Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30808


Recent Submissions

Now showing 1 - 3 of 3
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    Discontinuation of Basal and Bolus Insulin using a Combined Dietary and Pharmacologic Approach in a Patient with Type 2 Diabetes and NASH-Cirrhosis in the Primary Care Setting
    (2022) Yasuda, Tai; Paredes, Dante; Wesling, Megan
    Background:Currently, there are no FDA-approved pharmacologic treatments for NAFLD and lifestyle intervention remains first line. As patient adherence to dietary and exercise modification has limited success, NAFLD is currently the most rapidly increasing indication for liver transplant in Western countries. Further, NAFLD is considered an independent risk factor for both liver-related and all-cause mortality. Given that weight loss via dietary modifications is one of the few proven treatments for NAFLD, it is important to continue investigating the effectiveness of current dietary recommendations. Intermittent fasting (IF) has become an increasingly popular dietary regimen in the management of weight loss and metabolic disorders, including NAFLD. Time-restricted feeding (TRF) is a form of IF that allows intake of meals within a specific time frame, followed by periods of fasting. Fasting periods vary from 16 hours to several days and depend largely on patient tolerance and preference. This case report investigates the effectiveness of IF in a patient with severe NAFLD complicated by decompensated cirrhosis.Case Presentation: Patient is a 48-year-old male with past medical history of metabolic syndrome, meeting criteria with central obesity >40 in. circumference, HDL < 40, type 2 diabetes, and hypertension. He was admitted to the hospital for GI bleed in February 2021 with subsequent EGD showing ruptured esophageal varices. Further work up with abdominal CT showed fatty liver infiltrate with confirmed cirrhosis. Without history of excessive alcohol intake, use of hepatotoxic medications, or identifiable genetic causes, a diagnosis of NAFLD complicated by cirrhosis was made. At diagnosis, his weight was 303.2 lbs with BMI of 47.4. Medications included metformin 1000 mg BID, semaglutide 0.25 mg weekly, insulin glargine (U-300) 70 units daily, and insulin aspart 14 units TID plus sliding scale. Dietary interventions were discussed with patient and family in June 2021. Patient preferences, family adherence, access to food, and financial status were evaluated prior to initiation of dietary changes. After extensive dialogue, the following TRF regimen was implemented: ketogenic diet (carbohydrates < 30g/ day) with all food consumed within an 8-hour feeding window and one 36-hour fast per week. Medications were adjusted to reduce the risk of hypoglycemia. Patient was monitored closely via continuous glucose monitor throughout the intervention. After 3 weeks, the patient was able to discontinue his basal and bolus insulin and repeat imaging at week 8 showed resolution of NAFLD via MRI and a weight loss of > 10%. Conclusions: Medically supervised, therapeutic fasting regimens can help reverse hepatic steatosis in NAFLD. Intermittent fasting is a practical dietary intervention that can also increase insulin sensitivity and improve blood glucose control. Considering lifestyle interventions are the only treatment for NAFLD, more research is needed to determine effectiveness of current recommendations.
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    Health care provider recommendations for exercise in Mexican American elders with type two diabetes mellitus
    (2022) Hernandez, Arlene; Triana, Maria; Robinson, Shontia
    Abstract: Purpose: Mexican Americans (MA) are more likely to have risk factors for developing Type Two Diabetes Mellitus (T2DM) than Non-Hispanic Whites. They are also reported to have some of the lowest levels of physical activity in the United States. Exercise lowers blood sugar levels and recommending specific exercises that are tailored to patients can become a more effective form of blood glucose control. This study aims to examine the relationship between healthcare provider recommendations on T2DM management for MA patients. Methods: The data was collected from 196 MA with T2DM from a community-based epidemiological study of aging. The healthcare provider recommendations were assessed using the Summary of Diabetes Self-Diabetes Care Activities Questionnaire (SDSCA). This questionnaire examines participant's diabetes and self-care. Descriptive statistics were used to describe what health care providers recommend for exercise. Results: The demographic characteristics were an age of T2DM onset (M=52, SD=10.2), fasting glucose (M=155, SD=62), average Hemoglobin A1C (M=7.99, SD 1.8). 87 percent of participants stated their providers recommended to maintain low levels of exercise. While 68.9 percent of participants endorsed that their health care team advised 20 minutes of daily exercise at least three times a week. 67.3 percent of participants said their providers recommended daily exercise. In contrast, only 31.1 percent were given specific instructions about the type, duration, and level of exercise. Conclusion: The study demonstrates that providers give general recommendations but not tailored ones about exercises to help manage participant's T2DM. The results show participants endorse low levels of exercise, but those levels are not enough. Findings support integrated recommendations from health care teams that reinforce specific information so patients can exercise enough to prevent the sequelae of diabetes.
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    The Impact of COVID-19 on Access to Insulin and Other Supplies among Patients with Diabetes
    (2022) Jodray, Megan; McKeefer, Haley
    Purpose: Diabetes is a well-researched primary prevalent comorbidity among patients infected with COVID-19; however, there is little literature on the management of Type 2 diabetes during government-mandated quarantine periods. To our knowledge, there is no literature assessing the impact of COVID-19 on diabetic management in an underserved population in the outpatient or ambulatory care setting. The PROMIS (Partnership in Resilience for Medication Safety) research team was tasked to understand how diabetes was managed in the outpatient setting in an underserved patient population. Our study objective is to explore the impact COVID-19 had on patient access to insulin, other diabetic therapeutics, and diabetic supplies in the outpatient setting. Our secondary objective is to describe if differences in diabetic management occurred between patients who utilized telehealth vs inpatient appointments. Methods: A retrospective analysis of deidentified claims data from HSC Health and John Peter Smith (JPS) Health Network was performed. Hemoglobin A1c (HgbA1c), type of visit (telehealth vs in-person), and number of appropriate diabetic management changes were compared between two cohorts, a pre-COVID-19 cohort (May 2019-April 2020) and a COVID-19 cohort (May 2020-July 2020). Adult patients were included in the study if they had at least one HgbA1c in both time periods. Controlled HgbA1c results were defined as < 7. Evaluation of appropriate diabetes was defined by the American Diabetes Association 2021 Standards of Medical Care in Diabetes guidelines. Results: Pending. Conclusion: Analysis of drug regimen changes, HgbA1c changes, and telehealth utilization between the cohorts will provide insight into access barriers and how changes to therapeutic regimens were implemented as a result. These important findings will shed light on the impact of COVID-19 on diabetes care and prompt value considerations for pharmacists, physicians and other health care professionals in their diabetic management.