Endocrinology, Diabetes, and Metabolism Commons^™

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Individuals Diagnosed With And Without Type 2 Diabetes, Minghao Zhou, Hairui Yu, Renee Underwood, Hongning Cai, Tung Sung Tseng, Susu Luo

School of Public Health Faculty Publications

Background: Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates …

Cardiovascular Disease And Fracture Risk In People With Type 2 Diabetes: A Nationwide Matched Case–Control Study, Aksayan Arunanthy Mahalingasivam, Annika Vestergaard Kvist, Joop P. Van Den Bergh, Cassandra Smith, Joshua R. Lewis, Peter Vestergaard, Nicklas Højgaard Hessellund Rasmussen

Research outputs 2022 to 2026

To examine, among people with type 2 diabetes (T2D), whether cardiovascular disease (CVD) phenotypes and cardiovascular medications are associated with any fracture as the primary outcome and major osteoporotic fracture (MOF) as a secondary outcome. Nationwide registry-based matched case–control study in Denmark (2013–2021) among people with T2D. Cases were individuals with T2D who sustained an incident fracture (n = 12,390), and controls were fracture-free individuals with T2D matched 1:3 by age, sex, T2D onset date, and weighted Charlson Comorbidity Index (n = 37,170). The exposures were overall CVD, prespecified clinical CVD phenotypes (acute myocardial infarction (AMI), stroke, heart failure, atrial …

Skin Carotenoid Scores Reflect Immune Status Among Children Living With Hiv In Tanzania, Wilbert Mbuya, Thobias Boniphace, Michael Mwagala, Peter Agrea, Nazareth M Mbilinyi, Nancy E Moran, Andrew R Dinardo, Mkunde Chachage

Children’s Nutrition Research Center Staff Publications

Many individuals living with HIV experience persistent inflammation despite antiretroviral treatment, increasing their risk for cardiovascular diseases, cognitive decline, and other noncommunicable diseases. Carotenoids can inhibit this inflammation by reducing lipid peroxidation. Carotenoid intake and plasma concentrations can be approximated using a noninvasive cutaneous spectrophotometer. This study quantified skin carotenoid levels in Tanzanian children ages 5 to 15 years old (N = 185) both with and without HIV. Over 95% had low to moderate skin carotenoid scores (< 400 units). In children living with HIV, higher viral loads were linked to lower skin carotenoid scores (rho = -0.57, P < 0.001), whereas higher CD4 counts correlated with increased skin carotenoid scores (rho = 0.52, P < 0.001). Overall, carotenoid levels were low and associated with immune status, suggesting that elevated carotenoid scores correlate with lower inflammation in children living with HIV. Future studies investigating dietary carotenoid interventions to support immune function are warranted.

The High Cost Of Incomplete Physical Exams: Missed Diagnosis Of Cushing Syndrome In A Patient With Recurrent Hospital Admissions, Tarah M Burton, Miranda K Hunter, Mihail Zilbermint

Journal of Community Hospital Internal Medicine Perspectives

Cushing syndrome is a rare but life-threatening endocrine disorder associated with a classic constellation of physical exam findings (e.g. “moon facies”, abdominal striae, etc.). However, thorough biochemical testing is needed to confirm this diagnosis. We present the case of a 35-year-old male with multiple hospitalizations across a variety of healthcare institutions for heart failure, cellulitis, uncontrolled hypertension, and diabetes.  While an adrenal mass was eventually identified on imaging, classic signs of Cushing syndrome – including violaceous striae, truncal obesity, and facial plethora – were missed during prior admissions.  This case illustrates the diagnostic delay that can result from incomplete physical …

Skin Carotenoid Scores Are A Valid Approximation Of Fruit And Vegetable Intake Among Adults With Obesity, Stephanie B Jilcott Pitts, Qiang Wu, Elizabeth Gates, Melissa N Laska, Andrew R Dinardo, Nancy E Moran

