Browsing by Subject "diabetes mellitus"

Now showing 1 - 10 of 17
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    Associations between immigrant status and pharmacological treatments for diabetes in U.S. adults
    (APA, 2018) Hsueh, Loretta; Vrany, Elizabeth A.; Patel, Jay S.; Hollingshead, Nicole A.; Hirsh, Adam T.; de Groot, Mary; Stewart, Jesse C.; Psychology, School of Science
    Objectives: Although treatment disparities in diabetes have been documented along racial/ethnic lines, it is unclear if immigrant groups in the United States experience similar treatment disparities. Our objective was to determine whether immigrant status is associated with differences in pharmacological treatment of diabetes in a nationally representative sample of adults with diabetes. We were specifically interested in differences in treatment with oral hypoglycemic agents (OHA) and insulin. Method: Respondents were 2,260 adults from National Health and Nutritional Examination Survey (NHANES) 2003–2012 with a self-reported diabetes diagnosis. Immigrant status was indicated by birth within (U.S.-born) or outside (foreign-born) the 50 U.S. States or Washington, DC. Multinomial logistic regression analyses examined associations between immigrant status and (a) treatment with OHAs only and (b) treatment with insulin only or insulin and OHA combination therapy, using no treatment as the reference group. Results: Adjusting for demographics, diabetes severity and duration, cardiovascular disease (CVD), and CVD risk factors, being foreign-born versus U.S.-born was not associated with treatment with OHAs only (odds ratio [OR] = 1.59; 95% confidence interval [CI] [0.97, 2.60]). However, being foreign-born was associated with decreased odds (OR = 0.53; 95% CI [0.28, 0.99]) of treatment with insulin. Conclusions: Pharmacological treatment of diabetes differs along immigrant status lines. To understand these findings, studies capturing the processes underlying treatment differences in diabetes among immigrants are needed. Findings raise the possibility that integrating information about a patient’s immigrant status, in addition to racial/ethnic identity, may be an important component of culturally sensitive diabetes care.
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    Case Presentation: Shoulder pain as a rheumatic manifestation of diabetes mellitus
    (Association of Kenya Physicians, 2007) Okanga, J. B.; Yossa, G. P.; Association of Kenya Physicians Scientific Conference (11th : Mar. 2007 : Eldoret, Kenya)
    Shoulder pain, a common musculoskeletal symptom, aetiologically is related to periarticular lesions mainly subacronial impingment (SAI) (90% adults). Articular lesions e.g. Synovvitis adhesive capsulitis (frozen shoulder) etc may be referred to the neck and humeral deltoid insertion. Referred pain from the cervical or thoracic spine, thoracic outlet or subdiaphramatic structures may manifest at the shoulder. Diabetes mellitus syndrome may be complicated by adhesive capsulitis more frequently than in the general population. A case is presented of a 52yr old house wife of high social standing, who has been followed up for 5yrs. Initially left shoulder pain but in the last 2yrs predominantly right shoulder pain, less involvement of the neck, right wrist and right foot. She has been under several clinicians with a frustration long list of probable diagnoses to her ailment. Diabetes mellitus was diagnosed in September 2005 and attacks related to hyperglycaemia/metabolic decompensation. The last attack was in January 2007 which necessitated hospitalization. A visiting rheumatologist confirmed "FROZEN SHOULDER" with diabetes mellitus. A multidisciplinary and multifactorial intervention aimed at multiple risk factors of diabetes syndrome is the way forward. Patient education/nutrition counseling and physiotherapy is the cornerstone of effective management.
