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The Impact Of Comorbidities On Diabetes And Hypertension Co-Management And Healthcare Expenditures, Rashmi Goyat

Graduate Theses, Dissertations, and Problem Reports (ETD)

Hypertension and type-2 diabetes mellitus (T2DM) are among the most prevalent chronic conditions that often co-exist. Their co-existence increases the risk for comorbidities due to their impact on other organs such as blood vessels (leading to vasoconstriction/hypertension); brain (resulting in increased caloric intake); pancreas (decreased in beta-cell mass and glucose sensing); bone (possibly decreasing bone mass and strength). Occurrence of comorbidities can complicate the already complex care of diabetes and hypertension. It increases the risk of poor patient outcomes such as preventable hospitalization, adverse drug events and mortality. However, different comorbidities can affect the co-management differently. We identified the types …

Examining Participant Perceptions Of Benefits, Barriers And Social Support In A Diabetes Lifestyle Program, Samantha Shawley-Brzoska

Graduate Theses, Dissertations, and Problem Reports (ETD)

No abstract provided.

Inpatient Rehabilitation, Diabetes, And The Risk Of Clostridium Difficile Infection, Kerry A. Flint

Walden Dissertations and Doctoral Studies

Clostridium difficile is a frequent cause of healthcare-associated infections (HAI) and is associated with increased risk of morbidity and mortality. Studies suggest environmental and host characteristics increase patient's susceptibility to C. difficile infection (CDI). However, few studies have examined the risk of CDI among those with diabetes or patients in the acute rehabilitation (AR) setting. A case-control study, using secondary data (n = 473), evaluated the relationship between CDI and diabetes and identified modifiable environmental exposures. An ecosocial framework was used to examine the relationship between these two complex diseases among hospitalized patients in an AR setting. Results of the …

Implementation Of A Diabetic Resource Toolkit In A Veterans Administration Emergency Department, Caroline Hairston

Walden Dissertations and Doctoral Studies

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 …

Using Diabetes Self-Management Education To Enhance Adolescent Transition, Jessica Adkins

Walden Dissertations and Doctoral Studies

Type 1 diabetes is a long-term diagnosis, the prognosis of which is directly related to the patient's ability to self-manage the disorder. Adolescents are not currently taught how to manage diabetes; instead, parents and educators expect self-management to be more of a learned behavior from their parents. The purpose of this project was to create a quality improvement plan which the regional pediatric diabetes center study site could implement to improve adolescent glycemic control. Orem's self-care theory was used as theoretical framework for the design and evaluation of the project. The practice-focused question for this doctoral project was: Can a …

The Impact Of Diabetes And Obesity In The African American Population, Andrea Lynette Swails

Walden Dissertations and Doctoral Studies

Within the 21st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. …

Kaposi Sarcoma Incidence In Females Is Nearly Four-Fold Higher In The Lower Rio Grande Valley Compared To The Texas Average, Wendy Innis-Whitehouse, Xiaohui Wang, Nicolas Restrepo, Carlos Salas, Katia Moreno, Alvaro Restrepo, Megan Keniry

School of Medicine Publications

The Lower Rio Grande Valley (LRGV) is located on U.S.-Mexican border with a population that is 90% Hispanic[1]. Comprised of Hidalgo, Cameron, Starr and Willacy counties, this region has the highest poverty rate and one of the highest incidences of Type 2 diabetes in the United States[2],[3],[4]. Previous studies demonstrated a high prevalence of Human Herpes Virus 8 (HHV8) in the LRGV[5],[6],[7]. HHV8 infection has been causally linked to Kaposi Sarcoma (KS)[8]. Here, we retrospectively examine the incidence of KS in the LRGV in a set of HIV-negative Hispanic patients. Strikingly, the incidence of KS was higher in LRGV women …

Prevalence Of And Trends In Diabetes Among Veterans, United States, 2005–2014, Ying Liu, Sonica Sayam, Xiaonan Shao, Kesheng Wang, Shimin Zheng, Ying Li, Liang Wang

ETSU Faculty Works

Diabetes is a highly prevalent chronic disease among US adults, and its prevalence among US veterans is even higher. This study aimed to examine the prevalence of and trends in diabetes in US veterans by using data from the US National Health and Nutrition Examination Survey from 2005 through 2014. The overall prevalence of diabetes and undiagnosed diabetes was 20.5% and 3.4%, respectively, and increased from 15.5% in 2005–2006 to 20.5% in 2013–2014 (P = .04). Effective prevention and intervention approaches are needed to lower diabetes prevalence among US veterans and ultimately improve their health status.

