Endocrinology, Diabetes, and Metabolism Commons^™

Double Diabetes: The Search For A Treatment Paradigm In Children And Adolescents, Benjamin U. Nwosu

Endocrinology/Diabetes

Discusses double diabetes -- the coexistence of features of both type 1 and type 2 diabetes in the same individual -- with a comprehensive discussion of the various aspects of this disorder and a focus on the search for a treatment paradigm in children and adolescents.

Association Of Acculturation And Country Of Origin With Self-Reported Hypertension And Diabetes In A Heterogeneous Hispanic Population, Fatima Rodriguez, Leroi S. Hicks, Lenny Lopez

Open Access Articles

BACKGROUND: Hispanics are the fasting growing population in the U.S. and disproportionately suffer from chronic diseases such as hypertension and diabetes. Little is known about the complex interplay between acculturation and chronic disease prevalence in the growing and increasingly diverse Hispanic population. We explored the association between diabetes and hypertension prevalence among distinct U.S. Hispanic subgroups by country of origin and by degree of acculturation.

METHODS: We examined the adult participants in the 2001, 2003, 2005, and 2007 California Health Interview Survey (CHIS). Using weighted logistic regression stratified by nativity, we measured the association between country of origin ...

Genetic Modification Of The Association Between Peripubertal Dioxin Exposure And Pubertal Onset In A Cohort Of Russian Boys, Olivier Humblet, Susan A. Korrick, Paige L. Williams, Oleg Sergeyev, Claude Emond, Linda S. Birnbaum, Jane S. Burns, Larisa Altshul, Donald G. Patterson Jr., Wayman E. Turner, Mary M. Lee, Boris Revich, Russ Hauser

Cell and Developmental Biology Publications and Presentations

BACKGROUND: Exposure to dioxins has been associated with delayed pubertal onset in both epidemiologic and animal studies. Whether genetic polymorphisms may modify this association is currently unknown. Identifying such genes could provide insight into mechanistic pathways. This is one of the first studies to assess genetic susceptibility to dioxins.

OBJECTIVES: We evaluated whether common polymorphisms in genes affecting either molecular responses to dioxin exposure or pubertal onset influence the association between peripubertal serum dioxin concentration and male pubertal onset.

METHODS: In this prospective cohort of Russian adolescent boys (n = 392), we assessed gene-environment interactions for 337 tagging single-nucleotide polymorphisms (SNPs ...

Lessons Learned From Training Of Promotores De Salud For Obesity And Diabetes Prevention, Erica T. Sosa, Lesli Biediger-Friedman, Zenong Yin

Journal of Health Disparities Research and Practice

Background: Promotores de Salud are impactful in reducing health disparities for Hispanic communities. The purpose of this paper is to present the training process and fidelity of study protocol implementation using a promotora model for community-based diabetes prevention.

Methods: Five Hispanic bilingual promotores were recruited from a Community Health Worker program and received intensive 30-hour promotora training on how to recruit participants, lead group sessions, and support participants making behavior changes. Evaluation of the training included a survey and focus group to assess promotores’ feedback, a post-training knowledge test to assess knowledge acquired during the training and an observational assessment ...

Double Diabetes: The Evolving Treatment Paradigm In Children And Adolescents, Benjamin U. Nwosu

Endocrinology/Diabetes

The global pandemic of obesity in children and adolescents has resulted in a new expression of diabetes mellitus designated as double diabetes. The entity encompasses the autoimmune load of Type 1 Diabetes and the metabolic load of Type 2 Diabetes. There is no consensus on the best therapeutic modality for this new expression of diabetes mellitus. Optimal therapeutic options must address the coexistence of both metabolic and autoimmune components of diabetes mellitus in the patient. There have also been calls to revise the current classification of diabetes mellitus to take into account the surging prevalence of double diabetes in children ...

