management. We analyzed 80,481 randomly selected deidentified peer-to-peer messages from 1212 members, posted between June 1, 2012, and May 30, 2019. Our mixed methods approach comprised qualitative coding and automated text analysis to identify, visualize, and analyze content-specific communication patterns underlying diabetes self-management. RESULTS Qualitative analysis revealed that "social support" was the most prevalent theme (84.9%), followed by "readiness to change" (18.8%), "teachable moments" (14.7%), "pharmacotherapy" (13.7%), and "progress" (13.3%). The support vector machine classifier resulted in reasonable accuracy with a recall of 0.76 and precision 0.78 and allowed us to extend our thematic codes to the entire data set. CONCLUSIONS Modeling health-related communication through high throughput methods can enable the identification of specific content related to sustainable chronic disease management, which facilitates targeted health promotion.
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Affiliation(s)
- Sahiti Myneni
- University of Texas School of Biomedical Informatics at Houston, Houston, TX, United States
| | - Brittney Lewis
- Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Tavleen Singh
- University of Texas School of Biomedical Informatics at Houston, Houston, TX, United States
| | - Kristi Paiva
- Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Seon Min Kim
- Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Adrian V Cebula
- Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Gloria Villanueva
- Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Lam WMJ, Al-Khalifah R, Florez ID, Cruz-Lopes L, Sekercioglu MF, Couban R, Fu R, Cherney DZI, Sekercioglu N. Management of type 2 diabetes using non-insulin glucose-lowering therapies: a critical appraisal of clinical practice guidelines with the AGREE II instrument. Diabet Med 2020; 37:636-647. [PMID: 31943344 DOI: 10.1111/dme.14231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/31/2022]
Abstract
AIM Type 2 diabetes is a major global epidemic affecting over 400 million people worldwide. The objective of this systematic review was to provide an overview of recommendations from clinical practice guidelines (guidelines) addressing non-insulin based pharmacological management of among non-pregnant adults in an outpatient setting, and critically appraise their methodological development. METHODS We systematically searched MEDLINE and Embase databases, for relevant guidelines using the Ovid interface. We scanned the bibliographies of all eligible guidelines for additional relevant citations. Teams of two reviewers, independently and in duplicate, screened titles and abstracts and potentially eligible full text reports to determine eligibility and appraised the reporting quality of guidelines using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE II) instrument. RESULTS Our search yielded 11264 unique citations, of which 124 were retrieved for full-text review; 17 guidelines proved eligible. The highest scoring AGREE domain was 'clarity of presentation' (66%; range 7-92%), followed by 'scope and purpose' (58%; range 25-92%), 'editorial independence' (55%; range 0-91%), 'stakeholder involvement' (45%; range 11-90%) and 'rigour of development' (43%; range 4-92%). The poorest domain was 'applicability' (37%; range 6-84%). The guidelines authored by the World Health Organization group achieved the highest AGREE overall score. CONCLUSIONS Most of the guidelines provided recommendations with a local jurisdictional focus and showed significant variation in the quality. Nevertheless, only a small number of those scored well overall.
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Affiliation(s)
- W M J Lam
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Al-Khalifah
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - I D Florez
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, Universidad de Antioquia, Colombia
| | - L Cruz-Lopes
- Universidade de Sorocaba - UNISO, Sorocaba, Brazil
| | - M F Sekercioglu
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - R Couban
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - R Fu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
| | - D Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology and Banting and Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
| | - N Sekercioglu
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Comer-HaGans D, Austin S, Ramamonjiarivelo Z, Matthews AK. Diabetes Standard of Care Among Individuals Who Have Diabetes With and Without Cognitive Limitation Disabilities. DIABETES EDUCATOR 2019; 46:94-107. [DOI: 10.1177/0145721719896262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs. Methods We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors. Results Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs. Conclusions Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.
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Affiliation(s)
| | - Shamly Austin
- Gateway Health, Research & Development, Quality Improvement Department, Pittsburgh, Pennsylvania
| | - Zo Ramamonjiarivelo
- Texas State University, School of Health Administration, Encino Hall, San Marcos, Texas
| | - Alicia K. Matthews
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois
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14
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Abreu M, Tumyan A, Elhassan A, Peicher K, Papacostea O, Dimachkie P, Siddiqui MS, Pop LM, Gunasekaran U, Meneghini LF, Adams-Huet B, Li X, Lingvay I. A randomized trial comparing the efficacy and safety of treating patients with type 2 diabetes and highly elevated HbA1c levels with basal-bolus insulin or a glucagon-like peptide-1 receptor agonist plus basal insulin: The SIMPLE study. Diabetes Obes Metab 2019; 21:2133-2141. [PMID: 31144435 DOI: 10.1111/dom.13794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 01/18/2023]
Abstract
AIM To compare the efficacy and safety of a glucagon-like peptide-1 receptor agonist (GLP1RA) plus basal insulin versus basal-bolus insulin treatment in patients with very uncontrolled type 2 diabetes. MATERIALS AND METHODS The SIMPLE study was a 6-month pragmatic, randomized, open-label trial testing the effectiveness of two approaches to treat patients with type 2 diabetes and HbA1c ≥10%. We randomized patients to detemir plus liraglutide or detemir plus aspart (before each meal). The primary endpoint was change in HbA1c; changes in body weight, insulin dose, hypoglycaemia and diabetes-related quality-of-life were secondary outcomes. RESULTS We randomized 120 participants aged 47.4 ± 9.5 years, Hispanic 40%, African American 42%, diabetes duration 10 [25th-75th percentile (6 to 15)] years, body mass index 37.2 ± 10.3 kg/m2 . HbA1c decreased more with GLP1RA plus basal insulin [12.2% (95% CI 11.8% to 12.6%) to 8.1% (95% CI 7.4% to 8.7%)] compared with basal-bolus insulin [11.8% (95% CI 11.5% to 12.2%) to 8.8% (95% CI 88.1% to 9.55%)]; estimated treatment difference (ETD) of -1.1% (95% CI -2.0% to -0.1%) (non-inferiority margin 0.4% and P = .0001, superiority P = .026). Compared with basal-bolus insulin, treatment with GLP1RA plus basal insulin led to a body weight ETD of -3.7 kg (95% CI -5.8 to -1.5; P = .001), fewer patients experiencing hypoglycaemia [66.1% vs 35.2% (P = .002)], and greater improvements in general/current health perception, treatment satisfaction, and fear of hypoglycaemia, while taking a lower total daily dose of insulin [estimated treatment ratio 0.68 (95% CI 0.55 to 0.84)]. CONCLUSIONS In patients with HbA1c ≥10% treatment with GLP1RA plus basal insulin, compared with basal-bolus insulin, resulted in better glycaemic control and body weight, lower insulin dosage and hypoglycaemia, and improved quality of life. This treatment strategy is an effective and safe alternative to a basal-bolus insulin regimen.
