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Delk JA, Al-Dahir S, Singleton BA, Kirchain W, Bailey-Wheeler J. The Effect of Food Access on Type 2 Diabetes Control in Patients of a New Orleans, Louisiana Clinic. J Am Pharm Assoc (2003) 2022; 62:1675-1679. [DOI: 10.1016/j.japh.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
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Guan Y, Ebrahimzadeh SA, Cheng CH, Chen W, Leung T, Bigornia S, Palacios N, Garelnabi MO, Scott T, Bhadelia R, Tucker KL, Koo BB. Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort. Neurology 2022; 98:e1534-e1544. [PMID: 35354581 PMCID: PMC9012269 DOI: 10.1212/wnl.0000000000200120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto Rican older adults living in the Greater Boston area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and National Alzheimer's Coordinating Center (NACC) databases. METHODS BPRHS participants who underwent brain MRI and cognitive testing were divided into 4 groups based on their HTN and T2D status: HTN-/T2D-, HTN+/T2D-, HTN-/T2D+, and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes, and brain age using T1-weighted MRI and cognitive test scores. BPRHS results were then compared with results from non-Hispanic White and Hispanic participants from the ADNI and NACC databases. RESULTS The prevalence of HTN was almost 2 times (66.7% vs 38.7%) and of T2D was 5 times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D- group compared to the HTN-/T2D- group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and global cognitive scores were observed in HTN+/T2D+ relative to HTN-/T2D- individuals. MRI measures and the Mini-Mental State Examination (MMSE) scores from the HTN+/T2D+ BPRHS group resembled those of ADNI White participants with progressive mild cognitive impairment (MCI), while the BPRHS HTN-/T2D- participants resembled participants with stable MCI. The BPRHS was not significantly different from the ADNI + NACC Hispanic cohort on imaging or MMSE measures. DISCUSSION The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group compared to non-Hispanic White adults in the same age range. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier: NCT01231958.
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Affiliation(s)
- Yi Guan
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Seyed Amir Ebrahimzadeh
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Chia-Hsin Cheng
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Weifan Chen
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Tiffany Leung
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Sherman Bigornia
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Natalia Palacios
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Mahdi O Garelnabi
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Tammy Scott
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Rafeeque Bhadelia
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Katherine L Tucker
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
| | - Bang-Bon Koo
- From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA
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Hung HHY, Chan EYY, Chow E, Leung SY, Lai FTT, Yeoh EK. Consumption of home-prepared meal at workplace as a predictor of glycated haemoglobin among people with type 2 diabetes in Hong Kong: a mixed-methods study. Nutr Diabetes 2022; 12:16. [PMID: 35379796 PMCID: PMC8979147 DOI: 10.1038/s41387-022-00188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES There is increasing attention on association between eating patterns and diabetes control following global changes in eating patterns. There had been very limited research on the eating patterns of diabetic patients with employment, although working age population has seen the highest increase in diabetes incidence. This study aimed to identify workplace eating patterns in relation to glycaemic control among type 2 diabetic patients with employment. METHODS This is a sequential mixed-methods study. The exploratory qualitative study involved focus group interviews with 31 type 2 diabetic patients with employment, which guided the design of a subsequent cross-sectional investigation involving 185 patients with employment. Thematic analysis was conducted on the qualitative data to identify workplace eating patterns most relevant to glycaemic control. Hierarchical multiple linear regression was performed to examine association between workplace eating pattern and glycaemic control, proxied by HbA1c. RESULTS The focus group interviews identified frequency in the consumption of home-prepared meals (HPM) and meal hours as the major workplace eating patterns that affected glycaemic control. The cross-sectional study confirmed that regular consumption of HPM at workplace could explain variance of HbA1c, independent of socio-demographic factors, lifestyle factors and disease condition, with R2 = 0.146, F(14, 170) = 2.075, p = 0.015; adjusted R2 = 0.076. Patients who were female, in non-skilled occupation, on shift, with fixed work location and had break during work were more likely to consume HPM. CONCLUSIONS Consumption of HPM at workplace should be promoted to facilitate better glycaemic control by type 2 diabetic patients with employment, possibly through more practical dietary advice, and workplace accommodation in terms of space and facilities. In the context of COVID-19 pandemic, consumption of HPM also meant additional protection for diabetic patients through reducing close contact exposures in restaurants.
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Affiliation(s)
- Heidi H Y Hung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Emily Ying Yang Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,François-Xavier Bagnoud Center for Health & Human Rights, Harvard University, Boston, MA, USA.
