Diabetes
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Item Associations between dietary intakes of magnesium and calcium and overweight and obesity in US children from National Health and Nutrition Examination Survey (NHANES) 2003-2012(2018-03-14) Tan, Zhengqi; Chen, Shande; Tao, Menghua; Huang, YuhanMagnesium and calcium are important micronutrients for normal growth and development, and they may play a role in the development of obesity. Previous studies showed abnormalities of serum magnesium and calcium levels were detected among obese children. We examine the associations between intakes of magnesium and calcium from food and overweight/obesity among children in a population-based cross-sectional study. A total number of 5,813 children aged 8 to 14 years from the National Health and Nutrition Examination Survey (NHANES) 2003 to 2012 were included in our analyses. Dietary intakes of calcium and magnesium were determined from 24-h dietary recalls. NHANES anthropometric measurements were used, and body mass index (BMI) and BMI-for-age percentiles were calculated for boys and girls. Based on the International Child BMI-cut-offs, overweight was defined as BMI≥85% to BMIItem Association between diabetic complications and frequency of HbA1c checks in the United States – Analysis of the 2015 Behavioral Risk Factors Surveillance System (BRFSS) data.(2018-03-14) Suzuki, Sumihiro; Orimoloye, HelenPurpose: Hemoglobin A1c levels are considered to be the best indicator of good glycemic control. Poor glycemic control leads to diabetic complications. The purpose of this study was to examine the relationship between diabetic complications and the frequency of hemoglobin A1c monitoring. Methods: Behavioral risk factor surveillance system data from 2015 were analyzed to estimate the frequency of hemoglobin A1c monitoring in people with diabetes. Ordinal logistic regression was used to examine the association between frequency of hemoglobin A1c checks and diabetic complications. Results: People with diabetic complications had higher proportional odds (adjusted odds ratio [AOR]=1.27; 95% confidence interval [CI] = [1.08, 1.50]) of checking hemoglobin A1c more frequently when compared to those without diabetic complications. For individual diabetic complications, those who reported having kidney disease (AOR = 1.23; 95% CI = [1.02, 1.50]), eye disease (AOR = 1.34; 95% CI = [1.12, 1.60]), and coronary heart disease (AOR =1.25; 95% CI = [1.03, 1.52]), showed statistically significant association with increased frequency of hemoglobin A1c checks. Conclusion: Our results suggest that people with diabetes do not adhere to recommended care guidelines until complications develop. Interventions should focus on HemoglobinA1c monitoring prior to complications developing to improve diabetic outcomes.Item Short term exposure to high glucose negatively regulates store-operated calcium channel proteins in mesangial cells.(2018-03-14) Jiang, Hui; Zou, Shubiao; Huang, Linjing; Ma, Rong; Chaudhari, SarikaPurpose: Glomerular mesangial cells (MCs) are an important target of metabolic abnormalities in diabetic environment. The Orai1-mediated store-operated calcium entry (SOCE) is associated with many physiological processes in a variety of cells, including MCs. However, whether SOCE in MCs is involved in diabetic kidney disease is not clear. High glucose (HG) is the principal cause of MC pathogenesis in diabetes and altered MC function by HG is central to the pathogenesis of progressive diabetic glomerulopathy. The present study was carried out to determine if HG treatment altered the protein content of Orai1 and the protein-mediated SOCE in MCs. Methods: Western blot was conducted to estimate abundance of Orai1 protein and Fura-2 fluorescence ratiometry was used to analyze SOCE. Results: We found that treatment of rat MCs with HG (25 mM) for time periods ranging from 2 hours to 24 hours decreased abundance of Orai1 protein. A significant decrease was observed at the time point of 8 hours, which sustained at least for additional 16 hours. Consistently, HG treatment for 8 hours significantly reduced SOCE. HG treatment for the same time periods did not alter the level of Orai1 transcript. In the presence of cycloheximide, a protein synthesis inhibitor, the HG effects on the level of Orai1 protein still existed, suggesting posttranslational mechanisms involved. Furthermore, both MG132 (the ubiquitin-proteasome inhibitor) and NH4Cl (the lysosomal pathway inhibitor) significantly attenuated the HG-induced reduction of Orai1 protein abundance. Moreover, HG treatment for 8 hours stimulated ubiquitination of Orai1 protein. We further found that HG treatment elevated the level of cellular hydrogen peroxide (H2O2) in a time-dependent manner. Treatment of cells with PEG-catalase significantly blunted the HG-induced reduction of Orai1 protein abundance. In addition, H2O2 itself also significantly decreased abundance of Orai1 protein and increased the level of ubiquitinated Orai1. Conclusion: Taking together, these results suggest that HG treatment for a short-term, decreased the abundance of Orai1 protein in MCs by promoting its degradation through the ubiquitination-proteosome and –lysosome mechanisms. This HG-stimulated posttranslational regulation of Orai1 protein was mediated by H2O2.Item Does the Relationship Between Activity Limitations and Mental Health Differ by Gender in Diabetic Adults Age 45 Years and Older?