Children’s Nutrition Research Center Staff Publications

Skin carotenoid score (SCS) as measured using pressure-mediated reflection spectroscopy has been validated among adults with normal and overweight body mass index, with little validation research among adults with obesity. Therefore, the purpose of this exploratory study was to examine the validity of SCS as an approximation of fruit and vegetable intake among adults with obesity. We used samples from adults with obesity from three prior studies: The first study examined the validity of SCS among 213 adults, 34 with obesity; the second, examined sensitivity of SCS to a β-carotene-rich juice intervention among 162 adults, 14 with obesity; the third …

Myxedema Coma With Cardiogenic Shock: Diagnostic Challenges And Risks Of Amiodarone In Acute Thyroid Failure, Jean Carlos Ramos Cardona, Gunjan Mundhra, Munachiso Egbo, Veniamin Melnychuk, Suzanne Quinn Martinez

HCA Healthcare Journal of Medicine

Background

Myxedema coma is a rare but life-threatening manifestation of severe hypothyroidism characterized by altered mental status, hypothermia, bradycardia, and multiorgan dysfunction. Delayed diagnosis is common, particularly in elderly patients with multiple comorbidities. Cardiac complications, including malignant arrhythmias, are underrecognized contributors to morbidity and mortality. Profound hypothyroidism compromises cardiac myocyte function through reduced activity of enzymes involved in calcium uptake, leading to impaired myocardial contraction and relaxation. This results in decreased heart rate, reduced cardiac output, and altered left ventricular function, which may be further exacerbated in patients with heart failure with reduced ejection fraction. Prolongation of the ventricular action …

For Weight Loss: Why Do Glp-1 Agonists Work, And How Can We Make Them Work Better?, Charlise Giang, Jieyi Meng, Mahmoud Ali Mohammad, Zhenqi Liu, Xinle Wu, Yi Zhu

Children’s Nutrition Research Center Staff Publications

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have revolutionized the management of not only type 2 diabetes but also obesity. However, even with rapid therapeutic advances in GLP-1RAs, questions regarding the fundamental principles of GLP-1-mediated weight loss and the enhanced efficacy of next-generation therapies remain. In this comprehensive review article, we first examine the milestones of GLP-1, from its initial discovery and biological characterization to its successful translation into clinical therapy. Furthermore, this review highlights the latest clinical trial data, specifically HbA1c reduction, weight-loss efficacy, and safety profiles, while exploring current pipelines of major pharmaceutical companies. Additionally, we delineate the mechanistic …

A Rare Sight: Isolated Third Nerve Palsy As The Sole Presentation Of A Non-Functional Pituitary Adenoma, Jorge A. Aboytes, Jose J. Loayza, Ivan Mogollon, Ismael Cantu

Research Colloquium

Introduction: Hypopituitarism results from insufficient pituitary hormone production, often due to adenomas—accounting for ~15% of intracranial tumors. Non-functional adenomas, typically affecting older adults, may present with visual field deficits, headaches, or cranial nerve palsies when extending into the cavernous sinus. Isolated oculomotor (third nerve) palsy is a rare initial manifestation.

Case: A 46-year-old man with uncontrolled type 2 diabetes presented with acute right-sided headache, diplopia, ptosis, and right leg weakness. He had right ptosis, a fixed dilated pupil, facial droop, and right leg weakness. Given concern for stroke, he received thrombolytic therapy with partial leg improvement, but persistent diplopia and …

Interpreting Continuous Glucose Monitoring Through Metabolic Physiology: A Framework For Precision Nutrition In Type 2 Diabetes, Jitendra D. Belani

College of Pharmacy Faculty Papers

Background: Type 2 diabetes is characterized by substantial interindividual variability in postprandial glucose responses, yet continuous glucose monitoring (CGM)-derived glucose patterns are commonly described using quantitative metrics without sufficient consideration of the physiological mechanisms that generate them. Objective: To develop a physiology-based framework for interpreting CGM-derived glycemic phenotypes in relation to dietary exposures and individual metabolic characteristics, thereby supporting precision nutrition in adults with type 2 diabetes. Methods: A structured narrative review of the literature was conducted using PubMed to identify studies examining CGM, postprandial glucose regulation, dietary exposures, metabolic physiology, and precision nutrition. Evidence was synthesized within a predefined …

