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Pritchard R, Darko N, Stevenson E. Enhancing community engagement, public involvement, and social capital through researchers' participation in community dance projects: unexpected outcomes in underserved communities. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:79. [PMID: 39095873 PMCID: PMC11297768 DOI: 10.1186/s40900-024-00616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The Dance and Health project aimed to promote public involvement in health research. Public involvement leads worked with project partner community groups, Aakash Odedra Dance Company and Moving Together, to develop a community engagement project with people living in low-socioeconomic areas/deprivation and diverse ethnic minority groups. Dance and Health included a weekly 60-min dance class and 30 min of facilitated health science discussion, that could either be a public involvement discussion for a research project, an activity about a particular biomedical research theme or ongoing discussions with a visiting researcher. The goal of this paper is to explore the impact of the Dance and Health project on the social capital of participants and provide key learnings on how to engage and build partnerships with people from underserved groups in health research contexts. METHODS Qualitative interviews and focus groups were completed which explored participant and dance tutor experiences in community venues. Participants were aged between 22 and 90, most were female and were from Asian ethnic minority groups and White British groups living in deprived neighbourhoods in Leicester. Qualitative data were analysed using qualitative content analysis. RESULTS The responses to the Dance and Health project were positive across all the focus groups. Central themes identified were Feedback on the Project, Motivation to Exercise, Criticism of the NHS, Mental Wellbeing, Engagement in a Post Pandemic New Normal, Accessibility and Inclusivity, Empowerment and Building Social Capital. DISCUSSION The focus groups evidenced that the project had broad impact. Participants expressed empowerment and ownership and described a range of social capital enrichment generated through the project including networks and friendships, access to the institutional resource of health science, and the opportunity to engage with a health and leisure activity that was valued and meaningful.
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Affiliation(s)
- Rebecca Pritchard
- BMTO, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Natalie Darko
- NIHR Leicester BRC, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Elizabeth Stevenson
- BMTO, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Kyaw KLS, Pana TA, Bettencourt-Silva JH, Metcalf AK, Myint PK, Potter JF. The individual and combined impacts of pre-existing diabetes and dementia on ischemic stroke outcomes: a registry-based cohort study. BMC Cardiovasc Disord 2024; 24:396. [PMID: 39080558 PMCID: PMC11290225 DOI: 10.1186/s12872-024-04050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Individually, diabetes mellitus and dementia are associated with poorer outcomes after stroke. However, the combined impact of these pre-existing factors on acute ischemic stroke (AIS) outcomes has not been examined. METHODS All consecutive patients with AIS admitted to Norfolk and Norwich University Hospitals between 2003 and 2016 (catchment population ~ 900,000) were divided into four groups: those with neither diabetes nor dementia (reference), with diabetes without dementia, with dementia without diabetes, and with both co-morbidities. In-hospital mortality, length of hospital stay (LoS), and disability outcomes were analysed using logistic regressions. Post-discharge mortality and recurrence were assessed using Cox regressions. Additionally, interaction terms were added to the models for the short-term outcomes and long-term mortality to test for synergistic effects of diabetes and dementia. Models were adjusted for age, sex, Oxfordshire Community Stroke Project classification, comorbidities, hematological and biochemical measures, and antithrombotic medications. RESULTS The cohort was 10,812 patients with 52% females and a median age of 80. The median follow-up was 3.8 years for stroke recurrence and 5.5 years for mortality. No significant differences between the four groups existed for in-hospital mortality and post-stroke disability. Patients with dementia had significantly longer LoS (OR 2.25 [95% CI: 1.34-3.77] and 1.31 [1.02-1.68] with and without diabetes, respectively). Patients with both comorbidities had the highest risk of stroke recurrence (HR 2.06 [1.12-3.77]), followed by those with only dementia (1.59 [1.15-2.20]) and only diabetes (1.25 [1.06-1.49]). Similarly, the patient group with both diabetes and dementia had the highest long-term mortality risk (1.76 [1.33-2.37]). The hazard ratios for patients with only dementia and only diabetes were 1.71 [1.46-2.01] and 1.19 [1.08-1.32], respectively. No significant interactions were seen between diabetes and dementia with regards to their effects on the outcomes. CONCLUSION Individual and cumulative impacts of the two conditions on long-term mortality and stroke recurrence were notable. However, no synergistic impact of the two comorbidities were seen on the stroke outcomes tested in our study. Therefore, tailoring the management of stroke patients based on additional requirements associated with each pre-existing condition will be more impactful towards improving outcomes.
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Affiliation(s)
- Kyi Lae Shune Kyaw
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Tiberiu A Pana
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Joao H Bettencourt-Silva
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Healthcare and Life Sciences, IBM Research, Norwich, UK
| | - Anthony K Metcalf
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phyo K Myint
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UK.
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Armstrong ND, Patki A, Srinivasasainagendra V, Ge T, Lange LA, Kottyan L, Namjou B, Shah AS, Rasmussen-Torvik LJ, Jarvik GP, Meigs JB, Karlson EW, Limdi NA, Irvin MR, Tiwari HK. Variant level heritability estimates of type 2 diabetes in African Americans. Sci Rep 2024; 14:14009. [PMID: 38890458 PMCID: PMC11189523 DOI: 10.1038/s41598-024-64711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
Type 2 diabetes (T2D) is caused by both genetic and environmental factors and is associated with an increased risk of cardiorenal complications and mortality. Though disproportionately affected by the condition, African Americans (AA) are largely underrepresented in genetic studies of T2D, and few estimates of heritability have been calculated in this race group. Using genome-wide association study (GWAS) data paired with phenotypic data from ~ 19,300 AA participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, Genetics of Hypertension Associated Treatments (GenHAT) study, and the Electronic Medical Records and Genomics (eMERGE) network, we estimated narrow-sense heritability using two methods: Linkage-Disequilibrium Adjusted Kinships (LDAK) and Genome-Wide Complex Trait Analysis (GCTA). Study-level heritability estimates adjusting for age, sex, and genetic ancestry ranged from 18% to 34% across both methods. Overall, the current study narrows the expected range for T2D heritability in this race group compared to prior estimates, while providing new insight into the genetic basis of T2D in AAs for ongoing genetic discovery efforts.
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Affiliation(s)
- Nicole D Armstrong
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Amit Patki
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Tian Ge
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Leslie A Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Leah Kottyan
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bahram Namjou
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center &, The University of Cincinnati, Cincinnati, OH, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - James B Meigs
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Elizabeth W Karlson
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Mass General Brigham Personalized Medicine, Boston, MA, USA
| | - Nita A Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Hu L, Shi Y, Wylie-Rosett J, Sevick MA, Xu X, Lieu R, Wang C, Li H, Bao H, Jiang Y, Zhu Z, Yeh MC, Islam N. Feasibility of a family-oriented mHealth intervention for Chinese Americans with type 2 diabetes: A pilot randomized control trial. PLoS One 2024; 19:e0299799. [PMID: 38466714 PMCID: PMC10927140 DOI: 10.1371/journal.pone.0299799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for Chinese immigrant families with type 2 diabetes (T2D). METHODS We conducted a pilot randomized controlled trial (RCT) with baseline, 3-, and 6-month measurements. Participating dyads, T2D patients and families/friends from NYC, were randomized into the intervention group (n = 11) or the wait-list control group (n = 12). Intervention includes 24 videos covering T2D self-management, behavioral techniques, and family-oriented sessions. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients' HbA1c, weight, and self-management were also assessed to test potential efficacy. RESULTS Most T2D patients (n = 23; mean age 56.2±9.4 years; 52.2% male) and families/friends (n = 23, mean age 54.6±11.2 years; 52.2% female) had high school education or less (69.6% and 69.6%), annual household income < $25,000 (65.2% and 52.2%), and limited English proficiency (95.7% and 95.7%). The retention rates were not significantly different between the intervention and the control groups for both the patients (90.91% vs 83.3%, p = 0.589); and their families/friends (3-month: 90.9% vs 75%, p = 0.313; 6-month: 90.9% vs 83.3%, p = 0.589). The mean video watch rate was 76.8% (7%). T2D patients and families/friends rated satisfaction as 9.4 and 10 out of 10, respectively. Despite no between-group differences, the intervention group had significantly lower HbA1c (p = 0.014) and better self-management (p = 0.009), and lost 12 lbs. on average at 6 months (p = 0.079), compared to their baseline levels. CONCLUSIONS A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management within the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy.
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Affiliation(s)
- Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Yun Shi
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, United States of America
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Xinyi Xu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ricki Lieu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Han Bao
- Jacobi Medical Center, New York, NY, United States of America
| | - Yulin Jiang
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ziqiang Zhu
- Wellsure Medical Practice, New York, NY, United States of America
| | - Ming-Chin Yeh
- School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States of America
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
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McCoy RG, Swarna KS, Jiang DH, Van Houten HK, Chen J, Davis EM, Herrin J. Enrollment in High-Deductible Health Plans and Incident Diabetes Complications. JAMA Netw Open 2024; 7:e243394. [PMID: 38517436 PMCID: PMC10960199 DOI: 10.1001/jamanetworkopen.2024.3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/25/2024] [Indexed: 03/23/2024] Open
Abstract
Importance Preventing diabetes complications requires monitoring and control of hyperglycemia and cardiovascular risk factors. Switching to high-deductible health plans (HDHPs) has been shown to hinder aspects of diabetes care; however, the association of HDHP enrollment with microvascular and macrovascular diabetes complications is unknown. Objective To examine the association between an employer-required switch to an HDHP and incident complications of diabetes. Design, Setting, and Participants This retrospective cohort study used deidentified administrative claims data for US adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. Data analysis was performed from May 26, 2022, to January 2, 2024. Exposures Adults with a baseline year of non-HDHP enrollment who had to switch to an HDHP because their employer offered no non-HDHP alternative in that year were compared with adults who were continuously enrolled in a non-HDHP. Main Outcomes and Measures Mixed-effects logistic regression models examined the association between switching to an HDHP and, individually, the odds of myocardial infarction, stroke, hospitalization for heart failure, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, and blindness. Models were adjusted for demographics, comorbidities, and medications, with inverse propensity score weighting used to account for potential selection bias. Results The study included 42 326 adults who switched to an HDHP (mean [SD] age, 52 [10] years; 19 752 [46.7%] female) and 202 729 adults who did not switch (mean [SD] age, 53 [10] years; 89 828 [44.3%] female). Those who switched to an HDHP had greater odds of experiencing all diabetes complications (odds ratio [OR], 1.11; 95% CI, 1.06-1.16 for myocardial infarction; OR, 1.15; 95% CI, 1.09-1.21 for stroke; OR, 1.35; 95% CI, 1.30-1.41 for hospitalization for heart failure; OR, 2.53; 95% CI, 2.38-2.70 for end-stage kidney disease; OR, 2.23; 95% CI, 2.17-2.29 for lower-extremity complication; OR, 1.17; 95% CI, 1.13-1.21 for proliferative retinopathy; OR, 2.35; 95% CI, 2.18-2.54 for blindness; and OR, 2.28; 95% CI, 2.15-2.41 for retinopathy treatment). Conclusions and Relevance This study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.
