Medicine and Health Sciences Commons^™

A Call To Action On Prediabetes, Joy A. Moverley, Alegria Cantillep, Kathryn Newberry, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Diabetes and prediabetes have become an epidemic in the United States. The keys to battling this public health challenge are effective screening and evidence-based interventions. Studies show that intensive lifestyle interventions, medications, and weight loss surgery can reduce or delay new-onset type 2 diabetes. This article reviews the steps clinicians can take to help patients stay ahead of this disease.

Comparative Effectiveness And Safety Of Empagliflozin On Cardiovascular Mortality And Morbidity In Adults With Type 2 Diabetes, Wilbert S. Aronow, Tatyana Shamliyan

NYMC Faculty Publications

Background: Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods: We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results: Empagliflozin reduces all-cause mortality [relative …

Association Of Obesity With Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Lifestyle Measures For Treating Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Annual Wormwood Leaf Inhibits The Adipogenesis Of 3t3-L1 And Obesity In High-Fat Diet-Induced Obese Rats, Y Song, S Lee, S Jang, T Kim, Hong-Duck Kim, S Kim, C Won, J Cho

NYMC Faculty Publications

Annual wormwood (AW) (Artemisia annua L.) has anti-malarial, anti-bacterial, anti-oxidant, anti-tumour, and anti-inflammatory activities. In the present study, we evaluated the effects of annual wormwood leaves (AWL) on adipocyte differentiation in 3T3-L1 cells and high-fat diet (HFD)-induced obese rats. 3T3-L1 adipocytes and HFD-induced obese rats were treated with AWL, and its effect on gene expression was analyzed using RT-PCR and Western blotting experiments. Treatment with AWL effectively prevented triglyceride accumulation during adipogenesis in a dose-dependent manner. Consistently, AWL suppressed the differentiation of 3T3-L1 preadipocytes into adipocytes through the downregulation of dexamethasone, 3-isobutyl-1- methylxanthine, and insulin (DMI)-induced serine/threonine kinase protein kinase …

Rationale For, Initiation And Titration Of The Basal Insulin/Glp-1ra Fixed-Ratio Combination Products, Ideglira And Iglarlixi, For The Management Of Type 2 Diabetes, Virginia Valentine, Jennifer Goldman, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Type 2 diabetes (T2D) is a progressive disease affecting glucose regulation and a major cause of morbidity and mortality globally. Many patients are not escalated up the treatment ladder appropriately despite failing to achieve glycemic control, with barriers such as fear of hypoglycemia, weight gain, and treatment burden recognized as factors. Exogenous basal insulin is titrated to address control of fasting plasma glucose and may preserve residual β-cell function, thus promoting a greater endogenous prandial insulin response. Native glucagon-like peptide-1 (GLP-1) is a peptide hormone secreted by the gut in response to nutrient ingestion; it increases insulin secretion, inhibits glucagon …

Cardiometabolic Risk Factors, Metabolic Syndrome And Pre-Diabetes In Adolescents In The Sierra Region Of Ecuador, Sharon L. Casapulla, Cheryl A. Howe, Gabriela Rosero Mora, Darlene Berryman, Mario J. Grijalva, Edgar W. Rojas, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Background: Excess weight (overweight and obesity) is the major modifiable risk factor for type 2 diabetes mellitus (T2DM) and other non-communicable diseases. However, excess weight may not be as predictive of diabetes risk as once thought. While excess weight and other obesity-related non-communicable diseases are of growing concern in low-middle income countries in Latin America, there is limited research on risk factors associated with T2DM in adolescents. This study investigated prevalence of overweight, obesity, prediabetes, diabetes and metabolic syndrome in adolescents in Ecuador.

Methods: A cross-sectional study was conducted with 433 adolescents from two schools in a small …

Do Antibiotics In Early Life Contribute To Obesity?, Shimon Kadosh

The Science Journal of the Lander College of Arts and Sciences

In recent years, science has made great strides in its understanding of the microbiome, discovering that it plays a role in regulating many body processes. One area of study is the microbiomes interaction and influence on host metabolic processes. Studies using both mice and humans have established a clear correlation between obesity and the composition of the microbiome, identifying a microbiome unique to obese individuals. Furthermore, experiments with germ-free mice have shown that the microbiome effects host metabolism, causing germ free mice to increase in mass when inoculated with normal microbiota. Inoculation with microbiota from obese mice yielded greater increases …

The Impacts Of Childhood Obesity On Adult Health And Quality Of Life‌, Miriam Weinstock