Dose-Expansion Study Of Obi-999, A Globo H-Targeting Antibody-Drug Conjugate, In Patients With Advanced Solid Tumors, Apostolia Maria Tsimberidou, Darren Sigal, Anna Varghese, Daniel Vaena, Li-Yuan Bai, Ming-Huang Chen, Chun-Nan Yeh, Chia-Jui Yen, Mehmet A Baysal, Abhijit Chakraborty, Ingly Lee, Chi-Sheng Shia, Konul Ristoski, Dong Xu

Children’s Nutrition Research Center Staff Publications

Background: OBI-999 is an antibody-drug conjugate consisting of the Globo H-targeting antibody OBI-888 linked to the cytotoxic payload monomethyl auristatin E. In a dose-escalation study, the OBI-999 recommended phase 2 dose (RP2D) was 1.2 mg/kg every 3 weeks. This dose-expansion study evaluated the efficacy and safety of OBI-999 in patients with pancreatic cancer, colorectal cancer (CRC), or other tumor types ("basket cohort") and tumoral Globo H H-scores ≥100 (NCT04084366).

Patients and methods: Patients were treated at RP2D of OBI-999. We assessed response, progression-free survival (PFS), treatment-emergent adverse events (TEAEs), and pharmacokinetics of OBI-999.

Results: Of 29 patients treated, …

Non-Enzymatic Hepatic Abhd6 Interacts With Akt-Foxo1 Axis To Regulate Metabolic Health, Guannan Li, Laurence T Maeyens, Jiyuan Yin, Jan-Bernd Funcke, Chanmin Joung, Ruizhen Li, Ziying Xu, Ting Wu, Xin Li, Nisi Jiang, Mbolle Ekane, Maria Paula Lopez, Pengju Cao, Sijia He, Adam B Salmon, S R Murthy Madiraju, Marc Prentki, Juli Bai, James F Nelson, Xianlin Han, Yi Zhu, Shangang Zhao

Children’s Nutrition Research Center Staff Publications

The enzymatic role of ABHD6 in insulin secretion and resistance is well documented. However, its non-enzymatic function, especially its effects on metabolic health, including selective hepatic insulin resistance and metabolic dysfunction-associated steatotic liver disease (MASLD), is poorly understood. To define the role of ABHD6 in liver physiology, we generated liver-specific ABHD6 knockout mice, as well as liver-specific native and enzymatically inactive mutant ABHD6 overexpression mouse models. We demonstrate that non-enzymatic ABHD6 contributes to the regulation of selective hepatic insulin resistance and MASLD progression. Mechanistically, we show that ABHD6 localizes to the nucleus and interacts with Akt/FoxO1 axis to regulate insulin …

Dnp Final Report: Improving Diabetes Self-Efficacy Through Nutrition Education: A Quality Improvement Project, Lakimberely S. Wooten

DNP Final Reports

Diabetes affects 12.7% of residents in Northeast Texas and is the 7th leading cause of death. Internal evidence indicates low health literacy and a heavy disease burden in the service area, underscoring the need for a standardized, low-cost, and feasible approach to nutrition education. This quality improvement project evaluated the feasibility of implementing an instructor-led nutrition education session. Guided by the Johns Hopkins Evidence-Based Practice Framework and the ADKAR behavioral change model, adult participants with Type 2 diabetes received instruction on the Plate Method. Participants enrolled in a 4-week, instructor-led diabetes education class completed a 1-hour, nutrition education session using …

