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Trent SA, Allen LA, Regensteiner JG, Huebschmann AG. Toward Personalized and Equitable Chest Pain Pathways: Considerations Related to Sex and Gender Differences. J Womens Health (Larchmt) 2024. [PMID: 38607925 DOI: 10.1089/jwh.2024.0242] [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: 04/14/2024] Open
Affiliation(s)
- Stacy A Trent
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
- Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Judith G Regensteiner
- Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Amy G Huebschmann
- Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Abushamat LA, Schauer IE, Low Wang CC, Mitchell S, Herlache L, Bridenstine M, Durbin R, Snell-Bergeon JK, Regensteiner JG, Reusch JE. Rosiglitazone improves insulin resistance but does not improve exercise capacity in individuals with impaired glucose tolerance: A randomized clinical study. J Investig Med 2024; 72:294-304. [PMID: 38148342 DOI: 10.1177/10815589231225183] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Dysmetabolic states, such as type 2 diabetes (T2D), characterized by insulin resistance (IR), are associated with fatty liver, increased cardiovascular disease (CVD) risk, and decreased functional exercise capacity (FEC). Rosiglitazone (RO) improves exercise capacity and IR in T2D. However, the effects of RO on FEC and other markers of CVD risk in prediabetes are unknown. We hypothesized that insulin sensitization with RO would improve exercise capacity and markers of CVD risk in participants with impaired glucose tolerance (IGT). Exercise performance (peak oxygen consumption and oxygen uptake kinetics), IR (homeostasis model assessment of IR and quantitative insulin sensitivity check index), and surrogate cardiovascular endpoints (coronary artery calcium (CAC) volume and density and C-reactive protein (CRP)) were measured in participants with IGT after 12 and 18 months of RO or placebo (PL). RO did not significantly improve exercise capacity. Glycemic measures and IR were significantly lower in people on RO compared to PL at 18 months. CAC volume progression was not different between PL and RO groups. RO did not improve exercise capacity during an 18-month intervention despite improved IR and glycemia in people with IGT. Future studies should explore why effects on FEC with RO occur in T2D but not IGT. Understanding these questions may help in targeting therapeutic approaches in T2D and IGT.
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Affiliation(s)
- Layla A Abushamat
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - Irene E Schauer
- Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
- Endocrine Section, Denver Veterans Affairs Medical Center, Denver, CO, USA
- Ludeman Family Center for Women's Health Research, Aurora, CO, USA
| | - Cecilia C Low Wang
- Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - Stacey Mitchell
- Endocrine Section, Denver Veterans Affairs Medical Center, Denver, CO, USA
- Denver Endocrinology, Diabetes and Thyroid Center, Englewood, CO, USA
| | - Leah Herlache
- Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | | | - Roy Durbin
- Arbor Family Medicine PC, Westminster, CO, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus School of Public Health, Aurora, CO, USA
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women's Health Research, Aurora, CO, USA
| | - Jane Eb Reusch
- Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
- Endocrine Section, Denver Veterans Affairs Medical Center, Denver, CO, USA
- Ludeman Family Center for Women's Health Research, Aurora, CO, USA
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3
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Usselman CW, Lindsey ML, Robinson AT, Habecker BA, Taylor CE, Merryman WD, Kimmerly D, Bender JR, Regensteiner JG, Moreau KL, Pilote L, Wenner MM, O'Brien M, Yarovinsky TO, Stachenfeld NS, Charkoudian N, Denfeld QE, Moreira-Bouchard JD, Pyle WG, DeLeon-Pennell KY. Guidelines on the use of sex and gender in cardiovascular research. Am J Physiol Heart Circ Physiol 2024; 326:H238-H255. [PMID: 37999647 DOI: 10.1152/ajpheart.00535.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 08/31/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
In cardiovascular research, sex and gender have not typically been considered in research design and reporting until recently. This has resulted in clinical research findings from which not only all women, but also gender-diverse individuals have been excluded. The resulting dearth of data has led to a lack of sex- and gender-specific clinical guidelines and raises serious questions about evidence-based care. Basic research has also excluded considerations of sex. Including sex and/or gender as research variables not only has the potential to improve the health of society overall now, but it also provides a foundation of knowledge on which to build future advances. The goal of this guidelines article is to provide advice on best practices to include sex and gender considerations in study design, as well as data collection, analysis, and interpretation to optimally establish rigor and reproducibility needed to inform clinical decision-making and improve outcomes. In cardiovascular physiology, incorporating sex and gender is a necessary component when optimally designing and executing research plans. The guidelines serve as the first guidance on how to include sex and gender in cardiovascular research. We provide here a beginning path toward achieving this goal and improve the ability of the research community to interpret results through a sex and gender lens to enable comparison across studies and laboratories, resulting in better health for all.
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Affiliation(s)
- Charlotte W Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Merry L Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, United States
- Research Service, Nashville Veterans Affairs Medical Center, Nashville, Tennessee, United States
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry and Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Chloe E Taylor
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - W David Merryman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - Derek Kimmerly
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey R Bender
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale Cardiovascular Research Center, New Haven, Connecticut, United States
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Judith G Regensteiner
- Divisions of General Internal Medicine and Cardiology, Department of Medicine, Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Kerrie L Moreau
- Division of Geriatrics, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, United States
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Megan M Wenner
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Myles O'Brien
- School of Physiotherapy and Department of Medicine, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timur O Yarovinsky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale Cardiovascular Research Center, New Haven, Connecticut, United States
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nina S Stachenfeld
- John B. Pierce Laboratory, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Quin E Denfeld
- School of Nursing and Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Jesse D Moreira-Bouchard
- Q.U.E.E.R. Lab, Programs in Human Physiology, Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - W Glen Pyle
- IMPART Team Canada Network, Dalhousie Medicine, Saint John, New Brunswick, Canada
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Kristine Y DeLeon-Pennell
- School of Medicine, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
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4
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Abushamat LA, Enge D, Fujiwara T, Schäfer M, Clark EW, Englund EK, Scalzo RL, Johnston A, Rafferty D, Schauer IE, Whipple MO, Hunter K, Huebschmann AG, Nadeau KJ, Jarvis K, Barker AJ, Regensteiner JG, Reusch JEB. Obesity dominates early effects on cardiac structure and arterial stiffness in people with type 2 diabetes. J Hypertens 2023; 41:1775-1784. [PMID: 37589719 PMCID: PMC10592255 DOI: 10.1097/hjh.0000000000003534] [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] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) and obesity are global epidemics leading to excess cardiovascular disease (CVD). This study investigates standard and novel cardiac MRI parameters to detect subclinical cardiac and central vascular dysfunction in inactive people with and without T2D. METHODS Physically inactive age and BMI-similar premenopausal women and men with ( n = 22) and without [ n = 34, controls with overweight/obesity (CWO)] uncomplicated T2D were compared to an age-similar and sex-similar reference control cohort ( n = 20). Left ventricular (LV) structure, function, and aortic stiffness were assessed by MRI. Global arterial pulse wave velocity (PWV) was assessed using carotid-to-femoral applanation tonometry. Regional PWV was measured via 2D phase-contrast MRI and 4D flow MRI. RESULTS Global arterial PWV did not differ between CWO and T2D. 2D PC-MRI PWV in the ascending aorta was higher in people with T2D compared with CWOs ( P < 0.01). 4D flow PWV in the thoracic aorta was higher in CWO ( P < 0.01), and T2D ( P < 0.001) compared with RC. End-diastolic volume, end-systolic volume, stroke volume, and cardiac output were lower in CWO and T2D groups compared with reference control. CONCLUSION Subclinical changes in arterial stiffening and cardiac remodeling in inactive CWO and T2D compared with reference control support obesity and/or physical inactivity as determinants of incipient CVD complications in uncomplicated T2D. Future studies should determine the mechanistic causes of the CVD complications in greater detail in order to create therapeutic targets. CLINICAL TRIAL REGISTRATION Cardiovascular Mechanisms of Exercise Intolerance in Diabetes and the Role of Sex (NCT03419195).
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Affiliation(s)
- Layla A Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Daniel Enge
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Department of Bioengineering
| | - Takashi Fujiwara
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Michal Schäfer
- Division of General Internal Medicine
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus
| | - Ethan W Clark
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erin K Englund
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Rebecca L Scalzo
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | - Aspen Johnston
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | | | - Irene E Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | - Mary O Whipple
- Division of General Internal Medicine
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | | | - Amy G Huebschmann
- Ludeman Family Center for Women's Health Research
- Division of General Internal Medicine
| | - Kristen J Nadeau
- Ludeman Family Center for Women's Health Research
- Pediatric Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Bioengineering
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Judith G Regensteiner
- Ludeman Family Center for Women's Health Research
- Division of General Internal Medicine
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus
| | - Jane E B Reusch
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
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5
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Thielen SC, Reusch JEB, Regensteiner JG. A narrative review of exercise participation among adults with prediabetes or type 2 diabetes: barriers and solutions. Front Clin Diabetes Healthc 2023; 4:1218692. [PMID: 37711232 PMCID: PMC10499496 DOI: 10.3389/fcdhc.2023.1218692] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
Type 2 diabetes (T2D) has been rising in prevalence over the past few decades in the US and worldwide. T2D contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Exercise is a major cornerstone of therapy for T2D as a result of its positive effects on glycemic control, blood pressure, weight loss and cardiovascular risk as well as other measures of health. However, studies show that a majority of people with T2D do not exercise regularly. The reasons given as to why exercise goals are not met are varied and include physiological, psychological, social, cultural and environmental barriers to exercise. One potential cause of inactivity in people with T2D is impaired cardiorespiratory fitness, even in the absence of clinically evident complications. The exercise impairment, although present in both sexes, is greater in women than men with T2D. Women with T2D also experience greater perceived exertion with exercise than their counterparts without diabetes. These physiological barriers are in addition to constructed societal barriers including cultural expectations of bearing the burden of childrearing for women and in some cultures, having limited access to exercise because of additional cultural expectations. People at risk for and with diabetes more commonly experience unfavorable social determinants of health (SDOH) than people without diabetes, represented by neighborhood deprivation. Neighborhood deprivation measures lack of resources in an area influencing socioeconomic status including many SDOH such as income, housing conditions, living environment, education and employment. Higher indices of neighborhood deprivation have been associated with increased risk of all-cause, cardiovascular and cancer related mortality. Unfavorable SDOH is also associated with obesity and lower levels of physical activity. Ideally regular physical activity should be incorporated into all communities as part of a productive and healthy lifestyle. One potential solution to improve access to physical activity is designing and building environments with increased walkability, greenspace and safe recreational areas. Other potential solutions include the use of continuous glucose monitors as real-time feedback tools aimed to increase motivation for physical activity, counseling aimed at improving self-efficacy towards exercise and even acquiring a dog to increase walking time. In this narrative review, we aim to examine some traditional and novel barriers to exercise, as well as present evidence on novel interventions or solutions to overcome barriers to increase exercise and physical activity in all people with prediabetes and T2D.
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Affiliation(s)
- Samantha C. Thielen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E. B. Reusch
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Rocky Mountain Regional Department of Veterans Affairs Medical Center (VAMC), Aurora, CO, United States
| | - Judith G. Regensteiner
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Temkin SM, Barr E, Moore H, Caviston JP, Regensteiner JG, Clayton JA. Chronic conditions in women: the development of a National Institutes of health framework. BMC Womens Health 2023; 23:162. [PMID: 37024841 PMCID: PMC10077654 DOI: 10.1186/s12905-023-02319-x] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Rising rates of chronic conditions were cited as one of the key public health concerns in the Fiscal Year (FY) 2021 U.S. Senate and House of Representatives appropriations bills, where a review of current National Institutes of Health (NIH) portfolios relevant to research on women's health was requested. Chronic conditions were last defined by the US Department of Health and Human Services (HHS) in 2010. However, existing definitions of chronic conditions do not incorporate sex or gender considerations. Sex and gender influence health, yet significant knowledge gaps exist in the evidence-base for prevention, diagnosis, and treatment of chronic diseases amongst women. The presentation, prevalence, and long-term effects of chronic conditions and multimorbidity differs in women from men. A clinical framework was developed to adequately assess the NIH investment in research related to chronic conditions in women. The public health needs and NIH investment related to conditions included in the framework were measured. By available measures, research within the NIH has not mapped to the burden of chronic conditions among women. Clinical research questions and endpoints centered around women can be developed and implemented; clinical trials networks with expanded or extended eligibility criteria can be created; and data science could be used to extrapolate the effects of overlapping or multiple morbidities on the health of women. Aligning NIH research priorities to address the specific needs of women with chronic diseases is critical to addressing women's health needs from a life course perspective.
