Browsing by Subject "diabetes"
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Item An examination of the relationship among patient factors, patient-physician interaction, and utilization of health services in adults with diabetes(2009-05-15) Rivers, Desiree AviaIn this study, patient-physician interaction, patient socio-demographic factors, health literacy, sources of care, and use of diabetes-related health services, were examined to assess the relationships to patients? satisfaction with the quality of health care they received in the past 2 years. By examining the relationship among patient, physician and environmental systems? factors, research findings will be used to develop interventions that will inform patient education and physician training and foster patient and physician behavior change that ultimately leads to improved health outcomes for adults with diabetes. To answer the research questions, univariate and multivariate logistic regression analyses were conducted to assess the predictability of the 5 groups of dependent variables: 1) socio-demographic factors, 2) sources of care ?factors?, 3) health literacy ?factors?, 4) patient-physician interaction ?factors?, and 5) use of diabetes-related services ?factors?. Individually these groups comprised thirty-two dependent variables. Three dependent variables, specifically confidence and trust in doctor; doctor spend as much time as wanted; and had a hemoglobin A1c in the last 6 months, were statistically significantly predictive of a relationship with patient satisfaction with quality of health care. This study provides insight regarding the specific aspects of patient-physician interaction and use of diabetes-related services that impact patient health outcomes. By knowing that a statistically significant relationship exists among confidence and trust in a doctor, being able to spend as much as time as wanted with a doctor, having a hemoglobin A1c in the last 6 months, and satisfaction with quality of health care, future investigators know which influences are perhaps most influential and deserve further exploration to predict satisfaction with quality of health care.Item Diabetes and obesity as risk factors for the development of Hepatocellular carcinoma in the hispanic population(2008-12-08) Sathya Jaganmohan; Gagan Sood; Karen SzauterHepatocellular carcinoma is the fifth most prevalent cancer in the world with an overall 5-year survival rate of 6.9%. The well known etiological factors for HCC are infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), alcohol abuse and environmental exposure to aflatoxins. The prevalence and mortality from HCC is rising in the U.S. In the U.S, Hispanics have a 2.7 times higher risk for HCC development than non-Hispanic whites and the highest mortality rate next to Asian population. The reason for this increased HCC risk in Hispanics is unknown. While it is conceivable that this disparity could be secondary to the incidence of hepatitis or alcohol abuse in the Hispanic population, the primary objective of this study was to evaluate other non-conventional risk factors in Hispanics such as diabetes and obesity. Diabetes and obesity are widespread health problems in the Hispanic population. Diabetes and obesity are known to predispose to the development of fatty liver disease resulting in Non Alcoholic Steatohepatitis (NASH) and cirrhosis. Primary liver cancer is about 4 times more likely in diabetic patients than non diabetics. Increasing BMI has also been shown to increase cancer risk and HCC risk. There is recent evidence suggesting diabetes and obesity not only accelerate the development of fibrosis in patients with chronic hepatitis, but also promote the molecular carcinogenesis of HCC. \r\nMy hypothesis is that, after controlling for traditionally recognized risk factors, an increased incidence of diabetes and obesity in the Hispanic population plays a causative role in the development of HCC. Using local inpatient and outpatient hospital data, a retrospective case control study was conducted with Hispanic patients afflicted with HCC as cases and patients with cirrhosis grouped as controls. A total of 63 cases and 98 controls were identified. The mean age of controls 52.28 and cases was 57.34. The mean BMI was 29.66 for controls and 28.78 for cases. 20 patients with HCC and 33 patients in the control group had been diagnosed with diabetes.