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Reutrakul S, Park JC, McAnany JJ, Chau FY, Danielson KK, Prasad B, Cross A, Sintetas S, Law J, Pannain S, Pratuangtham S, Van Cauter E, Hanlon EC. Dysregulated 24 h melatonin secretion associated with intrinsically photosensitive retinal ganglion cell function in diabetic retinopathy: a cross-sectional study. Diabetologia 2024:10.1007/s00125-024-06118-3. [PMID: 38413436 DOI: 10.1007/s00125-024-06118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to explore whether diabetic retinopathy is associated with alterations of the circadian system, and to examine the role of reduced intrinsically photosensitive retinal ganglion cell (ipRGC) function. METHODS Participants with type 2 diabetes, with diabetic retinopathy (n=14) and without diabetic retinopathy (n=9) underwent 24 h blood sampling for melatonin and cortisol under controlled laboratory conditions. ipRGC function was inferred from the post-illumination pupil response (PIPR). Habitual sleep duration, efficiency and variability were assessed by actigraphy. RESULTS Participants with diabetic retinopathy compared to participants without diabetic retinopathy had smaller PIPR (p=0.007), lower 24 h serum melatonin output (p=0.042) and greater day-to-day sleep variability (p=0.012). By contrast, 24 h cortisol profiles, sleep duration and efficiency were similar in both groups. Six individuals with diabetic retinopathy had no detectable dim-light melatonin onset. PIPR correlated with 24 h mean melatonin levels (r=0.555, p=0.007). CONCLUSIONS/INTERPRETATION ipRCG dysfunction in diabetic retinopathy is associated with disruptions of the 24 h melatonin rhythm, suggesting circadian dysregulation in diabetic retinopathy.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Felix Y Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Bharati Prasad
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Jessie Brown Department of Veterans Affairs Hospital, Chicago, IL, USA
| | - Andrew Cross
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Stephanie Sintetas
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Julie Law
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Silvana Pannain
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarida Pratuangtham
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Eve Van Cauter
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Erin C Hanlon
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
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Fuller KN, Bohne EM, Mey JT, Blackburn BK, Miranda VR, Varady KA, Danielson KK, Haus JM. Plasma undercarboxylated osteocalcin dynamics with glycemic stress reflects insulin sensitivity and beta-cell function in humans with and without T2DM. Metabol Open 2023; 20:100264. [PMID: 38115864 PMCID: PMC10728569 DOI: 10.1016/j.metop.2023.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
This study aimed to better understand the relationship between bone-related biomarkers and nutrient stress in the context of metabolic health. We investigated plasma osteocalcin (OC) during an oral glucose challenge and experimental hyperinsulinemia in Type 2 diabetes (T2DM) and lean healthy controls (LHC). Older individuals with obesity and T2DM (n = 9) and young LHCs (n = 9) underwent a 75g oral glucose tolerance test (OGTT) and a 40 mU/m2/min hyperinsulinemic-euglycemic clamp. Plasma undercarboxylated OC (ucOC) and total OC were measured at baseline, 60mins, and 120mins of the OGTT and clamp via ELISA. In addition, plasma alkaline phosphatase (ALP), leptin, adiponectin, Vitamin D and insulin were measured and indices of insulin sensitivity and β-cell function were derived. The T2DM group had lower (p<0.05) ucOC and ucOC:total OC ratio than LHC during both the OGTT and clamp. Further, baseline ucOC was positively correlated to indices of β-cell function and negatively correlated to indices of insulin resistance when both groups were combined (all p<0.05). Suppression of OC observed in T2DM may be related to glucose intolerance and insulin resistance. Similarly, our data suggest that the observed phenotypic differences between groups are likely a product of long-term glucose dysregulation rather than acute flux in glucose or insulin.
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Affiliation(s)
- Kelly N.Z. Fuller
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Erin M. Bohne
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, IL, USA
| | - Jacob T. Mey
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Brian K. Blackburn
- Applied Health Sciences and Kinesiology, Humboldt State University, Arcata, CA, USA
| | | | - Krista A. Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, IL, USA
| | - Kirstie K. Danielson
- Division of Endocrinology and Metabolism, University of Illinois at Chicago, IL, USA
| | - Jacob M. Haus
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Mirmira RG, Kulkarni RN, Xu P, Drossos T, Varady K, Knutson KL, Reutrakul S, Martyn-Nemeth P, Sargis RM, Wallia A, Tuchman AM, Weissberg-Benchell J, Danielson KK, Oakes SA, Thomas CC, Layden BT, May SC, Burbea Hoffmann M, Gatta E, Solway J, Philipson LH. Stress and human health in diabetes: A report from the 19 th Chicago Biomedical Consortium symposium. J Clin Transl Sci 2023; 7:e263. [PMID: 38229904 PMCID: PMC10790105 DOI: 10.1017/cts.2023.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/01/2023] [Indexed: 01/18/2024] Open
Abstract
Stress and diabetes coexist in a vicious cycle. Different types of stress lead to diabetes, while diabetes itself is a major life stressor. This was the focus of the Chicago Biomedical Consortium's 19th annual symposium, "Stress and Human Health: Diabetes," in November 2022. There, researchers primarily from the Chicago area met to explore how different sources of stress - from the cells to the community - impact diabetes outcomes. Presenters discussed the consequences of stress arising from mutant proteins, obesity, sleep disturbances, environmental pollutants, COVID-19, and racial and socioeconomic disparities. This symposium showcased the latest diabetes research and highlighted promising new treatment approaches for mitigating stress in diabetes.
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Affiliation(s)
- Raghavendra G. Mirmira
- Department of Medicine, Kovler Diabetes Center, The University of Chicago, Chicago, IL, USA
| | - Rohit N. Kulkarni
- Department of Medicine, Islet Cell and Regenerative Biology, Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Stem Cell Institute, Boston, MA, USA
| | - Pingwen Xu
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Krista Varady
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Kristen L. Knutson
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Robert M. Sargis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Amisha Wallia
- Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kirstie K. Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Scott A. Oakes
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Celeste C. Thomas
- Department of Medicine, Kovler Diabetes Center, The University of Chicago, Chicago, IL, USA
| | - Brian T. Layden
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA
| | - Sarah C. May
- Department of Medicine, Kovler Diabetes Center, The University of Chicago, Chicago, IL, USA
| | | | | | - Julian Solway
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Louis H. Philipson
- Department of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA
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Reutrakul S, McAnany JJ, Park JC, Chau FY, Danielson KK, Prasad B, Pannain S, Hanlon EC. Greater sleep variability is associated with higher systemic inflammation in type 2 diabetes. J Sleep Res 2023:e13989. [PMID: 37414725 PMCID: PMC10770284 DOI: 10.1111/jsr.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
Sleep irregularity and variability have been shown to be detrimental to cardiometabolic health. The present pilot study explored if higher day-to-day sleep irregularity and variability were associated with systemic inflammation, as assessed by high-sensitivity C-reactive protein, in type 2 diabetes. Thirty-five patients with type 2 diabetes (mean age 54.3 years, 54.3% female) who were not shift-workers participated. The presence of diabetic retinopathy was determined. The standard deviation of sleep duration and sleep midpoint across all recorded nights were used to quantify sleep variability and regularity, respectively, assessed by 14-day actigraphy. The presence and severity of sleep apnea were assessed using an overnight home monitor. Low-density lipoprotein, haemoglobin A1C and high-sensitivity C-reactive protein were collected. Multiple regression analysis using natural-log-transformed values was performed to establish an independent association between sleep variability and high-sensitivity C-reactive protein. Twenty-two (62.9%) patients had diabetic retinopathy. The median (interquartile range) of high-sensitivity C-reactive protein was 2.4 (1.4, 4.6) mg L-1 . Higher sleep variability was significantly associated with higher high-sensitivity C-reactive protein (r = 0.342, p = 0.044), as was haemoglobin A1C (r = 0.431, p = 0.010) and low-density lipoprotein (r = 0.379, p = 0.025), but not sleep regularity, sleep apnea severity or diabetic retinopathy. Multiple regression analysis showed that higher sleep variability (B = 0.907, p = 0.038) and higher HbA1c (B = 1.519, p = 0.035), but not low-density lipoprotein, contributed to higher high-sensitivity C-reactive protein. In conclusion, higher sleep variability in patients with type 2 diabetes who were not shift-workers was independently associated with higher systemic inflammation, conferring increased cardiovascular risk. Whether sleep interventions to reduce sleep variability can reduce systemic inflammation and improve cardiometabolic health should be investigated.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - J. Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Jason C. Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Felix Y. Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Kirstie K. Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - Bharati Prasad
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL
- Jesse Brown Department of Veterans Affairs Hospital, Chicago, Illinois
| | - Silvana Pannain
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL
| | - Erin C. Hanlon
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL
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Yazici C, Thaker S, Castellanos KK, Al Rashdan H, Huang Y, Sarraf P, Boulay B, Grippo P, Gaskins HR, Danielson KK, Papachristou GI, Tussing-Humphreys L, Dai Y, Mutlu ER, Layden BT. Diet, Gut Microbiome, and Their End Metabolites Associate With Acute Pancreatitis Risk. Clin Transl Gastroenterol 2023; 14:e00597. [PMID: 37162146 PMCID: PMC10371326 DOI: 10.14309/ctg.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Diet and decreased gut microbiome diversity has been associated with acute pancreatitis (AP) risk. However, differences in dietary intake, gut microbiome, and their impact on microbial end metabolites have not been studied in AP. We aimed to determine differences in (i) dietary intake (ii) gut microbiome diversity and sulfidogenic bacterial abundance, and (iii) serum short-chain fatty acid (SCFA) and hydrogen sulfide (H 2 S) concentrations in AP and control subjects. METHODS This case-control study recruited 54 AP and 46 control subjects during hospitalization. Clinical and diet data and stool and blood samples were collected. 16S rDNA sequencing was used to determine gut microbiome alpha diversity and composition. Serum SCFA and H 2 S levels were measured. Machine learning (ML) model was used to identify microbial targets associated with AP. RESULTS AP patients had a decreased intake of vitamin D 3 , whole grains, fish, and beneficial eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids. AP patients also had lower gut microbiome diversity ( P = 0.021) and a higher abundance of sulfidogenic bacteria including Veillonella sp. and Haemophilus sp., which were associated with AP risk. Serum acetate and H 2 S concentrations were significantly higher in the AP group ( P < 0.001 and P = 0.043, respectively). ML model had 96% predictive ability to distinguish AP patients from controls. DISCUSSION AP patients have decreased beneficial nutrient intake and gut microbiome diversity. An increased abundance of H 2 S-producing genera in the AP and SCFA-producing genera in the control group and predictive ability of ML model to distinguish AP patients indicates that diet, gut microbiota, and their end metabolites play a key role in AP.