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Affiliation(s)
- Sarah M Temkin
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Barr
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Holly Moore
- National Institute On Drug Abuse National Institutes of Health, Bethesda, MD, USA
| | - Juliane P Caviston
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Judith G Regensteiner
- Department of Medicine, Ludeman Family Center for Women's Health Research, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Janine A Clayton
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
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Domalpally A, Whittier SA, Pan Q, Dabelea DM, Darwin CH, Knowler WC, Lee CG, Luchsinger JA, White NH, Chew EY, Gadde KM, Culbert IW, Arceneaux J, Chatellier A, Dragg A, Champagne CM, Duncan C, Eberhardt B, Greenway F, Guillory FG, Herbert AA, Jeffirs ML, Kennedy BM, Levy E, Lockett M, Lovejoy JC, Morris LH, Melancon LE, Ryan DH, Sanford DA, Smith KG, Smith LL, St.Amant JA, Tulley RT, Vicknair PC, Williamson D, Zachwieja JJ, Polonsky KS, Tobian J, Ehrmann DA, Matulik MJ, Temple KA, Clark B, Czech K, DeSandre C, Dotson B, Hilbrich R, McNabb W, Semenske AR, Caro JF, Furlong K, Goldstein BJ, Watson PG, Smith KA, Mendoza J, Simmons M, Wildman W, Liberoni R, Spandorfer J, Pepe C, Donahue RP, Goldberg RB, Prineas R, Calles J, Giannella A, Rowe P, Sanguily J, Cassanova-Romero P, Castillo-Florez S, Florez HJ, Garg R, Kirby L, Lara O, Larreal C, McLymont V, Mendez J, Perry A, Saab P, Veciana B, Haffner SM, Hazuda HP, Montez MG, Hattaway K, Isaac J, Lorenzo C, Martinez A, Salazar M, Walker T, Hamman RF, Nash PV, Steinke SC, Testaverde L, Truong J, Anderson DR, Ballonoff LB, Bouffard A, Bucca B, Calonge BN, Delve L, Farago M, Hill JO, Hoyer SR, Jenkins T, Jortberg BT, Lenz D, Miller M, Nilan T, Perreault L, Price DW, Regensteiner JG, Schroeder EB, Seagle H, Smith CM, VanDorsten B, Horton ES, Munshi M, Lawton KE, Jackson SD, Poirier CS, Swift K, Arky RA, Bryant M, Burke JP, Caballero E, Callaphan KM, Fargnoli B, Franklin T, Ganda OP, Guidi A, Guido M, Jacobsen AM, Kula LM, Kocal M, Lambert L, Ledbury S, Malloy MA, Middelbeek RJ, Nicosia M, Oldmixon CF, Pan J, Quitingon M, Rainville R, Rubtchinsky S, Seely EW, Sansoucy J, Schweizer D, Simonson D, Smith F, Solomon CG, Spellman J, Warram J, Kahn SE, Fattaleh B, Montgomery BK, Colegrove C, Fujimoto W, Knopp RH, Lipkin EW, Marr M, Morgan-Taggart I, Murillo A, O’Neal K, Trence D, Taylor L, Thomas A, Tsai EC, Dagogo-Jack S, Kitabchi AE, Murphy ME, Taylor L, Dolgoff J, Applegate WB, Bryer-Ash M, Clark D, Frieson SL, Ibebuogu U, Imseis R, Lambeth H, Lichtermann LC, Oktaei H, Ricks H, Rutledge LM, Sherman AR, Smith CM, Soberman JE, Williams-Cleaves B, Patel A, Nyenwe EA, Hampton EF, Metzger BE, Molitch ME, Johnson MK, Adelman DT, Behrends C, Cook M, Fitzgibbon M, Giles MM, Heard D, Johnson CK, Larsen D, Lowe A, Lyman M, McPherson D, Penn SC, Pitts T, Reinhart R, Roston S, Schinleber PA, Wallia A, Nathan DM, McKitrick C, Turgeon H, Larkin M, Mugford M, Abbott K, Anderson E, Bissett L, Bondi K, Cagliero E, Florez JC, Delahanty L, Goldman V, Grassa E, Gurry L, D’Anna K, Leandre F, Lou P, Poulos A, Raymond E, Ripley V, Stevens C, Tseng B, Olefsky JM, Barrett-Connor E, Mudaliar S, Araneta MR, Carrion-Petersen ML, Vejvoda K, Bassiouni S, Beltran M, Claravall LN, Dowden JM, Edelman SV, Garimella P, Henry RR, Horne J, Lamkin M, Janesch SS, Leos D, Polonsky W, Ruiz R, Smith J, Torio-Hurley J, Pi-Sunyer FX, Lee JE, Hagamen S, Allison DB, Agharanya N, Aronoff NJ, Baldo M, Crandall JP, Foo ST, Luchsinger JA, Pal C, Parkes K, Pena MB, Rooney ES, Van Wye GE, Viscovich KA, de Groot M, Marrero DG, Mather KJ, Prince MJ, Kelly SM, Jackson MA, McAtee G, Putenney P, Ackermann RT, Cantrell CM, Dotson YF, Fineberg ES, Fultz M, Guare JC, Hadden A, Ignaut JM, Kirkman MS, Phillips EO, Pinner KL, Porter BD, Roach PJ, Rowland ND, Wheeler ML, Aroda V, Magee M, Ratner RE, Youssef G, Shapiro S, Andon N, Bavido-Arrage C, Boggs G, Bronsord M, Brown E, Love Burkott H, Cheatham WW, Cola S, Evans C, Gibbs P, Kellum T, Leon L, Lagarda M, Levatan C, Lindsay M, Nair AK, Park J, Passaro M, Silverman A, Uwaifo G, Wells-Thayer D, Wiggins R, Saad MF, Watson K, Budget M, Jinagouda S, Botrous M, Sosa A, Tadros S, Akbar K, Conzues C, Magpuri P, Ngo K, Rassam A, Waters D, Xapthalamous K, Santiago JV, Brown AL, Das S, Khare-Ranade P, Stich T, Santiago A, Fisher E, Hurt E, Jones T, Kerr M, Ryder L, Wernimont C, Golden SH, Saudek CD, Bradley V, Sullivan E, Whittington T, Abbas C, Allen A, Brancati FL, Cappelli S, Clark JM, Charleston JB, Freel J, Horak K, Greene A, Jiggetts D, Johnson D, Joseph H, Loman K, Mathioudakis N, Mosley H, Reusing J, Rubin RR, Samuels A, Shields T, Stephens S, Stewart KJ, Thomas L, Utsey E, Williamson P, Schade DS, Adams KS, Canady JL, Johannes C, Hemphill C, Hyde P, Atler LF, Boyle PJ, Burge MR, Chai L, Colleran K, Fondino A, Gonzales Y, Hernandez-McGinnis DA, Katz P, King C, Middendorf J, Rubinchik S, Senter W, Crandall J, Shamoon H, Brown JO, Trandafirescu G, Powell D, Adorno E, Cox L, Duffy H, Engel S, Friedler A, Goldstein A, Howard-Century CJ, Lukin J, Kloiber S, Longchamp N, Martinez H, Pompi D, Scheindlin J, Violino E, Walker EA, Wylie-Rosett J, Zimmerman E, Zonszein J, Orchard T, Venditti E, Wing RR, Jeffries S, Koenning G, Kramer MK, Smith M, Barr S, Benchoff C, Boraz M, Clifford L, Culyba R, Frazier M, Gilligan R, Guimond S, Harrier S, Harris L, Kriska A, Manjoo Q, Mullen M, Noel A, Otto A, Pettigrew J, Rockette-Wagner B, Rubinstein D, Semler L, Smith CF, Weinzierl V, Williams KV, Wilson T, Mau MK, Baker-Ladao NK, Melish JS, Arakaki RF, Latimer RW, Isonaga MK, Beddow R, Bermudez NE, Dias L, Inouye J, Mikami K, Mohideen P, Odom SK, Perry RU, Yamamoto RE, Anderson H, Cooeyate N, Dodge C, Hoskin MA, Percy CA, Enote A, Natewa C, Acton KJ, Andre VL, Barber R, Begay S, Bennett PH, Benson MB, Bird EC, Broussard BA, Bucca BC, Chavez M, Cook S, Curtis J, Dacawyma T, Doughty MS, Duncan R, Edgerton C, Ghahate JM, Glass J, Glass M, Gohdes D, Grant W, Hanson RL, Horse E, Ingraham LE, Jackson M, Jay P, Kaskalla RS, Kavena K, Kessler D, Kobus KM, Krakoff J, Kurland J, Manus C, McCabe C, Michaels S, Morgan T, Nashboo Y, Nelson JA, Poirier S, Polczynski E, Piromalli C, Reidy M, Roumain J, Rowse D, Roy RJ, Sangster S, Sewenemewa J, Smart M, Spencer C, Tonemah D, Williams R, Wilson C, Yazzie M, Bain R, Fowler S, Temprosa M, Larsen MD, Brenneman T, Edelstein SL, Abebe S, Bamdad J, Barkalow M, Bethepu J, Bezabeh T, Bowers A, Butler N, Callaghan J, Carter CE, Christophi C, Dwyer GM, Foulkes M, Gao Y, Gooding R, Gottlieb A, Grimes KL, Grover-Fairchild N, Haffner L, Hoffman H, Jablonski K, Jones S, Jones TL, Katz R, Kolinjivadi P, Lachin JM, Ma Y, Mucik P, Orlosky R, Reamer S, Rochon J, Sapozhnikova A, Sherif H, Stimpson C, Hogan Tjaden A, Walker-Murray F, Venditti EM, Kriska AM, Weinzierl V, Marcovina S, Aldrich FA, Harting J, Albers J, Strylewicz G, Eastman R, Fradkin J, Garfield S, Lee C, Gregg E, Zhang P, O’Leary D, Evans G, Budoff M, Dailing C, Stamm E, Schwartz A, Navy C, Palermo L, Rautaharju P, Prineas RJ, Alexander T, Campbell C, Hall S, Li Y, Mills M, Pemberton N, Rautaharju F, Zhang Z, Soliman EZ, Hu J, Hensley S, Keasler L, Taylor T, Blodi B, Danis R, Davis M, Hubbard* L, Endres** R, Elsas** D, Johnson** S, Myers** D, Barrett N, Baumhauer H, Benz W, Cohn H, Corkery E, Dohm K, Gama V, Goulding A, Ewen A, Hurtenbach C, Lawrence D, McDaniel K, Pak J, Reimers J, Shaw R, Swift M, Vargo P, Watson S, Manly J, Mayer-Davis E, Moran RR, Ganiats T, David K, Sarkin AJ, Groessl E, Katzir N, Chong H, Herman WH, Brändle M, Brown MB, Altshuler D, Billings LK, Chen L, Harden M, Knowler WC, Pollin TI, Shuldiner AR, Franks PW, Hivert MF. Association of Metformin With the Development of Age-Related Macular Degeneration. JAMA Ophthalmol 2023; 141:140-147. [PMID: 36547967 PMCID: PMC9936345 DOI: 10.1001/jamaophthalmol.2022.5567] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022]
Abstract
Importance Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD. Objective To investigate the association between metformin use and age-related macular degeneration (AMD). Design, Setting, and Participants The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for developing diabetes. Participants with retinal imaging at a follow-up visit 16 years posttrial (2017-2019) were included. Analysis took place between October 2019 and May 2022. Interventions Participants were randomly distributed between 3 interventional arms: lifestyle, metformin, and placebo. Main Outcomes and Measures Prevalence of AMD in the treatment arms. Results Of 1592 participants, 514 (32.3%) were in the lifestyle arm, 549 (34.5%) were in the metformin arm, and 529 (33.2%) were in the placebo arm. All 3 arms were balanced for baseline characteristics including age (mean [SD] age at randomization, 49 [9] years), sex (1128 [71%] male), race and ethnicity (784 [49%] White), smoking habits, body mass index, and education level. AMD was identified in 479 participants (30.1%); 229 (14.4%) had early AMD, 218 (13.7%) had intermediate AMD, and 32 (2.0%) had advanced AMD. There was no significant difference in the presence of AMD between the 3 groups: 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups. Mean duration of metformin use was similar for those with and without AMD (mean [SD], 8.0 [9.3] vs 8.5 [9.3] years; P = .69). In the multivariate models, history of smoking was associated with increased risks of AMD (odds ratio, 1.30; 95% CI, 1.05-1.61; P = .02). Conclusions and Relevance These data suggest neither metformin nor lifestyle changes initiated for diabetes prevention were associated with the risk of any AMD, with similar results for AMD severity. Duration of metformin use was also not associated with AMD. This analysis does not address the association of metformin with incidence or progression of AMD.
