Browsing by Subject "Type 2 diabetes"

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Adherence to oral antidiabetic medications in the pediatric population with type 2 diabetes
(2011-05) Adeyemi, Ayoade Olayemi; Rascati, Karen L.; Strassels, Scott A.; Lawson, Ken A.
The present study involved the analyses of the Texas Medicaid prescription claims data. The population studied was made up of subjects between 10 and 18 years who had at least 2 prescriptions of the same oral antidiabetic (OAD) medication from January 1, 2006 through December 31, 2009. Twelve months’ data for each subject were analyzed. The main aim of the study was to describe OAD medication use patterns in the study population, assess trends in Medication Possession Ratio (MPR) and persistence in the study population and determine the relationship between age and MPR and between age and persistence while controlling for covariates. Results of the descriptive statistics, multiple and logistic regression analyses are reported. The average age (± SD) of the 3,109 eligible subjects was 14 (± 2) years; minority populations made up the majority (87%) of the population; 67% of the population were females; and 91% were on the OAD metformin. The overall mean MPR (± SD) for the population was 45% (± 27). A significant negative relationship between MPR and age was reported while controlling for covariates (p<0.0001). Among the covariates, white race and male were significantly associated with a higher MPR, holding other variables constant. When adherence was dichotomized (MPR < 80% and MPR >= 80%), logistic regression analysis also found that age was significantly and negatively related to MPR (p < 0.0001). In addition, the white race and male were again significantly related to a higher level of adherence, holding other variables constant. The overall mean days to non-persistence (± SD) was 108 days (± 86). Persistence was significantly and negatively associated with age, holding other variables constant (p < 0.0001). Among the covariates, white race was significantly related to longer persistence. In conclusion, adherence and persistence are generally low in the study population. Age, gender and race were significantly associated with adherence. Being younger, male, and white were significantly associated with a higher level of adherence, while being younger and white were significantly associated with longer persistence. Healthcare providers therefore need to intensify efforts to improve adherence in pediatric patients especially those at the brink of adulthood.
Cuban Americans and type 2 diabetes : describing self-management decision making using an empowerment framework
(2013-08) Cuevas, Heather E.; Brown, Sharon A., 1943-
This qualitative descriptive study examined the day-to-day self-management decision making in Cuban Americans with type 2 diabetes including major decisions, resources and influences to decisions, desired amount of control and advice, and the role of the health care provider. The sample consisted of 20 English speaking, Cuban-American adults between the ages of 45 to 65 years. The mean A1C was 7.49%; mean diabetes duration 4.5 years. Data were collected through discussion of a short self-management decision-making scenario, a semi-structured interview, and demographic questionnaire. Interviews were analyzed using Miles and Huberman’s method of content analysis framed by the concepts of Paolo Freire’s empowerment theory. Self-management tasks of exercise, diet, medication administration, and glucose monitoring were all thought to be important by the participants. Cost, time, structural barriers, social environment, symptoms, and medical information influenced self-management decisions. Challenges included negotiating social occasions, acknowledgement of friends and family, structural barriers, and available resources. Most participants felt they had some personal control and responsibility in decision making. Health care providers, friends, and family were sources of advice. Attempts were made to integrate health care providers’ advice into day-to-day self-management. The aspects of Freire’s theory (dialogue, reflection, and praxis) were reflected in participants’ descriptions of self-management decisions. The findings of this study suggest the challenges of balancing self-management practices with everyday life should be considered when caring for Cuban Americans with diabetes. Culturally sensitive interventions that facilitate the integration of glucose monitoring, exercise, diet, and mediations need to be developed.
Culture and food practices of African-American women with type 2 diabetes
(2014-08) Sumlin, Lisa LaNell; Brown, Sharon A., 1943-
African-American women (AAW) have had the largest increase in diagnosed diabetes in the US. Few studies have focused solely on dietary changes (one of the foundations for diabetes self-care), particularly in the context of family and the role of AAW. The purpose of this descriptive ethnographic study was to explicate cultural influences on food practices of AAW with type 2 diabetes (T2DM) in order to inform the health care community as well as future development of culturally-tailored interventions. Specific aims were to describe typical daily food practices and identify cultural influences on food practices of AAW with T2DM. Symbolic Interactionism, a sensitizing framework for viewing AAW with T2DM as a subculture, guided this study. Purposeful sampling was used to recruit 20 AAW who: were between 35 and 70 years of age, had been diagnosed with T2DM, shopped and prepared meals for their families, and attended church functions where food was served . Data collection consisted of one-one-one interviews and participant observation of church fellowship dinners, grocery shopping, and food preparation. A social anthropological approach to content analysis was used to describe behavioral regularities in food practices. Trustworthiness was maintained by an audit trail. Findings indicate that for informants in this study, who had diabetes ranging from 2 to 30+ years, there is a constant struggle between cultural food practices and eating healthier because of diabetes, particularly within the home setting where a majority of daily food practices take place. Difficulties in making dietary modifications result from conflicts between the need to change dietary practices to control diabetes and personal food preferences, as well as the preferences of people within the participants' social network. In addition, difficulties derive from AAW's emotional dedication to the symbolism of food and traditional cultural food practices. AAW are the gatekeepers for family food practices and are the keys to healthy dietary practices. This study begins to fill the research gap regarding cultural dietary food practices of this population. With increased knowledge, researchers and health care providers will be better able to improve AAW food practices, and ultimately improve diabetes control in this high-risk population.
