Browsing by Subject "Diabetes"
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Item AN EVALUATION OF DIABETES KNOWLEDGE AMONGST TYPE 2 DIABETICS, HIGH RISK, AND LOW RISK DIABETIC POPULATIONS IN A RURAL COMMUNITY(2014-03) Riezenman, Ariel R.; Mendoza, Irwin; Chiapa-Scifres, Ana; Bowling, JohnPurpose (a): It has been predicted that 1 of 3 adults in the US will have diabetes by 2050. Most Texas rural communities lack adequate healthcare professionals and resources to serve their residents. The assessment of diabetes knowledge in a rural community identifies groups that may benefit from diabetes education in efforts to prevent diabetes and its associated medical complications. Methods (b): A cross-sectional study was performed within Guadalupe County at hospital and clinical settings. A consent and 24-item survey was provided to each participant. Data abstracted from 122 individual surveys were analyzed on SAS. Participants were classified as either having type 2 diabetes or being of high/low risk for type 2 diabetes. Risk status was based on the number of diabetes risk factors outlined by the National Diabetes Informational Clearinghouse. Diabetes exposure was determined by either having diabetes or knowing someone with diabetes, such as a family member or friend. Diabetes knowledge was categorized based on number of correct questions: poor (poor (<8), average (9-16), good (17-24). Results (c): Participants had an average age of 43 years, were predominantly white (63.87%), and female (61.34%). The average number of correct responses from the diabetes knowledge questionnaire was 12.38 (±3.43), with majority of participants having average diabetes knowledge, 78.15%. Independent sample t-tests were conducted to compare the average number of correct responses from the diabetes knowledge questionnaire and both diabetes exposure and age. Specifically, those with diabetes exposure had a significantly higher average number of correct responses (M = 12.69, SD = 3.23) when compared to participants not exposed to diabetes (M = 9.27, SD = 3.88), t (117) = -3.28, p = 0.001. Similarly, the average number of correct responses was significantly different between participants aged 18 to 25 (M = 10.87, SD = 3.13) and those aged 26 and older (M = 13, SD = 3.28), t (113) = -3.10, p = 0.003. A one-way ANOVA noted a significant effect for risk status on average number of correct responses, F (2, 118) = 5.14, p=0.007. Post hoc analysis using the Tukey HSD test indicated that the average number of correct response for those with diabetes (M = 13.7, SD = 2.69) was significantly different from those at low risk (M = 11.29, SD = 3.85). However, those at high risk (M = 12.68, SD = 3.02) did not differ significantly from either those at low risk or those with type 2 diabetes. A one-way ANOVA showed no significant effect for gender on average number of correct responses, F (2, 118) = 1.78, p=0.173. Conclusions (d): Overall, this study supports targeted diabetes education for persons aged 18-25 years, regardless of gender, in rural communities due to their lower levels of diabetes knowledge compared to persons aged 26 and older. Through diabetes awareness programs and health education classes, diabetes prevention and future medical complications may be reduced in rural settings.Item Calcium Sensitivy of β-cell Transcription Factor Binding to an Insulin Enhancer(1998-06-01) Scott, Gary Frank; Easom, Richard; Lacko, Andras G.; Wu, Ming-ChiGary Frank Scott, Calcium Sensitivity of β-cell Transcription Factor Binding to an Insulin Enhancer. Master of Science (Biochemistry and Molecular Biology), June 1998, 104 pp., 16 illustrations, bibliography, 94 titles. Insulin is an essential hormone and is produced exclusively in endocrine pancreas β-cells for the control of glucose homeostasis in mammals. The hypothesis tested in this thesis is that increased intracellular Ca2+ ([Ca2+]i) contributes to activation of glucose-induced insulin gene transcription. Glucose-induced insulin transcription has been mapped to binding of transcription factors by β-cell sequence motifs from -197 to -247, a glucose-response-enchancer (GRE), in the rat insulin1 gene (rINS1) promoter. Using oligonucleotide probes representing this glucose-response-enhancer (GRE) in electrophorectic mobility shift assays (EMSA), we have examined the Ca2+-sensitivity of transcription factor binding