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shuk-Yun Leung
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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The impact of canagliflozin on the risk of neuropathy events: a post-hoc exploratory analysis of the CREDENCE trial. DIABETES & METABOLISM 2022; 48:101331. [DOI: 10.1016/j.diabet.2022.101331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/29/2021] [Accepted: 02/08/2022] [Indexed: 12/17/2022]
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Curtis B, Lage MJ. Glycemic control among patients with type 2 diabetes who initiate basal insulin: a retrospective cohort study. J Med Econ 2014; 17:21-31. [PMID: 24195723 DOI: 10.3111/13696998.2013.862538] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine changes in glycemic control for patients with type 2 diabetes mellitus (T2DM) after initiation of basal insulin and factors associated with improved glycemic control. METHODS An analysis of retrospective medical records of patients with T2DM was examined using Humedica's electronic medical records database (January 2007-August 2012). Patients with T2DM, initiating basal insulin, age ≥ 21 years, with a recorded HbA1c test in both the 1 year prior and the 2 years post-initiation were included. A multivariate regression examined factors associated with changes in glycemic control. Logistic regressions examined factors associated with improvements or worsening of glycemic control, compared to relatively unchanged glycemic control. RESULTS Many (14,457) individuals met the inclusion-exclusion criteria. Multivariate analyses revealed that older age (p < 0.0001), residence in the Western region of the US (vs South) (p < 0.0001), Medicare insurance vs Medicaid or being uninsured (p = 0.0138), and higher household income (p = 0.0065) were associated with improved glycemic control. Patients diagnosed with comorbid peripheral vascular disease (p = 0.0072), cancer (p = 0.0019), obesity (p = 0.0002), moderate (p = 0.0103), and severe chronic kidney disease (p < 0.0001), or end-stage renal disease (p = 0.0075) in the pre-period were found to have significantly improved glycemic control in the post-period. Use of prandial insulin (p = 0.0087), pre-mix insulin (p = 0.0003) in the pre-period, a higher pre-period HbA1c score (p < 0.0001), and longer duration between pre-period and post-period HbA1c testing (p < 0.0001) were significantly associated with higher HbA1c levels in the post-period. LIMITATIONS Analyses rely on electronic medical records which cannot capture patient healthcare utilization occurring outside of the data capture system. Analyses do not control for insulin dosage or type of basal insulin prescribed. CONCLUSIONS Among patients with T2DM treated with basal insulin, a number of factors may influence glycemic outcomes. These findings suggest a role for a more personalized approach to the treatment of patients with T2DM.
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Affiliation(s)
- Bradley Curtis
- Global Health Outcomes, Eli Lilly and Company , Indianapolis, IN , USA
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Osborn CY, de Groot M, Wagner JA. Racial and ethnic disparities in diabetes complications in the northeastern United States: the role of socioeconomic status. J Natl Med Assoc 2013; 105:51-8. [PMID: 23862296 DOI: 10.1016/s0027-9684(15)30085-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of socioeconomic status (SES) in explaining racial/ ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications and the role of macro (eg, income, education) and micro (eg, owning a home or having a checking account) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were aged, on average, 55 years, and 55.6% non-Hispanic white, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic white, African American, and Hispanic participants, with Hispanic participants having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (eg, income) mediated racial differences (ie, non-Hispanic whites vs African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (eg, education, income, and ownirg a home or having a checking account) mediated racial/ethnic differences (ie, non-Hispanic white vs Hispanic participants) in self-reported cardiovascular disease, and only micro SES indicators (eg, owning a home or having a checking account) mediated differences between lower-income SES racial/ethnic minority groups (ie, African American vs Hispanic participants) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.
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Affiliation(s)
- Chandra Y Osborn
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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The prevalence of diabetes mellitus is increased in relatives of patients with a non-affective psychotic disorder. Schizophr Res 2013; 143:354-7. [PMID: 23245702 DOI: 10.1016/j.schres.2012.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 11/22/2022]
Abstract
Patients with schizophrenia are more likely to develop diabetes mellitus (DM) compared to the general population. In relatives, however, an increased rate of DM has not consistently been reported. In this study, we compared DM rates in 1740 unaffected first- and second-/third-degree relatives of patients with a non-affective psychotic disorder to 1271 control subjects, by administering the Family Interview for Genetic Studies (FIGS). The prevalence of DM (6.1%) was increased in the relatives of patients as compared to the relatives of the healthy subjects (3.6%, OR=1.6, p=0.007). Our findings support the hypothesis of a familial, possibly genetic, link between DM and non-affective psychotic disorders.
