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Yiu AC, Park S, Lustik M, Hussain A, Okonkwo UA. Using Reminder Letters to Improve Adherence to Routine Hemoglobin A1C Testing in Adults with Diabetes. Hawaii J Health Soc Welf 2022; 81:323-327. [PMID: 36504501 PMCID: PMC9727705] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The American Diabetes Association (ADA) recommends hemoglobin A1C (A1C) goals of < 7% for most non-pregnant adults and < 8% for adult patients with extensive or life-limiting comorbidities. A1C testing is indicated every 3-months for patients not meeting goals to assess glycemic control, adjust medications, suggest lifestyle changes, and offer counseling. However, many patients do not adhere to routine testing. A clinic-wide quality improvement (QI) pilot project was implemented using mailed reminder letters to improve patient adherence to routine A1C testing in patients with hemoglobin A1C . 8%. Sixty-eight patients were identified for this letter intervention. Of these, 14 patients (20%) were historically adherent to 3-month interval testing, 31 patients (46%) were historically non-adherent, and 23 (34%) had historical A1C test intervals of less than 3-months because of provider orders. The primary outcome was improvement in A1C testing adherence rates of those who were previously non-adherent. There was a 58% increase overall and a 103% increase in testing rates among women. Statistical significance was not observed at the P = .05 level. However, improvement in adherence rates among women reached the P = .10 significance level. Mailed reminder letters may be useful in improving adherence to routine A1C testing in patients with diabetes. Further study of this intervention in larger groups is needed to provide timely data for the management of diabetes care.
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Affiliation(s)
- Alvin C. Yiu
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (ACY, SP, AH, UAO)
| | - Sunny Park
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (ACY, SP, AH, UAO)
| | - Michael Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI (ML)
| | - Ali Hussain
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (ACY, SP, AH, UAO)
| | - Uzoagu A. Okonkwo
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (ACY, SP, AH, UAO)
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Rossella C, Laura F, Grazia MM, Raffaele B, Antonio T, Maria P, Francesco DV, Giovanni G. The crosstalk between gut microbiota, intestinal immunological niche and visceral adipose tissue as a new model for the pathogenesis of metabolic and inflammatory diseases: the paradigm of type 2 diabetes mellitus. Curr Med Chem 2022; 29:3189-3201. [PMID: 34986766 DOI: 10.2174/0929867329666220105121124] [Citation(s) in RCA: 2] [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] [Received: 09/19/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022]
Abstract
Gut microbiota (GM) comprises more than one thousand microorganisms between bacterial species, viruses, fungi, and protozoa, and represents the main actor of a wide net of molecular interactions, involving, among others, the endocrine system, immune responses, and metabolism. GM influences many endocrine functions such as adrenal steroidogenesis, thyroid function, sexual hormones, IGF-1 pathway and peptides produced in gastrointestinal system. It is fundamental in glycaemic control and obesity, while also exerting an important function in modulating the immune system and associated inflammatory disease. The result of this crosstalk in gut mucosa is the formation of the intestinal immunological niche. Visceral adipose tissue (VAT) produces about 600 different peptides, it is involved in lipid and glucose metabolism and in some immune reactions through several adipokines. GM and VAT interact in a bidirectional fashion: while gut dysbiosis can modify VAT adipokines and hormone secretion, VAT hyperplasia modifies GM composition. Acquired or genetic factors leading to gut dysbiosis or increasing VAT (i.e., Western diet) induce a proinflammatory condition, which plays a pivotal role in the development of dysmetabolic and immunologic conditions, such as diabetes mellitus. Diabetes is clearly associated with specific patterns of GM alterations, with an abundance or reduction of GM species involved in controlling mucosal barrier status, glycaemic levels and exerting a pro- or anti-inflammatory activity. All these factors could explain the higher incidence of several inflammatory conditions in Western countries; furthermore, besides the specific alterations observed in diabetes, this paradigm could represent a common pathway acting in many metabolic conditions and could pave the way to a new, interesting therapeutic approach.