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Affiliation(s)
- Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore
- University of Maryland Institute for Health Computing, Bethesda
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park
- OptumLabs, Eden Prairie, Minnesota
| | - Kavya S. Swarna
- OptumLabs, Eden Prairie, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Holly K. Van Houten
- OptumLabs, Eden Prairie, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park
| | - Esa M. Davis
- University of Maryland Institute for Health Computing, Bethesda
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Porterfield L, Santiago Delgado Z, Patel PG, Goodman ML, Campbell KM, Vaughan EM. Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study. Sci Diabetes Self Manag Care 2024; 50:56-64. [PMID: 38243754 PMCID: PMC10851650 DOI: 10.1177/26350106231220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). METHODS Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. RESULTS Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. CONCLUSIONS Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.
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Affiliation(s)
- Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas
- Sealy Institute for Vaccine Sciences, UTMB, Galveston, Texas
| | | | | | | | - Kendall M. Campbell
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas
| | - Elizabeth M. Vaughan
- Department of Internal Medicine, UTMB, Galveston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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So M, Jadoo H, Stong J, Klemenhagen KC, Philbrick AM, Freeman K. Effect of Virtual Versus In Person Interpreting on Diabetes Outcomes in Non-English Language Preference Patients: A Pilot Study. J Prim Care Community Health 2024; 15:21501319241240347. [PMID: 38695439 PMCID: PMC11067674 DOI: 10.1177/21501319241240347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE The objective of this pilot study was to explore the impact of interpreter format (virtual vs in person) on clinical outcomes in patients with non-English language preference (NELP) and type 2 diabetes mellitus (T2DM) in a primary care setting. We hypothesized that NELP patients utilizing in person interpreters would have improved HbA1c values, better follow-up rate, and more complex care plans compared to patients utilizing virtual interpreters. METHODS We completed a retrospective chart review of 137 NELP patients with T2DM who required a medical interpreter (February to June 2021). We calculated univariate and bivariate statistics to characterize the sample and assess the extent to which measures of continuity (follow-up visit rate and time to follow-up visit), quality (change in HbA1c), and complexity (medication intervention complexity) were associated with interpreter type. RESULTS There was no statistically significant difference in follow-up rate or average days to follow-up visit for NELP patients with in person as opposed to virtual interpreters. Patients with virtual interpreters demonstrated a non-statistically significant decrease in HbA1c compared to those with in person interpreters. Finally, there was no statistically significant association between interpreter format and intervention complexity. CONCLUSIONS Quality medical interpretation contributes to optimal health outcomes in NELP patients with diabetes. Our study suggests that both in person and virtual interpreters can be effective in providing care for NELP patients, especially for chronic disease management in the context of a primary care relationship. It also highlights the importance of pursuing additional qualitative and mixed method studies to better understand the benefits of various interpreter formats across different visit types.
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Affiliation(s)
- Marvin So
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Hailie Jadoo
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Jennifer Stong
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Ann M. Philbrick
- University of Minnesota College of Pharmacy and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kathryn Freeman
- University of Minnesota Medical School, Minneapolis, MN, USA
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Yoshida Y, Zu Y, Fonseca VA. Ethnic disparities of vascular complications in pre-diabetes, undiagnosed diabetes, and newly diagnosed diabetes. Prim Care Diabetes 2023; 17:661-664. [PMID: 37827908 DOI: 10.1016/j.pcd.2023.09.008] [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: 07/27/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
In the U.S., ethnic minorities with pre-diabetes, undiagnosed type 2 diabetes (T2D), and newly diagnosed T2D had a higher prevalence of microvascular complications than non-Hispanic Whites and exhibited distinct risk factors, whereas Whites had a higher rate of cardiovascular disease.
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Affiliation(s)
- Yilin Yoshida
- Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Yuanhao Zu
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Vivian A Fonseca
- Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Fayfman M, Gewirtz AT, Delaroque C, Blanco G, Gibanica S, Srinivasan S, Chassaing B. Microbiome differences related to metformin intolerance among Black individuals with diabetes, a pilot cross-sectional study. Metabol Open 2023; 20:100256. [PMID: 38115865 PMCID: PMC10728571 DOI: 10.1016/j.metop.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 12/21/2023] Open
Abstract
Aims Metformin is the broadly accepted the first-line medication for diabetes. Its use, however, is limited by gastrointestinal side effects present in approximately 25% of patients. This study aimed to better understand the interplay between metformin intolerance and gut microbiota among Black individuals with diabetes. Methods We performed a cross-sectional study among 29 Black individuals living with diabetes with or without metformin intolerance. Participants with mean age 59±11, 58% female, were stratified into three groups: 1)intolerant: metformin intolerance in the past, not on metformin; 2)partially intolerant: mild to moderate gastrointestinal symptoms, currently taking metformin 3)tolerant: using metformin without symptoms. We collected and analyzed rectal swabs and analyzed microbiota composition using V3-V4 regions of the 16s rRNA. Results Metformin intolerant subjects trended towards having greatest alpha diversity, followed by tolerant and partially tolerant (Intolerant:4.9; Tolerant:4.2; Partially tolerant:3.9). Mean difference in alpha diversity for intolerant versus partially tolerant was 1.0 (95% CI-0.1,2.1) and intolerant versus tolerant were 0.7 (95% CI -0.4,1.8). Conclusion This was the first study to evaluate the role of microbiota and metformin intolerance among Black individuals. We report on differences in alpha diversity as well as microbiota composition.
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Affiliation(s)
- Maya Fayfman
- Emory University Department of Medicine, Atlanta, GA, United States
- Grady Health System, Atlanta, GA, United States
| | - Andrew T. Gewirtz
- Institute of Biomedical Sciences, Georgia State University, Atlanta, GA, United States
| | - Clara Delaroque
- INSERM U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, CNRS, UMR 8104, Université Paris Cité, Paris, France
| | - Gerardo Blanco
- Emory University Department of Medicine, Atlanta, GA, United States
- Grady Health System, Atlanta, GA, United States
| | - Seid Gibanica
- Emory University Department of Medicine, Atlanta, GA, United States
- Grady Health System, Atlanta, GA, United States
| | - Shanthi Srinivasan
- Division of Digestive Diseases, Emory University Department of Medicine and VA Medical Center Atlanta, Decatur, GA, United States
| | - Benoit Chassaing
- INSERM U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, CNRS, UMR 8104, Université Paris Cité, Paris, France
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Vivanco-Rojas O, López-Letayf S, Londoño-Angarita V, Magaña-Guerrero FS, Buentello-Volante B, Garfias Y. Risk Factors for Diabetic Retinopathy in Latin America (Mexico) and the World: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6583. [PMID: 37892721 PMCID: PMC10607496 DOI: 10.3390/jcm12206583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic retinopathy (DR) is one of the main complications of diabetes, and the management of the main control parameters explains only an 11% reduction in the risk of progressing to DR, leaving 89% to be explained by other factors or correlations between the usual factors that are currently unknown. The objective of this systematic review and meta-analysis is to evaluate the similarities and differences between the possible risk factors for developing DR when comparing the world to Latin American populations. The search was performed first for Latin American (LA) populations and a second search for non-Latin American (Non-LA) populations. Using the PRISMA guidelines, five articles were found to be relevant for each of the groups. The patients who had elevated systolic blood pressure (SBP) developed DR more frequently than the patients without retinopathy (Z = 2.1, p = 0.03), an effect measured in the population at a global level (GL), behavior that becomes not significant when the LA and non-LA populations are grouped separately; relevant to this is that the diagnosis of hypertension (HBP) grouped globally and stratified does not present a risk factor for DR (Z = 0.79, p = 0.42). This indicates that SBP is a risk factor for the world population and that, by separating it into different regions, the omission could cause it not to be considered a possible risk factor. In conclusion, the relationship between the increase in DR associated with the risk factors present in different populations, the limited research conducted in Latin America, and the cultural, social, economic, and genetic differences makes for a complex condition, which reflects the necessity of researching in a more integrated way.
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Affiliation(s)
- Oscar Vivanco-Rojas
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Mexico City 04510, Mexico; (O.V.-R.); (S.L.-L.)
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Sonia López-Letayf
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Mexico City 04510, Mexico; (O.V.-R.); (S.L.-L.)
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Valentina Londoño-Angarita
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Fátima Sofía Magaña-Guerrero
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Beatriz Buentello-Volante
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Yonathan Garfias
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Mexico City 04510, Mexico; (O.V.-R.); (S.L.-L.)
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
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12
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Kunutsor SK, Khunti K, Seidu S. Racial, ethnic and regional differences in the effect of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists on cardiovascular and renal outcomes: a systematic review and meta-analysis of cardiovascular outcome trials. J R Soc Med 2023:1410768231198442. [PMID: 37734450 DOI: 10.1177/01410768231198442] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES The cardiorenal protective effects of sodium-glucose co-transporter 2 inhibitors (SGLT2-Is) and glucagon-like peptide 1 receptor agonists (GLP1-RAs) across racial and ethnic groups are not well defined. By conducting a systematic review and meta-analysis of all randomised, placebo-controlled, cardiovascular disease (CVD) outcomes trials (CVOTs), we aimed to compare racial/ethnic as well as regional patterns in the effects of SGLT2-Is and GLP1-RAs on cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). DESIGN Trials were identified from MEDLINE, Embase, the Cochrane Library, and search of bibliographies to 7 July 2023. Setting North America, South/Central America, Europe (Eastern and Western), Asia, Australia-New Zealand (Pacific), Asia/Pacific, and Africa. SETTING North America, South/Central America, Europe (Eastern and Western), Asia, Australia-New Zealand (Pacific), Asia/Pacific, and Africa. PARTICIPANTS people with type 2 diabetes enrolled in cardiovascular outcome trials of SGLT2-Is and GLP1-RAs. MAIN OUTCOME MEASURES Outcomes were (i) major adverse cardiovascular events (MACE), (ii) composite CVD death/heart failure (HF) hospitalization; (iii) composite renal outcome; and (iv) their components. Study-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled. RESULTS In total, 14 unique CVOTs (7 comparing SGLT2-Is vs placebo and 7 comparing GLP1-RAs vs placebo) were eligible. The proportion of participants enrolled in the trials ranged from 66.6-93.2% for White populations, 1.2-21.6% for Asian populations, 2.4-8.3% for Black populations and 0.9-23.1% for Other populations. The HR (95% CI) for MACE comparing SGLT2-Is vs placebo was 0.92 (0.86-0.98), 0.69 (0.53-0.92) and 0.70 (0.54-0.91) for White, Asian and Hispanic/Latino populations, respectively. Comparing GLP1-RAs vs placebo, the corresponding HR (95% CI) was 0.88 (0.80-0.97), 0.76 (0.63-0.93) and 0.82 (0.70-0.95), respectively. SGLT2-Is reduced the risk of all other cardiorenal outcomes in White and Asian populations, except for HF hospitalizations in Asians. No effects were observed in Black populations except for a reduced risk of HF hospitalizations by SGLT2-I. SGLT1-Is reduced the risk of composite CVD death/HF hospitalization in North America and Europe, whereas GLP1-RAs reduced the risk of MACE in Europe. GRADE certainty of evidence ranged from moderate to high. CONCLUSIONS There appears to be substantial racial/ethnic differences in the cardiorenal effects of SGLT2-Is and GLP1-RAs in patients with T2D, with consistent benefits observed among White and Asian populations and consistent lack of benefits in Black populations. Whether the differences are due to issues with under-representation of Black populations and low statistical power or racial/ethnic variations in the pharmacokinetics, pharmacodynamics and safety of SGLT2-Is and GLP1-RAs need further investigation.PROSPERO Registration: CRD42023401734.