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Affiliation(s)
- Cemal Yazici
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sarang Thaker
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Karla K. Castellanos
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Haya Al Rashdan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yongchao Huang
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, Illinois, USA
| | - Paya Sarraf
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Brian Boulay
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Paul Grippo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - H. Rex Gaskins
- Department of Animal Sciences, Cancer Center at Illinois, University of Illinois Urbana-Champaign, Urbana-Champaign, Illinois, USA
| | - Kirstie K. Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yang Dai
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, Illinois, USA
| | - Ece R. Mutlu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Brian T. Layden
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Danielson KK, Rydzon B, Nicosia M, Maheswaren A, Eisenberg Y, Lin J, Layden BT. Prevalence of Undiagnosed Diabetes Identified by a Novel Electronic Medical Record Diabetes Screening Program in an Urban Emergency Department in the US. JAMA Netw Open 2023; 6:e2253275. [PMID: 36701158 PMCID: PMC9880794 DOI: 10.1001/jamanetworkopen.2022.53275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This cross-sectional study describes a screening program that was developed to screen for type 2 diabetes in an urban emergency department setting in the US.
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Affiliation(s)
- Kirstie K. Danielson
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Illinois Chicago
| | - Brett Rydzon
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Illinois Chicago
| | - Milena Nicosia
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Illinois Chicago
| | | | - Yuval Eisenberg
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Illinois Chicago
| | - Janet Lin
- Department of Emergency Medicine, University of Illinois Chicago
| | - Brian T. Layden
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Illinois Chicago
- Department of Endocrinology, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
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Quadri P, Sanchez-Johnsen L, Aguiluz-Cornejo G, Masrur M, Sigmon D, Danielson KK, Gangemi A, Hassan C. Bariatric Surgery Hospital Readmissions in an Urban Academic Medical Center. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pablo Quadri
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa Sanchez-Johnsen
- Department of Psychiatry Surgery, Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Mario Masrur
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David Sigmon
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kirstie K. Danielson
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Antonio Gangemi
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chandra Hassan
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Dungan KM, Hart PA, Andersen DK, Basina M, Chinchilli VM, Danielson KK, Evans-Molina C, Goodarzi MO, Greenbaum CJ, Kalyani RR, Laughlin MR, Pichardo-Lowden A, Pratley RE, Serrano J, Sims EK, Speake C, Yadav D, Bellin MD, Toledo FGS. Assessing the Pathophysiology of Hyperglycemia in the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study: From the Type 1 Diabetes in Acute Pancreatitis Consortium. Pancreas 2022; 51:575-579. [PMID: 36206461 PMCID: PMC9580616 DOI: 10.1097/mpa.0000000000002074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The metabolic abnormalities that lead to diabetes mellitus (DM) after an episode of acute pancreatitis (AP) have not been extensively studied. This article describes the objectives, hypotheses, and methods of mechanistic studies of glucose metabolism that comprise secondary outcomes of the DREAM (Diabetes RElated to Acute pancreatitis and its Mechanisms) Study. METHODS Three months after an index episode of AP, participants without preexisting DM will undergo baseline testing with an oral glucose tolerance test. Participants will be followed longitudinally in three subcohorts with distinct metabolic tests. In the first and largest subcohort, oral glucose tolerance tests will be repeated 12 months after AP and annually to assess changes in β-cell function, insulin secretion, and insulin sensitivity. In the second, mixed meal tolerance tests will be performed at 3 and 12 months, then annually, and following incident DM to assess incretin and pancreatic polypeptide responses. In the third, frequently sampled intravenous glucose tolerance tests will be performed at 3 months and 12 months to assess the first-phase insulin response and more precisely measure β-cell function and insulin sensitivity. CONCLUSIONS The DREAM study will comprehensively assess the metabolic and endocrine changes that precede and lead to the development of DM after AP.
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Affiliation(s)
- Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Marina Basina
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kirstie K. Danielson
- Division of Endocrinology, Diabetes & Metabolism, University of Illinois, Chicago, IL
| | - Carmella Evans-Molina
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine; Indianapolis, IN
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carla J. Greenbaum
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maren R. Laughlin
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Ariana Pichardo-Lowden
- Division of Endocrinology, Diabetes & Metabolism, Penn State Health, Penn State College of Medicine, Hershey, PA
| | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Emily K. Sims
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine; Indianapolis, IN
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Melena D. Bellin
- Departments of Pediatrics and Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Frederico G. S. Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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Reutrakul S, Martyn-Nemeth P, Quinn L, Rydzon B, Priyadarshini M, Danielson KK, Baron KG, Duffecy J. Effects of Sleep-Extend on glucose metabolism in women with a history of gestational diabetes: a pilot randomized trial. Pilot Feasibility Stud 2022; 8:119. [PMID: 35659776 PMCID: PMC9166192 DOI: 10.1186/s40814-022-01076-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Women with a history of gestational diabetes (GDM) are at 7-fold increase in the risk of developing diabetes. Insufficient sleep has also been shown to increase diabetes risk. This study aimed to explore the feasibility of a sleep extension in women with a history of GDM and short sleep, and effects on glucose metabolism. Methods Women age 18–45 years with a history of GDM and actigraphy confirmed short sleep duration (<7 h/night) on weekdays were randomized at a ratio of 1 control (heathy living information) to 2 cases (6 weeks of “Sleep-Extend” intervention: use of a Fitbit, weekly digital content, and weekly coaching to increase sleep duration). An oral glucose tolerance test (OGTT), 7-day actigraphy recording, and questionnaires were obtained at baseline and 6 weeks. Mean differences between baseline and end-of-intervention parameters were compared using independent samples t-tests. Results Mean (SD) sleep duration increased within the Sleep-Extend group (n=9, +26.9 (42.5) min) but decreased within the controls (n=5, − 9.1 (20.4) min), a mean difference (MD) of 35.9 min (95% confidence interval (CI) − 8.6, 80.5). Fasting glucose increased, but less in Sleep-Extend vs. control groups (1.6 (9.4) vs 10.4 (8.2) mg/dL, MD − 8.8 mg/dL (95% CI − 19.8, 2.1), while 2-h glucose levels after an OGTT did not differ. Compared to controls, Sleep-Extend had decreased fatigue score (MD − 10.6, 95%CI − 20.7, − 0.6), and increased self-report physical activity (MD 5036 MET- minutes/week, 95%CI 343, 9729. Fitbit compliance and satisfaction in Sleep-Extend group was high. Conclusion Sleep extension is feasible in women with a history of GDM, with benefits in fatigue and physical activity, and possibly glucose metabolism. These data support a larger study exploring benefits of sleep extension on glucose metabolism in these high-risk women. Trial registration ClinicalTrials.gov, NCT03638102 (8/20/2018)
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA.
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Lauretta Quinn
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Brett Rydzon
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA
| | - Medha Priyadarshini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA
| | - Kelly G Baron
- Division of Public Health, Department of Family and Preventive Medicine, The University of Utah, 375 Chipeta Way, Salt Lake City, USA.,Departments of Psychology and Psychiatry, The University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, Chicago, IL, 60612, USA
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10
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Sheth U, Monson RS, Prasad B, Sahni AS, Matani S, Mercado T, Smith MA, Carlucci MA, Danielson KK, Reutrakul S. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. J Clin Sleep Med 2021; 17:1563-1569. [PMID: 34313215 DOI: 10.5664/jcsm.9248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To explore the association of continuous positive airway pressure (CPAP) adherence with clinical outcomes in patients with type 2 diabetes and obstructive sleep apnea in a real-world setting. METHODS This was a retrospective study of patients with type 2 diabetes diagnosed with obstructive sleep apnea between 2010 and 2017. CPAP adherence (usage for ≥ 4 h/night for ≥ 70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate, hemoglobin A1c, systolic and diastolic blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes. RESULTS Of the 1,295 patients, 260 (20.7%) were CPAP adherent, 318 (24.5%) were CPAP nonadherent, and 717 (55.3%) had insufficient data. The follow-up period was, on average, 2.5 (1.7) years. Compared to those who were CPAP nonadherent, those who were adherent had a significantly lower systolic blood pressure (β = -1.95 mm Hg, P = .001) and diastolic blood pressure (β = -2.33 mm Hg, P < .0001). Among the patients who were CPAP adherent, a 17% greater CPAP adherence was associated with a 2 mm Hg lower systolic blood pressure. Lipids, hemoglobin A1c, estimated glomerular filtration rate, and incident cardiovascular/peripheral vascular/cerebrovascular events were not different between the 2 groups. CONCLUSIONS Achieving CPAP adherence in patients with type 2 diabetes and obstructive sleep apnea was associated with significantly lower blood pressure. Greater CPAP use within patients who were adherent was associated with lower systolic blood pressure. CITATION Sheth U, Monson RS, Prasad B, et al. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. J Clin Sleep Med. 2021;17(8):1563-1569.
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Affiliation(s)
- Urmi Sheth
- University of Illinois at Chicago, Chicago, Illinois
| | - Rebecca S Monson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Bharati Prasad
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.,Jesse Brown VA Medical Center, Chicago, Illinois
| | - Ashima S Sahni
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sara Matani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Tomas Mercado
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Maureen A Smith
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Melissa A Carlucci
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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11
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Masrur M, Bustos R, Sanchez-Johnsen L, Gonzalez-Ciccarelli L, Mangano A, Gonzalez-Heredia R, Patel R, Danielson KK, Gangemi A, Elli EF. Factors Associated with Weight Loss After Metabolic Surgery in a Multiethnic Sample of 1012 Patients. Obes Surg 2021; 30:975-981. [PMID: 31848986 DOI: 10.1007/s11695-019-04338-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metabolic surgery is the most effective method for weight loss in the long-term treatment of morbid obesity and its comorbidities. The primary aim of this study was to examine factors associated with percent total weight loss (%TWL) after metabolic surgery among an ethnically diverse sample of patients. METHODS A retrospective review was performed on 1012 patients who underwent either a sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at our institution between January 2008 and June 2015. RESULTS African Americans had a lower %TWL than non-Hispanic/Latino Whites at 6, 9, 12, 18, and 48 months. At all timeframes, there was a negative association between pre-surgery TWL and %TWL after surgery. Female sex was negatively associated with %TWL at 3 months only. Higher initial BMI was also associated with greater post-operative %TWL at 18, 24 and 36 months. Older patients had lower %TWL at 6, 9, 12 and 24 months post-surgery. Patients who received RYGB had greater %TWL than those who received SG at 3, 6, 9, 12, 24 and 36 months. CONCLUSIONS African Americans had a lower %TWL than non-Hispanic/Latino Whites at most time points; there were no other significant race/ethnicity or sex differences. BMI (greater initial BMI), age (lower) and RYGB were associated with a greater post-operative %TWL at certain post-surgery follow-up time points. A limitation of this study is that there was missing data at a number of time points due to lack of attendance at certain follow-up visits.
