Gail Nunlee-Bland

The Metabolically Healthy But Obese Phenotype in African Americans

J Clin Hypertens (Greenwich).

Growth Hormone Deficiency in Patients with Sickle Cell Disease and Growth Failure

BACKGROUND Growth disorders are common in children with sickle cell disease (SCD). The etiology for growth disturbances in this population appears to be multifactorial. Recent evidence suggests abnormalities in the growth hormone (GH)/insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) axis may play a role. OBJECTIVE To measure GH levels through provocative stimulation in a group of patients with SCD with growth failure, and to evaluate response to treatment. PATIENTS AND METHODS Growth records were reviewed of 79 children with sickle cell hemoglobinopathies to identify children with growth failure. GH levels were measured in patients with SCD with and without growth failure using arginine and L-Dopa as provocative stimulation tests. Treatment with GH was offered to GH-deficient children with SCD and these patients were followed longitudinally over 5 years. RESULTS Of the 79 patients, 13 (16.5%, all SS) had heights less than -2 SD below the mean or a growth velocity < -2 SD below the mean for age. Seven of the 13 children with growth failure participated in this study. Five patients received GH for 3 or more years and demonstrated significant improvement in their height SDS. One of the two who declined treatment was lost to follow-up and the other had significant worsening of height SDS score. CONCLUSION GH deficiency may be associated with growth failure in some patients with SCD. These patients may benefit from treatment with GH.

BMI and the risk of colorectal adenoma in African-Americans.

Obesity is associated with the activation of the molecular pathways that increase the risk of colorectal cancer. Increasing body mass index may accelerate the development of adenomatous polyps, the antecedent lesion of colorectal cancer. The aim of this study was to assess the BMI effect on the risk of colonic polyp and adenoma in African‐American.

Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis

OBJECTIVE In 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Competitive Bidding Program (CBP) in nine markets for diabetes supplies. The intent was to lower costs to consumers. Medicare claims data (2009–2012) were used to confirm the CMS report (2012) that there were no disruptions in acquisition caused by CBP and no changes in health outcomes. RESEARCH DESIGN AND METHODS The study population consisted of insulin users: 43,939 beneficiaries in the nine test markets (TEST) and 485,688 beneficiaries in the nontest markets (NONTEST). TEST and NONTEST were subdivided: those with full self-monitoring of blood glucose (SMBG) supply acquisition (full SMBG) according to prescription and those with partial/no acquisition (partial/no SMBG). Propensity score–matched analysis was performed to reduce selection bias. Outcomes were impact of partial/no SMBG acquisition on mortality, inpatient admissions, and inpatient costs. RESULTS Survival was negatively associated with partial/no SMBG acquisition in both cohorts (P < 0.0001). Coterminous with CBP (2010–2011), there was a 23.0% (P < 0.0001) increase in partial/no SMBG acquisition in TEST vs. 1.7% (P = 0.0002) in NONTEST. Propensity score–matched analysis showed beneficiary migration from full to partial/no SMBG acquisition in 2011 (1,163 TEST vs. 605 NONTEST) was associated with more deaths within the TEST cohort (102 vs. 60), with higher inpatient hospital admissions and associated costs. CONCLUSIONS SMBG supply acquisition was disrupted in the TEST population, leading to increased migration to partial/no SMBG acquisition with associated increases in mortality, inpatient admissions, and costs. Based on our findings, more effective monitoring protocols are needed to protect beneficiary safety.