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Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4WP, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4WP, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4WP, UK
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Galindo RJ, Trujillo JM, Low Wang CC, McCoy RG. Advances in the management of type 2 diabetes in adults. BMJ MEDICINE 2023; 2:e000372. [PMID: 37680340 PMCID: PMC10481754 DOI: 10.1136/bmjmed-2022-000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/27/2023] [Indexed: 09/09/2023]
Abstract
Type 2 diabetes is a chronic and progressive cardiometabolic disorder that affects more than 10% of adults worldwide and is a major cause of morbidity, mortality, disability, and high costs. Over the past decade, the pattern of management of diabetes has shifted from a predominantly glucose centric approach, focused on lowering levels of haemoglobin A1c (HbA1c), to a directed complications centric approach, aimed at preventing short term and long term complications of diabetes, and a pathogenesis centric approach, which looks at the underlying metabolic dysfunction of excess adiposity that both causes and complicates the management of diabetes. In this review, we discuss the latest advances in patient centred care for type 2 diabetes, focusing on drug and non-drug approaches to reducing the risks of complications of diabetes in adults. We also discuss the effects of social determinants of health on the management of diabetes, particularly as they affect the treatment of hyperglycaemia in type 2 diabetes.
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Affiliation(s)
- Rodolfo J Galindo
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, USA
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer M Trujillo
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cecilia C Low Wang
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Rozalina G McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- University of Maryland Institute for Health Computing, Bethesda, Maryland, USA
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14
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Ahdi M, Gerards MC, Smits PH, Meesters EW, Brandjes DPM, Nieuwdorp M, Gerdes VEA. Genetic glucocorticoid receptor variants differ between ethnic groups but do not explain variation in age of diabetes onset, metabolic and inflammation parameters in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1200183. [PMID: 37732126 PMCID: PMC10507347 DOI: 10.3389/fendo.2023.1200183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023] Open
Abstract
Aims The effect of excess glucocorticoid receptor (GR) stimulation through glucocorticoid medication or cortisol on glucose metabolism is well established. There are genetic GR variants that result in increased or decreased GR stimulation. We aimed to determine the prevalence of genetic GR variants in different ethnic groups in a cohort of patients with type 2 diabetes, and we aimed to determine their association with age of diabetes onset and metabolic and inflammation parameters. Methods A cross-sectional analysis was performed in a multiethnic cohort (n = 602) of patients with established type 2 diabetes. Polymorphisms in the GR gene that have previously been associated with altered glucocorticoid sensitivity (TthIIII, ER22/23EK N363S, BclI and 9β) were determined and combined into 6 haplotypes. Associations with age of diabetes onset, HbA1c, hs-CRP and lipid values were evaluated in multivariate regression models. Results The prevalence of the SNPs of N363S and BclI was higher in Dutch than in non-Dutch patients. We observed a lower prevalence of the SNP 9β in Dutch, South(East) Asian and Black African patients versus Turkish and Moroccan patients. We did not detect an association between SNPs and diabetes age of onset or metabolic parameters. We only found a trend for lower age of onset and higher HbA1c in patients with 1 or 2 copies of haplotype 3 (TthIIII + 9β). Conclusions The prevalence of genetic GR variants differs between patients of different ethnic origins. We did not find a clear association between genetic GR variants and age of diabetes onset or metabolic and inflammation parameters. This indicates that the clinical relevance of GR variants in patients with established type 2 diabetes is limited.
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Affiliation(s)
- Mohamed Ahdi
- Department of Vascular Medicine, Amsterdam University Medical Centers (UMCs), Amsterdam, Netherlands
| | - Maaike C. Gerards
- Department of Vascular Medicine, Amsterdam University Medical Centers (UMCs), Amsterdam, Netherlands
| | - Paul H.M. Smits
- Department of Molecular Biology, Atalmedial, Amsterdam, Netherlands
| | - Eelco W. Meesters
- Department of Internal Medicine, Spaarne Hospital, Hoofddorp, Netherlands
| | - Dees P. M. Brandjes
- Department of Vascular Medicine, Amsterdam University Medical Centers (UMCs), Amsterdam, Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers (UMCs), Amsterdam, Netherlands
| | - Victor E. A. Gerdes
- Department of Vascular Medicine, Amsterdam University Medical Centers (UMCs), Amsterdam, Netherlands
- Department of Internal Medicine, Spaarne Hospital, Hoofddorp, Netherlands
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15
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Abed Al Ahad M, Demšar U, Sullivan F, Kulu H. The spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnic groups in the United Kingdom: a multilevel longitudinal analysis. BMC Public Health 2023; 23:897. [PMID: 37189130 DOI: 10.1186/s12889-023-15853-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data to investigate the spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnicity in the United-Kingdom (UK). METHODS Longitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009-2019) were utilized and were linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals' health (Likert scale: 1-5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health. RESULTS Higher concentrations of NO2, SO2, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO2 and SO2 pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO2, SO2, PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals. CONCLUSION Using longitudinal data on individuals' health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals' health, especially for ethnic minorities who are affected the most.
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Affiliation(s)
- Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK.
| | - Urška Demšar
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Hill Kulu
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK
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Thuemmler RJ, Pana TA, Mohamed MO, Poobalan A, Mamas MA, Myint PK. Race and sex disparities in acute outcomes of patients with acute ischemic stroke and diabetes mellitus. A national inpatient sample study. Clin Neurol Neurosurg 2023; 229:107747. [PMID: 37148817 DOI: 10.1016/j.clineuro.2023.107747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Diabetes Mellitus (DM) disproportionately affects racial minority groups and is a well-established risk factor for ischemic stroke and worse stroke outcomes. Whether racial disparities exist in acute outcomes of patients presenting with Acute Ischemic Stroke (AIS) and comorbid DM, including potential differences in the administration of evidence-based reperfusion therapy, remains unclear. We aimed to assess whether racial and sex differences exist in the acute outcomes and treatment of patients with DM presenting with AIS. METHODS January 2016-December 2018 AIS admissions with diabetes were extracted from the US National Inpatient Sample (NIS). Multivariable logistic regressions assessed the association between race, sex, and differences in in-hospital outcomes (mortality, hospitalisation >4 days, routine discharge, and stroke severity). Further models assessed the relationship between race, sex, and receipt of thrombolysis and thrombectomy. All models were adjusted for relevant confounders, including comorbidities and stroke severity. RESULTS 92,404 records representative of 462,020 admissions were extracted. Median (IQR) age was 72 (61-79), with 49 % women, 64 % White, 23 % African American, and 10 % Hispanic patients. African Americans had lower odds of in-hospital mortality compared to Whites (adjusted odds ratio; 99 % confidence interval=0.72;0.61-0.86), but were more likely to have prolonged hospitalisation (1.46;1.39-1.54), be discharged to locations other than home (0.78;0.74-0.82) and have moderate/severe stroke (1.17;1.08-1.27). Additionally, African American (0.76;0.62-0.93) and Hispanic patients (0.66;0.50-0.89) had lower odds of receiving thrombectomy. Compared to men, women had increased odds of in-hospital mortality (1.15;1.01-1.32). CONCLUSIONS Racial and sex disparities exist in both evidence-based reperfusion therapy and in-hospital outcomes amongst patients with AIS and diabetes. Further measures are needed to address these disparities and reduce the excess risk of adverse outcomes among women and African American patients.
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Affiliation(s)
- Rosa J Thuemmler
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom; Aberdeen Cardiovascular and Diabetes Centres Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.
| | - Tiberiu A Pana
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom; Aberdeen Cardiovascular and Diabetes Centres Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Amudha Poobalan
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Phyo K Myint
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom; Aberdeen Cardiovascular and Diabetes Centres Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Avgerinos I, Karagiannis T, Liakos A, Tsapas A, Bekiari E. Racial, ethnic and sex disparities among participants in cardiovascular outcomes trials in type 2 diabetes: A systematic review and descriptive analysis. Diabetes Obes Metab 2023; 25:618-622. [PMID: 36260699 DOI: 10.1111/dom.14900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Ioannis Avgerinos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention. J Community Health 2023; 48:141-151. [PMID: 36326989 PMCID: PMC9632564 DOI: 10.1007/s10900-022-01151-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.
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Jenks JD, Aneke CI, Al-Obaidi MM, Egger M, Garcia L, Gaines T, Hoenigl M, Thompson GR. Race and ethnicity: Risk factors for fungal infections? PLoS Pathog 2023; 19:e1011025. [PMID: 36602962 DOI: 10.1371/journal.ppat.1011025] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Racial and ethnic identities, largely understood as social rather than biologic constructs, may impact risk for acquiring infectious diseases, including fungal infections. Risk factors may include genetic and immunologic differences such as aberrations in host immune response, host polymorphisms, and epigenomic factors stemming from environmental exposures and underlying social determinants of health. In addition, certain racial and ethnic groups may be predisposed to diseases that increase risk for fungal infections, as well as disparities in healthcare access and health insurance. In this review, we analyzed racial and ethnic identities as risk factors for acquiring fungal infections, as well as race and ethnicity as they relate to risk for severe disease from fungal infections. Risk factors for invasive mold infections such as aspergillosis largely appear related to environmental differences and underlying social determinants of health, although immunologic aberrations and genetic polymorphisms may contribute in some circumstances. Although black and African American individuals appear to be at high risk for superficial and invasive Candida infections and cryptococcosis, the reasons for this are unclear and may be related to underling social determinants of health, disparities in access to healthcare, and other socioeconomic disparities. Risk factors for all the endemic fungi are likely largely related to underlying social determinants of health, socioeconomic, and health disparities, although immunologic mechanisms likely play a role as well, particularly in disseminated coccidioidomycosis.
