Monique Davis-Smith

Translation of the National Institutes of Health Diabetes Prevention Program in African American churches.

OBJECTIVE To translate the Diabetes Prevention Program (DPP) for delivery in African American churches. METHODS Two churches participated in a 6-week church-based DPP and 3 churches participated in a 16-week church-based DPP, with follow-up at 6 and 12 months. The primary outcomes were changes in fasting glucose and weight. RESULTS There were a total of 37 participants; 17 participated in the 6-session program and 20 participated in the 16-session program. Overall, the fasting glucose decreased from 108.1 to 101.7 mg/dL post intervention (p=.037), and this reduction persisted at the 12-month follow-up without any planned maintenance following the intervention. Weight decreased 1.7 kg post intervention with 0.9 kg regained at 12 months. Body mass index (BMI) decreased from 33.2 to 32.6 kg/m2 post intervention with a final mean BMI of 32.9 kg/m2 at the 12-month check (P<.05). Both the 6- and 16-session programs demonstrated similar reductions in glucose and weight; however, the material costs of implementing the modified 6-session DPP were

Continuous metabolic syndrome risk score, body mass index percentile, and leisure time physical activity in American children.

934.27 compared to

Trends and Clustering of Cardiometabolic Risk Factors in American Adolescents From 1999 to 2008

1075.09 for the modified 16-session DPP. CONCLUSION Translation of DPP can be achieved in at-risk African Americans if research teams build successful community-based relationships with members of African American churches. The 6-session modified DPP was associated with decreased fasting glucose and weight similar to the 16-session program, with lowered material costs for implementation. Further trials are needed to test the costs and effectiveness of church-based DPPs across different at-risk populations.

Validity of a Continuous Metabolic Risk Score as an Index for Modeling Metabolic Syndrome in Adolescents

J Clin Hypertens(Greenwich). 2010;12:636–644.

Awareness of diabetes risks is associated with healthy lifestyle behavior in diabetes free American adults: Evidence from a nationally representative sample

AIM To characterize trends and clustering of cardiometabolic risk factors in 12-17-year-old non-Hispanic white, non-Hispanic black (NHB), Mexican-American (MA), and multiracial American (MRA) adolescents. METHODS Data from the 1999-2000 to 2007-2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Clustering of cardiometabolic risk factors was determined using cardiometabolic risk factor clustering score (cMetS) computed by aggregating z scores of mean arterial blood pressure, triglycerides, fasting blood glucose, waist circumference, and high-density lipoprotein cholesterol. RESULTS There were significant increases in waist circumference and high-density lipoprotein cholesterol, and decreases in low density lipoprotein cholesterol, triglycerides, and mean arterial blood pressure in the 10-year period between 1999-2000 and 2007-2008. There were gender and racial/ethnic differences in cMetS, with NHB having a more favorable cMetS for each studied time point. Overall, cMetS decreased by 93% in the 10-year period between 1999-2000 and 2007-2008. cMetS decreased by 98% and 77.3% for male and female adolescents, respectively, in the period between 1999-2000 and 2007-2008. With the exception of Mexican-American and multiracial American female adolescents, all racial/ethnic groups had improved cMetS values on comparing mean cMetS values of 1999-2000 with mean values of 2007-2008. Compared with other racial/ethnic groups, NHB male and female adolescents had the most improved cMetS. CONCLUSION Because clustering of cardiometabolic risk factors is predictive of adult health status, early lifestyle intervention in adolescence may help slow down the progress and delay or prevent the onset of cardiovascular diseases in adulthood.

Cultural genogram: A tool for teaching and practice.

