Chronic care service delivery models for people living with type 1 diabetes in low- and lower-middle income countries: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the published literature that describes the distribution and organization of chronic care service delivery models for people living with type 1 diabetes (PLWT1D) in low- and lower-middle-income countries (LLMICs).

INTRODUCTION

Type 1 diabetes is an autoimmune condition commonly diagnosed in childhood and early adolescence; it cannot be prevented and is deadly without daily insulin injections. Among PLWT1D, the islet cells in the pancreas produce insufficient amounts of the glucose-regulating hormone, insulin, resulting in the need for chronic insulin replacement therapy. Epidemiological information regarding type 1 diabetes (T1D) is limited in LLMICs. Improving survival for PLWT1D in LLMICs requires early diagnosis and greater access to high quality chronic care service delivery models for T1D. The identification and reporting of service delivery model typologies for PLWT1D will allow for more specific research questions regarding individual typologies in subsequent systematic reviews.

INCLUSION CRITERIA

The review will consider all types of literature on the organization and distribution of chronic care services for the management of PLWT1D provided out of facilities in LLMICs, published from 2000 to the present.

METHODS

The JBI methodology for conducting scoping reviews will be employed. The search will be implemented across PubMed, Embase, and Web of Science. Full texts of the publications selected will be reviewed and data will be extracted through a charting table. The findings will be charted to summarize the results.

Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center

BACKGROUND

Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality.

RESULTS

Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race.

CONCLUSIONS

Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

Abstract 4836: Inhibition of PI3K/mTOR leads to adaptive resistance in extracellular matrix attached cancer cells

The PI3K/mTOR-pathway is the most commonly deregulated pathway in epithelial cancers and represents an important target for cancer therapeutics. Here we show that inhibition of PI3K/mTOR in ovarian and breast cancer 3D spheroids leads to death of inner extracellular matrix-deprived cells, whereas matrix-attached cells are resistant. Resistance to PI3K inhibitors is associated with upregulation of a cellular survival program that involves both FOXO-mediated transcription and a novel translational resistance mechanism. This program is evolutionarily well-conserved and resembles nutrient/growth deprivation, leading to translation of IRES-containing pro-survival mRNAs, previously associated with cellular stress responses. Inhibition of any of several upregulated pro-survival proteins, including Bcl-2, EGFR, or IGF1R, abrogates resistance to PI3K/mTOR inhibition in breast and ovarian cancer cells and ovarian cancer xenografts. These studies provide a platform for rational development of effective drug combinations through the use of 3D-based model systems together with high-throughput proteomics approaches and identify drug combinations for further analysis as cancer therapeutics.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4836. doi:1538-7445.AM2012-4836

DL1-1: Adaptive Resistance to Targeted Therapies

While therapies that target specific molecular alterations in human tumors are showing significant efficacy in the clinic, drug resistance remains a major obstacle. Studies from our laboratory and others have provided evidence that PI3K- and HER2− targeted therapies induce a program of molecular responses to drug treatment that significantly contributes to drug resistance. Interestingly, we have found that resistance in vitro and in mouse models is significantly enriched in cells attached to basement membrane. This resistance correlates with specific upregulation of the adaptive response in the matrix-attached cells. Importantly, inhibition of key components of the adaptive response, like BCL-2, abrogates the drug-induced adaptive resistance. We propose a model in which matrix-protection from targeted therapies allows survival of a subpopulation of tumor cells associated with matrix/basement membrane which expand and lead to more stable drug resistance.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr DL1-1.