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Affiliation(s)
- Jeffrey D Jenks
- Durham County Department of Public Health, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Chioma Inyang Aneke
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Matthias Egger
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Lorena Garcia
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, California, United States of America
| | - Tommi Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, California, United States of America
| | - Martin Hoenigl
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, California, United States of America
| | - George R Thompson
- University of California Davis Center for Valley Fever, Sacramento, California, United States of America
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
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20
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Russell AM, Opsasnick L, Yoon E, Bailey SC, O'Brien M, Wolf MS. Association between medication regimen complexity and glycemic control among patients with type 2 diabetes. J Am Pharm Assoc (2003) 2022; 63:769-777. [PMID: 36682933 DOI: 10.1016/j.japh.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/02/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and comorbid conditions require patients to take complex medication regimens. Greater regimen complexity has been associated with poorer T2DM management; however, the relationship between overall regimen complexity and glycemic control is unclear. OBJECTIVES Our objectives were: (1) to examine associations between regimen complexity (with the Medication Regimen Complexity Index [MRCI]) and glycemic control (A1C), and (2) to compare overall MRCI with other measures of regimen complexity (overall and diabetes-specific medication count) and diabetes-specific MRCI. METHODS This was a secondary data analysis of cross-sectional data from a parent trial. Participants were patients with T2DM taking at least 3 chronic medications followed in safety net clinics in the Chicago area. The MRCI measures complexity based on dosing frequency, route of administration, and special instructions for prescribed medications. MRCI scores were created for overall regimens and diabetes-specific medications. Sociodemographics and outpatient visit utilization were included in models as covariates. Linear regression was used to examine the associations between variables of interest and hemoglobin A1C. RESULTS Participants (N = 432) had a mean age of 56.9 years, most were female (66.0%), and Hispanic or Latino (73.3%). Regimen complexity was high based on overall medications (mean = 6.6 medications, SD: 3.09) and MRCI (mean = 21.4, SD: 11.3). Higher diabetes-specific MRCI was associated with higher A1C in bivariate and multivariable models. In multivariable models, overall MRCI greater than 14, fewer outpatient health care visits, male gender, and absence of health insurance were independently associated with higher A1C. The variance in A1C explained by MRCI was higher compared to medication count for overall and diabetes-specific regimen complexity. CONCLUSIONS More complex regimens are associated with worse A1C and measuring complexity with MRCI may have advantages. Deprescribing, increasing insurance coverage, and promoting engagement in health care may improve A1C among underserved populations with complex regimens.
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21
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Lowry S, Goff L, Irwin S, Brady O, Curran N, Lelliott Z, Sevdalis N, Walker A. Mixed-methods implementation study of a virtual culturally tailored diabetes self-management programme for African and Caribbean communities (HEAL-D) in south London and its scaling up across NHS regions in England: study protocol. BMJ Open 2022; 12:e067161. [PMID: 36351722 PMCID: PMC9644082 DOI: 10.1136/bmjopen-2022-067161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The National Health Service Insight Prioritisation Programme was established to accelerate the implementation and evaluation of innovation that supports post-pandemic working. Supporting this, the Academic Health Science Network and National Institute for Health and Care Research Applied Research Collaboration in South London are testing and evaluating the implementation and scale-up of a type 2 diabetes (T2D) intervention.T2D is estimated to be three times more prevalent in UK African and Caribbean communities than in white Europeans. To tackle ethnic inequities in T2D healthcare access, an evidence-based, culturally tailored self-management and education programme for African and Caribbean adults (Healthy Eating & Active Lifestyles for Diabetes, HEAL-D) has been codeveloped with people with lived experience. Initially a face-to-face programme, HEAL-D pivoted to virtual delivery in response to COVID-19.The purpose of this study is to explore the (1) feasibility and acceptability of a virtual delivery model for HEAL-D in south London and (2) factors affecting its scale-up across other areas in England. METHODS AND ANALYSIS The study will have two strands: (1) mixed-methods prospective evaluation of HEAL-D virtual delivery in south London using routinely collected service-level data, service delivery staff and service user interviews and observations; and (2) prospective qualitative study of the scale-up of this virtual delivery comprising interviews and focus groups with members of the public, and diabetes services commissioners and providers across England. Qualitative data will be analysed using thematic analysis. Quantitative analysis will use descriptive statistics and reporting summary tables and figures. The study will be grounded in well-established implementation frameworks and service user involvement. ETHICS AND DISSEMINATION 'Minimal Risk Registration' ethical clearance was granted by King's College London's Research Ethics Office (ref: MRA-21/22-28498). Results will be published in a peer-reviewed journal and summaries provided to the study funders and participants.
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Affiliation(s)
| | - Louise Goff
- Department of Nutritional Sciences, Kings College London, London, UK
| | | | | | | | | | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
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22
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Chen ZZ, Pacheco JA, Gao Y, Deng S, Peterson B, Shi X, Zheng S, Tahir UA, Katz DH, Cruz DE, Ngo D, Benson MD, Robbins JM, Guo X, del Rocio Sevilla Gonzalez M, Manning A, Correa A, Meigs JB, Taylor KD, Rich SS, Goodarzi MO, Rotter JI, Wilson JG, Clish CB, Gerszten RE. Nontargeted and Targeted Metabolomic Profiling Reveals Novel Metabolite Biomarkers of Incident Diabetes in African Americans. Diabetes 2022; 71:2426-2437. [PMID: 35998269 PMCID: PMC9630088 DOI: 10.2337/db22-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Nontargeted metabolomics methods have increased potential to identify new disease biomarkers, but assessments of the additive information provided in large human cohorts by these less biased techniques are limited. To diversify our knowledge of diabetes-associated metabolites, we leveraged a method that measures 305 targeted or "known" and 2,342 nontargeted or "unknown" compounds in fasting plasma samples from 2,750 participants (315 incident cases) in the Jackson Heart Study (JHS)-a community cohort of self-identified African Americans-who are underrepresented in omics studies. We found 307 unique compounds (82 known) associated with diabetes after adjusting for age and sex at a false discovery rate of <0.05 and 124 compounds (35 known, including 11 not previously associated) after further adjustments for BMI and fasting plasma glucose. Of these, 144 and 68 associations, respectively, replicated in a multiethnic cohort. Among these is an apparently novel isomer of the 1-deoxyceramide Cer(m18:1/24:0) with functional geonomics and high-resolution mass spectrometry. Overall, known and unknown metabolites provided complementary information (median correlation ρ = 0.29), and their inclusion with clinical risk factors improved diabetes prediction modeling. Our findings highlight the importance of including nontargeted metabolomics methods to provide new insights into diabetes development in ethnically diverse cohorts.
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Affiliation(s)
- Zsu-Zsu Chen
- Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard School of Medicine, Boston, MA
| | | | - Yan Gao
- University of Mississippi Medical Center, Jacksonville, MS
| | - Shuliang Deng
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Bennet Peterson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Xu Shi
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shuning Zheng
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Usman A. Tahir
- Harvard School of Medicine, Boston, MA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Daniel H. Katz
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Daniel E. Cruz
- Harvard School of Medicine, Boston, MA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Debby Ngo
- Harvard School of Medicine, Boston, MA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mark D. Benson
- Harvard School of Medicine, Boston, MA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jeremy M. Robbins
- Harvard School of Medicine, Boston, MA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Magdalena del Rocio Sevilla Gonzalez
- Harvard School of Medicine, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Alisa Manning
- Harvard School of Medicine, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Adolfo Correa
- University of Mississippi Medical Center, Jacksonville, MS
| | - James B. Meigs
- Harvard School of Medicine, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Stephen S. Rich
- University of Virginia School of Medicine, Charlottesville, VA
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - James G. Wilson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Robert E. Gerszten
- Harvard School of Medicine, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Goodspeed E, Dunn HK, Pearlman DN. Virtual Delivery of World Diabetes Day During COVID-19: Lessons Learned from the Field. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2120579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Huang S, Ash GI, Nam S, Jeon S, McMahon E, Whittemore R. Objectively-Measured Physical Activity and Sedentary Behaviors and Related Factors in Chinese Immigrants in the US with Prior Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811409. [PMID: 36141683 PMCID: PMC9517195 DOI: 10.3390/ijerph191811409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 05/24/2023]
Abstract
Chinese immigrants in the US are disproportionately affected by gestational diabetes mellitus (GDM) and type 2 diabetes (T2D). The aims of this study were to describe their physical activity (PA) and sedentary behaviors (SB) patterns and to identify determinates of objectively-measured PA and SB among Chinese immigrants in the US with prior GDM. We conducted a cross-sectional study among 106 Chinese immigrants with prior GDM across the US. PA and SB were measured by GT9X+ hip accelerometers for 7 consecutive days. Validated questionnaires in English and Chinese were used to assess knowledge and risk perceptions as well as cultural and psychosocial characteristics. Descriptive, bivariate, and multiple regression analyses were performed. Only 27% of participants met the PA guidelines. The median duration of moderate-vigorous-intensity PA (MVPA) per week was 79 (IQR 38-151) minutes. Participants had an average of 9.2 ± 1.4 h of sedentary time per day. Living with parents (who may provide family support) was associated with more MVPA minutes per week, more steps per day, and a greater likelihood of meeting PA guidelines. Higher levels of acculturative stress were associated with fewer MVPA minutes per week. Being employed and having a lower BMI were associated with more SB. Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing family support. Different strategies are needed to decrease SB among this population.
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Affiliation(s)
- Shuyuan Huang
- Rutgers-NYU Center for Asian Health Promotion and Equity, NYU Rory Meyers College of Nursing, New York, NY 10010, USA
| | - Garrett I. Ash
- Pain Research, Informatics, Multi-Morbidities, and Education (PRIME), VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Soohyun Nam
- Yale School of Nursing, Yale University, West Haven, CT 06477, USA
| | - Sangchoon Jeon
- Yale School of Nursing, Yale University, West Haven, CT 06477, USA
| | - Erin McMahon
- College of Nursing, The University of Arizona, Tucson, AZ 85721, USA
| | - Robin Whittemore
- Yale School of Nursing, Yale University, West Haven, CT 06477, USA
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Akushevich I, Kolpakov S, Yashkin AP, Kravchenko J. Vulnerability to Hypertension Is a Major Determinant of Racial Disparities in Alzheimer's Disease Risk. Am J Hypertens 2022; 35:745-751. [PMID: 35581146 PMCID: PMC9340628 DOI: 10.1093/ajh/hpac063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/15/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Higher incidence levels of Alzheimer's disease (AD) in Black Americans are well documented. However, quantitative explanations of this disparity in terms of risk-factor diseases acting through well-defined pathways are lacking. METHODS We applied a Blinder-Oaxaca-based algorithm modified for censored data to a 5% random sample of Medicare beneficiaries age 65+ to explain Black/White disparities in AD risk in terms of differences in exposure and vulnerability to morbidity profiles based on 10 major AD-risk-related diseases. RESULTS The primary contribution to racial disparities in AD risk comes from morbidity profiles that included hypertension with about 1/5th of their contribution due to differences in prevalence (exposure effect) and 4/5ths to differences in the effects of the morbidity profile on AD risk (vulnerability effect). In total, disease-related effects explained a higher proportion of AD incidence in Black Americans than in their White counterparts. CONCLUSIONS Disease-related causes may represent some of the most straightforward targets for targeted interventions aimed at the reduction of racial disparities in health among US older adults. Hypertension is a manageable and potentially preventable condition responsible for the majority of the Black/White differences in AD risk, making mitigation of the role of this disease in engendering higher AD incidence in Black Americans a prominent concern.