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Affiliation(s)
- Marconi Abreu
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Anna Tumyan
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Ahmed Elhassan
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Katherine Peicher
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Miami Beach Community Health Center, Miami, Florida
| | - Olivia Papacostea
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Veterans Affairs Loma Linda Healthcare System, Loma Linda, California
| | - Perihan Dimachkie
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Integris Endocrinology South, Oklahoma City, Oklahoma
| | - Muhammad S Siddiqui
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Texas Associates of Endocrinology & Diabetes P.A, McKinney, Texas
| | - Laurentiu M Pop
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Uma Gunasekaran
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Parkland Health and Hospital System, Dallas, Texas
| | - Luigi F Meneghini
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Parkland Health and Hospital System, Dallas, Texas
| | - Beverley Adams-Huet
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Xilong Li
- Department of Clinical Sciences, UT Southwestern Medical Center at Dallas, Dallas, Texas
| | - Ildiko Lingvay
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center at Dallas, Dallas, Texas
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Pirkle CM, Vu ND, Ilagan LSK, Cacal SL, Stupplebeen DA, Nett B. Greater Community-Clinical Linkages and Attention to Patient Life Stage: Recommendations to Improve Diabetes Self-Management Education in Hawai'i. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:70-77. [PMID: 31285974 PMCID: PMC6603883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients with diabetes regularly carry out multiple disease-management behaviors-taking prescribed medications, following diet and exercise regimens, self-monitoring their blood glucose concentrations, and coping emotionally with the condition-that may require ongoing support from community and clinical resources. Diabetes self-management education (DSME) is an ongoing, patient-centered process that helps provide the knowledge, skills, and ability for self-care. Evidence suggests that DSME is most effective when reinforced by community resources, through what are called community-clinical resources. We conducted a series of qualitative key-informant interviews with DSME coordinators/managers from all counties in Hawai'i to document the landscape of DSME services in the state, focusing specifically on challenges and recommendations. We analysed the results using the socioecological model in order to chart these factors by levels of influence on health care providers, in terms of service provision, and on patients, in terms of DSME utilization. Many interviewees highlighted concerns about low utilization of DSME services, as well as practical implementation challenges (eg, group versus 1-on-1 sessions). Nonetheless, DSME coordinators/managers offered numerous recommendations to improve DSME across Hawai'i, highlighting opportunities for improved community-clinical linkages. Finally, emergent from the interviews were anxieties about increasing numbers of youth with diabetes and insufficient resources for them in DSME or other community-clinical resources. This paper offers suggestions to expand community-clinical linkages and to adapt services provided by DSME to meet patient and community needs. It is particularly timely as Hawai'i is rapidly increasing the number and diversity of DSME programs available.
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Affiliation(s)
- Catherine M Pirkle
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (CMP, NDV, SLC, DAS)
| | - Ngoc D Vu
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (CMP, NDV, SLC, DAS)
| | - Lindsey SK Ilagan
- Chronic Disease Prevention and Health Promotion Division, Hawai‘i State Department of Health, Honolulu, HI (LSKI, BN)
| | - Stephanie L Cacal
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (CMP, NDV, SLC, DAS)
| | - David A Stupplebeen
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (CMP, NDV, SLC, DAS)
| | - Blythe Nett
- Chronic Disease Prevention and Health Promotion Division, Hawai‘i State Department of Health, Honolulu, HI (LSKI, BN)
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Attaran S, Yokoyama W, Pan J, Berrios JDJ. Influence of extruded lentil containing high chromium nutritional yeast on the main physiological factors associated with metabolic syndrome in rodent models. Food Funct 2018; 9:5238-5244. [PMID: 30207351 DOI: 10.1039/c8fo00612a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Insulin resistance, obesity and dyslipidemia are the main physiological factors associated with metabolic syndrome. The objectives of this study were to understand the effects of diets containing extruded lentil fortified with high chromium nutritional yeast (YCr) or chromium picolinate on glucose tolerance, clearance and fasting blood glucose concentrations in Normal and Obese (Ob/Ob) mice and to determine the effects of the diets on the mice plasma lipid profiles. Diets A, B and C contained YCr in different doses and concentrations, as follows: Diet A = 15.7 g and 16 ppm, B = 157.1 g and 16 ppm, and C = 299.3 g and 27 ppm, respectively. Diet D contained chromium picolinate at a dose and concentration of 15.7 g and 16 ppm, respectively. Intraperitoneal glucose tolerance tests and intraperitoneal insulin tolerance tests were conducted at 4-weeks and 8-weeks post diet initiation, in addition to, plasma lipoprotein profiles and organ weights. Normal mice showed only slight variability with respect to the studied biological parameters compared to the Ob/Ob mice group. Results indicated that following 4-weeks of diet supplementation, Ob/Ob mice fed diets A, C and D had significantly (p < 0.05) lower fasting blood glucose (FBG) than Ob/Ob mice fed Diet B. However, after 8-weeks Ob/Ob mice fed Diet C, containing YCr, had a significantly (p < 0.05) lower FBG than mice supplemented with Diet D, containing chromium picolinate. Therefore, based on these findings, it was concluded that YCr at the highest concentration and dose was more effective than chromium picolinate. These results indicate that ready-to-eat snacks and breakfast cereal type products supplemented with chromium in the form of YCr could be used as vehicles for the amelioration of main physiological factors associated with metabolic syndrome.
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Affiliation(s)
- Shireen Attaran
- U.S. Department of Agriculture, Agricultural Research Service, Western Regional Research Center, 800 Buchanan Street, Albany, California 94710, USA.
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17
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Kaur P, Sharma AK, Nag D, Das A, Datta S, Ganguli A, Goel V, Rajput S, Chakrabarti G, Basu B, Choudhury D. Novel nano-insulin formulation modulates cytokine secretion and remodeling to accelerate diabetic wound healing. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 15:47-57. [PMID: 30213518 DOI: 10.1016/j.nano.2018.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022]
Abstract
Little is known about insulin's wound healing capability in normal as well as diabetic conditions. We here report specific interaction of silver nanoparticles (AgNPs) with insulin by making a ~2 nm thick coat around the AgNPs and its potent wound healing efficacy. Characterization of the interaction of human insulin with silver nanoparticles showed confirmed alteration of amide-I in insulin whereas amide-II and III remained unaltered. Further, nanoparticles protein interaction kinetics showed spontaneous interaction at physiological temperature with ΔG, ΔS, Ea and Ka values -7.48, 0.076, 3.84 kcal mol-1 and 6 × 105 s-1 respectively. Insulin loaded AgNPs (IAgNPs) showed significant improvement in healing activity in vitro (HEKa cells) and in vivo (Wister Rats) in comparison with the control in both normal and diabetic conditions. The underlying mechanism was attributed to a regulation of the balance between pro (IL-6, TNFα) and anti-inflammatory cytokines (IL-10) at the wound site to promote faster wound remodeling.
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Affiliation(s)
- Pawandeep Kaur
- School of Chemistry and Biochemistry, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | | | - Debasish Nag
- Department of Biotechnology, University of Calcutta, Kolkata, West Bengal, India
| | - Amlan Das
- Department of Biotechnology, National Institute of Technology Sikkim, Sikkim, India
| | - Satabdi Datta
- Department of Biotechnology, University of Calcutta, Kolkata, West Bengal, India
| | - Arnab Ganguli
- Department of Biotechnology, University of Calcutta, Kolkata, West Bengal, India; Department of Microbiology, Techno India University, Kolkata, West Bengal, India
| | - Vanshita Goel
- School of Chemistry and Biochemistry, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | | | - Gopal Chakrabarti
- Department of Biotechnology, University of Calcutta, Kolkata, West Bengal, India
| | - Biswarup Basu
- Amity Institute of Biotechnology, Amity University, Noida, India.
| | - Diptiman Choudhury
- School of Chemistry and Biochemistry, Thapar Institute of Engineering and Technology, Patiala, Punjab, India.
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Liu L, Zhang SW, Lu J, Pang XY, Lv JP. Antidiabetic Effect of High-Chromium Yeast Against Type 2 Diabetic KK-Ay Mice. J Food Sci 2018; 83:1956-1963. [PMID: 29969524 DOI: 10.1111/1750-3841.14138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/07/2018] [Accepted: 03/04/2018] [Indexed: 11/28/2022]
Abstract
High chromium yeast has attracted many researchers for its high efficiency and high safety among chromium supplements. The preventive effect of oral high-chromium yeast on diabetes was assessed using KK-AY mice. Sixteen-wk-old type 2 diabetic KK-AY mice were divided into five groups and orally administered with two types of drying processed high-chromium yeast, chromium picolinate at 1000 μg Cr/kg/d, metformin (positive control), and normal yeast (negative control) for 13 weeks. The spray-dried high-chromium yeast significantly delayed the onset of hyperglycemia in type 2 diabetic KK-AY mice (P < 0.05) and significantly improved fasting blood glucose, TG(triglyceride), and TCHO(total cholesterol) . Histopathological analysis showed that the spray-dried high-chromium yeast led to high affinities for the stains to the β-cells in the islets of Langerhans and alleviated hepatic steatosis. High-chromium yeast could be a potential candidate for nutritional supplement to ameliorate diabetes. PRACTICAL APPLICATION Chromium plays an important role in fat and carbohydrate metabolism. The result show that spray-dried high chromium yeast significantly delayed the onset of hyperglycemia in type 2 diabetic KK-AY mice. As one of chromium supplements, the purpose of this study is to examine the efficacy of high chromium yeast on the type 2 diabetes and drying method on its bioactivity, which will be useful for research and development of high-chromium yeast and improvement of pharmacological activity-based quality control.