Hyperadhesive Von Willebrand Factor Contributes To Pathogenesis Of Preeclampsia, Yajuan Wang, Chenyu Wang, Katie L Houck, Xiaoli Gao, Yuanyuan Chen, Xin Xu, Xue Zhao, Miguel A Cruz, Shu Zhang, Chester Q Li, Fengxia Xue, Min Li, Swati Shree, Jing-Fei Dong, Cha Han

Children’s Nutrition Research Center Staff Publications

Background: Preeclampsia is the most common complication of pregnancy, significantly affecting maternal and fetal health, and is characterized by placental and systemic endotheliopathy. Patients with preeclampsia have elevated levels of VWF (von Willebrand Factor), which is associated with poor clinical outcomes. However, whether VWF serves as a marker for endotheliopathy or contributes to the pathogenesis of preeclampsia remains poorly understood.

Methods: We investigated the role of hyperadhesive VWF in the development of preeclampsia by studying patients, evaluating mouse models, and performing in vitro experiments.

Results: We show that patients develop VWF- and fibrin-rich thrombosis in the placenta and have significantly …

Concerns With The Statistical Analysis In “Effect Of Combined Glp-1 Analogue And Bupropion/Naltrexone On Weight Loss: A Retrospective Cohort Study”, Thirupathi Reddy Mokalla, Henry T Robertson, Sherri Pals, David B Allison

Children’s Nutrition Research Center Staff Publications

No abstract provided.

All-Cause And Cause-Specific Mortality In Gambling Disorder: Evidence From A Nation-Wide Matched And Sibling Cohort Study In Taiwan, Yang-Chieh Brian Chen, Chih-Wei Hsu, Liang-Jen Wang, Mu-Hong Chen, Yao-Hsu Yang, Chih-Sung Liang, Edward Chia-Cheng Lai

Children’s Nutrition Research Center Staff Publications

Background and aims: Gambling disorder (GD) has been linked to suicidal ideation and suicide deaths; however, evidence on all-cause and cause-specific mortality-particularly in Asian populations-remains limited. Using a retrospective cohort study based on nationwide matched and sibling cohort, we investigated all-cause and cause-specific mortality risk in patients with GD.

Design, setting and participants: A retrospective cohort study was conducted using 2000-2022 data from Taiwan's National Health Insurance Research Database. A cohort of 961 individuals diagnosed with GD was identified. An age- and sex-matched control cohort (n = 3,844) and an unaffected sibling cohort (n = 675) were constructed. Cumulative survival …

Genetic Associations With Pulmonary Embolism Among Those With A Deep Vein Thrombosis: The International Network Against Venous Thrombosis Consortium, Susana Lozano-Esparza, Gabrielle E Shakt, Jennifer A Brody, Angel Martinez-Perez, Matthew P Conomos, Marine Germain, Katharine R Clapham, Maris Teder-Laving, Astrid Van Hylckama Vlieg, Anni Kauko, Florian Thibord, Ohanna C L Bezerra, Girish N Nadkarni, Gaëlle Munsch, Therese Haugdahl Nøst, Ellen L Goode, Yuekai Ji, Daniel I Chasman, Alexander P Reiner, Constance Turman, Kerri L Wiggins, Colleen M Sitlani, Juan Carlos Souto, Pamela L Lutsey, Tiffany Bellomo, Estonian Biobank, Million Veteran Program, Ruifang Li-Gao, Aleksi Kristian Winstén, Ming-Huei Chen, Ron Do, Lénaick Gourhant, Kristian Hveem, Sebastian M Armasu, Noémie Saut, Nathan Pankratz, Franco Giulianini, Jeffrey Haessler, Mingyang Song, Robert Olaso, Eric Boerwinkle, Daniel Dochtermann, Jose Manuel Soria, Stephen S Rich, David Smadja, Satoshi Koyama, Frits R Rosendaal, Teemu Niiranen, France Gagnon, Ha My T Vy, Neil Zakai, Catherine Lemarie, Anne Heidi Skogholt, Jean-François Deleuze, James S Pankow, Paul M Ridker, Yuxi Liu, Kenneth M Rice, Saiju Pyarajan, Mary Cushman, Jospeh Emmerich, Bruce M Psaty, Pradeep Natarajan, Andrew D Johnson, Marc A Rodger, Pierre Suchon, Francis Couturaud, Pierre-Emmanuel Morange, Weihong Tang, Charles Kooperberg, Christopher Kabrhel, Maria Sabater-Lleal, David-Alexandre Trégouët, Alisa S Wolberg, Scott M Damrauer, Nicholas L Smith

Children’s Nutrition Research Center Staff Publications

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), the latter of which often originates from DVT and can be fatal.