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    Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction
    (American Heart Association, 2018-02) Bravata, Dawn M.; Daggy, Joanne; Brosch, Jared; Sico, Jason J.; Baye, Fitsum; Myers, Laura J.; Roumie, Christianne L.; Cheng, Eric; Coffing, Jessica; Arling, Greg; Medicine, School of Medicine
    BACKGROUND AND PURPOSE: The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI). METHODS: We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. RESULTS: Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P<0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia (P=0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). CONCLUSIONS: Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed
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    Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA: NHANES (2013–2018)
    (BMJ, 2021) Davis-Ajami, Mary L.; Lu, Zhiqiang K.; Wu, Jun
    Objective: The purpose of this study is to examine the association between delivery of healthcare provider's advice about lifestyle management and lifestyle behavioural change in pre-diabetes management in adults who were overweight or obese. Design: This cross-sectional study included adults with body mass index (BMI) ≥25 kg/m2 and reporting pre-diabetes in USA. Outcomes included the prevalence of receiving provider's advice on lifestyle management and patterns of practicing lifestyle change. The association between delivery of provider's advice and lifestyle-related behavioural change in pre-diabetes management was examined. Setting: US Continuous National Health and Nutrition Examination Survey (2013-2018). Participants: A total of 1039 adults with BMI ≥25 kg/m2 reported pre-diabetes. Results: Of eligible adults with pre-diabetes, 76.8% received provider's advice about lifestyle change. The advice group showed higher proportions of ongoing lifestyle change than no advice group, including weight reduction/control (80.1% vs 70.9%, p=0.018), exercise (70.9% vs 60.9%, p=0.013) and diet modifications (83.8% vs 61.8%, p<0.001). After adjustment, those receiving provider's advice were more likely to increase exercise (OR 1.63, 95% CI 1.12 to 2.38) and modify diet (OR 3.0, 95% CI 1.82 to 4.96). Conclusion: Over 75% of US adults who were overweight or obese and reported pre-diabetes received healthcare provider's advice about reducing the risk of diabetes through lifestyle change. Provider's advice increased the likelihood of lifestyle-related behavioural change to exercise and diet.
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    Diabetes reduces bone marrow and circulating porcine endothelial progenitor cells, an effect ameliorated by atorvastatin and independent of cholesterol
    (Wiley, 2009-01) Mohler III, Emile R.; Shi, Yuquan; Moore, Jonni; Bantly, Andrew; Hamamdzic, Damir; Yoder, Mervin; Rader, Daniel J.; Putt, Mary; Zhang, Lifeng; Parmacek, Michael; Wilensky, Robert L.; Pediatrics, School of Medicine
    Bone marrow derived endothelial progenitor cells (EPCs) are early precursors of mature endothelial cells which replenish aging and damaged endothelial cells. The authors studied a diabetic swine model to determine if induction of DM adversely affects either bone marrow or circulating EPCs and whether a HMG-CoA reductase inhibitor (statin) improves development and recruitment of EPCs in the absence of cholesterol lowering. Streptozotocin was administered to Yorkshire pigs to induce DM. One month after induction, diabetic pigs were treated with atorvastatin (statin, n = 10), ezetimibe (n = 10) or untreated (n = 10) and evaluated for number of bone marrow and circulating EPCs and femoral artery endothelial function. There was no effect of either medication on cholesterol level. One month after induction of DM prior to administration of drugs, the number of bone marrow and circulating EPCs significantly decreased (P < 0.0001) compared to baseline. Three months after DM induction, the mean proportion of circulating EPCs significantly increased in the atorvastatin group, but not in the control or ezetimibe groups. The control group showed progressive reduction in percentage of flow mediated vasodilatation (no dilatation at 3 months) whereas the atorvastatin group and ezetimibe exhibited vasodilatation, 6% and 4% respectively. DM results in significant impairment of bone marrow and circulating EPCs as well as endothelial function. The effect is ameliorated, in part, by atorvastatin independent of its cholesterol lowering effect. These data suggest a model wherein accelerated atherosclerosis seen with DM may, in part, result from reduction in EPCs which may be ameliorated by treatment with a statin.
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    High glucose alters the secretome of mechanically stimulated osteocyte-like cells affecting osteoclast precursor recruitment and differentiation
    (Wiley, 2017-12) Maycas, Marta; Portolés, Maria Teresa; Matesanz, María Concepción; Buendía, Irene; Linares, Javier; Feito, María José; Arcos, Daniel; Vallet-Regí, María; Plotkin, Lilian; Esbrit, Pedro; Gortázar, Arancha R.; Anatomy and Cell Biology, School of Medicine
    Diabetes mellitus (DM) induces bone deterioration, while mechanical stimulation promotes osteocyte-driven bone formation. We aimed to evaluate the interaction of acute exposure (24 h) to high glucose (HG) with both the pro-survival effect conferred to osteocytic MLO-Y4 cells and osteoblastic MC3T3-E1 cells by mechanical stimulation and the interaction of these cells with osteoclast precursor RAW264.7 cells. We found that 24 h of HG (25 mM) pre-exposure prevented both cell survival and ERK and β-catenin nuclear translocation upon mechanical stimulation by fluid flow (FF) (10 min) in both MLO-Y4 and MC3T3-E1 cells. However, migration of RAW 264.7 cells was inhibited by MLO-Y4 cell-conditioned medium (CM), but not by MC3T3-E1 cell-CM, with HG or FF. This inhibitory effect was associated with consistent changes in VEGF, RANTES, MIP-1α, MIP-1β MCP-1, and GM-CSF in MLO-Y4 cell-CM. RAW264.7 proliferation was inhibited by MLO-Y4 CM under static or HG conditions, but it increased by FF-CM with or without HG. In addition, both FF and HG abrogated the capacity of RAW 264.7 cells to differentiate into osteoclasts, but in a different manner. Thus, HG-CM in static condition allowed formation of osteoclast-like cells, which were unable to resorb hydroxyapatite. In contrast, FF-CM prevented osteoclastogenesis even in HG condition. Moreover, HG did not affect basal RANKL or IL-6 secretion or their inhibition induced by FF in MLO-Y4 cells. In conclusion, this in vitro study demonstrates that HG exerts disparate effects on osteocyte mechanotransduction, and provides a novel mechanism by which DM disturbs skeletal metabolism through altered osteocyte-osteoclast communication.