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Affiliation(s)
- Amitha Domalpally
- Wisconsin Reading Center, Department of Ophthalmology, University of Wisconsin School of Medicine and Public and Health, Madison
| | - Samuel A. Whittier
- Wisconsin Reading Center, Department of Ophthalmology, University of Wisconsin School of Medicine and Public and Health, Madison
| | - Qing Pan
- Department of Statistics, George Washington University, Washington, DC
| | - Dana M. Dabelea
- Department of Epidemiology, University of Colorado School of Public Health, Denver
| | - Christine H. Darwin
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Christine G. Lee
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Neil H. White
- Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Emily Y. Chew
- Division of Epidemiology and Clinical Applications–Clinical Trials Branch, National Eye Institute - National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Amber Dragg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Crystal Duncan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Frank Greenway
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Erma Levy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Monica Lockett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Donna H. Ryan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Lisa L. Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Janet Tobian
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Bart Clark
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kirsten Czech
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Wylie McNabb
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jose F. Caro
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kevin Furlong
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jewel Mendoza
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marsha Simmons
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Wendi Wildman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Renee Liberoni
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Constance Pepe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Ronald Prineas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anna Giannella
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Patricia Rowe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Rajesh Garg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Olga Lara
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carmen Larreal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jadell Mendez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Arlette Perry
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Patrice Saab
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Bertha Veciana
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kathy Hattaway
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Juan Isaac
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carlos Lorenzo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Monica Salazar
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tatiana Walker
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | | | - Brian Bucca
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - B. Ned Calonge
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lynne Delve
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Martha Farago
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James O. Hill
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Tonya Jenkins
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Dione Lenz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marsha Miller
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Nilan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - David W. Price
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Helen Seagle
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Medha Munshi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kati Swift
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ronald A. Arky
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Om P. Ganda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ashley Guidi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Mathew Guido
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Lyn M. Kula
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Margaret Kocal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lori Lambert
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sarah Ledbury
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Jocelyn Pan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Ellen W. Seely
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Dana Schweizer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Fannie Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - James Warram
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Steven E. Kahn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Basma Fattaleh
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Michelle Marr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anne Murillo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kayla O’Neal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dace Trence
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lonnese Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - April Thomas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Elaine C. Tsai
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mary E. Murphy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Laura Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Debra Clark
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Uzoma Ibebuogu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Raed Imseis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helen Lambeth
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hooman Oktaei
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Harriet Ricks
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Amy R. Sherman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Clara M. Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Avnisha Patel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | - Michelle Cook
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Mimi M. Giles
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Deloris Heard
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Diane Larsen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anne Lowe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Megan Lyman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Samsam C. Penn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Pitts
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Renee Reinhart
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Roston
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Amisha Wallia
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Mary Larkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Kathy Abbott
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ellen Anderson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Laurie Bissett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristy Bondi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jose C. Florez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Elaine Grassa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lindsery Gurry
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kali D’Anna
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Peter Lou
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Elyse Raymond
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Valerie Ripley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Beverly Tseng
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Karen Vejvoda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | - Javiva Horne
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marycie Lamkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Diana Leos
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rosa Ruiz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jean Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Jane E. Lee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Hagamen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Maria Baldo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sandra T. Foo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Carmen Pal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kathy Parkes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Mary Beth Pena
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Mary de Groot
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Susie M. Kelly
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Gina McAtee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Paula Putenney
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Megan Fultz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - John C. Guare
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Angela Hadden
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kisha L Pinner
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Paris J. Roach
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Vanita Aroda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Michelle Magee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Sue Shapiro
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Natalie Andon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Susan Cola
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Cindy Evans
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Peggy Gibbs
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tracy Kellum
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lilia Leon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Milvia Lagarda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Asha K. Nair
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jean Park
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Gabriel Uwaifo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Renee Wiggins
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Karol Watson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maria Budget
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Medhat Botrous
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anthony Sosa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sameh Tadros
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Khan Akbar
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Kathy Ngo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Amer Rassam
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Debra Waters
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Samia Das
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Tamara Stich
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ana Santiago
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Edwin Fisher
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Emma Hurt
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tracy Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Michelle Kerr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lucy Ryder
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Emily Sullivan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Caroline Abbas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Adrienne Allen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Janice Freel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Alicia Greene
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dawn Jiggetts
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hope Joseph
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kimberly Loman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Henry Mosley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - John Reusing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Alafia Samuels
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Shields
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - LeeLana Thomas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Evonne Utsey
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Penny Hyde
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mark R. Burge
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Chai
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ateka Fondino
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ysela Gonzales
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Patricia Katz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carolyn King
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jill Crandall
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Harry Shamoon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Janet O. Brown
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Elsie Adorno
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Liane Cox
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helena Duffy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Samuel Engel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jennifer Lukin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Stacey Kloiber
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Helen Martinez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dorothy Pompi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Elissa Violino
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Joel Zonszein
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Trevor Orchard
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rena R. Wing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Jeffries
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Gaye Koenning
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - M. Kaye Kramer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marie Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Barr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Miriam Boraz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Clifford
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Rebecca Culyba
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ryan Gilligan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Susan Harrier
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Louann Harris
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Andrea Kriska
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Monica Mullen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Alicia Noel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Amy Otto
- for the Diabetes Prevention Program Research (DPPOS) Group
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- for the Diabetes Prevention Program Research (DPPOS) Group
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- for the Diabetes Prevention Program Research (DPPOS) Group
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- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mae K. Isonaga
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ralph Beddow
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Lorna Dias
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jillian Inouye
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kathy Mikami
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sharon K. Odom
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Mary A. Hoskin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carol A. Percy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Alvera Enote
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Camille Natewa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kelly J. Acton
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rosalyn Barber
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Shandiin Begay
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Evelyn C. Bird
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Brian C. Bucca
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sherron Cook
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jeff Curtis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tara Dacawyma
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Roberta Duncan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Cyndy Edgerton
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Justin Glass
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Martia Glass
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dorothy Gohdes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Wendy Grant
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ellie Horse
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Merry Jackson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Priscilla Jay
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Karen Kavena
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - David Kessler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Jason Kurland
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Cherie McCabe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sara Michaels
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tina Morgan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Steven Poirier
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mike Reidy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Debra Rowse
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert J. Roy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Miranda Smart
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Darryl Tonemah
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Raymond Bain
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sarah Fowler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Tina Brenneman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Solome Abebe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Julie Bamdad
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Joel Bethepu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anna Bowers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Nicole Butler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Mary Foulkes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yuping Gao
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert Gooding
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Lori Haffner
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Steve Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tara L. Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Richard Katz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - John M. Lachin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yong Ma
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Pamela Mucik
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert Orlosky
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Reamer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James Rochon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hanna Sherif
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | | | | | - John Albers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - R. Eastman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Judith Fradkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Christine Lee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Edward Gregg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ping Zhang
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dan O’Leary
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Gregory Evans
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Matthew Budoff
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Chris Dailing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ann Schwartz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Caroline Navy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Palermo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Sharon Hall
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yabing Li
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Margaret Mills
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Zhuming Zhang
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Julie Hu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Hensley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Keasler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tonya Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Barbara Blodi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ronald Danis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Matthew Davis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Larry Hubbard*
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ryan Endres**
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Dawn Myers**
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Nancy Barrett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Wendy Benz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Holly Cohn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ellie Corkery
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristi Dohm
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Vonnie Gama
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anne Goulding
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Andy Ewen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Kyle McDaniel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jeong Pak
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James Reimers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ruth Shaw
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maria Swift
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Pamela Vargo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sheila Watson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jennifer Manly
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Ted Ganiats
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristin David
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Erik Groessl
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Naomi Katzir
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helen Chong
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Ling Chen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maegan Harden
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Toni I. Pollin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Paul W. Franks
- for the Diabetes Prevention Program Research (DPPOS) Group
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Jagsi R, Beeland TD, Sia K, Szczygiel LA, Allen MR, Arora VM, Bair-Merritt M, Bauman MD, Bogner HR, Daumit G, Davis E, Fagerlin A, Ford DE, Gbadegesin R, Griendling K, Hartmann K, Hedayati SS, Jackson RD, Matulevicius S, Mugavero MJ, Nehl EJ, Neogi T, Regensteiner JG, Rubin MA, Rubio D, Singer K, Tucker Edmonds B, Volerman A, Laney S, Patton C, Escobar Alvarez S. Doris Duke Charitable Foundation Fund to Retain Clinical Scientists: innovating support for early-career family caregivers. J Clin Invest 2022; 132:166075. [PMID: 36453546 PMCID: PMC9711869 DOI: 10.1172/jci166075] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - Kevin Sia
- Doris Duke Charitable Foundation, New York, New York, USA
| | | | - Matthew R. Allen
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vineet M. Arora
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | - Hillary R. Bogner
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gail Daumit
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Esa Davis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Angela Fagerlin
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Daniel E. Ford
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Michael A. Rubin
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Doris Rubio
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | - Anna Volerman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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9
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Whipple MO, Pinto AJ, Abushamat LA, Bergouignan A, Chapman K, Huebschmann AG, Masters KS, Nadeau KJ, Scalzo RL, Schauer IE, Rafferty D, Reusch JE, Regensteiner JG. Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis. Diabetes Care 2022; 45:2163-2177. [PMID: 36044665 PMCID: PMC9472508 DOI: 10.2337/dc22-0576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. PURPOSE To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span. DATA SOURCES Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus. STUDY SELECTION We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender. DATA EXTRACTION Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers. DATA SYNTHESIS A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women). LIMITATIONS Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. CONCLUSIONS Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.
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Affiliation(s)
- Mary O. Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ana J. Pinto
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Layla A. Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Hubert Curien Pluridisciplinary Institute UMR7178, CNRS and Université de Strasbourg, Strasbourg, France
| | - Kristina Chapman
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin S. Masters
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Clinical Health Psychology, Department of Psychology, University of Colorado Denver, Denver, CO
| | - Kristen J. Nadeau
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L. Scalzo
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Irene E. Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E.B. Reusch
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
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10
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Huebschmann AG, Glasgow RE, Leavitt IM, Chapman K, Rice JD, Lockhart S, Stevens-Lapsley JE, Reusch JEB, Dunn AL, Regensteiner JG. Integrating a physical activity coaching intervention into diabetes care: a mixed-methods evaluation of a pilot pragmatic trial. Transl Behav Med 2022; 12:601-610. [PMID: 35312788 PMCID: PMC9150080 DOI: 10.1093/tbm/ibac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Physical activity (PA) counseling is under-utilized in primary care for patients with type 2 diabetes mellitus (T2D), despite improving important health outcomes, including physical function. We adapted evidence-based PA counseling programs to primary care patients, staff, and leader's needs, resulting in "Be ACTIVE" comprised of shared PA tracker data (FitBit©), six theory-informed PA coaching calls, and three in-person clinician visits. In a pilot randomized pragmatic trial, we evaluated the feasibility, acceptability, and effectiveness of Be ACTIVE. Sedentary patients with T2D were randomized to Be ACTIVE versus an enhanced control condition. Mixed methods assessments of feasibility and acceptability included costs. Objective pilot effectiveness outcomes included PA (primary outcome, accelerometer steps/week), the Short Physical Performance Battery (SPPB) physical function measure, and behavioral PA predictors. Fifty patients were randomized to Be ACTIVE or control condition. Acceptability was >90% for patients and clinic staff. Coaching and PA tracking costs of ~$90/patient met Medicare reimbursement criteria. Pre-post PA increased by ~11% (Be ACTIVE) and ~6% in controls (group difference: 1574 ± 4391 steps/week, p = .72). As compared to controls, Be ACTIVE participants significantly improved SPPB (0.9 ± 0.3 vs. -0.1 ± 0.3, p = .01, changes >0.5 points prevent falls clinically), and PA predictors of self-efficacy (p = .02) and social-environmental support (p < .01). In this pilot trial, Be ACTIVE was feasible and highly acceptable to stakeholders and yielded significant improvements in objective physical function consistent with lower fall risk, whereas PA changes were less than anticipated. Be ACTIVE may need additional adaptation or a longer duration to improve PA outcomes.
