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Genetic Vulnerability To Diabetes And Obesity: Does Education Offset The Risk?, Sze Yan Liu, Stefan Walter, Jessica Daniel, David H. Rehkopf, Laura E. Kubzansky, M Maria Glymour

Sze Yan Liu

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n = 8398), we tested whether education modifies genetic risk for obesity …

Modifiable Disease Risk, Readiness To Change, And Psychosocial Functioning Improve With Integrative Medicine Immersion Model, Ruth Q. Wolever, Daniel M. Webber, Justin P. Meunier, Jeffrey M. Greeson, Evangeline R. Lausier, Tracy W. Gaudet

Jeffrey M. Greeson

Background—Stroke, diabetes, and coronary heart disease (CHD) remain leading causes of death in the United States and are largely attributable to lifestyle behaviors. Integrative medicine can provide a supportive partnership that focuses on improving health by identifying and implementing lifestyle changes based upon personal values and goals.

Objective—This prospective observational study was designed to assess the effectiveness of an integrative medicine intervention on modifiable disease risk, patient activation, and psychosocial risk factors for stroke, diabetes, and CHD.

Design—Sixty-three adults participated in a 3-day comprehensive, multimodal health immersion program at Duke Integrative Medicine, Duke University Medical Center, Durham, North Carolina. Participants …

Vitamin D Status And Demographic And Lifestyle Determinants Among Adults In The United States (Nhanes 2001-2006), Yan Cao, Katie L. Callahan, Sreenivas P. Veeranki, Yang Chen, Ying Liu, Shimin Zheng

Shimin Zheng

This study looked at risk factors associated with vitamin D levels in the body among a representative sample of adults in the U.S., NHANES III (2001-2006) data were used to assess the relationship between several demographic and health risk factors and vitamin D levels in the body. The Baseline-Category Logit Model was used to test the association between vitamin D level and the potential risk factors age, education, ethnicity, poverty status, physical activity, smoking, alcohol, obesity, diabetes and total cholesterol with both genders. Vitamin D insufficiency and deficiency were significantly associated with age, race, education, physical activity, obesity, diabetes and …

Impact Of The Heart Watch Program On Patients At Risk Of Developing Metabolic Syndrome, Prediabetes Or Cardiovascular Disease, Jennifer T. Fink, Kathryn K. Havens, Julia A. Schumacher, Renee E. Walker, George L. Morris Iii, David A. Nelson, Maharaj Singh, Ron A. Cisler

Maharaj Singh

Purpose

Metabolic syndrome is a set of metabolic risk factors associated with increased risk of developing cardiovascular disease and type 2 diabetes mellitus. We retrospectively evaluated the effectiveness of a lifestyle modification program (Heart WATCH) geared toward reducing development of chronic disease in women deemed at risk for metabolic syndrome, prediabetes and/or cardiovascular disease.

Methods

Our institution’s Heart WATCH program consists of screening sessions with a multidisciplinary team (physician/nurse, nutritionist and psychologist), a minimum of three visits with a nurse practitioner and weekly follow-up phone calls for a 14-week period. Sociodemographic variables were obtained at initial visit. Biometric testing indices …

Racial Disparities In Outcomes Following Kidney Transplantation: A Single-Center Experience, Vani Nilakantan, Maharaj Singh, Ruth M. Perez, Yang Shi, Ahmed Dalmar, Brittany T. Last, Ajay Sahajpal

Ahmed Dalmar, MD

Purpose

Kidney transplantation remains the best treatment option for end-stage renal disease. However, despite overall improvements in patient and graft survival rates after kidney transplantation, differences in outcomes still exist among different racial and ethnic groups, with African-Americans having lower graft survival. Gaps continue to exist in the understanding of how demographic factors contribute to the varying outcomes among racial/ethnic groups.

