Journal articles: 'Academic Diabetes Mellitus Hispanic Americans'

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Ness, Jose, Doron Nassimiha, Mary I. Feria, and Wilbert S. Aronow. "Diabetes mellitus in older African-Americans, Hispanics, and whites in an academic hospital-based geriatrics practice." Coronary Artery Disease 10, no. 5 (1999): 343–46. http://dx.doi.org/10.1097/00019501-199907000-00012.

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Cangialosi, Peter, Mark Liotta, Diana Finkel, Shobha Swaminathan, and Steven Keller. "601. Disparities in Diabetes Care: Smoking Cessation among Women and Minorities Living with HIV at an Urban Academic Medical Center." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S363. http://dx.doi.org/10.1093/ofid/ofaa439.795.

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Abstract Background People living with HIV (PLWH) and diabetes mellitus are at increased risk of developing significant medical complications such as atherosclerotic cardiovascular disease. Disproportionate rates of diabetes and HIV among minority groups raise the issue of how demographic disparities may impact care. The American Diabetes Association (ADA) 2020 guidelines for diabetes care recommend optimal glycemic levels (A), blood pressure control (B), lipid reduction (C), and smoking cessation (N), commonly referred to as ABC or ABCN criteria. This quality assessment project examines diabetes management in PLWH by gender, race/ethnicity, and BMI, in a predominantly minority-serving clinic, as assessed by rates of guideline adherence to the above metrics. Methods This project was reviewed and approved by the Rutgers IRB. Patients from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ were reviewed for a diagnosis of diabetes and both a clinic visit and an A1c score recorded between 2/1/2019 and 1/31/2020. Achieving glycemic target was defined as HbA1c < 7.5 for patients < 65 and HbA1c < 8 for patients > 65. Target adherence criteria also included a blood pressure average of < 140/90 over this period and an LDL-c of < 100 mg/dL. Non-smoking status includes both former and never smokers. Results Of 1035 patients reviewed, a total of 172 met criteria. Adherence rate for achieving goal HbA1c was 61.6% (95% CI 54.2-68.6, n=172). Blood pressure and LDL-c adherence rates were 65.1% (95% CI 57.7-71.8, n=172) and 67.4% (95% CI 60.1-74.0, n=172), respectively. ABC and ABCN rates were 24.4% (95% CI 18.6-31.4, n=172) and 18.6% (95% CI 13.5-25.1, n=172). The overall smoking rate, as well as the rates in the female subgroup, those with BMI 18.5-24.9, and the non-Hispanic black subgroup were significantly higher than the national average (P< 0.05). Table 1: Demographic Data of PLWH and Diabetes Table 2: Adherence to ABCN Criteria in Diabetes Care by Demographics for PLWH from 2/1/2019 – 1/31/2020 Conclusion For diabetic PLWH, smoking cessation requires improvement, particularly in female, normal BMI, and non-Hispanic black subgroups. These findings, in addition to a majority overweight patient population, highlight the need for increased education and interventions aimed at nutritional counseling and risk factor mitigation among all patient subgroups. Disclosures All Authors: No reported disclosures

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Janania Martinez, Michelle, Prathibha Surapaneni, Juan F. Garza, Tyler W. Snedden, Snegha Ananth, Jeremy Rawlings, David J. Gregorio, et al. "Hodgkin Lymphoma Outcomes: Can We Expect Ethnic Parity in a Hispanic Prevalent Population?" Blood 134, Supplement_1 (November 13, 2019): 4056. http://dx.doi.org/10.1182/blood-2019-129058.