Cytokine expression during the development and progression of type 2 diabetes in rats
(2018-08-14) Huo, Yu; Stone, Audrey J.
Previous research suggests that the exercise pressor reflex is exaggerated in individuals with type 2 diabetes (T2D) and that chronic low grade inflammation, a common T2D manifestation, might contribute to this exaggeration. Cytokines, which are small proteins released during inflammation, may sensitize the nerve endings and contribute to the exaggerated exercise pressor reflex in T2D. Before this can be determined, however, the individual cytokine patterns of expression must first be identified during the development and progression of T2D. The purpose of this study was to quantify concentrations of both circulating pro- and anti-inflammatory cytokines during the development and progression of T2D. We hypothesized that pro-inflammatory cytokines IL-1β and TNF-α would increase, and that anti-inflammatory cytokines IL-4, IL-10 and adiponectin would decrease in concentration as the rats progressed with diabetes. To do this, we measured the concentrations of circulating pro-inflammatory cytokines: IL-1β and TNF-α and anti-inflammatory cytokines: IL-4, IL-10 and adiponectin from 4 months to 8 months of age using UC Davis T2D rats (n=8). In this particular group of rats, all rats were officially diabetic, with non-fasted blood glucose levels >300 mg/dl, by 5 months of age. We found that pro-inflammatory cytokines IL-1β and TNF-α concentrations did not change over time as the rats progressed with T2D. Consistent with our hypothesis, the concentration of anti-inflammatory cytokine adiponectin was significantly decreased at 6 months of age compared to 4 months of age and continued to decrease over time. Contrary to our hypothesis, anti-inflammatory cytokines IL-4 and IL-10 concentrations fluctuated, although not significantly, from 5 months of age to 8 months of age. In conclusion, anti-inflammatory cytokine adiponectin concentrations decreased as rats developed and progressed with T2D. Other anti-inflammatory cytokines, however, presented with fluctuating patterns of expression during the progression of the disease but did not decrease steadily overtime. Likewise, pro-inflammatory cytokines did not simply increase with the progression of T2D. Both IL-1β and TNF-α maintained similar concentrations during the development and progression of T2D
Determining predictors of response to ambulatory pharmacist-led diabetes care
(2020-05-08) Palka, Samuel James; Reveles, Kelly Renee; Davidson, DeWayne A; Koeller, Jim
Purpose: There is a lack of guidance in referring patients to the clinical pharmacist for diabetes management, which likely results in patients missing out on this beneficial service. It would be useful to know which patients and specific clinical interventions are most likely to show benefit from pharmacy services. To our knowledge, only one study has assessed patient predictors of response to diabetes care provided by a clinical pharmacist, which was limited to baseline variables. Therefore, the primary objective was to describe clinical responses to pharmacist-led diabetes care and to identify baseline and interventional variables that are independently predictive of clinical response. Methods: This was a retrospective cohort study using patient data from two health systems in San Antonio, Texas. Included patients were ≥18 years old with a referral to the pharmacist for Type 2 Diabetes management. Patients were followed for up to 6 months and data were collected at baseline, during follow-up, and at the end of the study. Clinical response was defined as a reduction in the A1C from baseline by ≥1% or meeting the documented A1C goal. Non-responders failed to meet these A1C goals. Variables with P<0.20 on bivariate analysis were included in the multiple variable logistic regression model to determine predictors of response. Results: A total of 180 patients were included. Overall, patients were predominantly female (63%) and obese (58%) with a disease duration ≥10 years (67%). The median (IQR) change in A1C from baseline for responders and non-responders was -2.2% (-3.7 to 1.3) and 0.4% (-0.4 to 1.05) (P<0.001), respectively. Sixty-six percent of patients were considered responders. Significant predictors of response included baseline A1C (OR 1.41; 95% CI 1.08-1.85), number of completed visits with both the physician (OR 0.69; 95% CI 0.49-0.96) and the pharmacist (OR 1.65; 95% CI 1.03-2.64), and medication optimization (OR 10.7; 95% CI 1.04-109.9). Conclusion: Pharmacists are effective in diabetes management. Specifically, more visits with the pharmacist and utilizing medication optimization are especially helpful in lowering the A1C. Higher baseline A1C values are also predictive of response and should be incorporated into new protocols for pharmacist management of diabetes.