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Affiliation(s)
| | - Stanislav Kolpakov
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina, USA
| | | | - Julia Kravchenko
- Department of Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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26
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Speight J, Baptista S, Lee C, Sher L, Skinner TC, Brown A. The Social and Emotional Well-being of Indigenous Peoples Living With Diabetes: A Systematic Review Protocol. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:902395. [PMID: 36992776 PMCID: PMC10012064 DOI: 10.3389/fcdhc.2022.902395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022]
Abstract
IntroductionGlobally, Indigenous people have a greater incidence and earlier onset of diabetes than the general population and have higher documented rates of emotional distress and mental illness. This systematic review will provide a synthesis and critical appraisal of the evidence focused on the social and emotional well-being of Indigenous peoples living with diabetes, including prevalence, impact, moderators, and the efficacy of interventions.MethodsWe will search MEDLINE Complete, EMBASE, APA PsycINFO, and CINAHL Complete from inception until late April 2021. Search strategies will include keywords related to Indigenous peoples, diabetes, and social and emotional well-being. All abstracts will be rated independently by two researchers against specified inclusion criteria. Eligible studies will report social and emotional well-being data for Indigenous people with diabetes, and/or report on the efficacy of interventions designed to address social and emotional well-being in this population. For each eligible study, quality will be rated using standard checklists to appraise each study’s internal validity, to be determined based on study type. Any discrepancies will be resolved through discussions and consultation with other investigators as needed. We expect to present a narrative synthesis of the evidence.DiscussionThe findings of the systematic review will enable greater understanding of the impact of relationships between diabetes and emotional well-being among Indigenous peoples to inform research, policy and practice. The findings will be accessible to Indigenous people affected by diabetes through a summary published in plain language on our research centre’s website.Systematic Review RegistrationPROSPERO registration number: CRD42021246560.
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Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Shaira Baptista
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Shaira Baptista,
| | - Christopher Lee
- First Nations Diabetes consumer and advocate, Melbourne, VIC, Australia
| | - Louisa Sher
- Library, Deakin University, Geelong, VIC, Australia
| | - Timothy C. Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- LaTrobe University, Melbourne, VIC, Australia
| | - Alex Brown
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
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Talbo MK, Katz A, Dostie M, Legault L, Brazeau AS. Associations between socioeconomic status and patient experience with type 1 diabetes management and complications: cross-sectional analysis of a cohort from Quebec, Canada. Can J Diabetes 2022; 46:569-577. [DOI: 10.1016/j.jcjd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
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28
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Enyioha C, Hall M, Voisin C, Jonas D. Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review. JMIR Public Health Surveill 2022; 8:e25890. [PMID: 35119368 PMCID: PMC8857702 DOI: 10.2196/25890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/05/2021] [Accepted: 10/14/2021] [Indexed: 11/14/2022] Open
Abstract
Background Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes.
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Affiliation(s)
- Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Hall
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christiane Voisin
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Jonas
- Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
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Hu L, Trinh-Shevrin C, Islam N, Wu B, Cao S, Freeman J, Sevick MA. Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study. JMIR Aging 2022; 5:e27355. [PMID: 35107426 PMCID: PMC9135111 DOI: 10.2196/27355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 12/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group.
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Affiliation(s)
- Lu Hu
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Shimin Cao
- Charles B Wang Community Health Center, New York, NY, United States
| | - Jincong Freeman
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
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Ishikawa Y, Lewis RD, Laing EM, Anderson AK, Zhang D, Quyyumi AA, Dunbar SB, Trivedi-Kapoor R, Sattler ELP. Prevalence and trends of type 2 diabetes mellitus and prediabetes among community-dwelling heart failure patients in the United States. Diabetes Res Clin Pract 2022; 184:109191. [PMID: 35041861 DOI: 10.1016/j.diabres.2022.109191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 12/28/2022]
Abstract
AIMS This study estimated national prevalence and trends of diagnosed and undiagnosed type 2 diabetes mellitus (T2DM) and prediabetes among heart failure (HF) patients in the U.S. METHODS This cross-sectional study included 527 participants aged 20+ years with a diagnosis of HF, using data from the National Health and Nutrition Examination Survey 2005-2016. We assessed prevalence estimates of diagnosed and undiagnosed T2DM and prediabetes stratified by age-standardized sociodemographic and health characteristics. Trends of T2DM and prediabetes prevalence were examined using logistic regressions. RESULTS Prevalence rates of diagnosed and undiagnosed T2DM among HF patients were 34.7% (95% confidence interval (CI), 29.2-40.3%) and 12.8% (95% CI, 9.2-16.9%), respectively. Prediabetes affected 39.1% (95% CI, 33.6-44.9%) of HF patients. Prevalence estimates of diagnosed T2DM were significantly different between non-Hispanic White (20.1% [95% CI, 13.5-27.6%]) and Hispanic participants (52.1% [95% CI, 35.9-68.0%]) (P < 0.001). The prevalence of T2DM and prediabetes did not significantly change between 2005 and 2016. CONCLUSIONS Prevalence rates of T2DM and prediabetes among community-dwelling HF patients in the U.S. remained high between 2005 and 2016. Prevention of and targeted intervention for T2DM among at-risk HF patients is needed, particularly among those of Hispanic origin.
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Affiliation(s)
- Yuta Ishikawa
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia. 305 Sanford Drive, Dawson Hall, Athens, GA 30605, USA.
| | - Richard D Lewis
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia. 305 Sanford Drive, Dawson Hall, Athens, GA 30605, USA.
| | - Emma M Laing
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia. 305 Sanford Drive, Dawson Hall, Athens, GA 30605, USA.
| | - Alex K Anderson
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia. 305 Sanford Drive, Dawson Hall, Athens, GA 30605, USA.
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia. 100 Foster Road, Wright Hall, Athens, GA 30606, USA.
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University. 1462 Clifton Road N.E. Suite 507, Atlanta, GA 30322, USA.
| | - Sandra B Dunbar
- Department of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University. 1520 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Rupal Trivedi-Kapoor
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia. 250 West Green Street, R.C. Wilson Pharmacy, Athens, GA 30602, USA.
| | - Elisabeth L P Sattler
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia. 305 Sanford Drive, Dawson Hall, Athens, GA 30605, USA; Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia. 250 West Green Street, R.C. Wilson Pharmacy, Athens, GA 30602, USA.
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Elhussein A, Anderson A, Bancks MP, Coday M, Knowler WC, Peters A, Vaughan EM, Maruthur NM, Clark JM, Pilla S. Racial/ethnic and socioeconomic disparities in the use of newer diabetes medications in the Look AHEAD study. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100111. [PMID: 35291207 PMCID: PMC8920048 DOI: 10.1016/j.lana.2021.100111] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022]
Abstract
Background Among patients with type 2 diabetes, minority racial/ethnic groups have a higher burden of cardiovascular disease, chronic kidney disease, and hypoglycaemia. These groups may especially benefit from newer diabetes medication classes, but high cost may limit access. We examined the association of race/ethnicity with the initiation of newer diabetes medications (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors). Methods We conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) trial including participants with at least one study visit after April 28, 2005. Cox proportional hazards models were used to estimate the association between race/ethnicity and socioeconomic factors with time to initiation of any newer diabetes medication from April 2005 to February 2020. Models were adjusted for demographic and clinical characteristics. Findings Among 4,892 participants, 63.6%, 15.7%, 12.6%, 5.2%, and 2.9% were White, Black, Hispanic, American Indian or Alaskan Native (AI/AN), or other race/ethnicity, respectively. During a median follow-up of 8.3 years, 2,180 (45.2%) participants were initiated on newer diabetes medications. Race/ethnicity was associated with newer diabetes medication initiation (p=.019). Specifically, initiation was lower among Black (HR 0.81, 95% CI 0.70 -0.94) and AI/AN participants (HR 0.51, 95% CI 0.26-0.99). Yearly family income was inversely associated with initiation of newer diabetes medications (HR 0.78, 95% CI 0.62-0.98) comparing the lowest and highest income groups. Findings were mostly driven by GLP-1 receptor agonists. Interpretation These findings provide evidence of racial/ethnic disparities in the initiation of newer diabetes medications, independent of socioeconomic factors, which may contribute to worse health outcomes.
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Affiliation(s)
- Ahmed Elhussein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Anderson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mace Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Anne Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Nisa M. Maruthur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Jeanne M Clark
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Scott Pilla
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - The Look AHEAD Research Group
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
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Ali MK, Pearson-Stuttard J, Selvin E, Gregg EW. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia 2022; 65:3-13. [PMID: 34837505 PMCID: PMC8660730 DOI: 10.1007/s00125-021-05585-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/03/2021] [Indexed: 12/16/2022]
Abstract
International trends in traditional diabetes complications (cardiovascular, renal, peripheral vascular, ophthalmic, hepatic or neurological diseases) and mortality rates are poorly characterised. An earlier review of studies published up to 2015 demonstrated that most data come from a dozen high-income countries (HICs) in North America, Europe or the Asia-Pacific region and that, in these countries at least, rates of acute glycaemic fluctuations needing medical attention and amputations, myocardial infarction and mortality were all declining over the period. Here, we provide an updated review of published literature on trends in type 2 diabetes complications and mortality in adults since 2015. We also discuss issues related to data collection, analysis and reporting that have influenced global trends in type 2 diabetes and its complications. We found that most data on trends in type 2 diabetes, its complications and mortality come from a small number of HICs with comprehensive surveillance systems, though at least some low- and middle-income countries (LMICs) from Africa and Latin America are represented in this review. The published data suggest that HICs have experienced declines in cardiovascular complication rates and all-cause mortality in people with diabetes. In parallel, cardiovascular complications and mortality rates in people with diabetes have increased over time in LMICs. However, caution is warranted in interpreting trends from LMICs due to extremely sparse data or data that are not comparable across countries. We noted that approaches to case ascertainment and definitions of complications and mortality (numerators) and type 2 diabetes (the denominator) vary widely and influence the interpretation of international data. We offer four key recommendations to more rigorously document trends in rates of type 2 diabetes complications and mortality, over time and worldwide: (1) increasing investments in data collection systems; (2) standardising case definitions and approaches to ascertainment; (3) strengthening analytical capacity; and (4) developing and implementing structured guidelines for reporting of data.