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BACKGROUND It is estimated that 8110 persons will be diagnosed with Hodgkin Lymphoma (HL) in the US during 2019, but the advent of new treatment options has increased the cure rate to at least 80%. It has been reported that the rates of HL are lower in the adolescent and young adult (AYA) Hispanic population but significantly higher in the Hispanic population older than 65. The relative survival estimates are stated to be similar between AYA Hispanics (HI) and non-Hispanics (NH) but for ages 65-84, HI have a significantly higher mortality rate. Pediatric studies have suggested that ethnicity plays a role in outcomes in patients with HL but there is limited data in the adult population. There is an unmet need in the field, where dossiers on underrepresented ethnic minorities need to be carefully considered and compared to existing data. Therefore, our study aims to compare survival outcomes in Hispanics vs Non-Hispanics with HL, who were treated at the only NCI designated cancer center of South Texas. To our knowledge this is the largest cohort of HL patients from a single academic institution that serves primarily Hispanics. METHODS We located and retrospectively analyzed a total of 616 patients with diagnosis of Lymphoma (HL and NHL) by International Classification of Diseases (ICD) codes and identified 116 cases of HL; all the patients received care at UT Health San Antonio, between 2008-2018. Key variables for each patient included age, gender, race/ethnicity, comorbidities, insurance status, stage, BM and extranodal involvement, treatment received, outcome at 3 and 5 years and vitality status in 2018. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. The significance of variation in the mean with disease category was assessed with one way ANOVA and the significance of associations between categorical outcomes was assessed with Pearson's Chi Square or Fisher's Exact test as appropriate. Multivariate logistic regression was used to model binary outcomes in terms of covariates and indicators of disease. All statistical testing was two-sided with a significance level of 5%. R1 was used throughout. The study was approved by the local Institutional Review Board. The findings will be available to patients, funders and medical community through traditional publishing and social media. RESULTS We identified 116 patients with HL, of which 73 were HI (63%), 43 NH (36%) and 1 not specified (1%). In regard to race, 92% identified as Caucasian, 4% as African American, 3% other and 1% Asian. The median age at diagnosis was 37.4, (SD 15.13). There were 49 females (42%) and 67 males (58%). The most common funding source was commercial insurance N=54 (47%), followed by a hospital payment plan N=30 (26%), Medicare N=16 (14%), unfunded N=13 (11%) and Medicaid N=3 (2%). Most prevalent co-morbidities were HTN N=28 (24%) and diabetes mellitus N= 23(20%); 50% of patients had no co-morbidities (N=63).At diagnosis ECOG of 0-1 was seen in 108 patients (93%); 8 were Stage I (7%), 39 stage II (33%), 32 stage III (28%), and 37 stage IV (32%). EBV was positive in 26 patients (22%). There were 15 patients that were HIV positive (13%), 54% with CD4 count <200, and 12 (75%) on antiretroviral therapy at diagnosis. Median PFS was 853.85 days (SD 912.92). We excluded patients who were lost to follow up or had not reached 3/5 years. At 3 year follow up there was: complete response in 37 HI (74%) vs 22 NH (92%); disease progression in 8 (16%) vs 0 (0%); death in 5 (10%) vs 2 (8%), respectively (p-value= 0.094). At 5 year follow up there was: complete response in 30 HI (77%) vs 17 NH (90%); progressive disease in 2 (5%) vs 0 (0); death 7 (18%) vs 2 (11%), respectively (p-value = 0.619). At the end of 2018, 41 HI (84%) were alive compared to 22 NH (88%) [p-value 0.74]. CONCLUSION Within the limitations of sample size, our study demonstrates that in the prevalently Hispanic population of our institution, HI patients with HL have no statistically significant difference in outcome when compared to NH patients. Disclosures No relevant conflicts of interest to declare.

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Zhou, Jifang, Jin Han, Edith A. Nutescu, William Galanter, Surrey M. Walton, Victor R. Gordeuk, Santosh L. Saraf, Andrew Srisuwananukorn, and Gregory Sampang Calip. "Type 2 Diabetes Mellitus in Patients with Sickle Cell Disease: A Population-Based Longitudinal Analysis of Three Cohorts." Blood 132, Supplement 1 (November 29, 2018): 4817. http://dx.doi.org/10.1182/blood-2018-99-119039.

