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Orfanoudaki A, Cook CB, Saghafian S, Castro J, Kosiorek HE, Chakkera HA. Diabetes mellitus and blood glucose variability increases the 30-day readmission rate after kidney transplantation. Clin Transplant 2024; 38:e15177. [PMID: 37922214 DOI: 10.1111/ctr.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Inpatient hyperglycemia is an established independent risk factor among several patient cohorts for hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. METHODS Data on first-time solitary kidney transplantations were retrieved between September 2015 and December 2018. Information was linked to the electronic health records to determine diagnosis of diabetes mellitus and extract glucometric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on bootstrapped partitions of the data to ensure statistical significance. RESULTS The cohort included 1036 patients who received kidney transplantation; 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average area under the receiver operator curve (AUC) of 78% with (76.1%, 79.9%) 95% confidence interval (CI). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia, the recipient and donor body mass index (BMI) values, presence of delayed graft function, and African American race as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. CONCLUSIONS Suboptimal glucose metrics during hospitalization after kidney transplantation are associated with an increased risk for 30-day hospital readmission. Optimizing hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.
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Affiliation(s)
- Agni Orfanoudaki
- University of Oxford, England, Oxford, UK
- Harvard Kennedy School, Harvard University, Cambridge, Massachusetts, USA
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Soroush Saghafian
- Harvard Kennedy School, Harvard University, Cambridge, Massachusetts, USA
| | - Janna Castro
- Department of Information Technology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Spanakis EK, Cook CB, Kulasa K, Aloi JA, Bally L, Davis G, Dungan KM, Galindo RJ, Mendez CE, Pasquel FJ, Shah VN, Umpierrez GE, Aaron RE, Tian T, Yeung AM, Huang J, Klonoff DC. A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials. J Diabetes Sci Technol 2023; 17:1527-1552. [PMID: 37592726 PMCID: PMC10658683 DOI: 10.1177/19322968231191104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Diabetes Technology Society organized an expert consensus panel to develop metrics for research in the use of continuous glucose monitors (CGMs) in a hospital setting. The experts met virtually in small groups both before and after an April 13, 2023 virtual meeting of the entire panel. The goal of the panel was to develop consensus definitions in anticipation of greater use of CGMs in hospital settings in the future. Establishment of consensus definitions of inpatient analytical metrics will be easier to compare outcomes between studies. Panelists defined terms related to 10 dimensions of measurements related to the use of CGMs including (1) hospital hypoglycemia, (2) hospital hyperglycemia, (3) hospital time in range, (4) hospital glycemic variability, (5) hospital glycemia risk index, (6) accuracy of CGM devices and reference methods for CGMs in the hospital, (7) meaningful time blocks for hospital glycemic goals, (8) hospital CGM data sufficiency, (9) using CGM data for insulin dosing, and (10) miscellaneous factors. The panelists voted on 51 proposed recommendations. Based on the panel vote, 51 recommendations were classified as either strong (43) or mild (8). Additional research is needed on CGM performance in the hospital. This consensus report is intended to support that type of research intended to improve outcomes for hospitalized people with diabetes.
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Affiliation(s)
- Elias K. Spanakis
- Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kristen Kulasa
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Joseph A. Aloi
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Georgia Davis
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, USA
| | | | | | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Klonoff DC, Wang J, Rodbard D, Kohn MA, Li C, Liepmann D, Kerr D, Ahn D, Peters AL, Umpierrez GE, Seley JJ, Xu NY, Nguyen KT, Simonson G, Agus MSD, Al-Sofiani ME, Armaiz-Pena G, Bailey TS, Basu A, Battelino T, Bekele SY, Benhamou PY, Bequette BW, Blevins T, Breton MD, Castle JR, Chase JG, Chen KY, Choudhary P, Clements MA, Close KL, Cook CB, Danne T, Doyle FJ, Drincic A, Dungan KM, Edelman SV, Ejskjaer N, Espinoza JC, Fleming GA, Forlenza GP, Freckmann G, Galindo RJ, Gomez AM, Gutow HA, Heinemann L, Hirsch IB, Hoang TD, Hovorka R, Jendle JH, Ji L, Joshi SR, Joubert M, Koliwad SK, Lal RA, Lansang MC, Lee WA(A, Leelarathna L, Leiter LA, Lind M, Litchman ML, Mader JK, Mahoney KM, Mankovsky B, Masharani U, Mathioudakis NN, Mayorov A, Messler J, Miller JD, Mohan V, Nichols JH, Nørgaard K, O’Neal DN, Pasquel FJ, Philis-Tsimikas A, Pieber T, Phillip M, Polonsky WH, Pop-Busui R, Rayman G, Rhee EJ, Russell SJ, Shah VN, Sherr JL, Sode K, Spanakis EK, Wake DJ, Waki K, Wallia A, Weinberg ME, Wolpert H, Wright EE, Zilbermint M, Kovatchev B. A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings. J Diabetes Sci Technol 2023; 17:1226-1242. [PMID: 35348391 PMCID: PMC10563532 DOI: 10.1177/19322968221085273] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clinicians and researchers to determine the glycemic effects of prescribed and investigational treatments.
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Affiliation(s)
- David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Jing Wang
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, USA
| | - Michael A. Kohn
- University of California, San Francisco, San Francisco, CA, USA
| | - Chengdong Li
- Florida State University College of Nursing, Tallahassee, FL, USA
| | | | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - David Ahn
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | | | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | | | | | | | | | - Ananda Basu
- University of Virginia, Charlottesville, VA, USA
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | | | | | - Kong Y. Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | | | | | | | | | - Thomas Danne
- Diabetes Center Auf der Bult, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Juan C. Espinoza
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | - Thanh D. Hoang
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | - Linong Ji
- Peking University People’s Hospital, Peking University Diabetes Center, Beijing, China
| | | | | | | | | | - M. Cecilia Lansang
- Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Wei-An (Andy) Lee
- LAC + USC Medical Center, Los Angeles County Department of Health Service, Los Angeles, CA, USA
| | - Lalantha Leelarathna
- Manchester University NHS Foundation Trust and The University of Manchester, Manchester, UK
| | - Lawrence A. Leiter
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
| | - Marcus Lind
- University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Umesh Masharani
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialities Centre, Chennai, India
- Madras Diabetes Research Foundation, Chennai, India
| | | | | | | | | | | | | | - Moshe Phillip
- Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Gerry Rayman
- Ipswich Hospital, East Suffolk and North Essex Foundation Trust and University of East Anglia, Ipswich, UK
| | - Eun-Jung Rhee
- Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Steven J. Russell
- Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA
| | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | | | - Koji Sode
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- North Carolina State University, Raleigh, NC, USA
| | | | | | - Kayo Waki
- The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Mihail Zilbermint
- Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Bethesda, MD, USA
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Engle K, Bacani G, Cook CB, Maynard GA, Messler J, Kulasa K. Glucometrics: Where Are We Now? Curr Diab Rep 2023:10.1007/s11892-023-01507-1. [PMID: 37052789 DOI: 10.1007/s11892-023-01507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE OF REVIEW Inpatient glucose data analysis, or glucometrics, has developed alongside the growing emphasis on glycemic control in the hospital. Shortcomings in the initial capabilities for glucometrics have pushed advancements in defining meaningful units of measurement and methods for capturing glucose data. This review addresses the growth in glucometrics and ends with its promising new state. RECENT FINDINGS Standardization, allowing for benchmarking and purposeful comparison, has been a goal of the field. The National Quality Foundation glycemic measures and recently enacted Center for Medicare and Medicaid Services (CMS) electronic quality measures for hypo- and hyperglycemia have allowed for improved integration and consistency. Prior systems have culminated in an upcoming measure from the Center for Disease Control and Prevention's National Healthcare Safety Network. It is poised to create a new gold standard for glucometrics by expanding and refining the CMS metrics, which should empower both local improvement and benchmarking as the program matures.
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Affiliation(s)
- Kelly Engle
- UCSD Division of Endocrinology, San Diego, CA, USA.
| | - Grace Bacani
- UCSD Nursing Development, Education and Research, San Diego, CA, USA
| | - Curtiss B Cook
- Mayo Clinic Arizona Division of Endocrinology, Phoenix, AZ, USA
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Abstract
Approximately eight billion therapeutic injections are administered outside of medical treatment facilities annually. The management of diabetes mellitus (DM) includes self-monitoring of blood glucose levels and administration of insulin and injectable non-insulin-related medications. The lancets, needles, and syringes used for DM management are categorized as medical sharps. Improperly discarded medical sharps can cause needlestick injuries in unsuspecting individuals and thereby pose a considerable public health risk. Release of these items into the environment will likely increase with the rising worldwide prevalence of DM, and a public safety crisis will emerge if proper disposal measures are not emphasized. This article reviews the literature from various geopolitical regions and describes how a substantial number of patients with DM improperly discard their sharps. Data support the need to develop multifaceted and innovative approaches to reduce risk associated with improper disposal of DM-related medical sharps into local communities.
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Affiliation(s)
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo
Clinic, Scottsdale, AZ, USA
- Curtiss B. Cook, MD, Division of
Endocrinology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259,
USA.
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6
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Saulnier GE, Castro JC, Mi L, Cook CB. Use of Cross-sectional and Perspective Mapping to Spatially and Statistically Represent Inpatient Glucose Control. J Diabetes Sci Technol 2022; 16:1385-1392. [PMID: 34210201 PMCID: PMC9631523 DOI: 10.1177/19322968211027230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of inpatient location for the depiction of glycemic control is an alternative approach to the traditional analysis of hospital-derived glucometric data. Our aim was to develop a method of spatial representation and to test for corresponding statistical variation in inpatient glucose control data. METHODS Point-of-care blood glucose data from inpatients with diabetes mellitus were extracted. Calculations included patient-day weighted means (PDWMs) and percentage of patient hospital days with hypoglycemia. Results were overlaid onto hospital floor plans, and room numbers were used as geolocators to generate cross-sectional (2-dimensional) and perspective (3-dimensional) views of the data. Linear mixed and mixed-effects logistic regression models were used to compare the location effect and to assess statistical variation in the data after adjusting for age, sex, and severity of illness. RESULTS Visual inspection of cross-sectional and perspective maps demonstrated variation in glucometric outcomes across areas within the hospital. Statistical analysis confirmed significant variation between some hospital wings and floors. CONCLUSIONS Spatial depiction of glucometric data within the hospital could yield insights into hot spots of poor glycemic control. Future studies on how to operationalize this approach, and whether this method of analysis can drive changes in glycemic management practices, need to be conducted.