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Campbell JA, Walker RJ, Smalls BL, Egede LE. Glucose control in diabetes: the impact of racial differences on monitoring and outcomes. Endocrine 2012; 42:471-82. [PMID: 22815042 PMCID: PMC3779599 DOI: 10.1007/s12020-012-9744-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/05/2012] [Indexed: 11/30/2022]
Abstract
Type 2 diabetes is the seventh leading cause of death in the US and is projected to increase in prevalence globally. Minorities are disproportionately affected by diabetes and data suggest that clinical outcomes consistently fall below American Diabetes Association recommendations. The purpose of this systematic review was to examine ethnic differences in self-monitoring and outcomes in adults with type 2 diabetes. Medline was searched for articles published between January 1990 and January 2012 by means of a reproducible strategy. Inclusion criteria included (1) published in English, (2) targeted African Americans, Hispanic, or Asian adults, ages 18+ years with type 2 diabetes, (3) cross-sectional, cohort, or intervention study, and (4) measured change in glycemic control, BP, lipids, or quality of life by race. Twenty-two papers met the inclusion criteria and were reviewed. Overall, significant racial differences and barriers were found in published studies in diabetes management as it pertains to self-monitoring and outcomes. African Americans tend to consistently exhibit worse outcomes and control when compared to other minority populations and non-Hispanic Whites. In conclusion, significant racial differences and barriers exist in diabetes management as it pertains to self-monitoring and outcomes when compared to non-Hispanic Whites. Explanatory and intervention studies are needed to determine the mechanisms and mediators of these differences and strategies to reduce these disparities. In addition, more research is needed to investigate the impact of racial differences in self-monitoring and outcomes on quality of life.
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Affiliation(s)
- Jennifer A. Campbell
- Center for Health Disparities Research, Medical University of South
Carolina Charleston, South Carolina
| | - Rebekah J. Walker
- Center for Health Disparities Research, Medical University of South
Carolina Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of
Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brittany L. Smalls
- Center for Health Disparities Research, Medical University of South
Carolina Charleston, South Carolina
| | - Leonard E. Egede
- Center for Health Disparities Research, Medical University of South
Carolina Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of
Medicine, Medical University of South Carolina, Charleston, South Carolina
- Center for Disease Prevention and Health Interventions for Diverse
Populations, Charleston VA REAP, Ralph H. Johnson VA Medical Center, Charleston,
South Carolina
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Kountz D. Special considerations of care and risk management for African American patients with type 2 diabetes mellitus. J Natl Med Assoc 2012; 104:265-73. [PMID: 22973676 DOI: 10.1016/s0027-9684(15)30158-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
It is well documented that African American populations are disproportionately affected by type 2 diabetes mellitus compared with their white counterparts. They have a higher prevalence of diabetes, a higher rate of diabetes-related complications, greater disability from these complications, and poorer control and quality of care. In order to improve diabetes care and outcomes in African Americans (and indeed all patients with diabetes), a multifactorial approach is needed to target all risk factors-not solely hyperglycemia-simultaneously. Culturally appropriate initiatives to improve lifestyle behaviors are a first step in management. Community-based programs, including those mediated through church groups, have reported varying degrees of success in effecting such beneficial lifestyle changes. If these measures fail to achieve desirable levels of blood glucose, blood pressure, and serum lipids, pharmacologic therapy is indicated. However, few evidence-based recommendations regarding the use of some drugs in African Americans currently exist due to their underrepresentation in randomized controlled clinical trials. Other essential components of diabetes care include regular screening for diabetic nephropathy and neuropathy, and eye and foot examinations, with prompt referral to specialists when important clinical changes are detected.
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Affiliation(s)
- David Kountz
- Jersey Shore University Medical Center, Neptune, New Jersey, USA.
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Otiniano ME, Al Snih S, Goodwin JS, Ray L, Al Ghatrif M, Markides KS. Factors associated with poor glycemic control in older Mexican American diabetics aged 75 years and older. J Diabetes Complications 2012; 26:181-6. [PMID: 22520403 PMCID: PMC3521032 DOI: 10.1016/j.jdiacomp.2012.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 10/11/2011] [Accepted: 03/12/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study examines the prevalence and correlates of poor glycemic control in Mexican Americans aged 75 years and older with diabetes. METHODS Data are from the 5(th) wave (2004-05) of the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE). A total of 2,069 Mexican Americans aged 75 and over were interviewed. Six hundred eighty nine subjects (33.5%) reported having been diagnosed with diabetes and 209 (30.3%) subjects agreed to a blood test of their HbA(1)c level. RESULTS Of the 209 diabetic subjects with an HbA(1)c test, 73 (34.9%) had good glycemic control (HbA(1)c <7%) and 136 (65.1%) had poor glycemic control (HbA(1)c >7%). Bivariate analysis revealed that subjects with poor control had longer disease duration, had lower education, used the glucometer more frequently, and had more diabetes-complications when compared to those in the good glycemic control group. Multivariable logistic regression analysis found the following factors associated with poor glycemic control: <8 years of education, foreign-born, smoking, obesity, longer disease duration, daily glucometer use, and having macro-complications. DISCUSSION Prevalence of poor glycemic control is very high in this population with very high and rising prevalence of diabetes. Further studies are needed to explore the effect of these and other characteristics on glycemic control among older Mexican Americans and to develop appropriate interventions to improve diabetes outcomes and increase life-expectancy.