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Affiliation(s)
- Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
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Pilla SJ, Kraschnewski JL, Lehman EB, Kong L, Francis E, Poger JM, Bryce CL, Maruthur NM, Yeh HC. Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002153. [PMID: 34933872 PMCID: PMC8679092 DOI: 10.1136/bmjdrc-2021-002153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/19/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Hypoglycemia is the most common serious adverse effect of diabetes treatment and a major cause of medication-related hospitalization. This study aimed to identify trends and predictors of hospital utilization for hypoglycemia among patients with type 2 diabetes using electronic health record data pooled from six academic health systems. RESEARCH DESIGN AND METHODS This retrospective open cohort study included 549 041 adults with type 2 diabetes receiving regular care from the included health systems between 2009 and 2019. The primary outcome was the yearly event rate for hypoglycemia hospital utilization: emergency department visits, observation visits, or inpatient admissions for hypoglycemia identified using a validated International Classification of Diseases Ninth Revision (ICD-9) algorithm from 2009 to 2014. After the transition to ICD-10 in 2015, we used two ICD-10 code sets (limited and expanded) for hypoglycemia hospital utilization from prior studies. We identified independent predictors of hypoglycemia hospital utilization using multivariable logistic regression analysis with data from 2014. RESULTS Yearly rates of hypoglycemia hospital utilization decreased from 2.7 to 1.6 events per 1000 patients from 2009 to 2014 (p-trend=0.023). From 2016 to 2019, yearly event rates were stable ranging from 5.6 to 6.6, or 6.3 to 7.3, using the limited and expanded ICD-10 code sets, respectively. In 2014, the strongest independent risk factors for hypoglycemia hospital utilization were chronic kidney disease (OR 2.86, 95% CI 2.33 to 3.57), ages 18-39 years (OR 2.43 vs age 40-64 years, 95% CI 1.78 to 3.31), and insulin use (OR 2.13 vs no diabetes medications, 95% CI 1.67 to 2.73). CONCLUSIONS Rates of hypoglycemia hospital utilization decreased from 2009 to 2014 and varied considerably by clinical risk factors such that younger adults, insulin users, and those with chronic kidney disease were at especially high risk. There is a need to validate hypoglycemia ascertainment using ICD-10 codes, which detect a substantially higher number of events compared with ICD-9.
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Affiliation(s)
- Scott J Pilla
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Kraschnewski
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer M Poger
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy L Bryce
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Nisa M Maruthur
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hsin-Chieh Yeh
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, García-Hermoso A. Racial differences in all-cause mortality and future complications among people with diabetes: a systematic review and meta-analysis of data from more than 2.4 million individuals. Diabetologia 2021; 64:2389-2401. [PMID: 34455457 DOI: 10.1007/s00125-021-05554-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to quantify racial/ethnic differences in risk for future diabetic complications and all-cause mortality by performing a meta-analysis of prospective studies. METHODS A systematic search in PubMed and EMBASE was performed from inception to May 2021. Prospective cohort studies that reported HRs and associated 95% CIs of diabetes complications and all-cause mortality among racial/ethnic groups, with White people as the reference group, were included. Study characteristics and HR estimates were extracted from each study. Estimates were pooled using random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman variance estimator. RESULTS A total of 23 studies were included, comprising 2,416,516 individuals diagnosed with diabetes (White 59.3%, Black 11.2%, Asian 1.3%, Hispanic-American 2.4%, Native American 0.2%, East Asian 1.9%, South Asian 0.8%, Pacific Islander 2.3%, Māori 2.4% and others 18.2%). Compared with White individuals with diabetes, individuals of Māori ethnicity were at higher risk for all-cause mortality (HR 1.88 [95% CI 1.61, 2.21]; I2 = 7.1%), Hispanic-American individuals had a significantly lower risk for CVD (HR 0.66 [95% CI 0.53, 0.81]; I2 = 0%) and Black individuals had higher risk for end-stage renal disease (HR 1.54 [95% CI 1.05, 2.24]; I2 = 95.4%). No significant higher risk for diabetes complications was found in other racial/ethnic groups relative to White people. CONCLUSIONS/INTERPRETATION Racial/ethnic differences exist in the risk for future diabetic complications and all-cause mortality. Our results support the use of such categories for international diabetes clinical guideline recommendations until better predictors become available. Efforts to identify high-risk groups and to better control cardiovascular risk factors across ethnically diverse populations are therefore needed. REGISTRATION PROSPERO registration ID CRD42021239274.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago, Chile.
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Goff LM, Moore AP, Harding S, Rivas C. Development of Healthy Eating and Active Lifestyles for Diabetes, a culturally tailored diabetes self-management education and support programme for Black-British adults: A participatory research approach. Diabet Med 2021; 38:e14594. [PMID: 33961307 DOI: 10.1111/dme.14594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS To develop an evidence-based, culturally tailored, diabetes self-management education and support programme for Black-British adults, called Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), using participatory methods to engage key stakeholders in the intervention design process. METHODS Black-British adults living with type 2 diabetes, healthcare professionals and community leaders were engaged in an intervention development study. The intervention structure, format, content and delivery were developed through three phases of participatory research: Phase 1, formative research, involved focus groups and interviews; interactive co-development workshops were conducted in Phase 2; and Phase 3 focused on materials development. RESULTS In Phase 1, focus groups and interviews identified the importance of nurturing collectivism, a reliance on informal sources of information/advice, barriers to attending appointments associated with competing priorities of work, travel and carer commitments, and a preference for directness and simple, clear advice/messages. A priority for healthcare professionals was the intervention embedding within current primary care structures and aligning with incentivised targets/metrics. Phase 2 (workshops) highlighted key requirements: avoidance of medical settings, appropriately trained and culturally knowledgeable educators, flexible appointments, preference for verbal and visual information and avoidance of technical/medical terminology. In Phase 3 (materials development), culturally sensitive videos, short films and information booklets were developed to convey educational messages, and food photography was used to provide culturally relevant dietary advice. CONCLUSIONS Participatory methods provide a means to understand the needs of specific communities. This approach enables the development of healthcare interventions that are sensitive to the needs of service users and providers.
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Affiliation(s)
- Louise M Goff
- Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Amanda P Moore
- Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Seeromanie Harding
- Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Carol Rivas
- Department of Social Science, University College London, London, UK
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Marcondes FO, Cheng D, Alegria M, Haas JS. Are racial/ethnic minorities recently diagnosed with diabetes less likely than white individuals to receive guideline-directed diabetes preventive care? BMC Health Serv Res 2021; 21:1150. [PMID: 34689778 PMCID: PMC8543926 DOI: 10.1186/s12913-021-07146-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus has reached epidemic proportions in the United States. As the prevalence of diabetes continues to rise, the burden of disease is divided unevenly among different populations. Racial/ethnic disparities in diabetes care are pervasive, including the provision of care for prevention of complications. Prevention efforts should be focused on the time that immediately follows a diagnosis of diabetes. The aim of this study was to assess racial/ethnic differences in the receipt of guideline-directed diabetes care for complication prevention by individuals recently diagnosed with diabetes. METHODS We used repeated cross-sections of individuals recently diagnosed with diabetes (within the past 5 years) from the National Health Interview Survey from 2011 to 2017. Multivariate regression was used to estimate the associations between race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic) and guideline-directed process measures for prevention of diabetes complications (visits to an eye and foot specialist, and blood pressure and cholesterol checks by a health professional - each in the prior year). We assessed effect modification of these associations by socioeconomic status (SES). RESULTS In a sample of 7,341 participants, Hispanics had lower rates of having any insurance coverage (75.9 %) than Non-Hispanic Whites (93.2 %) and Blacks (88.1 %; p<0.001). After adjustment for demographics, total comorbidities, SES, and health insurance status, Hispanics were less likely to have an eye exam in the prior year (OR 0.80; (95 % CI 0.65-0.99); p=0.04) and a blood pressure check (OR 0.42; (95 % CI 0.28-0.65); p<0.001) compared to Non-Hispanic Whites. There was no significant effect modification of race/ethnicity by SES. CONCLUSIONS Hispanics recently diagnosed with diabetes were less likely to receive some indicators of guideline-directed care for the prevention of complications. Lack of insurance and SES may partially explain those differences. Future work should consider policy change and providers' behaviors linked to racial/ethnic disparities in diabetes care.
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Affiliation(s)
- Felippe O Marcondes
- Division of General Internal Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, MA, Boston, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, MA, Boston, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, MA, Boston, USA.
- Division of General Internal Medicine, MGH, 100 Cambridge St, Suite 1600, MA, 02114, Boston, USA.
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Busby J, Heaney LG, Brown T, Chaudhuri R, Dennison P, Gore R, Jackson DJ, Mansur AH, Menzies-Gow A, Message S, Niven R, Patel M, Price D, Siddiqui S, Stone R, Pfeffer PE. Ethnic Differences in Severe Asthma Clinical Care and Outcomes: An Analysis of United Kingdom Primary and Specialist Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:495-505.e2. [PMID: 34626858 DOI: 10.1016/j.jaip.2021.09.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care. OBJECTIVE To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom. METHODS We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD). RESULTS A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92). CONCLUSIONS Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.
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Affiliation(s)
- John Busby
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
| | - Liam G Heaney
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, United Kingdom; Belfast Health and Social Care NHS Trust, Belfast, United Kingdom
| | - Thomas Brown
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | | | - Paddy Dennison
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Robin Gore
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, United Kingdom; Asthma UK Centre, King's College London, London, United Kingdom
| | - Adel H Mansur
- University of Birmingham and Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | | | - Simon Message
- Gloucester Royal Hospital, Gloucester, United Kingdom
| | - Rob Niven
- Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Mitesh Patel
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - David Price
- Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Salman Siddiqui
- NIHR Leicester Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Robert Stone
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, United Kingdom
| | - Paul E Pfeffer
- Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Goff LM, Rivas C, Moore A, Beckley-Hoelscher N, Reid F, Harding S. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: a randomized controlled feasibility trial. BMJ Open Diabetes Res Care 2021; 9:e002438. [PMID: 34518159 PMCID: PMC8438730 DOI: 10.1136/bmjdrc-2021-002438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Black-British communities are disproportionately affected by type 2 diabetes (T2D). Structured education programs are a core component of T2D healthcare but they are less successful in people from minority ethnic groups. Culturally tailored T2D education has demonstrated greater benefits than usual care. The aim of our study was to evaluate acceptability, fidelity and trial feasibility of the Healthy Eating and Active Lifestyles for Diabetes ('HEAL-D') culturally tailored T2D self-management education and support (DSMES) program. RESEARCH DESIGN AND METHODS A mixed-methods randomized controlled feasibility trial in black-British adults with T2D was conducted. Participants were assigned to control (usual care) or intervention (HEAL-D; 7 sessions, 14 hours of group-based culturally tailored diet and lifestyle education, behavior change support and supervised physical activity), in a ratio of 1:1. Primary outcomes were recruitment and retention rates, intervention attendance and completion. Fidelity was assessed through observations and qualitative evaluation was undertaken with participants and educators. RESULTS 102 patients responded to invitation letters (n=1335); 63 were randomized but 8 were subsequently deemed ineligible due to high baseline glycosylated hemoglogin (HbA1c) requiring intensive medical management or missing baseline HbA1c measurement. Of the remaining 55 participants (27 intervention, 28 control), 69% were female, 47% were of African and 51% were of Caribbean ethnicity. 93% completed the trial, providing end point data. Intervention attendance was high; 85% completed the program (attendance at ≥5 sessions), and 74% attended ≥6 sessions. The intervention was delivered with acceptable fidelity, although the qualitative evaluations identified some areas of structure and format in need of refinement. CONCLUSIONS We have shown it is feasible to recruit and randomize black-British adults with T2D to a trial of a culturally tailored DSMES program. We have shown the intervention is highly acceptable for both patients and healthcare providers. A future trial should assess clinical and cost-effectiveness of HEAL-D. TRIAL REGISTRATION NUMBER NCT03531177.