to nuclear extracts from cultured rat insulinoma β-cells (INS-1). In the presence or absence of kinase inhibitors, Ca2+ chelators, and Ca2+ channel blockers, binding was assayed for the following cell conditions: 1) in situ permeabilized cells exposed to Ca2+; 2) in vitro 32p-phosphorylated nuclear extracts; and 3) in situ glucose-stimulated and K+-depolarized intact cells. Binding was Ca2+-sensitive due to activation by K+depolarization as well as inhibition by a Ca2+-chelator, a Ca2+-channel blocker, and KN-93, specific for Ca2+/calmodulin kinases, suggesting a phosphorylation-dependent mechanism. Taken together, these findings identify a role for the Ca2+ second messenger in the glucose regulation of the insulin gene which points to novel treatments for type II diabetes.Item Canonical Transient Receptor Potential 6 (TRPC6) Dysregulation in Mesangial Cells and Glomerular Hyperfiltration during the Early Stages of Diabetes(2010-12-01) Graham, Sarabeth M.; Rong MaGlomerular mesangial cells (MCs) regulate the glomerular filtration rate (GFR) by contracting and relaxing in response to agonists. The contractile function of MCs is controlled by intracellular Ca2+. Canonical Transient receptor potential 6 (TRPC6) contribute to Ca2+ signaling in a variety of cells. However, the physiological and pathological relevance of TRPC6 in MCs remains unknown. The present study was conducted to examine 1) if TRPC6 mediated an agonist-induced Ca2+ response in MCs and if this Ca2+ signaling mechanism was impaired in diabetes 2) the mechanism by which TRPC6 is dysregulated in diabetes. In the first study, angiotensin II (AngII)-stimulated membrane currents were significantly enhanced in TRPC6 overexpressing MCs, but significantly attenuated in cells with TRPC6 knockdown. AngII-induced calcium influx was suppressed in MCs with TRPC6 knockdown, as well as in MCs cultured in high glucose (HG). HG reduced both the mRNA and protein levels of TRPC6, but not other isoforms of TRPCs, in a time and dose dependent manner. Furthermore, in streptozotocin (STZ)-induced diabetic rat glomeruli, TRPC6 but not TRPC1 was downregulated. In the second study, we found that the diabetes-induced decrease in TRPC6 protein expression was specific for glomeruli and no change in TRPC6 expression was observed in the heart or aorta. In cultured MCs, hydrogen peroxide (H2O2) decreased TRPC6 protein expression in a dose and time dependent manner. Antioxidants prevented the inhibitory effect of HG on TRPC6 in MCs. Consistently, treatment of STZ-diabetic rats with tempol preserved TRPC6 in the glomeruli. Nox4 knockdown led to an increase in TRPC6 protein in MCs. Furthermore, PMA, but not its analog 4α-PDD, suppressed TRPC6 and this PMA effect was not altered by catalase. A PKC inhibitor, Gö6976, attenuated the downregulation of TRPC6 caused by both HG and H2O2. Taken together, these studies suggest that TRPC6 participates in Ca2+ signaling in MCs and hyperglycemia in diabetes downregulates TRPC6 protein expression through a Nox4-ROS-PKC pathway.Item CLASSIFICATION OF CHILDREN WITH NEWLY DIAGNOSED DIABETES MELLITUS(2014-03) Prakash, Sameer; Leung-Pineda, Van; Suzuki, Sumihiro; Radack, Jill A.; Dallas, John; Thornton, Paul; Wilson, DonPurpose (a): Historically the diagnosis of Type 2 Diabetes Mellitus (T2DM) has relied on a well described clinical phenotype. The reliability of this clinical phenotype in classifying children with diabetes is, however, not clear. The ability of experienced clinicians to correctly classify the type of diabetes based upon the clinical phenotype has recently been challenged. According to the American Diabetes Association, the diagnosis of T2DM requires a fasting plasma glucose of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dl or higher during a 75-g oral glucose tolerance test, or a random plasma glucose of 200 mg/dL or higher in a patient with classic symptoms of hyperglycemia or hyperglycemia crisis. In addition, those with T2DM should demonstrate the absence of diabetes auto-antibodies. Since the appropriate classification of a child's diabetes has important implications with regard to treatment options, expected outcomes and genetic counseling, a systematic, cost-effective algorithm to assist in the initial classification of diabetes mellitus is needed. Methods (b): We propose a retrospective analysis of diabetes related autoantibody