Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21733


Recent Submissions

Now showing 1 - 12 of 12
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    The effect of social support on outcomes of disease management for type II diabetic patients in a rural community
    (2015-03) Nu, Jessica; Chiapa-Scifres, Ana; Bowling, John
    Purpose: The Texas Diabetes Prevention and Control program reported a 23% prevalence of Texas residents above the age of 65 who have diabetes. Factors such as health literacy, education, socioeconomic resources, and social support play an important role in compliance to diabetes treatment and medical outcomes. The objective of this study is to explore the relationship between support and outcomes of disease management, such as hemoglobin A1C (HbA1C), in diabetic patients over the age of 65 in rural Fredericksburg, Texas. Materials and Methods: Diabetic patients from the Fredericksburg Clinic who were 65 years or older were administered a 16 question survey. The survey consisted of questions about demographics, previous therapy received for diabetes, and the modified Medical Outcomes Study Social Support Survey. Patient charts were reviewed to obtain the most current HbA1C and fasting blood glucose levels. The survey was completed by 52 patients from July 7, 2014 to September 26, 2014. Pearson’s correlation coefficient was used to analyze the relationship between social support and HbA1C. Results: A total of 29 males and 23 females were surveyed. The average patient had an education of 1-3 years of college or technical school. The majority of surveyed patients were Caucasian (48 of 52). The average income was $36,000-$45,000.The average age was 74 years. The average age of diagnosis was 60 years old. Patients had an average of 3 diabetes-focused doctor visits per year. The average social support score was 4.1 and the standard deviation was 1.04. The average HbA1C and fasting blood glucose were 6.7 and 130.9, respectively. The standard deviation of HbA1C and fasting blood glucose were 0.94 and 46.61, respectively. The Pearson’s correlation coefficient between average social support score and HbA1C was 0.11. The Pearson’s correlation coefficient between average social support score and fasting blood glucose was 0.04. Therefore, no correlation exists between HbA1C and fasting blood glucose with average social support score. Conclusion: Due to a relatively small sample size, no correlation between social support and diabetes management was found. However, further research is still needed to explore the impact of social factors on diabetes management in larger group studies.
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    The effect of sensory reintegration training with virtual reality and vibratory noise on gait in patients with diabetic peripheral neuropathy
    (2015-03) McCrory, Bethany; Bugnariu, Nicoleta
    Purpose: The purpose of this study was to assess the effectiveness of a training program designed to improve gait function and decrease fall risk through sensory reweighting based on the principles of stochastic resonance and using virtual reality (VR) in subjects with diabetic peripheral neuropathy. Methods: This study was conducted using a V-Gait CAREN system. Subjects had 6, one hour long training sessions in which they walked on the treadmill at self-selected speed while practicing increasingly more challenging mobility tasks while their visual attention was engaged by the VR. During training, subjects were fitted with vibratory devices placed above the level of sensory loss (around the ankles) delivering constant sub-threshold white noise. At visits 1 and 8, assessments of gait function and fall risk were conducted using self-selected gait speed, Timed Up and Go (TUG) and Dynamic Gait Index (DGI). Data was analyzed with paired t-tests. Results: Comparisons of pre- and post-training data revealed a significant change in TUG (p=0.02) and a significant change in DGI (p=0.02). At the end of the training subjects were able to maintain a straight walking trajectory even in the presence of visual inputs entraining lateral movements. Conclusions: Preliminary results suggest support for the stochastic resonance theory and show that sensory retraining with VR and the vibratory device is feasible in diabetic subjects, holding promise for improvement of function due to an increased ability to integrate all sensory inputs available and a decreased reliance on visual inputs.