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Affiliation(s)
- Amy G Huebschmann
- Department of Medicine, Division of General Internal Medicine, University of Colorado (CU) School of Medicine, Aurora, CO 80045, USA
- CU Ludeman Family Center for Women’s Health Research, Aurora, CO, USA
- CU Adult and Child Consortium of Outcomes Research and Delivery Scienc, Aurora, CO, USA
- Correspondence to: A Huebschmann,
| | - Russell E Glasgow
- CU Adult and Child Consortium of Outcomes Research and Delivery Scienc, Aurora, CO, USA
- CU Department of Family Medicine, Aurora, CO, USA
| | - Ian M Leavitt
- University of Texas, MD Anderson Cancer Center, Department of Social and Behavioral Sciences, Houston, TX, USA
| | - Kristi Chapman
- Department of Medicine, Division of General Internal Medicine, University of Colorado (CU) School of Medicine, Aurora, CO 80045, USA
| | - John D Rice
- Colorado School of Public Health, Department of Biostatistics, Aurora, CO, USA
| | - Steven Lockhart
- CU Adult and Child Consortium of Outcomes Research and Delivery Scienc, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- CU Physical Therapy Program, Aurora, CO, USA
- Rocky Mountain Regional VAMC, Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Jane E B Reusch
- CU Ludeman Family Center for Women’s Health Research, Aurora, CO, USA
- CU Division of Endocrinology, Aurora, CO, USA
- Rocky Mountain Regional VAMC, Division of Endocrinology, Aurora, CO, USA
| | - Andrea L Dunn
- Klein-Buendel, Inc. (Retired Senior Scientist Emeritus), Golden, CO, USA
| | - Judith G Regensteiner
- Department of Medicine, Division of General Internal Medicine, University of Colorado (CU) School of Medicine, Aurora, CO 80045, USA
- CU Ludeman Family Center for Women’s Health Research, Aurora, CO, USA
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11
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Regensteiner JG, Reusch JEB. Sex Differences in Cardiovascular Consequences of Hypertension, Obesity, and Diabetes: JACC Focus Seminar 4/7. J Am Coll Cardiol 2022; 79:1492-1505. [PMID: 35422246 PMCID: PMC9503760 DOI: 10.1016/j.jacc.2022.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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] [Received: 10/28/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
It has long been recognized that there are significant differences between the sexes affecting prevalence, incidence, and severity over a broad range of diseases. Until the early 1990s, the limited research conducted on women's health focused primarily on diseases affecting fertility and reproduction, and women were excluded from most clinical trials. For these reasons, the prevention, diagnosis, and treatment of serious chronic diseases such as cardiovascular disease in women continue to be based primarily on findings in men, and sex-specific clinical guidelines are mostly lacking. Hypertension, obesity, and diabetes, interrelated risk factors for cardiovascular disease, differ by sex in terms of prevalence and adverse effects as well as by genetics and biology. Research is needed to understand sex differences in hypertension, obesity, and diabetes to optimally inform sex-specific prevention, diagnosis, and treatment strategies for women and men. In this way, sex-specific clinical guidelines can be developed where warranted.
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Affiliation(s)
- Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Jane E B Reusch
- Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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Regensteiner JG, Treat-Jacobson D. What does the future hold for structured exercise training for people with PAD? Ideas from two Masters of the Society for Vascular Medicine. Vasc Med 2022; 27:116-119. [PMID: 35388717 DOI: 10.1177/1358863x221083342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith G Regensteiner
- Department of Medicine, Division of General Internal Medicine, Division of Cardiology, Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
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13
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Kalet A, Libby AM, Jagsi R, Brady K, Chavis-Keeling D, Pillinger MH, Daumit GL, Drake AF, Drake WP, Fraser V, Ford D, Hochman JS, Jones RD, Mangurian C, Meagher EA, McGuinness G, Regensteiner JG, Rubin DC, Yaffe K, Ravenell JE. Mentoring Underrepresented Minority Physician-Scientists to Success. Acad Med 2022; 97:497-502. [PMID: 34495889 DOI: 10.1097/acm.0000000000004402] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As the nation seeks to recruit and retain physician-scientists, gaps remain in understanding and addressing mitigatable challenges to the success of faculty from underrepresented minority (URM) backgrounds. The Doris Duke Charitable Foundation Fund to Retain Clinical Scientists program, implemented in 2015 at 10 academic medical centers in the United States, seeks to retain physician-scientists at risk of leaving science because of periods of extraordinary family caregiving needs, hardships that URM faculty-especially those who identify as female-are more likely to experience. At the annual Fund to Retain Clinical Scientists program directors conference in 2018, program directors-21% of whom identify as URM individuals and 13% as male-addressed issues that affect URM physician-scientists in particular. Key issues that threaten the retention of URM physician-scientists were identified through focused literature reviews; institutional environmental scans; and structured small- and large-group discussions with program directors, staff, and participants. These issues include bias and discrimination, personal wealth differential, the minority tax (i.e., service burdens placed on URM faculty who represent URM perspectives on committees and at conferences), lack of mentorship training, intersectionality and isolation, concerns about confirming stereotypes, and institutional-level factors. The authors present recommendations for how to create an environment in which URM physician-scientists can expect equitable opportunities to thrive, as institutions demonstrate proactive allyship and remove structural barriers to success. Recommendations include providing universal training to reduce interpersonal bias and discrimination, addressing the consequences of the personal wealth gap through financial counseling and benefits, measuring the service faculty members provide to the institution as advocates for URM faculty issues and compensating them appropriately, supporting URM faculty who wish to engage in national leadership programs, and sustaining institutional policies that address structural and interpersonal barriers to inclusive excellence.
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Affiliation(s)
- Adina Kalet
- A. Kalet is professor and Stephen and Shelagh Roell Endowed Chair, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Wauwatosa, Wisconsin; ORCID: https://orcid.org/0000-0003-4855-0223
| | - Anne M Libby
- A.M. Libby is professor and vice chair for academic affairs, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-4564-9407
| | - Reshma Jagsi
- R. Jagsi is Newman Family Professor and deputy chair, Department of Radiation Oncology, and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6562-1228
| | - Kathleen Brady
- K. Brady is professor and vice president for research, Medical University of South Carolina, Charleston, South Carolina; ORCID: https://orcid.org/0000-0002-3944-8051
| | - Deborah Chavis-Keeling
- D. Chavis-Keeling is executive director, Administration, Finance, and Operations, Clinical and Translational Science Institute, and director, Administrative Core, Clinical and Translational Science Award, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-1528-8532
| | - Michael H Pillinger
- M.H. Pillinger is professor of medicine and director, Translational Research Education and Careers Unit, Clinical and Translational Science Institute, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0003-3168-1542
| | - Gail L Daumit
- G.L. Daumit is Samsung Professor of Medicine and vice chair, Clinical and Translational Research, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0717-0216
| | - Amelia F Drake
- A.F. Drake is Newton D. Fischer Distinguished Professor of Otolaryngology/Head and Neck Surgery, director, University of North Carolina Craniofacial Center (School of Dentistry), and executive associate dean of academic programs, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wonder Puryear Drake
- W.P. Drake is professor of medicine and pathology, microbiology, and immunology, Robert A. Goodwin Jr. Director in Medicine, and director, Sarcoidosis Center of Excellence, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9406-3130
| | - Victoria Fraser
- V. Fraser is Adolphus Busch Professor of Medicine and chair, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; ORCID: https://orcid.org/0000-0001-6251-0733
| | - Daniel Ford
- D. Ford is professor of medicine and director, Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland
| | - Judith S Hochman
- J.S. Hochman is Harold Snyder Family Professor of Cardiology, associate director, Leon H. Charney Division of Cardiology, senior associate dean for clinical sciences, and codirector, Clinical and Translational Science Institute, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-5889-5981
| | - Rochelle D Jones
- R.D. Jones is a research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christina Mangurian
- C. Mangurian is professor of psychiatry and vice chair for diversity and health equity, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), affiliate faculty, UCSF Philip R. Lee Institute for Health Policy Studies, and core faculty, UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California; ORCID: https://orcid.org/0000-0002-9839-652X
| | - Emma A Meagher
- E.A. Meagher is professor, medicine and pharmacology, and vice dean and chief clinical research officer, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-1841-4570
| | - Georgeann McGuinness
- G. McGuinness is professor and vice chair of academic affairs, senior vice chair of radiology, associate dean for mentoring and professional development, and director, clinical faculty mentoring, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-5326-9180
| | - Judith G Regensteiner
- J.G. Regensteiner is professor, Judith and Joseph Wagner Chair in Women's Health Research, director, Center for Women's Health Research, and director, Office of Women in Medicine and Science, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-9331-3908
| | - Deborah C Rubin
- D.C. Rubin is William B. Kountz Professor of Medicine, professor of developmental biology, and associate director of faculty affairs, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri; ORCID: https://orcid.org/0000-0002-4192-909X
| | - Kristine Yaffe
- K. Yaffe is professor of psychiatry, neurology, and epidemiology, University of California, San Francisco, Weill Institute for Neurosciences, and Roy and Marie Scola Endowed Chair and vice chair of research in psychiatry, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0003-0919-3825
| | - Joseph E Ravenell
- J.E. Ravenell is associate professor, Departments of Population Health and Internal Medicine, associate dean for diversity affairs and inclusion, and director, Diversity in Research, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0001-7024-3460
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14
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Abstract
Peripheral artery disease (PAD), a prevalent manifestation of atherosclerosis, is associated with increased cardiovascular morbidity and mortality as well as decreased functional ability. Exercise training for PAD is acknowledged to be a highly effective treatment, which improves walking ability and cardiovascular risk. The historical development of this treatment has not been the focus of a report. Therefore, we present a historical review of research on exercise training for PAD. Overall, this body of knowledge has provided strong evidence of the efficacy of supervised exercise training (SET) to improve walking ability for patients with claudication due to PAD. SET, using intermittent bouts of walking exercise to moderate claudication pain on a treadmill, is considered the most efficacious mode of exercise to improve walking ability in patients with claudication. This compelling evidence published over the past 60 years was evaluated by the Centers for Medicare & Medicaid Services in 2017, which culminated in a national coverage determination for SET to improve symptomatic PAD. Future directions include determining optimal delivery strategies for SET and further elucidation of the mechanisms of improvement in walking ability resulting from SET. In addition, alternative forms of exercise should be evaluated and effective home- and community-based exercise interventions should be assessed. There is an enormous need to increase the inclusion of women and racial and ethnic minority groups in studies. It is to be hoped that researchers will continue with new innovative research and persistence in the treatment of claudication due to PAD.
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Affiliation(s)
- Ulf G Bronas
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois – Chicago, Chicago, IL, USA
| | - Judith G Regensteiner
- Ludeman Family Center for Women’s Health Research; Divisions of General Internal Medicine and Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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15
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Love KM, Barrett EJ, Malin SK, Reusch JEB, Regensteiner JG, Liu Z. Diabetes pathogenesis and management: the endothelium comes of age. J Mol Cell Biol 2021; 13:500-512. [PMID: 33787922 PMCID: PMC8530521 DOI: 10.1093/jmcb/mjab024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Endothelium, acting as a barrier, protects tissues against factors that provoke insulin resistance and type 2 diabetes and itself responds to the insult of insulin resistance inducers with altered function. Endothelial insulin resistance and vascular dysfunction occur early in the evolution of insulin resistance-related disease, can co-exist with and even contribute to the development of metabolic insulin resistance, and promote vascular complications in those affected. The impact of endothelial insulin resistance and vascular dysfunction varies depending on the blood vessel size and location, resulting in decreased arterial plasticity, increased atherosclerosis and vascular resistance, and decreased tissue perfusion. Women with insulin resistance and diabetes are disproportionately impacted by cardiovascular disease, likely related to differential sex-hormone endothelium effects. Thus, reducing endothelial insulin resistance and improving endothelial function in the conduit arteries may reduce atherosclerotic complications, in the resistance arteries lead to better blood pressure control, and in the microvasculature lead to less microvascular complications and more effective tissue perfusion. Multiple diabetes therapeutic modalities, including medications and exercise training, improve endothelial insulin action and vascular function. This action may delay the onset of type 2 diabetes and/or its complications, making the vascular endothelium an attractive therapeutic target for type 2 diabetes and potentially type 1 diabetes.