tests (GAD, IA-2, Tg, Gliadin Peptide IGA, Gliadin Peptide IGG) in children (< 18 yrs of age) seen for evaluation of newly diagnosed diabetes mellitus in the Pediatric Endocrine Clinic hospitalized at Cook Children’s Medical Center for Jan 2010-June 2012.Following IRB approval, children and adolescents. Results (c): Following IRB approval, we conducted a retrospective chart review of 348 children(178 males; 170 females) hospitalized at Cook’s Children’s Medical Center from Jan 2010 – Jun 2012 with new onset diabetes mellitus to determine the frequency of antibody positive vs. antibody negative diabetes mellitus. In addition the frequency and test results for other diabetes-associated conditions (i.e. thyroid and celiac disease) were summarized. As expected the majority of patients were positive for one or more diabetes related antibodies. A much smaller number of patients were also tested for diabetes-associated conditions. Conclusions (d): We conclude that the majority of children < 18 years of age with new onset diabetes are positive for diabetes antibodies at the time of presentation. Those that are antibody negative need further evaluation to 1) determine whether these patients may have T2DM, a genetic form of DM (i.e. MODY) or some other form of diabetes and 2) to provide appropriate therapeutic and genetic counseling. Given the complexity of diagnosing diabetes mellitus and the rising cost of healthcare, a systematic algorithm may be useful in providing a cost-effective means of classifying children with new onset diabetes mellitus.Item DIETARY PATTERNS AMONG DIABETIC AND NON-DIABETIC MEXICAN AMERICAN WOMEN(2013-04-12) Alexander, ShanePurpose: Targeting ethnic disparities in diabetes mellitus (DM) prevalence has become a major focus of disease prevention. In the U.S., 13.3% of Mexican Americans have been diagnosed with DM - a rate 1.9 times higher than among non-Hispanic whites. Recent literature has focused on cultural perceptions and behaviors contributing to risk factors that lead to DM. The goal of this pilot study was to examine what type of information was given by health care providers, as well as obtain self-reported diabetic care activities among Mexican American women. Additionally, this study sought to compare the dietary patterns of diabetics and non-diabetics. Methods: Data was analyzed from 47 Mexican American women (diabetic n=24; non-diabetic n=23) recruited through the Health and Aging Brain Study among Latino Elders (HABLE), a translational research study that examines factors related to aging among Hispanics. Variables included age, food frequency questionnaire, HbA1c levels, blood glucose, BMI, and a summary of diabetes self-care activity measures. A one-way ANOVA was conducted to examine the difference in nutritional intake according to diabetic status. Results: The average age of onset of a DM diagnosis was 48 years old. Diabetics reported their health care providers advised them to: follow a healthy eating plan (94%), reduce number of calories (95%), follow a complex carbohydrate diet (74%), follow a diet high in fiber (74%), eat 5 servings of fruit and vegetables daily (63%), and lose weight (80%). Further examination showed that 50% had uncontrolled HbA1c (X=8.7) and blood glucose levels (X=170). Significant elevations in BMI [F(1,44)=5.4, p=0.02] and daily caloric intake [F(1,45)=4.2, p=0.04] were found in diabetic women compared to non-diabetic participants. No significant difference was found in daily intake of carbohydrates, protein, and total fat. Conclusions: The results suggest that diabetic women have a higher BMI and daily caloric intake than non-diabetic women despite reporting advice given from their health care providers regarding dietary patterns. This may be due to several reasons. First, it is possible that participants have changed their eating habits, though not enough to achieve glycemic control. Secondly, it is possible that more in depth dietary intervention or nutritional counseling is needed. Limitations include small sample size. More research into dietary patterns of diabetics is needed to design culturally appropriate interventions.Item HIP CIRCUMFERENCE AND WAIST CIRCUMFERENCE AS A MEASUREMENT OF RISK FOR TYPE II DIABETES IN MEXICAN AND MEXICAN AMERICAN CHILDREN(2013-04-12) Simon, KaleyPurpose: It is well documented that Hispanics have higher rates of