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Affiliation(s)
- Max E. Otiniano
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, University of Texas Medical Branch
- Sealy Center on Aging, University of Texas Medical Branch
| | | | - Laura Ray
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
| | | | - Kyriakos S. Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
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Racial and ethnic differences in longitudinal blood pressure control in veterans with type 2 diabetes mellitus. J Gen Intern Med 2011; 26:1278-83. [PMID: 21671132 PMCID: PMC3208462 DOI: 10.1007/s11606-011-1752-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 04/13/2011] [Accepted: 05/18/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have examined racial/ethnic differences in blood pressure (BP) control over time, especially in an equal access system. We examined racial/ethnic differences in longitudinal BP control in Veterans with type 2 diabetes. METHODS We collected data on a retrospective cohort of 5,319 Veterans with type 2 diabetes and initially uncontrolled BP followed from 1996 to 2006 at a Veterans Administration (VA) facility in the southeastern United States. The mean blood pressure value for each subject for each year was used for the analysis with BP control defined as <140/<90 mmHg. The primary outcome measure was proportion with controlled BP. The main predictor variable was race/ethnicity categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic/Other (H/O). Other covariates included age, gender, employment, marital status, service connectedness, and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models were used to assess the relationship between race/ethnicity and BP control after adjusting for covariates. RESULTS Mean follow-up was 5.0 years. The sample was 46% NHW, 26% NHB, 19% H/O, and 9% unknown. The average age was 68 years. In the final model, after adjusting for covariates, NHB race (OR = 1.38, 95%CI: 1.2, 1.6) and H/O race (OR = 1.57, 95% CI: 1.3, 1.8) were associated with increased likelihood of poor BP control (>140/>90 mmHg) over time compared to NHW patients. CONCLUSION Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns.
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Ko KD, Lee KY, Cho B, Park MS, Son KY, Ha JH, Park SM. Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean National Health and Nutrition Examination Survey. Arch Phys Med Rehabil 2011; 92:1230-7. [PMID: 21807142 DOI: 10.1016/j.apmr.2011.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/12/2011] [Accepted: 03/02/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine how disability status is related with health disparities in South Korea. DESIGN The study compared 3 indicators of health (health-risk behaviors, preventive health care utilizations, and chronic health conditions) according to the presence of disabilities using the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). SETTING We obtained data from the KNHANES III, which is the third nationwide representative study using a stratified, multistage probability sampling design. PARTICIPANTS Subjects (N=5475) aged 20 years or older were included in the study; persons with disabilities (n=218) and persons without disabilities (n=5257). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Nonconditional multiple logistic regression and adjusted mean were used to identify health disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions. RESULTS Subjects with disabilities were more likely to be physically inactive (adjusted odds ratio [AOR]=3.06; 95% confidence interval [CI], 1.71-5.48 for no physical activity; AOR=1.70; 95% CI, 1.19-2.43 for insufficient physical activity) than those without disabilities. Women aged 40 years or older with disabilities were less likely to receive cervical cancer screening services (AOR=0.52; 95% CI, 0.27-0.98). Adults with disabilities had higher proportion of osteoporosis (AOR=2.41; 95% CI, 1.50-3.88), underweight (AOR=2.14; 95% CI, 1.07-4.28), suicidal thoughts (AOR=1.86; 95% CI, 1.35-2.56), and had impaired quality of life (95% CI of adjusted mean, 60.89-65.35 compared to 69.95-70.84 in adults without disabilities). CONCLUSIONS There exists substantial disability-related health disparities in South Korea. People with disabilities may be the underserved subpopulation demonstrating health disparities. The findings in this study underscore the continued needs in order to reduce health problems and disparities for people with disabilities.
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Affiliation(s)
- Ki Dong Ko
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
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Baker TA, Buchanan NT, Small BJ, Hines RD, Whitfield KE. Identifying the Relationship Between Chronic Pain, Depression, and Life Satisfaction in Older African Americans. Res Aging 2011. [DOI: 10.1177/0164027511403159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Empirical research on the chronic pain experience of older African Americans is scarce. Here, the authors examined the influence psychosocial indicators have on the pain experience in a sample of older African Americans. Data were collected from African Americans ( N = 247) 50 to 96 years of age (69.4 ± 9.4). All participants provided self-report data on pain indicators, demographic characteristics, social (social support, locus of control, life satisfaction) variables, and depression. Those reporting higher levels of social support and depressive symptoms experienced greater pain intensity. Pain had an indirect effect on depression as mediated through life satisfaction.These findings demonstrate the need to focus more on the means to prevent and treat pain and to ameliorate its impact on social well-being, psychological functioning, and quality of life in older adults in general and older minority adults in particular.
