Medicine and Health Sciences Commons^™

Evaluation Of Nutritional Guidance From Providers For Patients With Type 2 Diabetes In A Primary Care Setting, Whitney Rice

DNP Projects

Background: Adherence to diet is a challenging part of managing type 2 diabetes mellitus (T2DM). Guidelines recommend including a registered dietician and/or a diabetes educator. While this is the gold standard, there are barriers to implementation in primary care. The Starting the Conversation (STC) diet recall tool can aid primary care providers (PCPs) in providing brief nutrition counseling for patients with T2DM. Purpose: To evaluate the perceptions and practices of PCPs regarding dietary education and documentation for patients with T2DM after provider education and initiation of the STC tool. Methods: This was a quality improvement project using a quasi-experimental pretest …

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% …

Evaluating The Association Between Depressive Symptoms And Glycemic Control Among Residents Of Rural Appalachia, Brittany L. Smalls, Adebola Adegboyega, Ellen Combs, Eli W. Travis, Felipe De La Barra, Lovoria B. Williams, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Type 2 diabetes mellitus (T2DM) is associated with a range of co-morbid physical and psychological conditions, including depression. Yet there is a dearth of evidence regarding the prevalence of depression among those in Appalachia living with T2DM; this gap persists despite the higher regional prevalence of T2DM and challenging social determinants of health.

Purpose: This study aimed to provide greater detail about the relationships between T2DM and depressive symptoms in adults living in Appalachia Kentucky.

Methods: The present study was a cross-sectional analysis of baseline data derived from an ongoing study of Appalachia Kentucky adults living with T2DM. Outcome …

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 …

Evaluation Of Universal Depression Screening In A Pediatric Diabetes Outpatient Clinic With The Integration Of A Depression Screening Tool Into An Electronic Health Record, Jenna Westberry

DNP Projects

Background: Depression is a significant problem for adolescents with chronic health conditions. Prevalence rates are two to three times higher in adolescents with diabetes compared to adolescents without diabetes (Badescu et al., 2016). Routine depression screening is not transpiring at rates and frequency recommended by the American Diabetes Association for this population. Implementing use of the Patient Health Questionnaire for all adolescents over the age of twelve years with Type 1 & Type 2 Diabetes Mellitus during routine health visits may improve early identification and diagnosis of depression and improve long-term health outcomes.

Purpose: The goal of this project was …

Evaluating The Feasibility And Efficacy Of A Brief Motivational Interviewing Nutrition Intervention For Women With Type 2 Diabetes In Primary Care, Charlotte M. Adams

DNP Projects

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

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 …

The Efficacy Of Plant-Based Dietary Program In Patients With Diabetes: A Pilot Study, Reuben Adatorwovor, Nisha Sharma, Dakota Mccoy, Sharon Wasserstrom, Matthew Robinson, Jacquelyn Nyenhuis, Sowmya Suryanarayanan

Biostatistics Faculty Publications

Dietary choices play a key role in insulin sensitivity among diabetes patients. An 8-week pilot study was conducted to evaluate whether a mostly plant-based dietary program will lead to improvement in biochemical markers in adults with diabetes. The dietary program included educational presentations, weekly cooking demonstrations and small group discussions. A sample of thirty-two adults with diabetes (types 1 and 2) were recruited and seventeen (53%) completed the study. Matched-pair tests and Fishers exact tests were used to compare the changes in means and proportion of the participants’ responses. There were changes in HbA1c, lipids, CRP (mg/L), cholesterol (mg/dL), HDL …

Fibroblast Growth Factor 19 Increases The Excitability Of Pre-Motor Glutamatergic Dorsal Vagal Complex Neurons From Hyperglycemic Mice, Jordan B. Wean, Bret N. Smith

Physiology Faculty Publications

Intracerebroventricular administration of the protein hormone fibroblast growth factor 19 (FGF19) to the hindbrain produces potent antidiabetic effects in hyperglycemic mice that are likely mediated through a vagal parasympathetic mechanism. FGF19 increases the synaptic excitability of parasympathetic motor neurons in the dorsal motor nucleus of the vagus (DMV) from hyperglycemic, but not normoglycemic, mice but the source of this synaptic input is unknown. Neurons in the area postrema (AP) and nucleus tractus solitarius (NTS) express high levels of FGF receptors and exert glutamatergic control over the DMV. This study tested the hypothesis that FGF19 increases glutamate release in the DMV …

The Mediating/Moderating Role Of Cultural Context Factors On Self-Care Practices Among Those Living With Diabetes In Rural Appalachia, Brittany L. Smalls, Adebola Adegboyega, Ellen Combs, Matthew Rutledge, Philip M. Westgate, Md. Tofial Azam, Felipe De La Barra, Lovoria B. Williams, Nancy E. Schoenberg

Family and Community Medicine Faculty Publications

Background

The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community.

