Medicine and Health Sciences Commons^™

Diabetes Prevalence And Monitoring In Nonmetropolitan And Metropolitan Areas Within A Commercially Insured U.S. Population, Lindsey R. Hammerslag, Jeffery Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Enrollees living in nonmetropolitan areas had 22% higher likelihood of having diabetes, even after controlling for factors like age and region.
• The prevalence of diabetes in 2019-2020 was 7.9% in nonmetropolitan areas and 6.2% in metropolitan areas.
• Annual hemoglobin A1c (HbA1c) testing occurred for 85.1% of nonmetropolitan and 85.7% of metropolitan enrollees with diabetes. After controlling for other factors, we found significantly lower testing for those in nonmetropolitan areas.
• For diabetic enrollees, having an HbA1c test in 2019 was associated with an 8% decrease in the likelihood of non-cardiovascular complications related to diabetes and a 6% …

The Relationship Between Psychosocial Factors, Self-Care, And Blood Sugar In An Appalachian Population, Brittany L. Smalls, Md. Tofial Azam, Madeline Dunfee, Philip M. Westgate, Susan C. Westneat, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial …

Frequency And Type Of Diabetes Screening Tests In A Sample Of Women With Polycystic Ovarian Syndrome: A Descriptive Study, Jacklyn Vollmer

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects 6-12% of United States women of reproductive age. Women with PCOS are at an increased risk of developing type 2 diabetes and fall into high-risk groups for screening guidelines put out by the American College of Obstetricians and Gynecologists (ACOG). Guidelines further suggest that an oral glucose tolerance test (OGTT) be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is to examine rates and type of diabetes screening used among a sample of women …

Rates Of Diabetes Screening In Kentucky Before And After Implementation Of The Affordable Care Act (Aca), Cory Reinert

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Diabetes mellitus, commonly referred to as “diabetes”, is currently at epidemic proportions in the United States as its prevalence has drastically increased over the past several decades. The percentage of Americans with diagnosed diabetes has risen from 0.93 percent of the population in 1958 to 10.5 percent in 2018 (ADA, 2021). Diabetes also impacts record numbers of Kentucky residents.

Regular screening for those considered at-risk can encourage patients to implement lifestyle modifications, pharmacological therapy, or other interventions earlier in the course of disease. This can help prevent or delay onset of T2D and can reduce diabetes-related complications in those who …

Assessing Diabetes Risk Factors In Rural Dwelling Grandparent Caregivers, Brittany L. Smalls, Adebola Olamide Adegboyega, Omar A. Contreras, Kelly Palmer, Jennifer Hatcher

Family and Community Medicine Faculty Publications

Objective:

The purpose of this study is to assess type 2 diabetes mellitus (T2DM) risk factors in grandparent caregivers living in a rural environment.

Methods:

Clinical measures (hemoglobin A1c [HbA1c], blood pressure, and lipids) and self-reported data on social environment factors were attained. Data were analyzed via Pearson’s correlation and regression models.

Results:

By clinical definition of diabetes (HbA1c ≥ 6.5%), 21% were prediabetic and 28% had undiagnosed T2DM. There was an association between the number of individuals in the home and triglycerides (r = −.25), high-density lipoproteins (HDL; r = .43), and body mass index (BMI; r = …

Racial/Ethnic Differences In Glycemic Control In Older Adults With Type 2 Diabetes: United States 2003-2014, Brittany L. Smalls, Tiarney D. Ritchwood, Kinfe G. Bishu, Leonard E. Egede

Family and Community Medicine Faculty Publications

The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003-2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin …

Diabetes Locus Of Control And Depression In Older Adults With Type 1 And Type 2 Diabetes: The Study Of Longevity In Diabetes, Jahvona Pretty

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract:

Objective: To determine if diabetes locus of control (dLOC) is associated with depression in older adults with type 1 and type 2 diabetes and whether this association differs by diabetes type.

Methods: Data for the current study were obtained from The Study of Longevity in Diabetes (SOLID), a prospective cohort study of aging, and diabetes. SOLID participants aged 60 and older with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes were recruited from members of Kaiser Permanente Northern California (KPNC). For the current study, we excluded all of the participants without diabetes since the primary exposure, …

West Virginia’S Sugary Drink Tax: Examining Print Media Frames In Local News Sources, Lauri Andress, Ogaga Urhie, Christine Compton

Journal of Appalachian Health

Introduction: Framing is an important aspect of the policy process that helps the public and decision makers sort through and resolve highly charged claims about an issue. Through slight changes in the presentation of issues, a framing effect may alter public support. The way a proposed sugary drink tax is discussed in public discourse and by the media significantly influences policy acceptance. Given the public health significance of obesity and diabetes in West Virginia (WV) the study of media frames employed to represent a sugary drink tax policy is useful.