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Affiliation(s)
- Lu Liu
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Science/Key Laboratory of Agro-Food Processing and Quality Control, Ministry of Agriculture, Beijing 100193, China
| | - Shu-Wen Zhang
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Science/Key Laboratory of Agro-Food Processing and Quality Control, Ministry of Agriculture, Beijing 100193, China
| | - Jing Lu
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Science/Key Laboratory of Agro-Food Processing and Quality Control, Ministry of Agriculture, Beijing 100193, China
| | - Xiao-Yang Pang
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Science/Key Laboratory of Agro-Food Processing and Quality Control, Ministry of Agriculture, Beijing 100193, China
| | - Jia-Ping Lv
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Science/Key Laboratory of Agro-Food Processing and Quality Control, Ministry of Agriculture, Beijing 100193, China
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Demmler KM, Klasen S, Nzuma JM, Qaim M. Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya. PLoS One 2017; 12:e0185148. [PMID: 28934333 PMCID: PMC5608323 DOI: 10.1371/journal.pone.0185148] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people's health have not been analyzed up till now. OBJECTIVE This study investigates the effects of purchasing food in supermarkets on people's BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome. DESIGN This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality. RESULTS Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed. CONCLUSIONS Supermarkets and their food sales strategies seem to have direct effects on people's health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people's food choices.
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Affiliation(s)
- Kathrin M. Demmler
- Department of Agricultural Economics and Rural Development, University of Goettingen, Goettingen, Germany
| | - Stephan Klasen
- Department of Economics, University of Goettingen, Goettingen, Germany
| | - Jonathan M. Nzuma
- Department of Agricultural Economics, University of Nairobi, Nairobi, Kenya
| | - Matin Qaim
- Department of Agricultural Economics and Rural Development, University of Goettingen, Goettingen, Germany
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Dower K, Zhao S, Schlerman FJ, Savary L, Campanholle G, Johnson BG, Xi L, Nguyen V, Zhan Y, Lech MP, Wang J, Nie Q, Karsdal MA, Genovese F, Boucher G, Brown TP, Zhang B, Homer BL, Martinez RV. High resolution molecular and histological analysis of renal disease progression in ZSF1 fa/faCP rats, a model of type 2 diabetic nephropathy. PLoS One 2017; 12:e0181861. [PMID: 28746409 PMCID: PMC5529026 DOI: 10.1371/journal.pone.0181861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023] Open
Abstract
ZSF1 rats exhibit spontaneous nephropathy secondary to obesity, hypertension, and diabetes, and have gained interest as a model system with potentially high translational value to progressive human disease. To thoroughly characterize this model, and to better understand how closely it recapitulates human disease, we performed a high resolution longitudinal analysis of renal disease progression in ZSF1 rats spanning from early disease to end stage renal disease. Analyses included metabolic endpoints, renal histology and ultrastructure, evaluation of a urinary biomarker of fibrosis, and transcriptome analysis of glomerular-enriched tissue over the course of disease. Our findings support the translational value of the ZSF1 rat model, and are provided here to assist researchers in the determination of the model’s suitability for testing a particular mechanism of interest, the design of therapeutic intervention studies, and the identification of new targets and biomarkers for type 2 diabetic nephropathy.
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Affiliation(s)
- Ken Dower
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
- * E-mail: (KD); (RVM)
| | - Shanrong Zhao
- Clinical Bioinformatics, Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Franklin J. Schlerman
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Leigh Savary
- Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America
| | - Gabriela Campanholle
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Bryce G. Johnson
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Li Xi
- Clinical Bioinformatics, Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Vuong Nguyen
- Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America
| | - Yutian Zhan
- Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America
| | - Matthew P. Lech
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Ju Wang
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Qing Nie
- Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America
| | | | | | - Germaine Boucher
- Drug Safety, Pfizer Worldwide Research and Development, Groton, Connecticut, United States of America
| | - Thomas P. Brown
- Drug Safety, Pfizer Worldwide Research and Development, Groton, Connecticut, United States of America
| | - Baohong Zhang
- Clinical Bioinformatics, Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
| | - Bruce L. Homer
- Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America
| | - Robert V. Martinez
- Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America
- * E-mail: (KD); (RVM)
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Fujiati II, Damanik HA, Bachtiar A, Nurdin AA, Ward P. Development and validation of prediabetes risk score for predicting prediabetes among Indonesian adults in primary care: Cross-sectional diagnostic study. Interv Med Appl Sci 2017. [DOI: 10.1556/1646.9.2017.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Isti Ilmiati Fujiati
- Department of Public Health, Preventive and Community Medicine, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Harun Alrasyid Damanik
- Department of Nutrition, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Adang Bachtiar
- Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Andi Armyn Nurdin
- Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Paul Ward
- Department of Public Health, School of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
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Fujiati II, Damanik HA, Bachtiar A, Nurdin AA, Ward P. Development and validation of prediabetes risk score for predicting prediabetes among Indonesian adults in primary care: Cross-sectional diagnostic study. Interv Med Appl Sci 2017; 9:76-85. [PMID: 28932501 PMCID: PMC5598131 DOI: 10.1556/1646.9.2017.2.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/13/2017] [Accepted: 05/05/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To develop and validate a risk score model for recognizing prediabetes among Indonesian adults in primary care. METHODS This was a cross-sectional diagnostic study. After excluding subjects with diabetes from Indonesian National Basic Health Survey (INBHS) data set, 21,720 subjects who have completed fasting plasma glucose test and aged >18 years were selected for development stage. About 6,933 subjects were selected randomly from INBHS for validation stage in different diagnostic criteria of prediabetes-based random plasma glucose. Logistic regression was used to determine significant diagnostic variable and the receiver operating characteristic analysis was used to calculate area under the curve (AUC), cutoff point, sensitivity, specificity, and predictive values. RESULTS Age, sex, education level, family history of diabetes, smoking habit, physical activity, body mass index, and hypertension were significant variables for Indonesian Prediabetes Risk Score (INA-PRISC). The scoring range from 0 to 24, the AUC was 0.623 (95% CI 0.616-0.631) and cutoff point of 12 yielded sensitivity/specificity (50.03%/67.19%, respectively). The validation study showed the AUC was 0.646 (95% CI 0.623-0.669) and cutoff point of 12 yielded sensitivity/specificity (55.11%/65.81%, respectively). CONCLUSION INA-PRISC, which consists of eight demographical and clinical variables, is a valid and a simple prediabetes risk score in primary care.
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Affiliation(s)
- Isti Ilmiati Fujiati
- Department of Public Health, Preventive and Community Medicine, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Harun Alrasyid Damanik
- Department of Nutrition, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Adang Bachtiar
- Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Andi Armyn Nurdin
- Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Paul Ward
- Department of Public Health, School of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
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Neuman JC, Fenske RJ, Kimple ME. Dietary polyunsaturated fatty acids and their metabolites: Implications for diabetes pathophysiology, prevention, and treatment. NUTRITION AND HEALTHY AGING 2017; 4:127-140. [PMID: 28447067 PMCID: PMC5391679 DOI: 10.3233/nha-160004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- Joshua C. Neuman
- Interdisciplinary Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Rachel J. Fenske
- Interdisciplinary Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Michelle E. Kimple
- Interdisciplinary Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, Division of Endocrinology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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Abstract
The number of people with diabetes is expected to rise to over 592 million by the year 2035. Past work provides evidence that the conventional method of primary care delivery may not meet many patients' needs. An alternative to the conventional one-on-one appointment is care offered to a group of patients through group medical visits (GMVs). Group medical visits for diabetes have a positive impact on physiologic and self-care outcomes including improved HbA1c, blood pressure control and self-management skills. Less work has examined the impacts of GMVs on systems of care; however, evidence suggests improved primary and secondary prevention strategies and the potential for GMVs to decrease emergency room visits and hospitalizations. Additional work is needed to examine the effect of GMVs on patient reported quality of life, functional health status and cost-savings. Further work is also needed on which patients GMVs work best for and patient barriers to attending GMVs.