(2018-03-14) Boyde, Bryttin; Durnil, Amber; Khanjae, Sonam; Hartos, Jessica; Eissa, ShadiaPurpose: In the United States, there is a moderate prevalence of disability and mental illness among adults, with diabetes as a contributing risk factor. Given the limited research among diabetics, the purpose of this study was to determine whether the relationship between activity limitations and mental health differs by gender in diabetic adults age 45 and older. Method: This cross-sectional analysis used data from the 2015 BRFSS for pre-diabetic and diabetic adults age 45 years and older from Arkansas, Tennessee, Oklahoma, and Alabama. Multiple logistic regression analysis was used to assess the relationship between mental health and activity limitations while controlling for depression, health conditions, weight status, age, ethnicity/race, marital status, education level, employment status, income level, and gender. Results: About two-thirds of pre-diabetic and diabetic adults age 45 years and older reported less than 30 days of good mental health (33-36%) and less than half reported two or more activity limitations (36-42%). After controlling for socioeconomic, demographic, and health related variables, males with two or more activity limitations were about 3-5 times less likely to report good mental health in all four states. Likewise, females with two or more activity limitations were about 2-4 times less likely to report good mental health in all states except Arkansas. Additionally, depression was found to be significantly and inversely related to mental health in four of four states in both males and females. Conclusion: Overall, mental health and activity limitations were found to be inversely related in pre-diabetic and diabetic adults age 45 and older. A major limitation of this study was the inability to assess the severity of disease states, and whether they were controlled with medication. General practitioners can expect to see a moderate prevalence of poor mental health and activity limitations in pre-diabetic and diabetic adults age 45 years and older, particularly in patients with a history of depression. Primary care providers should provide mental health screens and referrals in pre-diabetic and diabetic adult patients presenting with two or more activity limitations, especially in males. Additionally, providers should screen for activity limitations if pre-diabetic and diabetic adult patients present with poor mental health.Item A Preliminary Look at the Effect of Light Exposure on Blood Glucose Levels of Overweight and Obese Teens(2018-03-14) Roane, Brandy; Fulda, Kimberly; Fernando, Shane; Shah, Deep; Habiba, Nusrath; Bowman, Paul; Shum, KathyPurpose: Teens experience a puberty-driven delay in their circadian clock due to a mismatch in their internal and social clocks that increases their risk of adverse health outcomes. Disruption to the circadian system from ill-timed light exposure before bedtime and reduced melatonin levels produces adverse changes in glucose control and increases Type 2 Diabetes Mellitus (T2DM) risk. As such, teens may be more susceptible to developing T2DM. This study sought to provide better insight into the relationship between light exposure around the sleep period and risk of developing T2DM in this vulnerable and understudied population. We proposed that light levels would be positively associated with HbA1c levels in teens during the two hours before bedtime and during the sleep period. Methods: Current analyses utilized baseline data from a 13-week pilot intervention study (PI: Roane) that examined the impact of a circadian-conscious intervention on T2DM risk. Teens and caregivers provided informed consent/assent. HbA1c levels (mmol/mol) were collected via finger prick. Teens followed a “typical” self-selected sleep schedule for 1-week while wearing a wrist actigraph (AMI MicroMotion Logger) to capture 24-hour sleep and light data. BMI %tile was calculated from in-lab measured height and weight. Mean lux, percent time above 20 lux, minimum lux, and maximum lux were calculated for the two hours pre-bedtime and during the sleep period. Correlation analyses were run to examine the association between light exposure and HbA1c due to small sample size. Results: Teens (n=7) were age 16 years, 57% female, and 57% Hispanic with low to moderate T2DM risk. Mean BMI %tile was 97th, HbA1c was 5.4, and 57% exhibited Acanthosis Nigricans. Mean sleep period duration was 496 minutes (mean sleep duration during this period = 410 minutes). Correlation analyses were not significant; however, visual inspection showed sex-differences in HbA1c levels and different patterns in how light exposure during these two crucial periods may relate to HbA1c. Conclusion: These pilot findings did not confirm an association between light exposure (lux) and HbA1c levels (mmol/mol) in obese and overweight teenagers. Findings were limited by a sample that was small in size and low in T2DM risk. Suggested sex differences in these data combined with documented sex differences in the literature support further examining sex differences in a larger sample with more diverse T2DM risk.Item Losing the Protective Effect of Cognitive Aging in Mexican American Diabetics(2018-03-14) Gomez, Julie; Munoz, Haydee; Vintimilla, Raul; O'Jile, Judith; Johnson, Leigh; O'Bryant, Sid E.; Filipetto, FrancescaBackground: Diabetes is a serious