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Affiliation(s)
- Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.
| | - Lisa Sanchez-Johnsen
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.,Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Luis Gonzalez-Ciccarelli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | | | - Ronak Patel
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Antonio Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Enrique Fernando Elli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.,Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA
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12
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Reutrakul S, Crowley SJ, Park JC, Chau FY, Priyadarshini M, Hanlon EC, Danielson KK, Gerber BS, Baynard T, Yeh JJ, McAnany JJ. Relationship between Intrinsically Photosensitive Ganglion Cell Function and Circadian Regulation in Diabetic Retinopathy. Sci Rep 2020; 10:1560. [PMID: 32005914 PMCID: PMC6994721 DOI: 10.1038/s41598-020-58205-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/08/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intrinsically photosensitive retinal ganglion cells (ipRGCs) control non-visual light responses (e.g. pupillary light reflex and circadian entrainment). Patients with diabetic retinopathy (DR) show reduced ipRGC function, as inferred by abnormalities in the post illumination pupil response (PIPR). We explored whether ipRGC function in DR is associated with circadian outputs and sleep/wake behavior. METHODS Forty-five participants (15 without diabetes, 15 with type 2 diabetes (T2D) and no DR, 15 with T2D and DR) participated. ipRGC function was inferred from the PIPR (pupil size following stimulus offset). Circadian outputs were melatonin amplitude (overnight urinary 6-sulfatoxymelatonin (aMT6s)) and timing (dim light melatonin onset (DLMO)), and evening salivary cortisol levels. Sleep/wake patterns were measured with wrist actigraphy and insomnia symptoms were assessed subjectively. RESULTS Patients with T2D and DR had smaller PIPR and lower urinary aMT6s than other groups (p < 0.001). In adjusted regression models, smaller PIPR was associated with lower urinary aMT6s (β = 4.552, p = 0.005). Patients with DR were more likely to have no detectable DLMO (p = 0.049), higher evening salivary cortisol, greater insomnia symptoms and greater sleep variability compared to other groups. Sleep duration, efficiency and rest-activity rhythms were similar. CONCLUSION Reduced ipRGC function in DR is associated with circadian dysregulation and sleep disturbances, although a causal relationship cannot be established in this cross-sectional study. Prospective mechanistic and intervention studies examining circadian and sleep health in these patients are warranted.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Felix Y Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Medha Priyadarshini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Erin C Hanlon
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Jade J Yeh
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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13
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Masrur MA, Ciccarelli Gonzalez LF, Bustos R, Patel RA, Danielson KK, Sanchez-Johnsen L, Gangemi AA, Elli F. Preoperative Weight Loss as a Predictor of Percentage Excess Weight Loss after Bariatric Surgery. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Quadri P, Esposito S, Coleoglou A, Danielson KK, Masrur M, Giulianotti PC. Robotic Adrenalectomy: Are We Expanding the Indications of Minimally Invasive Surgery? J Laparoendosc Adv Surg Tech A 2018; 29:19-23. [PMID: 30265584 DOI: 10.1089/lap.2018.0286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy (LA) is accepted as the gold standard treatment for most adrenal pathologies. Open surgery is still considered the standard of care for large tumors and malignancies. In the past decade, robotic adrenalectomy (RA) has become an alternative to the laparoscopic and open approaches. The aim of this study was to analyze perioperative and postoperative outcomes in a series of consecutive nonselected patients undergoing a RA, to determine whether factors that negatively affect outcomes in LA (body mass index [BMI], size, and side of the tumor) have the same impact in RA. MATERIALS AND METHODS This is a single-center single-surgeon retrospective study with 43 patients who underwent a RA. Patients were divided into different groups according to tumor size (cutoff values of 5 or 8 cm), tumor side (left/right), and BMI (cutoff value of kg/m2). Perioperative and postoperative outcomes included operative time, length of hospital stay, blood loss, readmissions, complications, and conversions to open. RESULTS There were no significant differences between the groups with tumors <5 cm versus ≥5 cm regarding gender, age, race, BMI, American Society of Anesthesiologists (ASA) score, history of previous abdominal surgery, tumor side, and histopathological diagnosis (all P values ≥.06). There were no significant differences in any of the outcomes analyzed with respect to the tumor size (all P values ≥.14) except for a higher occurrence of complications in patients with tumors ≥8 cm versus <8 cm (P = .03). There were no significant differences in any outcomes related to side (left versus right) of the tumor nor BMI (<30 versus ≥30 kg/m2). The overall readmission and conversion rates were both 2.3% and no mortalities were registered. CONCLUSION Patient's BMI, tumor side, and size did not demonstrate a negative impact on perioperative and postoperative outcomes of RA. This approach could potentially expand the indications of minimally invasive surgery.
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Affiliation(s)
- Pablo Quadri
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sofia Esposito
- 2 Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
| | - Adrian Coleoglou
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kirstie K Danielson
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.,2 Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Masrur
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pier C Giulianotti
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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15
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Luu QF, Villareal CJ, Fritschi C, Monson RS, Oberholzer J, Danielson KK. Concerns and hopes of patients with type 1 diabetes prior to islet cell transplantation: A content analysis. J Diabetes Complications 2018; 32:677-681. [PMID: 29779835 PMCID: PMC6015784 DOI: 10.1016/j.jdiacomp.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/26/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
AIMS Islet cell transplantation can functionally cure type 1 diabetes complicated by hypoglycemia unawareness (HU), but requires immunosuppression. This study identified the lived experiences and risk/benefit considerations of patients pre-transplant. METHODS Content analysis identified themes from four open-ended questions pre-transplant in an islet transplant clinical trial. The sample included 23 (19 female) patients, with a mean age = 48.3 and diabetes duration = 29.3 years. RESULTS Lack of control due to diabetes and HU was the overarching theme pre-transplant. Four sub-themes were also identified: fear of hypoglycemia, diabetes-related complications, hopes/expectations after transplant, and transplant outcomes. Patients expressed fear of HU and long-term complications pre-transplant, and hoped islet transplant would improve diabetes management. Patients further emphasized anxiety over burdening others, and hopes of advancing research. In addition, other patients emphasized frustrations regarding the impact of HU on themselves, such as the inability to perform activities of daily living. Many patients were primarily worried about immunosuppressive side effects rather than islet transplant success. CONCLUSIONS Patients viewed islet transplantation as a means to gain autonomy and control over their lives. They desired reduced anxiety associated with HU, despite concerns over immunosuppressive side-effects. These findings need confirmation, but may help to further improve patient education and patient-provider communication.
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Affiliation(s)
- Queena F Luu
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA
| | - Celine J Villareal
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA
| | - Cynthia Fritschi
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA.
| | - Rebecca S Monson
- Department of Surgery, College of Medicine, University of Illinois at Chicago, 840 S. Wood St., Chicago, IL 60612, USA.
| | - Jose Oberholzer
- Department of Surgery, College of Medicine, University of Illinois at Chicago, 840 S. Wood St., Chicago, IL 60612, USA.
| | - Kirstie K Danielson
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA; Department of Surgery, College of Medicine, University of Illinois at Chicago, 840 S. Wood St., Chicago, IL 60612, USA.
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16
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Rydzon B, Monson RS, Oberholzer J, Varady KA, Bellin MD, Danielson KK. Long term (4 years) improved insulin sensitivity following islet cell transplant in type 1 diabetes. Diabetes Metab Res Rev 2018; 34:10.1002/dmrr.2972. [PMID: 29230944 PMCID: PMC5873303 DOI: 10.1002/dmrr.2972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Impaired insulin sensitivity (IS) predicts complications and mortality in type 1 diabetes (T1D). Insulin sensitivity improves shortly after islet cell transplant for T1D, yet long-term changes in IS and associated factors such as patient characteristics, transplant factors, clinical management, and IS-related biomarkers are unknown. METHODS Up to 9 years (mean 4) of longitudinal data were available on 22 adults (18 female) with T1D who received 1 to 3 transplants in Phase 1/2 or 3 clinical trials (2004-2014). Metabolic testing posttransplant estimated IS by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR; 111 observations) and the Simple Index of Insulin Sensitivity (SIis ; 95 observations). RESULTS Simple Index of Insulin Sensitivity significantly increased the first year posttransplant (P = .02), then stabilized (P = .39); HOMA-IR remained stable posttransplant (P = .92). Adjusting for age and BMI, higher SIis was associated with lower HbA1c following transplant (P = .03). Greater IS as measured by lower HOMA-IR and higher SIis was associated with lower fasting C-peptide (both P ≤ .04) and also with higher exenatide dose (both P ≤ .01). More islets transplanted were associated with higher SIis (P < .0001). Lower leptin at transplant predicted lower HOMA-IR and higher SIis after transplant, and lower bone marker receptor activator of nuclear factor kappa-B ligand predicted lower HOMA-IR (all P ≤ .01). CONCLUSIONS Insulin sensitivity measured by SIis was improved several years following transplant, while IS measured by HOMA-IR did not worsen. Higher exenatide dose, more islets transplanted, and diet and exercise (lowering leptin and receptor activator of nuclear factor kappa-B ligand) may improve IS, which may enhance glycaemic control and lower metabolic demand on transplanted islets. Long-term clamp studies are needed to confirm these results.
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Affiliation(s)
- Brett Rydzon
- Division of Transplant Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca S. Monson
- Division of Transplant Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jose Oberholzer
- Division of Transplant Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Krista A. Varady
- Department of Kinesiology & Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Melena D. Bellin
- Division of Pediatric Endocrinology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Kirstie K. Danielson
- Division of Transplant Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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17
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Williams J, Jacus N, Kavalackal K, Danielson KK, Monson RS, Wang Y, Oberholzer J. Over ten-year insulin independence following single allogeneic islet transplant without T-cell depleting antibody induction. Islets 2018; 10:168-174. [PMID: 30024826 PMCID: PMC6281363 DOI: 10.1080/19382014.2018.1451281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Islet cell transplantation is a promising functional cure for type 1 diabetes; however, maintaining long-term islet graft function and insulin independence is difficult to achieve. In this short report we present a patient with situs inversus, who at the time of islet transplantation had a 26-year history of type 1 diabetes, complicated by hypoglycemic unawareness and severe hypoglycemic events. After a single allogeneic islet transplant of a low islet mass, and despite developing de novo anti-insulin and anti-GAD65 autoantibodies, the patient has remarkably maintained insulin independence with tight glycemic control and normal metabolic profiles for 10 years, after receiving prolonged non-T-cell depleting immunosuppression.