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Cantrell RA, Alatorre CI, Davis EJ, Zarotsky V, Le Nestour E, Carter GC, Goetz I, Paczkowski R, Sierra-Johnson J. A review of treatment response in type 2 diabetes: assessing the role of patient heterogeneity. Diabetes Obes Metab 2010; 12:845-57. [PMID: 20920036 DOI: 10.1111/j.1463-1326.2010.01248.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The response to treatment for type 2 diabetes typically varies among individuals within a study population. This variation is known as heterogeneity of treatment response. We conducted a comprehensive literature review to identify factors that account for heterogeneity of treatment response in patients treated for type 2 diabetes. Three databases (PubMed, EMBASE and Cochrane Library) were searched for articles published in the last 10 years describing investigations of factors associated with treatment response and outcomes among people with type 2 diabetes receiving pharmacological treatment. Of the 43 articles extracted and summarized, 35 (81%) discussed clinical factors, 31 (72%) described sociodemographic factors and 17 (40%) reported on comorbidity or behavioural factors. Clinical factors identified included baseline glycated hemoglobin A1c or fasting plasma glucose (FPG) levels, insulin response or sensitivity, C-peptide, body composition, adipose tissue proteins, lipid profile, plasma albumin levels and duration of disease or insulin treatment. Other factors identified included age, sex, race, socioeconomic status and comorbidities. This review identified the following research gaps: use of multiple definitions for response, few patient-reported measures and lack of evidence regarding whether factors were associated with treatment response for only specific medications or across pharmacological therapies. Furthermore, identification of factors associated with type 2 diabetes treatment response was generally a secondary objective in the research reviewed. Understanding which patient subgroups are more likely to respond to treatment and identifying factors associated with response may result in targeted treatment decisions and alter the interpretation of efficacy or effectiveness of results. In conclusion, accounting for these factors in clinical trials and when making clinical treatment decisions may improve therapy selection and individual patient outcomes.
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Affiliation(s)
- R A Cantrell
- Epidemiology and Health Services Research, Global Health Outcomes, Eli Lilly and Company, Global Health Outcomes, Indianapolis, IN 46285, USA.
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Hausmann LRM, Ren D, Sevick MA. Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes. Patient Prefer Adherence 2010; 4:291-9. [PMID: 20859456 PMCID: PMC2943221 DOI: 10.2147/ppa.s12353] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We examined whether diabetes-related psychosocial factors differ between African American and white patients with type 2 diabetes. We also tested whether racial differences in glycemic control are independent of such factors. METHODS Baseline glycosylated hemoglobin (HbA(1c)) and survey measures from 79 African American and 203 white adult participants in a diabetes self-management clinical trial were analyzed. RESULTS Several psychosocial characteristics varied by race. Perceived interference of diabetes with daily life, perceived diabetes severity, and diabetes-related emotional distress were higher for African Americans than for whites, as were access to illness-management resources and social support. Mean HbA(1c) levels were higher among African Americans than whites (8.14 vs 7.40, beta = 0.17). This difference persisted after adjusting for demographic, clinical, and diabetes-related psychosocial characteristics that differed by race (beta = 0.18). Less access to illness-management resources (beta = -0.25) and greater perceived severity of diabetes (beta = 0.21) also predicted higher HbA(1c). DISCUSSION Although racial differences in diabetes-related psychosocial factors were observed, African Americans continued to have poorer glycemic control than whites even after such differences were taken into account. Interventions that target psychosocial factors related to diabetes management, particularly illness-management resources, may be a promising way to improve glycemic control for all patients.
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Affiliation(s)
- Leslie RM Hausmann
- Center for Health Equity Research and Promotion
- Correspondence: Leslie RM Hausmann, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, 7180 Highland Drive (151C-H), Pittsburgh, PA 15206, USA, Tel +1 412 954 5221, Fax +1 412 954 5264 Email
| | | | - Mary Ann Sevick
- Center for Health Equity Research and Promotion
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Medicine
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Pabon-Nau LP, Cohen A, Meigs JB, Grant RW. Hypertension and diabetes prevalence among U.S. Hispanics by country of origin: the National Health Interview Survey 2000-2005. J Gen Intern Med 2010; 25:847-52. [PMID: 20490949 PMCID: PMC2896588 DOI: 10.1007/s11606-010-1335-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 10/12/2009] [Accepted: 03/10/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite their diverse cultural origins, Hispanics in the US are generally studied as a single ethnic group. OBJECTIVES 1) Assess demographic and disease-related differences among U.S. Hispanics by country of origin, and 2) Examine the mediating roles of socioeconomic status and acculturation on disease prevalence in these subgroups. DESIGN AND PARTICIPANTS Using data from the 2000-2005 National Health Interview Survey (NHIS), we compared characteristics of Mexican-Americans with Hispanics originally from: Mexico, Puerto Rico, Central/South America, Cuba, and Dominican Republic (n = 31,240). We stratified the analysis by foreign versus US-born Hispanic subgroups and modeled hypertension and diabetes prevalence, adjusting for demographic and acculturation differences. MAIN RESULTS The six Hispanic subgroups were significantly diverse in all measured variables. Prevalence of hypertension (32%) and diabetes (15%) was highest in foreign-born Puerto Ricans. After adjusting for age, BMI, smoking, socioeconomic status and acculturation in foreign-born Hispanics, Puerto Ricans (OR = 1.76 [95% CI: 1.23, 2.50], p = 0.002) and Dominicans (OR = 1.93 [1.24, 3.00], p = 0.004), had higher prevalence of hypertension relative to Mexican-Americans. Adjusted diabetes prevalence among foreign-born Hispanics was half or less in Cubans (OR = 0.42 [0.25, 0.68] p < 0.001), Dominicans (OR = 0.48 [0.26, 0.91], p = 0.02) and Central/South Americans (OR = 0.51 [0.33, 0.78], p = 0.002) relative to Mexican-Americans. Among US-born Hispanic subgroups, Cubans had lower hypertension (OR = 0.53, [0.33, 0.83], p = 0.006) and Mexicans (OR = 0.76 [0.60, 0.98], p = 0.03) had lower diabetes prevalence compared to Mexican-Americans in adjusted models. CONCLUSIONS The prevalence of hypertension and diabetes varies significantly among Hispanics by country of origin. Health disparities research should include representation from all Hispanic subgroups.