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    Association Between Peak Plantar Shear Stresses and Physical Body Measures
    (2015-03) Master, Hiral; Rieder, Stephen; Udofia, Joseph; Adams, Linda; Yavuz, Metin
    Purpose: Peak pressure has been long considered a risk factor for diabetic foot ulceration. Recent studies also indicated shear as a significant pathological factor. Cavanagh et al (1991) demonstrated a significant correlation between body mass and peak pressures in diabetic patients]. However, Ahroni et al (1987) claimed that peak pressure values of heavier individuals may not necessarily be abnormally high. Another physical body attribute, body height, has been associated with step length which depends on anteroposterior ground reaction forces. To our knowledge the literature does not contain any reports that discuss a potential correlation between peak plantar shear stress and pressure and body measures such as body mass, height or presence of neuropathy. The purpose of this study was to explore these relationships using a custom-built pressure-shear plate. Methods: The study was approved by the Institutional Review Board. Subjects gave informed consent before participation. There are three groups: first - (DN) consisted of 14 diabetic neuropathic patients, second - (DC) comprised 14 diabetic patients without neuropathy and third - (HC) healthy control group, which included 11 subjects. Peripheral neuropathy was tested with a biothesiometer. Each subject walked multiple times at self-selected speeds on the stress plate, which was installed on a 12-ft walkway and set flush. Data from three trials were averaged and used in statistical analysis. Two shear stress and pressure variables were identified in each subject; peak shear (PS), peak shear-time integral (STI), peak pressure (PP) and peak pressure-time integral (PTI). These were correlated against the patients’ body mass, height and vibration. Results: Normality assumption was satisfied. Pearson correlation analysis was carried out for each group and each stress and pressure variable. No correlation was statistically significant. Body mass and body height could not account for any degree of variance in PS, STI, PP and PTI. In addition, plantar shear and pressure magnitudes do not correlate with vibration perception in DN group. Conclusion: Thus, plantar shear stresses do not depend on body weight and body height and they need to be measured rather than calculated.
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    The Diabetes Epidemic in America
    (2015-03) Dunks, Leah N.; Hagenasr, Daniela; Gotlib, Daniel; Avellan, Andrea
    Purpose: Diabetes (DM) is a chronic disease that results from either childhood onset autoimmune destruction of insulin producing pancreatic beta cells (Type 1 Diabetes (T1DM)) or the adult onset inability to effectively utilize the insulin it produces (Type 2 Diabetes (T2DM)). Once considered to be a disease of little significance, DM has grown to be one of the largest medical issues of the 21st century. T2DM is estimated to account for 90% of cases globally. The strong correlation of DM and obesity has lead to the utilization of the term “diabesity’. T1DM continues to be the leading form of DM in children, but T2DM is projected to become the main cause of childhood DM. In this study we discuss the symptoms, mechanisms and statistics of the DM epidemic, and highlight the importance of an increase in T2DM. This analysis is also aimed to promote awareness and education by identifying resources at a national level, as well as resources readily available in Tarrant County. Methods: Our review of the literature was conducted as an evaluative assessment, and focused on the growing trend of DM in society. Our search criteria included assessing lifestyle habits, diet, etiology, and epidemiology of DM. Relevant articles and statistics were identified by a systematic search of Centers for Disease Control (CDC) and Prevention, American Diabetes Association, and PubMeD databases. Results: In the US DM affects 29.1 million people.This figure accounts for the approximately 8.1 million undiagnosed cases. Ethnicity can often increase chances for developing DM, with Native Americans being most at risk. Additionally, CDC research has shown that while having just one relative diagnosed with DM can increase your chances four-fold, the likelihood continues to increase with each subsequent diagnosis. New DM cases are occurring exponentially in the United States as never before. Fortunately, National Diabetes Wellness, Education and Prevention programs at a federal level, and University of North Texas Health Science Center, JPS Health network at a local level provide DM education, care and management at reduced or no cost. Conclusions: Unlike many other diseases DM requires not only medication, but a complete lifestyle change. Despite programs on the national and local level the number of new cases of T2DM and T1DM continue to rise. Future recommendations might include mandatory public school DM education, offering longer recess time, as well as walking desks for older students.