Obesity And Diabetes: Evaluating The Impact Of Promotores As A Prevention And Intervention Strategy In The Latino Community, Jessica Castaneda

Master's Projects and Capstones

This paper aims to examine obesity and diabetes among the Latino population as a health problem. As the largest minority racial group in the U.S, Latino rates of obesity and diabetes are greatly higher than whites. The prevalence of obesity in Latinos is 45% compared to that of whites at 34.5% (CDC, 2015). The disproportionate rates at which Latinos are affected by obesity and diabetes have prompted numerous programs to combat this health problem. Promotores or Latino community health workers have been able to provide the important piece of culturally and linguistically appropriate education for the population. Evidence shows Promotores …

The Role Of Pre-Existing Type 2 Diabetes Mellitus In Colorectal Cancer Stage And Survival In Elderly Americans: A Seer-Medicare Population-Based Study 2002-~2011, Sanae El Ibrahimi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Diabetes is a common comorbid condition among colorectal cancer (CRC) patients, yet its effects in CRC outcomes, particularly stage at diagnosis, risk of death and variations by diabetes severity (complications vs no complications) and Hispanic ethnicity have not been adequately studied. The purpose of this study was to investigate the association between pre-existing T2DM and advanced stage at diagnosis in elderly patients with CRC; to examine whether diabetes is an independent predictor of poor survival from all-cause and CRC-specific mortality; to assess whether variations exist by diabetes severity and to analyze the outcomes for the Hispanic group.

The Surveillance Epidemiology …

Role Of Race/Ethniciy, Pre-Pregnancy Bmi, And Socioeconomic Status On Risk For Large-For-Gestational (Lga) Infants Born To Women With Gestational Diabetes Mellitus (Gdm), Anna M. Kiefer

Masters Theses

Background Fetal macrosomia occurs in approximately 10% of all pregnancies taking place in the United States. Babies born LGA are placed at a greater risk for shoulder dystocia, perinatal trauma, cesarean section, jaundice, hypoglycemia, and neonatal intensive care admission. Even more, the long-term impacts are severe and include increased risk of becoming overweight or obese and developing type 2 diabetes later in life. Women with gestational diabetes mellitus (GDM) have higher rates of delivering macrosomic offspring due to insulin resistance taking place beyond what is normal during a pregnancy. Additionally, maternal obesity, socioeconomic status, and race/ethnicity have been associated with …

Primary Care Provider’S Perspectives Of Integrating Public Health Into The Prevention And Management Of Type Ii Diabetes Mellitus In Rural Nebraska, Emma Frost-Briley

Capstone Experience: Master of Public Health

Through the 2011 Community Health Needs Assessment, the Four Corners Health Department has identified type II diabetes mellitus as one of the communities top concerns within their communities. The goals of this project were: to develop a survey to assess the state of current practices of primary care providers on type II diabetes mellitus in the health department district, to identify primary care providers views on prevention, treatment, and management of type II diabetes mellitus in the health department district, and to examine primary care providers and local health department’s views on how primary care and public health can be …

Use Of Point Of Care Testing To Affect Clinician Treatment Decisions For Patients With Diabetes, Shannon I. Brow

DNP and Student Works

This process improvement initiative implemented a policy for medical assistants (MAs) to perform and record point of care (POC) glucose test results in the electronic medical record (EMR), for all patients with diabetes during clinic check-in. Actions and behaviors of practice staff were evaluated to determine how POC results affected clinician treatment decisions. A retrospective review of staff recorded (EMR) data was assessed at baseline, after a 2-week run-in, and 4-weeks prospectively. This initiative was implemented in a small group internal medicine practice, treating predominantly low-income, Hispanic immigrant patients in Texas.