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Affiliation(s)
- Jack Williams
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Nicholas Jacus
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kevin Kavalackal
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kirstie K. Danielson
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Rebecca S. Monson
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Yong Wang
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Jose Oberholzer
- Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
- CONTACT José Oberholzer Division of Transplant, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Rm 428, Chicago, IL 60612
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18
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Madrigal JM, Monson RS, Hatipoglu B, Oberholzer J, Kondos GT, Varady KA, Danielson KK. Coronary artery calcium may stabilize following islet cell transplantation in patients with type 1 diabetes. Clin Transplant 2017; 31. [PMID: 28748581 DOI: 10.1111/ctr.13059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 12/22/2022]
Abstract
Islet cell transplantation can functionally cure type 1 diabetes and also improve carotid intima-media thickness. This study provides a preliminary description of changes in coronary artery calcium following islet transplantation, and associated factors. Coronary artery calcium was measured in 14 patients with type 1 diabetes (11 had measures both pre- and post-transplant [mean 2.3 years]) in the University of Illinois at Chicago's clinical trial. Multivariable mixed-effects linear regression of repeated measures was used to quantify calcium change and determine if this change was longitudinally associated with risk/protective factors. Thirteen of the patients were female, with mean baseline age, diabetes duration, and BMI of 47.6 and 28.7 years, and 23.1, respectively. Over half (57%) had detectable coronary artery calcium pre-transplant. Minimal change (0.39 mm3 /y, P = .02) occurred in coronary artery calcium levels pre- to post-transplant. No patient met criteria for calcium progression. Coronary artery calcium was positively associated with total and small VLDL particles (P ≤ .02), statin dose (P = .02), and urine albumin-to-creatinine ratio (P = .04) and negatively associated with free fatty acids (P = .03), total HDL (P = .03), large HDL particles (P = .005), and tacrolimus dose (P = .02). Islet transplant may stabilize coronary artery calcium, with optimal management of lipids and kidney function remaining key therapeutic targets. [NCT00679041].
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Affiliation(s)
- Jessica M Madrigal
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL, USA.,Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca S Monson
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Betul Hatipoglu
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - José Oberholzer
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - George T Kondos
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Krista A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Kirstie K Danielson
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL, USA.,Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
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19
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Hassan LS, Monson RS, Danielson KK. Oestradiol levels may differ between premenopausal women, ages 18-50, with type 1 diabetes and matched controls. Diabetes Metab Res Rev 2017; 33:10.1002/dmrr.2829. [PMID: 27235200 PMCID: PMC5124523 DOI: 10.1002/dmrr.2829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 04/19/2016] [Accepted: 05/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to investigate whether oestradiol differs between premenopausal women with and without type 1 diabetes and whether levels are associated with such factors as age, reproductive history or diabetes management. METHODS Oestradiol in premenopausal women with type 1 diabetes (n = 89; age = 18-50 years; duration = 13-18 years) and age-matched/race-matched controls without diabetes (n = 76) was collected during a cross-sectional ancillary study of the Wisconsin Diabetes Registry Study, a population-based incident cohort. Total and bioavailable oestradiol and sex hormone-binding globulin were compared using multivariable regression (e.g. adjusting for reproductive history). RESULTS Adjusted mean total and bioavailable oestradiol did not differ overall by diabetes status (p ≥ 0.74), while adjusted mean sex hormone-binding globulin was higher in type 1 diabetes women (p = 0.02). However, only in women with type 1 diabetes and not controls (interaction p = 0.0005) was total oestradiol positively associated with the duration of reproductive years with unsuppressed ovarian function (UnsuppOvFx = years since menarche minus years on hormonal contraceptives/pregnant/breastfeeding). When stratified into less than/equal to or greater than the median 9 years' duration of UnsuppOvFx, compared with controls, women with type 1 diabetes had significantly lower total oestradiol in the ≤9 years group [β = -43.2 pg mL-1 (-158.6 pmol L-1 ), p = 0.04] and significantly higher total oestradiol in the >9 years group [β = 53.9 pg mL-1 (197.9 pmol L-1 ), p = 0.04]. Results remained consistent during additional statistical adjustments and sensitivity analyses. CONCLUSIONS Compared with controls, women with type 1 diabetes may have lower oestradiol when they have a shorter duration of UnsuppOvFx and higher oestradiol when they have a longer duration of UnsuppOvFx. Given the potential effects of insulin on ovarian function, oestradiol production may vary across the lifespan for women with type 1 diabetes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lina Saleh Hassan
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago
| | | | - Kirstie K. Danielson
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago
- Division of Transplant Surgery, University of Illinois at Chicago
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Rodby KA, Danielson KK, Shay E, Robinson E, Benjamin M, Antony AK. Trends in Breast Reconstruction by Ethnicity: An Institutional Review Centered on the Treatment of an Urban Population. Am Surg 2017; 82:497-504. [PMID: 27305880 DOI: 10.1177/000313481608200609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies have investigated reconstructive decisions after mastectomy and such studies document a preference among African American women for autologous tissue-based procedures and among Latin American women for implant-based reconstructions, however, there is a paucity of studies evaluating the current relationship between ethnicity and reconstructive preferences. This institutional review provides a unique, up-to-date evaluation of an understudied urban population composed of majority ethnic minority patients and explores reconstructive trends. Consecutive breast reconstruction patients were entered into a prospectively maintained database at the University of Illinois at Chicago and affiliate hospitals between July 2010 and October 2013. Demographics and oncologic characteristics including tumor stage, pathology, BRCA status, and adjuvant treatment were reviewed, and reconstructive trends were assessed by racial group with a focus on reconstructive procedure, mastectomy volume, and implant characteristics. Statistical analysis was performed using SAS (version 9.2). One-hundred and sixty breast reconstructions were performed in 105 women; of which 50 per cent were African American, 26 per cent Hispanic, 22 per cent Caucasian, and 2 per cent Asian. Age, tumor stage, prevalence of triple negative disease, chemotherapy, and radiation treatment was comparable between groups. Rates of obesity, hypertension, and diabetes mellitus were slightly higher in African American and Hispanic cohorts, with more African American patients having one or more of these comorbidities as compared with the Caucasian and Hispanic cohorts (P = 0.047). Despite comparable positive BRCA testing rates, significant differences were seen in the percentage of bilateral mastectomy; 68 per cent African American, 48 per cent Caucasian, and 30 per cent Hispanic (P = 0.004). Hispanics predominantly underwent flap-based reconstruction (56%), while African American (74%) and Caucasian (60%) patients had a preference toward tissue expander reconstruction (P = 0.04 across all groups). African American and Hispanic presented with increased mastectomy weights and thus required higher implant volumes as compared with Caucasians that approached significance (P = 0.06 and P = 0.06). Implant size utilization followed a unimodal distribution for Caucasians, peaking at 500 cc; while African American and Hispanic demonstrated a bimodal distribution, peaking once at 550 cc and again at the max implant volume of 800 cc. This study of a large proportion of minority patients in an urban geographic setting offers an evolving understanding of breast reconstruction patterns. The data demonstrated unique findings of increased rates of bilateral implant-based reconstruction in African American women and unilateral flap-based reconstructions in Hispanic patients. Reconstructive decision-making seems to be greatly influenced by cultural and geographically driven preferences.
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Affiliation(s)
- Katherine A Rodby
- Division of Plastic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Danielson KK, Monson RS, LeCaire TJ. Factors Associated with Higher Pro-Inflammatory Tumor Necrosis Factor-α Levels in Young Women with Type 1 Diabetes. Exp Clin Endocrinol Diabetes 2016; 124:140-7. [PMID: 27008631 DOI: 10.1055/s-0035-1569374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS While cytokines play a role in the etiology of type 1 diabetes, cytokines later in the disease are less understood. We therefore investigated associations of pro-inflammatory tumor necrosis factor-α levels measured at prolonged disease duration with C-peptide at diagnosis, long-term glycemic control, diabetes duration, clinical factors, and health behaviors. METHODS Data and blood were collected during an ancillary study to the longitudinal Wisconsin Diabetes Registry, a population-based cohort followed since diagnosis of type 1 diabetes. The ancillary study was conducted at 13-18 years diabetes duration, and enrolled premenopausal women age 18-45 years (n=87). RESULTS Higher tumor necrosis factor-α levels at 13-18 years diabetes duration were independently associated with longer duration (p=0.0004) and worse current renal function (p=0.02). Additionally, diabetes duration modified both of the positive associations of tumor necrosis factor-α levels (both interactions p≤0.01) with mean glycemic control during the previous 10 years (significant only in women with longer durations) and current daily caffeine intake (significant only in women with shorter durations). In women with C-peptide measured at diagnosis (n=50), higher tumor necrosis factor-α levels at 13-18 years duration were associated with lower C-peptide (p=0.01), independent of glycemic control during the previous 10 years. CONCLUSIONS Lower residual C-peptide at diagnosis and poor long-term glycemic control independently predicted higher pro-inflammatory tumor necrosis factor-α levels years later. The novel relationship with C-peptide needs confirmation in a larger cohort. Given the association between tumor necrosis factor-α and diabetes complications, further longitudinal studies may help clarify the potentially complex associations between glycemic control, inflammatory cytokines, and complications.
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Affiliation(s)
- K K Danielson
- Division of Transplant Surgery, College of Medicine, University of Illinois at Chicago
| | - R S Monson
- Division of Transplant Surgery, College of Medicine, University of Illinois at Chicago
| | - T J LeCaire
- Department of Population Health Sciences, University of Wisconsin-Madison
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Rodby KA, Robinson E, Danielson KK, Quinn KP, Antony AK. Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution. Am Surg 2016. [DOI: 10.1177/000313481608200316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts <40 and ≥40 as well cohorts by decade (20s, 30s, 40s, 50s, and 60s). Statistical trends were reported as odds of risk per year of increasing age using logistic regression; linear regression, χ2, and Fischer's exact were used to compare <40 and ≥40 and split cohorts for comparison. Comorbidities, tumor staging, oncologic treatment including chemotherapy and radiation, disease characteristics and genetics, and mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends ( P < 0.005). Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications ( P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.
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Affiliation(s)
- Katherine A. Rodby
- Division of Plastic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Emilie Robinson
- Rush University, Plastic and Reconstructive Surgery, Chicago, Illinois
| | - Kirstie K. Danielson
- Division of Plastic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Karina P. Quinn
- Division of Plastic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Anuja K. Antony
- Rush University, Plastic and Reconstructive Surgery, Chicago, Illinois
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Rodby KA, Robinson E, Danielson KK, Quinn KP, Antony AK. Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution. Am Surg 2016; 82:227-235. [PMID: 27099059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts <40 and ≥40 as well cohorts by decade (20s, 30s, 40s, 50s, and 60s). Statistical trends were reported as odds of risk per year of increasing age using logistic regression; linear regression, χ(2), and Fischer's exact were used to compare <40 and ≥40 and split cohorts for comparison. Comorbidities, tumor staging, oncologic treatment including chemotherapy and radiation, disease characteristics and genetics, and mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends (P < 0.005). Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications (P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.