Development and progression of mechanical allodynia in UC Davis-type 2 diabetes mellitus rats
(2019-09-05) Ybarbo, Kai Michael; Stone, Audrey J.
Type 2 Diabetes (T2D) is a metabolic disease associated with sensory nerve damage. One of the most common complications of diabetes is neuropathy. A painful symptom of neuropathy that can develop is mechanical allodynia, which is a painful sensation to a normally non-painful stimulus. However, it is not known when symptoms of allodynia begin to show and how pain thresholds would change over time with T2D. Therefore, the purpose of this study was to determine the changes in pain threshold and to identify the onset of allodynia in a T2D rat model. Pain threshold was measured on male UC Davis type 2 diabetic (UCD-T2DM) rats (n=7) using von Frey monofilaments, which were applied to the L5 dermatome on the plantar surface of the hind paw. The lowest force that elicited a quick paw withdrawal was averaged between both hind paws. Mechanical allodynia was defined as a significant reduction in force that elicited a paw withdrawal. Pain threshold, non-fasted blood glucose, HbA1C and body weight were taken monthly from four to eight months of age. We found that non-fasted blood glucose from five to eight months of age (5mo: 388 ± 163 mg/dl, 6mo: 475 ± 145 mg/dl, 7mo: 504 ± 118 mg/dl, and 8mo: 577 ± 47 mg/dl) was significantly higher than the non-diabetic rats of four months (4mo: 239 ± 76 mg/dl). HbA1C values from six to eight months (6mo: 9.96 +/- 3.13%, 7mo: 11.5 ± 2.8%, and 8mo: 12.5 ± 0.73%) were significantly higher than that at four months (4mo: 5.8 ± 0.36%). Body weight was significantly higher at five to seven months (5mo: 609 ± 8.5g, 6mo: 603 ± 59g, and 7mo: 577 ± 76g) than at four (527.7 ± 12.3 g) and eight months (530 ± 56.6g). Pain threshold was significantly lower at six, seven and eight months (6mo: 15.7 ± 10.6g, 7mo: 10.36 ± 5.85g and 8mo: 8.95 ± 2.79g) compared to four months (32.78 ± 27.13g). Our data show that as blood glucose and HbA1C continued to increase, pain threshold continued to decrease. These findings suggest that mechanical allodynia increases as T2D progresses
DHEA in hair and glucose control in African-American adults
(2015-08) Lehrer, Henry Matthew; Steinhardt, Mary; Maslowsky, Julie
The relationship between dehydroepiandrosterone (DHEA) and glucose control is unclear. Hair DHEA analysis, which allows the assessment of long-term integrated hormone levels, may provide an advantage over previous DHEA measures and bring clarity to the association between DHEA and glucose control. We used the analysis of DHEA in hair to examine associations of long-term DHEA levels with prevalence of Type 2 Diabetes Mellitus (T2DM) and elevated glycated hemoglobin (HbA[subscript 1C]) in a group of African-American adults. Participants included 69 community-dwelling African-American adults (aged 21–84 years; 84% female). The first 3 cm of scalp-near hair were analyzed for DHEA concentration using enzyme-linked immunoassay analysis (ELISA). HbA[subscript 1C] was assessed and dichotomized into T2DM (HbA[subscript 1C] >= 6.5%) or not and Elevated HbA[subscript 1C] (>= 5.7%) or not, based on National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) criteria. In logistic regression analyses, DHEA concentrations inversely predicted T2DM and Elevated HbA[subscript 1C] statuses (separately), independent of age, sex, depressive symptoms, and minutes of exercise per week. Long-term DHEA secretion, as assessed in scalp hair, inversely predicted T2DM and elevated HbA[subscript 1C] statuses in African-American adults. Scalp hair may be a useful tool for future work involving DHEA and metabolic function.