Novel Calcium-Related Targets Of Insulin In Hippocampal Neurons, Shaniya Maimaiti, Hilaree N. Frazier, Katie L. Anderson, Adam O. Ghoweri, Lawrence D. Brewer, Nada M. Porter, Olivier Thibault

Pharmacology and Nutritional Sciences Faculty Publications

Both insulin signaling disruption and Ca²⁺ dysregulation are closely related to memory loss during aging and increase the vulnerability to Alzheimer's disease (AD). In hippocampal neurons, aging-related changes in calcium regulatory pathways have been shown to lead to higher intracellular calcium levels and an increase in the Ca²⁺-dependent afterhyperpolarization (AHP), which is associated with cognitive decline. Recent studies suggest that insulin reduces the Ca²⁺-dependent AHP. Given the sensitivity of neurons to insulin and evidence that brain insulin signaling is reduced with age, insulin-mediated alterations in calcium homeostasis may underlie the beneficial actions of insulin in …

The Lifestyle Initiative: An Innovative Coaching-Based Quality Improvement Study To Improve The Health Of Aurora Health Care Caregivers And Family Members, Tiffany A. Mullen, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Self-management support has been shown to improve clinical outcomes. Health coaching, one form of self-management support, empowers patients within the health care system by providing information and through collaboratively developed care plans.

Purpose: Assess the impact of The Lifestyle Initiative, a coaching-based health program utilized by Aurora Health Care caregivers or family members.

Methods: The Lifestyle Initiative is a coaching-based approach for Aurora caregivers or family members enrolled in Aurora’s health insurance network. Individuals were recruited from the care management database, and all participants had an Aurora primary care provider. Participation was limited to those ≥ 18 years of …

Improved Service Efficiency Improves Racial Disparity In Diabetic Care, Abel Irena, Kushal Patel, David Thompson, Gregory Schleis, Abiy Gesese, Richard Battiola

Journal of Patient-Centered Research and Reviews

Background: Racial disparities in diabetes care have been documented. Disparities also have been shown to affect service quality and outcome of diabetic care. Analysis of our internal medicine residency clinic diabetic care management performance across REAL-G (race, ethnicity, age, preferred language and/or gender) showed race-based disparity on two outcome measures: 1) measurement of glycohemoglobin (A1C) at least twice a year; and 2) target blood pressure of < 140/90.

Purpose: Develop interventions to decrease racial disparities in diabetes care among patients managed by an internal medicine residency clinic, as part of the Alliance of Independent Academic Medical Center’s National Initiative V project.

Methods: …

Repeated Plyometric Exercise Attenuates Blood Glucose In Healthy Adults, Saldiam R. Barillas, Casey M. Watkins, Megan A. Wong, Ian J. Dobbs, David C. Archer, Cameron N. Munger, Andrew J. Galpin, Jared W. Coburn, Lee E. Brown

International Journal of Exercise Science

International Journal of Exercise Science 10(7): 1076-1084, 2017. Plyometric exercise is popular in commercial exercise programs aiming to maximize energy expenditure for weight loss. However, the effect of plyometric exercise on blood glucose is unknown. The purpose of this study was to investigate the effect of relatively high intensity plyometric exercise on blood glucose. Thirteen subjects (6 females age= 21.8 ± 1.0 yrs.; height= 163.7 ± 7.8 cm; mass= 60.8 ± 6.7 kg and 7 males age= 22.0 ± 2.6 yrs.; height= 182.3 ± 3.6 cm; mass= 87.4 ± 12.5 kg) volunteered to participate. Subjects completed two random conditions on …

Omega-6 Fatty Acid Biomarkers And Incident Type 2 Diabetes: Pooled Analysis Of Individual-Level Data For 39 740 Adults From 20 Prospective Cohort Studies, Jason H Y Wu, Matti Marklund, Fumiaki Imamura, Nathan L. Tintle, Andres V Ardisson Korat, Janette De Goede, Xia Zhou, Wei-Sin Yang, Marcia C De Oliveira Otto, Janine Kroger, Waqas Qureshi, Jyrki K. Virtanen, Julie K. Bassett, Alexis C. Frazier-Wood, Maria Lankinen, Rachel A. Murphy, Kalina Rajaobelina, Liana C. Del Gobbo, Nita G. Forouhi, Robert Luben, Kay-Tee Khaw, Nick Wareham, Anya Kalsbeek, Jenna Veenstra, Juhua Luo, Frank B. Hu, Hung-Ju Lin, David S. Siscovick, Heiner Boeing, Tzu-An Chen, Brian Steffen, Lyn M. Steffen, Allison Hodge, Gudny Eriksdottir, Albert V. Smith, Vilmunder Gudnason, Tamara B. Harris, Ingeborg A. Brouwer, Claudine Berr, Catherine Helmer, Cecilia Samieri, Markku Laakso, Michael Y. Tsai, Graham G. Giles, Tarja Nurmi, Lynne Wagenknecht, Matthias B. Schulze, Rozenn N. Lemaitre, Kuo-Liong Chien, Sabita S. Soedamah-Muthu, Johanna M. Geleijnse, Qi Sun, William S. Harris, Lars Lind, Johan Arnlov, Ulf Riserus, Renata Micha, Dariush Mozaffairian