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MESH Headings
- Age Factors
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/ethnology
- Cardiovascular Diseases/metabolism
- Cardiovascular Diseases/physiopathology
- Comorbidity
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/physiopathology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Exercise
- Female
- Humans
- Hypoglycemic Agents/pharmacology
- Hypoglycemic Agents/therapeutic use
- Insulin Resistance
- Male
- Racial Groups
- Risk Factors
- Sex Factors
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Affiliation(s)
- Kaitlin M Love
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Eugene J Barrett
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Steven K Malin
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
- Division of Endocrinology, Metabolism and Nutrition, Rutgers University, New Brunswick, NJ, USA
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, USA
- Institute of Translational Medicine and Research, Rutgers University, New Brunswick, NJ, USA
| | - Jane E B Reusch
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Judith G Regensteiner
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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16
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Szczygiel LA, Jones RD, Drake AF, Drake WP, Ford DE, Hartmann KE, Libby AM, Marshall BA, Regensteiner JG, Yaffe K, Jagsi R. Insights from an Intervention to Support Early Career Faculty with Extraprofessional Caregiving Responsibilities. Womens Health Rep (New Rochelle) 2021; 2:355-368. [PMID: 34476418 PMCID: PMC8409229 DOI: 10.1089/whr.2021.0018] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/03/2022]
Abstract
Background: Insufficient support for balancing career and family responsibilities hinders retention of physician-scientists. Programs to improve retention of this important group of faculty are crucial. Understanding the experiences of program implementers is key to refining and improving program offerings. Methods: We conducted an interpretive, descriptive, and qualitative study as part of an ongoing evaluation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS) awards. We conducted telephone interviews with 12 program directors representing all 10 US medical schools who received the Doris Duke funding in 2016. Results: Of the 12 participants, 10 were women (83.3%). Participating program directors perceived the FRCS award as capable of producing paradigmatic changes regarding how responsibilities at home and work in academic medicine are viewed and integrated by early-career faculty members. The main qualitative themes that captured directors' experiences implementing the program were as follows: (1) championing a new paradigm of support, (2) lessons learned while implementing the new paradigm, (3) results of the new paradigm, and (4) sustaining the paradigm. Conclusions: These findings may help to inform development of similar programs to retain and support the career progress of physician-scientists with extraprofessional caregiving responsibilities. The interviews illuminate ways in which the Doris Duke FRCS award has driven institutional culture change by normalizing discussion and prompted reassessment of extraprofessional challenges and how best to aid early-career faculty members in overcoming these challenges.
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Affiliation(s)
- Lauren A. Szczygiel
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rochelle D. Jones
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amelia F. Drake
- Division of Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Wonder P. Drake
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Daniel E. Ford
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology and Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Anne M. Libby
- Department of Emergency Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bess A. Marshall
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Judith G. Regensteiner
- Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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17
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Whipple MO, Masters KS, Huebschmann AG, Scalzo RL, Reusch JE, Bergouignan A, Regensteiner JG. Acute effects of sedentary breaks on vascular health in adults at risk for type 2 diabetes: A systematic review. Vasc Med 2021; 26:448-458. [PMID: 33977799 PMCID: PMC9074004 DOI: 10.1177/1358863x211009307] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this systematic review was to evaluate the available evidence regarding the acute effects of interrupting/breaking up prolonged sedentary behavior (SB) on vascular health among individuals at elevated risk for type 2 diabetes (T2D). Searches of MEDLINE, Embase, Web of Science, and Cochrane Library databases were conducted on April 7, 2020. Included studies: (1) examined the effect of breaking up prolonged SB in adults with or at elevated risk for T2D and (2) assessed a vascular health outcome, such as blood pressure (BP), flow-mediated dilation (FMD), pulse-wave velocity, or endothelin-1. A total of 20 articles (17 unique studies) were included. Only three studies reported adequate statistical power for the specified vascular outcome. The available evidence suggests that light and moderate intensity activity breaks are effective in acutely lowering BP when compared to prolonged sitting. The small number of studies that included FMD or other vascular outcomes prohibits conclusions regarding the impact of SB breaks on these outcomes. Few studies evaluating the impact of breaking up SB among adults at risk for T2D have included and been adequately powered to examine vascular outcomes, but our preliminary finding, that certain SB breaks improve BP, provides proof-of-concept for this line of inquiry. Future studies should examine both the acute and chronic vascular effects of breaking up SB among individuals most vulnerable to the effects of SB (e.g. older adults, those with T2D), as these individuals are both highly sedentary and at greatest risk of poor health outcomes. PROSPERO ID: CRD42020183423.
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Affiliation(s)
- Mary O. Whipple
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin S. Masters
- Department of Psychology, Clinical Health Psychology, University of Colorado Denver, Denver, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L. Scalzo
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA, Aurora, CO
| | - Jane E.B. Reusch
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA, Aurora, CO
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Institut Pluridisciplinaire Hubert Curien, French National Center for Scientific Research, Université de Strasbourg, UMR 7178, Strasbourg, France
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
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18
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Affiliation(s)
- Mark A Creager
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Marc P Bonaca
- University of Colorado School of Medicine; Colorado Prevention Center, Denver, CO, USA
| | | | | | - Heather L Gornik
- University Hospitals Cleveland Medical Center; Case Western Reserve University, Cleveland, OH, USA
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19
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Mays RJ, Regensteiner JG. Quantifying meaningful change: Improving how we evaluate functional ability in peripheral artery disease. J Vasc Surg 2021; 73:277-278. [PMID: 33349383 DOI: 10.1016/j.jvs.2020.04.462] [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] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Ryan J Mays
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minn; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo; Division of Cardiology and Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
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20
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Tommerdahl KL, Baumgartner K, Schäfer M, Bjornstad P, Melena I, Hegemann S, Baumgartner AD, Pyle L, Cree-Green M, Truong U, Browne L, Regensteiner JG, Reusch JEB, Nadeau KJ. Impact of Obesity on Measures of Cardiovascular and Kidney Health in Youth With Type 1 Diabetes as Compared With Youth With Type 2 Diabetes. Diabetes Care 2021; 44:795-803. [PMID: 33402367 PMCID: PMC7896261 DOI: 10.2337/dc20-1879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance and obesity are independently associated with type 1 diabetes (T1D) and are known risk factors for cardiovascular and kidney diseases, the leading causes of death in T1D. We evaluated the effect of BMI on cardiovascular and kidney outcomes in youth with T1D versus control youth with normal weight or obesity and youth with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Pubertal youth (n = 284) aged 12-21 years underwent assessments of resting heart rate (RHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), leptin, hs-CRP, adiponectin, ratio of urine albumin to creatinine, and estimated glomerular filtration rate. Participants with T1D underwent bicycle ergometry for VO2peak, monitoring for peripheral brachial artery distensibility (BAD), endothelial function testing for reactive hyperemic index, and aortic MRI for central arterial stiffness or shear. RESULTS In adolescents with T1D, RHR, SBP, DBP, mean arterial pressure, leptin, hs-CRP, and hypertension prevalence were significantly higher, and BAD, descending aorta pulse wave velocity, and VO2peak lower with an obese versus normal BMI. Although hypertension prevalence and RHR were highest in obese adolescents with T1D and adiponectin lowest in youth with T2D, other measures were similar between obese adolescents with T1D and those with T2D. CONCLUSIONS Obesity, now increasingly prevalent in people with T1D, correlates with a less favorable cardiovascular and kidney risk profile, nearly approximating the phenotype of youth with T2D. Focused lifestyle management in youth-onset T1D is critically needed to reduce cardiovascular risk.
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Affiliation(s)
- Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO.,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karl Baumgartner
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michal Schäfer
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Petter Bjornstad
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Isabella Melena
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shannon Hegemann
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy D Baumgartner
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Uyen Truong
- Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Pediatrics, Section of Cardiology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Lorna Browne
- Department of Pediatrics, Section of Radiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith G Regensteiner
- Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Divisions of General Internal Medicine and Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E B Reusch
- Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO .,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
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21
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Scalzo RL, Schauer IE, Rafferty D, Knaub LA, Kvaratskhelia N, Johnson TK, Pott GB, Abushamat LA, Whipple MO, Huebschmann AG, Cree-Green M, Reusch JEB, Regensteiner JG. Single-leg exercise training augments in vivo skeletal muscle oxidative flux and vascular content and function in adults with type 2 diabetes. J Physiol 2021; 600:963-978. [PMID: 33569797 DOI: 10.1113/jp280603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/28/2021] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS People with type 2 diabetes (T2D) have impaired skeletal muscle oxidative flux due to limited oxygen delivery. In the current study, this impairment in oxidative flux in people with T2D was abrogated with a single-leg exercise training protocol. Additionally, single-leg exercise training increased skeletal muscle CD31 content, calf blood flow and state 4 mitochondrial respiration in all participants. ABSTRACT Cardiorespiratory fitness is impaired in type 2 diabetes (T2D), conferring significant cardiovascular risk in this population; interventions are needed. Previously, we reported that a T2D-associated decrement in skeletal muscle oxidative flux is ameliorated with acute use of supplemental oxygen, suggesting that skeletal muscle oxygenation is rate-limiting to in vivo mitochondrial oxidative flux during exercise in T2D. We hypothesized that single-leg exercise training (SLET) would improve the T2D-specific impairment in in vivo mitochondrial oxidative flux during exercise. Adults with (n = 19) and without T2D (n = 22) with similar body mass indexes and levels of physical activity participated in two weeks of SLET. Following SLET, in vivo oxidative flux measured by 31 P-MRS increased in participants with T2D, but not people without T2D, measured by the increase in initial phosphocreatine synthesis (P = 0.0455 for the group × exercise interaction) and maximum rate of oxidative ATP synthesis (P = 0.0286 for the interaction). Additionally, oxidative phosphorylation increased in all participants with SLET (P = 0.0209). After SLET, there was no effect of supplemental oxygen on any of the in vivo oxidative flux measurements in either group (P > 0.02), consistent with resolution of the T2D-associated oxygen limitation previously observed at baseline in subjects with T2D. State 4 mitochondrial respiration also improved in muscle fibres ex vivo. Skeletal muscle vasculature content and calf blood flow increased in all participants with SLET (P < 0.0040); oxygen extraction in the calf increased only in T2D (P = 0.0461). SLET resolves the T2D-associated impairment of skeletal muscle in vivo mitochondrial oxidative flux potentially through improved effective blood flow/oxygen delivery.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Irene E Schauer
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Deirdre Rafferty
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Leslie A Knaub
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Nina Kvaratskhelia
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Taro Kaelix Johnson
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gregory B Pott
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Layla A Abushamat
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Mary O Whipple
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Melanie Cree-Green
- Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jane E B Reusch
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Judith G Regensteiner
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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22
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Affiliation(s)
- Mary O Whipple
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Center for Women's Health Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Center for Women's Health Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Université de Strasbourg, CNRS, IPHC UMR 7178, Strasbourg, France
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23
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Jones RD, Miller J, Vitous CA, Krenz C, Brady KT, Brown AJ, Daumit GL, Drake AF, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Kalet AL, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Jagsi R. From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities. J Womens Health (Larchmt) 2020; 29:1547-1558. [PMID: 32286931 PMCID: PMC7864110 DOI: 10.1089/jwh.2019.7999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Research is needed to improve understanding of work-life integration issues in academic medicine and to guide the implementation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS), a national initiative offering financial support to physician-scientists facing caregiving challenges. Materials and Methods: In 2018, as part of a prospective program evaluation, the authors conducted a qualitative study to examine FRCS program participants' initial impressions, solicit descriptions of their career and caregiving experiences, and inquire how such factors might influence their professional advancement. The authors invited all 33 awardees who had been granted FRCS funding in the first year of the program to participate in the study, of whom 28 agreed to complete an interview. Analysts evaluated de-identified transcripts and explicated the data using a thematic analysis approach. Results: While participants described aspects of a culture that harbor stigma against caregivers and impede satisfactory work-life integration, they also perceived an optimistic cultural shift taking place as a result of programs like the FRCS. Their comments indicated that the FRCS has the potential to influence culture if institutional leadership simultaneously fosters a community that validates individuals both as caregivers and as scientists. Conclusions: Insights garnered from this qualitative study suggest that there is a pressing need for institutional leaders to implement programs that can foster awareness and normalization of caregiving challenges. In addition to providing funding and other tangible resources, interventions should strive to reinforce a broader culture that affirms the presence of work-life integration challenges and openly embraces solutions.