Awareness Of Type Ii Diabetes In The Developing World: Case Study In Binh Du’O’Ng, Vietnam, Anna Hong Le

Independent Study Project (ISP) Collection

Vietnam’s rapid economic development after 1986 forever changed the lifestyle of the Vietnamese. Economic development has highly impacted behavior, “changing from a traditional lifestyle to an industrial lifestyle [increasing] noncommunicable diseases (NCDs) : diabetes, overweight, high blood pressure, and high cholesterol disorders” (Danh, Personal Interview). With the increase of NCDs within the country, it is important to focus on awareness education that motivates the population especially those living in the urban sector to practice healthy behaviors. This study project focuses on the evaluating the reach and effectiveness of current diabetes awareness educational materials. One week was spent in Ha Noi ...

Ethnic And Gender Differences In Psychosocial Factors In Native Hawaiian, Other Pacific Islanders, And Asian American Adults With Type 2 Diabetes, Jillian Inouye, Dongmei Li, James Davis, Richard Arakaki

Journal of Health Disparities Research and Practice

This study examined the differences between 207 Asians and Native Hawaiian, other Pacific Islanders (NHOPI) with type 2 diabetes among various psychosocial measures. Responses to five multivariable regression models including the Diabetes Quality of Life Questionnaire (DQOL) and Short Form -36® Health Survey (SF-36) were analyzed. Differences were determined by linear contrasts in the multivariate linear regression models after adjusted for multiple demographic and socioeconomic variables. Compared to Asians, NHOPIs perceived a lower impact of diabetes on their quality of life; highlighting differences in perceptions of self-efficacy and self-care activities. Females did better on their diet while males perceived better ...

Evaluating The Impact Of Two Different Methods Of Diabetes Self-Management Education On Knowledge, Attitude, And Behaviours Of Patients With Type 2 Diabetes Mellitus, Laura B. Briden

Electronic Thesis and Dissertation Repository

This study compared the effectiveness of diabetes self-management education (DSME) methods by examining changes in knowledge, attitude, and behaviour (KAB) after receiving education. Participants from a convenience sample were randomized into two groups, one receiving education through conversation maps and the other through traditional group education. Participants’ knowledge and attitude changes were measured by using a repeated measures pre-test/post-test design and changes in Hb A1c were observed. Focus groups were conducted after education was received to obtain perceptions and self-reported behaviour changes. Significant knowledge and attitude score changes were observed in the conversation map group after education. When comparing ...

Health Maintenance Regarding Carbohydrate Counting And Calorie Restricted Diets In Diabetes Mellitus Type 2 Patients, Chelsea Stoltzfus, Katie Siegle, Lauren Trainer

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Diabetes Mellitus is a rapidly growing epidemic in today’s society. In 2000, 2.8% (171 million) of the world had this diagnosis. In 2030, it is expected to increase to 4.4% (366 million). There is an increased need for research and implementation in the nursing field to manage diabetic symptoms. Diabetes mellitus type 2 is a cellular change causing insulin to be resistant to the cells which leads to a build up of glucose. Multiple medical complications can result from the diagnosis of diabetes mellitus type 2. The purpose of this study is to determine which diabetic diet ...

Selective Screening Of Type 2 Diabetes For Washoe County’S Hispanic Population, Linda M. Dunn

Nevada Journal of Public Health

Hispanic Americans with unrecognized, asymptomatic diabetes are more likely to experience poor quality of life and diabetic complications such as heart, eye and kidney disease than non-Hispanic whites of similar age. Multiple factors, such as cultural beliefs, lack of knowledge and limited access to health care, contribute to the fact that one-third of total diabetes among Hispanic Americans is undiagnosed. For Washoe County, Nevada, the actual percentage of adult Hispanics with diabetes may be almost 12%. In 2003, the Defeat Diabetes Screening Project provided three screenings targeting the Hispanic population in Reno and Sparks. Seventy-one percent of 348 screened were ...