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Affiliation(s)
- Lina P Pabon-Nau
- Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA.
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Ariza MA, Vimalananda VG, Rosenzweig JL. The economic consequences of diabetes and cardiovascular disease in the United States. Rev Endocr Metab Disord 2010; 11:1-10. [PMID: 20191325 DOI: 10.1007/s11154-010-9128-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diabetes-related care and complications constitute a significant proportion of the United States' (US) health care expenditure. Of these complications, cardiovascular disease (CVD) is a major component. Higher morbidity and mortality rates translate to higher costs of care in patients with diabetes compared to those who do not have the disease. Minorities bear a disproportionate burden of diabetes and CVD. We review this disparity and examine potential etiologies for it in Hispanics and African-Americans, the two largest minority groups in the US. We examine strategies in these populations that may improve outcomes in diabetes and CVD, potentially decreasing health care costs.
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Affiliation(s)
- Miguel A Ariza
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, 88 East Newton Street, Evans 201, Boston, MA 02118, USA
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Baker TA, Buchanan NT, Corson N. Factors influencing chronic pain intensity in older black women: examining depression, locus of control, and physical health. J Womens Health (Larchmt) 2008; 17:869-78. [PMID: 18537488 DOI: 10.1089/jwh.2007.0452] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic pain may function uniquely within a given race group, which may affect their physical health and psychological well-being. This is particularly relevant among women from diverse race populations. METHODS Hierarchical multivariate regression analysis was used to examine pain intensity and its relationship to depressive symptoms, health locus of control, life satisfaction, and various health and demographic characteristics in a cross-sectional sample of 181 black women >or=50 years old. RESULTS Results from the multivariate model showed that age, depression, physical functioning, and locus of control explained unique variance in pain intensity (44%), suggesting that younger age, reporting more depressive symptoms, limited functional capacity, the belief that one has control over one's health, and the belief that one's health is not controlled by others were significant predictors of greater pain intensity among this sample. CONCLUSIONS These findings underscore the importance of continued research on disease processes, as well as physical and mental health outcomes of older black women reporting chronic pain. Specifically, the study demonstrates the value of research focusing on within-group factors impacting a single population, thereby understanding the myriad of factors that may explain the unique pain experience of older black women.
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Affiliation(s)
- Tamara A Baker
- University of South Florida, School of Aging Studies, Tampa, Florida 33620, USA.
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Tang TS, Brown MB, Funnell MM, Anderson RM. Social support, quality of life, and self-care behaviors amongAfrican Americans with type 2 diabetes. DIABETES EDUCATOR 2008; 34:266-76. [PMID: 18375776 DOI: 10.1177/0145721708315680] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to examine social support and its relationship to diabetes-specific quality of life and self-care behaviors in African Americans with type 2 diabetes. METHODS The study followed a cross-sectional, observational design and recruited 89 African American adults, age 40 and older (mean = 60, SD = 10.5), diagnosed with type 2 diabetes. Participants completed measures assessing diabetes-specific quality of life, self-care behaviors (healthy eating, physical activity, self-monitoring of blood glucose, foot care, medication and/or insulin use), demographic background, and diabetes-related social support. Diabetes-related social support variables included amount of social support received, satisfaction with support, positive support behavior, negative support behavior, and primary source of support. RESULTS Stepwise regressions, controlling for demographic variables, were conducted to identify predictors of diabetes-specific quality of life and self-care behaviors from the diabetes-related social support variables. Satisfaction with support was a predictor for improved diabetes-specific quality of life (r = -.579, P < .001) and blood glucose monitoring (r = .258, P < .05). Positive support behavior was a predictor for following a healthy eating plan (r = .280, P < .05), spacing out carbohydrates evenly throughout the day (r = .367, P < .01), and performing physical activity at least 30 minutes per day (r = .296, P < .05). Negative support behavior was a predictor for not taking medication as recommended (r = -.348, P < .01). CONCLUSIONS Findings indicate that social support plays a role in diabetes-specific quality of life and self-management practices. Social support encompasses multiple dimensions that differentially influence specific diabetes health-related outcomes and behaviors.