Effect of intermittent hypoxia on plasma glucose levels during an oral glucose tolerance test
(2022-05-05) Massoudian, Sahar Dawn; Lalande, Sophie
Hypoxia triggers glucose uptake independently from the action of insulin. The purpose of this study was to determine the acute effect of intermittent hypoxia, defined as alternating short bouts of breathing hypoxic and room air, on plasma glucose levels during an oral glucose tolerance test in healthy individuals. We hypothesized that exposure to intermittent hypoxia would attenuate the increase in glucose levels in response to an oral glucose tolerance test. Nine individuals (5 men, age: 24±4 years, height: 175±9 cm, weight: 71.0±13.5 kg, HbA1c: 5.4±0.1%) participated in the study. Participants visited the laboratory on two occasions. On both visits, a 2-hour oral glucose tolerance test was performed, with venous blood samples collected 0, 30, 60, 90 and 120 minutes following the ingestion of a 75 g glucose drink. On visit 1, an intermittent hypoxia (IH) protocol, consisting of eight 4-minute hypoxic cycles at a targeted arterial oxygen saturation of 80% interspersed with breathing room air to resaturation, was performed following ingestion of the glucose drink. On visit 2, an intermittent normoxia protocol consisting of eight 4-minute normoxic cycles interspersed with breathing room air was performed following ingestion of the glucose drink. Visit order was randomized and participants were blinded to the condition. As expected, intermittent hypoxia resulted in a lower arterial oxygen saturation than intermittent normoxia (IH: 83±3, IN: 98±1%, p<0.01) which corresponded to lower levels of inspired oxygen (IH: 10.9±0.7, IN: 20.9±0.3%, p<0.01). Plasma glucose responses to the oral glucose tolerance test were not different between conditions (IH vs. IN: 0: 90±7 vs. 89±6; 30: 135±21 vs. 137±24; 60: 110±28 vs. 108±25; 90: 96±18 vs. 88±14; and 120: 101±19 vs. 83±14 mg/dl, p=0.29). Intermittent hypoxia triggered an increase in cardiac output (6.1±0.9 to 6.8±1.3 L/min, p<0.01) caused by an increase in heart rate (67±10 to 79±12 bpm, p<0.01). Contrary to our hypothesis, intermittent exposure to hypoxia did not attenuate the increase in plasma glucose levels during an oral glucose tolerance test in individuals with normal glycemic control. It remains to be determined whether intermittent hypoxia can attenuate the increase in plasma glucose levels in response to an oral glucose tolerance test in individuals with impaired glucose tolerance.
Erythropoietin response to intermittent hypoxia in health and type 2 diabetes
(2023-04-24) Wojan, Frank; Lalande, Sophie; Tanaka, Hirofumi; Coyle, Edward; Burtscher, Martin
Patients with type 2 diabetes and aging individuals experience declines in maximal oxygen consumption. Hemoglobin mass, a component of oxygen transport, strongly correlates to maximal oxygen consumption. Interventions that increase hemoglobin mass may therefore increase maximal oxygen consumption in older adults and patients with type 2 diabetes. Intermittent hypoxia, characterized by alternating periods of breathing low levels of oxygen interspersed with periods breathing normoxic air, has the potential to elicit an acute increase in erythropoietin levels and hemoglobin mass. Despite several instances of repeated exposures to intermittent hypoxia increasing red blood cell count over the course of five days to three weeks, there exists a lack of consistent stimuli across the literature, with deviations in hypoxic duration, number of cycles, and hypoxic severity. Furthermore, studies that successfully increased oxygen transport following intermittent hypoxia did not measure erythropoietin levels, the hormone regulating red cell production, thereby eliminating the possibility for protocol comparison. Therefore, the following three studies aimed to identify the shortest intermittent hypoxia protocol to increase erythropoietin levels in healthy young individuals, and to apply this intermittent hypoxia protocol to older individuals and patients with type 2 diabetes, with the goal of potentially increasing hemoglobin mass. In the first study, we identified the shortest hypoxic protocol within the literature to increase EPO concentrations among young healthy adults. The EPO response to the 32 total hypoxic minutes was no different than a 2-hour continuous hypoxia protocol. In the second study, we demonstrated that EPO concentrations increased following the same intermittent hypoxia in middle-aged adults but found no increase to hemoglobin mass. In the third study, we demonstrated a lack of EPO response to intermittent hypoxia in patients with type 2 diabetes. Furthermore, this study was the first to report hemoglobin mass levels in patients with type 2 diabetes. Collectively, the overall findings highlight the acute effects of intermittent hypoxia on erythropoietin in health and type 2 diabetes.