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Affiliation(s)
- Cianci Rossella
- Dipartimento di Medicina e Chirurgia Traslazionale Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli, IRCCS Largo A. Gemelli, 8 00168 Rome, Italy
| | - Franza Laura
- Emergency Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Massaro Maria Grazia
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Borriello Raffaele
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Tota Antonio
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pallozzi Maria
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - De Vito Francesco
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gambassi Giovanni
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Ak E, Ak K, Midi A, Kervancıoğlu-Demirci E, Arsan S, Çetinel Ş, Pişiriciler R. Histopathologic evaluation of saphenous vein grafts in patients with type II diabetes mellitus undergoing coronary artery bypass grafting. Cardiovasc Pathol 2021; 52:107328. [PMID: 33639243 DOI: 10.1016/j.carpath.2021.107328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/13/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Diabetes Mellitus (DM) has been known to be a risk factor for the development of more severe form of saphenous vein graft disease after coronary artery bypass grafting (CABG). We aimed to evaluate the impact of type II-DM on histopathological features of great saphenous vein grafts of patients undergoing CABG. PATIENTS AND METHODS Forty consecutive patients undergoing elective CABG were enrolled into the study. Patients were grouped into two; Diabetic group (n = 20); includes patients with preoperative diagnosis of type II-DM and Nondiabetic group (n = 20): those without type II-DM. In all patients, a short segment of the great saphenous vein graft at the level of medial malleolus was taken for light microscopy and transmission electron microscopy (TEM) evaluation. Moreover, immunoexpressions of Caveolin-1, Vascular cell adhesion protein 1 (VCAM-1) and endothelial nitric oxide synthase (eNOS) were studied. RESULTS There were no differences in the demographics of patients between two groups. The magnitude of intimal fibrosis in diabetic group was slightly higher than in nondiabetics (1.95 ± 0.99 versus 1.3 ± 0.8, P = .04). In TEM, vacuolization in endothelial cells, substance accumulation along with coarse collagen fibers and cytoplasmic degeneration with vacuolization in muscle cells were detected in diabetic group. While there were no differences in Caveolin-1 and VCAM-1 immunostaining, the intensity of positive eNOS immunostaining was significantly higher in endothelium (2.10 ± 0.64 versus 1.55 ± 0.68, P = .01) and tunica media 1.75 ± 0.63 versus 1.2 ± 0.52, P = .007) in nondiabetic group, respectively) compared with diabetic group. CONCLUSION Type II DM might be a reason for decreased expression of eNOS and increased intimal fibrosis, vacuolization of endothelial and smooth muscle cells in saphenous vein grafts. The clinical implications of these alterations on the graft patency need to be evaluated.
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Affiliation(s)
- Esin Ak
- Department of Basic Medical Sciences, Histology and Embryology, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
| | - Koray Ak
- Department of Cardiovascular Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ahmet Midi
- Department of Pathology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | | | - Sinan Arsan
- Department of Cardiovascular Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Şule Çetinel
- Department of Histology and Embryology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Rabia Pişiriciler
- Department of Basic Medical Sciences, Histology and Embryology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Kolb JM, Kitos NR, Ramachandran A, Lin JJ, Mann DM. What do primary care prediabetes patients need? A baseline assessment of patients engaging in a technology-enhanced lifestyle intervention. J Bioinform Diabetes 2014; 1:4. [PMID: 25594073 PMCID: PMC4291122] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study assessed the baseline knowledge, perceptions, attitudes and behaviors of prediabetes patients in order to tailor a new technology-enhanced primary care-based lifestyle modification intervention. METHODS Patients with a diagnosis of prediabetes were enrolled in a randomized, controlled pilot study, Avoiding Diabetes Thru Action Plan Targeting (ADAPT), a technology-based intervention to promote action plan discussions around patient-selected behavior change goals. RESULTS A total of 54 adults (82% female) were enrolled in the pilot study. Most (89%) had comorbid conditions and mean BMI was 36. Participants exhibited high risk of diabetes knowledge (knowledge score 20 on a 32 point scale) and high levels of willingness to make changes to decrease diabetes risk. Number of daily steps was inversely correlated with perceived physical activity (r=-0.35082, p<0.001). Poorer scores on diet quality were inversely correlated with BMI. CONCLUSION Participants in this sample demonstrated requisite levels of knowledge, self-efficacy, motivation and risk perception for effective behavior change. These data suggest that primary care-based prediabetes interventions can move beyond educational goals and focus on enhancing patients' ability to select, plan and enact action plans.