Faculty Work Comprehensive List

Background: The metabolic effects of omega-6 polyunsaturated fatty acids (PUFAs) remain contentious, and little evidence is available regarding their potential role in primary prevention of type 2 diabetes. We aimed to assess the associations of linoleic acid and arachidonic acid biomarkers with incident type 2 diabetes. Methods: We did a pooled analysis of new, harmonised, individual-level analyses for the biomarkers linoleic acid and its metabolite arachidonic acid and incident type 2 diabetes. We analysed data from 20 prospective cohort studies from ten countries (Iceland, the Netherlands, the USA, Taiwan, the UK, Germany, Finland, Australia, Sweden, and France), with biomarkers sampled …

Sleep, Internalizing Symptoms, Executive Functioning, And Diabetes Outcomes In Adolescents With Type 1 Diabetes Mellitus, Ashley Charlene Moss

Dissertations (1934 -)

Insufficient sleep is a nearly universal problem during adolescence and is likely associated with various biopsychosocial and contextual factors present with this developmental period. Youth with type 1 diabetes mellitus (T1DM) may experience greater sleep difficulties, poorer sleep quality, and greater daytime sleepiness/fatigue compared to healthy youth. Also, sleep difficulties are associated with poorer diabetes outcomes (e.g., treatment adherence). Understanding how sleep may impact illness management during adolescence is critical given increasing rates of non-adherence during this developmental period. Although research suggests poor sleep is associated with decreased neurocognitive functioning and increased internalizing behavior among healthy youth, limited research has …

Evaluation Of Trends In Diabetes Care In A Patient-Centered Medical Home, Ashley N. Saucier, Danielle Mcmechan, Julie Dahl-Smith, Carla Duffie, Denise M. Hodo, Holly E. Andrews, Joseph Hobbs

Journal of the Georgia Public Health Association

Background: The patient-centered medical home (PCMH) is a model used in primary care to achieve effective management of chronic diseases. The Augusta University Health Family Medicine Center (AUFMC), a PCMH recognized by the National Committee for Quality Assurance, has implemented strategies to manage its patient population with diabetes. The present study evaluated the effects of these interventions through trend analysis of selected diabetic core measures by use of a qualified clinical data registry, the Practice Partner Research Network.

Methods: For this retrospective study, de-identified data were abstracted for adult patients with diabetes for the period of 2013-2015. Process and outcome …

Use Of Dark Chocolate For Diabetic Patients: A Review Of The Literature And Current Evidence, Syed Raza Shah, Richard Alweis, Najla Issa Najim, Amin Muhammad Dharani, Muhammad Ahmed Jangda, Maira Shahid, Ahmed Nabeel Kazi, Syed Arbab Shah

Internal Medicine Faculty Publications

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin …

Clustering Diabetes Appointments And Education, April Pugh

Doctoral Dissertations and Scholarly Projects

Diabetes impacts the lives of millions of Americans, and the number is growing rapidly every year. Diabetes education has been demonstrated to have a positive impact of the self-management of this chronic disease and effective in the reduction of A1C, weight, and blood pressure. Barriers to attendance at both diabetes education classes and provider appointments are varied with lack of transportation and available time cited as two of the many reasons, especially in the rural and medically underserved regions of the country. The project assessed a process improvement intervention clustering diabetes education with provider appointments to increase attendance and decrease …

Control Of Hypertension Among Diabetic Patients In A Referral Hospital In Tanzania: A Cross-Sectional Study, Semvua B. Kilonzo, Daniel W. Gunda, Fatma Bakshi, Fredrick Kalokola, Henry A. Mayala, Hollo Dadi

Internal Medicine, East Africa

BACKGROUND: Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients.

METHODS: Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used to …

Principal Component Regression Analysis Of Nutrition Factors And Physical Activities With Diabetes, Ke-Sheng Wang, Ying Lu, Xin Xie, Shaoqing Gong, Chun Xu, Zhanxin Sha

Health & Biomedical Sciences Faculty Publications

The associations of nutrition factors and physical activities with adult diabetes are inconsistent; while most of these factors are inter correlated. The aims of this study are to overcome the disturbance of the multicollinearity of the risk factors and examine the associations of these factors with diabetes using the principal component analysis (PCA) and regression analysis with principal component scores (PCS). Totally, 659 adults with diabetes and 2827 non-diabetic were selected from the 2012 Health Information National Trends Survey (HINTS 4, Cycle 2). PCA was utilized to deal with multicollinearity of the risk factors. Weighted univariate and multiple logistic regression …

Control Of Hypertension Among Diabetic Patients In A Referral Hospital In Tanzania: A Cross-Sectional Study, Semvua B. Kilonzo, Daniel W. Gunda, Fatma Bakshi, Fredrick Kalokola, Henry A. Mayala, Hollo Dadi

Faculty of Health Sciences, East Africa

Background:

Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients.