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Affiliation(s)
- Tricia S Tang
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
| | - Morton B Brown
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
| | - Martha M Funnell
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
| | - Robert M Anderson
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
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Muñoz B, O'Leary M, Fonseca-Becker F, Rosario E, Burguess I, Aguilar M, Fickes C, West SK. Knowledge of diabetic eye disease and vision care guidelines among Hispanic individuals in Baltimore with and without diabetes. ACTA ACUST UNITED AC 2008; 126:968-74. [PMID: 18625945 DOI: 10.1001/archopht.126.7.968] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine gaps in knowledge and barriers to care for diabetic eye disease in Hispanic individuals in Baltimore, Maryland. METHODS Interviews with a random sample of self-reported Hispanic individuals (n = 349), and a convenience sample of Hispanic individuals with diabetes (n = 204). Four groups were constructed: without diabetes, with and without a family history of diabetes, newly diagnosed with diabetes, and diagnosed with diabetes more than 1 year before the study. RESULTS Less than 10% of participants preferred reading in English; 50% reported having providers who do not speak Spanish as a barrier to care. Knowledge of eye disease as a consequence of diabetes was reported by 18% of nondiabetic participants with no family history, 29% of nondiabetic participants with a family history, 36% of newly diagnosed diabetic patients, and 52% of participants diagnosed with diabetes more than 1 year before the study. Only 16%, 28%, 13%, and 34%, respectively, knew that strict control could prevent eye problems, and 33%, 51%, 31%, and 48%, respectively, knew that dilated eye examinations were important. A total of 30% of diabetic participants had had an eye examination in the previous year. CONCLUSIONS Knowledge of the ocular complications of diabetes is low. The frequency of eye examinations among Hispanic individuals with diabetes is less than the national average for Hispanic individuals. Culturally appropriate health education and innovations to reduce barriers to eye care are needed.
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Affiliation(s)
- Beatriz Muñoz
- Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Room 118, Baltimore, MD 21205, USA.
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Gambassi G, Agha SA, Sui X, Yancy CW, Butler J, Giamouzis G, Love TE, Ahmed A. Race and the natural history of chronic heart failure: a propensity-matched study. J Card Fail 2008; 14:373-8. [PMID: 18514928 DOI: 10.1016/j.cardfail.2008.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 02/04/2008] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Racial differences in the epidemiology and outcomes of heart failure are well known. However, the association of race with the natural history of heart failure has not been previously studied in a propensity-matched population of chronic heart failure in which all measured baseline patient characteristics are well-balanced between the races. METHODS AND RESULTS Of the 7788 patients with chronic systolic and diastolic heart failure in the Digitalis Investigation Group trial, 1128 were nonwhites. Propensity scores for being nonwhite were calculated for each patient and were used to match 1018 pairs of white and nonwhite patients. Matched Cox regression analyses were used to estimate associations of race with outcomes during 38 months of median follow-up. All-cause mortality occurred in 34% (rate, 1180/10000 person-years) of whites and 33% (rate, 1130/10000 person-years) of nonwhite patients (hazard ratio when nonwhite patients were compared with whites, 0.95, 95% confidence interval, 0.80-1.14; P = .593). All-cause hospitalization occurred in 63% (rate, 3616/10000 person-years) of whites and 65% (rate, 3877/10000 person-years) of nonwhite patients (hazard ratio, 1.03, 95% confidence interval, 0.90-1.18; P = .701). Respective hazard ratios (95% confidence intervals) for other outcomes were: 0.95 (0.75-1.12) for cardiovascular mortality, 0.82 (0.60-1.11) for heart failure mortality, 1.05 (0.91-1.22) for cardiovascular hospitalization, and 1.17 (0.98-1.39) for heart failure hospitalization. CONCLUSIONS In a propensity-matched population of heart failure patients where whites and nonwhites were balanced in all measured baseline characteristics, there were no racial differences in major natural history end points.
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Brenes-Camacho G, Rosero-Bixby L. Metabolic control in a nationally representative diabetic elderly sample in Costa Rica: patients at community health centers vs. patients at other health care settings. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2008; 8:5. [PMID: 18447930 PMCID: PMC2396151 DOI: 10.1186/1472-698x-8-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 05/14/2008] [Indexed: 11/13/2022]
Abstract
Background Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control. Methods Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions. Results Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings. Conclusion Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas.