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Affiliation(s)
- Katherine A Rodby
- Division of Plastic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Marchese E, Rodeghier C, Monson RS, McCracken B, Shi T, Schrock W, Martellotto J, Oberholzer J, Danielson KK. Enumerating β-Cells in Whole Human Islets: Sex Differences and Associations With Clinical Outcomes After Islet Transplantation. Diabetes Care 2015; 38:e176-7. [PMID: 26384388 PMCID: PMC4613918 DOI: 10.2337/dc15-0723] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/17/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Enza Marchese
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Caitlin Rodeghier
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Rebecca S Monson
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Benjamin McCracken
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Tingqi Shi
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Wesley Schrock
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Joan Martellotto
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Jose Oberholzer
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kirstie K Danielson
- Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
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Kujath AS, Quinn L, Elliott ME, LeCaire TJ, Binkley N, Molino AR, Danielson KK. Different health behaviours and clinical factors associated with bone mineral density and bone turnover in premenopausal women with and without type 1 diabetes. Diabetes Metab Res Rev 2015; 31:421-32. [PMID: 25470722 PMCID: PMC4406845 DOI: 10.1002/dmrr.2627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/23/2014] [Accepted: 11/24/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women with type 1 diabetes (T1DM) have an elevated fracture risk. We therefore compared the associations of health behaviours and clinical factors with bone mineral density (BMD) and bone remodelling between premenopausal women with and without T1DM to inform potential interventions. METHODS Participants included women with T1DM (n = 89) from the Wisconsin Diabetes Registry Study and age-matched and race-matched controls without diabetes (n = 76). Peripheral (heel and forearm) and central (hip and spine) BMD, markers of bone resorption and formation, bone cell signalling, glycaemic control, and kidney function were assessed. Health behaviours and medical history were self-reported. RESULTS In controls, but not in women with T1DM, older age was associated with lower bone resorption (p ≤ 0.006) and formation (p = 0.0007). Body mass index was positively associated with heel and forearm BMD in both controls and T1DM women (all p < 0.0001), but with hip and spine BMD only in controls (p ≤ 0.005). Worse glycaemic control during the previous 10 years, greater alcohol intake, history of smoking, and lack of physical activity were associated with poorer bone outcomes only in women with T1DM (all p ≤ 0.002), whereas use of hormonal contraceptives was related to low bone formation in both women with and without T1DM (all p ≤ 0.006). Diabetes duration, insulin dose, residual C-peptide, and kidney function were not associated with bone in T1DM. CONCLUSIONS Age and body mass index may not predict bone health in T1DM women. However, modifiable behaviours such as optimizing glycaemic control, limiting substance and hormonal contraceptive use, and increasing physical activity may improve bone health in T1DM women.
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Affiliation(s)
| | - Lauretta Quinn
- Department of Biobehavioral Health Science, University of Illinois at Chicago
| | | | | | - Neil Binkley
- Department of Medicine, University of Wisconsin-Madison
| | - Andrea R. Molino
- Division of Transplant Surgery, University of Illinois at Chicago
| | - Kirstie K. Danielson
- Division of Transplant Surgery, University of Illinois at Chicago
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago
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Ruggiero L, Moadsiri A, Quinn LT, Riley BB, Danielson KK, Monahan C, Bangs VA, Gerber BS. Diabetes island: preliminary impact of a virtual world self-care educational intervention for african americans with type 2 diabetes. JMIR Serious Games 2015; 2. [PMID: 25584346 PMCID: PMC4288760 DOI: 10.2196/games.3260] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes is a serious worldwide public health challenge. The burden of diabetes, including prevalence and risk of complications, is greater for minorities, particularly African Americans. Internet-based immersive virtual worlds offer a unique opportunity to reach large and diverse populations with diabetes for self-management education and support. Objective The objective of the study was to examine the acceptability, usage, and preliminary outcome of a virtual world intervention, Diabetes Island, in low-income African Americans with type 2 diabetes.
The main hypotheses were that the intervention would: (1) be perceived as acceptable and useful; and (2) improve diabetes self-care (eg, behaviors and barriers) and self-care related outcomes, including glycemic control (A1C), body mass index (BMI), and psychosocial factors (ie, empowerment and distress) over six months. Methods The evaluation of the intervention impact used a single-group repeated measures design, including three assessment time points: (1) baseline, (2) 3 month (mid intervention), and (3) 6 month (immediate post intervention). Participants were recruited from a university primary care clinic. A total of 41 participants enrolled in the 6 month intervention study.
The intervention components included: (1) a study website for communication, feedback, and tracking; and (2) access to an immersive virtual world (Diabetes Island) through Second Life, where a variety of diabetes self-care education activities and resources were available. Outcome measures included A1C, BMI, self-care behaviors, barriers to adherence, eating habits, empowerment, and distress. In addition, acceptability and usage were examined. A series of mixed-effects analyses, with time as a single repeated measures factor, were performed to examine preliminary outcomes. Results The intervention study sample (N=41) characteristics were: (1) mean age of 55 years, (2) 71% (29/41) female, (3) 100% (41/41) African American, and (4) 76% (31/41) reported annual incomes below US $20,000.
Significant changes over time in the expected direction were observed for BMI (P<.02); diabetes-related distress (P<.02); global (P<.01) and dietary (P<.01) environmental barriers to self-care; one physical activity subscale (P<.04); and one dietary intake (P<.01) subscale. The participant feedback regarding the intervention (eg, ease of use, interest, and perceived impact) was consistently positive. The usage patterns showed that the majority of participants logged in regularly during the first two months, and around half logged in each week on average across the six month period. Conclusions This study demonstrated promising initial results of an immersive virtual world approach to reaching underserved individuals with diabetes to deliver diabetes self-management education. This intervention model and method show promise and could be tailored for other populations. A large scale controlled trial is needed to further examine efficacy.
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Affiliation(s)
- Laurie Ruggiero
- Institute for Health Research and Policy and Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Ada Moadsiri
- Institute for Health Research and Policy and Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Lauretta T Quinn
- College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Barth B Riley
- College of Nursing, Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Kirstie K Danielson
- Division of Transplant Surgery, Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, United States
| | - Colleen Monahan
- Center for Advancement of Distance Education, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Valerie A Bangs
- Institute for Health Research and Policy and Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Ben S Gerber
- Institute for Health Research and Policy and Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States ; Jesse Brown VA Medical Center, Chicago, IL, United States ; College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Kujath AS, Quinn L, Elliott ME, Varady KA, LeCaire TJ, Carter CS, Danielson KK. Oxytocin levels are lower in premenopausal women with type 1 diabetes mellitus compared with matched controls. Diabetes Metab Res Rev 2015; 31:102-12. [PMID: 25044726 PMCID: PMC4286520 DOI: 10.1002/dmrr.2577] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/17/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oxytocin, a hormone most commonly associated with parturition and lactation, may have additional roles in diabetes complications. We determined oxytocin levels in premenopausal women with type 1 diabetes mellitus (T1DM) compared with non-diabetic controls and examined associations of oxytocin with health behaviours, clinical factors, biomarkers, kidney function and bone health. Lower oxytocin was hypothesized for T1DM. METHODS A cross-sectional study of premenopausal women with T1DM (n = 88) from the Wisconsin Diabetes Registry Study, a population-based cohort of incident T1DM cases, and matched non-diabetic controls (n = 74) was conducted. RESULTS Women with T1DM had lower oxytocin levels than controls adjusting for caffeine and alcohol use (p = 0.03). Health behaviours associated with oxytocin differed between women with and without T1DM: oxytocin was negatively associated with hormonal contraceptive use (quantified as lifetime contraceptive oestrogen exposure) in women with T1DM (p = 0.003), whereas positively related to hormonal contraceptive use (quantified as never/former/current) in controls (p < 0.001). Oxytocin had a positive association with adiposity (waist-to-hip ratio and leptin) in women with T1DM and a negative relationship with adiposity (weight gain) in controls. In T1DM only, oxytocin was positively associated with caffeine intake (p = 0.01) and negatively associated with alcohol use (p = 0.01). Oxytocin was not related to glycemic control, kidney function or bone health in T1DM. CONCLUSIONS Oxytocin levels are lower in women with T1DM than matched controls. Oxytocin also has opposing associations with hormonal contraceptives and adiposity in women with and without T1DM. Research is needed to determine if the altered oxytocin milieu in T1DM is associated with oxytocinher health outcomes.
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Affiliation(s)
- Amber S. Kujath
- College of Nursing, Rush University Medical Center, Chicago, IL
| | - Lauretta Quinn
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Mary E. Elliott
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison
| | - Krista A. Varady
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago
| | - Tamara J. LeCaire
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - C. Sue Carter
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Kirstie K. Danielson
- Divisions of Transplant Surgery and Epidemiology & Biostatistics, University of Illinois at Chicago
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Palta M, LeCaire T, Sadek-Badawi M, Herrera V, Danielson KK. The trajectory of IGF-1 across age and duration of type 1 diabetes. Diabetes Metab Res Rev 2014; 30:777-83. [PMID: 24845759 PMCID: PMC4236234 DOI: 10.1002/dmrr.2554] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/07/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Individuals with type 1 diabetes may have low IGF-1, related to insulinopenia and insulin resistance. There are few longitudinal studies of IGF-1 levels to establish its pattern in type 1 diabetes with duration and age, and to examine whether IGF-1 tracks within individuals over time. We examine age and duration trends, and the relationship of IGF-1 to gender, glycaemic control, insulin level and other factors. METHODS Participants in the Wisconsin Diabetes Registry Study, an incident cohort study of type 1 diabetes diagnosed May 1987-April 1992, were followed for up to 18 years with IGF-1 samples up to age 45 for women and age 37 for men. RESULTS IGF-1 is lower with type 1 diabetes than in normative samples. Although, the pattern across age resembles that in normative samples with a peak in adolescence and slow decline after age 20, the adolescent peak is delayed for women with type 1 diabetes. There was low to moderate tracking of IGF-1 within an individual. Higher insulin dose was associated with higher IGF-1 as was puberty, and female gender. Adjusted for these factors, IGF-1 declined rapidly across early diabetes duration. Lower HbA1c was most strongly related to higher IGF-1 at Tanner stages 1 and 2. CONCLUSIONS IGF-1 is low in type 1 diabetes, with a delayed adolescent peak in women and is especially influenced by glycaemic control in early and pre-adolescence. High variability within an individual is likely a challenge in investigating associations between IGF-1 and long-term outcomes, and may explain contradictory findings.