health issue, affecting nearly 29 million people in the US. Mexican Americans (MA) have higher rates of diabetes, a risk factor for Alzheimer’s disease and mild cognitive impairment. Normal cognitive aging is associated with decline, not impairment, in some areas of cognition (processing speed, memory, etc). Diabetes may contribute to age associated cognitive decline and to the development of cognitive impairment. This study examines the effect of age on memory and executive functioning (EF) among diabetic and nondiabetic MA. Methods: Data from 415 MA subjects from the Health and Aging Brain among Latino Elders study (HABLE) were analyzed. Participants were classified as diabetic (n=171) or non-diabetic (n=244) and young (50 to 64, n=326) or old (65 and older, n=89). All participants were classified as normal controls (i.e., no diagnosis of dementia or MCI). Each participant underwent an interview (i.e., medical history and medications), cognitive testing, blood tests, and medical examination, as well as informant interviews. Memory was assessed by the Ravens Auditory Verbal Learning Test (RAVLT) Recognition and Delayed Recall, while EF was measured by Trail Making Test (TMT) Parts A&B and CLOX Part 1&2. Analyses were split by diabetes status (diabetic, non-diabetic) and age group (young, old), using independent t-tests. Results: Younger non-diabetic subjects scored significantly better than older non-diabetic subjects on measures of memory: RAVLT-Delayed Recall, t (3)=3.109, p=.002 , and executive functioning: TMT-A, t(56.450)=-3.529, p=.001, TMT-B, t(206)=-2.09, p=.004, and CLOX Part 2. Younger diabetic subjects scored significantly better than older diabetic subjects on measures of memory: RAVLT-Delayed Recall, t (109)=2.57, p=.012, and EF: TMT-A, t(44.177)=-2.257, p=.03, TMT-B, t(138)= -2.250, p=.026, and CLOX Part 2. Conclusion: It was expected that younger participants would perform better than older participants on all cognitive tests, regardless of diabetic status. However, the results indicated that younger and older diabetics demonstrated a similar pattern of performance on measures of memory and executive functioning, suggesting that younger age may no longer be a protective for diabetics. This study was limited by small sample size and cross sectional nature of the data. Further research is needed to understand the impact of health risks on normal cognitive aging.Item Safer Living with Diabetes: A Team Approach(2018-03-14) Naziruddin, Zahra; Elrod, Shara; Hamill, VictoriaPurpose Few published reports have described the use of interprofessional diabetes education courses to improve clinical outcomes, including hypoglycemic events and hemoglobin A1c (HbA1c) in geriatric patients with Type 2 Diabetes Mellitus (T2DM). The complex nature of T2DM in older adults necessitates a team of healthcare providers to focus on the various aspects of the disease including pathophysiology, complications, medications, and diet. Additionally, because of the increased risk of falls and hospitalizations associated with hypoglycemia in older adults, this should be an essential component of any education course. The aim of our study is to determine the effect of interprofessional interventions in improving HbA1c outcomes and reducing hypoglycemic episodes in older adults with T2DM. Methods The ‘Safer Living with Diabetes’ diabetes education class is an interprofessional two-hour patient education course taught by a pharmacist, nurse practitioner, and dietician explaining the disease process, complications, medications, and healthy diet. Eligible patients were referred by their medical provider and must have been diagnosed with pre-diabetes or T2DM. Point-of-care HbA1c levels were collected in patients requiring clinical assessment. Prior to the course, the nurse practitioner and pharmacist met to review treatment plans for patients scheduled to attend the course. Following the course, attendees met with either the nurse practitioner or pharmacist to review their point-of-care HbA1c results for possible medication adjustments. Attendees then followed-up with either the nurse practitioner or pharmacist in the clinic as appropriate. Attendees were asked to complete a pre- and post-course questionnaire to assess diabetes knowledge. Results Thirty-five patients (28% female, 94% T2DM) participated in the diabetes education course from September 2016 to June 2017. Mean age of participants was 74 years. Pre and post course surveys found improvement in patient’s understanding of the risk of hypoglycemia. HbA1c levels were reduced following the education course (7.88% prior, 7.64% post). A follow-up telephone survey to determine number of hypoglycemic events and the participants’ overall thoughts of the course is planned. Conclusion An interprofessional diabetes education course appears to benefit HbA1c levels in older adults with T2DM.Item Effect of an evidenced-based diabetic ketoacidosis pathway in a pediatric emergency department on patient outcomes(2018-03-14) Jessu, Rishita; Hamby, Tyler; Tobin, Kimberly; Wilson, RobertAbstract Purpose: Our primary objective was to measure time to first insulin dose, before and after usage of a diabetic ketoacidosis (DKA) order set in a pediatric emergency department. We had multiple secondary objectives, including determining the relation of patient outcomes to time to first insulin (such as their length of stay in the ED, as well as