Methods:

Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used …

Increasing Participation Of Diabetes Patients In Diabetes Self-Management By Identifying Barriers Hindering The Achievement Of Diabetes Self-Management Behaviors In A Medical-Surgical Unit, Francois Njomo

Master's Projects and Capstones

The overall goal of my CNL project was to increase participation of diabetic patients in diabetes self-management education (DSME) by at least 20%, by identifying and addressing barriers and obstacles hindering the achievement or maintenance of diabetes self-management behaviors in a medical-surgical unit. A total of 20 diabetic patients completed both the pre – and pot-test questionnaires; 40% of participants were Asian Americans, 30% were African Americans, 20% were Hispanics, 10% were Caucasians.

A pre- test questionnaire was administered to identify the barriers susceptible to hinder the achievement of diabetes self-care behaviors. The main barriers identified include the limited accessibility …

Pursuing Equity In Diabetes Population, Aisha Rawlinson

Master's Projects and Capstones

Abstract

Background

Poor glycemic control (HbA1c >8) overtime leads to microvascular and macrovascular complications after the first and third years respectively, ultimately resulting in death after five years (Karter, 2016). Current Kaiser Permanente (KP) data stratified by race, ethnicity, age, and gender shows a significant disparity gap between Hispanics/Latino and Caucasian populations. The Pursuing IHI initiative is over a 2-year period completed at a microsystem that is focusing on health equity practices to reduce disparity gaps.

Project aim

KP Riverside, microsystem selected has a large population of Hispanic/Latino KP members, with focus on health equity. The project aim is to …

Diabetes In Sub-Saharan Africa: From Clinical Care To Health Policy., Rifat Atun, Justine I. Davies, Edwin A.M. Gal, Till Bärnighausen, David Beran, Andre Pascal Kengne, Naomi S. Levitt, Florence Mangugu, Moffat J. Nyirenda, Graham D. Ogle, Kaushik Ramaiya

Paediatrics and Child Health, East Africa

Rapid demographic, sociocultural, and economic transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs) in sub-Saharan Africa. The impacts of these transitions and their health and economic consequences are evident. Whereas, in 1990, the leading causes of death in sub-Saharan Africa were HIV/AIDS, lower respiratory infections, diarrhoeal diseases, malaria, and vaccine-preventable diseases in children, in more recent years, cardiovascular diseases and their risk factors are replacing infectious diseases as the leading causes of death in this region, and rates of increase of cardiovascular risk factors are predicted to be greater in sub-Saharan Africa …

Maternal Diabetes, Related Biomarkers And Genes, And Risk Of Orofacial Clefts, Tiwaporn Maneerattanasuporn

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Orofacial clefts (OFCs) are among the most common congenital birth defects and are characterized by incomplete development of the lip or the palate or both. The lip and palate develop separately at different times during the first trimester of pregnancy. The etiology of OFCs is multifactorial and includes a combination of genetic and environmental factors. This project aims to examine role of maternal diabetes mellitus in orofacial clefts through studies of medical histories, biomarkers, and genes.

In a study of Utah birth certificates, mothers with pre-existing diabetes and gestational diabetes mellitus (GDM) had an increased risk of OFCs, and obese …

Application Of Support Vector Machine Modeling And Graph Theory Metrics For Disease Classification, Jessica M. Rudd

Published and Grey Literature from PhD Candidates

Disease classification is a crucial element of biomedical research. Recent studies have demonstrated that machine learning techniques, such as Support Vector Machine (SVM) modeling, produce similar or improved predictive capabilities in comparison to the traditional method of Logistic Regression. In addition, it has been found that social network metrics can provide useful predictive information for disease modeling. In this study, we combine simulated social network metrics with SVM to predict diabetes in a sample of data from the Behavioral Risk Factor Surveillance System. In this dataset, Logistic Regression outperformed SVM with ROC index of 81.8 and 81.7 for models with …