Care Patterns And Outcomes For Hospitalized Patients With Diabetes In Nevada, Jay J. Shen

Nevada Journal of Public Health

This study demonstrates substantial differences between Nevada and the national average in patterns of hospital based care in patients with type 2 diabetes. Diabetic patients in Nevada are more likely to be hospitalized through the emergency department, and more likely to be admitted for a condition related to diabetes. Moreover, in Nevada, Medicaid and uninsured patients with diabetes are more likely to experience adverse outcomes then their privately insured counterparts. These differences may be primarily reflective of variances in access to ambulatory care, care seeking behavior, and availability of health services and facilities. Policies promoting expansion of health care benefits ...

A Pilot Study Of Diabetes Management In The Managed Care Setting, Rachel Wagman

The Medicine Forum

Diabetes mellitus represents a disease entity that primary care providers commonly encounter in the outpatient setting. Patient visits encompass a broad range of concerns, from optimizing management of hyperglycemia to the sequelae of chronic disease. The third National Health and Nutrition Exam Survey, (NHANES III) 1988-1994 has reported the prevalence of diabetes mellitus type 2 in the U.S. adult population at 12.3%. The cost of diabetes in 1998, estimated at $77 billion, is a formidable challenge to the health care community and third-party payers. Historically, Health Maintenance Organizations (HMOs) have encouraged more preventative tests, procedures, and exams to ...

Melena With Fever, Monica Patel, Jennifer Wilhelm

The Medicine Forum

The patient is a 62 year old Indian male with a past medical history significant for myasthenia gravis, hypertension, and diabetes mellitus, who presented to an outside hospital with fever, fecal incontinence, and melena. Work up at that hospital was remarkable for elevated liver function tests, heme-positive brown stool and a CT of the abdomen showing a thick ascending colon suggesting possible mass. The patient had an episode of desaturation and fever to 105 degrees Fahrenheit prior to transfer to Thomas Jefferson University Hospital for further evaluation. Upon arrival, the patient was in respiratory distress with oxygen saturation of 70 ...

A Case Of Hypercalcemia, Daniel Lin

The Medicine Forum

A 79-year-old man with a past medical history of diet-controlled type 2 diabetes mellitus, hypertension, and chronic lower extremity venous stasis ulcers requiring two skin grafts was admitted to the hospital due to dehydration. He was in his usual state of health intermittently being wheelchair bound due to leg ulcers until four days earlier, when he accidentally spilled hot tea on his left arm while in the kitchen. In his attempt to maneuver the wheelchair away from the spill, the wheelchair turned over, pinning him on the floor and against the cabinets. He remained in that position for four days ...

Metabolic Syndrome In Type 2 Diabetes: Comparison Of Who, Modified Atpiii & Idf Criteria, Asma Ahmed, Talha Ehsan Khan, Tahira Yasmeen, Safia Awan, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVES: To determine the frequency of metabolic syndrome in type 2 diabetes according to three commonly used operational definitions {World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) and International Diabetes Federation( IDF)}. To evaluate the agreement between these classifications in the Pakistani cohort.

METHODS: Data was collected retrospectively of 210 patients with type 2 diabetes visiting outpatient clinics of one of the large tertiary care hospitals at Karachi, Pakistan between June 2008 to November 2008.

RESULTS: The prevalence of metabolic syndrome was found to be 81.4% (WHO), 86.7 % (IDF) and 91.9 ...

The Iddm14 Gene Is Tcrbv-13s1a1: Prevention Of Autoimmune Diabetes In The Rat With An Allele-Specific Depleting Antibody That Recognizes The Vβ13a T Cell Receptor Beta Chain, Michael Habib, Ryan Eberwine, Zhijun Liu, Thomas Herrmann, Dale Greiner, Laura Cort, Elizabeth P. Blankenhorn, John P. Mordes