Evaluation of patient demographics, clinical characteristics, and cardiovascular outcomes in patients with type 2 diabetes newly initiated on sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and other antidiabetic medications
(2019-05) Pineda, Elmor David; Rascati, Karen L.; Wilson, James P.
Objectives: To evaluate and compare patient characteristics and cardiovascular outcomes among adults with type 2 diabetes (T2D) newly initiated on sodium-glucose cotransporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and other antidiabetic medications (oADMs). Methods: This retrospective new user cohort study used administrative claims and electronic health record data from an integrated delivery network in Texas. Patients ages ≥18 years with T2D and ≥1 prescription claim for either a SGLT-2i, GLP-1RA, or oADM filled between April 2013 through December 2018 were included. Patients were divided into three 1:1 propensity matched groups according to index medication identified. Pairwise comparisons of patient characteristics between SGLT-2is versus oADMs, GLP-1RAs versus oADMs, and SGLT-2is versus GLP-1RAs were compared before and after matching. Primary outcomes were heart failure hospitalization and a composite endpoint of myocardial infarction, stroke, unstable angina, or coronary. Secondary outcomes were the individual components of the composite endpoint. Cumulative incidences of all outcome variables were described using Kaplan-Meier failure plots and compared using log-rank tests and cox regression models. Results: Among 9,477 patients, 1,134 were SGL-2is initiators, 1,072 were GLP-1RA initiators, and 7,271 were oADM initiators. After propensity score matching, there were 815 matched pairs for SGLT-2i versus oADM), 817 pairs for GLP-RA versus oADM, and 947 pairs for SGLT-2i versus GLP-1RA. Patients initiating SGLT-2is versus oADMs had significantly lower risk of the composite endpoint (HR 0.69, 95% CI: 0.52-0.92), heart failure hospitalization (HR 0.66, 95% CI: 0.47-0.93), and unstable angina requiring hospitalization (HR 0.58, 95% CI: 0.41-0.82). Patients initiating SGLT-2is compared to oADMs had significantly lower risk of the composite endpoint (HR 0.70, 95% CI: 0.52- 0.94) and unstable angina requiring hospitalization (HR 0.59, 95% CI: 0.42-0.83). There were no differences in CV outcomes between SGLT-2is and GLP-1RAs. Conclusions: Both SGLT-2is and GLP-1RAs showed significant reductions in the composite outcome and unstable angina requiring hospitalization versus oADMs. However, only SGLT-2is were associated with a lower risk for heart failure hospitalizations. Nevertheless, CV outcomes were similar between SGLT-2is and GLP- 1RAs when compared to each other. This study provides real-world evidence for patients, payers, and providers, to consider selection of novel antidiabetic agents with CV benefits, SGLT-2is and GLP-1RAs, over other agents regardless of CVD status
Incident coronary atherosclerosis, unstable angina, non-ST-segment elevation myocardial infarction or ST-segment elevation myocardial infarction in type 2 diabetes : is mean glycated hemoglobin a good predictor?
(2010-12) Owusu, Yaw Boahene; Lawson, Kenneth Allen, 1952-; Barner, Jamie C.; Jokerst, Jason R.; Lopez, Debra
Background: Glycated hemoglobin is the indicator of long-term diabetes control and a value below 7 percent is recommended by the American Diabetes Association (ADA) to reduce cardiovascular complications. Diabetic patients have a two- to four-fold risk of cardiovascular disease and approximately two-thirds of diabetic patients die as a result of cardiovascular complications. Three large prospective randomized controlled long-term trials within the last decade reported no significant reduction in cardiovascular complications in type 2 diabetic patients by intensive glycemic control. To the author's knowledge, no known retrospective studies have examined the association between mean serial glycated hemoglobin and coronary atherosclerosis (CA) or acute coronary syndromes (ACS). Objective: This study was designed to determine the association between mean serial glycated hemoglobin with incident CA or ACS in type 2 diabetic patients after controlling for age, gender, hypertension, low density lipoprotein cholesterol (LDL-C), microalbuminuria, aspirin use, statin use, insulin use, tobacco use, and body mass index (BMI). Methods: The study was a retrospective cohort database analysis using the Austin Travis County CommUnityCare[trademark] clinics' electronic medical record for the time period between October 1, 2004 and September 30, 2009. The primary outcome of the study was the incidence of CA or ACS and the primary independent variable was glycated hemoglobin (<7% vs. [greater than or equal to]7%). The study subjects included type 2 diabetic patients aged 30 to 80 years with at least one glycated hemoglobin value per year for a minimum of two consecutive years. Study subjects were excluded if CA or ACS occurred within six months of the index date (i.e., first glycated hemoglobin). Logistic regression analysis was used to address the study objective. Results: Overall, 3069 