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Abstract Introduction The prevalence and incidence of type 2 diabetes mellitus (T2DM) in the United States (U.S.) is increasing with more than 100 million adults living with diabetes or pre-diabetes. Population-based evidence on the prevalence and risks for T2DM in patients with sickle cell disease (SCD) is limited. This study measured the prevalence of T2DM in patients with SCD and clinical characteristics associated with its incidence in a large commercially insured adult SCD cohort and also an academic institution-based clinical cohort. Methods We performed a population-based cohort study of commercially-insured health plan enrollees using the Truven MarketScan® Research Databases. Patients with SCD (1 inpatient or 2 outpatient claims that are at least 30 days apart) were identified and sampled each calendar year between 2009 and 2014. Prevalence in each closed cohort of continuously enrolled patients was determined per calendar year. Incidence rates of T2DM were estimated and compared with adult non-Hispanic Black respondents to the National Health and Nutrition Examination Survey (NHANES) over the same study period (2009-2014). Among SCD patients, multivariable Cox proportional hazard models were used to identify factors associated with incident T2DM, adjusting for relevant patient characteristics. Finally, prevalence of T2DM was measured in a cohort of patients with SCD aged ≥20 years at first medical encounter at the University of Illinois at Chicago (UIC) from January 2008 to December 2017. Prevalent T2DM was identified through a combination of diagnosis codes, self-reporting, anti-diabetic medications excluding insulin and glucose tests in outpatient settings. Results Among 7,070 health plan enrollees with SCD, the median age (mean) was 37.0 (38.9) years and 60.8% were female. Compared to SCD patients without T2DM, more SCD patients with T2DM had nephropathy (28.0% vs. 9.5%; p<0.001), neuropathy (17.7% vs. 5.2%; p<0.001), and history of stroke (24.1% vs. 9.2%; p<0.001). The standardized prevalence of T2DM among patients with SCD showed a modest increase from 15.7% to 16.5% from 2009 to 2014 (p trend=0.0259), and SCD patients had comparable prevalence of T2DM compared to the NHANES subjects (18.2%). [Figure A] Over 17,024 person-years, we observed a crude incidence rate for T2DM of 25.4 per 1,000 person-years. Risk of developing T2DM in patients with SCD increased with age, and incident T2DM was associated with comorbid hypertension (HR=1.45, 95%CI 1.14-1.83) and dyslipidemia (HR=1.43, 95%CI 1.04-1.96). [Figure B] Of the 672 adults in the UIC cohort of patients with SCD, 61.1% were female, the median (mean) age was 30.0 [32.9] years, and 478 (71.1%) had homozygous HbS disease (HbSS). A total of 76 (11.3%) patients had T2DM, with the highest prevalence among SCD patients ages ≥ 40 years (50/190, 26.3%). [Figure C] Abnormal glucose test results (≥200 mg/dl) were documented in 41 patients with mean (SD) of 294 (94) mg/dl. Among 31 patients with abnormal fructosamine tests (>285 µmol/L), the mean (SD) fructoasmine value was 392 (90) µmol/L. Conclusion We present evidence describing the prevalence of T2DM in patients with SCD both in a commercially-insured population and from an institution-based clinical cohort. These findings were similar to a general African American population with an increasing trend in T2DM over recent years. These trends support the routine screening for T2DM in patients with SCD, especially those of older age and with presence of comorbid hypertension and/or dyslipidemia. Disclosures No relevant conflicts of interest to declare.

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Vishnu, Abhishek, Anoop Shankar, and Sita Kalidindi. "Examination of the Association between Insufficient Sleep and Cardiovascular Disease and Diabetes by Race/Ethnicity." International Journal of Endocrinology 2011 (2011): 1–8. http://dx.doi.org/10.1155/2011/789358.

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Background. We examined the association between insufficient rest/sleep and cardiovascular disease or diabetes mellitus separately among non-Hispanic whites, non-Hispanic blacks, Hispanic Americans, and other races in a contemporary sample of US adults.Methods. Multiethnic, nationally representative, cross-sectional survey (2008 BRFSS) participants who were >20 years of age (n=369, 217; 50% women). Self-reported insufficient rest/sleep in the previous month was categorized into: zero, 1–13, 14–29, and all 30 days. Outcomes were: (1) any CVD, (2) coronary artery disease (CHD), (3) stroke, and (4) diabetes mellitus.Results.Insufficient rest/sleep was found to be positively associated with (1) any CVD, (2) CHD, and (3) stroke among all race-ethnicities. In contrast, insufficient rest/sleep was positively associated with diabetes mellitus in all race-ethnicities except non-Hispanic blacks. The odds ratio of diabetes association with insufficient rest/sleep for all 30 days was 1.37 (1.26–1.48) among non-Hispanic whites, 1.11 (0.90–1.36) among non-Hispanic blacks, 1.88 (1.46–2.42) among Hispanic Americans, and 1.48 (1.10–2.00) among other race/ethnicities.Conclusion. In a multiethnic sample of US adults, perceived insufficient rest/sleep was associated with CVD, among all race-ethnicities. However, the association between insufficient rest/sleep and diabetes mellitus was present among all race-ethnicities except non-Hispanic blacks.

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Sarma, Maithreyi, Ashwini Ronghe, Samar Nasir, Ankita Kapoor, Kristopher Attwood, and Shipra Gandhi. "Clinical outcomes in HER2-positive and triple-negative breast cancer: Assessing racial disparities." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18624-e18624. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18624.