PURPOSE Although continuous values of metabolic syndrome risk scores (cMetS) has been suggested for modeling the association between potential risk factors and metabolic syndrome (MetS) in young people, the construct validity of cMetS has not been sufficiently examined in a representative sample of youngsters. This study examined: (i) sex and race/ethnic-specific optimal cut-off points of cMetS that are associated with MetS and (ii) the construct validity of cMetS in 12- to 19-year old non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican-American (MA) subjects. METHODS Data (n = 1239) from the 2003 to 2004 and 2005 to 2006 National Health and Nutrition Examination Surveys were used in this study. cMetS was derived by aggregating age- and sex-standardized residuals of arterial blood pressure, triglycerides, glucose, waist circumference, and high-density lipoprotein cholesterol. Receiver operating characteristics analysis was used to determine the validity and performance of cMetS. The overall performance of the receiver operating characteristics test was quantified with area under the curve (AUC). RESULTS A graded relationship between cMetS and increased number of MetS factors was observed, with MetS factors of 3 or greater yielding the greatest cMetS. In male adolescents, the optimal cMetS cut-off points of cMetS that are associated with MetS in NHW, NHB, and MA were 2.01, 2.45, and 2.34, respectively. The corresponding values in female adolescents for NBW, NHB, and MA were 1.93, 2.12, and 2.23, respectively. The construct validity of cMetS for MetS was high (AUC ≥0.885; sensitivity ≥66.7; specificity ≥74.8%). CONCLUSIONS cMetS appears to be a suitable index for investigating the association between potential risk factors and MetS in adolescents. An understanding of the role of genetic and environmental risk factors in MetS in children may be enhanced with the use of cMetS.

Applicability of a combination of hemoglobin A1c and fasting plasma glucose in population‐based prediabetes screening

PURPOSE The purpose of this study was to examine whether diabetes free healthy non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Mexican-Americans (MA) who are told of their diabetes risk were more likely to adopt healthy lifestyle behavior defined as current weight control, physical activity and reduced fat/calories intake than those who were not told that they were at increased risk. METHODS A nationally representative data (n=5073) from the 2007-2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether diabetes free NHW, NHB, and MA who are told of their increased diabetes risk were more likely than those who are not told of their diabetes risk to adopt healthy lifestyle behavior. RESULTS Being told of increased diabetes risk was associated with increased adoption of healthy lifestyle behaviors as indicated by odds ratio of 2.38 (95% CI=1.34-4.05) in NHW, 2.46 (95% CI=1.20-5.05) in NHB and 2.27 (95% CI=1.32-3.89) in MA who have no diabetes, after adjusting for age, sex, race/ethnicity, hypertension, education, household income and total cholesterol. CONCLUSIONS Awareness of increased risk for diabetes is associated with implementing healthy lifestyle behaviors in diabetes free healthy American adults. Population-based programs designed to assess and communicate diabetes risk may be helpful in preventing or delaying the onset of type 2 diabetes. Programs designed along racial/ethnic line may be needed to reduce racial/ethnic differences in rates of type 2 diabetes.

Implementing a diabetes prevention program in a rural African-American church.

Cultural issues affect patients’, families’, and providers’ perspectives on health, illness, and disease, thus a provider’s sensitivity and awareness to cultural issues can influence the quality and outcome of the patient and family encounter. As the population of the United States becomes more culturally diverse, health care professionals render care to patients whose cultural beliefs, values, attitudes, and health practices differ from their own. The cultural genogram is used as an educational tool to teach health care professionals a structured way to address patients’ and families’ cultural beliefs and practices. This article describes instructional activities for undergraduates, graduates, and faculty; presents a case example and personal reflections of a resident in family medicine; describes practical issues for the clinician; and proposes implications for evaluation and research.

Hemoglobin A1C Levels in Diagnosed and Undiagnosed Black, Hispanic, and White Persons with Diabetes: Results from NHANES 1999-2000

Background:  The purpose of this study is to determine: (i) the concordance between a combination of hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) (HbA1c + FPG) and a combination of FPG and 2‐h plasma glucose (2hPG) (FPG + 2hPG); and (ii) whether substituting FPG + 2hPG with HbA1c + FPG can enhance the detection of prediabetes in diabetes‐free non‐Hispanic Whites, non‐Hispanic Blacks, and Mexican–Americans adults.