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Affiliation(s)
- George E. Saulnier
- Department of Information Technology,
Mayo Clinic, Scottsdale, AZ, USA
- George E. Saulnier, MS, Department of
Information Technology, Mayo Clinic, 5777 E. Mayo Blvd, Scottsdale, AZ
85259-5499, USA.
| | - Janna C. Castro
- Department of Information Technology,
Mayo Clinic, Scottsdale, AZ, USA
| | - Lanyu Mi
- Mayo Clinic Hospital, Phoenix, Arizona,
and Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
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7
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Karlin NJ, Kosiorek HE, Verona PM, Coppola KE, Cook CB. Cancer, diabetes, survival and glycemic control: a large multisite analysis. Future Sci OA 2022; 8:FSO820. [PMID: 36788982 PMCID: PMC9912249 DOI: 10.2144/fsoa-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/14/2022] [Indexed: 02/16/2023] Open
Abstract
Aim To determine overall survival (OS) and glycemic control in patients with cancer and diabetes. Materials & methods Patients of our institution with breast, colon, lung, pancreas and prostate cancer were retrospectively reviewed. OS was compared between matched patients with and without diabetes, and changes in glucose value over time were assessed. Results For 3934 patients each with and without diabetes, adjusted analysis showed no difference in OS according to diabetes status (hazard ratio: 1.07; 95% CI: 0.96-1.20). Mean glucose values decreased over time in patients with and without diabetes (p = 0.01). Conclusion In this large study of patients with five common cancers, the co-occurrence of diabetes did not affect OS. Cancer did not adversely affect glucose levels.
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Affiliation(s)
- Nina J Karlin
- Division of Hematology & Medical Oncology, Mayo Clinic, Phoenix, Arizona, USA,Author for correspondence: Tel.: +1 480 301 8586;
| | - Heidi E Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, USA
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Apolinario M, Brussels A, Cook CB, Yang S. Autoimmune polyglandular syndrome type 3: A case report of an unusual presentation and literature review. Clin Case Rep 2022; 10:e05391. [PMID: 35140971 PMCID: PMC8815091 DOI: 10.1002/ccr3.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/20/2021] [Accepted: 01/14/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michael Apolinario
- Department of Internal Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
| | - Aaron Brussels
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
| | - Curtiss B. Cook
- Division of Endocrinology Department of Internal Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
| | - Shaun Yang
- Division of Hospital Internal Medicine Department of Internal Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
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Drost JM, Cook CB, Spangehl MJ, Probst NE, Mi L, Trentman TL. A Plant-Based Dietary Intervention for Preoperative Glucose Optimization in Diabetic Patients Undergoing Total Joint Arthroplasty. Am J Lifestyle Med 2022; 16:150-154. [PMID: 35185437 PMCID: PMC8848119 DOI: 10.1177/1559827619879073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Purpose. The purpose of this study was to assess the feasibility and effectiveness of a whole food plant-based diet (WFPBD) to improve day of surgery fasting blood glucose (FBG) among patients with type 2 diabetes (T2D). Patients and Methods. Ten patients with T2D scheduled for a total hip or total knee replacement were recruited. For 3 weeks preceding their surgeries, subjects were asked to consume an entirely WFPBD. Frozen WFPBD meals were professionally prepared and delivered to each participant for the 3 weeks prior to surgery. FBG was reassessed on the morning of surgery and compared with preintervention values. Compliance with the diet was assessed. Results. Mean age of subjects and reported duration of diabetes was 65 and 8 years, respectively, average hemoglobin A1c (HbA1c) was 6.6%, and 6 were women. Mean FBG decreased from 127 to 116 mg/dL (P = .2). Five of the subjects experienced improvement in glycemic control, with an average decline of 11 mg/dL. Conclusion. A WFPBD is a potentially effective intervention to improve glycemic control among patients with T2D during the period leading up to surgery. Future controlled trials on a larger sample of patients to assess the impact of a WFPBD on glycemic control and surgical outcomes are warranted.
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Affiliation(s)
- Jennifer M. Drost
- Jennifer M. Drost, MS, PA-C, Department of Anesthesiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054; e-mail:
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10
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Munshi VN, Saghafian S, Cook CB, Aradhyula SV, Chakkera HA. Use of Imputation and Decision Modeling to Improve Diagnosis and Management of Patients at Risk for New-Onset Diabetes After Transplantation. Ann Transplant 2021; 26:e928624. [PMID: 33723204 PMCID: PMC7980500 DOI: 10.12659/aot.928624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND New-onset diabetes after transplantation (NODAT) is a complication of solid organ transplantation. We sought to determine the extent to which NODAT goes undiagnosed over the course of 1 year following transplantation, analyze missed or later-diagnosed cases of NODAT due to poor hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) collection, and to estimate the impact that improved NODAT screening metrics may have on long-term outcomes. MATERIAL AND METHODS This was a retrospective study utilizing 3 datasets from a single center on kidney, liver, and heart transplantation patients. Retrospective analysis was supplemented with an imputation procedure to account for missing data and project outcomes under perfect information. In addition, the data were used to inform a simulation model used to estimate life expectancy and cost-effectiveness of a hypothetical intervention. RESULTS Estimates of NODAT incidence increased from 27% to 31% in kidney transplantation patients, from 31% to 40% in liver transplantation patients, and from 45% to 67% in heart transplantation patients, when HbA1c and FBG were assumed to be collected perfectly at all points. Perfect screening for kidney transplantation patients was cost-saving, while perfect screening for liver and heart transplantation patients was cost-effective at a willingness-to-pay threshold of $100 000 per life-year. CONCLUSIONS Improved collection of HbA1c and FBG is a cost-effective method for detecting many additional cases of NODAT within the first year alone. Additional research into both improved glucometric monitoring as well as effective strategies for mitigating NODAT risk will become increasingly important to improve health in this population.
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Affiliation(s)
- Vidit N. Munshi
- Department of Health Policy, Harvard University, Cambridge, MA, U.S.A
| | | | - Curtiss B. Cook
- Department of Endocrinology, Mayo Clinic, Scottsdale, AZ, U.S.A
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11
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Kusne YN, Kosiorek HE, Buras MR, Verona PM, Coppola KE, Rone KA, Cook CB, Karlin NJ. Implications of neuroendocrine tumor and diabetes mellitus on patient outcomes and care: a matched case-control study. Future Sci OA 2021; 7:FSO684. [PMID: 34046189 PMCID: PMC8147757 DOI: 10.2144/fsoa-2020-0190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: We aimed to determine the impact of diabetes mellitus (DM) on survival of patients with neuroendocrine tumors (NETs) and of NETs on glycemic control. Patients & methods: Patients with newly diagnosed NETs with/without DM were matched 1:1 by age, sex and diagnosis year (2005–2017), and survival compared (Kaplan–Meier and Cox proportional hazards). Mixed models compared hemoglobin A1c (HbA1c) and glucose during the year after cancer diagnosis. Results: Three-year overall survival was 72% (95% CI: 60–86%) for DM patients versus 80% (95% CI: 70–92%) for non-DM patients (p = 0.82). Hazard ratio was 1.33 (95% CI: 0.56–3.16; p = 0.51); mean DM HbA1c, 7.3%. Conclusion: DM did not adversely affect survival of patients with NET. NET and its treatment did not affect glycemic control. The aim of this study was to evaluate the effect of diabetes mellitus (DM) on survival of patients with neuroendocrine tumor (NET) and to determine whether NET affected glycemic control. From an institutional cancer registry, 118 patients with NET were identified and grouped by DM (n = 59) or no DM (n = 59). The two groups were matched by age, sex and year of NET diagnosis. DM did not decrease survival, and NET did not significantly affect glycemic control in patients with DM.
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Affiliation(s)
- Yael N Kusne
- Department of Internal Medicine, Mayo Clinic, Scottsdale 85259, Arizona
| | | | | | - Patricia M Verona
- Enterprise Technology Services, Mayo Clinic, Scottsdale 85259, Arizona
| | - Kyle E Coppola
- Mayo Clinic Cancer Center, Mayo Clinic, Scottsdale 85259, Arizona
| | - Kelley A Rone
- Division of Hematology & Medical Oncology, Mayo Clinic Hospital, Phoenix 85054, Arizona
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic, Scottsdale 85259, Arizona
| | - Nina J Karlin
- Mayo Clinic Cancer Center, Mayo Clinic, Scottsdale 85259, Arizona.,Division of Hematology & Medical Oncology, Mayo Clinic Hospital, Phoenix 85054, Arizona
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12
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Ederaine SA, Dominguez JL, Harvey JA, Mangold AR, Cook CB, Kosiorek H, Buras M, Coppola K, Karlin NJ. Survival and glycemic control in patients with co-existing squamous cell carcinoma and diabetes mellitus. Future Sci OA 2021; 7:FSO683. [PMID: 34046188 PMCID: PMC8147738 DOI: 10.2144/fsoa-2020-0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study examined the impact of diabetes mellitus (DM) on survival in squamous cell carcinoma (SCC) patients, and the impact of SCC on glycemic control. Materials & methods: Patients with newly diagnosed SCC with and without DM were matched 1:1 (2007–2017). Overall survival and recurrence-free survival were estimated using the Kaplan–Meier method. Hemoglobin A1c (HbA1c) and glucose level during the year following cancer diagnosis were compared using mixed models. Results: HbA1c decreased over time in DM patients (p = 0.04). The 5-year overall survival was 61% in DM patients, compared with 78% in patients without DM (p = 0.004). Conclusion: The presence of co-existing DM adversely impacted survival in patients with SCC. SCC did not affect glycemic control. The objective of this study was to identify the effect of diabetes mellitus (DM) on survival of patients with squamous cell carcinoma (SCC) and to determine whether SCC and its treatment affected glycemic control. We used an institutional cancer registry to identify 190 patients with SCC and grouped them by the presence (n = 95) or absence (n = 95) of DM. Patients were matched by age and year of SCC diagnosis. For individuals with SCC, DM did decrease survival rates, and the diagnosis of SCC did not affect glycemic control.