The Science Journal of the Lander College of Arts and Sciences

Obesity has emerged as one of the most preeminent concerns of the modern era. Thirty six percent of our country’s citizens are classified as obese and six percent qualify as extremely obese. Developing obesity as an adult is fairly common, but countless studies have shown a direct correlation between childhood obesity and remaining severely overweight as an adult. Aside from the physical and aesthetic discomfort of maintaining superfluous girth, the health hazards threatening the obese population are extremely discomfiting. The enormity of the issue requires extensive study so that society can educate themselves of the dangers and how to prevent …

Repurposing Diabetes Drugs To Treat Insulin Resistance In Alzheimer’S Disease‌, Yael Lazarus

The Science Journal of the Lander College of Arts and Sciences

Alzheimer’s disease is a neurodegenerative condition which results in a significant decline in cognitive status. Novel treatment approaches for Alzheimer’s are sorely needed, as current medications for the disease offer only marginal clinical benefit. Research has discovered a connection between the pathology of Alzheimer’s and Type 2 Diabetes, two serious and seemingly unrelated disorders. Clinical studies have shown that Alzheimer’s disease is associated with brain insulin resistance similar to the pathology of Type 2 Diabetes. This observation has led to the notion that drugs developed for the treatment of Type 2 Diabetes may be beneficial in modifying the cognitive function …

Take The Stigma Out Of Obesity, Joseph Indelicato

The School of Health Sciences Publications and Research

The author describes Metabolic Factor as something that should be considered when public health professionals treat obese individuals. He further states that public health professional should work to take away the stigma of obesity.

Diabetes Update: Your Guide To The Latest Ada Standards, Eric Johnson, Florence Warren, Neil Skolnik, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

The authors highlight the latest changes in the ADA standards and review recommendations of particular relevance for family physicians.

The Mechanisms Of Weight Gain In Sleep-Deprived Individuals, Chaya Rosen

The Science Journal of the Lander College of Arts and Sciences

The obese population in America has grown during the last century. During these years as well, American’s have been sleeping less. Cross sectional studies show that there is a correlation of the two factors, and indeed find a greater number of overweight individuals amongst the sleep-deprived population. Though they are unclear, studies attempt to establish possible mechanisms through which weight gain occurs. Results of studies show that sleep deprivation may influence leptin and ghrelin levels, which can cause hunger, and excessive caloric intake. Sleep-deprived individuals also have an increased opportunity to eat during the wakeful nighttime hours. In the sleep-restricted …

Program Active Ii: Design And Methods For A Multi-Center Community-Based Depression Treatment For Rural And Urban Adults With Type 2 Diabetes, Mary De Groot, Jay H. Shubrook, Frank Schwartz, W. Guyton Hornsby Jr., Yegan Pillay, Chandan Saha

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Objective: Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to …

Regulation Of Ghrelin: A Possible Treatment Option For Obesity And Diabetes, Sarah Picciotto

The Science Journal of the Lander College of Arts and Sciences

Obesity is a mounting problem in America today. One major concern about obesity is that it is a risk factor for type 2 diabetes, a disease that impairs insulin sensitivity and secretion. This interferes with blood glucose levels and can cause hyperglycemia, which is when there is too much circulating glucose in the blood. Ghrelin, an amino acid peptide responsible for appetite stimulation and energy balance, plays a direct role in insulin secretion and glucose metabolism. In many experiments, elevated ghrelin levels are associated with decreased insulin secretion from pancreatic islet cells. Although ghrelin concentration is decreased in obese individuals …

Sglt2 Inhibitors For Type 2 Diabetes Mellitus Treatment, Raymond A. Plodkowski, Megan E. Mcgarvey, Heather M. Huribal, Keith Reisinger-Kindle, Bradley Kramer, Mordecai Solomon, Quang T. Nguyen

College of Osteopathic Medicine (TUN) Publications and Research

SGLT2 inhibitors are plausible second-line drugs that provide powerful additional A1c-lowering effects while inducing weight loss without hypoglycemia.

Association Of Abc (Hba1c, Blood Pressure, Ldl-Cholesterol) Goal Attainment With Depression And Health-Related Quality Of Life Among Adults With Type 2 Diabetes, Bijal M. Shah, Dylan J. Mezzio, Jackie Ho, Eric J. Ip

Faculty Publications & Research of the TUC College of Pharmacy

Aims: To determine the relationship between ABC goal attainment, depression, and health-related quality of life (HRQoL) among a national sample of patients with type 2 diabetes (T2DM).