Methods

Regression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively.

Results

The results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may …

The Impact Of Identifying And Addressing The Social Needs Of Patients With Type 2 Diabetes Mellitus In A Primary Care Clinic, Shelby Roberts

DNP Projects

BACKGROUND: A key aspect of successful Diabetes management is addressing social needs. Patients prefer individualized care that is tailored to their specific needs.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to screen patients regarding their diabetes distress and social needs requirements to develop and implement individualized social needs interventions.

METHODS: Patients were included in the study if they had a Hemoglobin A1C >9. Patients were screened, provided additional check in points and social needs were addressed in conjunction with the patient’s primary care provider and onsite social worker. Post intervention …

Metabolic And Electrophysiological Effects Of Fibroblast Growth Factor 19 In The Dorsal Vagal Complex, Jordan Wean

Theses and Dissertations--Physiology

The dorsal vagal complex (DVC) is an important homeostatic regulatory center located in the hindbrain that alters vagal parasympathetic activity in response to central, viscerosensory, and humoral cues. Within the DVC, second-order sensory neurons in the nucleus tractus solitarius (NTS) integrate ascending vagal sensory input with descending regulatory inputs from higher brain areas and respond to circulating hormones and glucose. In turn, the NTS projects to the dorsal motor nucleus of the vagus (DMV) which is comprised of cholinergic motor neurons and regulates gastric motility, hepatic glucose production, and pancreatic hormone release functions, among others.

Fibroblast growth factor 19 (FGF19) …

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 …

Oral Gavage Delivery Of Stable Isotope Tracer For In Vivo Metabolomics, Holden C. Williams, Margaret A. Piron, Grant K. Nation, Adeline E. Walsh, Lyndsay E. A. Young, Ramon C. Sun, Lance A. Johnson

Sanders-Brown Center on Aging Faculty Publications

Stable isotope-resolved metabolomics (SIRM) is a powerful tool for understanding disease. Advances in SIRM techniques have improved isotopic delivery and expanded the workflow from exclusively in vitro applications to in vivo methodologies to study systemic metabolism. Here, we report a simple, minimally-invasive and cost-effective method of tracer delivery to study SIRM in vivo in laboratory mice. Following a brief fasting period, we orally administered a solution of [U-¹³C] glucose through a blunt gavage needle without anesthesia, at a physiological dose commonly used for glucose tolerance tests (2 g/kg bodyweight). We defined isotopic enrichment in plasma and tissue at …

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 …

Nhe1 And Tau Pathology: Tragically Tangled Together?, Caitlin Rae Wessel

Lewis Honors College Capstone Collection

Alzheimer’s Disease (AD) is an age-related neurodegenerative disease that poses a large public health challenge due to its complex, mixed pathology. One hallmark characteristic of AD is the development of toxic neurofibrillary tau tangles (NFT), which have been associated with the neurodegenerative component of AD. There is also compelling evidence that cerebrovascular disease puts individuals at a greater risk for experiencing the cognitive decline characteristic of dementias like AD. Past research has shown that individuals suffering from cerebrovascular disease and AD (not necessarily simultaneously) display an increased expression of the sodium-hydrogen antiporter-1 (NHE1), a plasma membrane protein ubiquitously expressed throughout …

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 …

Sphk2−/− Mice Are Protected From Obesity And Insulin Resistance, Shwetha Ravichandran, Brian S. Finlin, Philip A. Kern, Sabire Özcan

Clinical and Translational Science Faculty Publications

Sphingosine kinases phosphorylate sphingosine to sphingosine 1‑phosphate (S1P), which functions as a signaling molecule. We have previously shown that sphingosine kinase 2 (Sphk2) is important for insulin secretion. To obtain a better understanding of the role of Sphk2 in glucose and lipid metabolism, we have characterized 20- and 52-week old Sphk2^−/− mice using glucose and insulin tolerance tests and by analyzing metabolic gene expression in adipose tissue. A detailed metabolic characterization of these mice revealed that aging Sphk2^−/− mice are protected from metabolic decline and obesity compared to WT mice. Specifically, we found that 52-week old …

Evaluation Of A Diabetic Point Of Care Education In Primary Care, Mary Cho

DNP Projects

BACKGROUND: Diabetes education is the cornerstone of managing diabetes. The education can be delivered in group or individual sessions. Given that group classes are not always well received, a brief five-minute point of care education was developed and incorporated into patients’ routine diabetic appointment. The effectiveness of the method is yet to be determined.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate the effectiveness and acceptability of a recently implemented diabetes point of care education as compared to patients’ usual care in an urban primary care clinic.