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e18624 Background: Triple negative breast cancer (TNBC) & HER2 positive breast cancer (Her2BC), are aggressive breast cancer subtypes. Both are associated with higher mortality in Non-Hispanic Black (NHB) compared to Non-Hispanic White women (NHW). Factors attributed to this racial disparity include socioeconomic status, insurance status, diagnosis(dx)/ treatment delays & comorbidities. We examined the association between race & clinical outcomes (pathological complete response, pCR; recurrence free survival, RFS & overall survival, OS) in patients (pts) dxed with TNBC/Her2BC treated with neoadjuvant chemotherapy (NAC) at Roswell Park Comprehensive Cancer Center. Methods: Pts dxed with Stage I-III TNBC/Her2BC who received NAC from 2000-2018 were included. pCR was defined as absence of residual invasive cancer in the breast & lymph nodes after NAC. Association of race with pCR & survival outcomes was evaluated using logistic & Cox regression models, respectively. Multivariate (MV) models were used to evaluate the association between race & pCR or survival while controlling for relevant confounders including age, BMI, insurance, comorbidities, clinical stage, grade & time from dx to chemotherapy(chemo)/surgery. Analysis was conducted using SAS v9.4 at a significance level of 0.05. Results: 174 TNBC (49 NHB, 125 NHW) & 80 Her2BC (13 NHB, 67 NHW) pts were analyzed. Among TNBC pts, NHB pts had higher baseline BMI(34.3 vs 28.6 kg/m2; p<0.001), higher incidence of hypertension (HTN) (45% vs. 24%; p<0.01), diabetes mellitus (20% vs 8%; p<0.05) & higher Medicare/Medicaid use (M/M) (55% vs. 28%; p<0.01). Among Her2BC pts, NHB pts had higher incidence of HTN (54% vs 25%; p<0.05). There was no statistically significant difference in mean chemo relative dose intensity by race. Among TNBC pts, those with pCR were younger (47 vs 53 yrs; p=0.002) & had more grade 3 tumors (96% vs 80.5%; p<0.05) at dx compared to pts without pCR. Similarly, among Her2BC pts, those with pCR had more grade 3 tumors (64% vs 36%; p<0.05) at dx compared to pts without pCR. Among TNBC pts, advanced age, higher clinical stage & longer time from dx to surgery were associated with worse RFS & OS (p<0.05). Among Her2BC pts, M/M use & advanced clinical stage were associated with worse RFS & OS (p<0.05). There were no significant associations between race & pCR/RFS/OS on MV analysis (table below). Conclusions: Similar outcomes were noted between races for TNBC/Her2BC pts treated at a single academic center in Buffalo, NY. Given the known genetic diversity of African American ancestry in the US, further studies investigating the interplay between race, geography & clinical outcomes are warranted.[Table: see text]

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Pandita, Aakriti, Fizza S. Gillani, Yiyun Shi, Anna hardesty, Jad Aridi, Meghan McCarthy, Silvia Chiang, and Curt Beckwith. "518. Factors Associated with Severe COVID-19 among Patients Hospitalized in Rhode Island." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S324—S325. http://dx.doi.org/10.1093/ofid/ofaa439.712.

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Abstract Background To better understand patient factors that impact clinical outcomes in COVID-19, we performed a retrospective cohort study of patients hospitalized with COVID-19 in Rhode Island to identify patient and clinical characteristics associated with severe disease. Methods We analyzed 259 patients admitted to our academic medical center during a three month period with confirmed COVID-19. Clinical data was extracted via chart review and lab results within the first 24 hours of admission were extracted directly from electronic medical records. Patients were divided in two groups based upon the highest level of supplemental oxygen (O2) required during hospitalization: severe COVID-19 (high flow O2, non-invasive, or invasive mechanical ventilation) and non-severe COVID-19 (low flow O2 or no supplemental O2). SAS 9.4 (Cary, NC) was used for statistical analyses. Chi-square or Fisher’s exact tests for categorical variables and the Student’s t-test for continuous variables were used to compare demographics, baseline comorbidities, and clinical data between the severe and non-severe groups. Table 1: Demographics Results Of 259 patients, 166 (64%) had non-severe disease, and 93 (36%) severe disease; median age [IQR] was 62 [51,73]. There were 138(53%) males and 75 (29%) Hispanics. Among non-Hispanics,124(48%) were White, 48(19%) African Americans, and 12(5%) other races. Sixty (23%) were admitted from a nursing facility and the in-hospital mortality rate was 15% (38/259). Severe COVID-19 was associated with older age (p=0.02), admission from nursing facility (p=0.009), increased BMI (p=0.03), diabetes mellitus (p=0.0002), and COPD (p=0.03). At the time of presentation, severe COVID-19 was associated with tachypnea, hypoxia, hypotension (all p< 0.0001), elevated BUN (p=0.002) and AST (p=0.001), and acute or chronic kidney injury (p=0.01). Median hospital stay [IQR] was 11 days [7,18] in the severe vs. 6 days [3,11] in the non-severe group. In the severe group, 72% required ICU admission and 39% died. Table 2: Medical comorbidities Table 3: Presenting symptoms and signs in the first 48 hours of admission Table 4: Basic labs in the first 24 hours Conclusion In this cohort of patients with COVID-19, specific comorbidities, and vital signs at presentation were associated with severe COVID-19. These findings help clinicians with early identification and triage of high risk patients. Disclosures All Authors: No reported disclosures

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Burroughs Peña, Melissa S., Dhaval Patel, Delfin Rodríguez Leyva, Bobby V. Khan, and Laurence Sperling. "Lifestyle Risk Factors and Cardiovascular Disease in Cubans and Cuban Americans." Cardiology Research and Practice 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/470705.