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Affiliation(s)
- Laura M Housden
- University of British Columbia School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Sørensen M, Arneberg F, Line TM, Berg TJ. Cost of diabetes in Norway 2011. Diabetes Res Clin Pract 2016; 122:124-132. [PMID: 27837695 DOI: 10.1016/j.diabres.2016.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 11/27/2022]
Abstract
AIMS To quantify the excess cost of diabetes in Norway in 2011. METHODS A national cross-sectional cost-of-illness analysis of direct and indirect diabetes-related healthcare costs, based on pseudonymised data from six public national registers, international studies, and clinical expertise. Direct medical costs are estimated from primary and secondary health care registers and the national prescription database. Indirect costs include social and productivity costs. RESULTS The total excess cost of diabetes in Norway in 2011 was €516 million. Direct costs amounted to €408 million and indirect costs amounted to €108 million. Scenario analysis proposes an upper boundary of total cost at €575 million, direct costs at €428 million and indirect costs at €161 million. Expenditure on blood glucose lowering agents was €71 million and expenditure on blood glucose monitoring strips was €55 million. Blood glucose lowering agents-, lipid lowering agents, and antihypertensives represented 28% of the direct costs. Loss of productivity (€0.9 million) scored highest among the indirect costs. CONCLUSIONS The cost implications of diabetes in Norway in 2011 were high and comparable to previous studies in Scandinavia. Prevention of complications contributed to a higher cost than treating diabetes-related complications. The more than five-fold higher expenditure in other countries might be due to differences in budget priorities, efficacy of healthcare, indirect healthcare cost applications, or research methodology.
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Affiliation(s)
- M Sørensen
- Dept. of Minority Health and Rehabilitation, Division of Primary Healthcare, Norwegian Directorate of Health, Oslo, Norway.
| | - F Arneberg
- Division of Financing and Health Economics, Norwegian Directorate of Health, Oslo, Norway
| | - T M Line
- Division of Financing and Health Economics, Norwegian Directorate of Health, Oslo, Norway
| | - T J Berg
- Dept. of Minority Health and Rehabilitation, Division of Primary Healthcare, Norwegian Directorate of Health, Oslo, Norway; Dept. of Endocrinology, Oslo University Hospital, Aker, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Mhatre SK, Serna O, Sansgiry S, Fleming ML, Essien EJ, Sansgiry SS. Risk of Nondherence to Diabetes Medications Among Medicare Advantage Enrollees: Development of a Validated Risk Prediction Tool. J Manag Care Spec Pharm 2016; 22:1293-1301. [PMID: 27783546 PMCID: PMC10397788 DOI: 10.18553/jmcp.2016.22.11.1293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Low adherence to oral antidiabetic drugs (OADs) in the Medicare population can greatly reduce Centers for Medicare & Medicaid Services (CMS) star ratings for managed care organizations (MCOs). OBJECTIVE To develop and validate a risk assessment tool (Prescription Medication Adherence Prediction Tool for Diabetes Medications [RxAPT-D]) to predict nonadherence to OADs using Medicare claims data. METHODS In this retrospective observational study, claims data for members enrolled in a Medicare Advantage Prescription Drug (MA-PD) program in Houston, Texas, were used. Data from 2012 (baseline period) were used to identify key variables to predict adherence in 2013 (follow-up period). Members aged 65 years and older with a diabetes diagnosis, at least 1 prescription for OADs (biguanides, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, or meglitinides), and continuously enrolled for both years were included in the study. Patients with insulin prescriptions were excluded from the cohort. The study outcome, nonadherence in 2013, was defined as proportion of days covered (PDC) < 80%. Multivariable logistic models using 200 bootstrap replications (with replacement) identified factors associated with nonadherence. The final model was tested for discrimination and calibration statistics and internally validated using 10-fold cross-validation. Using weighted beta coefficients of the predictors, the RxAPT-D was created to stratify nonadherence risk and was tested for sensitivity, specificity, positive prediction value, and negative prediction value. The predictive ability of the tool was compared with that of past PDC values using net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. RESULTS Data from 7,028 MA-PD members were used for tool development. Seven predictors (age, total OAD refills, total OAD classes filled, days supply of last filled OAD, pill burden, coverage of last filled OAD, and past adherence) statistically significant in ≥ 50% of the bootstrapped samples were identified from the logistic models. The final model demonstrated good discrimination (c-statistics = 0.75) and calibration (Hosmer-Lemeshow goodness-of-fit P < 0.05) statistics, with good internal validity (area under the curve = 0.73). The RxAPT-D demonstrated adequate sensitivity statistics: sensitivity = 0.73, specificity = 0.63, positive prediction value = 0.74, and negative prediction value = 0.62. Compared with use of past adherence measures, the RxAPT-D had higher prediction ability, relative IDI = 2.09, and user defined NRI = 0.16 with 24% events correctly reclassified. CONCLUSIONS The RxAPT is an effective tool to identify patients who are likely to become nonadherent to OADs in the follow-up year. Pharmacists in MCOs can use this tool to identify patients expected to be nonadherent to OADs and develop targeted intervention programs to assist in improving MCO CMS star ratings. DISCLOSURES This study received unrestricted partial funding from the Pharmaceutical Research and Manufacturers of America (PhRMA) Foundation Adherence Research Starter Award. Serna is employed by Cigna-HealthSpring. Mhatre is now employed with Genentech. The authors report no other potential conflicts of interest. The material in this study is based on work supported (or supported in part) by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. The abstract for this article was presented at the Academy of Managed Care Pharmacy's 28th Annual Meeting & Expo, April 2016, San Francisco, California, with the title "Development and Validation of a Tool to Predict Nonadherence to Oral Antidiabetic Drugs in Medicare Beneficiaries." Study concept and design were primarily contributed by Sujit Sansgiry and Mhatre, with assistance from the other authors. Mhatre, Serna, and Sujit Sansgiry took the lead in data collection, assisted by the other authors, and data interpretation was performed by Mhatre, Shubhada Sansgiry, and Essien, assisted by the other authors. The manuscript was written by Mhatre and Fleming, assisted by the other authors, and revised primarily by Mhatre, along with Sujit Sansgiry and assisted by the other authors.
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Affiliation(s)
| | | | - Shubhada Sansgiry
- 3 Houston VA Health Services Research and Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center; VA South Central Mental Illness Research, Education and Clinical Center; and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Marc L Fleming
- 1 University of Houston College of Pharmacy, Houston, Texas
| | - E James Essien
- 1 University of Houston College of Pharmacy, Houston, Texas
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Heintzman N, Kleinberg S. Using uncertain data from body-worn sensors to gain insight into type 1 diabetes. J Biomed Inform 2016; 63:259-268. [PMID: 27580935 PMCID: PMC5077631 DOI: 10.1016/j.jbi.2016.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/19/2016] [Accepted: 08/26/2016] [Indexed: 01/15/2023]
Abstract
The amount of observational data available for research is growing rapidly with the rise of electronic health records and patient-generated data. However, these data bring new challenges, as data collected outside controlled environments and generated for purposes other than research may be error-prone, biased, or systematically missing. Analysis of these data requires methods that are robust to such challenges, yet methods for causal inference currently only handle uncertainty at the level of causal relationships – rather than variables or specific observations. In contrast, we develop a new approach for causal inference from time series data that allows uncertainty at the level of individual data points, so that inferences depend more strongly on variables and individual observations that are more certain. In the limit, a completely uncertain variable will be treated as if it were not measured. Using simulated data we demonstrate that the approach is more accurate than the state of the art, making substantially fewer false discoveries. Finally, we apply the method to a unique set of data collected from 17 individuals with type 1 diabetes mellitus (T1DM) in free-living conditions over 72 h where glucose levels, insulin dosing, physical activity and sleep are measured using body-worn sensors. These data often have high rates of error that vary across time, but we are able to uncover the relationships such as that between anaerobic activity and hyperglycemia. Ultimately, better modeling of uncertainty may enable better translation of methods to free-living conditions, as well as better use of noisy and uncertain EHR data.