Methods

We retrospectively evaluated kidney transplant outcomes in four racial/ethnic groups over a 12-year period at a large tertiary care center. Primary and secondary study outcomes were patient and graft survival across groups. To determine factors that might predict …

Segregation Of A Latent High Adiposity Phenotype In Families With A History Of Type 2 Diabetes Mellitus Implicates Rare Obesity-Susceptibility Genetic Variants With Large Effects In Diabetes-Related Obesity, Arthur B. Jenkins, Marijka Batterham, Dorit Samocha-Bonet, Katherine Tonks, Jerry R. Greenfield, Lesley V. Campbell

Dr Marijka Batterham

Background We recently reported significantly greater weight gain in non-diabetic healthy subjects with a 1st degree family history (FH+) of type 2 diabetes mellitus (T2DM) than in a matched control group without such history (FH−) during voluntary overfeeding, implying co-inheritance of susceptibilities to T2DM and obesity. We have estimated the extent and mode of inheritance of susceptibility to increased adiposity in FH+. Methods Normoglycaemic participants were categorised either FH+ (≥1 1st degree relative with T2DM, 50F/30M, age 45±14 (SD) yr) or FH− (71F/51M, age 43±14 yr). Log-transformed anthropometric measurements (height, hip and waist circumferences) and lean, bone and fat mass …

Knowledge, Attitudes, Beliefs And Behaviors (Kabb) Of Diabetes Among Afro-Caribbeans Near Brooklyn, New York, Sophia Allen

Sophia I. Allen, Ph.D.

Diabetes is an epidemic in the U.S. that unduly affects minority groups. African Americans are more than two times as likely to die from diabetes than whites. Literature previously established that some population groups have a negative perception toward medical professionals and visiting a doctor's office and/or hospital when a health problem occurs. In New York City, where a large group of Afro-Caribbeans live, diabetes prevalence more than doubled over the past 10 years with over half a million adults diagnosed. Due to a gap in literature in the U.S. on type 2 diabetes among English-speaking Afro-Caribbeans, this study recruited …

Diabetes Self-Management Behaviors, Medical Care, Glycemic Control, And Self-Rated Health In Us Men By Race/Ethnicity, Joan A. Vaccaro, Kelitha Anderson, Fatma G. Huffman

Joan A. Vaccaro

Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes (N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and …

Optimal Strategies For Identifying Kidney Disease In Diabetes: Properties Of Screening Tests, Progression Of Renal Dysfunction And Impact Of Treatment- Systematic Review And Modelling Of Progression And Cost-Effectiveness, Andrew J. Farmer, Richard Stevens, Jennifer Hirst, Tom Lung, Jason Oke, Philip Clarke, Andrew Neil, Paul Glasziou, David Dunger, Helen Colhourn, Christopher Pugh, Germaine Wong, Rafael Perera, Brian Shine

Paul Glasziou

These results support current UK guidance, which recommends annual screening with ACR to identify early kidney disease in patients with diabetes, despite a high false-positive rate leading to, at worst, unnecessary or, at best, early therapeutic intervention. For type 1 diabetes, screening costs for annual compared with 2-yearly screening are well within the bounds of accepted cost-effectiveness. Annual screening is even more cost-effective in type 2 diabetes than in type 1 diabetes. Identification of alternative markers for developing diabetic nephropathy may improve targeting of treatment for those at high risk.

Monounsaturated Fatty Acid, Carbohydrate Intake, And Diabetes Status Are Associated With Arterial Pulse Pressure, Joan Vaccaro, Fatma G. Huffman

Joan A. Vaccaro

Background

Diabetes is a global epidemic. Cardiovascular disease (CVD) is one of the most prevalent consequences of diabetes. Nutrition is considered a modifiable risk factor for CVD, particularly for individuals with diabetes; albeit, there is little consensus on the role of carbohydrates, proteins and fats for arterial health for persons with or without diabetes. In this study, we examined the association of macronutrients with arterial pulse pressure (APP), a surrogate measure of arterial health by diabetes status and race.