subjects met the study inclusion criteria with a mean follow-up period of approximately two years. Two percent (N=62) of the subjects had incident CA or ACS. After controlling for age, gender, hypertension diagnosis, LDL-C, microalbuminuria, aspirin use, statin use, insulin use, tobacco use and BMI, there was no significant association (OR=1.026, 95% CI=0.589-1.785, p=0.9289) between mean serial glycated hemoglobin and the incident diagnosis of CA or ACS. Increasing age (OR=1.051, 95% CI=1.025-1.077, p<0.0001), male gender (OR=1.855, 95% CI=1.105-3.115, p=0.0195) and normal weight (normal or underweight compared to obese: OR=0.122, 95% CI=0.017-0.895, p=0.0438) were significantly associated with incident CA or ACS. Conclusions: Mean serial glycated hemoglobin (comparing [greater than or equal to]7% to <7%) was not significantly associated with CA or ACS over a mean follow-up period of approximately two years. Until more evidence becomes available, clinicians and diabetic patients should target glycated hemoglobin level below or close to 7 percent as recommended by the ADA soon after diagnosis while concomitantly controlling nonglycemic risk factors of cardiovascular disease (statin use, aspirin use, blood pressure control, smoking cessation and life style modification), to reduce their long-term risk of incident CA or ACS.
Influences of sleep health, psychological stress, and hair cortisol on cardiometabolic health and depressive symptoms
(2023-08-07) Woo, Jihun; Steinhardt, Mary; Loukas, Alexandra; Tanaka, Hirofumi; Whittaker, Tiffany A
This dissertation examined the influences of sleep health, psychological stress, and hair cortisol concentration on cardiometabolic health and depressive symptoms among African-American adults with type 2 diabetes. Study 1 examined the association of sleep health with A1C and depressive symptoms. Sleep health was assessed using the RuSATED (regularity, satisfaction, alertness, timing, efficiency) framework which incorporates both self-reported and objectively measured sleep data. Study 1 found that the composite sleep health score was associated with a lower likelihood of having depressive symptoms and there was a negative linear association between the composite sleep health score and depressive symptoms. Additionally, irregular sleep, poor subjective sleep satisfaction, and lower alertness during the day were significantly associated with a higher likelihood of having depressive symptoms. However, A1C was not associated with the composite sleep health score or individual sleep dimensions. Study 1 findings suggest that optimizing multidimensional sleep health may help decrease depressive symptoms among African-Americans adults with type 2 diabetes and longitudinal research is needed to establish the causal association between sleep health and depressive symptoms. Study 2 examined the longitudinal association between psychological stress and metabolic syndrome (MetS) severity and the mediating roles of sleep health and hair cortisol concentration. A parallel mediation model was used to test the direct association between psychological stress (baseline) and MetS severity (12-month follow-up) and indirect associations through sleep health and hair cortisol concentration (6-month follow up). Study 2 found that psychological stress was not associated with MetS severity, sleep health, or hair cortisol concentration. Both sleep health and hair cortisol concentration were not significantly associated with MetS and neither variable mediated the association between psychological stress and MetS severity. Poor subjective sleep satisfaction was positively associated with psychological stress and MetS severity in an unadjusted model, but it did not mediate the association between psychological stress and MetS severity. The non-significant study findings may be attributed to the psychological stress measurement which did not account for chronic psychological stressors including discrimination that may have greater long-term effects on adverse health outcomes among African-Americans. Study 2 findings underscore the importance of further exploration into the complex interplay among different types of psychological stress, different aspects of multiple sleep dimensions, and hair cortisol concentration with respect to long-term cardiometabolic health outcomes. Taken together, both studies address gaps in prior research by employing more comprehensive measurements and valuable insights into the unique experiences of psychological stress, sleep health, hair cortisol concentration, and MetS severity among African-Americans who are often underrepresented in health science research. The dissertation studies highlight the importance of optimizing multiple sleep dimensions in decreasing depressive symptoms and a potential beneficial role of sleep satisfaction in mitigating MetS severity among African-American adults with type 2 diabetes.
The impact of health literacy on self-care activities among underserved patients with type 2 diabetes
(2018-10-09) Murry, Nicole Streuding; Kim, Miyong; Carter, Patricia A; Radhakrishnan, Kavita; Mackert, Michael S.