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Affiliation(s)
| | - Samantha Kleinberg
- Department of Computer Science, Stevens Institute of Technology, NJ, United States.
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Ko SH, Kim DJ, Park JH, Park CY, Jung CH, Kwon HS, Park JY, Song KH, Han K, Lee KU, Ko KS. Trends of antidiabetic drug use in adult type 2 diabetes in Korea in 2002-2013: Nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4018. [PMID: 27399082 PMCID: PMC5058811 DOI: 10.1097/md.0000000000004018] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 02/03/2023] Open
Abstract
This study investigated trends in the prescription of antidiabetic medications for patients with type 2 diabetes, focusing on changing patterns of prescriptions and the cost of drugs during the last 10 years. Retrospective data on patients with type 2 diabetes aged 30 years or older were analyzed using information from the National Health Information Database collected by the National Health Insurance Service in Korea from January 2002 to December 2013. We identified patients with type 2 diabetes who had at least one service claim in each year during the study period. The prescribing information was collected and fixed-dose combination tablets were counted as each of their constituent classes. The total number of adults with type 2 diabetes who were treated using antidiabetic agents increased from 0.87 million in 2002 to 2.72 million in 2013 in Korea. Among antidiabetic medications in 2002, sulfonylurea (SU) was the most commonly used agent (87.2%), and metformin was the second (52.9%). However, in 2013, the use of metformin increased to 80.4% of the total antidiabetic prescriptions. The use of dipeptidyl peptidase-4 (DPP-4) inhibitor increased remarkably after release in late 2008 and composed one-third of the market share with 1 million prescriptions (38.4%) in 2013. Among the prescriptions for monotherapy, only 13.0% were metformin in 2002, but the amount increased to 53.2% by 2013. In contrast, the use of SU declined dramatically from 75.2% in 2002 to 30.6% in 2013. Dual and triple combinations steadily increased from 35.0% and 6.6% in 2002 to 44.9% and 15.5% in 2013, respectively. In 2013, SU with metformin (41.7%) and metformin with DPP-4 inhibitor (32.5%) combination were most frequently prescribed. The total antidiabetic medication cost increased explosively from U.S. $70 million (82.5 billion won) in 2002 to U.S. $4 billion (480 billion won) in 2013.The use of antidiabetic agents and their costs have been increasing steadily. Metformin is the most commonly used drug recently. The use of DPP-4 inhibitor increased significantly over the past decade, whereas the use of SU decreased. However, SUs still remain the most commonly prescribed second-line agents with metformin in 2013.
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Affiliation(s)
- Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Dae-Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon
| | | | - Cheol-Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Chang Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Joong-Yeol Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Kee-Ho Song
- Department of Internal Medicine, Konkuk University School of Medicine
| | - Kyungdo Han
- Department of Biostatistic, The Catholic University of Korea
| | - Ki-Up Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Kyung-Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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Abstract
A local safety net clinic provides pharmacy directed Diabetes Disease Management (DDM). The purpose of the study was to determine if a program like this would be successful in an underserved, uninsured poor minority population. Clinic providers referred patients to the DDM visits. Body Mass Index (BMI), low-density lipoprotein, high-density lipoprotein (HDL), triglycerides and hemoglobin A1c (HbA1c) were recorded pre- and post-intervention. Those who participated in pre-intervention and post-intervention visit were included in the study and laboratory values were compared. Participants in the pilot study showed statistically significant improvements in HbA1c, triglycerides and BMI. HDL values did not show statistical change. Pharmacy directed DDM can be effective in the reduction of HbA1c and triglycerides. It also may be an effective weight loss intervention for patients with diabetes.
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Zelen CM, Serena TE, Gould L, Le L, Carter MJ, Keller J, Li WW. Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative study examining clinical efficacy and cost. Int Wound J 2015; 13:272-82. [PMID: 26695998 PMCID: PMC7949818 DOI: 10.1111/iwj.12566] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 11/22/2015] [Accepted: 11/25/2015] [Indexed: 02/01/2023] Open
Abstract
Advanced therapies such as bioengineered skin substitutes (BSS) and dehydrated human amnion/chorion membrane (dHACM) have been shown to promote healing of chronic diabetic ulcers. An interim analysis of data from 60 patients enrolled in a prospective, randomised, controlled, parallel group, multi-centre clinical trial showed that dHACM (EpiFix, MiMedx Group Inc., Marietta, GA) is superior to standard wound care (SWC) and BSS (Apligraf, Organogenesis, Inc., Canton, MA) in achieving complete wound closure within 4-6 weeks. Rates and time to closure at a longer time interval and factors influencing outcomes remained unassessed; therefore, the study was continued in order to achieve at least 100 patients. With the larger cohort, we compare clinical outcomes at 12 weeks in 100 patients with chronic lower extremity diabetic ulcers treated with weekly applications of Apligraf (n = 33), EpiFix (n = 32) or SWC (n = 35) with collagen-alginate dressing as controls. A Cox regression was performed to analyse the time to heal within 12 weeks, adjusting for all significant covariates. A Kaplan-Meier analysis was conducted to compare time-to-heal within 12 weeks for the three treatment groups. Clinical characteristics were well matched across study groups. The proportion of wounds achieving complete closure within the 12-week study period were 73% (24/33), 97% (31/32), and 51% (18/35) for Apligraf, EpiFix and SWC, respectively (adjusted P = 0·00019). Subjects treated with EpiFix had a very significant higher probability of their wounds healing [hazard ratio (HR: 5·66; adjusted P: 1·3 x 10(-7) ] compared to SWC alone. No difference in probability of healing was observed for the Apligraf and SWC groups. Patients treated with Apligraf were less likely to heal than those treated with EpiFix [HR: 0·30; 95% confidence interval (CI): 0·17-0·54; unadjusted P: 5·8 x 10(-5) ]. Increased wound size and presence of hypertension were significant factors that influenced healing. Mean time-to-heal within 12 weeks was 47·9 days (95% CI: 38·2-57·7) with Apligraf, 23·6 days (95% CI: 17·0-30·2) with EpiFix group and 57·4 days (95%CI: 48·2-66·6) with the SWC alone group (adjusted P = 3·2 x 10(-7) ). Median number of grafts used per healed wound were six (range 1-13) and 2·5 (range 1-12) for the Apligraf and EpiFix groups, respectively. Median graft cost was $8918 (range $1,486-19,323) per healed wound for the Apligraf group and $1,517 (range $434-25,710) per healed wound in the EpiFix group (P < 0·0001). These results provide further evidence of the clinical and resource utilisation superiority of EpiFix compared to Apligraf for the treatment of lower extremity diabetic wounds.