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Affiliation(s)
| | | | - Jamison A Harvey
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Heidi Kosiorek
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Matthew Buras
- Department of Cancer Quality Program, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Kyle Coppola
- Department of Information Technology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Nina J Karlin
- Division of Hematology & Medical Oncology, Mayo Clinic Cancer Center, Phoenix, AZ 85054, USA
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Abstract
BACKGROUND The objective of this study was to assess disposal patterns for "sharps" among a cohort of patients with diabetes mellitus (DM) receiving insulin therapy. METHOD A convenience sample of inpatients and outpatients was surveyed about how they disposed of sharps, how often they reused lancets and needles, and what education they had received about proper disposal. Safe disposal was defined as discarding sharps into a formal sharps or sealable container; otherwise, disposal was categorized as unsafe. RESULTS Of 150 respondents, 56% were men and 75% were white. The mean (SD) age was 56 (15) years; duration of DM, 20 (13) years; and hemoglobin A1c, 8.1% (2.0%). Half the respondents reused a lancet two or more times, and 21% reused an insulin needle two or more times. Thirty-eight percent of respondents discarded lancets unsafely, and 33% discarded insulin needles unsafely, typically by throwing these items into household trash. Most respondents (75%) discarded insulin pens, vials, cartridges, insulin pump supplies, and continuous glucose monitor sensors into household trash. Most (64%) indicated that they had not received education on safe sharps-disposal practices, and 84% had never visited their municipal website for information on medical waste disposal. CONCLUSION Approximately one-third of patients unsafely disposed of sharps. Unsafe disposal could cause millions of sharps to appear in the municipal solid waste stream, thereby posing a substantial public health hazard. Point-of-care patient education is important, but a broader public health campaign may be required.
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Affiliation(s)
| | | | | | | | - Curtiss B. Cook
- Mayo Clinic, Scottsdale, AZ, USA
- Curtiss B. Cook, MD, Division of Endocrinology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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14
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Leighton ME, Thompson BM, Castro JC, Cook CB. Nurse adherence to post–hypoglycemic event monitoring for hospitalized patients with diabetes mellitus. Appl Nurs Res 2020; 56:151338. [DOI: 10.1016/j.apnr.2020.151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
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15
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Galindo RJ, Umpierrez GE, Rushakoff RJ, Basu A, Lohnes S, Nichols JH, Spanakis EK, Espinoza J, Palermo NE, Awadjie DG, Bak L, Buckingham B, Cook CB, Freckmann G, Heinemann L, Hovorka R, Mathioudakis N, Newman T, O’Neal DN, Rickert M, Sacks DB, Seley JJ, Wallia A, Shang T, Zhang JY, Han J, Klonoff DC. Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline. J Diabetes Sci Technol 2020; 14:1035-1064. [PMID: 32985262 PMCID: PMC7645140 DOI: 10.1177/1932296820954163] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.
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Affiliation(s)
| | | | | | - Ananda Basu
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Suzanne Lohnes
- University of California San Diego Medical Center, La Jolla, CA, USA
| | | | - Elias K. Spanakis
- University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
| | | | - Nadine E. Palermo
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Tonya Newman
- Neal, Gerber and Eisenberg LLP, Chicago, IL, USA
| | - David N. O’Neal
- University of Melbourne Department of Medicine, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | | | | | | | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trisha Shang
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Julia Han
- Diabetes Technology Society, Burlingame, CA, USA
| | - David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 South San Mateo Drive Room 5147, San Mateo, CA 94401, USA.
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16
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Wiedmeier JE, Mountjoy LJ, Buras MR, Kosiorek HE, Coppola KE, Verona PM, Cook CB, Karlin NJ. Mortality and glycemic control among patients with acute and chronic myeloid leukemia and diabetes: a case-control study. Future Sci OA 2020; 7:FSO639. [PMID: 33437503 PMCID: PMC7787137 DOI: 10.2144/fsoa-2020-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim We examined the association between diabetes and survival in patients with acute and chronic myeloid leukemia and the association of leukemia with glycemic control. Patients & methods Patients with leukemia with and without diabetes (2007-2015) were retrospectively identified and matched 1:1 (n = 70 per group). Overall survival was estimated by the Kaplan-Meier method. Hemoglobin A1c and glucose levels the year after leukemia diagnosis were compared by mixed models. Results Among 25 of 70 patients with diabetes, mean hemoglobin A1c during the year after leukemia diagnosis was 6.8%. Kaplan-Meier-estimated 3-year survival was 46% for diabetes patients versus 45% for controls (p = 0.79). Conclusion No associations were found between leukemia, diabetes, survival and glycemic control.
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Affiliation(s)
- Julia E Wiedmeier
- Department of Internal Medicine, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Luke J Mountjoy
- Division of Hematology & Medical Oncology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.,Colorado Blood Cancer Institute, 1721 E 19th Ave, Suites 200-300, Denver, CO 80218, USA
| | - Matthew R Buras
- Biostatistics, Mayo Clinic, 13400 E. SheaBlvd., Scottsdale, AZ 85259, USA
| | - Heidi E Kosiorek
- Biostatistics, Mayo Clinic, 13400 E. SheaBlvd., Scottsdale, AZ 85259, USA
| | - Kyle E Coppola
- Mayo Clinic Cancer Center, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
| | - Patricia M Verona
- Enterprise Technology Services, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
| | - Nina J Karlin
- Division of Hematology & Medical Oncology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.,Mayo Clinic Cancer Center, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
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17
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Staack SO, Rosenthal AC, Cook CB, Yang M. Glucocorticoid-Induced Hypermetabolism in White Adipose Tissue in Cushing Syndrome. J Nucl Med Technol 2020; 48:285-286. [DOI: 10.2967/jnmt.119.237545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022] Open
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18
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Affiliation(s)
- David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCPE, Fellow AIMBE Diabetes Research Institute, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, CA 94401, USA.
| | | | | | | | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
- David C. Klonoff, MD, FACP, FRCPE, Fellow AIMBE Diabetes Research Institute, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, CA 94401, USA.
| | - Julia Han
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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19
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Munshi VN, Saghafian S, Cook CB, Eric Steidley D, Hardaway B, Chakkera HA. Incidence, Risk Factors, and Trends for Postheart Transplantation Diabetes Mellitus. Am J Cardiol 2020; 125:436-440. [PMID: 31812226 DOI: 10.1016/j.amjcard.2019.10.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023]
Abstract
This retrospective study analyzed glycemic trends, incidence of post-transplant diabetes mellitus (PTDM) incidence and associated risk factors in a cohort of patients who underwent first-time heart transplantation (HT). Univariate analyses compared patient with and without pretransplant diabetes mellitus (DM). Multivariate regression analyses were conducted to determine association between PTDM and different risk factors. Finally, trends in glucometrics and other outcomes are described across follow-up time points. There were 152 patients who underwent HT between 2010 and 2015, 109 of whom had no pretransplant history of DM. PTDM incidence was 38% by the 1-year follow-up. Pretransplant body mass index (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.23, p = 0.03), insulin use during the final 24 hours of inpatient stay (OR 4.26, 95% CI 1.72 to 10.56, p <0.01), mean inpatient glucose (OR 2.21, 95% CI 1.33 to 3.69, p <0.01), and mean glucose in the final 24 hours before discharge (OR 1.29, 95% CI 1.03 to 1.60, p = 0.03) were associated with increased odds of PTDM at 1 year. In patients on insulin before discharge, blood glucose values were significantly higher compared with those who were not (136 mg/dl vs 114 mg/dl at 1 to 3 months, 112 vs 100 at 4 to 6 months, 109 vs 98 at 8 to 12 months, all p <0.01). This analysis improves understanding of PTDM incidence, glucometric trends, and risk differences by DM status in the HT population. Similar to liver and kidney patients, inpatient glucometrics may be informative of PTDM risk in HT patients. Guidelines for this population should be developed to account for risk heterogeneity and need for differential management.
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20
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Karlin NJ, Kosiorek HE, Buras M, Rone K, Verona PM, Coppola K, Cook CB. Implications of neuroendocrine tumor and diabetes mellitus on patient outcomes and care: A matched case control study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
612 Background: The aim of this study was to examine the impact of diabetes mellitus (DM) on survival in neuroendocrine tumor and the impact of neuroendocrine tumor on glycemic control in DM. Methods: Patients with newly diagnosed neuroendocrine tumor with and without DM were matched 1:1 according to age, gender, and year of cancer diagnosis (2005-2017). The file was linked to the electronic medical record to obtain information on DM and neuroendocrine tumor therapies and laboratory results. There were 59 matched pairs (total 118 patients) included in the analysis. We compared characteristics between cases and controls and assessed survival with the Kaplan-Meier method and Cox proportional hazards model. Mixed models compared hemoglobin A1c and glucose levels over time. Results: Median age of patients at diagnosis was 67 (40-86); 41% had stage IV disease. Women constituted 49% of the study population; 22% had pancreatic neuroendocrine tumor and 45% had another GI primary neuroendocrine tumor. No differences in race/ethnicity, marital status, alcohol or tobacco use were detected between cancer patients with and without DM. Mean BMI was significantly different between DM and non-DM patients (31.0 [7.90] versus 26.4 [5.27]); p = 0.011. Among those with DM, mean HbA1c during the year following cancer diagnosis was 7.3%. Mean glucose was significantly different between DM (159.1 [43.5] versus non-DM pts 117 [31.5]); p < 0.001. Median follow-up time was 32.8 (2.4-165.4) months in alive patients. Three year survival was estimated at 72% (95% CI: 60-86%) for DM patients versus 80% (95% CI: 70-92%) in non-DM patients by Kaplan Meier method (p = 0.82 log rank test). Hazard ratio (stratification for matched pairs) = 1.33 (95% CI: 0.56 – 3.16; p = 0.51). Conclusions: DM did not adversely impact survival in patients with neuroendocrine tumor. Neuroendocrine tumor and its treatment did not affect glycemic control. This should be reassuring to oncologists and endocrinologists who treat patients with neuroendocrine tumors and diabetes.