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Cardiovascular disease is the leading cause of mortality in Cuba. Lifestyle risk factors for coronary heart disease (CHD) in Cubans have not been compared to risk factors in Cuban Americans. Articles spanning the last 20 years were reviewed. The data on Cuban Americans are largely based on the Hispanic Health and Nutrition Examination Survey (HHANES), 1982–1984, while more recent data on epidemiological trends in Cuba are available. The prevalence of obesity and type 2 diabetes mellitus remains greater in Cuban Americans than in Cubans. However, dietary preferences, low physical activity, and tobacco use are contributing to the rising rates of obesity, type 2 diabetes mellitus, and CHD in Cuba, putting Cubans at increased cardiovascular risk. Comprehensive national strategies for cardiovascular prevention that address these modifiable lifestyle risk factors are necessary to address the increasing threat to public health in Cuba.

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Peña-Purcell, Ninfa C., Lauren Cutchen, and Traechel McCoy. "“You’ve Got to Love Yourself”: Photovoice Stories From African Americans and Hispanic/Latinos Living With Diabetes." Journal of Transcultural Nursing 29, no. 3 (March 10, 2017): 229–39. http://dx.doi.org/10.1177/1043659617696976.

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Introduction: Health disparities persist among African Americans (AAs) and Latino adults with type 2 diabetes. The purpose of this research was to use PhotoVoice to examine AAs and Latinos’ daily experiences of managing diabetes. Method: An exploratory, descriptive study using PhotoVoice and focus groups was conducted over a 3-week period: Week 1 orientation session, Week 2 photo taking and returning cameras, and Week 3 focus group to share and discuss photos. Results: Ten AAs and nine Latino adults were enrolled, forming four focus groups. Four categories emerged: (1) daily life living with type 2 diabetes mellitus, (2) negative and positive emotions, (3) supports and barriers, and (4) needs. The social determinants of health influencing diabetes self-care were observed in discussions and photos—this included the built environment to promote a healthy lifestyle, social support, and education. Implications: PhotoVoice promotes culturally congruent care to better understand AA and Latinos’ experience living with type 2 diabetes mellitus.

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Toriola, Adetunji T., Suhong Luo, Theodore Seth Thomas, Bettina F. Drake, Su-Hsin Chang, Kristen Marie Sanfilippo, and Kenneth Robert Carson. "Metformin use and pancreatic cancer survival in U.S. veterans with diabetes mellitus: Are there racial differences?" Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 4129. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.4129.

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4129 Background: Experimental and observational studies suggest that metformin holds promise in improving survival among pancreatic cancer patients. However, findings from prior observational studies have been questioned because most did not control for immortal time bias, which can overestimate the survival benefit of a drug. In addition, previous studies did not present data on African American patients. Thus, it is unknown if any survival advantage from metformin extends to African Americans. To address these limitations, we analyzed data from the U.S. Veterans Health Administration (VHA). Methods: A population-based retrospective cohort study of 3,811 (N = 773 are African Americans) pancreatic cancer patients with pre-existing diabetes mellitus diagnosed within the VHA between October 1, 1998 and December 30, 2010, and followed until December 2014. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using both the time-varying Cox proportional hazards regression model, which controls for immortal time bias, and conventional Cox model. Analyses were adjusted for confounders. We also stratified analyses by race. Further, we performed analyses among patients who were metformin naïve (N = 1158) at the time of pancreatic cancer diagnosis (most representative of patients enrolled in clinical trials). Results: Median survival was 4.5 months among metformin users versus 3.7 months among non-users. Metformin use was not associated with pancreatic cancer survival in analysis using the time-varying Cox model: HR = 1.05 (95% CI 0.92-1.14, P-value = 0.28). Results were identical among non-Hispanic Whites and African Americans. In analysis using conventional Cox model, metformin use was associated with an artificial survival benefit: HR = 0.89 (95% CI 0.83-0.98, P-value = 0.01). Among patients who were metformin naïve at the time of pancreatic cancer diagnosis, metformin use was associated with improved survival in analysis using the time-varying Cox model: HR = 0.77 (95% CI 0.61-0.98, P-value = 0.03). The HRs were 0.78 (95% CI 0.61-0.99, P-value = 0.04) among non-Hispanic Whites and 1.20 (95% CI 0.75-1.93, P-value = 0.45) among African American patients. Conclusions: We observed no associations between metformin use and pancreatic cancer survival. Nevertheless, we noted improved survival (limited to non-Hispanic White patients) among patients who were metformin naïve at the time of pancreatic cancer diagnosis, which requires conformation in other studies.