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    Parental Ideology of Diet and Exercise and Associated Risk of T2DM in Children
    (2015-03) Bauman, Thomas R.; Fernando, Shane I.; Fulda, Kimberly; Franks, Susan; Habiba, Nusrath
    Background: Type 2 diabetes mellitus (T2DM) in children is a major public health issue. This study examined parental ideology of diet and exercise and the associated risk of T2DM in children. Methods: Data were obtained from 10-14 year old children in North Central Texas participating in a study examining risk for T2DM. Questions on parental ideology were measured using three questions, including “Making my child eat a healthy diet and exercise regularly would be pleasant,” “I intend to make my child eat a healthy diet and exercise regularly” and “Making my child eat healthy and exercise regularly will reduce their risk of developing diabetes”. Associations were assessed using logistic regression models controlled for race, gender, SES, neighborhood safety and age. Results: Among 290 subjects, 5.7% were Caucasian, 15.4% were African-American, and 78.9% were Hispanic. Mean age was 11.87±1.4, while 50.3% of subjects were female. Increased pleasant perception of exercise and diet had decreased odds of being high risk for T2DM (0.916 OR, 95% CI: 0.901-1.124). Increased intention to make their child eat healthily and exercise had slightly increased odds of being high risk for T2DM (1.01 OR, 95% CI: 1.007-1.631). Finally, belief in healthy diet and exercise reducing risk for T2DM had decreased odds of being high risk for T2DM (0.969 OR, 95% CI: 0.591-0.997). Conclusion: Results from this study suggest that parental ideology of diet and exercise is associated with a child’s risk for T2DM. Improving parents’ positive ideology of exercise and diet may reduce children’s risk of T2DM.
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    Participant Attrition in Better Me Within, a Community-Based Diabetes Prevention Program
    (2015-03) Garner, Becky; Mallah, Janhavi; Zhang, Qianzi; Dodgen, Leilani; Kitzman-Ulrich, Heather; Robb, Jennifer
    Objectives: The purpose of this study was to evaluate the implementation and possible causes of attrition within the Better Me Within (BMW) program, a Community Based Participatory Research (CBPR) study testing a faith-enhanced Diabetes Prevention Program (DPP) compared to the DPP alone with African American (AA) women in church-based settings. Background: Participant attrition has been described as a major problem in obesity trials (or weight loss programs), with reported dropout rates as high as 80%. Previous research has shown positive correlations between attrition rates and attendance. Unlike weight loss studies that are delivered in clinical settings by health care professionals, the BMW program is delivered in church settings by trained lay health coaches (LHC). We intend to explore the association between training implementation for LHCs as that is related to participant engagement, attrition rates and ultimately, primary outcomes. Methods: Baseline demographic information, process evaluations, participant satisfaction surveys and attendance data were collected from three churches within Cohort One of the study and analyzed to identify factors that may both contribute to participant attrition, and serve to identify gaps that might exist in LHC training materials/methods. RESULTS: Process evaluation measures included the categories of fidelity and dose. Data analysis revealed, on a scale of 1-4, facilitator communication skills and social support were the highest (3.64 ± .56, 3.58 ± .59, respectively), across all three churches. However, all three churches were consistently lower in dose. On a scale of zero to one, with zero representing “no” and one representing “yes”, the dose analysis revealed that Church One received the highest overall dose (1.03 ± 0.25), followed by Church Three (0.83 ± 0.25) and Church Four (0.54 ± 0.34). Church Four had the lowest average for all participant satisfaction scores combined. This church also had the lowest attendance rates, with this group also experiencing the greatest decline in average weekly session attendance (57.51% vs. Churches One and Three both had higher average attendance rates in comparison to Church Four, 76.70% and 71.63%, respectively). Conclusions: Core factors that seem to contribute to attrition rates include lower participant satisfaction scores and attendance rates along with a lack of overall adherence to the DPP curriculum, as revealed by process evaluation. Training implementation strategies that may improve the areas of fidelity and dose include LHC training sessions that include assessment methods, with role play and immediate feedback. Strategies such as design and scheduling of LHC training sessions that are tailored to adult learners, along with concurrent booster sessions at regular intervals, may enable the LHCs to develop an understanding of when and why participants might drop out during specific phases of the program, thereby equipping them to exert additional efforts with at risk participants. Results from this study demonstrate that BMW is indeed a useful model for investigating this concept, with data supporting a rationale that supports a thorough investigation of training methodology in order to provide an evidence-based, practical approach to training lay health coaches.
