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Browsing by Subject "Hemoglobin A1c"
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Item Analyzing outcomes following pancreas transplantation: Definition of a failure or failure of a definition(Wiley, 2022) Stratta, Robert J.; Farney, Alan C.; Fridell, Jonathan A.; Surgery, School of MedicinePancreas transplantation has an identity crisis and is at a crossroads. Although outcomes continue to improve in each successive era, the number of pancreas transplants performed annually in the United States has been static for several years in spite of increasing numbers of deceased donors. For most practitioners who manage diabetes, pancreas transplantation is considered an extreme measure to control diabetes. With expanded recipient selection (primarily simultaneous pancreas-kidney transplantation) in patients who are older, have a higher BMI, are minorities, or who have a type 2 diabetes phenotype, the controversy regarding type of diabetes detracts from the success of intervention. The absence of a clear and precise definition of pancreas graft failure, particularly one that lacks a measure of glycemic control, inhibits wider application of pancreas transplantation with respect to reporting long-term outcomes, comparing this treatment to alternative therapies, developing listing and allocation policy, and having a better understanding of the patient perspective. It has been suggested that the definition of pancreas graft failure should differ depending on the type of pretransplant diabetes. In this commentary, we discuss current challenges regarding the development of a uniform definition of pancreas graft failure and propose a potential solution to this vexing problem.Item Cystic fibrosis-related diabetes: Prevalence, screening, and diagnosis(Elsevier, 2021-12-07) Khare, Swapnil; Desimone, Marisa; Kasim, Nader; Chan, Christine L.; Medicine, School of MedicineCystic fibrosis-related diabetes (CFRD) is the most common comorbidity in patients with cystic fibrosis (CF). Prevalence of CFRD increases with age and is greater with severe mutations. Other risk factors associated with CFRD are female sex, pancreatic insufficiency, liver disease, need for gastrostomy tube feedings, history of bronchopulmonary aspergillosis, and poor pulmonary function. CFRD is related to worse clinical outcomes and increased mortality. Early diagnosis and treatment have been shown to improve clinical outcomes. Screening for CFRD is recommended with an annual oral glucose tolerance test (OGTT) starting at age 10 years. Diagnosis of CFRD is made by standard American Diabetes Association (ADA) criteria during baseline health. CFRD can also be diagnosed in individuals with CF during acute illness, while on enteral feeds, and after transplant. In this review we will discuss the epidemiology of CFRD and provide an overview of the advantages and pitfalls of current screening and diagnostic tests for CFRD.Item Diabetes Distress, Emotional Regulation, HbA1c in People with Diabetes and A Controlled Pilot Study of an Emotion-Focused Behavioral Therapy Intervention in Adults with Type 2 Diabetes(Elsevier, 2022) Coccaro, Emil F.; Drossos, Tina; Kline, David; Lazarus, Sophie; Joseph, Joshua J.; de Groot, Mary; Medicine, School of MedicineAim: One potential barrier for people with diabetes to reach glycemic goals is diabetes distress. Accumulating evidence suggests diabetes distress may be linked to individuals' emotion regulation capacities. Thus, we conducted two studies to elucidate a model for how emotion regulation impacts diabetes distress and A1c levels and determine preliminary effect size estimates for an intervention targeting poor emotion regulation on glycemic control. Methods: Study I used structural equation modeling to assess the cross-sectional relationships between these variables in a sample of 216 individuals with Type 1 and Type 2 diabetes. Study II built on findings from Study I that highlighted the role of emotion regulation capacities in diabetes distress and A1c by conducting a pilot study of an emotion-focused behavioral intervention