\r\nUnivariate analysis did not show an increase in the odds of HCC development in patients with diabetes or obesity. Multivariate logistic regression analysis was then performed to control for various confounding factors. The adjusted odds ratio for diabetes as predictor for HCC development was 0.74 with CI (0.34-1.61) and was 0.80 for obesity with CI (0.35- 1.77). Neither diabetes nor obesity was a statistically significant factor in predicting the development of HCC in the Hispanic population. The results are subject to usual limitations of a retrospective study. Large prospective cohort studies are required to accurately determine the effect of diabetes and obesity on HCC risk in the Hispanic population.\r\nItem Diabetes mellitus in U.S. aviators(2009-04-02) Gregory Scott Hyland; James M. Vanderploeg, M.D.; Randal Reinertson, Ph.D.; LaDale St. Clair, M.D.Introduction: This project summarizes current information on the risks associated with diabetes mellitus and its medical management amongst aviation personnel. Methods: A literature review was accomplished looking at aviators with diabetes mellitus along with a literature review of the common medications used to treat type 2 diabetes. Results: Several aeromedical agencies do allow pilots with diabetes to operate aircraft, even if they require medical management to include oral or injectable medications for good control of their disease. In general, however, pilots with type 1 diabetes are restricted to non-military, non-transport duties and pilots with type 2 diabetes are more common. The risk for sudden incapacitation is the greatest concern and is increased for a number of medications commonly used to treat diabetes. Discussion: Each aeromedical agency sets it own standards regarding waiver requirements and the information presented in this project represents a general summary of these requirements. Type 2 diabetes is becoming increasingly prevalent in the aviation community and aeromedical examiners need to be aware of current clinical practice guidelines to ensure that aviators with diabetes remain at low risk for developing sudden incapacitation.Item Diabetes, diabetes complications, and their consequences in Mexican-American elders(2007-06-22) Max Elias Otiniano; Kyriakos S. Markides, Ph.D.; Kenneth Ottenbacher, Ph.D.; Jose Loera, MD; Carlos Moreno, MD; Billy U. Philips, Ph.D.The purpose of this study is to describe the epidemiology of diabetes, diabetes complications and their consequences over an 11-year period in Mexican-American elders. Design: This is an 11-year prospective cohort study (1993-1994 to 2004-2005). Setting: This study was conducted among residents of five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. Participants: This is a population-based sample of 3050 non-institutionalized Mexican American men and women aged 65 or older from the Hispanic Established Population for Epidemiologic Studies of the Elderly (H EPESE). Measures: A number of measures were developed that include socio demographic indicators; categories of health behaviors; and self-reports of diabetes, diabetes complications, functional disability, medical conditions, health service utilization, and depressive symptoms. Self-reported heart attack, self-reported stroke, mortality, and HbA1c measure were used as independent variables over the 11-year period. Results: 1) The estimated prevalence of diabetes was 22%. 2) The estimated prevalence of diabetic complications was 60% (retinopathy: 38%, nephropathy: 14%, peripheral vascular disease: 40%, and amputations: 8%). 3) Self-reported heart attack and self-reported stroke are significantly associated with diabetes at 7-year follow-up. 4) At 7-year follow-up, heart attack accounted for 45% of deaths in diabetics. 5) At 11-year follow-up, glycemic control was associated with low education, duration of disease, and severity of disease. Conclusions: These findings suggest that Mexican American elders with diabetes are at high risk of developing diabetes complications, primarily heart attack, stroke, and premature mortality. It is important to promote educational programs aimed at developing healthy lifestyle changes beginning in early adulthood as a preventive measure to delay the onset of disease in this high risk population.Item Dual wavelength polarimetry for monitoring glucose in the presence of varying birefringence(Texas A&M University, 2006-04-12) Wan, QiujieIn a continuing effort to develop a noninvasive means of monitoring glucose levels using the aqueous humor of the eye, a dual wavelength system has been developed in order to show that varying birefringence, similar to what is seen with a moving cornea, can be compensated. In this paper a dual wavelength, closed-loop, system was designed and a model was developed to extract the glucose concentration information. The system and model were tested using various concentrations of glucose in a birefringent test cell subject to motion artifact. The results