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    Hospital Admission Rates for Children with Diabetic Ketoacidosis (DKA)
    (2015-03) Deleeuw, Peter M.; Thornton, Paul; Gonzalez, Jose L.; Hsieh, Susan; Wilson, Don P.
    Background and Objective: Diabetic Ketoacidosis (DKA) is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Following stabilization in the ED, patients are generally discharged home for outpatient management or hospitalized for continued care. Our objective is to gain a better understanding of the patient characteristics and treatment/disposition strategies used by ED physicians to improve care of children with DKA. Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – Aug 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection. Results: During the study, 401 children were seen in the ED with a diagnosis of DKA. Ten percent (40) of patients were transferred from an outside facility to the ED for assessment and treatment; 90% (361) were not transferred. Of the total patients seen in the ED, 16.2% (65) were discharged for home management after initial assessment and treatment (1 transfer; 64 non-transferred); 83.8% (336) were admitted to the hospital (transfer 39; non-transfer 297). Of the patients who were admitted, the majority (66.9%) were admitted to the inpatient unit (inpatient 225 vs. PICU 111). Conclusion: A large number of children with DKA are evaluated and treated in Emergency Departments. Continuing research on the characteristics of these children and the treatment strategies used by ED physicians can help improve care of children with DKA.
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    The association of individual, interpersonal, and physiological factors on obesity in African American women.
    (2015-03) Reynolds, Courtney; Zhang, Qianzi; Dodgen, Leilani; Kitzman, Heather
    Objective(s): This study evaluated individual, interpersonal, and physiological factors related to obesity. By determining the various underlying factors associated to weight, potential protective factors against obesity can be identified. Background: 34.9% of adults are obese with African Americans (AA) demonstrating the highest rates of obesity (47.8%). Obesity is associated with a variety of chronic health conditions, and has been strongly linked to type II diabetes. In fact, nearly 90% of overweight or obese individuals have a concurrent diagnosis of type II diabetes. Methods: Associations between individual, interpersonal and physiological variables and Body Mass Index (BMI) were evaluated in 62 AA women (mean age 45.8 years [SD 12.4], mean BMI 37.4 [SD 8.3]). Individual and interpersonal variables including social support, self-efficacy for diet and physical activity, and weight management self-efficacy were evaluated with reliable and valid self-report surveys. Physiological variables including LDL cholesterol and Hemoglobin A1C were collected by trained measurement staff. BMI was calculated with objectively collected height and weight data. Results: Of the 62 participants, 21% were overweight (BMI 25-29.9), 24.3% were Class I Obese (BMI 30-34.9), 25.8% were Class II Obese (BMI 35-39.9),and 29.0% were Class III Obese (BMI≥40, extreme obesity). The only individual level variable associated with BMI was motivation for physical activity (r=-0.32; p=.01). The interpersonal variable of support for weight management was negatively associated with BMI (r=-0.23; p=.08). LDL cholesterol was not associated with BMI, however hemoglobin A1C was significantly associated with BMI (r=0.29; p<.05). Conclusion: In this sample, greater motivation for physical activity and social support for weight management were associated with lower BMI. Hemoglobin A1C was associated with greater BMI, demonstrating increased risk for diabetes based on weight. Future research should evaluate the role of motivation for physical activity and social support to improve weight management efforts in AA women.