Methods: A retrospective, cross-sectional analysis was performed examining 808 non-pregnant patients ≥ 20 years old with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. ABC goals were defined as HbA1c < 7%, BP < 130/80mmHg, and LDL-C < 100mg/dL. Patient characteristics associated with ABC goal attainment were examined.

Results: Overall, 23.7% of participants achieved simultaneous ABC goals. Severe depression was significantly associated with lower rates of ABC goal attainment compared to those with no depression (5.0% vs. 25.4%, p = 0.048). ABC goal attainment rates …

Effect Of Tai Chi Exercise Combined With Mental Imagery Theory In Improving Balance In A Diabetic And Elderly Population, Abdulrahman Alsubiheen, Jerrold S. Petrofsky, Noha S. Daher, Everett Lohman, Edward Balbas

College of Health & Human Services (TUN) Publications and Research

BACKGROUND: One of the effects of diabetes mellitus (DM), peripheral neuropathy, affects the sensation in the feet and can increase the chance of falling. The purpose of the study was to investigate the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on improving balance in people with diabetes and an age matched control group.
MATERIAL AND METHODS: Seventeen healthy subjects and 12 diabetic sedentary subjects ranging from 40–80 years of age were recruited. All subjects in both groups attended a Yang style of TC class using MI strategies, 2 sessions a week …

Empagliflozin In The Treatment Of Type 2 Diabetes: Evidence To Date, Jay H. Shubrook, Babak Baradar Bokaie, Sarah E. Adkins

Faculty Publications & Research of the TUC College of Osteopathic Medicine

In the last decade, researchers have gained a greater understanding of the pathophysiologic mechanisms of type 2 diabetes as a chronic and progressive disease. One of the more recent treatment targets is the kidney. The kidneys become maladaptive in diabetes by increasing the reabsorption of glucose above the normal physiologic renal threshold. This discovery has led to the development of the sodium/glucose cotransporter 2 inhibitors (SGLT2). These agents readjust the renal threshold for glucose reabsorption to a lower level and decrease glucose reabsorption, while increasing urinary glucose when the glucose is above the renal threshold and subsequently lowering plasma glucose. …

What To Do After Basal Insulin: 3 Tx Strategies For Type 2 Diabetes, Lubaina Presswala, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

While many family physicians have become comfortable with using once-daily basal insulin such as glargine or detemir, what to do after basal insulin is much more complex. This review builds upon an earlier article in this journal, “Insulin for type 2 diabetes: How and when to get started,” by explaining 3 strategies to consider when basal insulin alone isn't enough.

Sodium Glucose Co-Transporter 2 Inhibitors In The Treatment Of Type 2 Diabetes Mellitus, Eden Miller, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease, control of which typically requires multiple therapies. Current guidelines suggest that, in addition to improving glycemic control, antihyperglycemic therapy should be chosen on the basis of its effects on body weight and the risk of hypoglycemia. The newest class of oral antihyperglycemic agents, the sodium glucose cotransporter 2 (SGLT2) inhibitors, reduces renal glucose reabsorption and increases urinary glucose excretion via an insulin-independent mechanism of action. SGLT2 inhibitors have been shown to improve glycemic control and to reduce body weight and systolic blood pressure, and their use is associated with a …

Insulin Pumps: Beyond Basal-Bolus, Richard Millstein, Nancy Mora Becerra, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Insulin pumps are a major advance in diabetes management, making insulin dosing easier and more accurate and providing great flexibility, safety, and efficacy for people who need basal-bolus insulin therapy. They are the preferred treatment for people with type 1 diabetes and many with type 2 diabetes who require insulin. This article reviews the basics of how insulin pumps work, who benefits from a pump, and how to manage inpatients and outpatients on insulin pumps.

Cognitive Impairment In Patients With Type 2 Diabetes Mellitus: Perspectives And Challenges, Okezie I. Aruoma, Darshini Narrain, Joseph Indelicato, Emmanuel Bourdon, Fatima Murad, Theeshan Bahorun

The School of Health Sciences Publications and Research

Type 2 Diabetes Mellitus is associated with elevated blood glucose level, abnormal abdominal fat deposition, insulin resistance and a number of complications including embryopathy, cardiovascular diseases, nephropathy, neuropathy, microangiopathy and retinopathy. Complications extending to the central nervous system may have a deteriorating effect on mental health including a decline in cognitive functioning. This could be a reason for depression, lack of compliance towards medication/treatment, and the inability of patients to meet the day-to-day management demands of the disease. Due to the high metabolic demand for energy in the brain, perturbations in glucose metabolism can noticeably impact cognitive performance. This review …

The Interplay Of Diabetes, And Health Self Efficacy, Cognition And Compliance, Joseph Indelicato, Vanessa Gilchriest

The School of Health Sciences Publications and Research

The authors argue that screening tools for health self efficacy and cognitive impairment in patients with diabetes should be created to help implement interventions which would be most useful to those patients.

