Laurie Quinn

Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

Fatigue in Patients with Diabetes: A Review

OBJECTIVE Fatigue is a common and distressing complaint among people with diabetes and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject. METHODS A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue. RESULTS Diabetes presents many potential pathways for fatigue, but focused studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigues nonspecific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement, or diagnostic criteria. Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, although one that did provided some meaningful finding that symptom-focused education improved self-management practices, Hb(A1c) levels, quality of life, and symptom distress. CONCLUSION There is a need to standardize the definition, measurement, and diagnostic criteria of fatigue in diabetes. We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena (physiological, psychological, and lifestyle) associated with fatigue in diabetes.

Multivariable Adaptive Identification and Control for Artificial Pancreas Systems

A constrained weighted recursive least squares method is proposed to provide recursive models with guaranteed stability and better performance than models based on regular identification methods in predicting the variations of blood glucose concentration in patients with Type 1 Diabetes. Use of physiological information from a sports armband improves glucose concentration prediction and enables earlier recognition of the effects of physical activity on glucose concentration. Generalized predictive controllers (GPC) based on these recursive models are developed. The performance of GPC for artificial pancreas systems is illustrated by simulations with UVa-Padova simulator and clinical studies. The controllers developed are good candidates for artificial pancreas systems with no announcements from patients.

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus A Scientific Statement From the American Heart Association

The rates of both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are increasing in youth.1 In the past 10 years, guidelines for the identification and management of cardiovascular disease (CVD) risk factors in youth with diabetes mellitus have been published by multiple professional organizations, including the American Diabetes Association (ADA),2,3 the American Heart Association (AHA),4,5 the American Academy of Pediatrics,6 the International Society of Pediatric and Adolescent Diabetes (ISPAD),7 and the Pediatric Cardiovascular Risk Reduction Initiative.8 This scientific statement summarizes and interprets these guidelines and new developments in the field in the past decade and outlines future research and clinical needs to improve cardiovascular health and risk factor management in youth with diabetes mellitus. Additional goals for this statement are to increase awareness of CVD risk factors and their identification, prevention, and treatment and to improve cardiovascular health in youth with diabetes mellitus by encouraging advancement in research and clinical care, including understanding and implementing current CVD guidelines. Improving cardiovascular health in youth with diabetes mellitus has important public health implications; therefore, this statement aims to reach healthcare providers in diabetes mellitus, cardiology, and related fields. (Note: The sections within this scientific statement are organized by diabetes mellitus type, when possible, with brief summary statements concluding each section. Multiple definitions for CVD are used in the cited articles. Readers of this statement should include risk factors, surrogate markers, and end-organ damage under this umbrella term of CVD.) ### Type 1 Diabetes Mellitus Multiple studies document an increase of 2% to 5% annually in the incidence of T1DM worldwide.9 The SEARCH for Diabetes in Youth (SEARCH) study estimated that there were 166 018 to 179 388 youth with T1DM in the United States in 2010.1 Worldwide, rates of T1DM differ …

Feasibility of a health promotion intervention for a group of predominantly African American women with type 2 diabetes

PURPOSE this feasibility study was undertaken to determine if a group of predominantly low-income, low-education, African American women with type 2 diabetes could achieve good compliance and improved health outcomes with a carefully structured health promotion intervention. METHODS The sample consisted of 30 participants from an urban setting who were diagnosed with type 2 diabetes but also had multiple chronic conditions (eg, obesity, hypertension, joint pain, and depression). Participants attended a university-based health promotion program where they completed a 12-week intervention that addressed diet, nutrition, and health behavior. Transportation was provided at no cost to the participants. RESULTS Compliance with the 12-week program was 72.5%. Participants made significant improvements in total cholesterol and LDL-cholesterol levels, cardiovascular fitness, muscular strength and endurance, and nutrition knowledge. CONCLUSIONS African American women with type 2 diabetes residing in difficult living environments (ie, poverty, high crime, and lack of family support) can achieve good compliance and health outcomes with a structured health promotion program provided that barriers to participation (eg, transportation, cost, and commitment) are removed prior to and during the intervention.

Doctor talk and diabetes: towards an analysis of the clinical construction of chronic illness

During the last two decades the illness narrative has emerged as a popular North American literary form. Through poignant stories, well-educated patients have recounted their struggle with disabling diseases as well as with the hospitals and health care bureaucracies from whom they seek service. However, much less has been written about the doctors narrative construction of chronic diseases either in the process of learning medicine or through diagnosing, treating and counseling chronically ill patients. Indeed, following Kleinmans lead, the physicians narrative has been narrowly viewed as a discourse on the verifiable manifestations of pathophysiology. Drawing on contemporary theories of storytelling--including the conception of narrative as conversational interaction--the present paper argues that doctor narratives are equally complex if quite different than patient stories. Indeed, through an analysis of doctor talk centering on diabetes mellitus collected in several distinct venues--case presentations, narrative interviews and medical consultations--it is argued that physician stories not only employ very evocative tropes, but that these stories combine didactic, rhetorical and soterological elements in the telling. The research was conducted at two, urban family practice training sites in Chicago.