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    Prolonged High Glucose Treatment Increased Orai1 Protein Expression through Inhibition of Lysosomal Pathway in Human Mesangial Cells
    (2015-03) Chaudhari, Sarika; Wang, Yanxia; Ma, Rong
    The Orai1-mediated store operated calcium entry (SOCE) is associated with many physiological and pathological processes in a variety of cells, including glomerular mesangial cells (MCs). We have previously demonstrated that prolonged treatment of MCs with high glucose (HG) significantly increased Orai1 expression at protein level, but not at mRNA level. These findings suggest that a post-transcriptional mechanism(s) contributes to the HG effect. The aim of the present study was to identify if proteosomal and/or lysosomal pathways were involved in the increased abundance of Orai1 protein in response to HG. Cultured human MCs were with and without treatment with 10 μM MG132 (an inhibitor of proteosomal pathway) or 10 mM ammonium chloride (an inhibitor of lysosomal pathway) in the presence of normal glucose (NG, 5.6 mM) or HG (25 mM) for 6 days. Western blots of the whole cell lysates were conducted to evaluate Orai1 expression level. Fura-2 fluorescence ratiometry was performed to study the intracellular calcium changes in the human MCs. We found that both MG132 and ammonium chloride increased abundance of Orai1 protein in MCs incubated with NG. The MG132 response was further increased by HG treatment. However, HG failed to cause additional increase in Orai1 protein expression in ammonium chloride-treated cells. Furthermore, fura-2 fluorescence ratiometry study showed that both MG132 and ammonium chloride increased the cyclopiazonic acid (25 μM)-stimulated SOCE. Simultaneous treatment with HG only enhanced the MG132 response, but not the ammonium chloride response. Taken together, our results indicate that HG increased expression of Orai1 protein by inhibiting its degradation through the lysosomal pathway.
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    Link between Diabetic Treatment Modalities (Oral medication, Insulin) and Global Cognitive Functioning Among Mexican Americans: An HABLE Study
    (2015-03) Del Toro, Sophia V.; Edwards, Melissa; Johnson, Leigh; OBryant, Sid
    Background: Diabetes is a significant health concern for the Hispanic population as diagnosis occurs, on average 10 years earlier than among non-Hispanic Whites and at a higher frequency. The link between diabetes and cognitive impairment has been supported though this link is not well understood. Recent empirical findings have suggested the use of insulin as a potential means for improving cognitive functioning; however, only one study to date has examined the implications of diabetes medication treatment on cognitive functioning among a sample of non-Hispanic whites. The aim of this study was to examine the implications of diabetes treatment modalities (oral medication, insulin) on cognitive functioning among a sample of Hispanic adults and elders. Methods: Data was analyzed from 201 Hispanic Mexican American participants with a diagnosis of diabetes and who endorsed diabetic treatment (oral medication n=172; insulin n=54) from the Health and Aging Brain Study among Latino Elders (HABLE). Each participant underwent an interview (i.e. medical history, medications, and health behaviors), neuropsychological testing, blood draw, medical examination, and informant interviews. Diagnosis of MCI was assigned according to published criteria and was designated based on weekly consensus reviews. Global cognitive functioning was assessed utilizing the Mini Mental Status Examination (MMSE). HbA1c levels were categorized based on diabetic control status with values below 8% being considered controlled. Liner regressions were utilized with the dependent variable being global cognitive functioning and the independent variable being diabetic treatment modality. Age, gender and education were entered into the models as covariates. Results: Among the total sample, use of oral medication as a treatment for diabetes was associated with higher global cognitive functioning (B[SE] = 1.43[0.66], t-test=2.14, p-value = 0.033). When split by diabetic control status, those with uncontrolled diabetes (HbA1c level ≥ 8) and who were taking oral medications also demonstrated higher global cognitive functioning as measured by the MMSE (B[SE]= 2.28 [0.76], t-test=3.03, p-value = 0.003). Insulin treatment was not found to be significantly associated with global cognitive functioning within the total sample or when split by diabetic control status. Conclusions: The results of our study suggest that diabetic treatment modalities differentially impact cognitive functioning among a sample of Hispanic Mexican Americans with oral medication showing to be significantly impactful. Future studies should further examine the link between specific oral diabetic medications and cognitive functioning.