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Affiliation(s)
- Mari Palta
- Department of Population Health Sciences, University of Wisconsin, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI
| | - Tamara LeCaire
- Department of Population Health Sciences, University of Wisconsin, Madison, WI
| | - Mona Sadek-Badawi
- Department of Population Health Sciences, University of Wisconsin, Madison, WI
| | - Victor Herrera
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Kirstie K. Danielson
- Division of Epidemiology and Biostatistics, University of Illinois School of Public Health, Chicago, IL
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Qi M, Kinzer K, Danielson KK, Martellotto J, Barbaro B, Wang Y, Bui JT, Gaba RC, Knuttinen G, Garcia-Roca R, Tzvetanov I, Heitman A, Davis M, McGarrigle JJ, Benedetti E, Oberholzer J. Five-year follow-up of patients with type 1 diabetes transplanted with allogeneic islets: the UIC experience. Acta Diabetol 2014; 51:833-43. [PMID: 25034311 PMCID: PMC4801517 DOI: 10.1007/s00592-014-0627-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/01/2014] [Indexed: 12/16/2022]
Abstract
This report summarizes a 5-year phase 1/2 allogeneic islet transplantation clinical trial conducted at the University of Illinois at Chicago (UIC). Ten patients were enrolled in this single center, open label, and prospective trial in which patients received 1-3 transplants. The first four subjects underwent islet transplantation with the Edmonton immunosuppressive regimen and the remaining six subjects received the UIC immunosuppressive protocol (Edmonton plus etanercept and exenatide). All 10 patients achieved insulin independence after 1-3 transplants. At 5 years of follow-up, 6 of the initial 10 patients were free of exogenous insulin. During the follow-up period, 7 of the 10 patients maintained positive C-peptide levels and a composite hypoglycemic score of 0. Most patients maintained HbA1c levels <6.0 % (42.1 mmol/mol) and a significantly improved β-score. In conclusion, this study demonstrated long-term islet graft function without using T cell depleting induction, with an encouraging outcome that includes 60 % of patients remaining insulin independent after 5 years of initial transplantation.
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Affiliation(s)
- Meirigeng Qi
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Katie Kinzer
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Kirstie K. Danielson
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Joan Martellotto
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Barbara Barbaro
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Yong Wang
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - James T. Bui
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612
| | - Ron C. Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612
| | - Grace Knuttinen
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612
| | - Raquel Garcia-Roca
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | | | - Maureen Davis
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - James J. McGarrigle
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Jose Oberholzer
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
- Corresponding Author: José Oberholzer, MD, MHCM, FACS, University of Illinois at Chicago, 840 South Wood Street CSB (Rm 402), Chicago, Illinois 60612, USA, Tel: +1 312 996 6771, Fax: +1 312 413 3483,
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Sobotka SA, Danielson KK, Drum ML, Estrada CL, Lipton RB. Maternal body mass index (BMI) is independently associated with the control of diabetes mellitus in young patients. Pediatr Nurs 2014; 40:187-194. [PMID: 25269359 PMCID: PMC4183965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Investigate the cross-sectional association of glycemic control of ethnically diverse youth with diabetes mellitus with family characteristics. DESIGN Family study of 91 youth (probands) with diabetes mellitus and 142 parents. RESULTS Children's age and HbA1c averaged 11.9 years and 8.9%, respectively; 69% were minorities. After adjustment, poor glycemic control was associated with minority race/ethnicity, more television viewing, and higher maternal body mass index (BMI). Average HbA1c was 1.2 and 1.9% units higher for children of overweight and obese mothers, respectively (p = 0.004). CONCLUSIONS The positive association between maternal body composition and child HbA1c likely represents the unique behavioral influence of mothers.
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Qi M, Mørch Y, Lacík I, Formo K, Marchese E, Wang Y, Danielson KK, Kinzer K, Wang S, Barbaro B, Kolláriková G, Chorvát D, Hunkeler D, Skjåk-Braek G, Oberholzer J, Strand BL. Survival of human islets in microbeads containing high guluronic acid alginate crosslinked with Ca2+ and Ba2+. Xenotransplantation 2013. [PMID: 23198731 DOI: 10.1111/xen.12009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The main hurdles to the widespread use of islet transplantation for the treatment of type 1 diabetes continue to be the insufficient number of appropriate donors and the need for immunosuppression. Microencapsulation has been proposed as a means to protect transplanted islets from the host's immune system. METHODS This study investigated the function of human pancreatic islets encapsulated in Ca(2+) /Ba(2+) -alginate microbeads intraperitoneally transplanted in diabetic Balb/c mice. RESULTS All mice transplanted with encapsulated human islets (n = 29), at a quantity of 3000 islet equivalent (IEQ), achieved normoglycemia 1 day after transplantation and retained normoglycemia for extended periods of time (mean graft survival 134 ± 17 days). In comparison, diabetic Balb/c mice transplanted with an equal amount of non-encapsulated human islets rejected the islets within 2 to 7 days after transplantation (n = 5). Microbeads retrieved after 232 days (n = 3) were found with little to no fibrotic overgrowth and contained viable insulin-positive islets. Immunofluorescent staining on the retrieved microbeads showed F4/80-positive macrophages and alpha smooth muscle actin-positive fibroblasts but no CD3-positive T lymphocytes. CONCLUSIONS The Ca(2+) /Ba(2+) -alginate microbeads can protect human islets from xenogeneic rejection in immunocompetent mice without immunosuppression. However, grafts ultimately failed likely secondary to a macrophage-mediated foreign body reaction.
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Affiliation(s)
- Meirigeng Qi
- Department of Transplant/Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Oberholzer J, Giulianotti P, Danielson KK, Spaggiari M, Bejarano-Pineda L, Bianco F, Tzvetanov I, Ayloo S, Jeon H, Garcia-Roca R, Thielke J, Tang I, Akkina S, Becker B, Kinzer K, Patel A, Benedetti E. Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation. Am J Transplant 2013; 13:721-8. [PMID: 23437881 PMCID: PMC3647345 DOI: 10.1111/ajt.12078] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 02/06/2023]
Abstract
Obese patients with end-stage renal disease (ESRD) are often excluded from kidney transplantation due to concerns about surgical site infections. To reduce infections, we developed a robotic kidney transplantation method for obese recipients. From June 2009-December 2011, a prospective cohort of 39 obese patients underwent robotic kidney transplantation at a single center. The outcomes of patients with at least six months of follow-up (n=28) were compared to a frequency-matched retrospective cohort of obese patients who underwent open kidney transplantation from 2004-2009 (n=28). The 28 robotic patients were predominately African-American (46.4%) or Hispanic (35.7%), with a mean age of 47.9±10.7 years, similar to the control group. BMI in the robotic group was 42.6±7.8 kg/m2 compared to 38.1±5.4 kg/m2 in the control group (p=0.02). There were no surgical site infections in the robotic group (0/28), while 28.6% (8/28) in the control group developed an infection (p=0.004). Six-month creatinine (1.5±0.4 vs.1.6±0.6 mg/dL; p=0.47), and patient and graft survival (100%) were comparable between the two groups. Outcomes following robotic surgery compared favorably to conventional transplantation. Robotic surgery may therefore enable obese patients with ESRD to access kidney transplantation and may thereby reduce health disparities in groups with a high prevalence of obesity and ESRD.
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Affiliation(s)
- J Oberholzer
- Division of Transplantation, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
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Danielson KK, Hatipoglu B, Kinzer K, Kaplan B, Martellotto J, Qi M, Mele A, Benedetti E, Oberholzer J. Reduction in carotid intima-media thickness after pancreatic islet transplantation in patients with type 1 diabetes. Diabetes Care 2013; 36:450-6. [PMID: 23172970 PMCID: PMC3554308 DOI: 10.2337/dc12-0679] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/02/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Determine the impact of islet transplantation on carotid intima-media thickness (CIMT), a marker for atherosclerosis, in type 1 diabetes without kidney disease. RESEARCH DESIGN AND METHODS Consecutive case series of 15 adults (mean age [SD], 49 years [10 years]; 87% female) with type 1 diabetes for ≥5 years (mean duration [SD], 30 years [12 years]; mean HbA(1c) [SD], 7.2% [0.9%]), without kidney disease, presenting with severe hypoglycemic unawareness to undergo allogeneic pancreatic islet transplant(s) (one to three each) in a phase 1/2 and 3 clinical trial. Current follow-up ranges from 1 to 5 years (2005-2011). CIMT of the common and internal carotid arteries was measured before and every 12-16 months after the first transplant (two to six CIMTs each) by one ultrasonographer and one blinded reader. CIMT was analyzed as change from baseline to 12- and 50-month follow-up; a combined CIMT score was calculated as the sum of the standardized IMT scores (SD units [SDs]) of both arteries. RESULTS All patients achieved insulin independence after one to three transplants. CIMT decreased at 12 months (n = 15) for the common carotid (-0.058 mm; P = 0.006) and combined score (-1.28 SDs; P = 0.004). In those with 50-month follow-up (n = 7), the decrease in the combined score continued from 12 (-1.59 SDs; P = 0.04) to 50 months (-0.77 SDs; P = 0.04). During follow-up, the decreasing slope of change in CIMT was associated with decreasing slopes of change in HbA(1c), lipoproteins, and cardiovascular/inflammatory markers. CONCLUSIONS Islet transplantation may ameliorate diabetes-related atherosclerosis through improved glycemic control consequent to restoring endogenous insulin secretion, and optimal lipid management posttransplant also contributes.
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Affiliation(s)
- Kirstie K Danielson
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
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Wang Y, Danielson KK, Ropski A, Harvat T, Barbaro B, Paushter D, Qi M, Oberholzer J. Systematic analysis of donor and isolation factor's impact on human islet yield and size distribution. Cell Transplant 2013; 22:2323-33. [PMID: 23363652 DOI: 10.3727/096368912x662417] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Islet transplantation is a promising therapy for T1DM. Key factors influencing islet yield have been identified with conflicting results. In this study, we analyzed 276 isolations to identify variables for islet yield and, additionally, islet size and size distribution. Pearson correlation analyses demonstrated that BMI had a positive correlation with pancreas size, actual islet count (AIC), and islet equivalent (IEQ)/g (all p ≤ 0.009), while CIT had a negative correlation with AIC and IEQ/g (all p ≤ 0.003). In mixed linear regression, BMI also had a positive correlation with islet size but only for shorter digestion times (≤15 min); there was no association between BMI and islet size for longer digestion times (>15 min). CIT was not associated with islet size. Donor age, sex, and preservation solutions were shown to have no correlation with islet yields or size distribution. Pancreas size had a positive correlation with AIC and a negative association with IEQ/g; it also had positive association with islet size but only for females, not males. Overdigestion was positively associated with islet counts; however, there was also a greater proportion of smaller islets when digestion rate was >74% (p = 0.005). Of the three collagenases analyzed, Sigma V had the lowest digestion rate (mean = 65%), approximately 5% or 10% lower than Roche Liberase HI (p = 0.04) and Serva NB1 (p = 0.0003), respectively; however, the Sigma V group showed better islet size preservation. Yet, the enzymes resulted in similar IEQ/g digested tissue. Of the isolated islets, 70.2% were smaller than 150 µm and contributed only 20.4% to the total IEQ, while 7.4% of the islets were larger than 250 µm but contributed 42.4% to the total IEQ. In summary, BMI, pancreas size, and CIT are useful variables for predicting islet yield, but selection of enzyme and balancing digestion time and rate are also important.