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Affiliation(s)
- Charles M Zelen
- Professional Education and Research Institute, Roanoke, VA, USA
| | | | - Lisa Gould
- Department of Plastic Surgery, Wound Recovery Center, Kent Hospital, Warwick, RI, USA
| | - Lam Le
- St. John Wound Care, Tulsa, OK, USA
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Getting Bigger, Quicker? Gendered Socioeconomic Trajectories in Body Mass Index across the Adult Lifecourse: A Longitudinal Study of 21,403 Australians. PLoS One 2015; 10:e0141499. [PMID: 26496435 PMCID: PMC4619864 DOI: 10.1371/journal.pone.0141499] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/08/2015] [Indexed: 11/19/2022] Open
Abstract
Do socioeconomic inequities in body mass index (BMI) widen across the adult lifecourse? BMI data for 29,104 male and 32,454 female person-years aged 15 years and older (21,403 persons in total) were extracted from the Household, Income and Labour Dynamics in Australia between 2006 and 2012. Multilevel linear regression was used to examine age and gender specific trajectories in BMI by quintiles of neighborhood socioeconomic circumstance. Models were adjusted for probable sources of confounding, including couple status, number of children resident, if somebody in the household had been pregnant in the last 12 months, the highest level of education achieved, the average household gross income, and the percentage of time in the last year spent unemployed. Approximately 9.6% of BMI variation was observed between neighborhoods. High neighborhood disadvantage was associated with 2.09 kg/m2 heavier BMI (95%CI 1.82, 2.36). At age 15-24y, socioeconomic inequity in BMI was already evident among men and women especially (22.6 kg/m2 among women in the most affluent areas compared with 25.4 kg/m2 among the most disadvantaged). Among women only, the socioeconomic gap widened from 2.8 kg/m2 at age 15-24y to 3.2 kg/m2 by age 35-44y. Geographical factors may contribute to more rapid weight gain among women living in disadvantaged neighborhoods.
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Spaeth AM. Additional Sleep Duration Associates with Improved Blood Sugar Regulation. Sleep 2015. [DOI: 10.5665/sleep.4648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Andrea M. Spaeth
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
Diabetes in ageing communities imposes a substantial personal and public health burden by virtue of its high prevalence, its capacity to cause disabling vascular complications, the emergence of new non-vascular complications, and the effects of frailty. In this Review, we examine the current state of knowledge about diabetes in older people (aged ≥ 75 years) and discuss how recognition of the effect of frailty and disability is beginning to lead to new management approaches. A multidimensional and multidisciplinary assessment process is essential to obtain information on medical, psychosocial, and functional capabilities, and also on how impairments of these functions could limit activities. Major aims of diabetes care include maintenance of independence, functional status, and quality of life by reduction of symptom and medicine burden, and active identification of risks. Linking of therapeutic targets to individual functional status is mandatory and very tight glucose control is often not necessary. Hypoglycaemia remains an important avoidable iatrogenic event. Quality diabetes care in older people remains an important challenge for health professionals.
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Affiliation(s)
- Alan Sinclair
- Diabetes Frail, Hampton Lovett, Droitwich, Worcestershire, UK.
| | - Trisha Dunning
- Centre for Nursing and Allied Health Research at Deakin University, VIC, Australia; Barwon Health, VIC, Australia
| | - Leocadio Rodriguez-Mañas
- Department of Geriatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain; School of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
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Sinclair-White BM, Pressler V, Lowery St John T, Okubo J, Richards K, Irvin LH, Maddock J. Insights in public health: the tobacco settlement special fund: how investments in prevention save lives and dollars. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2015; 74:154-7. [PMID: 25954604 PMCID: PMC4407460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | | | | | | | | | | | - Jay Maddock
- Office of Public Health Studies at John A. Burns School of Medicine
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35
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Goto M, Goto A, Ikeda N, Noda H, Shibuya K, Noda M. Factors associated with untreated diabetes: analysis of data from 20,496 participants in the Japanese National Health and Nutrition Survey. PLoS One 2015; 10:e0118749. [PMID: 25756183 PMCID: PMC4355906 DOI: 10.1371/journal.pone.0118749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/06/2015] [Indexed: 11/18/2022] Open
Abstract
Objective We aimed to examine factors associated with untreated diabetes in a nationally representative sample of the Japanese population. Research Design and Methods We pooled data from the Japanese National Health and Nutrition Survey from 2005 to 2009 (n = 20,496). Individuals aged 20 years and older were included in the analysis. We classified participants as having diabetes if they had HbA1c levels ≥6.5% (≥48 mmol/mol). People with diabetes who self-reported that they were not currently receiving diabetic treatment were considered to be untreated. We conducted a multinomial logistic regression analysis to determine factors associated with untreated diabetes relative to non-diabetic individuals. Results Of 20,496 participants who were included in the analysis, untreated diabetes was present in 748 (3.6%). Among participants with untreated diabetes, 48.3% were previously diagnosed with diabetes, and 46.5% had HbA1c levels ≥7.0% (≥53 mmol/mol). Participants with untreated diabetes were significantly more likely than non-diabetic participants to be male, older, and currently smoking, have lower HDL cholesterol levels and higher BMI, non-HDL cholesterol levels, and systolic blood pressure. Conclusions A substantial proportion of people in Japan with untreated diabetes have poor glycemic control. Targeting relevant factors for untreated diabetes in screening programs may be effective to enhance the treatment and control of diabetes.
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Affiliation(s)
- Maki Goto
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Goto
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nayu Ikeda
- Center for International Collaboration and Partnership, National Institute of Health and Nutrition, Tokyo, Japan
| | - Hiroyuki Noda
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
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Navarro-Martínez A, Suárez-Beke MP, Sánchez-Nicolás JA, Lázaro-Aragues P, de Jesús Jiménez-Vázquez E, Huertas-de Mora O. [Primary care for diabetic patients: a quality improvement cycle]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2014; 29:302-310. [PMID: 25523162 DOI: 10.1016/j.cali.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association. MATERIAL AND METHODS The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed. RESULTS An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl in 2012. CONCLUSIONS This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease.
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LaBute MX, Zhang X, Lenderman J, Bennion BJ, Wong SE, Lightstone FC. Adverse drug reaction prediction using scores produced by large-scale drug-protein target docking on high-performance computing machines. PLoS One 2014; 9:e106298. [PMID: 25191698 PMCID: PMC4156361 DOI: 10.1371/journal.pone.0106298] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/05/2014] [Indexed: 01/12/2023] Open
Abstract
Late-stage or post-market identification of adverse drug reactions (ADRs) is a significant public health issue and a source of major economic liability for drug development. Thus, reliable in silico screening of drug candidates for possible ADRs would be advantageous. In this work, we introduce a computational approach that predicts ADRs by combining the results of molecular docking and leverages known ADR information from DrugBank and SIDER. We employed a recently parallelized version of AutoDock Vina (VinaLC) to dock 906 small molecule drugs to a virtual panel of 409 DrugBank protein targets. L1-regularized logistic regression models were trained on the resulting docking scores of a 560 compound subset from the initial 906 compounds to predict 85 side effects, grouped into 10 ADR phenotype groups. Only 21% (87 out of 409) of the drug-protein binding features involve known targets of the drug subset, providing a significant probe of off-target effects. As a control, associations of this drug subset with the 555 annotated targets of these compounds, as reported in DrugBank, were used as features to train a separate group of models. The Vina off-target models and the DrugBank on-target models yielded comparable median area-under-the-receiver-operating-characteristic-curves (AUCs) during 10-fold cross-validation (0.60-0.69 and 0.61-0.74, respectively). Evidence was found in the PubMed literature to support several putative ADR-protein associations identified by our analysis. Among them, several associations between neoplasm-related ADRs and known tumor suppressor and tumor invasiveness marker proteins were found. A dual role for interstitial collagenase in both neoplasms and aneurysm formation was also identified. These associations all involve off-target proteins and could not have been found using available drug/on-target interaction data. This study illustrates a path forward to comprehensive ADR virtual screening that can potentially scale with increasing number of CPUs to tens of thousands of protein targets and millions of potential drug candidates.