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Affiliation(s)
- Rochelle D. Jones
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacquelyn Miller
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - C. Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Chris Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen T. Brady
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ann J. Brown
- Department of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gail L. Daumit
- Departments of Health Policy and Management and Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amelia F. Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Victoria J. Fraser
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology & Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Judith S. Hochman
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Adina L. Kalet
- Stephen and Shelagh Roell Endowed Chair of the Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anne M. Libby
- CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Judith G. Regensteiner
- CU School of Medicine, Judith and Joseph Wagner Chair of Women's Health Research, and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kimberly Yonkers
- Departments of Psychiatry, Epidemiology, and of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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24
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Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A, Maki PM, McCullough LD, Regitz-Zagrosek V, Regensteiner JG, Rubin JB, Sandberg K, Suzuki A. Sex and gender: modifiers of health, disease, and medicine. Lancet 2020; 396:565-582. [PMID: 32828189 PMCID: PMC7440877 DOI: 10.1016/s0140-6736(20)31561-0] [Citation(s) in RCA: 830] [Impact Index Per Article: 207.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/09/2023]
Abstract
Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
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Affiliation(s)
- Franck Mauvais-Jarvis
- Diabetes Discovery & Sex-Based Medicine Laboratory, Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine and Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, LA, USA.
| | - Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Peter J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Roberta D Brinton
- Department of Pharmacology and Department of Neurology, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics and Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dawn L DeMeo
- Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Geert J De Vries
- Neuroscience Institute and Department of Biology, Georgia State University, Atlanta, GA, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Sabra L Klein
- W Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amedeo Lonardo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Pauline M Maki
- Department of Psychiatry, Department of Psychology, and Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiology, University Hospital Zürich, University of Zürich, Switzerland
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua B Rubin
- Department of Medicine, Department of Paediatrics, and Department of Neuroscience, Washington University School of Medicine St Louis, MO, USA
| | - Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University, Washington, DC, USA
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
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25
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Brown EC, Franklin BA, Regensteiner JG, Stewart KJ. Effects of single bout resistance exercise on glucose levels, insulin action, and cardiovascular risk in type 2 diabetes: A narrative review. J Diabetes Complications 2020; 34:107610. [PMID: 32402840 DOI: 10.1016/j.jdiacomp.2020.107610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 12/18/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 01/24/2023]
Abstract
AIMS Previous studies have reported beneficial effects of chronic resistance exercise in the prevention and treatment of type 2 diabetes. To clarify potential modulators of acute responses to resistance exercise, we reviewed the literature to determine the effects of a single bout of resistance exercise on cardiometabolic risk factors in type 2 diabetes. METHODS Pubmed and Embase were searched for studies investigating the effects of single bouts of resistance exercise on glucose and insulin levels, and cardiovascular disease risk in people with diabetes. Fourteen reports were identified and reviewed to formulate evidence-based resistance exercise prescription recommendations. RESULTS Glucose and insulin levels appear to decrease with resistance exercise with effects lasting up to 24 and 18 h, respectively. Bouts of resistance exercise may outperform aerobic exercise in reducing ambulatory blood pressure, with effects lasting up to 24 h. Moreover, resistance exercise after rather than before a meal may be more effective in reducing glucose, insulin, and triacylglycerol levels. However, reducing injectable insulin dosage prior to resistance exercise may blunt its favorable effects on glucose levels. CONCLUSIONS This review suggests that a single bout of resistance exercise may be effective for acutely improving cardiometabolic markers in people with diabetes.
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Affiliation(s)
- Elise C Brown
- School of Health Sciences, Oakland University, 433 Meadow Brook Rd, Rochester, MI 48309, USA.
| | - Barry A Franklin
- Preventative Cardiology/Cardiac Rehabilitation, Division of Cardiovascular Diseases, Beaumont Health and Wellness Center, Royal Oak, MI, USA.
| | - Judith G Regensteiner
- Center for Women's Health Research, School of Medicine, University of Colorado, Denver, CO, USA.
| | - Kerry J Stewart
- Division of Cardiology, School of Medicine, Department of Medicine, John Hopkins University, Baltimore, MD, USA.
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26
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Love KM, Liu J, Regensteiner JG, Reusch JE, Liu Z. GLP-1 and insulin regulation of skeletal and cardiac muscle microvascular perfusion in type 2 diabetes. J Diabetes 2020; 12:488-498. [PMID: 32274893 PMCID: PMC8393916 DOI: 10.1111/1753-0407.13045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Received: 02/20/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022] Open
Abstract
Muscle microvasculature critically regulates skeletal and cardiac muscle health and function. It provides endothelial surface area for substrate exchange between the plasma compartment and the muscle interstitium. Insulin fine-tunes muscle microvascular perfusion to regulate its own action in muscle and oxygen and nutrient supplies to muscle. Specifically, insulin increases muscle microvascular perfusion, which results in increased delivery of insulin to the capillaries that bathe the muscle cells and then facilitate its own transendothelial transport to reach the muscle interstitium. In type 2 diabetes, muscle microvascular responses to insulin are blunted and there is capillary rarefaction. Both loss of capillary density and decreased insulin-mediated capillary recruitment contribute to a decreased endothelial surface area available for substrate exchange. Vasculature expresses abundant glucagon-like peptide 1 (GLP-1) receptors. GLP-1, in addition to its well-characterized glycemic actions, improves endothelial function, increases muscle microvascular perfusion, and stimulates angiogenesis. Importantly, these actions are preserved in the insulin resistant states. Thus, treatment of insulin resistant patients with GLP-1 receptor agonists may improve skeletal and cardiac muscle microvascular perfusion and increase muscle capillarization, leading to improved delivery of oxygen, nutrients, and hormones such as insulin to the myocytes. These actions of GLP-1 impact skeletal and cardiac muscle function and systems biology such as functional exercise capacity. Preclinical studies and clinical trials involving the use of GLP-1 receptor agonists have shown salutary cardiovascular effects and improved cardiovascular outcomes in type 2 diabetes mellitus. Future studies should further examine the different roles of GLP-1 in cardiac as well as skeletal muscle function.
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Affiliation(s)
- Kaitlin M. Love
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Jia Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Judith G. Regensteiner
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, Colorado
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Jane E.B. Reusch
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, Colorado
- Department of Medicine, University of Colorado, Aurora, Colorado
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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27
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Abushamat LA, McClatchey PM, Scalzo RL, Schauer I, Huebschmann AG, Nadeau KJ, Liu Z, Regensteiner JG, Reusch JEB. Mechanistic Causes of Reduced Cardiorespiratory Fitness in Type 2 Diabetes. J Endocr Soc 2020; 4:bvaa063. [PMID: 32666009 PMCID: PMC7334033 DOI: 10.1210/jendso/bvaa063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) has been rising in prevalence in the United States and worldwide over the past few decades and contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable cardiovascular (CV) risk factor in the general population and in people with T2D. Young people and adults with T2D have reduced CRF when compared with their peers without T2D who are similarly active and of similar body mass index. Furthermore, the impairment in CRF conferred by T2D is greater in women than in men. Various factors may contribute to this abnormality in people with T2D, including insulin resistance and mitochondrial, vascular, and cardiac dysfunction. As proof of concept that understanding the mediators of impaired CRF in T2D can inform intervention, we previously demonstrated that an insulin sensitizer improved CRF in adults with T2D. This review focuses on how contributing factors influence CRF and why they may be compromised in T2D. Functional exercise capacity is a measure of interrelated systems biology; as such, the contribution of derangement in each of these factors to T2D-mediated impairment in CRF is complex and varied. Therefore, successful approaches to improve CRF in T2D should be multifaceted and individually designed. The current status of this research and future directions are outlined.
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Affiliation(s)
- Layla A Abushamat
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - Rebecca L Scalzo
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Irene Schauer
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Amy G Huebschmann
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Zhenqi Liu
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jane E B Reusch
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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28
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Libby AM, McGinnes HG, Regensteiner JG. Educating the Scientific Workforce on Sex and Gender Considerations in Research: A National Scan of the Literature and Building Interdisciplinary Research Careers in Women's Health Programs. J Womens Health (Larchmt) 2020; 29:876-885. [PMID: 32456574 DOI: 10.1089/jwh.2019.8067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: This study was a national scan of education resources on integrating sex and gender considerations into research. The purpose was to assess capacity for educating researchers and to identify gaps, with implications for implementation of guidelines or mandates to consider sex and gender differences in research. Information sources were U.S. training programs in women's health and sex/gender difference research, Building Interdisciplinary Research Careers in Women's Health (BIRCWH), and published peer-reviewed biomedical literature. Materials and Methods: This descriptive study used multiple methods: a national survey and a comprehensive literature review. BIRCWH leaders responded to a survey regarding education on sex/gender difference research for BIRCWH scholars (response rate 100%, 20 of 20). A comprehensive literature review was conducted for 1993-2018. Results: Nearly half (45%) of BIRCWH institutions offered education on integrating sex or gender differences in clinical translational research; of those, roughly half (54%) offered in-person training and one-third (31%) offered content within existing for-credit courses. Respondents preferred online training (84%) to in-person offerings or reference materials (47% and 42% respectively). Published indexed literature on sex or gender differences has quadrupled since 1993, although growth in these publications remained flat in the most recent six years. Conclusions: Published resources to educate researchers on integrating sex and gender differences into medical research have increased, and BIRCWH programs connect scholars to national resources. Educational gaps remain due to limited access to curricula on applied research approaches, design, and methods for sex/gender difference research. BIRCWH programs desire curricula that are easily accessible online and asynchronously; sanctioned and supported by national thought leaders; linked to required training such as rigor and reproducibility; foster collaboration; and offer practical applications. Evidence-based, high-quality educational curricula and a dissemination plan are needed to enhance the adoption and integration of sex and gender into scientific endeavors.
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Affiliation(s)
- Anne M Libby
- Department of Emergency Medicine and Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hannah G McGinnes
- Department of Emergency Medicine and Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Judith G Regensteiner
- Department of Medicine and Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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29
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Abstract
Women's health and sex differences research remain understudied. In 2016, to address the topic of sex differences, the Center for Women' s Health Research (CWHR) at the University of Colorado (cwhr@ucdenver.edu) held its inaugural National Conference, "Sex Differences Across the Lifespan: A Focus on Metabolism" and published a report summarizing the presentations. Two years later, in 2018, CWHR organized the 2nd National Conference. The research presentations and discussions from the 2018 conference also addressed sex differences across the lifespan with a focus on cardiometabolism and expanded the focus by including circadian physiology and effects of sleep on cardiometabolic health. Over 100 participants, including basic scientists, clinicians, policymakers, advocacy group leaders, and federal agency leadership participated. The meeting proceedings reveal that although exciting advances in the area of sex differences have taken place, significant questions and gaps remain about women's health and sex differences in critical areas of health. Identifying these gaps and the subsequent research that will result may lead to important breakthroughs.
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Affiliation(s)
- T Rajendra Kumar
- Department of Obstetrics and Gynecology and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jane E B Reusch
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Veterans Administration Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Wendy M Kohrt
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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30
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Regensteiner JG, Libby AM, Begg L, Ghim M, Clayton JA. Sex As a Biological Variable: The Importance of Curriculum Development in the 21st Century. J Womens Health (Larchmt) 2020; 29:854-857. [PMID: 32155377 DOI: 10.1089/jwh.2019.8114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Judith G Regensteiner
- Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Anne M Libby
- Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.,Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Lisa Begg
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Melissa Ghim
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Janine A Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
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31
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Jakicic JM, Horton ES, Curtis JM, Killean TM, Bray GA, Cheskin LJ, Johnson KC, Middelbeek RJW, Pi-Sunyer FX, Regensteiner JG, Ribisl PM, Wagenknecht L, Espeland MA. Abnormal Exercise Test or CVD History on Weight Loss or Fitness: the Look AHEAD Trial. Transl J Am Coll Sports Med 2020; 5:e000134. [PMID: 34017914 PMCID: PMC8130141 DOI: 10.1249/tjx.0000000000000134] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Obesity and type 2 diabetes are associated with an increased risk of cardiovascular disease (CVD) and the combination of weight loss and increased physical exercise are commonly recommended to reduce CVD. This study examined whether people with obesity and type 2 diabetes with an abnormal graded exercise tolerance test (GXT) or a history of CVD would have less success in achieving weight loss and improved fitness, compared to adults without these conditions. METHODS The Look AHEAD Study examined whether an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) reduced cardiovascular events in adults with overweight/obesity and type 2 diabetes. Participants underwent a baseline maximal GXT and provided medical history data. Weight loss and fitness change were examined in 5011 participants over four years in those with or without an abnormal baseline GXT and/or history of CVD. RESULTS After four years, weight loss in both ILI and DSE were significantly greater in those without a prior history of CVD than in those with a CVD history (6.69% vs 5.98%, p=0.02, in ILI and 0.73 vs -.07% (weight gain), p=0.01, in DSE). Likewise, those without a prior history of CVD experienced greater improvements in fitness in both ILI and DSE relative to those with a history of CVD. Having an abnormal GXT at baseline did not affect weight loss or fitness. CONCLUSIONS A history of CVD at baseline modestly lessened weight loss and fitness changes at 4 years, whereas having any abnormality on the baseline GXT did not affect these outcomes. Thus, weight loss and improved fitness are achievable in adults with a history of CVD or ECG abnormalities.