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Affiliation(s)
- Y Wang
- Department of Transplant/Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Paushter DH, Qi M, Danielson KK, Harvat TA, Kinzer K, Barbaro B, Patel S, Hassan SZ, Oberholzer J, Wang Y. Histidine-tryptophan-ketoglutarate and University of Wisconsin solution demonstrate equal effectiveness in the preservation of human pancreata intended for islet isolation: a large-scale, single-center experience. Cell Transplant 2012; 22:1113-21. [PMID: 23031661 DOI: 10.3727/096368912x657332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We previously reported a small-scale study on the efficacy of histidine-tryptophan-ketoglutarate (HTK) solution versus University of Wisconsin (UW) solution on pancreas preservation for islet isolation. In this large-scale, retrospective analysis (n = 252), we extend our initial description of the impact of HTK on islet isolation outcomes and include pancreatic digestion efficacy, purification outcomes, and islet size distribution. Multivariable linear regression analysis, adjusted for donor age, sex, BMI, cold ischemia time, and enzyme, demonstrated similar results for the HTK group (n = 95) and the UW group (n = 157), including postpurification islet yields (HTK: 289,702 IEQ vs. UW: 283,036 IEQ; p = 0.76), percentage of digested pancreatic tissue (HTK: 66.9% vs. UW: 64.1%; p = 0.18), and islet loss from postdigestion to postpurification (HTK: 24,972 IEQ vs. UW: 39,551 IEQ; p = 0.38). Changes in islet size between the postdigestion and postpurification stages were comparable within each islet size category for HTK and UW (p = 0.14-0.99). Tissue volume distribution across purification fractions and islet purity in the top fractions were similar between the groups; however, the HTK group had significantly higher islet purity in the middle fractions (p = 0.003-0.008). Islet viability and stimulation indices were also similar between the HTK and the UW groups. In addition, we analyzed a small sample of patients transplanted either with HTK (n = 7) or UW (n = 8) preserved islets and found no significant differences in posttransplant HbA1c, β-score, and frequency of insulin independence. This study demonstrates that HTK and UW solutions offer comparable pancreas preservation for islet transplantation. More in vivo islet outcome data are needed for a complete analysis of the effects of HTK on islet transplantation.
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Affiliation(s)
- Daniel H Paushter
- Department of Transplant/Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Abstract
OBJECTIVE We examined sleep in families of individuals with type 1 diabetes and the relationship of sleep with obesity, diabetes, and insulin resistance. METHODS Probands with type 1 diabetes diagnosed before age 18 and first- and second-degree relatives were included (n = 323). Demographic, anthropometric and clinical variables, and self-reported sleep duration and napping were assessed. RESULTS On average, adults (≥20 years) slept 7.5 (SD 1.5) hr, whereas children (5-11 years) and adolescents (12-19 years) slept 9.8 (SD 1.1) and 8.5 (SD 1.9) hr, respectively (p < .01). Based on national recommendations, 40.9% of participants slept insufficiently, particularly young people (vs. adults, p < .01). In age-group stratified analysis, there were no significant associations of insufficient sleep or sleep duration with obesity, diabetes status, or insulin resistance after adjustment for age, race/ethnicity, and gender. In all, 42% of participants reported napping regularly (≥1/week), with adolescents significantly more likely to do so (vs. adults, odds ratio [OR] = 1.95, p < .01). Non-Hispanic Blacks and Hispanics also had higher odds of regular napping (vs. non-Hispanic Whites, OR = 3.74, p < .01 and OR = 2.52, p = .03, respectively). In adjusted analysis, leaner (vs. obese) adolescents, whether measured by body mass index, percentage body fat, or waist circumference, were significantly more likely to nap regularly. CONCLUSIONS We found that insufficient sleep was significantly more likely in children and adolescents compared with adults in families with type 1 diabetes. Lower adiposity was associated with regular napping in adolescents. The high prevalence of insufficient sleep in young patients with type 1 diabetes and their relatives detected in the current study may have significant health consequences.
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Affiliation(s)
- Carmela L. Estrada
- Institute for Endocrine Discovery and Clinical Care, University of Chicago,
| | | | | | - Rebecca B. Lipton
- Institute for Endocrine Discovery and Clinical Care & Department of Health Studies, University of Chicago,
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Abstract
AIM To understand the etiology of childhood-onset diabetes, we examined genetic risk markers, autoantibodies, and β-cell function in a mixed race group of young patients. METHODS One hundred and forty-five patients aged 0-17 at diagnosis (54% African American, 22% Caucasian, 16% Latino, 8% mixed-other) were studied at mean duration 6.9 ± 5.7 (range 0.1-28.5) yr, including human leukocyte antigen (HLA)-DQA1-DQB1 genotyping, stimulated C peptide (CP), glutamic acid decarboxylase, and insulinoma-associated antigen 2 antibodies (ABs). Based on no residual β-cell function (CP-) and islet autoantibodies (AB+), 111 patients were classified with type 1 diabetes mellitus (T1DM), 22 were CP+ and AB- and thus considered to have type 2 diabetes mellitus (T2DM), and 12 patients had features of both T1DM and T2DM or mixed phenotype. RESULTS Based on the presence of two high-risk HLA-DQA1/B1 haplotypes, 39% of African Americans, 81% of Caucasians, 70% of Latinos, and 67% of mixed-others were at high genetic risk. In patients with T1DM, 41% of African Americans, 80% of Caucasians, 73% of Latinos, and 63% of mixed-others were genetically susceptible. Thirty-one percent of African Americans, including 29% of those with T1DM, could not be characterized because their haplotypes had unknown T1DM associations. These unusual haplotypes comprised 11% in T1DM, 14% in T2DM, and 8% in patients with mixed phenotype. CONCLUSIONS Fifty-nine percent of childhood-onset patients with T1DM were identified with high genetic risk based on known HLA-DQA1/B1 associations. Many non-Caucasian patients carry HLA-DQ alleles whose association with T1DM is undetermined. Genetic approaches can provide insights into the etiology and appropriate treatment of childhood-onset diabetes but only if sufficient data are available in diverse ethnic groups.
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Affiliation(s)
- Rebecca B. Lipton
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637,To whom reprint requests should be addressed. Rebecca B. Lipton, PhD, 5841 S. Maryland Ave. MC 5053, Chicago, IL 60637 phone:1-708-275-6355,
| | - Melinda Drum
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
| | - Siri Atma W. Greeley
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
| | - Kirstie K. Danielson
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
| | - Graeme I. Bell
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
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Abstract
AIM To explore whether it is possible to predict a child's eventual diabetes phenotype using characteristics at initial presentation, we reassessed 111 young patients on average 7.8 ± 4.2 (2.2-19.7) [mean ± SD (range)] years after diagnosis. METHODS Medical records at diagnosis for 111 patients, aged 0-17, were compared with their follow-up characteristics including stimulated C-peptide (CP) and islet autoantibodies (AB). RESULTS Initially, 18 patients were obese; 9 displayed other type 2 diabetes (T2DM) features (polycystic ovary syndrome, acanthosis, diagnosed T2DM); the remaining 84 had a classic type 1 diabetes (T1DM) presentation. At follow-up, 83 patients (75%) with no measured CP were classified as T1DM; 17 (15%) were CP+ and AB- and thus considered T2DM. Eleven patients with both T1DM and T2DM features were classified as having mixed diabetes phenotype (MDM). One-fifth (22 subjects) changed presumed phenotype at follow-up. In multivariable models, T1DM patients were younger at diagnosis, had higher initial glucose values, were more likely to have experienced ketoacidosis, and less likely to be obese or of African American ethnicity. CONCLUSIONS/INTERPRETATION Ten percent of subjects had MDM and 15% had T2DM at ∼8 years' duration. Although no onset feature was completely reliable, ketoacidosis and hyperglycemia were more likely to predict T1DM; obesity and African American ethnicity made T2DM more likely. At diagnosis, features of T2DM in addition to obesity were strongly predictive of eventual T2DM phenotype. Given the significant percentage who changed or had mixed phenotype, careful tracking of all young people with diabetes is essential to correctly determine eventual disease type.
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Affiliation(s)
- Rebecca B. Lipton
- Biological Sciences Division, University of Chicago, IL, USA,Corresponding author to whom reprint requests should be addressed. 5841 S. Maryland Avenue, MC 5053 Chicago, IL 60637 USA
| | - Melinda L. Drum
- Biological Sciences Division, University of Chicago, IL, USA
| | | | | | - Graeme I. Bell
- Biological Sciences Division, University of Chicago, IL, USA
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Wang Y, Paushter D, Wang S, Barbaro B, Harvat T, Danielson KK, Kinzer K, Zhang L, Qi M, Oberholzer J. Highly purified versus filtered crude collagenase: comparable human islet isolation outcomes. Cell Transplant 2011; 20:1817-25. [PMID: 21396158 DOI: 10.3727/096368911x564994] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study was designed to retrospectively compare the impact of crude Sigma V collagenase (Sigma V, n = 52) with high-purified Serva NB1 collagenase (Serva NB1, n = 42) on human islet isolation outcomes. A three-step filtration was applied to the crude Sigma V to remove endotoxin contamination and impurities; in addition, this process was used as a lot prescreening tool. Isolation outcomes were determined by digestion efficacy, islet yields, purity, viability, glucose-stimulated insulin release, and endotoxin content. The digestion efficacy between Sigma V and Serva NB1 was statistically significant (Sigma V: 64.71% vs. Serva NB1: 69.71%, p = 0.0014). However, the islet yields were similar (Sigma V: 23422.58 vs. Serva NB1: 271097 IEq, p = 0.23) between groups. There was no significant purity difference observed in fractions with purities greater than 75%. Viability (Sigma V: 93.3% vs. Serva NB1: 94.8%, p = 0.061) and stimulation indexes (Sigma V: 3.41 vs. Serva NB1: 2.74, p = 0.187) were also similar between the two groups. The impact of cold ischemia and age on the isolation outcome in the Sigma V group was comparable to the Serva NB1 group. The endotoxin content of the final products in the filtered Sigma V group was significantly less than that in the high-purified Serva NB1 group (0.022 vs. 0.052 EU/ml, p = 0.003). Additionally, in the Sigma V group there was minimal lot to lot variation and no significant loss of enzymatic activity after filtration. These findings indicate that the use of Sigma V or other crude enzyme blends for research pancreata is warranted to reduce isolation costs and increase the amount of islets available for critical islet research. These findings also validate the need for a systematic enzyme analysis to resolve these inconsistencies in overall enzyme quality once and for all.