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Affiliation(s)
- Montiago X LaBute
- Computational Engineering Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Xiaohua Zhang
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Jason Lenderman
- Computational Engineering Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Brian J Bennion
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Sergio E Wong
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Felice C Lightstone
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, California, United States of America
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Halter JB, Musi N, McFarland Horne F, Crandall JP, Goldberg A, Harkless L, Hazzard WR, Huang ES, Kirkman MS, Plutzky J, Schmader KE, Zieman S, High KP. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes 2014; 63:2578-89. [PMID: 25060886 PMCID: PMC4113072 DOI: 10.2337/db14-0020] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of diabetes increases with age, driven in part by an absolute increase in incidence among adults aged 65 years and older. Individuals with diabetes are at higher risk for cardiovascular disease, and age strongly predicts cardiovascular complications. Inflammation and oxidative stress appear to play some role in the mechanisms underlying aging, diabetes, cardiovascular disease, and other complications of diabetes. However, the mechanisms underlying the age-associated increase in risk for diabetes and diabetes-related cardiovascular disease remain poorly understood. Moreover, because of the heterogeneity of the older population, a lack of understanding of the biology of aging, and inadequate study of the effects of treatments on traditional complications and geriatric conditions associated with diabetes, no consensus exists on the optimal interventions for older diabetic adults. The Association of Specialty Professors, along with the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, and the American Diabetes Association, held a workshop, summarized in this Perspective, to discuss current knowledge regarding diabetes and cardiovascular disease in older adults, identify gaps, and propose questions to guide future research.
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Affiliation(s)
- Jeffrey B Halter
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Nicolas Musi
- Geriatric Research, Education and Clinical Center, University of Texas Health Sciences Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX
| | | | - Jill P Crandall
- Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
| | - Andrew Goldberg
- University of Maryland School of Medicine and Baltimore VA Medical Center Geriatric Research Education and Clinical Center, Baltimore, MD
| | | | - William R Hazzard
- Department of Medicine, University of Washington, Puget Sound VA Health Care System, Seattle, WA
| | - Elbert S Huang
- Department of Medicine, Division of General Internal Medicine, University of Chicago, Chicago, IL
| | - M Sue Kirkman
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Kenneth E Schmader
- Geriatric Research, Education and Clinical Center, Duke University School of Medicine and Durham VA Medical Center, Durham, NC
| | | | - Kevin P High
- Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
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Oxendine V, Meyer A, Reid PV, Adams A, Sabol V. Evaluating Diabetes Outcomes and Costs Within an Ambulatory Setting: A Strategic Approach Utilizing a Clinical Decision Support System. Clin Diabetes 2014; 32:113-20. [PMID: 26246682 PMCID: PMC4521435 DOI: 10.2337/diaclin.32.3.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Azad N, Agrawal L, Emanuele NV, Klein R, Bahn GD, Reaven P. Association of blood glucose control and pancreatic reserve with diabetic retinopathy in the Veterans Affairs Diabetes Trial (VADT). Diabetologia 2014; 57:1124-31. [PMID: 24599110 DOI: 10.1007/s00125-014-3199-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/03/2014] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to test the hypothesis that intensive glycaemic control (INT) and higher plasma C-peptide levels in patients with poorly controlled diabetes would be associated with better eye outcomes. METHODS The incidence and progression of diabetic retinopathy (DR) was assessed by grading seven-field stereoscopic fundus photographs at baseline and 5 years later in 858 of 1,791 participants in the Veterans Affairs Diabetes Trial (VADT). RESULTS After adjustment for all covariates, risk of progression (but not incidence) of DR increased by 30% for each 1% increase in baseline HbA1c (OR 1.3; 95% CI 1.123, 1.503; p = 0.0004). Neither assignment to INT nor age was independently associated with DR in the entire cohort. However, INT showed a biphasic interaction with age. The incidence of DR was decreased in INT participants ≤55 years of age (OR 0.49; 95% CI 0.24, 1.0) but increased in those ≥70 years old (OR 2.88; 95% CI 1.0, 8.24) (p = 0.0043). The incidence of DR was reduced by 67.2% with each 1 pmol/ml increment in baseline C-peptide (OR 0.328; 95% CI 0.155, 0.7; p = 0.0037). Baseline C-peptide was also an independent inverse risk factor for the progression of DR, with a reduction of 47% with each 1 pmol/ml increase in C-peptide (OR 0.53; 95% CI 0.305, 0.921; p = 0.0244). CONCLUSIONS/INTERPRETATION Poor glucose control at baseline was associated with an increased risk of progression of DR. INT was associated with a decreased incidence of DR in younger patients but with an increased risk of DR in older patients. Higher C-peptide at baseline was associated with reduced incidence and progression of DR.
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Affiliation(s)
- Nasrin Azad
- Endocrinology Section, Edward Hines, Jr VA Hospital, Building 1, Room D139, Hines, IL, 60141, USA,
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Di J, Price J, Gu X, Jiang X, Jing Y, Gu Z. Ultrasound-triggered regulation of blood glucose levels using injectable nano-network. Adv Healthc Mater 2014; 3:811-6. [PMID: 24255016 PMCID: PMC4026341 DOI: 10.1002/adhm.201300490] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 09/16/2013] [Indexed: 11/10/2022]
Abstract
The integration of an injectable insulin-encapsulated nano-network with a focused ultrasound system (FUS) can remotely regulate insulin release both in vitro and in vivo. A single subcutaneous injection of the nano-network with intermittent FUS administration facilitates reduction of the blood glucose levels in type 1 diabetic mice for up to 10 d.
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Affiliation(s)
- Jin Di
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, NC 27695, USA; Eshelman School of Pharmacy, Molecular Pharmaceutics Division, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jennifer Price
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, NC 27695, USA; Eshelman School of Pharmacy, Molecular Pharmaceutics Division, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Xiao Gu
- Department of Urology, Clinical Medical College at Yangzhou University, Yangzhou, Jiangsu 225001, P. R. China
| | - Xiaoning Jiang
- Department of Mechanical Engineering, North Carolina State University, NC 27695, USA
| | - Yun Jing
- Department of Mechanical Engineering, North Carolina State University, NC 27695, USA
| | - Zhen Gu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, NC 27695, USA; Eshelman School of Pharmacy, Molecular Pharmaceutics Division, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Andrews EB, Thomas J, Jaacks L, D'Agostino R, Ward D, Mayer-Davis EJ. Patient Perception of Midlevel Providers in Pediatric Diabetes Care. DIABETES EDUCATOR 2014; 40:329-335. [PMID: 24652057 DOI: 10.1177/0145721714527519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate perceptions of the role of midlevel providers among pediatric type 1 diabetes patients. METHODS The study population was a convenience sample of 82 youth with type 1 diabetes who were enrolled in the SEARCH for Diabetes in Youth Study, Carolina site, and attended either baseline (n = 22) or follow-up (n = 60) visits between May 25, 2012, and October 3, 2012. Self-administered surveys queried participants' understanding of providers' roles and perceived employment at clinics and whether participants had seen providers since diagnosis. Midlevel providers of interest included dietitians, nurse practitioners, physician assistants, and medical social workers. Mean proportions for each provider were compared to dietitians (referent) via a t test. Fisher exact tests were used to determine associations between survey responses. RESULTS Baseline participants reported seeing a dietitian since diagnosis more often than they reported seeing an nurse practitioner, physician assistant, or medical social worker. Baseline and follow-up participants both reported understanding the role of dietitians significantly more than the role of other providers. Dietitians were reported by all participants to be employed at clinics more frequently than physician assistants or medical social workers. Seeing the provider was associated with patients' self-reported understanding of providers and their employment at diabetes care clinics. CONCLUSIONS The survey population reported a high understanding of dietitian roles. However, the roles of other midlevel providers were not as well understood by youth with type 1 diabetes and their parents, which could represent a missed opportunity for care.