Methods: Using quantitative content analysis, this study assessed news articles—published …

The Economic Impact Of Diabetes In Kentucky, Michael W. Clark, Jenny A. Minier, Charles J. Courtemanche, Bethany L. Paris, Michael T. Childress

CBER Research Report

Excerpt from the Executive Summary:

The Kentucky Department of Public Health is responsible for improving the health and safety of Kentucky’s residents by preventing disease and injuries and encouraging healthy lifestyles. The department administers nearly 150 programs that address critical health issues affecting Kentuckians. These programs screen newborns for health problems, prevent the spread of infectious diseases, promote oral health, and provide numerous other services.

Diabetes represents a growing health concern for the nation and Kentucky. It is a chronic condition that causes blood sugar levels to rise and contributes to other serious health conditions such as heart and kidney …

Implementing The National Diabetes Prevention Program In Mason County, Kentucky, Cassandra Yelton

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The National Diabetes Prevention Program (DPP) is sponsored by the Centers for Disease Control and Prevention (CDC). The program’s goal is to reduce the incidence of diabetes through dietary modification and physical activity. On one hand, the DPP is currently offered by various organizations through the country. On the other hand, the DPP is mostly unavailable in rural areas, especially the Diabetes Belt. The Diabetes Belt is in the eastern Appalachian region of the United States. People who live in this area of the country are more likely to develop diabetes than those who do not. Mason County, Kentucky has …

Aps’Aalooke Led Diabetes Prevention Program, Lucy Hollingsworth Williamson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The primary objective of this proposed program is to decrease the burden of diabetes mellitus type II among the Crow Indian tribe members in Montana by preventing the progression of prediabetes to diabetes. Type II diabetes mellitus (DMII), is a debilitating disease that contributes to increased morbidity and mortality, in addition to billions of healthcare costs annually. In the United States, minority populations carry a higher burden of DMII, however American Indians have the highest prevalence of all. In fact, American Indians are 2.4 times more likely to be diagnosed with diabetes than white people.

In Montana, the Crow Indian …

Use Of Social Adaptability Index To Explain Self-Care And Diabetes Outcomes, Jennifer A. Campbell, Rebekah J. Walker, Brittany L. Smalls, Leonard E. Egede

Center for Health Services Research Faculty Publications

Background: To examine whether the social adaptability index (SAI) alone or components of the index provide a better explanatory model for self-care and diabetes outcomes.

Methods: Six hundred fifteen patients were recruited from two primary care settings. A series of multiple linear regression models were run to assess (1) associations between the SAI and diabetes self-care/outcomes, and (2) associations between individual SAI indicator variables and diabetes self-care/outcomes. Separate models were run for each self-care behavior and outcome. Two models were run for each dependent variable to compare associations with the SAI and components of the index.

Results: The SAI has …

Diagnostic Prevalence Of Diabetes Among Older Adults In Rural Appalachia, Gabriella Hodges

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background

The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.

Methods

Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service …

Evaluating The Relationship Between Diabetes And Menstrual Cycle Irregularities, Kailyn Leanne Conner

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Purpose. To evaluate the relationship between menstrual cycle irregularity and several key variables, and to determine whether the odds of diabetic women self-reporting menstrual cycle irregularities is greater than non-diabetic women self-reporting menstrual cycle irregularities.

Methods. A cross-sectional study was conducted using data from the Kentucky Women’s Health Registry from 2006 to 2014. The data was restricted based on age (used as a proxy for menopause status) and self-reported pregnancy and breastfeeding status, as well as eligibility to menstruate, yielding a final population of 4,256 participants for analysis. Basic statistical frequency analyses were conducted, stratified by menstrual cycle …

Dna Methylation Signatures Of Chronic Low-Grade Inflammation Are Associated With Complex Diseases, Symen Ligthart, Carola Marzi, Stella Aslibekyan, Michael M. Mendelson, Karen N. Conneely, Toshiko Tanaka, Elena Colicino, Lindsay L. Waite, Roby Joehanes, Weihua Guan, Jennifer A. Brody, Cathy Elks, Riccardo Marioni, Min A. Jhun, Golareh Agha, Jan Bressler, Cavin K. Ward-Caviness, Brian H. Chen, Tianxiao Huan, Kelly Bakulski, Elias L. Salfati, Whi-Empc Investigators, Giovanni Fiorito, Charge Epigenetics Of Coronary Heart Disease, Simone Wahl, Katharina Schramm, Jin Sha, Dena G. Hernandez, Allan C. Just, Jennifer A. Smith, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

Background: Chronic low-grade inflammation reflects a subclinical immune response implicated in the pathogenesis of complex diseases. Identifying genetic loci where DNA methylation is associated with chronic low-grade inflammation may reveal novel pathways or therapeutic targets for inflammation.