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Harris, Amanda J., and Amy E. Fathman. "Diabetes education mobile APP prototype for Hispanic communities." Journal of Nursing Education and Practice 10, no. 7 (April 3, 2020): 26. http://dx.doi.org/10.5430/jnep.v10n7p26.

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When compared with the general United States population, Hispanic Americans are at an increased risk of developing type 2 diabetes mellitus (DM2) and are far more likely to suffer devastating complications related to the disease. The purpose of this quality improvement project was to determine whether the use of a culturally tailored, mobile application prototype educational tool increased DM2 prevention knowledge among Hispanic patients at risk for DM2. The educational tool contained information about DM2 including risk factors, prevention, and health maintenance. The prototype was developed to function like a working mobile application and a pre/posttest was administered to participants at three local Hispanic community health fairs in Cincinnati, Ohio. Paired t test analysis of the 27 completed surveys showed a statistically significant improvement in posttest scores. The results showed that the average score was 4.1 out of a total of five possible points in the pre-test. The mean total score of the post-test was 4.7, with a total improvement of the mean score of 0.6 (0.0001). It was concluded that there was a statistically significant improvement in the knowledge of DM2 prevention after reviewing the material presented in the application prototype. In addition, participants expressed a strong interest in a working mobile application that offers culturally tailored DM2 prevention education.

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Holmes, Laurens, Jobayer Hossain, Doriel Ward, and Franklin Opara. "Racial/Ethnic Variability in Diabetes Mellitus among United States Residents Is Unexplained by Lifestyle, Sociodemographics and Prognostic Factors." ISRN Public Health 2012 (June 3, 2012): 1–8. http://dx.doi.org/10.5402/2012/408079.

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Background. The mortality and prevalence of diabetes mellitus (DM) vary across racial/ethnic groups with African Americans/blacks being disproportionately affected. However, it is unclear to what extent such disparities persist after the adjustment for covariates related to race/ethnicity and/or DM in the population. We aimed to assess racial/ethnic disparities in DM and to determine which covariates account for the observed racial/ethnic variabilities. Materials and Methods. We utilized a large cross-sectional survey of the US noninstitutionalized residents (n=30,852) to investigate the racial/ethnic disparities in diabetes mellitus, and the degree in which the disparities are explained by the relevant covariates. Pearson’s chi-square was used to examine study variables by race/ethnicity, while logistic regression was used to assess the effect of race/ethnicity and other covariates on DM prevalence. Results. There were statistically significant ethnic/racial differences with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P<0.05, but not insurance coverage, P>0.05. Race/ethnicity was a single independent predictor of DM, with African Americans (non-Hispanic blacks) more likely to be diagnosed for DM compared with non-Hispanic whites, prevalence odds ratio (POR) 1.45, 95% confidence interval (CI) 1.30–1.62, while Hispanics were less likely to be diagnosed, POR = 0.98, 95% CI 0.87–1.09. Similarly, after controlling for potential confounders, the racial/ethnic variability in DM between AA/blacks and non-Hispanic whites persisted, adjusted POR = 1.30, 95% CI 1.15–1.47. Conclusions. Racial/ethnic variability exists in DM prevalence and is unexplained by racial/ethnic variance in education, income, marital status, smoking, alcohol, physical activities, age, and sex.

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Ledford, Christy J. W., Dean A. Seehusen, and Paul F. Crawford. "Geographic and Race/Ethnicity Differences in Patient Perceptions of Diabetes." Journal of Primary Care & Community Health 10 (January 2019): 215013271984581. http://dx.doi.org/10.1177/2150132719845819.

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Objectives: The present study takes a culture-centered approach to better understand how the experiences of culture affect patient’s perception of type 2 diabetes mellitus (T2DM). This study explores personal models of T2DM and compares personal models across regional and race/ethnicity differences. Methods: In a practice-based research network, a cross-sectional survey was distributed to patients diagnosed with T2DM at medical centers in Nevada and Georgia. In analyses of covariance, controlling for age, health literacy, and patient activation, geographic location, and race/ethnicity were tested onto 5 dimensions of illness representation. Results: Among 685 patients, race/ethnicity was significantly associated with lower reported understanding diabetes ( P < .01) and less perceived longevity of diabetes ( P < .001). Geographic location was significantly associated with seriousness of the disease ( P < .005) and impact of diabetes ( P < .001). Conclusion: Non-Hispanic White Americans report greater understanding and perceive a longer disease course than non-Hispanic Black Americans and Asian Americans. Regionally, patients in Nevada perceive T2DM as more serious and having more impact on their lives than patients living in Georgia. Primary care physicians should elicit patient perceptions of diabetes within the context of the patient’s ethnic and geographic culture group to improve discussions about diabetes self-management. Specifically, primary care physicians should address the seriousness of a diabetes diagnosis and the chronic nature of the disease with patients who belong to communities with a higher prevalence of the disease.

