Endocrine System Diseases Commons^™

An N Of One: My Review Of Management Of Type 1 Diabetes, Myself As Patient, Jarred Daugherty

BU Well

As technology has advanced, so has the management of diabetes. Insulin, the essential medication for type 1 diabetes, is marketed in an array of formulations and devices. Continuous glucose monitors (CGM) can be inserted to measure blood glucose every 5 minutes. The rise of social media has given diabetics online support groups, where they can share their story and learn from others overcoming similar challenges. So, how well do the current diabetes management strategies work? My name Is Jarred and I’m a type 1 diabetic. I have tried many of these products and this article is a review of my …

The Role Of Drak2 In T Cell Function And Autoimmunity, Tarsha L. Harris

Theses and Dissertations (ETD)

The immune system utilizes many regulatory mechanisms to limit immune responses and ensure that immune cells target foreign pathogens and not healthy cells of the body. However, some immune cells can escape these checkpoints and attack the body’s healthy cells, leading to tissue destruction and devastating autoimmune disorders. For example, multiple sclerosis (MS) occurs when immune cells attack the myelin sheath surrounding neurons of the central nervous system (CNS). Likewise, the destruction of pancreatic islet cells by dysregulated immune cells leads to type 1 diabetes (T1D). Remarkably, there are more than 80 types of autoimmune diseases. An estimated 50 million …

Hit Identification For Pkcζ Inhibitors: Structure-Based Optimization, Virtual Screening, And Biological Evaluation, Xiaoxin Wu

Theses and Dissertations (ETD)

Protein kinase C ζ (PKCζ) is believed to be a promising target for the treatment of some diseases, including inflammatory diseases, obesity and diabetes. Hit identification of PKCζ inhibitors was conducted by structure-based modification, virtual screening and biological evaluation. Among all the compounds selected and synthesized, compound JW-1-60A showed moderate activity against PKCζ at 30 μM and 100 μM. The molecular modeling studies showed that the binding mode of JW-1-61A was very close to the binding mode of JP-3-149, a reported PKCζ inhibitor with very potent activity, which might partially explain the moderate activity of JW-1-61A. Based on the structure …

Examining Maternal Obesity Effects On Oogenesis, Follicular Development, And Embryonic Myogenesis, Chris Lindeman, Jennifer Wood

UCARE: Research Products

The CDC estimates that more than one-third of U.S. adults (approximately 78.6 million) are obese. Despite national efforts to combat this with diet and exercise, the number of obese adults and children continues to climb. It is critical to emphasize that obesity can lead to lifelong, chronic complications and health risks including hypertension, heart disease, and diabetes.

Diet and obesity also have important impacts on the reproductive health of female including the ability to become pregnant (fertility) and risk for complications during pregnancy. Furthermore, for women who do become pregnant, obesity can affect the development of the embryo and fetus, …

Stakeholder Perspectives On Changes In Hypertension Care Under The Patient-Centered Medical Home, Alison J. O'Donnell, Hillary R. Bogner, Peter F. Cronholm, Katherine Kellom, Michelle Miller-Day, Heather F. De Vries Mcclintock, Elise M. Kaye, Robert Gabbay

Communication Faculty Articles and Research

Introduction

Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patientcentered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control.

Methods

The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n …

Your Heart And Diabetes, Rodney Richmond

Faculty Research ​and Publications

No abstract provided.

Racial Disparities In Outcomes Following Kidney Transplantation: A Single-Center Experience, Vani Nilakantan, Maharaj Singh, Ruth M. Perez, Yang Shi, Ahmed Dalmar, Brittany T. Last, Ajay Sahajpal

Journal of Patient-Centered Research and Reviews

Purpose

Kidney transplantation remains the best treatment option for end-stage renal disease. However, despite overall improvements in patient and graft survival rates after kidney transplantation, differences in outcomes still exist among different racial and ethnic groups, with African-Americans having lower graft survival. Gaps continue to exist in the understanding of how demographic factors contribute to the varying outcomes among racial/ethnic groups.

Methods

We retrospectively evaluated kidney transplant outcomes in four racial/ethnic groups over a 12-year period at a large tertiary care center. Primary and secondary study outcomes were patient and graft survival across groups. To determine factors that might predict …

Treatment Of Pasireotide Lar-Associated Hyperglycemia In A Patient With Acromegaly, Cheryl Rosenfeld

Touro College of Osteopathic Medicine (Middletown) Publications and Research

Objective: Hyperglycemia was noted in pasireotide long-acting release (PAS LAR}-treated patients with acromegaly during clinical trials. We describe a clinical approach to hyperglycemia in a patient with acromegaly and diabetes mellitus type 2 (DM2) during PAS LAR initiation and treatment.