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    Type 2 Diabetes Mellitus in Adults: Social Barriers in Treatment and Prevention
    (2015-03) McGlennon, Matthew R.; Ikram, Haseeb R.; Mabile, Colten; Mohajir, Wasay A.; Nomad, Farad
    Purpose: Type 2 Diabetes Mellitus, also known as adult onset diabetes, is a disease in which there is development of insulin insensitivity within the body. Recently, rises in obesity and metabolic syndrome have caused increased prevalence of type 2 diabetes in the US population, with 9.3% of the US having the disease, and about 1.7 million new cases per year. As a health consequence, diabetes has become the 7th leading cause of death in the United States. The purpose of this research was to analyse the barriers in prevention and treatment of type 2 diabetes mellitus, as well as propose solutions to addressing this growing problem. Methods and Materials: To examine diabetes prevalence dependent on different social factors, information was collected from the CDC's National Diabetes Statistics Report and the American Diabetes Association. For Texas, statistics from the Texas Department of State Health Services were examined. From this information, significant barriers towards prevention and treatment were identified. Solutions to these barriers were analyzed to find the most efficacious methods of prevention and treatment of type 2 diabetes. Results: The prevalence of diabetes has risen in recent years, due in part to lack of diet, exercise, and education in the community. Dietary factors that are responsible for increased prevalence dealt with the lack of access to healthier foods and ease of access to foods that are cheaper but lack nutritional substance (so called ‘empty calories’), mainly seen in low socioeconomic locations. A decrease in time spent exercising was also noted; exercise results in a higher caloric consumption by the body, as well as being linked to prevention and mild reversal of insulin insensitivity. Lack of information was seen as a major contributor, especially for people of lower socioeconomic standing. Conclusions: These barriers provide a great deal of resistance in the treatment and in the prevention of type 2 diabetes, thus they must be brought down if there is to be effective containment of diabetes development. Programs and support groups have shown significant increases in the development of knowledge of the patient on not only treating their own diabetes, but in also helping people make more informed decisions. Early childhood intervention was shown to be a major benefit to disease prevention, with plans such as school lunch remodeling and nutrition education helping inform and direct children towards healthier lifestyles.
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    Care of Children with Diabetic Ketoacidosis in Hospital Emergency Departments
    (2015-03) Mou, Margaret; Pickard, Brenna; Hsieh, Susan; Thornton, Paul; Wilson, Don
    Background: Although preventable, diabetic ketoacidosis (DKA) remains a frequent and life-threatening complication of diabetes mellitus. Emergency Departments (ED) are the initial point of treatment for most children with DKA, which emphasizes the critical need for EDs to tailor therapy for their pediatric population. Understanding the evaluation, treatment, and disposition of such patients are critical to improving care and outcomes. Purpose: To conduct a survey of pediatric ED providers to better understand approaches to treating children with DKA. Subjects and Methods: An anonymous electronic survey was distributed to pediatric ED physicians in 6 pediatric emergency departments located in major metropolitan areas. Each of the EDs was part of a pediatric hospital that provides undergraduate and graduate medical education. Data and Conclusions: The majority of emergency department physicians correctly identified published criteria for diagnosis of DKA in children. While 89% either strongly agreed or agreed that children with DKA have ketonuria, only 43% strongly agreed or agreed that children with DKA had a BOBH >3. Reasons for admitting a child with DKA to the hospital included altered mental status, persistent vomiting, and lack of adult supervision. In the past 6 months, of all children treated in the ED with DKA approximately 70% were thought to be autoimmune (i.e. Type 1). The majority of children (91%) who presented to the ED with DKA were admitted; very few were discharged home (6.2%) or admitted to a short stay unit (2.8%). Aside from the pediatric ICU, use of a continuous IV insulin drip was not used either during emergency transport or while a child was admitted to the inpatient pediatric floor. However, 73.2% of respondents stated they used continuous IV insulin drip in the ED to treat DKA. Except for glucose and electrolytes, point of care testing was not available for hemoglobin or BOHB acid testing. Barriers to treating children with DKA in the ED included lack of familiarity with DKA treatment guidelines and lack of adequate inpatient facilities. Suggestions for enhancing knowledge of DKA treatment in the ED included education programs, educational materials, evidence based guidelines for treatment of DKA and a hospital or department sponsored DKA quality improvement initiative.