Characteristics and Health Perceptions of Complementary and Alternative Medicine Users in the United States

Background:Complementary and alternative medicine (CAM) use has been increasing and these unconventional therapies do have important adverse effects. We evaluated predictors of CAM use among U.S. adults. Methods:We analyzed the 2007 Health Information National Trends Survey (n = 7503) and used logistic regression models to evaluate the association of demographic, lifestyle characteristics and healthcare perceptions of respondents who used CAM within the previous 12 months (n = 1980) versus those who did not (n = 5523). We used survey weights in all analyses and performed variance estimations using Taylor series linearization to account for the complex survey design. Results:Females (odds ratio [OR] = 1.46; 95% confidence interval [CI]: 1.15–1.86), college graduates (OR = 1.61; 95% CI: 1.24–2.08) and those who considered the quality of their healthcare to be poor (OR = 2.16; 95% CI: 1.28–3.65) were more likely to use CAM, whereas blacks (OR = 0.58; 95% CI: 0.39–0.85) were less likely to use CAM. Among CAM users, 47.6% did not inform their doctors. However, no factor predicted those who did not inform their doctors of their CAM use. Conclusions:Many adults in the United States use CAM without informing their doctors. Care providers should inquire about CAM usage from their patients, document them and counsel their patients regarding their use of these less regulated therapies.

A Reversible Cause of Skin Hyperpigmentation and Postural Hypotension

Vitamin B12 deficiency results in neuropsychiatric, hematologic, gynecologic, cardiovascular, and cutaneous manifestations. It is seen most commonly in the elderly, malabsorption diseases  (>60% of all cases), vegans, and vegetarians. Manifestations of pernicious anemia may be similar to Addison disease and may lead to a misdiagnosis. Herein, we report two cases of vitamin B12 deficiency in which clinical features shared many similarities with Addison disease. Both patients presented with progressive darkening of hands and postural hypotension that reversed with replenishment of vitamin B12. Vitamin B12 deficiency should be considered in patients presenting with skin lesions especially with other coexisting autoimmune diseases.

Diabetic Cheiroarthropathy: A Case Report and Review of the Literature

Diabetes mellitus is associated with a wide variety of rheumatologic manifestations which can significantly affect a patients quality of life. One of these manifestations includes diabetic cheiroarthropathy (DCA) which affects the hands. We review a case of a 28-year-old female patient with type 1 diabetes mellitus who was diagnosed with DCA after complaining of limited movements of all joints in her hands and tightening of the skin. We examine how the diagnosis was made, the treatment administered, and the successful clinical outcome. Clinicians should be able to identify and treat this affliction. The diagnosis is mainly clinical. It is imperative to remember that the presence of DCA carries with it a significant relationship with microvascular disease.

Abstract 2522: Complementary and alternative medicine use among cancer survivors in the United States.

Background: Although there is little evidence of effectiveness of Complementary and Alternative Medicine (CAM), there has been an increase in the number of patients turning to these largely unproven medical therapies. In this study, we sought to determine if those with a personal history of cancer were more likely to have utilized CAM as compared to those without a history of cancer. Methods: We analyzed the 2007 Health Information National Trends Survey (HINTS) and identified 976 respondents who were cancer survivors and 6,235 respondents without a personal history of cancer. We compared the demographic, lifestyle, and healthcare perceptions of these participants and used logistic regression models to evaluate the association of personal history of cancer, cancer treatment and the time since cancer treatment with CAM use. We used survey weights in all analysis and Taylor series linearization to perform variance estimations to account for the complex survey design. Results: Overall, cancer survivors were as likely as those without history of cancer to use CAM in the previous 12 months (27.1% vs. 25.2%; OR = 1.09; 95%CI: 0.86-1.38). Cancer treatment and time since cancer treatment was not associated with CAM use (Table 1). Conclusions: Cancer survivors were as likely as adults without a history of cancer to use complementary and alternative medicine irrespective of cancer treatment. Adjusted for respondent9s age, sex, marital status, place of birth, race, income, education level, health insurance status, BMI, perception of health status, perception of health care quality received, and confidence in taking care of one9s own health Citation Format: Maryam Laiyemo, Gail Nunlee-Bland, Frederick Lombardo, R. George Adams, Adeyinka Laiyemo. Complementary and alternative medicine use among cancer survivors in the United States. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2522. doi:10.1158/1538-7445.AM2013-2522