show that for a static, non-moving sample, glucose can be predicted to within 10 mg/dl for the entire physiologic range (0-600mg/dl) for either laser wavelength (523nm or 635nm). In the presence of moving birefringence, each individual wavelength produced standard errors on the order of a few thousand mg/dL. However, when the two wavelengths are combined into the developed model, this error is less than 20mg/dL. The approach shows that multiple wavelengths can be used to drastically reduce the error in the presence of a moving birefringent sample. This research also shows promising preliminary results that the error is less than 25mg/dl in presence of a motion induced cornea birefringence artifact in NZW rabbits?? eyes.Item Enhancement of a fluorescent sensor for monitoring glucose concentration in diabetic patients(Texas A&M University, 2007-04-25) Ibey, Bennett LukeThe need for overnight and continuous monitoring of glucose levels in diabetic patients is profound, especially among juveniles. Implantation of a chemical assay which responds optically to changes in glucose concentration shows promise as a technology capable of continuously monitoring blood sugar with little invasion into the body. Previous fluorescent chemical assays, based on the affinity binding reaction between Concanavalin A protein and dextran, performed well but suffered from limited dermal penetration. In this work, a novel replacement for the dextran molecule (glycosylated dendrimer) was fabricated and tested to determine if it would improve the overall response of the sensing chemistry to glucose. Experiments were carried out and it was found that the assay??????s functionality was based on the controlled aggregation of the Con A protein and the modified dendrimer molecule. This new assay proved to be specific to glucose, reversible, and independent of fluorophore dye attached to the protein. This research was furthered by encapsulation of the new assay into a PEG hydrogel which showed response to glucose but, due to leeching, did not perform well under repeated exposures. A new method for encapsulation was proposed based on poration of the hydrogel to create micropores capable of holding the assay chemistry and allowing it to react to incoming glucose, while the surrounding polymer restricted leeching. Preliminary results with previous assays proved the potential of a mannitol based poration procedure, but unforeseen complications in lyophilization of the new sensor assay restricted its completion. Due to instability of Con A in solution, it was hypothesized that the immobilization of it onto the surface of an active substrate would increase its stability overtime as seen in previous works. The immobilization procedure was performed on Con A for both polystyrene spheres and gold (nanoshells and colloid). Both results showed an adequate amount of protein on the surface of the particles, but little binding activity was demonstrated. Overall, the improvements to the sensor chemistry response were notable and the potential for stabilization and enhancement of the response through the use of an active substrate is promising.Item Evaluation of a theoretical model of perceptual accuracy and self-management behavior in pediatric diabetes(Texas A&M University, 2005-11-01) Lane, Mariella MarieThis study evaluated a model of perceptual accuracy and self-management behavior in pediatric diabetes. Participants were 169 children and adolescents (10-18 years) attending diabetes summer camps. Error grid analysis quantified global perceptual accuracy and specific blood glucose estimation errors. The mean accuracy index was 15%, failure to detect hyperglycemia being the most frequent error. Path analysis evaluated models for failure to detect hypoglycemia, failure to detect hyperglycemia, and overestimation of normal blood glucose. Results reflected relatively good fit of the data with the models; however, results did not support mediational hypotheses and explained minimal variance in perceptual error. In sum, participants made considerable estimation errors that may affect self-management; however, results did not support the theoretical models in this sample.Item Investigating the molecular biology of aging and extended longevity: Proteomic and genomic analysis of mouse liver(2005-11-05) William H. Boylston; John Papaconstantinou, Ph.D.; Steven G. Widen, Ph.D.; Philip T. Palade, Ph.D.; Pamela L. Larsen, Ph.D.; Jeffrey P. Rabek, Ph.D.; Giulio Taglialatela, Ph.D.Recent advances in molecular gerontology have provided important clues about the fundamental biology of the aging process including the role of oxidative stress and the genetic basis of longevity. Progressive