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Affiliation(s)
| | - Nicole R Kitos
- Section of Preventive Medicine and Epidemiology, Boston University/Boston Medical Center, Boston, MA, USA
| | - Ambili Ramachandran
- Section of General Medicine, Boston University/Boston Medical Center, Boston, MA, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Nozari M, Khalilian A, Dousti Y. Spiritual Development and Death Attitude in Female Patients With Type II Diabetes. Iran J Psychiatry Behav Sci 2014; 8:58-64. [PMID: 25780376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/02/2013] [Accepted: 01/16/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The present study aimed to investigate the differences regarding spiritual development dimensions and death attitude profiles, and also to determinate association between them, in patients suffering from type II diabetes. METHODS In a cross-sectional design study, 100 female outpatients who were suffering from type II diabetes were recruited in Imam Khomeini Hospital, Sari, Iran. Data were collected through two questionnaires including the Spiritual Assessment Inventory (SAI) and the Death Attitude Profile-Revised (DAPR). Analysis of the data involved analysis of covariance (ANCOVA) with the Fisher's Least Significant Difference (LSD) as post-hoc test plus the Pearson correlation. RESULTS There was a statistical significant difference in spiritual development dimensions and death attitude profile. The results showed that spiritual development were significantly associated with some items of death attitude profiles. CONCLUSION Awareness of God was suitable in diabetic patients, but the quality of relationship with God indicated spiritually immature. It is necessary to provide instruction to improve patient's death attitude and following health behavior.
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S A, S M, P G, C R. Alveolar Gas Exchange and Pulmonary Functions in Patients with Type II Diabetes Mellitus. J Clin Diagn Res 2013; 7:1874-7. [PMID: 24179886 PMCID: PMC3809625 DOI: 10.7860/jcdr/2013/6550.3339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/17/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The incidence of diabetes is increasing tremendously throughout the world especially in the developing countries. This disease affects various organs like eyes, nerves, kidneys and the heart. In this study, we investigated whether lungs are also one of the target organs of diabetes mellitus or not. AIM To assess the pulmonary function parameters including alveolar gas exchange in patients with Type 2 Diabetes mellitus and to find the influence of hyperglycaemia and duration of diabetes. METHODOLOGY This cross sectional study involved 30 type II diabetic patients of age 30-60 years attending the diabetic outpatient department of SRM Medical College & Research Centre and 30 age and sex matched non-diabetic subjects as controls. The glycated haemoglobin (HbA1c) levels, fasting and post prandial blood glucose levels, pulmonary function parameters such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Forced Expiratory Volume Percentage (FEV1 /FVC), Peak Expiratory Flow Rate (PEFR), Forced Expiratory Flow (25 - 75%), Peak Inspiratory flow ( PIF), Forced Inspiratory Vital Capacity ( FIVC), Total Lung Capacity ( TLC),Diffusing capacity of lung for carbon monoxide( DLCO) were measured for all the participants using Easyone Pro computerised spirometer. DLCO was measured by single breath Carbon Monoxide (CO) diffusion test. The alveolar membrane permeability was assessed by evaluating the ratio of DLCO to Alveolar Ventilation (VA). RESULTS The pulmonary function parameters FVC, FEV1, PEFR, PIF, FIVC, TLC , DLCO and DLCO/VA were significantly low (p<0.05) in patients with type II diabetes mellitus when compared to control group. The DLCO and DLCO/VA were significantly lower (p<0.05) in patients with poor glycemic control(HbA1c > 7). CONCLUSION We conclude that the pulmonary function parameters like FVC, FEV1, PEFR, PIF, FIVC, TLC and alveolar gas exchange were significantly reduced in patients with type II diabetes. The patients with Type II diabetes mellitus had a restrictive pattern of respiratory abnormality. The patients with poor glycaemic control( HbA1c > 7) had reduced alveolar diffusion which was not dependent on the duration of diabetes. The impaired respiratory function may give way for the development of pulmonary complications. Spirometry can be used as a screening tool among diabetics as an early preventive measure.