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Affiliation(s)
- Nina J. Karlin
- Mayo Clinic Arizona Division Hematology Oncology, Phoenix, AZ
| | | | - Matthew Buras
- Mayo Clinic Arizona Department of Statistics, Scottsdale, AZ
| | - Kelley Rone
- Mayo Clinic Arizona Division Hematology Oncology, Phoenix, AZ
| | | | - Kyle Coppola
- Mayo Clinic Cancer Quality Program Department, Scottsdale, AZ
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21
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Munshi VN, Saghafian S, Cook CB, Werner KT, Chakkera HA. Comparison of post-transplantation diabetes mellitus incidence and risk factors between kidney and liver transplantation patients. PLoS One 2020; 15:e0226873. [PMID: 31923179 PMCID: PMC6953760 DOI: 10.1371/journal.pone.0226873] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022] Open
Abstract
Background Most prior studies characterizing post-transplantation diabetes mellitus (PTDM) have been limited to single-cohort, single-organ studies. This retrospective study determined PTDM across organs by comparing incidence and risk factors among 346 liver and 407 kidney transplant recipients from a single center. Methods Univariate and multivariate regression-based analyses were conducted to determine association of various risk factors and PTDM in the two cohorts, as well as differences in glucometrics and insulin use across time points. Results There was a higher incidence of PTDM among liver versus kidney transplant recipients (30% vs. 19%) at 1-year post-transplant. Liver transplant recipients demonstrated a 337% higher odds association to PTDM (OR 3.37, 95% CI (1.38–8.25), p<0.01). 1-month FBG was higher in kidney patients (135 mg/dL vs 104 mg/dL; p < .01), while 1-month insulin use was higher in liver patients (61% vs 27%, p < .01). Age, BMI, insulin use, and inpatient FBG were also significantly associated with differential PTDM risk. Conclusions Kidney and liver transplant patients have different PTDM risk profiles, both in terms of absolute PTDM risk as well as time course of risk. Management of this population should better reflect risk heterogeneity to short-term need for insulin therapy and potentially long-term outcomes.
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Affiliation(s)
- Vidit N. Munshi
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Soroush Saghafian
- Harvard Kennedy School, Harvard University, Cambridge, Massachusetts, United States of America
| | - Curtiss B. Cook
- Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
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22
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Grando MA, Bayuk M, Karway G, Corrette K, Groat D, Cook CB, Thompson B. Patient Perception and Satisfaction With Insulin Pump System: Pilot User Experience Survey. J Diabetes Sci Technol 2019; 13:1142-1148. [PMID: 31055947 PMCID: PMC6835185 DOI: 10.1177/1932296819843146] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goal of this study was to assess patient perspectives and satisfaction with the MiniMed 670G insulin pump. Those participants who used the pump as part of a hybrid closed loop were also asked to provide their views on the automatic feature (auto mode). METHODS Adults with type 1 diabetes mellitus using the Medtronic™ 670G pump were asked about their experience with the device using a semi-structured survey developed by the research team. Responses were quantified to identify emergent themes. RESULTS Seventeen participants used the pump as part of a hybrid closed loop system, while four participants used the pump in combination with a nonintegrated continuous glucose monitoring system. Overall, participants indicated a high level of satisfaction with the pump (14/21) mostly because of improvements in blood glucose (BG) control (15/21). Least liked features were physical design and structure (6/21), frequency of user input (5/21), alert frequency (4/21), and difficulty of use (3/21). Those using the hybrid closed loop were satisfied with the auto mode feature (11/17), mostly because of improvements in BG control (9/17). The least liked features of the auto mode technology were that blood glucose levels remained elevated (5/17) and the frequency of alerts (4/17). CONCLUSION Participants indicated a high level of satisfaction with the pump and its auto mode featured mostly because of improvements in BG control. They also pointed out some key aspects of the device that are of potential clinical or commercial relevance. Additional research is needed to further evaluate users' perspectives on this new device.
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Affiliation(s)
- Maria Adela Grando
- Biomedical Informatics, College of Health Solutions, Arizona State University, Scottsdale, AZ, USA
- Maria Adela Grando, PhD, Biomedical Informatics, College of Health Solutions, Arizona State University, 13212 E Shea Blvd, Scottsdale, AZ 85259, USA.
| | - Mike Bayuk
- Biomedical Informatics, College of Health Solutions, Arizona State University, Scottsdale, AZ, USA
| | - George Karway
- Biomedical Informatics, College of Health Solutions, Arizona State University, Scottsdale, AZ, USA
| | - Krystal Corrette
- Biomedical Informatics, College of Health Solutions, Arizona State University, Scottsdale, AZ, USA
| | - Danielle Groat
- Biomedical Informatics, College of Health Solutions, Arizona State University, Scottsdale, AZ, USA
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Curtiss B. Cook
- Department of Endocrinology, Arizona Mayo Clinic, Scottsdale, AZ, USA
| | - Bithika Thompson
- Department of Endocrinology, Arizona Mayo Clinic, Scottsdale, AZ, USA
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23
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Saulnier GE, Castro JC, Cook CB. Impact of measurement error on predicting population-based inpatient glucose control. Future Sci OA 2019; 5:FSO388. [PMID: 31363420 PMCID: PMC6554693 DOI: 10.2144/fsoa-2019-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/28/2019] [Indexed: 11/23/2022] Open
Abstract
Aim: Instrument measurement error (ME) may affect ability of damped trend analysis to forecast inpatient glycemic control. Materials & methods: A statistical approach was developed to introduce ME into damped trend analysis algorithm. Point-of-care blood glucose device data were extracted from the laboratory system. Forecasts were generated from various inpatient subgroups and time intervals. Results: ME produced differences in damped trend model during the forecast learning cycle. However, forecast trajectory stayed identical regardless of ME in 85% (119/140) of studied scenarios. Forecasts did not change with greater ME. Conclusion: ME inherent in the point-of-care blood glucose device had little effect on trajectory of damped trend exponential forecasts and apparently would not influence decision making in inpatient glycemic control algorithms. High blood glucose (sugar) levels can lead to complications for hospitalized patients, including more surgical infections or longer hospital stays. The ability to forecast glucose control through trend analysis could identify problems sooner and allow earlier care to keep levels in the recommended range. However, measurement error (ME) is inherent in the glucometer used to check point-of-care glucose values and could limit the usefulness of forecasting methods. This study examined how ME affects forecasting. It showed little effect on glucose forecasts and showed potential robustness of trend analysis in assessment of inpatient glucose control.
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Affiliation(s)
- George E Saulnier
- Department of Information Technology, Mayo Clinic, Phoenix, AZ 85054, USA.,Department of Information Technology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Janna C Castro
- Department of Information Technology, Mayo Clinic, Phoenix, AZ 85054, USA.,Department of Information Technology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Curtiss B Cook
- Mayo Clinic Hospital, Phoenix, Arizona, & Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, AZ 85259, USA.,Mayo Clinic Hospital, Phoenix, Arizona, & Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, AZ 85259, USA
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24
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Karlin NJ, Buras MR, Kosiorek HE, Verona PM, Cook CB. Glycemic control and survival of patients with coexisting diabetes mellitus and gastric or esophageal cancer. Future Sci OA 2019; 5:FSO397. [PMID: 31285842 PMCID: PMC6609893 DOI: 10.2144/fsoa-2019-0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To examine effects of diabetes mellitus (DM) on survival in gastric or esophageal (GE) cancer and the cancers' effects on glycemic control. MATERIALS & METHODS Patients with GE cancer with and without DM were matched 1 to 1 (2006-2016). Characteristics were compared and survival assessed with Kaplan-Meier method and Cox regression. Mixed models compared hemoglobin A1c and glucose over time. RESULTS Among DM cases, mean hemoglobin A1c was 6.8% in the year after cancer diagnosis. Three-year overall survival was 46% with DM versus 52% without DM (hazard ratio [95% CI]: 1.95 [1.14-3.34]; p = 0.02). CONCLUSION GE cancer and its treatment did not affect glycemic control. Risks of death and progression were greater for patients with DM than patients without DM.
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Affiliation(s)
- Nina J Karlin
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, AZ 85054, USA
- Author for correspondence:
| | - Matthew R Buras
- Division of Endocrinology, Department of Biostatistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Heidi E Kosiorek
- Division of Endocrinology, Department of Biostatistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Patricia M Verona
- Department of Information Technology, Department of Biostatistics, Mayo Clinic Hospital, Phoenix, AZ 85054, USA
| | - Curtiss B Cook
- Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Scottsdale, AZ 85259, USA
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25
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Karlin NJ, Buras M, Kosiorek HE, Verona PM, Cook CB. Mortality and glycemic control among patients with gastric and esophageal cancer and diabetes mellitus. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
73 Background: This study evaluated the impact of diabetes mellitus (DM) on survival in gastric and esophageal cancer patients, and examined the impact of these cancers on glycemic control in DM. Methods: Patients with newly diagnosed gastric and esophageal cancers with DM (n = 92) were identified from the Institutional Cancer Registry and matched to 92 gastric and esophageal cancer patients without DM according to age, gender and year of cancer diagnosis (2006 to 2016). The electronic medical record provided information on DM and cancer therapies and laboratory results. Overall survival (OS) was estimated with the Kaplan-Meier method and compared by Cox regression analysis using stratification for matched pairs. Mixed models were used to compare hemoglobin A1c (HbA1c) and glucose during the year following cancer diagnosis. Results: Mean age of the entire cohort was 68 years, 91% were white, 78% were men, and 53% had stage III/IV disease. Adenocarcinoma (79%) was the most common histologic type. BMI was significantly different between DM and non-DM patients (p = 0.006). Alcohol use at time of cancer diagnosis was more prevalent in non-DM patients vs. DM (p = 0.018). Among those with DM, mean HbA1c during the year following cancer diagnosis was 6.8%. Mean glucose was significantly different between DM and non-DM patients (149 mg/dL vs. 116 mg/dL, p < 0.001). For glucose, there was a significant interaction effect (p = 0.005) as DM patients demonstrated a decrease in glucose values over time compared to non-DM patients. Median follow-up time was 35 months. Three year OS was estimated at 46% (95% CI: 36-58%) for DM patients versus 52.0% (95% CI: 41-64%) in non-DM (p = 0.25). Hazard ratio (stratification for matched pairs) was 1.95 (95% CI: 1.14 – 3.43; p = 0.02). Three year PFS was estimated at 40% (95% CI: 31-53%) for DM patients versus 50% (95% CI: 40-63%) for non-DM patients (p = 0.12). Hazard ratio (stratification for matched pairs) was 1.74 (95% CI: 1.04-2.90; p = 0.03). Conclusions: Gastric and esophageal cancer and its treatment did not affect glycemic control. Risks of death and progression are greater in DM patients as compared to non-DM.
