Diabetes
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/32076
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Item The impact of the COVID-19 pandemic on the access to care for Type 2 Diabetic Patients(2023) Matthews, Hillary; Fulda, Kimberly; Blair, Somer; White, Annesha; Pitts, Samantha; Young, Richard; Hendrix, Noah; Espinoza, Anna; Xiao, YanBackground: Type 2 diabetic hemoglobin (HbA1c) A1c testing decreased substantially during the coronavirus (COVID-19) pandemic, resulting in gaps in care. Low socioeconomic populations may be affected in care received during the COVID-19 pandemic. The pandemic may have further amplified health disparities, such as inadequate HbA1c testing, and decreased resource availability, ultimately leading to potential health decline. The purpose of this study was to identify race/ethnicity predictors of gaps in care for HbA1c testing during the COVID-19 pandemic among patients with type 2 diabetes (T2DM). Methods: This study included analysis of electronic health records from patients with T2DM at two healthcare systems (John Peter Smith Health Network and UNT Health). Times between HbA1c testing were compared pre COVID (March 1, 2019 – March 1, 2020) and during COVID (March 2, 2020 – March 1, 2021). Established patients (with two or more visits) at the two systems during the pre COVID period and at least one visit during the COVID period were included for analysis. Variables for analysis were selected using the Anderson Social Behavioral Model to assess the impact predisposing, enabling, and need factors had on gaps in HbA1c testing among different racial/ethnic groups during COVID-19. Data were analyzed using multilevel clustered survival models. Analyses were stratified by race/ethnicity (non-Hispanic White, non-Hispanic Black American, Hispanic, and other). Age, sex, BMI, visit modality (telemedicine or in-person), taking insulin (yes, no), at least one HbA1c above 8%, hypertension (yes, no), anxiety (yes, no), lipid metabolism disorder (yes, no), and private insurance (yes, no) were included in the models. Comparisons were made using multilevel clustered survival models to assess trends that occurred and the impact variables had in care gaps in type 2 diabetic patients during the COVID-19 pandemic. Results: A total of 2,951 patients were included. Patients with HbA1c >8% pre-COVID had larger HbA1c testing gap times during COVID-19 for all race/ethnicities, compared with those with HbA1c <=8%. Larger testing gaps among patients with diabetic medications (oral and injectables) during COVID-19 were identified in Non-Hispanic Black Americans (p=0.02) and Hispanics (p=0.01), compared to those without diabetic medications. Men experienced larger gap times in HbA1c assessments compared to females among non-Hispanic Black Americans. Having at least one telemedicine appointment was associated with a decreased gap time among Hispanics. Conclusions: Research demonstrates a reduction in access to care for underrepresented populations due to COVID. Patients with diabetic medications (excluding insulin) experienced decreased HbA1c assessments, potentially resulting in worsened health. Inconsistent chronic disease management is associated with increased risk of all-cause mortality. Implementation of telemedicine and increased HbA1c testing is known to correlate with positive health overall.Item SARS-CoV-2 induced exacerbation of HbA1c in Type 2 Diabetics(2023) Ahmed, AffanBackground: The Covid-19 pandemic started when severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was discovered in Wuhan, China. Although the majority of those infected suffer mild symptoms and recover, it is estimated that about 20% of infected patients can develop pneumonia, and some of these patients can develop acute respiratory distress syndrome (ARDS). Diabetes mellitus is a complex disease that affects millions of people worldwide. When it comes to type 2 diabetes mellitus the CDC reports that about 11.3% of the United States population is affected by diabetes. Case Presentation: A 56-year-old Hispanic male presented to the clinic for his routine 6-month diabetes follow-up. He had a medical history of type 2 diabetes mellitus, morbid obesity, benign hypertension, BPH without urinary obstruction, and unspecified hyperlipidemia. For his diabetes, the patient took 500 mg metformin, 4 mg glimepiride, and 2 mg/dose semaglutide. The patient had been compliant with his medication. His only relevant family history included his mother with a diagnosis of diabetes mellitus. The patient denied constitutional, cardiovascular, respiratory, and neurological ROS questions. There was no change in the patient’s medical history except that he had contracted SARS-CoV-2 three months before the visit. The patient described his symptoms, and his infection was classified as a mild version of the disease. The patient’s vitals were within normal