Metabolic Factor: A New Clinical Tool In Obesity Diagnosis And Weight Management, Brandon Davis, Joseph Indelicato, Nicholas Kuiper

The School of Health Sciences Publications and Research

Obtaining resting metabolic rates (RMR) via indirect calorimetry is a critical component of weight management that is used to calculate a new concept, metabolic factor. This calculation allows for the standardized expression of RMR to make it possible to compare metabolism between people and over time. This study found an inverse relationship between weight and metabolic factor, statistically significant, r = -­‐.63, p < 0.001, effect size = .46, suggesting that people who weigh more tend to have lower metabolic factors. Furthermore, statistically significant differences were found in the metabolic factors between people who were normal weight, overweight, and obese, p < 0.001. There was also an inverse relationship between metabolic factor and age, r = -­‐0.21, p < .05, effect size = .03, suggesting that age has a small but significant effect of metabolic factor. This variable has the potential to play a key role in treatment planning as it can be used to set realistic weight goals, determine caloric needs for a given weight, and to make decisions as to surgical intervention. More importantly, metabolic factor can be a key instrument in clinical work used to educate people regarding unique differences in metabolism to lower prejudice against the obese and to reduce the devastating shame that often accompanies weight issues.

What Is The Role Of Incretin Mimetics In The Treatment Of Type 2 Diabetes?, Isaac Silberstein

The Science Journal of the Lander College of Arts and Sciences

Type 2 diabetes mellitus (DM) is an intricate disorder defined by insulin resistance, impaired insulin secretion, hyperglycemia, and both microvascular and macrovascular complications. Standard antidiabetic agents like metformin, insulin, sulfonylureas and thiazolidinediones are often insufficient at glucoregulation and do not address the decline in beta cell function that characterizes type 2 diabetes. Moreover, the adverse effects of some of these pharmaceuticals, such as hypoglycemia and weight gain, are disappointing and further limit their clinical utility. Research demonstrates that the actions of two potent incretins. Glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP), address these concerns as they stimulate beta …

Anorexia Nervosa: Current Research From A Biological Perspective, Udy Tropp

The Science Journal of the Lander College of Arts and Sciences

Eating disorders are viewed as serious mental illnesses, carrying significant, life-threatening medical and psychiatric implications, including morbidity and mortality. According to the Academy of Eating Disorders, anorexia nervosa has the highest mortality rate of any psychiatric disorder. The American Psychiatric Association (2004) claims that approximately three percent of the United States female population has a clinically relevant eating disorder. Risk of premature death is 6-12 times higher in women with anorexia as compared to the general population, and it has become the third most common form of chronic illness among adolescent women aged 15 to 19 years. Although the prevalence …

The Role Of Ghrelin And Leptin In Obesity: Is Exogenous Administration Of These Hormones A Possible Drug Therapy?, Peri Eckstein

The Science Journal of the Lander College of Arts and Sciences

Ghrelin and leptin are two hormones that have been recognized to have a major influence on energy balance. Leptin is a mediator of long term regulation of energy balance, suppressing food intake and thereby inducing weight loss. Ghrelin, on the other hand, is a fast acting hormone, playing a role in meal initiation. As a growing number of people suffer from obesity, understanding the mechanisms by which various hormones and neurotransmitters influence energy balance has been a subject of intense research. This paper provides background on leptin and ghrelin hormones, their role in food intake and body weight in humans, …

Pompe’S Disease And The Effects Of Alpha-Glucosidase Deficiency, Aaron Richler

The Science Journal of the Lander College of Arts and Sciences

The following is an excerpt from the introduction of this article: The energy that the body needs in order to function is obtained from carbohydrates that we get through our diet. These carbohydrates are monosacharides, disaccharides and polysacharides. The polysaccharides and disaccharides are hydrolyzed to monosaccharide’s such glucose (which comprises roughly 80%) fructose and galactose. Most cells convert the fructose and galactose to glucose. The body can use the glucose or store it. If energy is needed, glucose can be oxidized through the many reactions of glycolysis which gives a net production of 2 ATP and 2 NADH from one …