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Kirk JK, Passmore LV, Bell RA, Narayan KMV, D'Agostino RB, Arcury TA, Quandt SA. Disparities in A1C levels between Hispanic and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care 2008; 31:240-6. [PMID: 17977939 DOI: 10.2337/dc07-0382] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hispanics have higher rates of diabetes and diabetes-related complications than do non-Hispanic whites. A meta-analysis was conducted to estimate the difference between the mean values of A1C for these two groups. RESEARCH DESIGN AND METHODS We executed a PubMed search of articles published from 1993 through July 2007. Data sources included PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for Hispanics and non-Hispanic whites with diabetes were included. Studies were excluded if they included individuals <18 years of age or patients with pre-diabetes or gestational diabetes. RESULTS A total of 495 studies were reviewed, of which 73 contained data on A1C for Hispanics and non-Hispanic whites, and 11 met the inclusion criteria. Meta-analysis revealed a statistically significant mean difference (P < 0.0001) of -0.46 (95% CI -0.63 to -0.33), correlating to an approximately 0.5% higher A1C for Hispanics. Grouping studies by design (cross-sectional or cohort), method of data collection for A1C (chart review or blood sampling), and care type (managed or nonmanaged) yielded similar results. CONCLUSIONS In this meta-analysis, A1C was approximately 0.5% higher in Hispanic patients with diabetes than in non-Hispanic patients. Understanding the reasons for this disparity should be a focus for future research.
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Affiliation(s)
- Julienne K Kirk
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084, USA.
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Cheng EM, Siderowf AD, Swarztrauber K, Lee M, Vassar S, Jacob E, Eisa MS, Vickrey BG. Disparities of care in veterans with Parkinson's disease. Parkinsonism Relat Disord 2008; 14:8-14. [PMID: 17702625 DOI: 10.1016/j.parkreldis.2007.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 04/16/2007] [Accepted: 05/01/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Disparities of Parkinson's disease (PD) care have not been assessed. METHODS We examined the medical records of 309 (83%) non-Hispanic White and 65 (17%) non-White Los Angeles veterans with PD from 1998 to 2004 to determine if care quality as measured by 10 PD indicators different by race/ethnicity. RESULTS In multivariate modeling, adherence to indicators was higher among non-Hispanic Whites (71% vs. 65%, risk ratio 1.15, 95% CI [1.07-1.32]) compared to non-Whites. Differences in adherence by race/ethnicity were greatest for depression treatment (p<0.05). CONCLUSIONS We detected disparities in quality of PD care, particularly in depression treatment. Future research should determine causes for these so that interventions can be designed to reduce such disparities.
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Affiliation(s)
- E M Cheng
- Parkinson's Disease Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, B500, ML 127, Los Angeles, CA 90073, USA.
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Meduru P, Helmer D, Rajan M, Tseng CL, Pogach L, Sambamoorthi U. Chronic illness with complexity: implications for performance measurement of optimal glycemic control. J Gen Intern Med 2007; 22 Suppl 3:408-18. [PMID: 18026810 PMCID: PMC2150612 DOI: 10.1007/s11606-007-0310-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. PARTICIPANTS Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fiscal year (FY) 1999 and 2000, alive at FY2000 end (N = 95,423). DESIGN/MEASUREMENTS Outcomes were HbA1c < 7% in each FY. CIC included three domains: nondiabetes physical illness, diabetes-related, and mental illness/substance abuse conditions. Other independent variables included age, gender, race, marital status, VHA priority status, and diabetes severity. Longitudinal analyses were restricted to patients with HbA1c >or= 7% in FY1999 and included hospitalizations between final HbA1c's in FY1999 and FY2000. Multiple logistic regressions examined associations between CIC categories and HbA1c. RESULTS In FY1999, 33% had HbA1c <7%. In multivariate analyses, patients with nondiabetes physical illness and mental illness/substance abuse were more likely to have HbA1c <7% in FY1999 [adjusted odds ratios for cancer (AOR), 1.31; 95% CI (1.25-1.37); mental illness only, 1.18; 95% CI (1.14-1.22)]. Those with diabetes-related complications were less likely to have HbA1c <7% in FY1999. Associations generally held in FY2000. However, conditions in the mental illness/substance abuse complexity domain were less strongly associated with HbA1c <7%. Macrovascular-related hospitalizations were positively associated with HbA1c <7% [AOR, 1.41; 95% CI (1.34-1.49)]. CONCLUSIONS The association between CIC and HbA1c <7% is heterogeneous and depends on the domain of complexity. The varying associations of CIC categories with optimal glycemic control suggest the need for appropriate risk adjustment when using HbA1c <7% as a valid performance measure for diabetes quality of care.
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Affiliation(s)
- Pramod Meduru
- Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, 385 Tremont Ave. (129), East Orange, NJ 07018, USA.
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