Cardiovascular Endurance and Heart Rate Variability in Adolescents With Type 1 or Type 2 Diabetes

Background. Incidence rates of both type 1 and type 2 diabetes mellitus (DM) are increasing in youth and may eventually contribute to premature heart disease in early adulthood. This investigation explored the influence of type of diabetes, gender, body mass index (BMI), metabolic control (HbA 1c ), exercise beliefs and physical activity on cardiovascular endurance (CE), and heart rate variability (HRV). Differences in exercise beliefs, physical activity, HRV, and CE in youth with type 1 versus type 2 DM were determined. Methods. Adolescents with type 1 DM (n = 105) or with type 2DM (n = 27) completed the Exercise Belief Instrument and the Physical Activity Recall. Twenty-four HRV measures were obtained via Holter monitoring and analyzed using SpaceLabs Vision Premier™ software system. The McMaster cycle test was used to measure CE (V0 2peak). Results. Regardless of the type of DM, females and those with higher BMI, poorer metabolic control, and lower amounts of physical activity tended to have lower levels of CE. Exercise beliefs consistently predicted both frequency and time domain HRV measures. Measures of exercise beliefs, self-reported physical activity, CE (V0 2peak), and HRV were significantly lower in adolescents with type 2 DM in comparison to those with type 1 DM. Conclusions and Recommendations. Early findings of poor physical fitness, lower HRV, fewer positive beliefs about exercise, and less active lifestyles highlight the importance of developing culturally sensitive interventions for assisting youth to make lifelong changes in their physical activity routines. Females, those with poorer metabolic control, and minority youth with type 2 DM may be particularly vulnerable to later cardiovascular disease.

Meal Detection in Patients With Type 1 Diabetes: A New Module for the Multivariable Adaptive Artificial Pancreas Control System

A novel meal-detection algorithm is developed based on continuous glucose measurements. Bergmans minimal model is modified and used in an unscented Kalman filter for state estimations. The estimated rate of appearance of glucose is used for meal detection. Data from nine subjects are used to assess the performance of the algorithm. The results indicate that the proposed algorithm works successfully with high accuracy. The average change in glucose levels between the meals and the detection points is 16(±9.42) [mg/dl] for 61 successfully detected meals and snacks. The algorithm is developed as a new module of an integrated multivariable adaptive artificial pancreas control system. Meal detection with the proposed method is used to administer insulin boluses and prevent most of postprandial hyperglycemia without any manual meal announcements. A novel meal bolus calculation method is proposed and tested with the UVA/Padova simulator. The results indicate significant reduction in hyperglycemia.

Fatigue in Women With Type 2 Diabetes

Purpose The purpose of this study was to explore the relationship between fatigue and physiological, psychological, and lifestyle phenomena in women with type 2 diabetes (T2DM) in order to establish the magnitude and correlates of fatigue in women with T2DM and explore the interrelationships between fatigue and specific diabetes-related factors that may be associated with increased levels of fatigue. These factors included physiological factors (glucose control, diabetes symptoms), psychological factors (diabetes emotional distress, depressive symptoms in general), and lifestyle factors (body mass index, physical activity). Methods A cross-sectional, descriptive design was used. Women who reported conditions known to cause fatigue were excluded. Physiological measures included fasting blood glucose (FBG), hemoglobin A1C (A1C), glucose variability, and body mass index (BMI). Women completed questionnaires about health, fatigue levels, diabetes symptoms, diabetes emotional distress, depressive symptoms, physical activity, and current diabetes self-care practices. A subset of the women wore a Medtronic Gold CGM sensor for 3 days for assessment of glucose variability. Results Eighty-three women aged 40 to 65 years with T2DM completed the study. Fatigue was significantly related to diabetes symptoms, diabetes emotional distress, depressive symptoms, higher BMI, and reduced physical activity. There was no relationship between fatigue and FBG or A1C. The strongest explanatory factors for fatigue were diabetes symptoms, depressive symptoms, and BMI, which accounted for 48% of the variance in fatigue scores. Glucose variability was not significantly associated with fatigue in these women. Conclusions Fatigue is a persistent clinical complaint among women with T2DM and may signal the presence of physiological, psychological, and lifestyle-related phenomena that could undermine diabetes health outcomes.