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Raymond, Nicole R., and Gail D'Eramo-Melkus. "Non-Insulin-Dependent Diabetes and Obesity in the Black and Hispanic Population: Culturally Sensitive Management." Diabetes Educator 19, no. 4 (August 1993): 313–17. http://dx.doi.org/10.1177/014572179301900411.

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The prevalence of diabetes is considerably higher among ethnic minorities, particularly black and Hispanic Americans, than in the nonminority white population. Obesity, a significant risk factor for non-insulin-dependent diabetes mellitus (NIDDM), also is more common in these ethnic groups. Because the combined effects of obesity and NIDDM can lead to potentially serious complications, overweight patients with NIDDM must be treated aggressively. However, effective treatment of these ethnic groups requires a sensitivity to and recognition of their unique cultural values. Diabetes educators and health care providers need to take into account specific ethnic beliefs, customs, food patterns, and health care practices, with the goal of incorporating these cultural factors into a practical and beneficial treatment regimen.

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Nguyen, Brian, Chap-Kay Kendra Lau, Gloria Wu, Dwight Lubrin, and Vincent Siu. "Do COVID-19 Apps Address Diabetes Mellitus and Health Equity Issues." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A379. http://dx.doi.org/10.1210/jendso/bvab048.772.

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Abstract Purpose: To evaluate if COVID-19 apps address risk factors such as diabetes, hypertension, race, gender, sexual orientation, language. Background: In 2019, there were 204 Billion app downloads and 3.7 billion downloads of ehealth apps. COVID-19 affects ethnic minority patients with diabetes, hypertension, and other risk factors. Spanish is the second most commonly used language after English in the U.S.. African Americans, Hispanic Americans, and Asian Americans are at an increased risk of COVID-19. LGBTQ+ communities are also at higher risk for COVID due to historically poor access to healthcare. Methods: The search term, “COVID,” in Google Play store and Apple App store was used to find the most popular COVID-19 apps. App inclusion criteria: 1) Contains COVID-19 information and/or COVID symptom tracker, 2) Marketed and designed for the general public, 3) Free, 4) Android (DROID): 100,000+ Downloads; Apple (iOS): highest star ratings. Apple does not provide a number of downloads. App features: COVID-19 information, COVID-19 symptom questionnaire (QN), Diabetes, Hypertension, Cardiovascular disease, Languages (Spanish, Chinese), Race, Gender, and Sexual Orientation. Results: The top 10 DROID apps in descending order are: 1) GuideSafe, 2) CO Exposure Notifications, 3) Care19 Diary, 4) Care19 Alert, 5) Crush COVID RI, 6) MI COVID Alert, 7) DC CAN, 8) CombatCOVID MDC, 9) CombatCOVID PBC, 10) Stronger than C19. The top 10 iOS apps in descending order are: 1) SlowCOVIDNC, 2) COVIDWISE, 3) COVID Alert Pennsylvania, 4) COVID Alert DE, 5) COVID Alert NY, 6) Covid Watch Arizona, 7) Apple COVID-19, 8) COVID Alert NJ, 9) COVID Trace Nevada, 10) CDC. Of the 20 apps: COVID 19 information: 20/20; COVID-19 symptom QN: 8/20; DM: 2/20; HTN: 1/20; CardioVasc: 2/20; Spanish: 11/20 (2/11 of the Spanish apps have Chinese as well). Race: 5/20. Gender: 8/20; Sexual Orientation: 3/20; Age: 10/20. Conclusion: 1) Most apps do not ask about important risk factors such as DM, HTN, and Race. 2) Smartphone apps are not uniform in their health education features. 3) Healthcare providers should continue to play an important role in public education despite the ubiquity of mobile apps.

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Bazargan-Hejazi, Shahrzad, Jeffrey S. Arroyo, Stanley Hsia, Neda Rouhi Brojeni, and Deyu Pan. "A Racial Comparison of Differences between Self-Reported and Objectively Measured Physical Activity among US Adults with Diabetes." Ethnicity & Disease 27, no. 4 (December 7, 2017): 403. http://dx.doi.org/10.18865/ed.27.4.403.