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Affiliation(s)
- Erica Brecht Andrews
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Andrews, Ms Thomas, Ms Jaacks, Dr Ward, Dr Mayer-Davis)
| | - Joan Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Andrews, Ms Thomas, Ms Jaacks, Dr Ward, Dr Mayer-Davis)
| | - Lindsay Jaacks
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Andrews, Ms Thomas, Ms Jaacks, Dr Ward, Dr Mayer-Davis)
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA (Dr D'Agostino Jr)
| | - Dianne Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Andrews, Ms Thomas, Ms Jaacks, Dr Ward, Dr Mayer-Davis)
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Andrews, Ms Thomas, Ms Jaacks, Dr Ward, Dr Mayer-Davis),Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Mayer-Davis)
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Vincent D, McEwen MM, Hepworth JT, Stump CS. The effects of a community-based, culturally tailored diabetes prevention intervention for high-risk adults of Mexican descent. THE DIABETES EDUCATOR 2014; 40:202-13. [PMID: 24510942 PMCID: PMC6383713 DOI: 10.1177/0145721714521020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. METHODS The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. RESULTS There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. CONCLUSIONS Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.
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Affiliation(s)
- Shaodong Guo
- Division of Molecular Cardiology, Department of Medicine, College of Medicine, Texas A&M University Health Science Center, 1901 South 1st Street, Building 205, Temple, Texas 76504, USA Scott & White, Temple, Texas 76504, USA Central Texas Veterans Health Care System, Temple, Texas 76504, USA
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Resolution of Diabetes After Bariatric Surgery Among Predominantly African-American Patients. Obes Surg 2014; 24:835-40. [DOI: 10.1007/s11695-014-1187-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Berry DC, Schwartz TA, McMurray RG, Skelly AH, Neal M, Hall EG, Aimyong N, Amatuli DJ, Melkus G. The family partners for health study: a cluster randomized controlled trial for child and parent weight management. Nutr Diabetes 2014; 4:e101. [PMID: 24418827 PMCID: PMC3904082 DOI: 10.1038/nutd.2013.42] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this study was to test a two-phased nutrition and exercise education, coping skills training, and exercise intervention program for overweight or obese low-income ethnic minority 2nd to 4th grade children and their parents in rural North Carolina, USA. METHODS A cluster randomized controlled trial was carried out with 358 children (7-10 years) and a parent for each child (n=358). General linear mixed models were used to determine the effects of the intervention on weight, adiposity, health behaviors, and eating and exercise self-efficacy by examining changes in children and parents from baseline to completion of the study (18 months). RESULTS At 18 months, children in the experimental group did not have a significantly decreased body mass index (BMI) percentile (P=0.470); however, they showed a reduction in the growth rate of their triceps (P=0.001) and subscapular skinfolds (P<0.001) and an improvement in dietary knowledge (P=0.018) and drank less than one glass of soda per day (P=0.052) compared with the control group. Parents in the experimental group had decreased BMI (P=0.001), triceps (P<0.001) and subscapular skinfolds (P<0.001) and increased nutrition (P=0.003) and exercise (P<0.001) knowledge and more often drank water or unsweetened drinks (P=0.029). At 18 months, children in the experimental group did not show significant improvement in eating (P=0.956) or exercise self-efficacy (P=0.976). Experimental parents demonstrated improved socially acceptable eating self-efficacy (P=0.013); however, they did not show significant improvement in self-efficacy pertaining to emotional eating (P=0.155) and exercise (P=0.680). CONCLUSION The results suggest that inclusion of children and parents in the same intervention program is an effective way to decrease adiposity and improve nutrition behaviors in both children and parents and improve weight and eating self-efficacy in parents.
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Affiliation(s)
- D C Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Schwartz
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R G McMurray
- School of Exercise and Sport Science and Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A H Skelly
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E G Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N Aimyong
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D J Amatuli
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G Melkus
- School of Nursing, Muriel and Virginia Pless Center for Nursing Research, New York University, New York, NY, USA
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Abstract
The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes (eg, genetic, lifestyle, and behavioural risk factors) has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes, taking into account its many origins and heterogeneity. Thus, research needs to be directed at improved understanding of the potential role of determinants such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programmes.
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Affiliation(s)
- Paul Z Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | | | - William H Herman
- Michigan Center for Diabetes Translational Research, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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Berry DC, Neal M, Hall EG, Schwartz TA, Verbiest S, Bonuck K, Goodnight W, Brody S, Dorman KF, Menard MK, Stuebe AM. Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study. BMC Pregnancy Childbirth 2013; 13:184. [PMID: 24112417 PMCID: PMC3907028 DOI: 10.1186/1471-2393-13-184] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina. METHODS/DESIGN Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3 months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22-36 weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22-36 weeks pregnant) to 10 months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10 months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10 months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10 months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting. DISCUSSION Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations. TRIAL REGISTRATION NCT01809431.
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Affiliation(s)
- Diane C Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill 27599-7460, NC, USA
| | - Madeline Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill 27599-7460, NC, USA
| | - Emily G Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill 27599-7460, NC, USA
| | - Todd A Schwartz
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill 27599-7460, NC, USA
| | - Sarah Verbiest
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill 27599-7516, NC, USA
| | - Karen Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Rochester 14602, NY, USA
- Department of Obstetrics, Gynecology & Women’s Health, 1300 Morris Park Avenue, Bronx 10461, NY, USA
| | - William Goodnight
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill 27599-7516, NC, USA
- Rex Healthcare Inc, OB/GYN, 4420 Lake Boone Trail, Raleigh 27607, NC, USA
| | - Seth Brody
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill 27599-7516, NC, USA
- WakeMed Health & Hospitals, WakeMed Faculty Physicians, OB/GYN, 3024 New Bern Avenue, Raleigh 27610, NC, USA
| | - Karen F Dorman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill 27599-7516, NC, USA
| | - Mary K Menard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill 27599-7516, NC, USA
| | - Alison M Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill 27599-7516, NC, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 170 Rosenau Hall, Campus Box 7400, Chapel Hill 27599-7400, NC, USA
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Nadeau DA. Physiologic and weight-focused treatment strategies for managing type 2 diabetes mellitus: the metformin, glucagon-like peptide-1 receptor agonist, and insulin (MGI) approach. Postgrad Med 2013; 125:112-26. [PMID: 23748512 DOI: 10.3810/pgm.2013.05.2666] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is rising in association with an increase in obesity rates. Current treatment options for patients with T2DM include lifestyle modifications and numerous antidiabetic medications. Despite the availability of effective and well-tolerated treatments, many patients do not achieve recommended glycemic targets. Lack of efficacy is complicated by the wide range of available agents and little specificity in treatment guidelines, thus challenging clinicians to understand the relative benefits and risks of individual options for each patient. In this article, lifestyle intervention strategies and current antidiabetic agents are evaluated for their efficacy, safety, and weight-loss potential. Because of the heterogeneous and progressive nature of T2DM, physicians should advocate approaches that emphasize weight management, limit the risk of hypoglycemia and adverse events, and focus on the core pathophysiologic defects in patients with T2DM. A healthy, plant-based diet that is low in saturated fat and refined carbohydrates but high in whole grains, vegetables, legumes, and fruits, coupled with resistance and aerobic exercise regimens, are recommended for patients with T2DM. When necessary, drug intervention, described in this article as the MGI (metformin, glucagon-like peptide-1 receptor agonist, and insulin) approach, should begin with metformin and progress to the early addition of glucagon-like peptide-1 receptor agonists because of their weight loss potential and ability to target multiple pathophysiologic defects in patients with T2DM. For most patients, treatments that induce weight gain and hypoglycemia should be avoided. Long-acting insulin should be initiated if glycemic control is not achieved with metformin and glucagon-like peptide-1 receptor agonist combination therapy, focusing on long-acting insulin analogs that induce the least weight gain and have the lowest hypoglycemic risk. Ultimately, a patient-centered treatment approach that addresses the core pathologies of T2DM and obesity will not only increase overall efficacy and the likelihood that a patient adheres to treatment, but may also improve a patient's mental well-being and quality of life.
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Affiliation(s)
- Daniel A Nadeau
- Diabetes, Endocrine, and Nutrition Center, York Hospital, York, ME 03909, USA.
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