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Affiliation(s)
- Anandhalakshmi S
- Associate Professor, Department of Physiology, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur – 603203, Tamilnadu, India
| | - Manikandan S
- Post Graduate Student, Department of Physiology, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur – 603203, Tamilnadu, India
| | - Ganeshkumar P
- Assistant Professor, Department of Community Medicine, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur – 603203, Tamilnadu, India
| | - Ramachandran C
- Professor and Head, Department of Physiology, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur – 603203, Tamilnadu, India
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Abstract
Cardiovascular complications are the major cause of morbidity and mortality in diabetic patients. An attempt has been made to evaluate the risk factors for coronary heart disease in type II diabetics. In the present study the levels of fasting and postprandial plasma glucose, total cholesterol, low density lipoproteins, triglycerides were high and the levels of high density lipoproteins were low in the type II diabetics compared to controls. The markers of free radical induced injury i.e. malondialdehyde and nitrite/nitrate were high while total antioxidant status a marker for antioxidant protection against reactive oxygen species was low in diabetics compared to controls. The study therefore suggests the importance of assessing these markers of oxidative stress and antioxidant capacity along with the other routine investigations in diabetic patients for initiating antioxidant therapy in addition to primary and secondary preventive measures to mitigate the devastating consequences of diabetes leading to coronary heart disease.
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Affiliation(s)
- H Surekha Rani
- Dept. of Cell Biology, Institute of Genetics amd Hospital for Genetic Diseases, Osmania University, Begumpet, 16 Hyderabad
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Heravian J, Ehyaei A, Shoeibi N, Azimi A, Ostadi-Moghaddam H, Yekta AA, Khoshsima MJ, Esmaily H. Pattern Visual Evoked Potentials in Patients with Type II Diabetes Mellitus. J Ophthalmic Vis Res 2012; 7:225-30. [PMID: 23264865 PMCID: PMC3520591] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/04/2012] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To evaluate cortical and retinal activity by pattern visual evoked potentials (PVEP) in patients with type II diabetes mellitus. METHODS PVEP was recorded in 40 diabetic patients including 20 subjects with non-proliferative diabetic retinopathy (NPDR) and 20 others without any retinopathy on fundus photography, and compared to 40 age- and sex-matched normal non-diabetic controls. RESULTS P100 wave latency was significantly longer in diabetic patients as compared to normal controls (P<0.001); both diabetic subjects without retinopathy and those with NPDR had significantly longer P100 latency than controls (P<0.001 for both comparisons). There was significant reduction in N75 (P=0.037) and P100 (P=0.001) amplitudes in diabetic subjects. No correlation was observed between VEP amplitude or wave latency, and the level of glycemia or duration of diabetes mellitus. CONCLUSION Increased PVEP latency may be a sign of retinal ganglion cell damage which takes place before the appearance of the first ophthalmoscopically detectable signs of diabetic retinopathy. PVEP may be considered as a method for detecting prediabetic retinopathy and has the potential to reduce diabetic complications.
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Affiliation(s)
- Javad Heravian
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Ehyaei
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Eye Research Center, Khatam-al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbass Azimi
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Ostadi-Moghaddam
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas-Ali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamad Javad Khoshsima
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habbibolah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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