Results: We performed a meta-analysis of epigenome-wide association studies (EWAS) of serum C-reactive protein (CRP), which is a sensitive marker of low-grade inflammation, in a large European population (n = 8863) and trans-ethnic replication in African Americans (n = 4111). We found differential methylation at 218 CpG sites to be associated with CRP (P < 1.15 × 10^–7) in the discovery panel …

Diabetes Is Associated With Cerebrovascular But Not Alzheimer's Disease Neuropathology, Erin L. Abner, Peter T. Nelson, Richard J. Kryscio, Frederick A. Schmitt, David W. Fardo, Randall L. Woltjer, Nigel J. Cairns, Lei Yu, Hiroko H. Dodge, Chengjie Xiong, Kamal Masaki, Suzanne L. Tyas, David A. Bennett, Julie A. Schneider, Zoe Arvanitakis

Sanders-Brown Center on Aging Faculty Publications

INTRODUCTION: The relationship of diabetes to specific neuropathologic causes of dementia is incompletely understood.

METHODS: We used logistic regression to evaluate the association between diabetes and infarcts, Braak neurofibrillary tangle stage, and neuritic plaque score in 2365 autopsied persons. In a subset of >1300 persons with available cognitive data, we examined the association between diabetes and cognition using Poisson regression.

RESULTS: Diabetes increased odds of brain infarcts (odds ratio [OR] = 1.57, P < .0001), specifically lacunes (OR = 1.71, P < .0001), but not Alzheimer's disease neuropathology. Diabetes plus infarcts was associated with lower cognitive scores at end of life than infarcts or diabetes alone, and diabetes plus high level of Alzheimer's neuropathologic changes was associated with lower mini-mental state examination scores than the pathology alone.

DISCUSSION: This study supports the conclusions that diabetes increases the risk of cerebrovascular but not Alzheimer's disease pathology, and at least some of diabetes' relationship to …

The Role And Impact Of School Nurses And Intentions To Delegate Diabetes-Related Tasks Amidst Budget Cuts And Legislative Changes, Michelle J. Lineberry

Theses and Dissertations--Kinesiology and Health Promotion

As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding …

Examination Of The Prevalence And Mediating Factors Of Diabetes Diagnoses In Kentucky Women With A History Of Gestational Diabetes, Courtney Danielle Ryan

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Diabetes mellitus (DM) is an overwhelming health issue in the United States affecting 25.8 million people, which is equivalent to 8.3% of the population.1 It is the seventh leading cause of death and a major cause of serious complications such as heart disease, stroke, kidney failure, nontraumatic lower limb amputations, and new causes of blindness among adults in the U.S.1 Paralleling the obesity epidemic, the rates of DM incidence and prevalence continue to rise each year.2 One particularly troubling public health issue related to DM is that over a quarter of the people who have this disease are unaware, even …

An Investigation Of Perinatal Polychlorinated Biphenyl Exposure On Body Composition And Glucose Homeostasis, Cetewayo S. Rashid

Theses and Dissertations--Nutritional Sciences

Recent advancements have uncovered environmental contributions to obesity and diabetes etiology. In fact, perinatal malnutrition resulting in low birth weight (LBW) has been shown to correlate with later life obesity and impaired glucose tolerance in aged offspring. LBW can result from a myriad of developmental perturbations including macronutrient restriction, hypoxia, maternal stress and toxin exposure.

Polychlorinated biphenyls (PCBs) are ubiquitous environmental pollutants that bioaccumulate in the food chain resulting in dietary exposure in humans. Maternal and cord blood PCB levels are inversely associated with birth weight, and recent studies indicate that perinatal exposures to PCBs contribute to gender-specific obesity development …

Race-Ethnicity As An Effect Modifier Of The Association Between Hbalc And Mortality In U.S. Adults Without Diagnosed Diabetes, Katharina G. Kehl, Hannes M. Findeisen, David W. Fardo, Dennis Bruemmer, David M. Mannino, Wayne T. Sanderson

David M. Mannino

Objective

HbAlc is increasingly appreciated as a risk factor for all-cause and cardiovascular disease (CVD) mortality in the non-diabetic population. In this study, we investigated the association between HbAlc and mortality with a particular focus on the impact of race–ethnicity.

Design

Cohort study.

Methods

We analyzed the association between HbAlc and all-cause and CVD mortality in 12 698 non-diabetic adults 20 years or older from the Third National Health and Nutrition Examination Survey using separate models for people of different race–ethnicity.

Results

In our stratified analyses, higher non-diabetic HbAlc levels were associated with all-cause and CVD mortality in non-Hispanic whites …

The Role Of Body Mass Index And Diabetes In The Development Of Acute Organ Failure And Subsequent Mortality In An Observational Cohort, Katarina Slynkova, David M. Mannino, Greg S. Martin, Richard S. Morehead, Dennis E. Doherty

David M. Mannino

Introduction

Several studies have shown a correlation between body mass index (BMI) and both the development of critical illness and adverse outcomes in critically ill patients. The goal of our study was to examine this relationship prospectively with particular attention to the influence of concomitant diabetes mellitus (DM).

Methods

We analyzed data from 15,408 participants in the Atherosclerosis Risk in Communities (ARIC) study for this analysis. BMI and the presence of DM were defined at baseline. We defined 'acute organ failure' as those subjects who met a standard definition with diagnostic codes abstracted from hospitalization records. Outcomes assessed included the …