Methods: Clinical response to PAS LAR, including self­ monitored blood glucose (SMBG) levels, HbA1c, IGF-1, and adverse effects, was reported. Case Presentation: A 44-year-old male was referred for consultation in 2007 owing to uncontrolled DM2 despite maximum metformin (MET) dose. Testing led to a biochemical diagnosis of acromegaly. An 8-mm pituitary adenoma was seen on MRI. Transsphenoidal pituitary adenoma …

Identification Of The Effects Of Diabetes Mellitus On The Brain, Tryphina A. Mikhail

Honors Undergraduate Theses

As more studies accumulate on the impact of diabetes mellitus on the central nervous system, they resound with the same conclusion - diabetes has a detrimental effect on cognition regardless of the presence of comorbidities. Less consistent however, are the specific mental processes wherein these declines are noticeable, and the structural changes that accompany these reductions in mental capacity. From global atrophy to changes in the volume of gray and white matter, to conflicting results regarding the effects of hypo- and hyperglycemic states on the development of the hippocampus, the studies display a variety of results. The goal of this …

Diabetes Update: Your Guide To The Latest Ada Standards, Eric Johnson, Florence Warren, Neil Skolnik, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

The authors highlight the latest changes in the ADA standards and review recommendations of particular relevance for family physicians.

Effects Of Nox-1 Inhibition On Real-Time Blood Nitric Oxide And Hydrogen Peroxide In Acute Hyperglycemia, Ashley Mawhinney

PCOM Biomedical Studies Student Scholarship

Hyperglycemia has been associated with vascular endothelial dysfunction in part by a reduction in nitric oxide (NO) production and increased oxidative stress (e.g., increased superoxide (SO) and hydrogen peroxide (H₂O₂). Endothelial-derived NO can be significantly reduced by increased SO/H₂O₂ in part by the activation of NADPH oxidase during hyperglycemia. Of the 7 NADPH oxidase isoforms, NADPH oxidase isoform 1 (NOX1) is mainly expressed in the vasculature and may play a major role in hyperglycemia induced oxidative stress and vascular endothelial dysfunction. This hypothesis was tested by measuring blood NO and H2O2 levels in …

Vague Neuroglycopenic Complaints Camouflage Diagnosis Of Adolescent Insulinoma: A Case Report., Kelsee Halpin, Ryan Mcdonough, Patria Alba, Jared Halpin, Vivekanand Singh, Yun Yan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Insulinoma is a rare diagnosis in the general population with estimates of 1 in 250,000 people per year. Reports of these pancreatic islet cell tumors are even more unusual in children and adolescents. Chronic hypoglycemia due to an insulinoma often presents with neuroglycopenic symptoms that can easily be overlooked, especially in adolescents where nonspecific complaints are common. This may result in delayed diagnosis with prolonged periods of untreated hypoglycemia and associated complications. The rarity of pediatric insulinoma, vagueness of presenting symptoms, and challenge of tumor localization make insulinoma a true diagnostic quandary for clinicians.

CASE PRESENTATION: In this report, …

Is Topical Phenytoin Effective In Healing Diabetic Foot Ulcers In Patients Over Age 18?, Jordan Byrd

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not topical phenytoin is effective in healing diabetic foot ulcers in patients over age 18.

STUDY DESIGN: Systematic review of three randomized controlled trials, published in 2011, 2013 and 2014.

DATA SOURCES: Three randomized controlled trials comparing the effectiveness of topical phenytoin to placebo in healing diabetic foot ulcers. Data sources found using PubMed and Google Scholar.

OUTCOMES MEASURED: Greater than 50% reduction in ulcer area measured via graph paper tracings and area reduction calculations, discontinuation of slough and discharge from ulcers via blind observer decision, complete …

An Evaluation Of The Screening And Management Of Patients With Type 2 Diabetes, Laura A. Cahoe

DNP Projects

Purpose: This purpose of this project was to evaluate preventive screening practices and adherence to guidelines for patients with type 2 diabetes (T2DM) as recommended by the American Diabetes Association (ADA) and United States Preventive Services Task Force (USPSTF) in the primary care setting. The specific aims were to: 1) determine the percentage of patients who received recommended screenings from the ADA, 2) determine the percentage of patients who received recommended screenings from the USPSTF, and 3) determine if the proportion of patients to receive the recommended screenings met established benchmarks set by Healthy People 2020 (HP2020).

