Browsing by Subject "Type 2 Diabetes"
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Item An Alternative Approach to Type 2 Diabetes Care: The Inclusion of Community Health Worker Interventions in Patient Care(2017-05) Trump, LisaA wealth of research has been conducted on the successful management of Type 2 diabetes. Yet for many patients and their families, this disease remains a considerable challenge and current care practices are insufficient. Previous research has highlighted how problematic this gap is with respect to patient- and community-health. Recently, scholarship and clinical practice have shifted attention to exploring alternative approaches to care. The use of community health workers (CHW) to bridge the gap between patients and the medical system has gained attention and support from preliminary research and practice. The present research aims to extend what is known about the association between CHW interventions and patients’ biopsychosocial health outcomes via a two-pronged approach. First, I conducted a systematic review of randomized controlled trials of CHW-delivered interventions to orient researchers and clinicians to the current state of this work and to present a call to action for where future research needs to go. This study identified the lack of consistency in the theoretical conceptualization, design, and delivery of CHW interventions. Specifically, there was great variation across studies’ intervention dosages, attrition rates, and methods of CHW training. The main foci across studies’ findings demonstrated a relationship between a CHW-delivered intervention and improvements in patients’ physical and emotional health, diabetes knowledge, and self-care behaviors. Second, I conducted a pilot study following a mixed-method design testing a one-year CHW-delivered intervention. A sequential, explanatory mixed-method approach was used to gain breadth and depth of understanding, and to corroborate findings. More specifically, quantitative data collection and analyses preceded the qualitative interviews and thematic analysis, which included a sample of the intervention group. Quantitative data were gathered at baseline, 6-months, and 12-months to assess patients’ physical health, emotional well-being, and perceived social support. Health outcomes data were compared with a matched control group. Phenomenological qualitative data were gathered via key informant interviews and analyzed using Crabtree and Miller’s (1999) thematic analysis method. Findings from statistical analyses based on standardized measures revealed a significant improvement in perceived social support from baseline to 6-months, and a significant improvement in dietary adherence from baseline to 12-months. Findings from phenomenological interviews showed a significant improvement in perceived social support from a special person and in dietary adherence. Thematic analysis revealed a major theme regarding CHW roles (i.e., coach, advocate, teacher, and confidant). A second major theme outlined ecological impacts (i.e., support that participants received from family members was primarily tangible in-nature, and diabetes management – for participants – represents only a part of a considerably larger and more complex picture of health and well-being). Implications of these two studies point to the need for comprehensive care that includes the CHW as a member of care teams. With the growing need to provide more comprehensive health care, future research is warranted to continue to tease out the primary mechanisms of change within CHW interventions. This information is important to further refine the hiring process of CHWs best equipped for the role, CHW training, and the foci of CHW attention in their work with patients. These efforts will also further-equip providers to support patients’ Type 2 diabetes management, advancing the Triple Aim of healthcare.Item Analysis Of The Relationship Between Psychosocial Factors And Self-Efficacy On Self-Management Behaviors In Adult Patients With Type 2 Diabetes(2013-11) McClernon, SusanObjectives Only 20% of patients with type 2 diabetes implement recommended self-management behaviors (DAWN study) (Funnell, 2006). In this research, psychosocial factors significantly influenced self-management behaviors and A1c, having more influence than SES factors. The integrated conceptual model illuminated complex relationships between psychosocial factors, self-management(SM) and A1c levels. It posited self-efficacy (SE) as mediator between self-management and other psychosocial factors. Method This study explored direct and indirect relationships between diabetes social support (DSS), knowledge, affect, self-efficacy and dependent variables including diet, exercise, competency in adult patients with type 2 diabetes with suboptimal glycemic control (A1c <&ge> 7%) using cross sectional data from the IDEA study using structural equation modeling. Results The conceptual model fit test statistics are <&chi>;a1c2= 379 (df = 112; n=564, <&rho>-value = 000). The RSMEA estimate was .043 (.037 - .051 CI), SRMR was .045, and GFI was .94. The direct effects for knowledge (<&beta> = .647, <&rho> value ≤ .001) influenced SE and SE indirectly influenced A1c (<&beta> = .253, <&rho> value ≤ .001). DSS directly influenced knowledge (<&beta> = .579, <&rho> value ≤ .001) and SE (<&beta> range = .482, <&rho> value ≤ .001). Affect directly influenced knowledge (<&beta> range = .296, <&rho> value ≤ .05) and indirectly influenced SE (<&beta> = .192, <&rho> value ≤ .05). A second hypothesis found SE mediated SM and A1c only for knowledge, not for DSS or affect. DSS, knowledge, and affect indirectly influenced SM behaviors and A1c significantly (affect only for exercise and A1c). Knowledge was a mediator for DSS to SE. Conclusions The theoretically integrated conceptual model has merit. Affect and DSS (mediates) are directly influencing knowledge, with is significantly linked with SE. SE mediates SM and A1c. This new knowledge of relationships between psychosocial factors may assist caregivers in better engaging their patients with diabetes in improving SM behaviors and outcomes.Item Etiology of weight change, Type 2 diabetes, and mortality in adult Chinese Singaporeans: the Singapore Chinese health study.