accumulation of oxidative damage to macromolecules is thought to underlie the aging-associated decline in physiologic function characteristic of the senescent phenotype. Mitochondria are a major intracellular source of reactive oxygen species (ROS); however, other organelles are also endogenous sources of oxyradicals and oxidants that can damage macromolecules. This investigation examines the relationship between aging and oxidative damage to ER resident proteins, which exist in a strongly oxidizing environment necessary for disulfide bond formation. In these studies, young and aged mouse liver homogenates were separated into enriched sub-cellular fractions, and the ER/mitochondrial fraction was resolved by 2-dimensional gel electrophoresis and then assayed for oxidative damage as indicated by protein carbonylation. MALDI/TOF analysis and N-terminal sequencing of these proteins identified BiP/Grp78, protein disulfide isomerase (PDI), and calreticulin as exhibiting a specific age-associated increase in carbonyl content. This increase in oxidative damage to critical ER proteins in aged liver strongly indicates an impairment in protein folding, disulfide cross-linking, and glycosylation which may significantly contribute to the functional decline observed in aging liver.\r\nProviding evidence for the genetic basis of aging, several murine models demonstrate that longevity can be increased by mutations affecting endocrine signaling, particularly via the GH/IGF-1 axis. In this investigation of long-lived GH/IGF-1-deficient mice, characteristic patterns of hepatic gene expression in Pit1dw/dwJ dwarf mice were revealed. Comparative microarray analysis of young and aged male livers was utilized to identify specific genes differentially expressed in Pit1dw/dwJ mice. Further examination of both male and female livers by real-time RT-PCR demonstrated striking transcriptional differences in Pit1dw/dwJ mice comprised of genes regulating cholesterol biosynthesis, fatty acid utilization, and lipoprotein metabolism. Affecting global energy homeostasis, this programmatic shift in hepatic expression may contribute to longevity by influencing bioenergetic and oxidative reactions occurring within mitochondria, ER, and peroxisomes. Intriguingly, these long-term patterns in metabolic gene expression in Pit1dw/dwJ livers mirror many transcriptional changes induced by caloric restriction and fasting, further implicating energy metabolism in longevity.\r\nItem Relationship among religious coping, psychosocial factors, and quality of life in individuals with type 2 diabetes(2009-06-02) Lager, Julia M.The purpose of this study was to examine the relationship among religious coping, acceptance of diabetes, social support, diabetes management, and quality of life among individuals with type 2 diabetes (T2DM). Religious coping, acceptance of diabetes, and social support were hypothesized to encourage adherence to self - management behaviors thus enhancing quality of life. A convenience sample of 247 T2DM patients was recruited from local churches, clinics, a diabetes support group, and a diabetes education class. Participants completed a 10-page survey comprising the following reliable and valid scales: Religious Problem Solving Scale-Short Form, Ideas About Diabetes-Revised Scale (IAD-R), the PRQ2000, the Religious Support Scale, Summary of Diabetes Self-Care Activities-Revised, and the Diabetes Quality of Life Measure. The mean age of the respondents was 54 years, with the majority being female (68%), Caucasian (53%), and of Protestant religious affiliation (58%). Gender and ethnic differences were found for religious coping, acceptance of diabetes, and selfmanagement behaviors. African Americans and women were more religious and used more religious coping. African Americans also felt more inhibited by diabetes and women were more likely to regularly examine their feet. Gender, general social support, and feeling less inhibited by diabetes (subscale of acceptance) were significant predictors of quality of life in the multivariate (regression) analysis (F (19, 219) = 7.777, p < .001; adjusted R2 = .351). Results of this study support past research indicating the influence of gender, social support, and feeling inhibited by diabetes on respondents' quality of life. Attention to patients' level of social support and diabetes education that teaches patients how to integrate the disease into their life may be critical to improving quality of life.Item Relationships between psychosocial factors and adherence to diet and exercise in adults with type 2 diabetes: A test of a theoretical model(2007-05-21) Elizabeth Gressle Tovar; Michele Clark, RN, PhD; Susan Weller, PhD; Regina Lederman, RN, PhD; Hoang Nguyen, PhD; Carrie Jo Braden, RN, PhDIntroduction: Cardiovascular disease (CVD) is the leading cause of premature death among people with diabetes. Diet and exercise adherence are\r\nimportant diabetes self management behaviors that can reduce CVD risk; unfortunately, adherence rates are low among diabetics. Improved understanding of psychosocial factors related to diet and exercise adherence among adults with\r\ntype 2 diabetes can improve strategies to reduce CVD morbidity and mortality in this population.