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Abstract
In this special section of JDST, patch-pump delivery systems ("patch pumps") are discussed. Patch pumps are novel insulin delivery systems that have emerged on the market; offering flexible insulin delivery options. These systems offer several advantages over conventional insulin pump delivery systems and are gaining popularity. Patch pumps are free of tubing, small, and lightweight. In this special section, the authors discuss both the simple and complex patch pumps currently available on the US market as well as those that are currently under development. Current technologies used to operate these pumps are discussed in detail, and potential promising technologies are presented. Available data on patient preferences, clinical trial data, and the future of patch pumps are discussed.
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Affiliation(s)
- Bithika Thompson
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Groat D, Kwon HJ, Grando MA, Cook CB, Thompson B. Comparing Real-Time Self-Tracking and Device-Recorded Exercise Data in Subjects with Type 1 Diabetes. Appl Clin Inform 2018; 9:919-926. [PMID: 30586673 DOI: 10.1055/s-0038-1676458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Insulin therapy, medical nutrition therapy, and physical activity are required for the treatment of type 1 diabetes (T1D). There is a lack of studies in real-life environments that characterize patient-reported data from logs, activity trackers, and medical devices (e.g., glucose sensors) in the context of exercise. OBJECTIVE The objective of this study was to compare data from continuous glucose monitor (CGM), wristband heart rate monitor (WHRM), and self-tracking with a smartphone application (app), iDECIDE, with regards to exercise behaviors and rate of change in glucose levels. METHODS Participants with T1D on insulin pump therapy tracked exercise for 1 month with the smartphone app while WHRM and CGM recorded data in real time. Exercise behaviors tracked with the app were compared against WHRM. The rate of change in glucose levels, as recorded by CGM, resulting from exercise was compared between exercise events documented with the app and recorded by the WHRM. RESULTS Twelve participants generated 277 exercise events. Tracking with the app aligned well with WHRM with respect to frequency, 3.0 (2.1) and 2.5 (1.8) days per week, respectively (p = 0.60). Duration had very high agreement, the mean duration from the app was 65.6 (55.2) and 64.8 (54.9) minutes from WHRM (p = 0.45). Intensity had a low concordance between the data sources (Cohen's kappa = 0.2). The mean rate of change of glucose during exercise was -0.27 mg/(dL*min) and was not significantly different between data sources or intensity (p = 0.21). CONCLUSION We collated and analyzed data from three heterogeneous sources from free-living participants. Patients' perceived intensity of exercise can serve as a surrogate for exercise tracked by a WHRM when considering the glycemic impact of exercise on self-care regimens.
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Affiliation(s)
- Danielle Groat
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States.,Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States
| | - Hyo Jung Kwon
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States
| | - Maria Adela Grando
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States.,Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - Curtiss B Cook
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States.,Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - Bithika Thompson
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
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Abstract
PURPOSE OF REVIEW Summarize safety issues related to patients using insulin pump therapy and continuous glucose monitoring systems (CGMS) in the outpatient setting when they are hospitalized and to review steps that can be taken to mitigate risk associated with use or discontinuation of these devices. RECENT FINDINGS Two recent consensus conferences were held on the topics of inpatient use of insulin pumps and CGMS devices. In addition to commonly known safety issues (e.g., device malfunction, infection), cybersecurity and the vulnerability of contemporary technology to hacking have emerged. CGMS capabilities offer the promise of advancing the goal for development of glucometry (centralized monitoring of real-time glucose data). Strategies to assuring safe use of insulin pumps and CGMS in the hospital include collaboration between the patient and staff, proper patient selection, and clear policies and procedures outlining safe use. Available data indicates few adverse events associated with these devices in the hospital. Current data suggests, with proper patient selection and a clear process in place for glycemic management, that adverse events are rare, and consensus favors allowing use of the technology in the hospital. The topic of insulin pump and CGMS in the hospital would greatly benefit from more institutions reporting on their experiences and prospective clinical trials.
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Affiliation(s)
- Bithika Thompson
- Division of Endocrinology, Mayo Clinic Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA.
| | - Melinda Leighton
- Division of Endocrinology, Mayo Clinic Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Mary Korytkowski
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
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Abstract
In May 2017, the Diabetes Technology Society convened a panel of US experts on inpatient diabetes management to discuss the current and potential role of continuous subcutaneous insulin infusion (CSII) therapy in the hospital. The panel (1) discussed evidence for current use of CSII in the hospital, (2) recommended contraindications for use in the hospital, and (3) recommended guidelines to maximize chances for safe use of CSII in the hospital. Panel members agreed that larger, prospective, randomized studies are needed to evaluate safety and efficacy of CSII use in the hospital. As CSII technology becomes more complex and its use increases, it is imperative that institutional protocols be in place to ensure safe use of this technology and safe transitions across care areas. Providers need to be cognizant that not all patients currently using CSII as an outpatient are appropriate candidates for continued use in the hospital. This consensus statement provides guidelines for practitioners who may encounter patients using this technology in the inpatient setting.
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Affiliation(s)
- Bithika Thompson
- Division of Endocrinology, Mayo Clinic
Arizona, Scottsdale, AZ, USA
- Bithika Thompson, MD, Division of
Endocrinology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259,
USA.
| | - Mary Korytkowski
- Division of Endocrinology and
Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic
Arizona, Scottsdale, AZ, USA
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Lin CE, Ito Y, Deng A, Johns J, Matloff D, Cook CB, Sode K, La Belle JT. A Disposable Tear Glucose Biosensor-Part 5: Improvements in Reagents and Tear Sampling Component. J Diabetes Sci Technol 2018; 12:842-846. [PMID: 29667855 PMCID: PMC6134317 DOI: 10.1177/1932296818769944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A tear glucose (TG) sensor with an integrated tear sampler can provide a noninvasive method for calibrating the continuous TG contact lens and monitoring glucose. Expanding from previous work, an improved TG sensor that implements dried reagents, genetically modified glucose dehydrogenase (GDH), and a tear sampler was developed and compared against the TG sensor prepared with commercial GDH. It was found that neither sensor was affected by the tear interferents: ascorbic acid, acetaminophen, and uric acid. The sensor prepared with commercial GDH generated higher current. This suggests that using enzymes with lower Km may be advantageous when operating in low glucose environments like tears. The improved TG sensor also demonstrated the potential of integrating Schirmer's test strip as a tear sampler for self-monitoring of TG.
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Affiliation(s)
- Chi En Lin
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Yuka Ito
- Department of Biotechnology and Life
Science, Graduate School of Engineering, Tokyo University of Agriculture and
Technology, Koganei, Tokyo, Japan
| | - Anna Deng
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Jared Johns
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Daniel Matloff
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Curtiss B. Cook
- School of Medicine, Mayo Clinic Arizona,
Scottsdale, AZ, USA
| | - Koji Sode
- Department of Biotechnology and Life
Science, Graduate School of Engineering, Tokyo University of Agriculture and
Technology, Koganei, Tokyo, Japan
- Joint Department of Biomedical
Engineering, University of North Carolina at Chapel Hill, North Carolina State
University, Chapel Hill, NC, USA
| | - Jeffrey T. La Belle
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
- School of Medicine, Mayo Clinic Arizona,
Scottsdale, AZ, USA
- Jeffrey T. La Belle, PhD, Arizona State
University, 550 E Orange St, Tempe, AZ 85287, USA.
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Nelakurthi AR, Pinto AM, Cook CB, Jones L, Boyle M, Ye J, Lappas T, He J. Should patients with diabetes be encouraged to integrate social media into their care plan? Future Sci OA 2018; 4:FSO323. [PMID: 30112191 PMCID: PMC6088271 DOI: 10.4155/fsoa-2018-0021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022] Open
Abstract
AIM To evaluate the use of social media of individuals with diabetes mellitus (DM). MATERIALS & METHODS Both web-based and in-clinic surveys were collected from individuals with DM. Descriptive and correlation analyses were employed to evaluate respondents' diabetes-specific social networking site behaviors. RESULTS Forty-five patients with DM completed the web-based survey and 167, the clinic-based survey, of whom only 40 visited diabetes-specific social networking sites. Analysis of online survey data indicated that self-reported adherence to lifestyle recommendations was significantly correlated (p < 0.01) with visiting the sites. Clinic-based survey data found that patients who reported using DM-specific web sites monitored home glucose values more often and had better compliance with insulin administration (both p < 0.05) compared with nonusers. CONCLUSION This study provides insight into why individuals visit DM-specific social networking sites. Certain self-management behaviors may improve as a result of visiting these sites. Further work is needed to explore how to leverage social media technology to assist patients with the management of DM.