(2009-07) Odegaard, AndrewBackground: Diet and lifestyle are the primary channels in prevention of weight gain and type 2 diabetes, as well as being implicitly involved with body mass index (BMI). The literature on dietary factors related to obesity and type 2 diabetes has continued to expand, but little research has focused on Asian populations. Furthermore, debate over the optimal BMI range in Asians has become an important public health question in need of more thorough investigation. The objective of this dissertation is to investigate the associations between dietary patterns, weight gain and risk of obesity, dietary patterns and risk of type 2 diabetes, and BMI and all-cause mortality in 61,000+ middle aged Chinese men and women in the Singapore Chinese Health Study (SCHS). Methods: This dissertation includes three separate research projects aiming to investigate how dietary patterns associate with weight gain and risk of obesity (1), type 2 diabetes incidence (2), and how BMI is associated with all-cause mortality (3). In the first and second projects dietary patterns were derived using principal components analysis. The first project examined how these patterns along with a western fast food index associate with weight gain and risk of future obesity. The second project examined how the dietary patterns were associated with incident type 2 diabetes. Proportional hazards regression was used to characterize the prospective associations with incident obese status and type 2 diabetes. The last project also utilized proportional hazards regression along with a non-parametric trend graph analysis to investigate the association between BMI and all-cause mortality. Results: Results for the three projects were as follows: (1 and 2) two main dietary patterns were identified. A pattern characterized by high consumption of vegetables, fruit, and soy foods with some fish and seafood was termed vegetable, fruit and soy rich (VFS). The other dietary pattern was characterized by high consumption of dim sum, fresh and processed meats, higher relative intake of noodles and rice dishes, and some sweetened and deep fried foods and was termed dim sum and meat rich (DSM). 1) An increasing VFS dietary pattern score was associated with lower levels of weight gain and an increasing DSM pattern score was associated with increasing weight gain and risk of future obesity, relative risk (RR) of obesity for 4th and 5th vs. 1st quintile of DSM pattern score (1.59 and 1.62). Additionally, each increase in frequency of western fast food consumption was associated with a mean increase in weight gain. 2) Compared to the lowest quintile of VFS dietary pattern score an inverse association with type 2 diabetes was observed in quintiles 2-5, (RR= 0.80, 0.83, 0.75, 0.81). In the main models for the DSM pattern the RR increased similarly in quintiles 2-4 and was further heightened in quintile 5 compared to the 1st quintile (RR= 1.21, 1.17, 1.27, 1.55). The associations persisted after adjustment for all potential confounders including BMI and were limited to non-smokers. 3) In an optimal model of disease-free non-smokers excluding early deaths (< 5 years follow up time) there was a U-shaped association between BMI and all-cause mortality. Compared to the BMI referent group with the lowest mortality rate (18.5-20 kg/m2) persons with a BMI < 18.5 were at increased risk of premature death (RR=1.41; 95% CI 1.12-1.76), as well as persons with a BMI 26.0-27.4 (RR=1.31; 95% CI 1.05-1.63) and BMI 27.5, (RR=1.49; 95% CI=1.22-1.83). Further analyses suggest that the association observed at the low end of the BMI spectrum was driven by persons > 65 years of age with BMI < 17.0. Conclusions: These results indicate that higher intake of a dietary pattern rich in vegetables, fruits, soy and some fish and seafood is beneficial for weight maintenance and a decreased risk of future type 2 diabetes. On the other hand, higher intake of a dietary pattern rich in consumption of dim sum, meat, sweetened and deep fried foods was associated with increased weight gain, along with increased risks of future obesity and type 2 diabetes. Consideration of the association of BMI with all-cause mortality found a U-shaped association, with BMI from the normal range through the middle range of overweight status (18.5-26) not associated with risk of premature all-cause mortality. As obesity and diabetes become more prevalent in Asia, it is important that future research continues to address and provide data with which Asian populations can identify, in regards to diet and lifestyle. Continued and further sound methodological research is needed that assesses how direct and indirect measures of adiposity associate with chronic disease, mortality, and cause-specific mortality in order to make appropriate public health recommendations in relation to what an optimal weight range may be in Asians.Item Patient Use of the Electronic Communication Portal in Management of Type 2(2015-06) Peremislov, DianaThe high incidence and prevalence of Type 2 Diabetes require urgent attention to the management of this chronic disease. Previous studies present the advantages of e-communication via the patient portal to access Electronic Medical Records (EMR) by patients. The purpose of this study was to explore e-communication between patients with Type 2 Diabetes and their providers within the patient portal in one of the Midwest healthcare systems. The study