\r\n Purpose: 1) Evaluate psychometrics of the Health Beliefs related to Cardiovascular Disease scale (HBCVD) which measures perceived susceptibility to and severity of heart attack or stroke and perceived benefits of and barriers to\r\ndiet and exercise; 2) Explore relationships between selected bio-psychosocial factors and diet and exercise adherence; and 3) Evaluate the ability of a theoretical model integrating the Health Belief Model (HBM) and Stages of Change Model (SOC) to explain diet and exercise adherence.\r\n Methods: The study design was a descriptive correlational cross section using a convenience sample of 212 adults with type 2 diabetes who completed a series of questionnaires measuring study variables. Outcome variables measured were diet and exercise adherence scores. Predictor/independent variables included knowledge related to CVD risk, cues to action, health beliefs, stage of change, social support, depression, comorbidity, diabetes duration, and\r\nsocioeconomic status. Relationships among model variables were explored using analysis of variance and simple and multiple regression techniques.\r\n Results: The HBCVD demonstrated evidence of validity and reliability, although an improved barriers subscale is recommended. The theoretical model was not supported, although significant paths between model variables were identified. The best model to predict diet included diet stage, susceptibility, self efficacy, social support, and age. The best model to predict exercise included\r\nexercise stage, self efficacy, and social support. Models including HBM and SOC provided greater explanatory power for diet and exercise adherence than either model alone. Susceptibility, barriers, and self efficacy varied significantly across\r\nstages of change. Significant group differences were found among model variables. Participants with depressive symptoms and the least education had lower diet and exercise adherence scores. Younger age and unemployment were also associated with lower diet adherence.\r\nItem Socios para su Salud – A program evaluation of a community-based health education program in Cameron Park, Texas(2009-07-17) Charu Sawhney; Dr. Kirk L. Smith, M.D., Ph.D.; Dr. Susan Weller, Ph.D.; Dr. Laura Rudkin, Ph.D.INTRODUCTION: Management of chronic diseases such as diabetes requires a multi-faceted approach. Diabetes care involves educating patients on the disease process, their medication regimen, adequate blood sugar monitoring, proper nutritional habits, adequate physical exercise requirements, and preventive measures to avoid future complications. These services are difficult to obtain for patients without medical insurance and for those who live in resource poor settings. Community-Based Health Education Programs, such as Socios para su Salud, utilize community health workers or promotores to offer comprehensive education on the management of diabetes and focus on prevention strategies to decrease the chronic disease burden of the community. The research done at Cameron Park, Texas examines the efforts of such an outreach program by assessing participation and evaluating diabetic patients’ health outcomes. \r\nMETHODS: Over the period of October 2007 to October 2008 data of all patients attending classes pertaining to diabetes education and management along with their lab data and patients who had any lab data drawn were compiled into a Microsoft Excel database.\r\nRESULTS: The database included 332 patients, of which 164 were diabetic. Of these 164 diabetics 102 (62 percent) participants had no lab data recorded, 37 (22.5 percent) had one set of lab data, and only 25 (15 percent) had two or more sets of lab data. \r\nCONCLUSIONS: Although strong participation in program activities was demonstrated through sign-in-sheets, it was not possible to evaluate the effectiveness of these sessions, since systematic participation and lab data on attendees was not collected. Consistent data collection methods with the appropriate tools and defined interventions need to be in place for each program course to aid in assessing health outcomes of participants over time.\r\n