METHODS: An outcome evaluation using a retrospective …

An Evaluation Of Depression In Adolescents With Type 1 Diabetes Mellitus, Elleanor Gray

DNP Projects

Depression can significantly affect how adolescents with T1DM self-manage their disease. The combination of depression and diabetes is closely linked to reduction in self-care behaviors, poor treatment adherence, and sub-optimal metabolic control.

PURPOSE: The purpose of this study was to evaluate current screening for depression in adolescents with T1DM and determine the need for additional support or services to improve the quality of routine, follow-up diabetes care.

METHODS: A cross-sectional, retrospective review of electronic medical records was used to evaluate current practice of depression screening for adolescents with T1DM (11-21years) bring followed at a local pediatric diabetes center between April …

Mechanisms And Potential Therapy On Disrupted Blood Pressure Circadian Rhythm In Diabetes, Tianfei Hou

Theses and Dissertations--Pharmacology and Nutritional Sciences

Arterial blood pressure (BP) undergoes a 24-hour oscillation that peaks in the active day and reaches a nadir at night during sleep in humans. Reduced nocturnal BP fall (also known as non-dipper) is the most common disruption of BP circadian rhythm and is associated with increased risk of untoward cardiovascular events and target organ injury. Up to 75% of diabetic patients are non-dippers. However, the mechanisms underlying diabetes associated non-dipping BP are largely unknown. To address this important question, we generated a novel diabetic db/db-mPer2^Luc mouse model (db/db-mPer2^Luc) that allows quantitatively measuring of mPER2 protein oscillation …

The Need For Certified Diabetes Educators And Community Health Workers In Community-Based Diabetes Self-Management Education For High Risk Groups, Frances J. Feltner, Sydney P. Thompson, Melissa Slone

Center of Excellence in Rural Health Workforce Reports

The number of Americans with diabetes is projected to double, or triple by 2050 according to the Center for Disease Control (CDC). The CDC reports that as many as 1 in 3 U.S. adults could have diabetes by 2050, currently 1 in 10 U.S. adults has diabetes. Longer lifespans and an older, more diverse population are consider contributing factors for the current trend. Research shows that in spite of prevention efforts and medical advances, the prevalence of diabetes will increase by 54% between 2015 and 2030; annual deaths attributed to diabetes will climb by 38%; and total annual medical and …

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 …

Methylglyoxal Requires Ac1 And Trpa1 To Produce Pain And Spinal Neuron Activation, Ryan B. Griggs, Don E. Laird, Renee R. Donahue, Weisi Fu, Bradley K. Taylor

Physiology Faculty Publications

Methylglyoxal (MG) is a metabolite of glucose that may contribute to peripheral neuropathy and pain in diabetic patients. MG increases intracellular calcium in sensory neurons and produces behavioral nociception via the cation channel transient receptor potential ankyrin 1 (TRPA1). However, rigorous characterization of an animal model of methylglyoxal-evoked pain is needed, including testing whether methylglyoxal promotes negative pain affect. Furthermore, it remains unknown whether methylglyoxal is sufficient to activate neurons in the spinal cord dorsal horn, whether this requires TRPA1, and if the calcium-sensitive adenylyl cyclase 1 isoform (AC1) contributes to MG-evoked pain. We administered intraplantar methylglyoxal and then evaluated …

Preserving And Restoring Bone With Continuous Insulin Infusion Therapy In A Mouse Model Of Type 1 Diabetes, Jeffry S. Nyman, Evangelia Kalaitzoglou, R. Clay Bunn, Sasidhar Uppuganti, Kathryn M. Thrailkill, John L. Fowlkes

Barnstable Brown Diabetes Center Faculty Publications

Those with type 1 diabetes (T1D) are more likely to suffer a fracture than age- and sex-matched individuals without diabetes, despite daily insulin therapy. In rodent studies examining the effect of bone- or glucose-targeting therapies on preventing the T1D-related decrease in bone strength, insulin co-therapy is often not included, despite the known importance of insulin signaling to bone mass accrual. Therefore, working toward a relevant pre-clinical model of diabetic bone disease, we assessed the effect of continuous subcutaneous insulin infusion (CSII) therapy at escalating doses on preserving bone and the effect of delayed CSII on rescuing the T1D-related bone deterioration …