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Affiliation(s)
- Louise M Goff
- Department of Nutritional Sciences, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Carol Rivas
- Social Research Institute, University College London, London, UK
| | - Amanda Moore
- Department of Nutritional Sciences, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | | | - Fiona Reid
- Population Health, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Seeromanie Harding
- Department of Nutritional Sciences, King's College London, Faculty of Life Sciences and Medicine, London, UK
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Das-Munshi J, Schofield P, Ashworth M, Gaughran F, Hull S, Ismail K, Robson J, Stewart R, Mathur R. Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years. BMJ Open Diabetes Res Care 2021; 9:e002118. [PMID: 34497046 PMCID: PMC8438718 DOI: 10.1136/bmjdrc-2021-002118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/29/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Using data from a a primary care pay-for-performance scheme targeting quality indicators, the objective of this study was to assess if people living with type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMI) experienced poorer glycemic management compared with people living with T2DM alone, and if observed differences varied by race/ethnicity, deprivation, gender, or exclusion from the scheme. RESEARCH DESIGN AND METHODS Primary care data from a cohort of 56 770 people with T2DM, including 2272 people with T2DM and SMI, from London (UK), diagnosed between January 17, 2008 and January 16, 2018, were used. Adjusted mean glycated hemoglobin (HbA1c) and HbA1c differences were assessed using multilevel regression models. RESULTS Compared with people with T2DM only, people with T2DM/SMI were more likely to be of an ethnic minority background, excluded from the pay-for-performance scheme and residing in more deprived areas. Across the sample, mean HbA1c was lower in those with T2DM and SMI (mean HbA1c: 58 mmol/mol; 95% CI 57 to 59), compared with people with T2DM only (mean HbA1c: 59 mmol/mol; 95% CI 59 to 60). However, HbA1c levels were greater in Bangladeshi, Indian, Pakistani, and Chinese people compared with the White British reference in the T2DM/SMI group. People with T2DM/SMI who had been excluded from the pay-for-performance scheme, had HbA1c levels which were +7 mmol/mol (95% CI 2 to 11) greater than those with T2DM/SMI not excluded. Irrespective of SMI status, increasing deprivation and male gender were associated with increased HbA1c levels. CONCLUSIONS Despite a pay-for-performance scheme to improve quality standards, inequalities in glycemic management in people with T2DM and SMI persist in those excluded from the scheme and by gender, ethnicity, and area-level deprivation.
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Affiliation(s)
- Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
- South London and Maudsley (SLaM) NHS Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Peter Schofield
- School of Population Health & Environmental Sciences, King's College London, Faculty of Life Sciences & Medicine (FOLSM), London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College London, Faculty of Life Sciences & Medicine (FOLSM), London, UK
| | - Fiona Gaughran
- South London and Maudsley (SLaM) NHS Trust, London, UK
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Sally Hull
- Clinical Effectiveness Group, Institute of Population Health Sciences, Queen Mary, University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
- South London and Maudsley (SLaM) NHS Trust, London, UK
| | - John Robson
- Clinical Effectiveness Group, Institute of Population Health Sciences, Queen Mary, University of London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
- South London and Maudsley (SLaM) NHS Trust, London, UK
| | - Rohini Mathur
- Clinical Effectiveness Group, Institute of Population Health Sciences, Queen Mary, University of London, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Personalized Behavioral Nutrition Among Older Asian Americans: Study Protocol. Nurs Res 2021; 70:317-322. [PMID: 34160184 DOI: 10.1097/nnr.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Metabolomics profiling is an objective assessment of metabolic responses to intricate dietary patterns. However, few studies have investigated the potential benefits associated with personalized behavioral nutrition (PBN) interventions incorporating the metabolomics approach for improving diabetes outcomes for older Asian Americans with Type 2 diabetes. OBJECTIVE This article describes the protocol for a pilot study testing self-management of a nutrition intervention-provided personalized dietary advice incorporating metabolites phenotypic feedback and digital self-monitoring of diet and blood glucose. METHODS A total of 60 older Asian Americans will be randomized into two groups: a PBN group and a control group. Participants in the PBN group will receive personalized dietary advice based on dietary and phenotypic feedback-used metabolic profiles. This study aims to examine the feasibility and preliminary effects of the PBN on diabetes outcomes. RESULTS The study began in September 2020, with estimated complete data collection by late 2021. DISCUSSION Findings from this pilot study will inform future research for developing personalized nutrition interventions for people with Type 2 diabetes.
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Zang E, Lynch SM, Liu C, Lu N, Banas J. Racial/Ethnic and Educational Disparities in the Impact of Diabetes on Population Health among the US-Born Population. J Gerontol B Psychol Sci Soc Sci 2021; 77:1519-1528. [PMID: 34374764 DOI: 10.1093/geronb/gbab149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines total life expectancies (TLE) for both healthy and diabetic US-born populations and two measures capturing quality of life: 1) the proportion of remaining life to be spent without either other chronic conditions or ADL disabilities (ADLs), and 2) the proportion of remaining life to be spent with ADLs for US-born diabetic populations by race/ethnicity and educational attainment. METHODS Using the 1998-2014 waves of the Health and Retirement Study (n=16,983), we apply a Bayesian multistate life table method to calculate these quantities from the constructed life tables. RESULTS TLE at age 50 is shorter for diabetic individuals than healthy individuals, for non-Hispanic Blacks than members of other racial/ethnic groups, and for less-educated individuals. Gaps in TLE at age 50 between healthy and diabetic populations range from 6.3 to 8.8 years across sex-race combinations, and 5.6 to 9.2 years across sex-education combinations. Among the diabetic population, those with at least a college degree on average have a higher proportion of remaining life to be spent without either other chronic conditions or ADLs. Hispanics and those without a college degree have a particularly high proportion of remaining life to be spent with ADLs. Although diabetic women on average live longer than men, their quality of life tends to be lower. DISCUSSION The impact of diabetes on population health varies across racial/ethnic and educational groups. The findings support targeted interventions for vulnerable groups, such as people of color, women, and less-educated individuals.
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Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, New Haven, CT
| | - Scott M Lynch
- Department of Sociology, Duke University, Durham, NC.,Duke University Population Research Institute, Duke University, Durham, NC.,Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Chen Liu
- Department of Biostatistics, Yale University, New Haven, CT
| | - Nancy Lu
- Harvard Medical School, Harvard University, Boston, MA
| | - Julia Banas
- Department of Epidemiology, Yale University, New Haven, CT
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Khalid SI, Maasarani S, Shanker RM, Becerra AZ, Omotosho P, Torquati A. Social determinants of health and their impact on rates of postoperative complications among patients undergoing vertical sleeve gastrectomy. Surgery 2021; 171:447-452. [PMID: 34303546 DOI: 10.1016/j.surg.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vertical sleeve gastrectomy is one of the most common bariatric procedures worldwide, but the impact of social determinants of health on postoperative outcomes for this procedure has not been well characterized. The objective of this study was to analyze the impact that social determinants of health have on postoperative outcomes after vertical sleeve gastrectomy. METHOD This was a population-based study using the MARINER-15 database, an all-payer claims database. The primary endpoint of this study was the development of any complication, including cardiac complication, acute kidney injury, deep vein thrombosis, wound complication, hematoma, pneumonia, pulmonary embolism, transfusion, or urinary tract infection within 60 days, 30- and 90-day all-cause mortality, or readmission within 30 or 90 days in patients undergoing vertical sleeve gastrectomy procedures. RESULTS Individuals in the social determinants of health cohort had a significantly longer length of stay when compared with those without social determinants of health (3.07 days vs 1.582 days, P < .001). These patients were more likely to develop any complication within 60 days after surgery (hazard ratio 1.20, 95% confidence interval 1.03-1.40) but were less likely to return for readmission within 30 and 90 days (hazard ratio 0.80, 95% confidence interval 0.66-0.96; hazard ratio 0.85 95% confidence interval 0.72-0.99). CONCLUSION Vertical sleeve gastrectomy is an effective treatment for morbid obesity and its associated comorbidities. Although patients with social determinants of health are more likely to develop any of the analyzed postoperative complications within 60 days, they are less likely to return for readmission, highlighting the importance of focused follow-up and other measures to avoid lapses in care and eliminate further barriers to care in this population.
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Affiliation(s)
- Syed I Khalid
- Department of Surgery, Rush University Medical Center, Chicago, IL; Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
| | - Samantha Maasarani
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. https://twitter.com/smaasarani
| | - Rachyl M Shanker
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL. https://twitter.com/AdanZBecerra1
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, IL. https://twitter.com/RushBariatrics
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, IL. https://twitter.com/RushSurgery
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Seewoodhary J. Black Lives Matter: tackling racial and ethnic inequalities in diabetes health care. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jason Seewoodhary
- BSc (Hons), MBBCh (Hons), MRCP (UK), MSc (Dist), MRCGP (UK), DRCOG (UK), General Practitioner with a Special Interest in Diabetes & Endocrinology, NHS England, UK
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Vyas MV, Chaturvedi N, Hughes AD, Marmot M, Tillin T. Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort. Heart 2021; 107:996-1002. [PMID: 33067326 PMCID: PMC8165149 DOI: 10.1136/heartjnl-2020-317641] [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: 06/24/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Ethnic differences in cardiovascular disease incidence, but not cardiovascular disease recurrence, are reported. We characterised long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a British cohort of South Asians, African Caribbeans and Europeans. METHODS We identified index and recurrent cardiovascular events and mortality between 1988 and 2017 using hospital records and death registry. Using multivariable hazards models, we separately calculated the adjusted HR of MACE and death following index event, adjusting for demographics, vascular and lifestyle risk factors. Using interaction terms, we evaluated if decade of index event modified the association between ethnicity and outcomes. RESULTS South Asians were younger at the index event (median age 66 years, n=396) than Europeans (69 years, n=335) and African Caribbeans (70 years, n=70). During 4228 person-years, of the 801 patients, 537 developed MACE and 338 died, with the highest crude rate of MACE in South Asians. On adjustment of baseline factors, compared with the Europeans, the higher risk of MACE (HR 0.97, 95% CI 0.77 to 1.21) and the lower risk of mortality (HR 0.95, 95% CI 0.72 to 1.26) in South Asians was eliminated. African Caribbeans had similar outcomes to Europeans (HR MACE 1.04, 95% CI 0.74 to 1.47; and HR death 1.07, 95% CI 0.70 to 1.64). Long-term survival following an index event improved in South Asians (ptrend 0.02) and African Caribbeans (ptrend 0.07) compared with Europeans. CONCLUSIONS Baseline vascular risk factors explained the observed ethnic variation in cardiovascular disease recurrence and long-term mortality, with a relative improvement in survival of minority ethnic groups over time.