inpatient admissions as a whole), and improving time to resolution of all DKA patients. Methods: This project was implemented after an agreement between the Endocrine and Emergency Departments that the establishment of a guideline would be helpful; the ICFISH pathway was created and implemented. ICFISH is an acronym for identify, call endocrinology, fluids, insulin, status, and finally hand-off. The retrospective data collection occurred between October 1, 2014 and March 31, 2016. The prospective data collection was between November 1, 2016 and June 8, 2017. All patients admitted for DKA during this time frame were included, but patients with new-onset diabetes and transfer patients were excluded from analyses. Patient records were entered into REDCap and analyses were performed via SAS (Statistical Analysis Software). Time to resolution, length of stay, whether the patient was discharged from the ED, and whether patient was admitted to PICU were compared based on whether the patient was admitted before or after ICFISH implementation. Results: A total of 198 patients met inclusion criteria, and 127 were excluded, leaving 71 patients. There was a statistically significant decrease in the time to resolution of patients on the floor or PICU from the pre-group to the post-group (p=0.032), as well as length of stay (p=0.004), ED discharge (p=0.028), and PICU admission (p=0.001). Conclusion: A standardized order set to treat patients admitted for DKA, via the ICFISH pathway, leads to decreased variability, thus resulting in shorter length of stay in the hospital overall, decreased PICU admissions, and increased ED discharge. Research Area Cook Children’s Medical Center Presentation Type PosterItem Management of Type Two Diabetes with Chronic Kidney Disease(2018-03-14) Monk, Nicole; Smith, AllieManagement of Type Two Diabetes with Chronic Kidney Disease Allie Smith MS-III, Nicole Monk MS-III, Long Wong M.D. Chronic kidney disease is a complex disease that occurs in over 200 million people worldwide. There are multiple causes, including: chronic hypertension, arteriolosclerosis and diabetes. Diabetic kidney disease occurs in about 40% of all patients with type two diabetes. Due to the insidious nature of renal damage and the high risk of both secondary hypertension and diabetic nephropathy caused by type two diabetes, early intervention and tight glycemic control are crucial to slowing the progression of renal disease. Renal disease in these patients also poses a complicated problem due to the fact that the effects and concentrations of typical drugs use to control type two diabetes, are partially dependent on renal function as are the unique side effects of each drug. Therefore, close monitoring and frequent adjustment of these medications is needed when managing a type two diabetic with chronic kidney disease. In this report, we offer a brief overview of management of patients with type two diabetes that also have chronic kidney disease and present the case of a 71 year old female with type two diabetes and recently diagnosed chronic kidney disease.Item Does General Health Differ by Physical Activity Level in Middle Aged Diabetic Females?(2018-03-14) Moccia, Angela; Looten, Kalli; Hartos, Jessica; Turner, Christine; Bliha, MadelinePurpose: Diabetes is a widespread health issue in the general population, but limited information is available for the relationship between physical activity level and general health in diabetic patients, especially in specific age or gender subpopulations. The goal of this study was to determine whether general health differs by physical activity level in middle-aged diabetic females. Methods: This cross-sectional analysis used 2015 BRFSS data for middle-aged diabetic females ages 45-64 from Arkansas, Missouri, Ohio and West Virginia. Multiple logistic regression analysis assessed the relationship between physical activity level and general health while controlling for weight status, health conditions, alcohol use, tobacco use, education level, employment status, age, and ethnicity/race. Results: Across states, about half of the females ages 45-64 reported having good or better general health (38-52%) and less reported being highly active (16-23%). The results of adjusted analysis indicated good or better general health was significantly related to highly active physical activity level in Ohio (AOR= 3.09, 95%CI= 1.55, 6.15) and Missouri (AOR= 5.72, 95%CI= 1.99-16.80). Additionally, good or better general health was related to employment status in all four states (large effect sizes). In contrast, good or better general health was inversely related to health conditions in two of the four states (large effect sizes). Conclusions: A highly active physical activity level was found to be significantly related to general health in two out of four states. Since this data was from a population-based study, the results may generalize to middle-aged diabetic females presenting to a general practice clinic. Thus, primary care practitioners can expect to see a low to moderate prevalence of middle-aged diabetic females reporting a highly active physical activity level and good or better general health. Providers should consider assessing the activity level and general health of diabetic middle-aged female patients as well as consider their comorbid health conditions and provide education and resources to encourage physical activity as indicated.