Clinical and Translational Science Research Retreat

To identify new intervention strategies for autoimmune type 1 diabetes (T1D), we investigated several rat models of the disorder. We dissected the powerful Iddm14 diabetes susceptibility locus in eight T1D susceptible vs. resistant rat strains by single nucleotide polymorphism (SNP) haplotyping. We identified an allele of a T cell receptor (TCR) beta chain gene, Tcrb-V13S1A1 (encoding V13βa) as a candidate gene. In three separate trials, treating LEW.1WR1 rats, which are susceptible to T1D, with a depleting anti-Vβ13 monoclonal antibody reduced diabetes frequency from 75% (N=50) to 17% (N=30, p<0.001. Anti-Vβ13 monoclonal antibody also prevented T1D in spontaneously diabetic BBDP rats. We then analyzed the phenotype of infiltrating T cells recovered from the cultured islets of LEW.1WR1 rats exposed to a diabetogenic trigger. Within 5 days, up to 22% of CD4+ T cells recovered from islets were V13β+, most of these CD25+FoxP3-. We also recovered Vβ13 transcripts from pre-diabetic islets and observed a limited number of Jβ variant transcripts, indicating an oligoclonal TCR response to pancreatic beta cells. These data indicate that, in susceptible rats, V13βa on diabetogenic T cells is required to recognize a critical T1D autoantigen. Interestingly, the diabetogenic and non-diabetogenic alleles of Vβ13 have non-conservative sequence differences in both CRR1 and CDR2. The data suggest that it is possible to prevent T1D in the rat with a very narrowly targeted deletional therapy. Preliminary data suggest that a specific alpha chain may preferentially pair with Vβ13a. We are currently generating rat T cell hybridoma clones with which to analyze the interaction of putative autoantigens with a diabetogenic TCR.

Gene Expression And Profiling Of Human Islet Cell Subtypes, David M. Blodgett, Susanne Pechhold, David M. Harlan

Clinical and Translational Science Research Retreat

The endocrine pancreas contains multiple cell types co-localized into clusters called the islets of Langerhans. The predominant cell types include alpha and beta cells, which produce glucagon and insulin, respectively. The regulated release of these hormones maintains whole body glucose homeostasis, essential to prevent complications from diabetes (e.g. blindness, kidney failure, and cardiovascular disease). In type 1 diabetes, an autoimmune reaction destroys the beta cells and patients must monitor their blood sugar levels and inject insulin in order to maintain euglycemia. In type 2 diabetes, the beta cells fail to produce sufficient insulin to overcome the individual’s decreased ...

What Works In A Pediatric Obesity Treatment Program?, Mary Savoye

Clinical and Translational Science Research Retreat

Ms. Savoye will present a brief overview of the research and program model of Yale University's Bright Bodies Weight Management Program for Children. She will discuss the components that make the Program unique and successful and include staffing and other operating strategies that have contributed to the sustainability of the treatment model housed throughout the community and operated by the university.

Pilot Study With Overweight Youth: Greater Lowell Boys And Girls Club, Garry Handelman

Clinical and Translational Science Research Retreat

In collaboration with the Lowell Community Health Center and the Lowell Boys and Girls Club, Dr. Handelman, Dr. Pbert and colleagues carried out an intervention trial, recruiting 25 overweight youth for a 5-month after-school intervention program. BMI, fasting insulin, and behavioral attitudes were monitored. There were not short-term improvements in physical health. The youth and their families had a very positive attitude toward the program, with changes in the direction of healthier diet behaviors. The social structure of this youth organization would be compatible with provision of long-term diet and life-style programs for all youth, including youth seeking to achieve ...

Methodological Challenges And Clinical Applications Of Hair Cortisol Analysis, Evan W. Russell

Electronic Thesis and Dissertation Repository

This thesis examines methodological and clinical aspects of hair cortisol analysis. The methodological study examines the role of sweat as a contributor to hair cortisol concentrations. Hair cortisol analysis is an effective measure of chronic stress. Cortisol is assumed to enter the hair via blood, sebum, and sweat, however the extent to which sweat contributes to hair cortisol content was unknown. This study concluded that human sweat contains cortisol that likely contributes to hair cortisol content. Subjects with prolonged sweating at the time of hair collection may have increased hair cortisol concentrations that cannot be decreased with conventional laboratory washing ...