Significance of Plasma C-peptide in Obese African American Adolescents

BACKGROUND C-peptide blood levels can indicate whether or not a person is producing insulin and roughly how much. C-peptide is secreted as a byproduct of the biosynthesis of insulin from proinsulin. C-peptide has proposed biological activity and a well-established diagnostic value. The significance of C-peptide concentration in the plasma and urine in the pediatric population needs further delineation. AIM To determine the significance of plasma C-peptide in obese African American adolescents with mild insulin resistance but no evidence of diabetes. METHODS This study included 19 African American adolescents with body mass index (BMI) in at least the 85th percentile evaluated with anthropometric measurements, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) score, and oral glucose tolerance test (OGTT), and 24-hour urine collections. The study also included an age-matched control group of 15 healthy African American adolescent controls and were not subjected for OGTT. The correlation among BMI, fasting plasma C-peptide concentrations, and 24-hour-urine C-peptide concentrations was calculated. T Tests were conducted to compare plasma C-peptide and 24-hour-urine C-peptide concentrations for the test group and controls. RESULTS Mean HOMA score (3.96 +/- 1.84) signified mild insulin resistance among the adolescent test group. The test subjects exhibited adequate glucose tolerance (glucose range, 89.4-122.5 mg/dL) during the OGTT. A significant positive relationship was observed between BMI and fasting plasma C-peptide concentration in the control group (r = 0.537) but not the test group (r = 0.335). An insignificant positive relationship was exhibited between BMI and 24-hour-urine C-peptide concentration in the test group (r = 0.150) and controls (r = 0.254). CONCLUSIONS The positive relationship among BMI, plasma C-peptide, and urine C-peptide is worth further evaluation in studies conducting multiple rounds of OGTT with a larger sample of pediatric subjects. The potential diagnostic value of C-peptide may facilitate early detection of insulin resistance in the pediatric population.

Adiponectin, Leptin, IGF-1, and Tumor Necrosis Factor Alpha As Potential Serum Biomarkers for Non-Invasive Diagnosis of Colorectal Adenoma in African Americans

The potential role of adiponectin, leptin, IGF-1, and tumor necrosis factor alpha (TNF-α) as biomarkers in colorectal adenoma is not clear. Therefore, we aimed to investigate the blood serum levels of these biomarkers in colorectal adenoma. The case–control study consisted of serum from 180 African American patients with colon adenoma (cases) and 198 healthy African Americans (controls) at Howard University Hospital. We used ELISA for adiponectin, leptin, IGF-1, and TNF-α detection and quantification. Statistical analysis was performed by t-test and multivariate logistic regression. The respective differences in median leptin, adiponectin, IGF-1, and TNF-α levels between control and case groups (13.9 vs. 16.4), (11.3 vs. 46.0), (4.5 vs. 12.9), and (71.4 vs. 130.8) were statistically significant (P < 0.05). In a multivariate model, the odds ratio for adiponectin, TNF-α, and IGF-1 were 2.0 (95% CI = 1.6–2.5; P < 0.001), 1.5 (95% CI = 1.5(1.1–2.0); P = 0.004), and 1.6 (95% CI = 1.3–2.0; P < 0.001), respectively. There was a positive correlation between serum adiponectin and IGF-1 concentrations with age (r = 0.17, P < 0.001 and r = 0.13, P = 0.009), TNF-α, IGF-1, and leptin concentration with body mass index (BMI) (r = 0.44, P < 0.001; r = 0.11, P = 0.03; and r = 0.48, P < 0.001), respectively. Also, there was a negative correlation between adiponectin and leptin concentrations with BMI (r = −0.40, P < 0.001), respectively. These data support the hypothesis that adiponectin, IGF-1, and TNF-α high levels correlate with higher risk of colon adenoma and can thus be used for colorectal adenomas risk assessment.