employed a qualitative design, based on the use of content analysis methods. Conversation Theory served as the theoretical framework. A purposive, random sample of 90 charts of patients with Type 2 Diabetes in a Midwestern health system was subjected to a retrospective review of the e-communication within the patient portal. The sample consisted of patients between the ages of 50 and 70, the majority of whom were White, Non-Hispanic, English-speaking, and married. Patients were described as receiving good care, with the mean duration of Diabetes at 8.41 years. Patients were also relatively experienced in using the patient portal. The three main themes that emerged in the e-communication via patient portal were the Inform Theme, the Question Theme, and the Instruct/Request Theme. The Inform theme was the most frequently identified; the Instruct/Request Theme was mainly used in initiation of e-communication. The Question Theme was the least frequently observed of the three themes in e-message encounters. The fit with Conversation Theory revealed that most of the staff-initiated e-message encounters fit within the monolog type, while most of the patient-initiated e-message encounters fit within the dialogue type. Dialectic and construction types of conversation were very rare. Limitations of the study include the bias of the researcher, and lack of certain data in EMR. There is a need to develop standardized templates for Type 2 Diabetes e-communication via patient portal to capture complete data from the patients, and to promote diabetes education via patient portal using a construction type of conversation. Healthcare system guidelines should include information about the initiation and the use of e-communication via patient portal, and specifically target engaging patients who are not meeting desired diabetes care outcomes.Item A randomized controlled trial of an automated telephone intervention to improve glycemic control in Type 2 diabetes.(2008-12) Graziano, Judith AType 2 diabetes is a condition that affects millions of Americans and often results in serious vascular complications. Studies have found that lowering HbA1c levels in this population plays an essential role in reducing both micro and macro vascular complications. Consequently, medical management of type 2 diabetes has become more intensive; however HbA1c levels remain too high in this population. This study evaluates the effect of an automated telephone intervention aimed at improving HbA1c levels and self monitoring of blood glucose in adults with type 2 diabetes. One-hundred-twenty participants were randomly assigned to a treatment or a control group. The treatment group received a daily, automated telephone message regarding diabetes and was asked to report blood glucose levels. No difference in mean change in HbA1c between treatment groups was seen at the end of the 90-day intervention. Participants in the treatment group demonstrated a significant improvement in frequency of daily self-monitoring of blood glucose (an increase of .66 times per day in the telephone group compared to .05 times per day in the control group, p = <.001). The treatment group also showed favorable trends on improvement in attitudes toward diabetes and perceived monitoring and exercise barriers. This study shows that an automated telephone intervention increases daily frequency of self-monitoring of blood glucose in adults with type 2 diabetes. This finding has important clinical implications because understanding daily fluctuations in blood glucose informs treatment decisions beyond the information provided by HbA1c levels. Future studies are needed to determine whether this effect is long-lasting, whether changes in attitudes and beliefs mediate the behavior change, and whether the behavior change precedes physiological changes.Item The Role of Inflammation and Oxidative Stress in Adipocytes in the Development of Insulin Resistance(2015-08) Burrill, JoelInflammation plays a critical role in the pathology of obesity-linked insulin resistance and is mechanistically linked to the effects of macrophage-derived cytokines on adipocyte energy metabolism, particularly that of the mitochondrial branched chain amino acid (BCAA) and tricarboxylic acid (TCA) pathways. To address the role of inflammation on energy metabolism in adipocytes we utilized high fat fed C57Bl/6J mice and lean controls and measured down regulation of genes linked to BCAA and TCA cycle metabolism selectively in visceral but not in subcutaneous adipose tissue, brown fat, liver or muscle. Using 3T3-L1 cells, TNFα and other pro-inflammatory cytokine treatments reduced the expression of genes linked to BCAA transport and oxidation. Consistent with this, [14C]-leucine uptake and conversion to triglycerides was markedly attenuated in TNFα-treated adipocytes whereas conversion to protein was relatively unaffected. Since inflammatory cytokines lead to induction of ER stress, we evaluated the effects of tunicamycin or thapsigargin treatment of 3T3-L1 cells and measured a similar down regulation in the BCAA/TCA cycle pathway. Moreover, transgenic mice overexpressing XBP1s in adipocytes similarly down regulated genes of BCAA and TCA metabolism in vivo. These results indicate that inflammation and ER stress attenuate lipogenesis in visceral adipose depots by down regulating the BCAA/TCA metabolism pathway and are consistent with a model whereby the accumulation of serum BCAA in the obese insulin-resistant state is linked to adipose inflammation.Item Type 2 Diabetes Education and Prevention(2010-07-29) Bleet, MichaelType 2 Diabetes is a chronic disease of high blood sugars. This pamphlet briefly explains Type 2 Diabetes and how it can be prevented or delayed. A healthy diet and regular exercise, or treatment with a Diabetes medication known as Metformin, can help to prevent Type 2 Diabetes.