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Affiliation(s)
- Manav V Vyas
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Michael Marmot
- Epidemiology and Public Health, University College London, London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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do Vale Moreira NC, Ceriello A, Basit A, Balde N, Mohan V, Gupta R, Misra A, Bhowmik B, Lee MK, Zuo H, Shi Z, Wang Y, Montenegro RM, Fernandes VO, Colagiuri S, Boulton AJM, Hussain A. Race/ethnicity and challenges for optimal insulin therapy. Diabetes Res Clin Pract 2021; 175:108823. [PMID: 33887353 DOI: 10.1016/j.diabres.2021.108823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
AIMS We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. METHODS We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: "ethnicity", "diabetes", "insulin", "history of insulin", "insulin therapy", "food/rice", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "insulin sensitivity", "insulin response", "glycaemic index", "glycaemic response", "efficacy and safety", with interposition of the Boolean operator "AND".In addition, we reviewed the reference lists of the articles found. RESULTS The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. CONCLUSIONS Race/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.
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Affiliation(s)
| | | | - Abdul Basit
- Baquai Medical University, Karachi, Pakistan
| | - Naby Balde
- Endocrinology and Diabetes Department, Donka Conakry University Hospital, Conakry, Guinea; Foundation Diabetes and NCD, Conakry, Guinea; International Diabetes Federation, IDF, Brussels, Belgium
| | - V Mohan
- Dr. Mohans Diabetes Specialties Centre, Chennai, India
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Delhi, India
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Moon K Lee
- International Diabetes Federation, IDF, Brussels, Belgium; Division of Endocrinology & Metabolism, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Hui Zuo
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Renan M Montenegro
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil
| | | | - Stephen Colagiuri
- International Diabetes Federation, IDF, Brussels, Belgium; Boden Collaboration, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew J M Boulton
- International Diabetes Federation, IDF, Brussels, Belgium; University of Manchester, UK
| | - Akhtar Hussain
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil; International Diabetes Federation, IDF, Brussels, Belgium; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh; Faculty of Health Sciences, Nord University, Bodø, Norway.
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Shoily SS, Ahsan T, Fatema K, Sajib AA. Common genetic variants and pathways in diabetes and associated complications and vulnerability of populations with different ethnic origins. Sci Rep 2021; 11:7504. [PMID: 33820928 PMCID: PMC8021559 DOI: 10.1038/s41598-021-86801-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
Diabetes mellitus is a complex and heterogeneous metabolic disorder which is often pre- or post-existent with complications such as cardiovascular disease, hypertension, inflammation, chronic kidney disease, diabetic retino- and nephropathies. However, the frequencies of these co-morbidities vary among individuals and across populations. It is, therefore, not unlikely that certain genetic variants might commonly contribute to these conditions. Here, we identified four single nucleotide polymorphisms (rs5186, rs1800795, rs1799983 and rs1800629 in AGTR1, IL6, NOS3 and TNFA genes, respectively) to be commonly associated with each of these conditions. We explored their possible interplay in diabetes and associated complications. The variant allele and haplotype frequencies at these polymorphic loci vary among different super-populations (African, European, admixed Americans, South and East Asians). The variant alleles are particularly highly prevalent in different European and admixed American populations. Differential distribution of these variants in different ethnic groups suggests that certain drugs might be more effective in selective populations rather than all. Therefore, population specific genetic architectures should be considered before considering a drug for these conditions.
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Affiliation(s)
- Sabrina Samad Shoily
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - Tamim Ahsan
- Department of Genetic Engineering & Biotechnology, Bangabandhu Sheikh Mujibur Rahman Maritime University, Dhaka, Bangladesh
| | - Kaniz Fatema
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - Abu Ashfaqur Sajib
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh.
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"A Touch of Sugar": A Qualitative Study of the Impact of Health Beliefs on Type 1 and Type 2 Diabetes Self-Management Among Black Canadian Adults. Can J Diabetes 2021; 45:607-613.e2. [PMID: 33582043 DOI: 10.1016/j.jcjd.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/07/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Black Canadians have higher rates of diabetes and complications compared with White Canadians. However, research on diabetes self-management in this community is lacking. We conducted a qualitative study to explore diabetes self-management in the Black Canadian community using the lens of the Health Belief Model. METHODS Forty-three individuals who identify as Black Canadians, living with or caring for a person with diabetes, were recruited. Data were collected through focus groups and interviews, and then analyzed using content analysis. RESULTS We found that participants appreciated they are susceptible to diabetes based on family or peer experiences. Perceived severity is variable for which some believe that diabetes is only a "sugar problem," and the majority highlighted a perceived lack of knowledge about diabetes complications. Perceived benefits to treatment included prolonging life and cleansing one's body. Perceived barriers included lack of culturally appropriate dietary advice, lack of shared decision-making driven by a language barrier and cultural mismatch between patient and provider, socioeconomic status and difficulty navigating and accessing the Canadian health-care system. Peers, family members, churches and online platforms served as the main information sources and cues to action, influencing each of the 4 aforementioned categories. A number of solutions were proposed by the participants to address the barriers from patient, health-care delivery and health advocacy perspectives. CONCLUSIONS Black Canadians face unique barriers to diabetes self-management, some of which are rooted within health belief systems. Avenues for intervention include peer education through narratives and a renewed focus on providing culturally appropriate care.
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Pham Q, Gamble A, Hearn J, Cafazzo JA. The Need for Ethnoracial Equity in Artificial Intelligence for Diabetes Management: Review and Recommendations. J Med Internet Res 2021; 23:e22320. [PMID: 33565982 PMCID: PMC7904401 DOI: 10.2196/22320] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/02/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
There is clear evidence to suggest that diabetes does not affect all populations equally. Among adults living with diabetes, those from ethnoracial minority communities—foreign-born, immigrant, refugee, and culturally marginalized—are at increased risk of poor health outcomes. Artificial intelligence (AI) is actively being researched as a means of improving diabetes management and care; however, several factors may predispose AI to ethnoracial bias. To better understand whether diabetes AI interventions are being designed in an ethnoracially equitable manner, we conducted a secondary analysis of 141 articles included in a 2018 review by Contreras and Vehi entitled “Artificial Intelligence for Diabetes Management and Decision Support: Literature Review.” Two members of our research team independently reviewed each article and selected those reporting ethnoracial data for further analysis. Only 10 articles (7.1%) were ultimately selected for secondary analysis in our case study. Of the 131 excluded articles, 118 (90.1%) failed to mention participants’ ethnic or racial backgrounds. The included articles reported ethnoracial data under various categories, including race (n=6), ethnicity (n=2), race/ethnicity (n=3), and percentage of Caucasian participants (n=1). Among articles specifically reporting race, the average distribution was 69.5% White, 17.1% Black, and 3.7% Asian. Only 2 articles reported inclusion of Native American participants. Given the clear ethnic and racial differences in diabetes biomarkers, prevalence, and outcomes, the inclusion of ethnoracial training data is likely to improve the accuracy of predictive models. Such considerations are imperative in AI-based tools, which are predisposed to negative biases due to their black-box nature and proneness to distributional shift. Based on our findings, we propose a short questionnaire to assess ethnoracial equity in research describing AI-based diabetes interventions. At this unprecedented time in history, AI can either mitigate or exacerbate disparities in health care. Future accounts of the infancy of diabetes AI must reflect our early and decisive action to confront ethnoracial inequities before they are coded into our systems and perpetuate the very biases we aim to eliminate. If we take deliberate and meaningful steps now toward training our algorithms to be ethnoracially inclusive, we can architect innovations in diabetes care that are bound by the diverse fabric of our society.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anissa Gamble
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Do Diabetes Mellitus Differences Exist within Generations? Three Generations of Moluccans in the Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020493. [PMID: 33435344 PMCID: PMC7827698 DOI: 10.3390/ijerph18020493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
Background: Diabetes mellitus (DM) is known to be more prevalent among migrants compared to their host populations. It is unclear whether DM prevalence differs between generations among migrants. We investigated the differences in DM prevalence among three generations of Moluccans, who have been living for over 65 years in the Netherlands, compared to the Dutch population. Methods: In this cross-sectional study, data of a healthcare insurance database on hospital and medication use (Achmea Health Database) were used. The dataset contained 5394 Moluccans and 52,880 Dutch persons of all ages. DM differences were assessed by means of logistic regression, adjusting for age, sex, urbanization, and area socio-economic status. Results: The prevalence of DM was higher in all generations of Moluccans compared to the Dutch. The adjusted odds ratios (AORs) for DM were significantly higher in total group of Moluccans compared to the Dutch (AOR 1.60, 95% CI 1.42–1.80) and across the first and second generation of Moluccans compared to the Dutch (first generation (1.73, 1.47–2.04) and second generation (1.44, 1.19–1.75). Higher AOR were found for first generation men (1.55, 1.22–1.97) and first (1.90, 1.52–2.37) and second (1.63, 1.24–2.13) generation Moluccan women compared to the Dutch. AOR for the third generation Moluccans was increased to a similar extent (1.51, 0.97–2.34), although not statistical significant. Conclusions: Our findings show higher odds of DM across generations of Moluccans compared to the Dutch. DM prevention strategies for minorities should be targeted at all migrant generations in host countries.
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An J, Nichols GA, Qian L, Munis MA, Harrison TN, Li Z, Wei R, Weiss T, Rajpathak S, Reynolds K. Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e001847. [PMID: 33397671 PMCID: PMC7783518 DOI: 10.1136/bmjdrc-2020-001847] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/06/2020] [Accepted: 11/29/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is a common condition that, if left untreated or poorly managed, can lead to adverse microvascular and macrovascular complications. We estimated the prevalence and incidence of microvascular and macrovascular complications among patients newly diagnosed with T2D within a US integrated healthcare system. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study among patients newly diagnosed with T2D between 2003 and 2014. We evaluated 13 complications, including chronic kidney disease (CKD), cardiovascular disease (CVD), and all-cause mortality through 2018. Multivariable Cox proportional hazards models were used to study factors associated with complications. RESULTS We identified 135 199 patients with incident T2D. The mean age was 58 years, and 48% were women. The prevalence of CKD was the highest of the complications at the time of T2D diagnosis (prevalence=12.3%, 95% CI 12.2% to 12.5%), while the prevalence of CVD was among the lowest at 3.3% (95% CI 3.2% to 3.3%). The median time to incidence of a T2D complication ranged from 3.0 to 5.2 years. High incidence rates (95% CI) of T2D complications included peripheral neuropathy (26.9, 95% CI 26.5 to 27.3 per 1000 person-years (PY)), CKD (21.2, 95% CI 20.9 to 21.6 per 1000 PY), and CVD (11.9, 95% CI 11.7 to 12.2 per 1000 PY). The trend of 5-year incidence rates of T2D complications by diagnosis year decreased over time (p value<0.001). Older age, non-Hispanic white race/ethnicity, sex, higher A1C, smoking, and hypertension were associated with increased CKD and CVD incidence. CONCLUSION Though incidence rates of T2D complications were lower in more recent years (2010-2014), a significant proportion of patients had complications at T2D diagnosis. Earlier preventive therapies as well as managing modifiable factors may help delay the development and progression of T2D complications.
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Affiliation(s)
- Jaejin An
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Gregory A Nichols
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Lei Qian
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mercedes A Munis
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Teresa N Harrison
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Zhuoxin Li
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rong Wei
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Tracey Weiss
- Center for Observational and Real World Evidence, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Swapnil Rajpathak
- Center for Observational and Real World Evidence, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Kristi Reynolds
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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