To maintain good health, patients with Type 2 diabetes (T2DM) must perform self-care activities (SCA), many of which require health literacy – the ability to obtain, find, and use healthcare information to make decisions about health. In this dissertation, using the information-motivation-behavioral skills theoretical framework, I assess and examine health literacy in relation to SCA among underserved people with T2DM. This descriptive correlational study is a secondary analysis of data from a larger study of participants from six federally qualified health centers in an urban county in South Central Texas. The sample comprised 388 patients with T2DM (261 English-speaking, 127 Spanish-speaking; 53±10.33 years old), with the majority reporting an annual income of less than $10,000. Functional health literacy was measured with the Newest Vital Sign screening tool; diabetes-specific oral health literacy, with the DM-REALM – a modification of the original REALM instrument. Only 18.3% of participants exhibited adequate functional health literacy; 10.4%, adequate oral health literacy. In bivariate analysis, functional health literacy was related to age, gender, language, acculturation, income, education, and marital status. Oral health literacy was related to gender, employment status, and type of insurance. Significant predictors of functional health literacy included gender, education, and type of insurance. Significant predictors of oral health literacy included gender, employment status, and years with T2DM. In bivariate analysis, diabetes self-efficacy and health information-seeking behaviors were related to diabetes SCA. In hierarchical multiple regression, functional health literacy, health information-seeking behaviors, and diabetes self-efficacy were significant predictors of diabetes SCA. Although health literacy did not exhibit a significant direct effect on diabetes SCA, health information-seeking behaviors mediated the relationship between oral health literacy and diabetes SCA. These findings add to previous findings showing the high prevalence of limited health literacy among underserved people and the negative influence of limited health literacy on SCA among people with T2DM. Further studies of the impact of limited health literacy on diabetes SCA in diverse, underserved populations of people with T2DM are warranted. Future health literacy interventions should incorporate individual- and systems-level approaches in addressing promotion of diabetes SCA.
The impact of illness perception, diabetes management self-efficacy, and emotional distress on Type 2 diabetes self-management among Americans with Chinese backgrounds
(2019-02-06) Huang, Ya-Ching; García, Alexandra Anne, 1964-; Jang, Yuri; Kim, Miyong; Zuniga, Julie
This descriptive correlational study explored the relationships of diabetes illness perception (consequences, personal control, treatment control, and cause), emotional distress (diabetes distress and depressive symptoms), and diabetes management self-efficacy with diabetes self-management activities; the mediator effects of diabetes management self-efficacy on the relationship between diabetes illness perception (consequences, personal control, treatment control, and cause) and self-management activities; and the moderator effects of emotional distress (diabetes distress and depressive symptoms) on the relationship between diabetes illness perception and self-management activities among Americans with Chinese backgrounds. The conceptual framework was based on an adaptation of Leventhal’s Common- Sense Model of self-regulation. A hundred and fifty-three survey participants with Type 2 diabetes were recruited from Chinese speaking communities in three major metropolitan areas in Texas. Participants average age was 69.1 years old, female (52.3%), and had at least a high school education. Their average acculturation score was 14.82 ± 7.66 (relatively low). The average number of comorbidities was 1.30 ± 1.27; participants were diagnosed with T2DM for an average of 13.43 ± 10.20 years; 14.4% were prescribed insulin. A mean item score for diabetes self-management self-efficacy was 7.4 out of 10. Diabetes distress mean score was 2.36, indicating a moderate level of distress. The average score of depressive symptoms was 11.25, and 24.8% of the participants met the clinical definition of depression. Participants performed diabetes management activities about 4.3 days out of the preceding 7 days. The significant bivariate correlations among variables included older age, longer years of diabetes, insulin usage, lower acculturation level; and participants with higher self-efficacy were more likely to report having better self-management activities. Neither illness perceptions nor emotional distress were found to be significant predictors of diabetes self-management in hierarchical multiple models. However, age, duration of diabetes, and self-efficacy were shown to significantly predict self-management. Self-efficacy also significantly mediated the relationship between illness perceptions and self-management activities; and the relationship between emotional distress and self-management activities. These findings contribute to our understanding of the factors that facilitate patients of Chinese American backgrounds to perform self-management activities on a daily basis
The mediating role of emotional dysregulation on the association between diabetes distress and depressive symptoms in Black adults with type 2 diabetes
(2024-05) Cebulske, Lauren ; Steinhardt, Mary; Montero-Zamora, Pablo
Aims: This study aimed to examine the mediating role of emotional dysregulation on the association between diabetes distress and depressive symptoms in Black adults with type 2 diabetes. Methods: Participants (N = 284, 72% female, 62±11 years old, diagnosis duration 11±9 years) were recruited through local churches in the greater Austin, Texas area and completed self-report measures of diabetes distress, emotional dysregulation, and depressive symptoms. Path analyses were performed using MPlus 8 MODEL INDIRECT command to test for all direct and indirect effects. Results: There was a significant direct association between diabetes distress and depressive symptoms (β = .12, p = .02). A significant indirect association between diabetes distress and depressive symptoms through emotional dysregulation (β = .30, p < .001) was also found. The overall association between diabetes distress and depressive symptoms including the mediated association was β = .42, p < .001. Conclusions: In our sample, the positive association between diabetes distress and depressive symptoms was partially mediated by emotional dysregulation. These findings suggest that strategies aimed at reducing diabetes distress along with strategies to enhance emotional regulation may decrease depressive symptoms among older Black adults with type 2 diabetes.