Methods: A retrospective …

The Hormonal Regulation Of The Claudin Genes In The Ovary, Sean Gadson, April Binder, Kenneth Korach, Katherine Hamilton

All Master's Theses

The ovary is a dynamic organ that responds to many hormonal signals. When these hormonal signals are disrupted, ovarian dysfunction can occur. One such example is Polycystic Ovarian Syndrome (PCOS). PCOS patients suffer from high levels of testosterone. Excess testosterone may misregulate genes in the ovary and disrupt ovarian function. The Claudin (Cldn) 3 and Cldn11 genes have been shown to be regulated by androgens in the testis, while studies in ovarian cancer cells suggests a coregulatory mechanism for the expressions of Cldn3 and Cldn4 in the ovary. The objective of this study was to characterize the hormonal …

Ethnic Differences In Maternal Adipokines During Normal Pregnancy, Xinhua Chen, Theresa O Scholl

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Two adipokines (adiponectin and resistin) have opposite relations with insulin resistance and inflammation. Our major focus was to determine whether there were detectable ethnic differences in maternal adipokines during pregnancy. We also explored the correlation of the adipokines with maternal glucose homeostasis, blood pressure and anthropometric parameters. Pregnant women (n = 1634) were from a large prospective cohort study in Camden NJ (African-American 36.8%; Hispanic 47.6%; Caucasian 15.6%). Serum adiponectin and resistin were measured at entry (week 16.8) and the 3rd trimester (week 30.7) using the Luminex xMapTechnology. Significant differences were observed among ethnic groups, controlling for confounding variables. African …

The Feedforward And Feedback Controls On Gait In Adults With Diabetes, Chun-Kai Huang

Theses & Dissertations

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback …

Enhanced Fitness And Renal Function In Type 2 Diabetes., Eric S. Nylen, S. M. Gandhi, Raya E. Kheirbek, Peter Kokkinos

Medicine Faculty Publications

Aims

To investigate the renal effects of fitness in people with diabetes with mild renal dysfunction.

Methods

The effect of a 12-week exercise programme on estimated GFR in 128 people with diabetes was evaluated.

Results

All cardiometabolic variables improved after 12 weeks of supervised exercise. Although there was a modest 3.9% increase in estimated GFR from baseline in the 128 people who completed the study, those with baseline chronic kidney disease stages 2 and 3 were found to have significant (6 and 12%, respectively; p < 0.01) improvements in post-exercise estimated GFR. Moreover, 42% of the people with chronic kidney disease stage 3 improved to chronic kidney disease stage 2 after the intervention.

Conclusion

Short-term exercise improves renal function in those with more moderate baseline chronic kidney disease. …

New-Onset Diabetes Mellitus With Exposure To Ledipasvir And Sofosbuvir., Resmi Premji, Nira Roopnarinesingh, Nazia Qazi, Eric S. Nylen

Medicine Faculty Publications

The combination therapy of ledipasvir/sofosbuvir was approved by the Food and Drug Administration in 2014 for the treatment of chronic hepatitis C. Although hyperglycemia is not well known to occur with its use, we present 2 cases of new-onset diabetes mellitus and a review of the literature suggesting an adverse event association. In the first patient with HIV, we postulate that ledipasvir/sofosbuvir increased the levels of tenofovir and thereby potentiated hyperglycemia. In the second case of a patient with prediabetes, ledipasvir/sofosbuvir appeared to increase insulin resistance. A literature review further supported an association of hyperglycemia and the use of ledipasvir/sofosbuvir. …

Diabetic Ketoacidosis, Mario Bianconi

Nursing Student Class Projects (Formerly MSN)

According to “Statistics About Diabetes” (2014), in 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. Additionally, of the 29.1 million, 21 million of the population were diagnosed, and 8.1 million were undiagnosed. With such a high prevalence, it is imperative that the hospital nurse is aware not only how to treat diabetes, but also how to look for complications of diabetes. One of the severe complications of diabetes is Diabetic Ketoacidosis, or DKA. DKA occurs as a result of prolonged untreated diabetes. It is the result of the body not being able to produce, or use, insulin …