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Affiliation(s)
- Arun R Nelakurthi
- School of Computing, Informatics, & Decision Systems Engineering, Arizona State University, Tempe, AZ, 85281, USA
| | - Angela M Pinto
- Department of Psychology, Baruch College, City University of New York, New York, NY, 10010, USA
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Lynne Jones
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Mary Boyle
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Jieping Ye
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Theodoros Lappas
- School of Business, Stevens Institute of Technology, Hoboken, NJ, 07030, USA
| | - Jingrui He
- School of Computing, Informatics, & Decision Systems Engineering, Arizona State University, Tempe, AZ, 85281, USA
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Groat D, Soni H, Grando MA, Thompson B, Kaufman D, Cook CB. Design and Testing of a Smartphone Application for Real-Time Self-Tracking Diabetes Self-Management Behaviors. Appl Clin Inform 2018; 9:440-449. [PMID: 29925098 DOI: 10.1055/s-0038-1660438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) care requires multiple daily self-management behaviors (SMBs). Preliminary studies on SMBs rely mainly on self-reported survey and interview data. There is little information on adult T1D SMBs, along with corresponding compensation techniques (CTs), gathered in real-time. OBJECTIVE The article aims to use a patient-centered approach to design iDECIDE, a smartphone application that gathers daily diabetes SMBs and CTs related to meal and alcohol intake and exercise in real-time, and contrast patients' actual behaviors against those self-reported with the app. METHODS Two usability studies were used to improve iDECIDE's functionality. These were followed by a 30-day pilot test of the redesigned app. A survey designed to capture diabetes SMBs and CTs was administered prior to the 30-day pilot test. Survey results were compared against iDECIDE logs. RESULTS Usability studies revealed that participants desired advanced features for self-tracking meals and alcohol intake. Thirteen participants recorded over 1,200 CTs for carbohydrates during the 30-day study. Participants also recorded 76 alcohol and 166 exercise CTs. Comparisons of survey responses and iDECIDE logs showed mean% (standard deviation) concordance of 77% (25) for SMBs related to meals, where concordance of 100% indicates a perfect match. There was low concordance of 35% (35) and 46% (41) for alcohol and exercise events, respectively. CONCLUSION The high variability found in SMBs and CTs highlights the need for real-time diabetes self-tracking mechanisms to better understand SMBs and CTs. Future work will use the developed app to collect SMBs and CTs and identify patient-specific diabetes adherence barriers that could be addressed with individualized education interventions.
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Affiliation(s)
- Danielle Groat
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States.,Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States
| | - Hiral Soni
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States
| | - Maria Adela Grando
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States
| | - Bithika Thompson
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - David Kaufman
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States
| | - Curtiss B Cook
- Department of Biomedical Informatics, Arizona State University, Scottsdale, Arizona, United States.,Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
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Karlin NJ, Kosiorek HE, Buras M, Amin S, Verona PM, Cook CB. Implications of melanoma with diabetes mellitus on patient outcomes. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Karlin NJ, Amin S, Verona PM, Kosiorek HE, Buras M, Cook CB. Survival and glycemic control in patients with colorectal cancer and diabetes mellitus. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Groat D, Soni H, Grando MA, Thompson B, Cook CB. Self-Reported Compensation Techniques for Carbohydrate, Exercise, and Alcohol Behaviors in Patients With Type 1 Diabetes on Insulin Pump Therapy. J Diabetes Sci Technol 2018; 12:412-414. [PMID: 28677414 PMCID: PMC5851212 DOI: 10.1177/1932296817718848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies have found variability in self-care behaviors in patients with type 1 diabetes, particularly when incorporating exercise and alcohol consumption. The objective of this study was to provide results from a survey to understand (1) insulin pump behaviors, (2) reported self-management behaviors for exercise and alcohol, and (3) perceptions of the effects of exercise and alcohol on blood glucose (BG) control. Fourteen participants from an outpatient endocrinology practice were recruited and administered an electronic survey. Compensation techniques for exercise and alcohol, along with reasons for employing the techniques were identified. Also identified were factors that participants said affected BG control with regard to exercise and alcohol. These results confirm the considerable inconsistency patients have about incorporating exercise and alcohol into decisions about self-management behaviors.
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Affiliation(s)
- Danielle Groat
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Hiral Soni
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Maria Adela Grando
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
- Department of Endocrinology, Arizona Mayo Clinic, Scottsdale, AZ, USA
| | - Bithika Thompson
- Department of Endocrinology, Arizona Mayo Clinic, Scottsdale, AZ, USA
| | - Curtiss B. Cook
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
- Department of Endocrinology, Arizona Mayo Clinic, Scottsdale, AZ, USA
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36
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Karlin NJ, Amin S, Buras M, Kosiorek HE, Verona PM, Cook CB. Implications of pancreatic cancer with diabetes mellitus on patient outcomes and care: A matched case-control study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
239 Background: The aim of this case-control study was to determine the impact of DM on survival in pancreatic cancer patients, and to examine the impact of pancreatic cancer on glycemic control in DM. Methods: Ninety-two patients with newly diagnosed pancreatic cancer from 2007 to 2015 with DM were identified from the institutional Cancer Registry and matched to ninety-two pancreatic cancer patients without DM according to age, gender, and year of pancreatic cancer diagnosis. The file was linked to the electronic medical record to obtain information on DM and pancreatic cancer therapies, and laboratory results. Overall survival (OS) was estimated with the Kaplan-Meier method and compared by Cox regression analysis. Mixed models were used to compare hemoglobin A1c (HbA1c) and glucose over time. Results: Mean age of the entire pancreatic cancer cohort was 70 years, most (92%) were white, most common (88%) histology was adenocarcinoma, and majority (41%) were stage IV. No differences in age, race/ethnicity, histology, or tumor stage were detected between patients with and without DM, although DM patients had higher body mass index (P = 0.014). Mean ca 19-9 (U/ml) was 804 for diabetics, and 395 for non-diabetics. Among those with DM the mean HbA1c during the year following cancer diagnosis was 7.3%. Time (days since diagnosis) was significant in DM patients (p = 0.014) as HbA1c decreased over time. Mean glucose during the year following diagnosis among DM patients was significantly higher compared to non-DM patients [160.6 (SD = 38.0) versus 117.2 (SD = 19.0); p < 0.001]. Both groups had a decline in glucose over time (p = 0.008). In Kaplan-Meier survival analysis (median follow-up time of 11.9 months), 2 year overall survival was estimated at 15% [95% CI: 8-24%] for DM patients versus 26% [95% CI: 17-36%] in non-DM patients. Hazard ratio (for matched pairs) was 1.15 (95% CI: 0.75-1.77; p = 0.51). Conclusions: DM did not adversely impact survival in patients with pancreatic cancer. Pancreatic cancer did not affect glycemic control. Elevated ca 19-9 in diabetic patients may be an unreliable marker for gauging disease progression.
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Abstract
BACKGROUND We propose a methodology to analyze complex real-life glucose data in insulin pump users. METHODS Patients with type 1 diabetes (T1D) on insulin pumps were recruited from an academic endocrinology practice. Glucose data, insulin bolus (IB) amounts, and self-reported alcohol consumption and exercise events were collected for 30 days. Rules were developed to retrospectively compare IB recommendations from the insulin pump bolus calculator (IPBC) against recommendations from a proposed decision aid (PDA) and for assessing the PDA's recommendation for exercise and alcohol. RESULTS Data from 15 participants were analyzed. When considering instances where glucose was below target, the PDA recommended a smaller dose in 14%, but a larger dose in 13% and an equivalent IB in 73%. For glucose levels at target, the PDA suggested an equivalent IB in 58% compared to the subject's IPBC, but higher doses in 20% and lower in 22%. In events where postprandial glucose was higher than target, the PDA suggested higher doses in 25%, lower doses in 13%, and equivalent doses in 62%. In 64% of all alcohol events the PDA would have provided appropriate advice. In 75% of exercise events, the PDA appropriately advised an IB, a carbohydrate snack, or neither. CONCLUSIONS This study provides a methodology to systematically analyze real-life data generated by insulin pumps and allowed a preliminary analysis of the performance of the PDA for insulin dosing. Further testing of the methodological approach in a broader diabetes population and prospective testing of the PDA are needed.
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Affiliation(s)
- Danielle Groat
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
| | - Maria A. Grando
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
- Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA
| | - Bithika Thompson
- Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA
| | - Pedro Neto
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
| | - Hiral Soni
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
| | - Mary E. Boyle
- Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA
| | - Marilyn Bailey
- Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA
| | - Curtiss B. Cook
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
- Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA
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Abstract
PURPOSE OF REVIEW Glucometrics is the systematic analysis of inpatient glucose data and is of key interest as hospitals strive to improve inpatient glycemic control. Insulinometrics is the systematic analysis and reporting of inpatient insulin therapy. This paper reviews some of the questions to be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines. RECENT FINDINGS There remains a lack of standardization on how glucometircs should be measured and reported. Before hospitals can commit resources to compiling and extracting data, consensus must be reached on such questions as which measures to report, definitions of glycemic targets, and how data should be obtained. Examples are provided on how insulin administration can be measured and reported. Hospitals should begin assessment of glucometrics and insulinometrics. However, consensus and standardization must first occur to allow for a national benchmarking process.
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Affiliation(s)
- Bithika M Thompson
- Division of Endocrinology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Curtiss B Cook
- Division of Endocrinology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
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Malkoc A, Probst D, Lin C, Khanwalker M, Beck C, Cook CB, La Belle JT. Enhancing Glycemic Control via Detection of Insulin Using Electrochemical Impedance Spectroscopy. J Diabetes Sci Technol 2017; 11:930-935. [PMID: 28299957 PMCID: PMC5950988 DOI: 10.1177/1932296817699639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Currently, glycemic management for individuals with diabetes mellitus involves monitoring glucose only, which is insufficient as glucose metabolism involves other biomarkers such as insulin. Monitoring additional biomarkers alongside glucose has been proposed to improve glycemic control. In this work, the development of a rapid and label-free insulin biosensor with high sensitivity and accuracy is presented. The insulin sensor prototype also serves as a prior study for a multimarker sensing platform technology that can further improve glycemic control in the future. METHODS Electrochemical impedance spectroscopy was used to identify an optimal frequency specific to insulin detection on a gold disk electrode with insulin antibody immobilized, which was accomplished by conjugating the primary amines of insulin antibody to the carboxylic bond of the self-assembling monolayer on the gold surface. After blocking with ethanolamine, the insulin physiological concentration gradient was tested. The imaginary impedance was correlated to insulin concentration and the results were compared with standard equivalent circuit analysis and correlation of charge transfer resistance to target concentration. RESULTS The optimal frequency of insulin is 810.5 Hz, which is characterized by having the highest sensitivity and sufficient specificity. The lower limit of detection was 2.26 [Formula: see text] which is comparable to a standard and better than traditional approaches. CONCLUSION An insulin biosensor prototype capable of detecting insulin in physiological range without complex data normalization was developed. This prototype will be the ground works of a multimarker platform sensor technology for future all-in-one glycemic management sensors.