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Affiliation(s)
| | | | - Jeffrey M. Curtis
- NIDDK, Phoenix, AZ
- St. Joseph’s Hospital and Medical Center, Phoenix, AZ
| | - Tina M. Killean
- NIDDK, Phoenix, AZ
- Northern Navajo Medical Center, Shiprock, NM
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32
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Jones RD, Miller J, Vitous CA, Krenz C, Brady KT, Brown AJ, Daumit GL, Drake AF, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Jagsi R. The Most Valuable Resource Is Time: Insights From a Novel National Program to Improve Retention of Physician-Scientists With Caregiving Responsibilities. Acad Med 2019; 94:1746-1756. [PMID: 31348060 DOI: 10.1097/acm.0000000000002903] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To enhance understanding of challenges related to work-life integration in academic medicine and to inform the ongoing implementation of an existing program and the development of other interventions to promote success of physician-scientists. METHOD This study is part of a prospective analysis of the effects of the Fund to Retain Clinical Scientists (FRCS), a national program launched by the Doris Duke Charitable Foundation at 10 U.S. institutions, which provides financial support to physician-scientists facing caregiving challenges. In early 2018, 28 of 33 program awardees participated in semistructured interviews. Questions were about challenges faced by physician-scientists as caregivers and their early perceptions of the FRCS. Multiple analysts reviewed deidentified transcripts, iteratively revised the coding scheme, and interpreted the data using qualitative thematic analysis. RESULTS Participants' rich descriptions illuminated 5 interconnected themes: (1) Time is a critical and limited resource, (2) timing is key, (3) limited time resources and timing conflicts may have a particularly adverse effect on women's careers, (4) flexible funds enable reclamation and repurposing of time resources, and (5) FRCS leaders should be cognizant of time and timing conflicts when developing program-related offerings. CONCLUSIONS Programs such as the FRCS are instrumental in supporting individuals to delegate time-consuming tasks and to control how they spend their valuable time. Qualitative analysis suggests that access to and command of valuable time resources are crucial to career advancement, research productivity, and work-life flexibility, especially during critical time points along the physician-scientist trajectory.
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Affiliation(s)
- Rochelle D Jones
- R.D. Jones is research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan. J. Miller is research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-0110-0567. C.A. Vitous is qualitative research analyst, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. C. Krenz is research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-0514-4586. K.T. Brady is distinguished university professor, Medical University of South Carolina, Charleston, South Carolina. A.J. Brown is professor of medicine, Duke University School of Medicine, Durham, North Carolina. G.L. Daumit is Samsung Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. A.F. Drake is Newton D. Fischer Distinguished Professor, University of North Carolina School of Medicine, Chapel Hill, North Carolina. V.J. Fraser is Adolphus Busch Professor of Medicine and chair, Washington University School of Medicine, St. Louis, Missouri. K.E. Hartmann is professor, Vanderbilt University School of Medicine, Nashville, Tennessee. J.S. Hochman is Harold Snyder Family Professor of Cardiology, NYU School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-5889-5981. S. Girdler is professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-0190-0938. A.M. Libby is professor, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-4564-9407. C. Mangurian is professor, University of California, San Francisco School of Medicine, San Francisco, California. J.G. Regensteiner is professor, CU School of Medicine, and director, Center for Women's Health Research, Judith and Joseph Wagner Chair in Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-9331-3908. K. Yonkers is professor, Yale School of Medicine, New Haven, Connecticut. R. Jagsi is professor, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6562-1228
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Huebschmann AG, Huxley RR, Kohrt WM, Zeitler P, Regensteiner JG, Reusch JEB. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia 2019; 62:1761-1772. [PMID: 31451872 PMCID: PMC7008947 DOI: 10.1007/s00125-019-4939-5] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [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] [Received: 04/20/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
By 2017 estimates, diabetes mellitus affects 425 million people globally; approximately 90-95% of these have type 2 diabetes. This narrative review highlights two domains of sex differences related to the burden of type 2 diabetes across the life span: sex differences in the prevalence and incidence of type 2 diabetes, and sex differences in the cardiovascular burden conferred by type 2 diabetes. In the presence of type 2 diabetes, the difference in the absolute rates of cardiovascular disease (CVD) between men and women lessens, albeit remaining higher in men. Large-scale observational studies suggest that type 2 diabetes confers 25-50% greater excess risk of incident CVD in women compared with men. Physiological and behavioural mechanisms that may underpin both the observed sex differences in the prevalence of type 2 diabetes and the associated cardiovascular burden are discussed in this review. Gender differences in social behavioural norms and disparities in provider-level treatment patterns are also highlighted, but not described in detail. We conclude by discussing research gaps in this area that are worthy of further investigation.
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Affiliation(s)
- Amy G Huebschmann
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel R Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Wendy M Kohrt
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Philip Zeitler
- Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Judith G Regensteiner
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine (CU-SOM), Aurora, CO, USA
| | - Jane E B Reusch
- Center for Women's Health Research, University of Colorado School of Medicine, MS C263, 12348 E. Montview Boulevard, Aurora, CO, 80045, USA.
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
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Treat-Jacobson D, McDermott MM, Beckman JA, Burt MA, Creager MA, Ehrman JK, Gardner AW, Mays RJ, Regensteiner JG, Salisbury DL, Schorr EN, Walsh ME. Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association. Circulation 2019; 140:e700-e710. [PMID: 31446770 DOI: 10.1161/cir.0000000000000727] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.
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Scalzo RL, Rafferty D, Schauer I, Huebschmann AG, Cree-Green M, Reusch JEB, Regensteiner JG. Sitagliptin improves diastolic cardiac function but not cardiorespiratory fitness in adults with type 2 diabetes. J Diabetes Complications 2019; 33:561-566. [PMID: 31182338 PMCID: PMC7278036 DOI: 10.1016/j.jdiacomp.2019.05.002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND People with type 2 diabetes mellitus (T2D) have preclinical cardiac and vascular dysfunction associated with low cardiorespiratory fitness (CRF). This is especially concerning because CRF is a powerful predictor of cardiovascular mortality, a primary issue in T2D management. Glucagon-like pepetide-1 (GLP-1) augments cardiovascular function and our previous data in rodents demonstrate that potentiating the GLP-1 signal with a dipeptidyl peptidase-4 (DPP4) inhibitor augments CRF. Lacking are pharmacological treatments which can target T2D-specific physiological barriers to exercise to potentially permit adaptations necessary to improve CRF and thereby health outcomes in people with T2D. We therefore hypothesized that administration of a DPP4-inhibitor (sitagliptin) would improve CRF in adults with T2D. METHODS AND RESULTS Thirty-eight participants (64 ± 1 years; mean ± SE) with T2D were randomized in a double-blinded study to receive 100 mg/day sitagliptin, 2 mg/day glimepiride, or placebo for 3 months after baseline measurements. Fasting glucose decreased with both glimepiride and sitagliptin compared with placebo (P = 0.002). CRF did not change in any group (Placebo: Pre: 15.4 ± 0.9 vs. Post: 16.1 ± 1.1 ml/kg/min vs. Glimepiride: 18.5 ± 1.0 vs. 17.7 ± 1.2 ml/kg/min vs. Sitagliptin: 19.1 ± 1.2 vs. 18.3 ± 1.1 ml/kg/min; P = 0.3). Sitagliptin improved measures of cardiac diastolic function, however, measures of vascular function did not change with any treatment. CONCLUSIONS Three months of sitagliptin improved diastolic cardiac function, however, CRF did not change. These data suggest that targeting the physiological contributors to CRF with sitagliptin alone is not an adequate strategy to improve CRF in people with T2D. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov NCT01951339.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America.
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America
| | - Irene Schauer
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America
| | - Amy G Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America
| | - Melanie Cree-Green
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Division of Pediatric Endocrinology, University of Colorado School of Medicine, United States of America
| | - Jane E B Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America
| | - Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America
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Pokharel Y, Jones PG, Graham G, Collins T, Regensteiner JG, Murphy TP, Cohen D, Spertus JA, Smolderen K. Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease: Insights From the CLEVER Trial (Claudication: Exercise Versus Endoluminal Revascularization). Circ Cardiovasc Qual Outcomes 2019; 11:e004157. [PMID: 29643064 DOI: 10.1161/circoutcomes.117.004157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Yashashwi Pokharel
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.).
| | - Philip G Jones
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Garth Graham
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Tracie Collins
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Judith G Regensteiner
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Timothy P Murphy
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - David Cohen
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - John A Spertus
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Kim Smolderen
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 69:e71-e126. [PMID: 27851992 DOI: 10.1016/j.jacc.2016.11.007] [Citation(s) in RCA: 415] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA. Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 2019; 74:133-153. [PMID: 31097258 PMCID: PMC7341112 DOI: 10.1016/j.jacc.2019.03.008] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.
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Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA. Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation 2019; 140:e69-e89. [PMID: 31082266 DOI: 10.1161/cir.0000000000000663] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.
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Regensteiner JG, Libby AM, Huxley R, Clayton JA. Integrating sex and gender considerations in research: educating the scientific workforce. Lancet Diabetes Endocrinol 2019; 7:248-250. [PMID: 30744946 DOI: 10.1016/s2213-8587(19)30038-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Judith G Regensteiner
- Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA; Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Anne M Libby
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA; Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rachel Huxley
- College of Science, Health and Engineering and Research Centre for Cardiovascular Biology and Disease, La Trobe University, Melbourne, VIC, Australia
| | - Janine Austin Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
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Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e10-e33. [DOI: 10.1161/cir.0000000000000623] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Chandramouli C, Teng THK, Tay WT, Yap J, MacDonald MR, Tromp J, Yan L, Siswanto B, Reyes EB, Ngarmukos T, Yu CM, Hung CL, Anand I, Richards AM, Ling LH, Regensteiner JG, Lam CSP. Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry. Eur J Heart Fail 2018; 21:297-307. [PMID: 30548089 DOI: 10.1002/ejhf.1358] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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] [Received: 06/06/2018] [Revised: 09/24/2018] [Accepted: 10/14/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). METHODS AND RESULTS Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2 , Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; Pinteraction = 0.005). CONCLUSIONS Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.
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Affiliation(s)
| | | | | | | | | | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Limin Yan
- National Heart Centre Singapore, Singapore
| | - Bambang Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Cheuk-Man Yu
- Hong Kong Baptist Hospital, The Chinese University of Hong Kong, Hong Kong, The People's Republic of China
| | | | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - A Mark Richards
- Cardiovascular Research Institute, Singapore.,National University of Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Otago, New Zealand
| | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.,Duke-National University of Singapore, Singapore
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME, Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Pressler SJ, Wijeysundera DN. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary. Vasc Med 2018; 22:NP1-NP43. [PMID: 28494710 DOI: 10.1177/1358863x17701592] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
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- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | | | - Heather L Gornik
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | | | | | | | - Douglas E Drachman
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,5 Society for Cardiovascular Angiography and Interventions Representative
| | - Lee A Fleisher
- 6 ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Francis Gerry R Fowkes
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,7 Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative
| | | | - Scott Kinlay
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,8 Society for Vascular Medicine Representative
| | - Robert Lookstein
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Sanjay Misra
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,9 Society of Interventional Radiology Representative
| | - Leila Mureebe
- 10 Society for Clinical Vascular Surgery Representative
| | - Jeffrey W Olin
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Rajan A G Patel
- 7 Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative
| | | | - Andres Schanzer
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,11 Society for Vascular Surgery Representative
| | - Mehdi H Shishehbor
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Kerry J Stewart
- 3 ACC/AHA Representative.,12 American Association of Cardiovascular and Pulmonary Rehabilitation Representative
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Jagsi R, Jones RD, Griffith KA, Brady KT, Brown AJ, Davis RD, Drake AF, Ford D, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Escobar-Alvarez S, Myers ER. An Innovative Program to Support Gender Equity and Success in Academic Medicine: Early Experiences From the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists. Ann Intern Med 2018; 169:128-130. [PMID: 29554690 DOI: 10.7326/m17-2676] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Reshma Jagsi
- University of Michigan, Ann Arbor, Michigan (R.J., R.D.J., K.A.G.)
| | - Rochelle D Jones
- University of Michigan, Ann Arbor, Michigan (R.J., R.D.J., K.A.G.)
| | - Kent A Griffith
- University of Michigan, Ann Arbor, Michigan (R.J., R.D.J., K.A.G.)
| | - Kathleen T Brady
- Medical University of South Carolina, Charleston, South Carolina (K.T.B., R.D.D.)
| | - Ann J Brown
- Duke University School of Medicine, Durham, North Carolina (A.J.B.)
| | - Randal D Davis
- Medical University of South Carolina, Charleston, South Carolina (K.T.B., R.D.D.)
| | - Amelia F Drake
- University of North Carolina School of Medicine, Chapel Hill, North Carolina (A.F.D.)
| | - Daniel Ford
- Johns Hopkins School of Medicine, Baltimore, Maryland (D.F.)
| | - Victoria J Fraser
- Washington University School of Medicine, St. Louis, Missouri (V.J.F.)
| | | | - Judith S Hochman
- New York University Langone Medical Center, New York, New York (J.S.H.)
| | - Susan Girdler
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (S.G.)
| | - Anne M Libby
- University of Colorado School of Medicine, Aurora, Colorado (A.M.L., J.G.R.)
| | - Christina Mangurian
- University of California, San Francisco, School of Medicine, San Francisco, California (C.M.)