compared to treatment as usual in a sample of individuals with Type 2 diabetes. Results: Study I examined two potential explanatory models with one of the models (Model II) showing a more comprehensive view of the data revealing a total effect of poor emotional regulation of 42% of all effects on A1c levels. Study II tested an emotion-focused behavioral intervention in patients with Type 2 diabetes compared to treatment as usual and found medium sized reductions in A1c levels and smaller reductions in diabetes distress that correlated with changes in emotion regulation. Conclusions: These studies suggest that, in people with diabetes, elevated A1c levels and diabetes distress are linked with poor emotion regulation. While the effect sizes from Study 2 are preliminary, an emotion-focused behavioral intervention may reduce both A1c and diabetes distress levels, through improvements in emotion regulation. Overall, these data suggest that targeting difficulties in emotion regulation may hold promise for maximizing improvement in diabetes distress and A1c in individuals with diabetes.Item Impact of Rare and Common Genetic Variants on Diabetes Diagnosis by Hemoglobin A1c in Multi-Ancestry Cohorts: The Trans-Omics for Precision Medicine Program(Elsevier, 2019-09-26) Sarnowski, Chloé; Leong, Aaron; Raffield, Laura M.; Wu, Peitao; de Vries, Paul S.; DiCorpo, Daniel; Guo, Xiuqing; Xu, Huichun; Liu, Yongmei; Zheng, Xiuwen; Hu, Yao; Brody, Jennifer A.; Goodarzi, Mark O.; Hidalgo, Bertha A.; Highland, Heather M.; Jain, Deepti; Liu, Ching-Ti; Naik, Rakhi P.; O’Connell, Jeffrey R.; Perry, James A.; Porneala, Bianca C.; Selvin, Elizabeth; Wessel, Jennifer; Psaty, Bruce M.; Curran, Joanne E.; Peralta, Juan M.; Blangero, John; Kooperberg, Charles; Mathias, Rasika; Johnson, Andrew D.; Reiner, Alexander P.; Mitchell, Braxton D.; Cupples, L. Adrienne; Vasan, Ramachandran S.; Correa, Adolfo; Morrison, Alanna C.; Boerwinkle, Eric; Rotter, Jerome I.; Rich, Stephen S.; Manning, Alisa K.; Dupuis, Josée; Meigs, James B.; TOPMed Diabetes Working Group; TOPMed Hematology Working Group; TOPMed Hemostasis Working Group; National Heart, Lung, and Blood Institute TOPMed Consortium; Epidemiology, School of Public HealthHemoglobin A1c (HbA1c) is widely used to diagnose diabetes and assess glycemic control in individuals with diabetes. However, nonglycemic determinants, including genetic variation, may influence how accurately HbA1c reflects underlying glycemia. Analyzing the NHLBI Trans-Omics for Precision Medicine (TOPMed) sequence data in 10,338 individuals from five studies and four ancestries (6,158 Europeans, 3,123 African-Americans, 650 Hispanics, and 407 East Asians), we confirmed five regions associated with HbA1c (GCK in Europeans and African-Americans, HK1 in Europeans and Hispanics, FN3K and/or FN3KRP in Europeans, and G6PD in African-Americans and Hispanics) and we identified an African-ancestry-specific low-frequency variant (rs1039215 in HBG2 and HBE1, minor allele frequency (MAF) = 0.03). The most associated G6PD variant (rs1050828-T, p.Val98Met, MAF = 12% in African-Americans, MAF = 2% in Hispanics) lowered HbA1c (−0.88% in hemizygous males, −0.34% in heterozygous females) and explained 23% of HbA1c variance in African-Americans and 4% in Hispanics. Additionally, we identified a rare distinct G6PD coding variant (rs76723693, p.Leu353Pro, MAF = 0.5%; −0.98% in hemizygous males, −0.46% in heterozygous females) and detected significant association with HbA1c when aggregating rare missense variants in G6PD. We observed similar magnitude and direction of effects for rs1039215 (HBG2) and rs76723693 (G6PD) in the two largest TOPMed African American cohorts, and we replicated the rs76723693 association in the UK Biobank African-ancestry participants. These variants in G6PD and HBG2 were monomorphic in the European and Asian samples. African or Hispanic ancestry individuals carrying G6PD variants may be underdiagnosed for diabetes when screened with HbA1c. Thus, assessment of these variants should be considered for incorporation into precision medicine approaches for diabetes diagnosis.