The predicting factors of sodium intake of Korean Americans with type 2 diabetes
(2016-08) Ko, Jisook; Timmerman, Gayle M; Kim, Miyong; Walker, Lorraine O; Garcia, Alexandra; Jang, Yuri
The primary aim of the study was to examine the predictive relationships among personal factors (age, gender, education level, income, marital status, acculturation, duration of diagnosed diabetes), barriers to recommended sodium intake (low health literacy, high energy intake, high depressive symptoms, and absence of primary health care provider), interpersonal influences (social support), and sodium intake among Korean Americans (KAs) with type 2 diabetes mellitus (T2DM). The second aim was to describe the daily sodium intake and to identify the main sources of sodium intake for KAs with T2DM. The conceptual framework was adapted from Pender’s Health Promotion Model. This descriptive correlational study was a secondary data analysis of a large, randomized clinical trial with community-dwelling KAs diagnosed with T2DM. The sample consisted of 232 KAs between the ages of 35 to 76 years. The average daily sodium intake was 3,600 mg with the majority of the sample (68.1%) exceeding the sodium recommendations of the American Diabetes Association of 2,300 mg per day. The main finding of the study was high level of energy intake (calories) was the strongest predictor for sodium intake and gender and marital status were also related to sodium intake. The top five major contributors to sodium intake were noodles and dumplings (15.14%), Korean-style soups (12.75%), Kimchi (12.14%), bread and snacks (10.28%), and boiled or seasoned vegetables (7.37%). Four out of the five top contributors to sodium intake were foods from the Korean traditional diet. This study extends the growing literature on excessive sodium intake in high-risk cardiovascular disease among KAs with T2DM. These findings will assist health care providers, researchers, and policy makers in identifying the relating factors to consume high amounts of sodium and in providing guidance on how culturally-tailored dietary education and intervention strategies can best be designed, implemented, and distributed to meet the recommendations of dietary sodium intake.
Type 2 diabetes mellitus self-management of Burmese refugees in Texas: a clinical ethnographic interview
(2024-05) Bang, So Hyeon; García, Alexandra Anne, 1964-; Julie Zuñiga; Lauren E. Gulbas; Jung Kwak; Ya-Ching Huang
Refugees are at risk of chronic diseases like type 2 diabetes mellitus (T2DM) because of physical and emotional trauma in their home countries, poor living conditions in overcrowded official or makeshift refugee camps, and stressors during and after resettling in the host country. As the largest refugee group in the US, the Burmese—including Karen, Karenni, and Chin ethnicities—have been understudied in terms of T2DM self-management (SM). This qualitative study aimed to explore the meanings, beliefs, practices, and the barriers and facilitators related to T2DM-SM among them. Data were collected through clinically ethnographic interviews (CEI), with 15 Burmese adults with T2DM in Texas, conducted in their preferred language and analyzed with applied thematic analysis (ATA). The findings indicated that T2DM, often unexpected, elicited negative emotions and sometimes indifference due to unfamiliarity. Despite uncertainties about the disease's reasons the participants displayed resilience and hope. They attempted to manage T2DM while navigating cultural and lifestyle constraints, highlighting struggles with diet, considering jobs or house chores as exercise, and ambivalence toward medication. T2DM-SM was further complicated by traditional diets, financial constraints, low health literacy, and language barriers impacting communication with healthcare providers. However, spiritual practices and strong support networks were key to effective T2DM-SM. The study emphasized the necessity for comprehensive, culturally sensitive healthcare tailored to Burmese refugees managing T2DM, incorporating preventive care, early screening, health education, digital tools, and trauma-informed practices. Mental health support, overcoming language and literacy hurdles, and building community support are crucial. This study offered recommendations for nursing education, practice, research and health policy to improve care for this one of the largest refugee groups in the US.