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Cree-Green M, Scalzo RL, Harrall K, Newcomer BR, Schauer IE, Huebschmann AG, McMillin S, Brown MS, Orlicky D, Knaub L, Nadeau KJ, McClatchey PM, Bauer TA, Regensteiner JG, Reusch JEB. Supplemental Oxygen Improves In Vivo Mitochondrial Oxidative Phosphorylation Flux in Sedentary Obese Adults With Type 2 Diabetes. Diabetes 2018; 67:1369-1379. [PMID: 29643061 PMCID: PMC6463751 DOI: 10.2337/db17-1124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes is associated with impaired exercise capacity. Alterations in both muscle perfusion and mitochondrial function can contribute to exercise impairment. We hypothesized that impaired muscle mitochondrial function in type 2 diabetes is mediated, in part, by decreased tissue oxygen delivery and would improve with oxygen supplementation. Ex vivo muscle mitochondrial content and respiration assessed from biopsy samples demonstrated expected differences in obese individuals with (n = 18) and without (n = 17) diabetes. Similarly, in vivo mitochondrial oxidative phosphorylation capacity measured in the gastrocnemius muscle via 31P-MRS indicated an impairment in the rate of ADP depletion with rest (27 ± 6 s [diabetes], 21 ± 7 s [control subjects]; P = 0.008) and oxidative phosphorylation (P = 0.046) in type 2 diabetes after isometric calf exercise compared with control subjects. Importantly, the in vivo impairment in oxidative capacity resolved with oxygen supplementation in adults with diabetes (ADP depletion rate 5.0 s faster, P = 0.012; oxidative phosphorylation 0.046 ± 0.079 mmol/L/s faster, P = 0.027). Multiple in vivo mitochondrial measures related to HbA1c These data suggest that oxygen availability is rate limiting for in vivo mitochondrial oxidative exercise recovery measured with 31P-MRS in individuals with uncomplicated diabetes. Targeting muscle oxygenation could improve exercise function in type 2 diabetes.
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Affiliation(s)
- Melanie Cree-Green
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L Scalzo
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kylie Harrall
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Irene E Schauer
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Veterans Affairs Medical Center, Denver, CO
| | - Amy G Huebschmann
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shawna McMillin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mark S Brown
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Orlicky
- Division of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Leslie Knaub
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kristen J Nadeau
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - P Mason McClatchey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Timothy A Bauer
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith G Regensteiner
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E B Reusch
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Veterans Affairs Medical Center, Denver, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Bjornstad P, Cree-Green M, Baumgartner A, Coe G, Reyes YG, Schäfer M, Pyle L, Regensteiner JG, Reusch JE, Nadeau KJ. Achieving ADA/ISPAD clinical guideline goals is associated with higher insulin sensitivity and cardiopulmonary fitness in adolescents with type 1 diabetes: Results from RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) and Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD) Studies. Pediatr Diabetes 2018; 19:436-442. [PMID: 29082640 PMCID: PMC5918223 DOI: 10.1111/pedi.12598] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/23/2017] [Accepted: 09/22/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for hemoglobin A1c (HbA1c), blood pressure (BP), lipids, and body mass index (BMI). We hypothesized that ISPAD/ADA goal achievement would be associated with better insulin sensitivity (IS) and cardiopulmonary fitness. METHODS IS was quantified as glucose infusion rate (GIR) from a hyperinsulinemic-euglycemic clamp in youth with type 1 diabetes from the RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) (n = 86) and Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD) (n = 41) cohorts (n = 127; age 15.7 ± 2.2 years, 52% girls). Cardiopulmonary fitness was measured as peak oxygen consumption (VO2 peak/kg) during upright (RESISTANT) or supine (EMERALD) cycle ergometry and were stratified by cycle type. Goal achievement was defined as HbA1c < 7.5%, BP < 90th percentile, LDL-cholesterol < 100 mg/dL, HDL-cholesterol > 35 mg/dL, triglycerides < 150 mg/dL and BMI < 85th percentile. Participants were stratified into 3 groups: achieving 0-3 goals (n = 52), 4 goals (n = 48), and 5-6 goals (n = 27). Differences between groups were examined with generalized linear models. RESULTS IS was lower in youth who met 0-3 goals (5.2 ± 3.4 mg/kg/min) vs those who met 4 goals (7.4 ± 4.1 mg/kg/min, P = .04) and those who met 5-6 goals (8.5 ± 4.3 mg/kg/min, P = .003), and remained significant after adjustments for sex and diabetes duration. Upright VO2 peak was lower in youth who met 0-3 goals (25.8 ± 4.6 mL/kg/min) vs those who met 4 goals (33.0 ± 7.8 mL/kg/min, P = .01) and those who met 5-6 goals (33.2 ± 4.4 mL/kg/min, P = .004). Similar and significant relationships were observed in EMERALD participants for supine VO2 peak. CONCLUSIONS ADA/ISPAD goal achievement was associated with greater IS and cardiopulmonary fitness.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States,Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Yesenia Garcia Reyes
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michal Schäfer
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Laura Pyle
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, United States
| | - Judith G. Regensteiner
- Center for Women’s Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States,Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Jane E.B. Reusch
- Center for Women’s Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States,Division of Endocrinology, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Kristen J. Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States,Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
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Wahl MP, Scalzo RL, Regensteiner JG, Reusch JEB. Mechanisms of Aerobic Exercise Impairment in Diabetes: A Narrative Review. Front Endocrinol (Lausanne) 2018; 9:181. [PMID: 29720965 PMCID: PMC5915473 DOI: 10.3389/fendo.2018.00181] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022] Open
Abstract
The prevalence of diabetes in the United States and globally has been rapidly increasing over the last several decades. There are now estimated to be 30.3 million people in the United States and 422 million people worldwide with diabetes. Diabetes is associated with a greatly increased risk of cardiovascular mortality, which is the leading cause of death in adults with diabetes. While exercise training is a cornerstone of diabetes treatment, people with diabetes have well-described aerobic exercise impairments that may create an additional diabetes-specific barrier to adding regular exercise to their lifestyle. Physiologic mechanisms linked to exercise impairment in diabetes include insulin resistance, cardiac abnormalities, mitochondrial function, and the ability of the body to supply oxygen. In this paper, we highlight the abnormalities of exercise in type 2 diabetes as well as potential therapeutic approaches.
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Affiliation(s)
- Matthew P. Wahl
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
- Veterans Administration Eastern Colorado Health Care System, Denver, CO, United States
| | - Rebecca L. Scalzo
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
- Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith G. Regensteiner
- Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E. B. Reusch
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
- Veterans Administration Eastern Colorado Health Care System, Denver, CO, United States
- Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- *Correspondence: Jane E. B. Reusch,
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Reusch JEB, Kumar TR, Regensteiner JG, Zeitler PS. Identifying the Critical Gaps in Research on Sex Differences in Metabolism Across the Life Span. Endocrinology 2018; 159:9-19. [PMID: 29300998 PMCID: PMC5761606 DOI: 10.1210/en.2017-03019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/13/2017] [Indexed: 12/12/2022]
Abstract
The National Institutes of Health (NIH) Office of Research in Women's Health now functions under a mandate calling for the systematic inclusion of both female and male cells, animals, and human subjects in all types of research, so that sex as a biological variable is understood in health and disease. Sex-specific data can improve disease prevention, diagnosis, and treatment as well as reduce inequities. Inclusion of women in research studies has modestly improved over the last 20 years, yet preclinical research is still primarily done using male animal models and male-derived cells, with the result that many conclusions are made based on incomplete and sex-biased data. There are important, yet poorly studied, sex differences in cardiometabolic disease. To begin to address these sex differences, the Center for Women's Health Research at the University of Colorado held its inaugural National Conference, "Sex Differences Across the Lifespan: A Focus on Metabolism," in September 2016 (cwhr@ucdenver.edu). Research to address the important goal of understanding key sex differences in cardiometabolic disease across the life span is lacking. The goal of this article is to discuss the current state of research addressing sex differences in cardiometabolic health across the life span, to outline critical research gaps that must be addressed in response to NIH mandates, and, importantly, to develop strategies to address sex as a biological variable to understand disease mechanisms as well as develop diagnostic and therapeutic modalities.
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Affiliation(s)
- Jane E. B. Reusch
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, Colorado 80045
- Veterans Administration Eastern Colorado Health Care System, Denver, Colorado 80220
| | - T. Rajendra Kumar
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Judith G. Regensteiner
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Philip S. Zeitler
- Department of and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - on Behalf of the Conference Participants
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, Colorado 80045
- Veterans Administration Eastern Colorado Health Care System, Denver, Colorado 80220
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado 80045
- Department of and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 80045
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49
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Scalzo RL, Bauer TA, Harrall K, Moreau K, Ozemek C, Herlache L, McMillin S, Huebschmann AG, Dorosz J, Reusch JEB, Regensteiner JG. Acute vitamin C improves cardiac function, not exercise capacity, in adults with type 2 diabetes. Diabetol Metab Syndr 2018; 10:7. [PMID: 29456629 PMCID: PMC5813393 DOI: 10.1186/s13098-018-0306-9] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/04/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with type 2 diabetes (T2D) have impaired exercise capacity, even in the absence of complications, which is predictive of their increased cardiovascular mortality. Cardiovascular dysfunction is one potential cause of this exercise defect. Acute infusion of vitamin C has been separately shown to improve diastolic and endothelial function in prior studies. We hypothesized that acute vitamin C infusion would improve exercise capacity and that these improvements would be associated with improved cardiovascular function. METHODS Adults with T2D (n = 31, 7 female, 24 male, body mass index (BMI): 31.5 ± 0.8 kg/m2) and BMI-similar healthy adults (n = 21, 11 female, 10 male, BMI: 30.4 ± 0.7 kg/m2) completed two randomly ordered visits: IV infusion of vitamin C (7.5 g) and a volume-matched saline infusion. During each visit peak oxygen uptake (VO2peak), brachial artery flow mediated dilation (FMD), reactive hyperemia (RH; plethysmography), and cardiac echocardiography were measured. General linear mixed models were utilized to assess the differences in all study variables. RESULTS Acute vitamin C infusion improved diastolic function, assessed by lateral and septal E:E' (P < 0.01), but did not change RH (P = 0.92), or VO2peak (P = 0.33) in any participants. CONCLUSION Acute vitamin C infusion improved diastolic function but did not change FMD, forearm reactive hyperemia, or peak exercise capacity. Future studies should further clarify the role of endothelial function as well as other possible physiological causes of exercise impairment in order to provide potential therapeutic targets.Trial registration NCT00786019. Prospectively registered May 2008.
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Affiliation(s)
- Rebecca L. Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), 12801 E17th Ave, Aurora, CO 80045 USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Timothy A. Bauer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Kylie Harrall
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Kerrie Moreau
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- VAMC-Geriatric Research Education and Clinical Center (GRECC), Denver, CO 80215 USA
| | - Cemal Ozemek
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Leah Herlache
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Shawna McMillin
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Jennifer Dorosz
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Jane E. B. Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), 12801 E17th Ave, Aurora, CO 80045 USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Veterans Administration Medical Center (VAMC), Denver, CO 80215 USA
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
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Brindis CD, Freund KM, Baecher-Lind L, Bairey Merz CN, Carnes M, Gulati M, Joffe H, Klein WS, Mazure CM, Pace LE, Regensteiner JG, Redberg RF, Wenger NK, Younger L. The Risk of Remaining Silent: Addressing the Current Threats to Women's Health. Womens Health Issues 2017; 27:621-624. [DOI: 10.1016/j.whi.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022]
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