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Affiliation(s)
- Aldin Malkoc
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - David Probst
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Chi Lin
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Mukund Khanwalker
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Connor Beck
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | | | - Jeffrey T. La Belle
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
- Mayo Clinic Arizona, Scottsdale, AZ, USA
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Wallia A, Umpierrez GE, Rushakoff RJ, Klonoff DC, Rubin DJ, Hill Golden S, Cook CB, Thompson B. Consensus Statement on Inpatient Use of Continuous Glucose Monitoring. J Diabetes Sci Technol 2017; 11:1036-1044. [PMID: 28429611 PMCID: PMC5950996 DOI: 10.1177/1932296817706151] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In June 2016, Diabetes Technology Society convened a panel of US experts in inpatient diabetes management to discuss the current and potential role of continuous glucose monitoring (CGM) in the hospital. This discussion combined with a literature review was a follow-up to a meeting, which took place in May 2015. The panel reviewed evidence on use of CGM in 3 potential inpatient scenarios: (1) the intensive care unit (ICU), (2) non-ICU, and (3) transitioning outpatient CGM use into the hospital setting. Panel members agreed that data from limited studies and theoretical considerations suggested that use of CGM in the hospital had the potential to improve patient clinical outcomes, and in particular reduction of hypoglycemia. Panel members discussed barriers to widespread adoption of CGM, which patients would benefit most from use of this technology, and what type of outcome studies are needed to guide use of CGM in the inpatient setting.
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Affiliation(s)
- Amisha Wallia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Daniel J. Rubin
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Curtiss B. Cook
- Arizona State University, Scottsdale, AZ, USA
- Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Bithika Thompson
- Mayo Clinic Arizona, Scottsdale, AZ, USA
- Bithika Thompson, MD, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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Karlin NJ, Amin SB, Verona PM, Kosiorek HE, Cook CB. CO-EXISTING PROSTATE CANCER AND DIABETES MELLITUS: IMPLICATIONS FOR PATIENT OUTCOMES AND CARE. Endocr Pract 2017; 23:816-821. [PMID: 28534688 DOI: 10.4158/ep161702.or] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate how diabetes mellitus (DM) impacts short-term overall survival (OS) for patients with prostate cancer and to examine how prostate cancer impacts glycemic control in DM. METHODS Patients with DM and prostate cancer newly diagnosed from 2007 to 2014 were identified from the institutional cancer registry and matched to patients with prostate cancer but no DM according to age and year of prostate cancer diagnosis. RESULTS The study included 276 cases and 276 controls; the mean age was 72 years, most (93%) were white, the most common Gleason score (52%) was 7, and the majority (56%) were tumor stage II. Patients with DM had a higher mean body mass index (P = .03). Alcohol use and performance status differed by group (P<.001), but the 2 groups otherwise were not significantly different. Among those with DM, the mean hemoglobin A1c (HbA1c) was 6.7%. In Kaplan-Meier survival analysis (median follow-up time, 43.7 months), the 5-year OS rates were estimated at 88% and 93% for patients with and without DM, respectively (hazard ratio, 1.64; 95% confidence interval, 0.77-3.46; P = .20). Mean glucose among patients with DM was significantly higher (P<.001) compared with non-DM patients, but mean HbA1c and glucose values did not change significantly over 1 year (P≥.13). CONCLUSION DM did not adversely impact survival in patients with prostate cancer. In addition, prostate cancer and its treatment did not affect glycemic control. Patients and their providers can be reassured that the concurrent diagnoses do not adversely interact to worsen short-term outcomes. ABBREVIATIONS DM = diabetes mellitus; HbA1c = hemoglobin A1c; OS = overall survival.
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Cook CB, Apsey HA, Habermann EB, Glasgow AE, Castro JC, Schlinkert RT. UPDATE ON A QUALITY INITIATIVE TO OVERCOME CLINICAL INERTIA IN THE POSTOPERATIVE CARE OF INPATIENTS WITH DIABETES MELLITUS. Endocr Pract 2017; 23:498-500. [PMID: 28095039 DOI: 10.4158/ep161621.co] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Successful diabetes management requires behavioral changes. Little is known about self-management behaviors (SMB) in adults on insulin pump (IP) therapy. OBJECTIVE Analyze and characterize observed common diabetes SMB in adult participants with type 1 diabetes (T1D) using IPs and to correlate behaviors with glycemic outcomes based on participant's individual glucose targets. MATERIALS AND METHODS One month of IP data from adults with T1D were downloaded. Computer programs were written to automatically quantify the observed frequency of expected behaviors such as: insulin bolusing, checking blood glucose (BG), and recording carbohydrate intake, and other interactions with the IP. RESULTS Nineteen participants were recruited and 4,249 IP interactions were analyzed to ascertain behaviors. Intersubject variability of adherence to minimally expected behaviors was observed: daily documentation of carbohydrates and BG checks in 76.6 (31.7)% and 60.0 (32.5)%, respectively, and bolusing without consulting the IPBC in 13.0 (16.9)% of delivered boluses, while daily insulin bolus delivery was consistent 96.8 (5.7)%. Higher frequency of adherence to daily behaviors correlated with a higher number of glucose readings at target. CONCLUSION Results indicate variability in SMB and do not always match recommendations. Case-scenarios based on observed real-life SMB could be incorporated into interviews/surveys to elucidate ways to improve SMB.
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Affiliation(s)
- Danielle Groat
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
| | - Maria Adela Grando
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
- Mayo Clinic Arizona Division of Endocrinology, Scottsdale, AZ, USA
| | - Hiral Soni
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
| | - Bithika Thompson
- Mayo Clinic Arizona Division of Endocrinology, Scottsdale, AZ, USA
| | - Mary Boyle
- Mayo Clinic Arizona Division of Endocrinology, Scottsdale, AZ, USA
| | - Marilyn Bailey
- Mayo Clinic Arizona Division of Endocrinology, Scottsdale, AZ, USA
| | - Curtiss B. Cook
- Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA
- Mayo Clinic Arizona Division of Endocrinology, Scottsdale, AZ, USA
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Grando MA, Groat D, Soni H, Boyle M, Bailey M, Thompson B, Cook CB. Characterization of Exercise and Alcohol Self-Management Behaviors of Type 1 Diabetes Patients on Insulin Pump Therapy. J Diabetes Sci Technol 2017; 11:240-246. [PMID: 27595712 PMCID: PMC5478020 DOI: 10.1177/1932296816663746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a lack of systematic ways to analyze how diabetes patients use their insulin pumps to self-manage blood glucose to compensate for alcohol ingestion and exercise. The objective was to analyze "real-life" insulin dosing decisions occurring in conjunction with alcohol intake and exercise among patients using insulin pumps. METHODS We recruited adult type 1 diabetes (T1D) patients on insulin pump therapy. Participants were asked to maintain their daily routines, including those related to exercising and consuming alcohol, and keep a 30-day journal on exercise performed and alcohol consumed. Thirty days of insulin pump data were downloaded. Participants' actual insulin dosing behaviors were compared against their self-reported behaviors in the setting of exercise and alcohol. RESULTS Nineteen T1D patients were recruited and over 4000 interactions with the insulin pump were analyzed. The analysis exposed variability in how subjects perceived the effects of exercise/alcohol on their blood glucose, inconsistencies between self-reported and observed behaviors, and higher rates of blood glucose control behaviors for exercise versus alcohol. CONCLUSION Compensation techniques and perceptions on how exercise and alcohol affect their blood glucose levels vary between patients. Improved individualized educational techniques that take into consideration a patient's unique life style are needed to help patients effectively apply alcohol and exercise compensation techniques.
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Affiliation(s)
- Maria Adela Grando
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Maria Adela Grando, PhD, Department of Biomedical Informatics, Arizona State University, Mayo Clinic, Samuel C. Johnson Research Building, 13212 E Shea Blvd, Scottsdale, AZ 85259, USA.
| | - Danielle Groat
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Hiral Soni
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Mary Boyle
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Marilyn Bailey
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Bithika Thompson
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Curtiss B. Cook
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Karlin NJ, Kosiorek H, Verona PM, Amin S, Cook CB. Implications of prostate cancer with diabetes mellitus on patient outcomes and care: A matched case-control study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
101 Background: Diabetes mellitus (DM) has been associated with an increased risk of mortality among patients with many types of cancers. The aim of this case-control study was to determine the impact of DM on short-term overall survival in prostate cancer patients, and to examine the impact of prostate cancer on glycemic control in DM. Methods: 276 patients with newly diagnosed prostate cancer from 2007-2014 with DM were identified from the Institutional Cancer Registry and matched to 276 prostate cancer patients without DM according to age and year of prostate cancer diagnosis. The file was linked to the electronic medical record to obtain information on DM and cancer therapies, and laboratory results. Results: The mean age of the entire prostate cancer cohort was 72 years, most (93%) were white, the most common Gleason score (in 52%) was 7, and the majority (56%) were tumor stage 2. No differences in age, race/ethnicity, Gleason score, or tumor stage were detected between patients with and without DM, although DM patients had higher body mass index (P = .031). Among those with DM the mean hemoglobin A1c (HbA1c) was 6.7%. In Kaplan-Meier survival analysis (median follow-up time of 43.7 months), 5-year overall survival was estimated at 88% for DM patients versus 93% in non-DM patients. Hazard ratio (for matched pairs) was 1.64 (95% CI: 0.77-3.46, P = .20). Moreover, mean HbA1c and glucose values among DM cases did not significantly change over 1 year (P ≥ .13). Mean glucose among DM patients was significantly (p < 0.01) higher compared to non-DM patients. Conclusions: DM did not adversely impact survival in prostate cancer patients. In addition, prostate cancer or its treatment does not appear to affect glycemic control. Both patients and their providers can be reassured that the two concurrent diagnoses do not adversely interact to worsen short term outcomes.