Objectives: The aim of this study was to identify causal genetic factors that alter risk of PE among those with a presumed DVT.

Methods: Using a case-only design of VTE, we conducted meta-analyses of genome-wide association studies (GWASs) in the International Network Against Venous Thrombosis Consortium. Among participants diagnosed with VTE, each study identified those who had a clinically reported PE, with or without a clinically reported DVT; those remaining had isolated DVT. Logistic regression …

Timing Matters: Safe And Timely Insulin Administration, Katlyn Lenox

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely insulin administration is essential for safe inpatient diabetes management and is strongly associated with improved glycemic control and fewer adverse events. Despite ADA recommendations to administer insulin within 30 minutes of point‑of‑care (POC) glucose testing, internal data showed only 44% compliance, with an average delay of 44 minutes. These delays increased the risk of hypo‑ and hyperglycemia and highlighted the need for workflow redesign and strengthened nursing processes.

Aim of the Project: To increase the percentage of insulin doses administered within 30 minutes of POC glucose testing, reduce adverse glycemic events, enhance patient safety, and align practice with …

Trends In Emergency Department Utilization After Metabolic And Bariatric Surgery In The United States, Andrew Sanders, Isabella Moncada, Sabrina Avanzato, Michelle Fakler, Michael Dombek, R. Wesley Vosburg

HCA Healthcare Journal of Medicine

Background

In this article, we sought to understand the factors associated with emergency department (ED) utilization by patients after metabolic and bariatric surgery (MBS). The hopes were that modifiable risk factors could be identified to reduce ED visits after MBS.

Methods

We analyzed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (MBSAQIP) which is comprised of data from all nationally accredited bariatric centers in the United States. For our study, we included a population of 681 743 patients having undergone the 2 most common MBS procedures: sleeve gastrectomy (SG) and gastric bypass (GBP). Using logistic …

Us Race/Ethnic Disparities In Diabetes Technologies: A Systematic Review And Meta-Analysis Of 950 000 Individuals, Maria L. M. Rego, Maxim Barnett, Maria Helena Siqueira Tavares De Melo, Ana Rivadeneira

Einstein Health Papers

PURPOSE: To provide a descriptive summary and to quantitatively examine racial and ethnic disparities in the use of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) among people living with diabetes in the United States.

RESEARCH DESIGN AND METHODS: We followed the Cochrane and PRISMA guidelines (PROSPERO: CRD420251124678). Search was conducted on PubMed, Embase, and Cochrane up to August 2025. Observational studies were included if they (1) were conducted in the United States, (2) evaluated the use of CGM/CSII across different races/ethnic groups, and (3) reported odds ratios (ORs) for between-group comparisons. Three-level random-effect meta-analyses examined OR in …

Activated Dorsomedial Hypothalamic Astrocytes Regulate Feeding Behavior, Bella M. Lisenby

Honors Projects

The dorsomedial hypothalamus (DMH) region of the brain has been shown to be important for anticipatory feeding activity and play a role in restricting excessive food intake. In obese animals that overconsume calories, astrocytes within the DMH exhibit intracellular signaling changes indicative of cellular activation. Because astrocytes are known to influence neuronal function, we hypothesize that activated astrocytes regulate behavior. In the current study, we use chemogenetics combined with stereotaxic surgery to assess the contribution of astrocyte activity in the DMH towards metabolic behaviors.