limits, and he had a BMI of 37.3. His general, cardio, respiratory, and skin PE findings were all normal as well. HbA1c was recorded at 10.2% and his estimated average blood glucose was 242 mg/dl. Both values had increased from 7.1% and 157 mg/dl respectively since his previous visit on July 22, 2022. At this current visit, his (nonfasting) glucose was 324 mg/dl. The patient’s semaglutide was stopped and replaced with tirzepatide in hopes of reducing his HbA1c along with helping him lose weight. Unfortunately, the patient could not tolerate a higher dose of metformin. Discussion: The question remains whether this patient’s sudden increase in HbA1c of 3.1% from 7.1% to 10.2% could be attributed to the patient’s mild infection of COVID-19. A study published by Joshi & Pozzilli in 2022 in the Diabetes Research and Clinical Practice journal found that SARS-CoV-2 can dysregulate glucose homeostasis even in patients with no previous risk factors for diabetes mellitus. One report that studied the relationship between these two variables found that there was an association between severe COVID-19 and increased blood glucose. They also found that HbA1c was slightly elevated in those with severe COVID-19 compared to mild COVID-19 however, this finding did not reach significance. Physicians taking care of type 2 diabetic patients can caution their patients on the possibility of being infected with COVID-19 and worsening their A1c levels. For those patients battling a severe form of COVID-19, their A1c levels could also be measured after the infection to rule out COVID-19-induced diabetes mellitus. This case report also expands the list of long-term complications from COVID-19.Item Sleep Duration and Social Determinants of Health Predict Osteoporosis in Adults 50 Years of Age and Older After Controlling for Vitamin D, Demographic Characteristics, and Physical Activity.(2023) Campbell, Blake; Fulda, Kimberly; Zhang, Fan; Webb, Brian; Espinoza, Anna; Navid, DanielPurpose: Osteoporosis is a bone disease that develops when bone density and mass decreases, or when the quality or structure of bone changes. There are many causes of osteoporosis, with some etiologies being more understood than others. Prevention is critical in the treatment of osteoporosis, due to its serious complications, including life altering hip and spine fractures. Despite prevention and treatment, osteoporosis in most cases is inevitable, but the onset and severity is what can be helped. Finding other ways to slow or even prevent osteoporosis is an active area of study, with sleep being one of the many variables of interest due to its role in homeostasis. The literature demonstrates contradictory findings for the relationship between sleep and osteoporosis. Many of the studies lack a recent and/or big enough sample size, and there is a need for further research on the subject. Additionally, recent literature has not included variables representative of social determinants of health, such as income and education. The purpose of this study was to further investigate the association that between sleep and osteoporosis in individuals 50 and older using the NHANES Database while controlling for potential covariates such as social determinants of health. Methods: Data from the National Health and Nutrition Examination Survey (NHANES), 2017-2020 were analyzed to determine the association between sleep duration and osteoporosis in adults 50 and older. Multivariate logistic regression was performed controlling for race/ethnicity, age (≥50 years), gender, highest household education, physical activity, poverty, vitamin D, and BMI. Analyses were considered statistically significant at p<0.05. Results: Analyses included 4963 adults over the age of 50, with 51% (2507) being female. A total of 12.3% (611) of the cohort had a diagnosis of osteoporosis, with 87% of the osteoporotic group being female (530). Mean age was 65.2 years (sd=9.3) for the total sample, 64.5 (sd=9.2) for non-osteoporotic individuals, and 70.0 (sd=8.8) for osteoporotic individuals. In the adjusted analyses, we found no statistically significant association between sleep duration and osteoporosis. There is a statistically significant association between family monthly poverty level and osteoporosis ([OR:0.93; 95%CI(0.87-0.99) p=0.047]. BMI, Age, and Gender were also significantly associated with osteoporosis. Other social determinants of health such as race, physical activity, and education were not statistically significant. Vitamin D was also not associated with osteoporosis. Conclusion: The purpose of this study was to further investigate the association between sleep and osteoporosis in individuals 50 and older while controlling for covariates, particularly social determinants of health. We looked at specifically sleep duration, and a previous diagnosis of osteoporosis. We theorized that lower sleep durations may