Diabetes type 2 in comparison to other races. This paper will examine data on child study participant's waist circumference and hip circumference and the relation to being at higher risk of developing type 2 Diabetes and Depression. Most studies have found girls age 10 to 14 to have average waist measurements ranging from 62.8 cm to 70.6 cm and boys ages 10 to 14 to have measurements ranging from 63.3 cm to 70.6 cm. Our study population of children in the same age range has an average waist measurement of 83.34 cm, well above both of the averages. Methods: Data from 47 Mexican and Mexican-American children, ages 10 to 14 were collected. Of those that participated, 27 (57.4%) were female and 20 (42.6%) were male. Statistical analysis was conducted in SPSS and SAS software programs to obtain chi-square analysis, descriptive statistics and logistic regression. Child Depression Inventory (CDI) measurements were used to test the levels of depression of the child. Both children and parents completed CDI surveys and both were used for descriptive analysis in this study. Dependent variables examined are high risk and low risk of diabetes and CDI indicators. Independent variables examined were that of CDI indicators, and waist and hip circumference. Results: Of those children that participated, 36.2% are at high risk for developing Diabetes Mellitus based on participants meeting 3 to 5 of the criterion. Additionally, 10.6% have a glucose level in the pre-diabetic range. The CDI results on the child survey were 14.9% of children scored above high average, with 4.2% above the elevated range. The parent CDI results were similar with 17.0% of parents scoring their children above the high average range. Using logistic regression, waist circumference was found to be a significant indicator of High risk for diabetes with an odds ratio of .013. The 95% confidence intervals support this find with a lower limit of .685 and an upper limit of .957. Confounding will be examined to address why the odds ratio for waist circumference is inverse of the expected outcome. Conclusions: Waist circumference is a predictor of high risk status of developing Diabetes Type 2 among this population of participants. It should be noted that caution should be taken when interpreting the results so as to avoid bias. The participants in this study may have chosen to participate because they perceived themselves to be at greater risk than others.Item INCREASED POTENTIAL FOR GLUCOSE METABOLISM INTERFERENCE AND RETINAL ANEURYSMS FROM CARBON DISFULDIE EXPOSURE IN OIL AND NATURAL GAS WORKERS: A SYSTEMATIC REVIEW(2014-03) Patel, Jay T.; Rich, Alisa L.; Al-Angari, Samiah S.Exposure to chemicals in the air from manufacturing emissions may cause health impact to workers and the general public. A chemical historically found in rayon manufacturing emissions, carbon disulfide (CS2) is also present in emissions from oil and natural gas operations. This research identified how exposure to CS2 can affect blood glucose levels and can lead to damage to eyes. With the current trend in urban drilling, the general public may experience these health impacts from breathing CS2 in the air. Workers need to be tested regularly to prevent health complications. Purpose (a): This study examined the relationship of glucose metabolism interference and retinal microaneurysms from exposure to carbon disulfide (CS2) in natural gas workers. This study is the first to identify an increased potential for glucose metabolism interference, resulting in diabetogenic effect and subsequent retinal microaneurysms in natural gas occupational workers exposed to CS2. Methods (b): The review of literature was conducted as an evaluative assessment rather than an annotated bibliography and focused on the potential diabetogenic effects from CS2 exposure. The search criteria were inclusive to all papers on occupational health effects related to CS2 exposure. Relevant articles were identified by a systematic search of Medline, TOXLINE, Scopus, and PubMed databases. Due to the lack of current literature, all study designs were included. Results (c): The literature review found a strong association in viscose rayon occupational workers exposed to CS2 and an increased potential for alteration of normal glucose metabolism and retinal microaneurysms. CS2 wasalso found to be present in emissions from extraction and