Methods

Participants were 892 Mexican Americans (MA), 1059 Black, non-Hispanics (BNH) and 2473 White, non-Hispanics (WNH) with and without diabetes of …

Race/Ethnicity-, Gender- And Age-Specific Differences In Micronutrient Intakes Of Us Adults With And Without Diabetes, Joan Vaccaro, Fatma Huffman

Joan A. Vaccaro

Race/ethnicity-, gender- and age-specific differences in dietary micronutrient intakes of US adults ≥ 21 years were assessed from National Health and Nutrition Examination Survey, 2007–2008. The participants included Black non-Hispanics, Mexican-American and White non-Hispanics who signed an informed consent form for the interview and who completed the in-person 24-h recall. Micronutrient intakes were based on the Institute of Medicines' classifications of recommended dietary allowances specific for age and gender. Likelihood of many micronutrient insufficiencies was associated with being female, over 65 years, having diabetes and minority status. Younger and female adults had a greater likelihood of iron insufficiency than male …

Obesity Indicators By Race/Ethnicity For Diagnosis Of Cardiometabolic Diseases For A Us Representative Sample Of Adults, Joan A. Vaccaro, Fatma G. Huffman

Joan A. Vaccaro

Background: Obesity, a growing epidemic, is a preventable risk factor for cardiometabolic diseases. Obesity and cardiometabolic diseases affect Hispanics and African Americans more than non-Hispanic Caucasians. This study examined the relationship among race/ethnicity, obesity diagnostic measures (body mass index, waist circumference, subscapular and triceps skinfold thickness), and cardiometabolic risk factors (hyperglycemia, high, non-high-density lipoprotein cholesterol, low, high-density lipoprotein cholesterol, and hypertension) for adults across the United States.

Methods: Using data from two-cycles of the National Health and Examination Survey (NHANES) 2007-2010, and accounting for the complex sample design, logistic regression models were conducted comparing obesity indicators in Mexican Americans, other …

Awareness, Agreement, Adoption And Adherence To Type 2 Diabetes Mellitus Guidelines: A Survey Of Indonesian Primary Care Physician, Indah Widyahening, Yolanda Van Der Graaf, Pradana Soewondo, Paul Glasziou, Geert Van Der Heijden

Paul Glasziou

Background: To assess the degree of awareness, agreement, adoption and adherence of physicians in Indonesia to type 2 diabetes mellitus guidelines, and their association with characteristics of the responders. Methods. Questionnaire survey among General Practitioners (GPs) attending the Indonesian Association of Family Practitioners annual conference in November 2012. The proportion of GPs who were aware of, agreed with, adopted and adhered to the seven recommendations in the guidelines (screening for diabetes, diagnosis, lifestyle modification, use of sulfonylurea, target blood glucose, target blood pressure and use of statin) were calculated in the total number of responders. Results: Of the 399 GPs …

Comorbid Diabetes And Depression And Increased Risk For Cognitive Impairment In Mexican Americans, Tony Dickensheets, Leigh Johnson, James Hall, Sid Obryant

Sid O'Bryant

Background: By 2050, the percent of Hispanics in America age 65 and above will nearly triple compared to other ethnic groups. During this timeframe, the numbers of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI, a prodromal stage to AD) cases among Hispanic elders is expected to grow exponentially. Given that 65% of the U.S. Hispanic population is Mexican American (MA), this ethnic group represent the fastest growing segment of the aging population, which will be disproportionately impacted by MCI and /AD in the near future. Recent work from our group suggest that depression is a significant risk factor for …

A Cost-Benefit Analysis Of Sugary Drink Regulation In New York City, Shi-Ling Hsu

Shi-Ling Hsu

New York City Mayor Bill de Blasio, who has been critical of the administration of his predecessor, Michael Bloomberg, has nevertheless committed to carry forward one Bloomberg initiative: the citywide size restriction on sales of "sugary drinks," or most commonly, sodas. The "Portion Cap Rule" would have prohibited the sale of sugary drinks in containers exceeding 16 ounces, but is currently enjoined from taking effect and awaits a ruling from the New York State Court of Appeal. The Portion Cap Rule was motivated by public health concerns, and the growing obesity problem that stems in part from the overconsumption of …

Diabetes Alters Vascular Mechanotransduction: Pressure-Induced Regulation Of Mitogen Activated Protein Kinases In The Rat Inferior Vena Cava, Kevin M. Rice, Devashish H. Desai, Sunil K. Kakarla, Anjaiah Katta, Deborah L. Preston, Paulette Wehner, Eric R. Blough