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    Improving Medication Adherence for Chronic Disease Using Integrated e-Technologies
    (2013) Dixon, Brian E.; Jabour, Abdulrahman M.; Phillips, Erin O'Kelly; Marrero, David G.
    Diabetes mellitus (DM) is a chronic disease affecting more than 285 people worldwide and the fourth leading cause of death. Increasing evidence suggests that many DM patients have poor adherence with prescribed medication therapies, impacting clinical outcomes. Patients' barriers to medication adherence and the extent to which barriers contribute to poor outcomes, however, are not routinely assessed. We designed a dashboard for an electronic health record system to integrate DM disease and medication data, including patient-reported barriers to adherence. Processes to support routine capture of data from patients are also being explored. The dashboard is being evaluated at multiple ambulatory clinics to examine whether integrated electronic tools can support patient-centered decision-making processes involving complex medication regimens for DM and other chronic diseases.
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    Literature-Based Discovery of Salivary Biomarkers for Type 2 Diabetes Mellitus
    (Libertas Academia, 2015-02) Srinivasan, Mythily; Blackburn, Corinne; Mohamed, Mohamed; Sivagami, A. V.; Blum, Janice; Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry
    The alarming increase in type 2 diabetes mellitus (T2DM) underscores the need for efficient screening and preventive strategies. Select protein biomarker profiles emerge over time during T2DM development. Periodic evaluation of these markers will increase the predictive ability of diabetes risk scores. Noninvasive methods for frequent measurements of biomarkers are increasingly being investigated. Application of salivary diagnostics has gained importance with the establishment of significant similarities between the salivary and serum proteomes. The objective of this study is to identify T2DM-specific salivary biomarkers by literature-based discovery. A serial interrogation of the PubMed database was performed using MeSH terms of specific T2DM pathological processes in primary and secondary iterations to compile cohorts of T2DM-specific serum markers. Subsequent search consisted of mining for the identified serum markers in human saliva. More than 60% of T2DM-associated serum proteins have been measured in saliva. Nearly half of these proteins have been reported in diabetic saliva. Measurements of salivary lipids and oxidative stress markers that can exhibit correlated saliva plasma ratio could constitute reliable factors for T2DM risk assessment. We conclude that a high percentage of T2DM-associated serum proteins can be measured in saliva, which offers an attractive and economical strategy for T2DM screening.
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    Molecular mechanisms and therapeutic targets for diabetic kidney disease
    (Elsevier, 2022) Tuttle, Katherine R.; Agarwal, Rajiv; Alpers, Charles E.; Bakris, George L.; Brosius, Frank C.; Kolkhof, Peter; Uribarri, Jaime; Medicine, School of Medicine
    Diabetic kidney disease has a high global disease burden and substantially increases the risk of kidney failure and cardiovascular events. Despite treatment, there is substantial residual risk of disease progression with existing therapies. Therefore, there is an urgent need to better understand the molecular mechanisms driving diabetic kidney disease to help identify new therapies that slow progression and reduce associated risks. Diabetic kidney disease is initiated by diabetes-related disturbances in glucose metabolism, which then trigger other metabolic, hemodynamic, inflammatory, and fibrotic processes that contribute to disease progression. This review summarizes existing evidence on the molecular drivers of diabetic kidney disease onset and progression, focusing on inflammatory and fibrotic mediators—factors that are largely unaddressed as primary treatment targets and for which there is increasing evidence supporting key roles in the pathophysiology of diabetic kidney disease. Results from recent clinical trials highlight promising new drug therapies, as well as a role for dietary strategies, in treating diabetic kidney disease
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    Pancreas Transplantation Alone: Radical or Rationale?
    (Wolters Kluwer, 2021-01) Stratta, Robert J.; Fridell, Jonathan A.; Surgery, School of Medicine