have an association with osteoporosis; however, our results did not support this. The association between family poverty index and osteoporosis highlights the importance of exploring socioeconomic differences in sleep and osteoporosis research in the future, respectively. Finally, this study is limited by a lack of a quantitative measure of osteoporosis. Future work with additional socioeconomic variables and more consistent data collecting modalities should shed more light on the subjectItem Diabetes-Related Outcomes of an Interprofessional Chronic Care Management (CCM) Service in Medicare Beneficiaries(2023) Rodriguez, Emmanuel; Wesling, Megan; Nguyenly, Angel; Ebert-Blackburn, Didi; Aguiniga, AshlynPurpose: Patients with type 2 diabetes (T2D) often have coexisting conditions requiring consistent monitoring and preventative measures. Chronic Care Management (CCM) is a Medicare program that aims to improve chronic disease state management, however literature on clinical outcomes is lacking. The purpose of this study is to evaluate the diabetes-related outcomes of an interprofessionally-delivered CCM program in patients where Medicare is the singular payer and secondarily, its financial impact. Methods: Adult Medicare patients with T2D enrolled in CCM between February 2020 and August 2021 were included in this retrospective chart review. Participants were evaluated pre- and post-CCM enrollment using non-parametric tests on 1) clinical measures such as A1C; 2) preventative measures; and 3) involvement of clinical staff such as pharmacists and social workers. Descriptive statistics were used to describe financials. Results: Thirty-three patients were included in the study. Changes in clinical measures included a significant reduction in mean A1C from 8.4% to 7.4% (p=0.012), and a nonsignificant reduction in blood pressure and body mass index. There was also a significant increase in pharmacist and social worker involvement, but no significant changes to preventative measures. A total of $26,673.00 was billed to Medicare, with a reimbursement rate of 44%. Conclusion: The CCM service demonstrated a significant reduction in A1C and a significant increase in pharmacist and social worker access. There were no significant changes in preventative measures, likely due to the overlapping study period and COVID-19 pandemic. Future studies outside of pandemic conditions are needed to further assess these nonsignificant outcomes.Item Neonatal Diabetic Ketoacidosis - A Case Report(2023) Bommakanti, Maalini; Borrego, Natali; Radack, Jill; Hamilton, Luke; Wilson, DonBackground: Neonatal diabetes mellitus (NDM) is a rare condition (1 in 400,000 live births). It generally presents within the first 6 months of life and may be transient or permanent. The transient form is commonly associated with paternal isodisomy and monogenic variants, such as KCNJ11 and ABCC8, located on chromosome 6. The permanent form is also associated with monogenic variants, most commonly KCNJ11 and ABCC8. Diabetic ketoacidosis (DKA), which is common in older children and teens with autoimmune diabetes mellitus (T1D), is rare in NDM and often overlooked. Case Study: A 1-day-old female with low birthweight (2.520 kg) was referred to Cook Children’s Medical Center for tachypnea (78 to 84 bpm) and hyperglycemia. Her blood pH was 7.22 (7.29 – 7.24), pCO2 <12 (27- 40 mmHg), pO2 122 (54-95 mmHg), and HCO3 of 4.1 (19.0-24.0 mmol/L). Blood glucose levels were >200 mg/dL. Due to persistent respiratory symptoms, she was suspected of being septic and was treated with ampicillin and gentamicin. She was on the cutoff for SGA. Within the initial 48 hours of admission, her lab test results were consistent with DKA - blood glucose of 305 mg/dL (50-96 normal), lactic acid of 2.3 mmol/L (0.5-2.0 normal), anion gap of 21 (10-16 normal) and B-hydroxybutyrate of 9 mmol/L (0.4-0.5 normal). Genetic testing showed a variant of unknown significance in HNF1a. Following stabilization, the parents underwent diabetes education, and the infant was discharged on daily insulin therapy for follow-up in the Endocrine clinic. By 5 years-of-age, she continued to require daily injections of insulin for glucose control. This case is unique in that the infant was found to have a variant of unknown significance for HNF1a, a monogenic mutation that is typically seen in maturity-onset diabetes of the young (MODY). In general, MODY is not typically associated with DKA. Therefore, while our finding is intriguing, we cannot state that this variant is causative in the case we presented. Further reports of HNF1 variants are needed to help determine if there is an association with NDM and DKA. Conclusions: In infants, NDM and DKA are rare and present with nonspecific symptoms, which often delays the diagnosis. Although rare, it is imperative that NDM and DKA be considered in order to avoid adverse consequences, including death.