Deborah L Preston

Background Diabetes mellitus is an important risk factor for increased vein graft failure after bypass surgery. However, the cellular and molecular mechanism(s) underlying vessel attrition in this population remain largely unexplored. Recent reports have suggested that the pathological remodeling of vein grafts may be mediated by mechanically-induced activation of the mitogen activated protein kinase (MAPK) signaling pathways and the MAPK-related induction of caspase-3 activity. On the basis of these findings, we hypothesized that diabetes may be associated with alterations in how veins "sense" and "respond" to altered mechanical loading. Methods Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and …

Diabetes Alters Vascular Mechanotransduction: Pressure-Induced Regulation Of Mitogen Activated Protein Kinases In The Rat Inferior Vena Cava, Kevin M. Rice, Devashish H. Desai, Sunil K. Kakarla, Anjaiah Katta, Deborah L. Preston, Paulette Wehner, Eric R. Blough

Kevin M Rice

Background Diabetes mellitus is an important risk factor for increased vein graft failure after bypass surgery. However, the cellular and molecular mechanism(s) underlying vessel attrition in this population remain largely unexplored. Recent reports have suggested that the pathological remodeling of vein grafts may be mediated by mechanically-induced activation of the mitogen activated protein kinase (MAPK) signaling pathways and the MAPK-related induction of caspase-3 activity. On the basis of these findings, we hypothesized that diabetes may be associated with alterations in how veins "sense" and "respond" to altered mechanical loading. Methods Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and …

Severe Diabetes And Leptin Resistance Cause Differential Hepatic And Renal Transporter Expression In Mice, Vijay More, Xia Wen, Paul E. Thomas, Lauren M. Aleksunes, Angela L. Slitt

Angela L. Slitt

Background: Type-2 Diabetes is a major health concern in the United States and other Westernized countries, with prevalence increasing yearly. There is a need to better model and predict adverse drug reactions, drug-induced liver injury, and drug efficacy in this population. Because transporters significantly contribute to drug clearance and disposition, it is highly significant to determine whether a severe diabetes phenotype alters drug transporter expression, and whether diabetic mouse models have altered disposition of acetaminophen (APAP) metabolites. Results: Transporter mRNA and protein expression were quantified in livers and kidneys of adult C57BKS and db/db mice, which have a severe diabetes …

Diabetes Alters Vascular Mechanotransduction: Pressure-Induced Regulation Of Mitogen Activated Protein Kinases In The Rat Inferior Vena Cava, Kevin M. Rice, Devashish H. Desai, Sunil K. Kakarla, Anjaiah Katta, Deborah L. Preston, Paulette Wehner, Eric R. Blough

Eric Blough

Background Diabetes mellitus is an important risk factor for increased vein graft failure after bypass surgery. However, the cellular and molecular mechanism(s) underlying vessel attrition in this population remain largely unexplored. Recent reports have suggested that the pathological remodeling of vein grafts may be mediated by mechanically-induced activation of the mitogen activated protein kinase (MAPK) signaling pathways and the MAPK-related induction of caspase-3 activity. On the basis of these findings, we hypothesized that diabetes may be associated with alterations in how veins "sense" and "respond" to altered mechanical loading. Methods Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and …

Diabetes Alters Vascular Mechanotransduction: Pressure-Induced Regulation Of Mitogen Activated Protein Kinases In The Rat Inferior Vena Cava, Kevin M. Rice, Devashish H. Desai, Sunil K. Kakarla, Anjaiah Katta, Deborah L. Preston, Paulette Wehner, Eric R. Blough

Paulette S. Wehner

Background Diabetes mellitus is an important risk factor for increased vein graft failure after bypass surgery. However, the cellular and molecular mechanism(s) underlying vessel attrition in this population remain largely unexplored. Recent reports have suggested that the pathological remodeling of vein grafts may be mediated by mechanically-induced activation of the mitogen activated protein kinase (MAPK) signaling pathways and the MAPK-related induction of caspase-3 activity. On the basis of these findings, we hypothesized that diabetes may be associated with alterations in how veins "sense" and "respond" to altered mechanical loading. Methods Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and …

Implementing Patient Accessible Health Information Site For Diabetes Management, Khin Than Win