processing of oil and natural gas. The mechanism of action of CS2 on a biochemical level proved similar in viscose rayon and oil and natural gas workers. Conclusions (d): Natural gas occupational workers exposed to CS2 may experience an increased potential for glucose metabolism interference, which has been an indicator for diabetogenic effect and increased incidence for retinal disease. The recommendation is for regular monitoring of blood glucose levels in CS2-exposed workers preventing diabetogenic effect and ensuing retinopathy.Item PARENT'S PERCEPTIONS OF NEIGHBORHOOD SAFETY AND RISK OF TYPE 2 DIABETES IN MEXICAN AMERICAN CHILDREN AND ADOLESCENTS(2014-03) Ramirez, Roberto C.; Fulda, Kimberly; Lee, Michelle; Proffitt Leyva, Randi; Franks, Susan; Espinoza, AnnaWe conducted a study with Mexican American children and their parents and found that having playgrounds in the child's neighborhood lowers the risk of having type 2 diabetes. Purpose (a): The number of people suffering from type 2 diabetes (2 DM) has increased drastically over the last 30 years, especially in children under the age of 18. Specifically, Mexican American children have been diagnosed at alarming rates. Inactivity in children has contributed to these high rates of diabetes, but there is not sufficient information on factors that contribute to this inactivity. The purpose of this study was to explore parent’s perceptions of the features in their neighborhoods and its safety as it relates to their child being at risk of developing 2 DM. Methods (b): 144 Mexican American participants, ages 10-14 were enrolled in this study which included one visit that lasted approximately two hours. The primary caregiver was asked via a survey to assess the features and safety of the neighborhood in which the child participant lives. A set of measurements and family history were taken on each participant. “High-risk” status was assigned if participants had ≥3 of the following risk factors: BMI ≥95 percentile, high blood glucose, presence of Acanthosis Nigricans, family history of 2 DM in a 1st or 2nd degree relative, and history of hypertension or blood pressure ≥95th percentile. Simple and multiple logistic regressions were performed with high risk status for 2 DM as the outcome variable and neighborhood safety, presence of sidewalks and playgrounds in neighborhoods as the primary predictors. The adjusted model controlled for child’s age, gender, highest education level of household and household income. Results (c): Adjusted analyses illustrate that the presence of playgrounds in the respondent’s neighborhoods presented a 76% decreased odds of being at risk for 2 DM [OR: 0.24; 95% CI (0.06-0.86)]. The parent’s perceptions of neighborhood safety and the presence of sidewalks were not significant findings. In secondary findings, participants who responded that Spanish was the primary language spoken in the home had 79% decreased odds of being at risk for 2 DM [OR: 0.21; 95% CI (0.11-1.35)]. Conclusions (d): Potential policy implications resulting from the analysis of the study point to an increase in potential support for the establishment of playgrounds in areas that are deprived of such elements.Item The Tarrant County Diabetes Collaboration: A Case Study of a Community Diabetes Coalition(2001-08-01) Sammer, Christine; Lykens, Kristine; Lurie, Sue; Gonzalez, AdelaSammer, Christine, The Tarrant County Diabetes Collaboration: A Case of a Community Diabetes Coalition. Master of Public Health (Health Administration), August, 2001, 66 pp., 2 tables, 1 figure, bibliography, 20 titles. This study considers the characteristics of a diabetes coalition that are necessary for coalition maintenance beyond the formation and building stages. A case study was done of the Tarrant County Diabetes Collaboration (TCDC). Data were collected through recorded interviews and a review of documents. The concepts of collaboration identified were: composition, ownership, value, governance, operational map, fiscal structure, and domain. These concepts are presented in a conceptual model. Conclusions made were that the two main strengths of the TCDC were composition and member’s perception of value. Opportunities for growth included defining member roles, developing strong leadership, operating by an operational map and fiscal plan, and becoming recognized as a force for diabetes in the community.