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Osburne RC, Cook CB, Stockton L, Baird M, Harmon V, Keddo A, Pounds T, Lowey L, Reid J, McGowan KA, Davidson PC. Improving Hyperglycemia Management in the Intensive Care Unit. Diabetes Educ 2016; 32:394-403. [PMID: 16772655 DOI: 10.1177/0145721706288072] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose The purpose of this study was to assess the feasibility of a nurse-driven effort to improve hyperglycemia management in the intensive care unit (ICU) setting. Methods The setting was the ICU of a large urban hospital. The program was composed of 3 components: nurses as leaders, a clinical pathway to identify patients in need of hyperglycemia therapy, and implementation of a redesigned insulin infusion algorithm (the Columnar Insulin Dosing Chart). Time to reach a target glucose range of 80 to 110 mg/dL (4.4-6.1 mmol/L) was evaluated. Results One hundred sixteen ICU nurses were trained in the project. The Columnar Insulin Dosing Chart was applied to 20 patients. The average time required to reach the target blood glucose range was 12.8 hours. Below-target blood glucose levels were 6.9% of all blood glucose levels recorded, but only 0.9% were below 60 mg/dL (3.3 mmol/L). There was no sustained hypoglycemia, and no persistent clinical findings attributable to hypoglycemia were noted. Barriers to implementing the project included an increased nursing workload, the need for more finger-stick blood glucose monitors, and the need to acquire new finger-lancing devices that allowed for shallower skin puncture and increased patient comfort. Conclusions Tighter glycemic control goals can be attained in a busy ICU by a nurse-led team using a pathway for identifying and treating hyperglycemia, clear decision support tools, and adequate nurse education. The novel chart based insulin infusion algorithm chosen as the standard for this pilot was an effective tool for reducing the blood glucose to target range with no clinically significant hypoglycemia.
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Affiliation(s)
- Robert C Osburne
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | | | | | | | - Valerie Harmon
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Annie Keddo
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Teresa Pounds
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Linda Lowey
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Joyce Reid
- Georgia Hospital Association, Marietta (Ms Reid, Ms McGowan)
| | | | - Paul C Davidson
- Atlanta Diabetes Associates, Atlanta, Georgia (Dr Davidson), for the Georgia Hospital Association Diabetes Special Interest Group
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Miller CD, Ziemer DC, Kolm P, El-Kebbi IM, Cook CB, Gallina DL, Doyle JP, Barnes CS, Phillips LS. Use of a Glucose Algorithm to Direct Diabetes Therapy Improves A1C Outcomes and Defines an Approach to Assess Provider Behavior. Diabetes Educ 2016; 32:533-45. [PMID: 16873591 DOI: 10.1177/0145721706290834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose The purpose of this study was to determine whether an algorithm that recommended individualized changes in therapy would help providers to change therapy appropriately and improve glycemic control in their patients. Methods The algorithm recommended specific doses of oral agents and insulin based on a patient's medications and glucose or A1C levels at the time of the visit. The prospective observational study analyzed the effect of the algorithm on treatment decisions and A1C levels in patients with type 2 diabetes. Results The study included 1250 patients seen in pairs of initial and follow-up visits during a 7-month baseline and/or a subsequent 7-month algorithm period. The patients had a mean age of 62 years, body mass index of 33 kg/m2, duration of diabetes of 10 years, were 94% African American and 71% female, and had average initial A1C level of 7.7%. When the algorithm was available, providers were 45% more likely to intensify therapy when indicated (P = .005) and increased therapy by a 20% greater amount (P < .001). A1C level at follow-up was 90% more likely to be <7% in the algorithm group, even after adjusting for differences in age, sex, body mass index, race, duration of diabetes and therapy, glucose, and A1C level at the initial visit (P < .001). Conclusions Use of an algorithm that recommends patient-specific changes in diabetes medications improves both provider behavior and patient A1C levels and should allow quantitative evaluation of provider actions for that provider's patients.
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Affiliation(s)
- Christopher D Miller
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
- Dr Miller is currently based at the Bond Clinic, Winter Haven, Florida, and Dr Cook is based at the Mayo Clinic, Scottsdale, Arizona
| | - David C Ziemer
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
| | - Paul Kolm
- Cardiology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Dr Kolm)
| | - Imad M El-Kebbi
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
| | - Curtiss B Cook
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
- Dr Miller is currently based at the Bond Clinic, Winter Haven, Florida, and Dr Cook is based at the Mayo Clinic, Scottsdale, Arizona
| | - Daniel L Gallina
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
| | - Joyce P Doyle
- General Internal Medicine, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Dr Doyle)
| | - Catherine S Barnes
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
| | - Lawrence S Phillips
- The Divisions of Endocrinology, Department of Medicine, Emory University School of Medicine and Diabetes Clinic, Grady Health Systems, Atlanta, Georgia (Drs Miller, Ziemer, El-Kebbi, Cook, Gallina, Barnes, Phillips)
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Ziemer DC, Miller CD, Rhee MK, Doyle JP, Watkins C, Cook CB, Gallina DL, El-Kebbi IM, Barnes CS, Dunbar VG, Branch WT, Phillips LS. Clinical Inertia Contributes to Poor Diabetes Control in a Primary Care Setting. Diabetes Educ 2016; 31:564-71. [PMID: 16100332 DOI: 10.1177/0145721705279050] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose The purpose of this study was to determine whether “clinical inertia”—inadequate intensification of therapy by the provider—could contribute to high A1C levels in patients with type 2 diabetes managed in a primary care site. Methods In a prospective observational study, management was compared in the Medical Clinic, a primary care site supervised by general internal medicine faculty, and the Diabetes Clinic, a specialty site supervised by endocrinologists. These municipal hospital clinics serve a common population that is largely African American, poor, and uninsured. Results Four hundred thirty-eight African American patients in the Medical Clinic and 2157 in the Diabetes Clinic were similar in average age, diabetes duration, body mass index, and gender, but A1C averaged 8.6% in the Medical Clinic versus 7.7% in the Diabetes Clinic (P < .0001). Use of pharmacotherapy was less intensive in the Medical Clinic (less use of insulin), and when patients had elevated glucose levels during clinic visits, therapy was less than half as likely to be advanced in the Medical Clinic compared to the Diabetes Clinic (P < .0001). Intensification rates were lower in the Medical Clinic regardless of type of therapy (P < .0001), and intensification of therapy was independently associated with improvement in A1C (P < .001). Conclusions Medical Clinic patients had worse glycemic control, were less likely to be treated with insulin, and were less likely to have their therapy intensified if glucose levels were elevated. To improve diabetes management and glycemic control nationwide, physicians in training and generalists must learn to overcome clinical inertia, to intensify therapy when appropriate, and to use insulin when clinically indicated.
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Affiliation(s)
- David C Ziemer
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Christopher D Miller
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Mary K Rhee
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Joyce P Doyle
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Clyde Watkins
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Curtiss B Cook
- The Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, and Mayo Clinic, Scottsdale, Arizona (Dr Cook)
| | - Daniel L Gallina
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Imad M El-Kebbi
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Catherine S Barnes
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Virginia G Dunbar
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - William T Branch
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
| | - Lawrence S Phillips
- Divisions of Endocrinology and Metabolism and General Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia
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Wanko NS, Brazier CW, Young-Rogers D, Dunbar VG, Boyd B, George CD, Rhee MK, el-Kebbi IM, Cook CB. Exercise Preferences and Barriers in Urban African Americans With Type 2 Diabetes. Diabetes Educ 2016; 30:502-13. [PMID: 15208848 DOI: 10.1177/014572170403000322] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to determine physical activity preferences and barriers to exercise in an urban diabetes clinic population. METHODS A survey was conducted of all patients attending the clinic for the first time. Evaluation measures were type and frequency of favorite leisure-time physical activity, prevalence and types of reported barriers to exercise, and analysis of patient characteristics associated with reporting an obstacle to exercise. RESULTS For 605 patients (44% male, 89% African American, mean age = 50 years, mean duration of diabetes = 5.6 years), the average frequency of leisure activity was 3.5 days per week (mean time = 45 minutes per session). Walking outdoors was preferred, but 52% reported an exercise barrier (predominantly pain). Patients who cited an impediment to physical activity exercised fewer days per week and less time each session compared with persons without a barrier. Increasing age, body mass index, college education, and being a smoker increased the odds of reporting a barrier; being male decreased the chances. Men reported more leisure-time physical activity than women. Exercise preferences and types of barriers changed with age. CONCLUSIONS Recognition of patient exercise preferences and barriers should help in developing exercise strategies for improving glycemic control.
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Affiliation(s)
- Nancy S Wanko
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Carol W Brazier
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Denine Young-Rogers
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Virginia G Dunbar
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Barbara Boyd
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Christopher D George
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Mary K Rhee
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
| | - Imad M el-Kebbi
- Department of Medicine, Emory University, and the Grady Health System, Atlanta, Georgia, USA
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Barnes CS, Ziemer DC, Miller CD, Doyle JP, Watkins C, Cook CB, Gallina DL, el-Kebbi I, Branch WT, Phillips LS. Little Time for Diabetes Management in the Primary Care Setting. Diabetes Educ 2016; 30:126-35. [PMID: 14999900 DOI: 10.1177/014572170403000120] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE This study was conducted to determine how time is allocated to diabetes care. METHODS Patients with type 2 diabetes who were receiving care from the internal medicine residents were shadowed by research nurses to observe the process of management. The amount of time spent with patients and the care provided were observed and documented. RESULTS The total time patients spent in the clinic averaged 2 hours and 26 minutes: 1 to 9 minutes waiting, 25 minutes with the resident, and 12 minutes with medical assistants and nurses. The residents spent an average of only 5 minutes on diabetes. Glucose monitoring was addressed in 70% of visits; a history of hypoglycemia was sought in only 30%. Blood pressure values were mentioned in 75% of visits; hemoglobin A1c (A1C) values were addressed in only 40%. The need for proper foot care was discussed in 55% of visits; feet were examined in only 40%. Although 65% of patients had capillary glucose levels greater than 150 mg/dL during the visit and their A1C averaged 8.9%, therapy was intensified for only 15% of patients. CONCLUSIONS During a routine office visit in a resident-staffed general medicine clinic, little time is devoted to diabetes management. Given the time pressures on the primary care practitioner and the need for better diabetes care, it is essential to teach an efficient but systematic approach to diabetes care.
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Affiliation(s)
- Catherine S Barnes
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - David C Ziemer
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Chris D Miller
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Joyce P Doyle
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Clyde Watkins
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Curtiss B Cook
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Dan L Gallina
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Imad el-Kebbi
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
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