Dr Khin Win

The focus of health care has changed from health care provider paternalistic approach to consumer focused approach. The aim of this study is to implement an online health information site for patient education of Diabetes. To achieve this, design criteria for effective patient education were considered and diabetes patients information site was implemented which includes patient information access, diabetes challenge, administrator module and the scheduler module. Implementing patients access for their health information with providing patients tailored health information according to their needs to enhance patient education is important. This project contributes vastly in consumer health informatics as it develops …

Performance Of Body Mass Index In Predicting Diabetes And Hypertension In The Eastern Province Of Saudi Arabia, Ali M. Almajwal, Nadira A. Al-Baghli, Marijka J. Batterham, Peter G. Williams, Khalid A. Al-Turki, Aqeel J. Al-Ghamdi

Dr Marijka Batterham

BACKGROUND AND OBJECTIVES: BMI is the most widely used measure to diagnose obesity but its accuracy and usefulness in Saudi subjects is unknown. This study aimed to assess the validity of standard BMI cut-point values in the Saudi population. SUBJECTS/ METHODS: 197,681 adults participated in a cross-sectional study to detect diabetes and hypertension in the Saudi Eastern province in 2004/5, with blood pressure, fasting blood sugar, height and weight measurements taken. Sensitivities, specificities, areas under the curves, predictive values, likelihood ratios, false positive, false negatives and total misclassification ratios were calculated for various BMI values determined from receiver operating characteristic …

Development Of Food Groupings To Guide Dietary Advice In People With Diabetes, L. J. Gillen, Linda C. Tapsell

L. C. Tapsell

Foods commonly consumed by 16 adults with diabetes were grouped according to macrinutrient value and type of fat to form 13 categories of which 10 would form the focus of dietary advice. Dietary modeling demonstrated that the food group pattern provided adequate nutrition and low variation in dietary targets. Idealised proportions of fat types were achieved only when daily servings of foods such as oils, nuts, oily fish and soy were included. The food groupings proved appropriate for dietary advice for diabetes.

Are Podcasts Effective At Educating African American Men About Diabetes, Jarrett Johnson, Levi Ross, Walter Iwanenko, Judith Schiffert, Arup Sen

Levi Ross

Education is a critical component of the National Blueprint to eliminate racial disparities in diabetes. Research indicates that traditional methods of diabetes education has had limited effectiveness with minority populations and suggests that different educational approaches be explored. The purpose of the research was to explore the effectiveness of an emergent technology (podcast) for use in educating inner-city, African American men about diabetes prevention. Thirty African American men participated in self-administered, pretest-posttest surveys in August 2009. Surveys collected information on demographic characteristics, perceptions of diabetes, and diabetes knowledge. Paired samples t test was computed to evaluate pretest-posttest changes in overall …

Performance Of Body Mass Index In Predicting Diabetes And Hypertension In The Eastern Province Of Saudi Arabia, Ali M. Almajwal, Nadira A. Al-Baghli, Marijka J. Batterham, Peter G. Williams, Khalid A. Al-Turki, Aqeel J. Al-Ghamdi

Peter Williams

BACKGROUND AND OBJECTIVES: BMI is the most widely used measure to diagnose obesity but its accuracy and usefulness in Saudi subjects is unknown. This study aimed to assess the validity of standard BMI cut-point values in the Saudi population. SUBJECTS/ METHODS: 197,681 adults participated in a cross-sectional study to detect diabetes and hypertension in the Saudi Eastern province in 2004/5, with blood pressure, fasting blood sugar, height and weight measurements taken. Sensitivities, specificities, areas under the curves, predictive values, likelihood ratios, false positive, false negatives and total misclassification ratios were calculated for various BMI values determined from receiver operating characteristic …

Diabetes Self-Management In The Migrant Latino Population, Dawn Weiler, Janice D. Crist

Dawn Weiler

This article will present an in-depth exploration and synthesis of current literature that informs nursing knowledge of diabetes self-management for the migrant Latino population. Extensive research in diabetes care has been conducted, however, there is a significant knowledge gap related to the factors that influence the achievement of glycemic control and self-management practices of the Latino population. Based on well-documented disparities in complications and health outcomes among Latinos when compared with White Americans, there is sufficient evidence to question whether traditional White beliefs about self-management are successful or appropriate for the Latino population in general and migrants specifically. Traditional models …