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Affiliation(s)
- Yong Wang
- Department of Transplant/Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Danielson KK, Drum ML, Estrada CL, Lipton RB. Racial and ethnic differences in an estimated measure of insulin resistance among individuals with type 1 diabetes. Diabetes Care 2010; 33:614-9. [PMID: 20007942 PMCID: PMC2827519 DOI: 10.2337/dc09-1220] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance is greater in racial/ethnic minorities than in non-Hispanic whites (NHWs) for those with and without type 2 diabetes. Because previous research on insulin resistance in type 1 diabetes was limited to NHWs, racial/ethnic variation in an estimated measure of insulin resistance in type 1 diabetes was determined. RESEARCH DESIGN AND METHODS The sample included 79 individuals with type 1 diabetes diagnosed at age <18 years (32.9% NHWs, 46.8% non-Hispanic black [NHB], 7.6% other/mixed, and 12.7% Hispanic) and their families. Estimated glucose disposal rate (eGDR) (milligrams per kilogram per minute; a lower eGDR indicates greater insulin resistance) was calculated using A1C, waist circumference, and hypertension status. RESULTS Mean current age was 13.5 years (range 3.2-32.5) and diabetes duration was 5.7 years (0.1-19.9). eGDR was inversely associated with age. Compared with that in NHWs, age-adjusted eGDR was significantly lower among nonwhites (NHB, other/mixed, and Hispanic: Delta = -1.83, P = 0.0006). Age-adjusted eGDR was negatively associated with body fat, triglycerides, urinary albumin/creatinine, acanthosis nigricans, parental obesity, and parental insulin resistance and positively related to HDL and sex hormone-binding globulin. In multivariable analysis, lower eGDR was significantly associated with older age, nonwhite race/ethnicity, acanthosis, and lower HDL. CONCLUSIONS Minorities with type 1 diabetes are significantly more insulin resistant, as measured by eGDR, than NHWs. Exploring potential mechanisms, including disparities in care and/or physiological variation, may contribute to preventing racial/ethnic differences in insulin resistance-associated outcomes.
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Affiliation(s)
- Kirstie K Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, USA.
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Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study. J Gen Intern Med 2010; 25:141-6. [PMID: 19967465 PMCID: PMC2837501 DOI: 10.1007/s11606-009-1179-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 07/21/2009] [Accepted: 10/29/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes. OBJECTIVE We evaluated the association between number of prescription medications and incident falls in a multi-ethnic population of type-2 diabetes patients in order to establish an evidence-based medication threshold for fall risk in diabetes. DESIGN Baseline survey (1994-1997) with 5 years of longitudinal follow-up. PARTICIPANTS Eligible subjects (N = 46,946) had type-2 diabetes, were >or=18 years old, and enrolled in the Kaiser Permanente Northern California Diabetes Registry. MEASUREMENTS AND MAIN RESULTS We identified clinically recognized incident falls based on diagnostic codes (ICD-9 codes: E880-E888). Relative to regimens of 0-1 medications, regimens including 4 or more prescription medications were significantly associated with an increased risk of falls [4-5 medications adjusted HR 1.22 (1.04, 1.43), 6-7 medications 1.33 (1.12, 1.58), >7 medications 1.59 (1.34, 1.89)]. None of the individual glucose-lowering medications was found to be significantly associated with a higher risk of falls in predictive models. CONCLUSIONS The prescription of four or more medications was associated with an increased risk of falls among adult diabetes patients, while no specific glucose-lowering agent was linked to increased risk. Baseline risk of falls and number of baseline medications are additional factors to consider when deciding whether to intensify diabetes treatments.
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Affiliation(s)
- Elbert S Huang
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Abstract
OBJECTIVES Rehospitalization after a diabetes diagnosis in youth signals the failure of outpatient management. We examined risk factors for rehospitalization among young patients with diabetes. PATIENTS AND METHODS We queried 535 participants diagnosed before 18 years of age from the Chicago Childhood Diabetes Registry. Demographic, social, and clinical data were used in logistic models of diabetes-related rehospitalization, as well as, among those rehospitalized, frequent (> or = once per 2 years' duration) versus infrequent rehospitalization rates. RESULTS Mean (range) duration was 5.1 years (0.1-19.2 years). The sample was 55% non-Hispanic black, 11% non-Hispanic white, 26% Hispanic, and 7% other/mixed race; 86% had presumed type 1 diabetes; and 47% were underinsured. Overall, 46% reported rehospitalization for diabetes. In multivariable logistic regression, ever being rehospitalized was significantly associated with diabetes duration (per year, odds ratio [OR]: 1.26; P < .01), female gender (OR: 1.67; P = .01), underinsurance (versus private insurance; OR: 1.79; P < .01), presumed phenotype (non-type 1 diabetes versus type 1; OR: 0.32; P < .01), and diagnosis at a community hospital (versus tertiary care facility; OR: 1.96; P < .01) and tended to be higher for those of nonwhite race (OR: 1.94; P = .07). Among those rehospitalized, multivariable associations with frequent rehospitalization were presumed phenotype (non-type 1 diabetes versus type 1; OR: 2.74; P = .04), head of household not working (versus employed; OR: 1.88; P = .02), and younger age at questionnaire (per year; OR: 0.94; P = .01). CONCLUSIONS Rehospitalization is common in young patients with diabetes, especially for those with limited resources, indicating the need for improved outpatient services. Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects.
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Affiliation(s)
- Carmela L. Estrada
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Kirstie K. Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Melinda L. Drum
- Department of Health Studies, University of Chicago, Chicago, Illinois
| | - Rebecca B. Lipton
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, Department of Health Studies, University of Chicago, Chicago, Illinois
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Danielson KK, Elliott ME, LeCaire T, Binkley N, Palta M. Poor glycemic control is associated with low BMD detected in premenopausal women with type 1 diabetes. Osteoporos Int 2009; 20:923-33. [PMID: 18830554 PMCID: PMC2748939 DOI: 10.1007/s00198-008-0763-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 08/18/2008] [Indexed: 12/24/2022]
Abstract
SUMMARY The etiology of bone fragility in individuals with type 1 diabetes is unknown. This study demonstrated that bone turnover favors resorption and that poor glycemic control is associated with low bone mineral density (BMD) and low bone turnover, in premenopausal women with type 1 diabetes. The results could inform future interventions. INTRODUCTION Low BMD and fracture may be complications of type 1 diabetes. We sought to determine the roles of bone turnover and glycemic control in the etiology of low BMD. METHODS Premenopausal women from the Wisconsin Diabetes Registry Study and matched controls were compared (n = 75 pairs). Heel and forearm BMD were measured, and hip and spine BMD were measured in a subset. Markers of bone formation (osteocalcin) and resorption (NTx), and glycemic control (HbA1c) were determined. RESULTS Age ranged from 18 to 50 years with a mean of 28, and 97% were Non-Hispanic white. Among women with diabetes, mean disease duration was 16 years and current HbA1c was 8%. Compared to controls, women with diabetes had a high prevalence of previous fracture (37% vs. 24%) and low BMD for age (heel or forearm: 49% vs. 31%), low heel and forearm BMD, and low osteocalcin levels. Levels of NTx were similar, suggesting uncoupled turnover favoring resorption. Poor glycemic control was associated with low BMD at all bone sites except the spine, and with low osteocalcin and NTx levels. CONCLUSIONS Optimal glycemic control may prevent low BMD and altered bone turnover in type 1 diabetes, and decrease fracture risk.
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Affiliation(s)
- K K Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, IL, USA.
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Abstract
OBJECTIVE Insulin downregulates hepatic production of sex hormone-binding globulin (SHBG), which in turn influences sex hormone bioavailability. The effects of childhood-onset diabetes and insulin resistance in nondiabetic individuals on SHBG and testosterone in children and young adults are poorly understood. RESEARCH DESIGN AND METHODS Individuals with diabetes diagnosed at <18 years of age (n = 48) and their siblings without diabetes (n = 47) were recruited for the Chicago Childhood Diabetes Registry Family Study. SHBG and total and free testosterone were measured. Participants ranged in age from 10 to 32 years; 39% were non-Hispanic white. The majority of individuals with diabetes had the classic type 1 phenotype (75%), while the remainder exhibited features of type 2 or mixed diabetes; 96% were treated with insulin. RESULTS SHBG and total testosterone were higher in male subjects with diabetes compared with those in male siblings. Elevated SHBG was associated with the absence of endogenous insulin independent of sex; elevated total testosterone was similarly associated with the absence of C-peptide for male subjects only. Diabetes type and treatment were unrelated. In those without diabetes, greater insulin resistance had a small, nonsignificant association with lower SHBG and higher free testosterone. CONCLUSIONS SHBG and total testosterone appear to be higher in male children and young adults with diabetes compared with nondiabetic male siblings, which is apparently related to the absence of endogenous insulin. This may have implications for sex hormone-dependent processes across the lifespan in male individuals diagnosed with diabetes as children.
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Affiliation(s)
- Kirstie K Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, USA.
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Danielson KK, Palta M, Allen C, D'Alessio DJ. The association of increased total glycosylated hemoglobin levels with delayed age at menarche in young women with type 1 diabetes. J Clin Endocrinol Metab 2005; 90:6466-71. [PMID: 16204372 PMCID: PMC1351299 DOI: 10.1210/jc.2005-0349] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Delayed menarche is associated with subsequent reproductive and skeletal complications. Previous research has found delayed growth and pubertal maturation with type 1 diabetes and poor glycemic control. The effect of diabetes management on menarche is important to clarify, because tighter control might prevent these complications. OBJECTIVE The objective of this study was to investigate age at menarche in young women with type 1 diabetes and examine the effect of diabetes management [e.g. total glycosylated hemoglobin (GHb) level, number of blood glucose checks, insulin therapy intensity, and insulin dose] on age at menarche in those diagnosed before menarche. DESIGN The Wisconsin Diabetes Registry Project is a follow-up study of a type 1 diabetes population-based incident cohort initially enrolled between 1987 and 1992. SETTING This study was performed in 28 counties in south-central Wisconsin. PATIENTS OR OTHER PARTICIPANTS The study participants were recruited through referrals, self-report, and hospital/clinic ascertainment. Individuals with newly diagnosed type 1 diabetes, less than 30 yr old, were invited to participate. Of 288 young women enrolled, 188 reported menarche by 2002; 105 were diagnosed before menarche. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURE The main outcome measure was age at menarche. RESULTS Mean age at menarche was 12.78 yr, compared with 12.54 yr in the United States (P = 0.01). Ages at menarche and diagnosis were not associated. For those diagnosed before menarche, age at menarche was delayed 1.3 months with each 1% increase in mean total GHb level in the 3 yr before menarche. CONCLUSIONS Age at menarche was moderately delayed in young women with type 1 diabetes. Delayed menarche could potentially be minimized with improved GHb levels.
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Affiliation(s)
- Kirstie K Danielson
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin 53726-2397, USA.
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Abstract
OBJECTIVE The purpose of this study was to report the prevalence, risk, and implications of comorbidity between partner violence and psychiatric disorders. METHOD Data were obtained from a representative birth cohort of 941 young adults through use of the Conflict Tactics Scales and Diagnostic Interview Schedule. RESULTS Half of those involved in partner violence had a psychiatric disorder; one-third of those with a psychiatric disorder were involved in partner violence. Individuals involved in severe partner violence had elevated rates of a wide spectrum of disorders. CONCLUSIONS The findings support the importance of mental health clinicians screening for partner violence and treating victims and perpetrators before injury occurs.
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