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Objective: To investigate: 1) the racial/ethnic disparities in meeting the recommended physical activity as measured by subjective vs objective measures in a national sample of individuals with type 2 diabetes mellitus; and 2) the racial/ethnic differences with respect to the magnitude of the discrepancy between self-reported and objectively measured moderate-to-vigorous intensity aerobic physical activity (MVPA). Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2003-06 to calculate and compare the percentage of individuals with diabetes who achieved the recommended levels of physical activity as measured by subjective self-report (500 metabolic equivalents (MET)-minutes/week) and objective accelerometer measurement (150 minutes per week of MVPA) across racial/ ethnic groups. Results: 71.2%, 15.7%, and 13.1% of participants were White, African American, and Hispanic, respectively. Based on self-report, 67.1%, 39.2%, and 55.1% of Whites, African Americans, and Hispanics, respectively, met the 500 MET-minutes/week threshold of physical activity (P<.0001). Objective measurement by accelerometer showed that 44.2%, 42.6%, and 65.1% of Whites, African Americans, and Hispanics, respectively, met the threshold (P<.0003). Conclusions: Many individuals with type 2 diabetes mellitus did not meet the recommended physical activity thresholds. African Americans had the lowest proportion of meeting both the self-reported and objectively measured thresholds. White patients with diabetes overestimated frequency of their physical activity, while their Hispanic counterparts significantly underestimated it. Also, the gap between the two measures of MVPA was largest among Hispanics. Ethn Dis. 2017;27(4):403-410; doi:10.18865/ ed.27.4.403.

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Sozener, Cemal B., Lynda D. Lisabeth, Fatema Shafie-Khorassani, Sehee Kim, Darin B. Zahuranec, Devin L. Brown, Lesli E. Skolarus, et al. "Trends in Stroke Recurrence in Mexican Americans and Non-Hispanic Whites." Stroke 51, no. 8 (August 2020): 2428–34. http://dx.doi.org/10.1161/strokeaha.120.029376.

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Background and Purpose: Stroke incidence and mortality are declining rapidly in developed countries. Little data on ethnic-specific stroke recurrence trends exist. Fourteen-year stroke recurrence trend estimates were evaluated in Mexican Americans and non-Hispanic whites in a population-based study. Methods: Recurrent stroke was ascertained prospectively in the population-based BASIC (Brain Attack Surveillance in Corpus Christi) project in Texas, between 2000 and 2013. Incident cases were followed forward to determine 1- and 2-year recurrence. Fine & Gray subdistribution hazard models were used to estimate adjusted trends in the absolute recurrence risk and ethnic differences in the secular trends. The ethnic difference in the secular trend was examined using an interaction term between index year and ethnicity in the models adjusted for age, sex, hypertension, diabetes mellitus, smoking, atrial fibrillation, insurance, and cholesterol and relevant interaction terms. Results: From January 1, 2000 to December 31, 2013 (N=3571), the cumulative incidence of 1-year recurrence in Mexican Americans decreased from 9.26% (95% CI, 6.9%–12.43%) in 2000 to 3.42% (95% CI, 2.25%–5.21%) in 2013. Among non-Hispanic whites, the cumulative incidence of 1-year recurrence in non-Hispanic whites decreased from 5.67% (95% CI, 3.74%–8.62%) in 2000 to 3.59% (95% CI, 2.27%–5.68%) in 2013. The significant ethnic disparity in stroke recurrence existed in 2000 (risk difference, 3.59% [95% CI, 0.94%–6.22%]) but was no longer seen by 2013 (risk difference, −0.17% [95% CI, −1.96% to 1.5%]). The competing 1-year mortality risk was stable over time among Mexican Americans, while for non-Hispanic whites it was decreasing over time (difference between 2000 and 2013: −4.67% [95% CI, −8.72% to −0.75%]). Conclusions: Mexican Americans had significant reductions in stroke recurrence despite a stable death rate, a promising indicator. The ethnic disparity in stroke recurrence present early in the study was gone by 2013.

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Jain, Rajesh K., Mark G. Weiner, Huaqing Zhao, Kevin Jon Williams, and Tamara Vokes. "Diabetes-Related Fracture Risk Is Different in African Americans Compared With Hispanics and Caucasians." Journal of Clinical Endocrinology & Metabolism 104, no. 11 (August 1, 2019): 5729–36. http://dx.doi.org/10.1210/jc.2019-00931.

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Abstract Context Diabetes mellitus (DM) has been associated with a 60% to 90% increased risk of fracture but few studies have been performed in African American and Hispanic subjects. Objective The aim of the present study was to quantify the risk of incident major osteoporotic fractures (MOFs) of the hip, wrist, and humerus in African Americans, Hispanics, and Caucasians with DM compared with those with hypertension (HTN). Methods We performed a retrospective cohort study of 19,153 subjects with DM (7618 Caucasians, 7456 African Americans, and 4079 Hispanics) and 26,217 with HTN (15,138 Caucasians, 8301 African Americans, and 2778 Hispanics) aged ≥40 years, treated at a large health care system in Philadelphia, Pennsylvania. All information about the subjects was obtained from electronic health records. Results The unadjusted MOF rates for each race/ethnicity were similar among those with DM and those with HTN (Caucasians, 1.85% vs 1.84%; African Americans, 1.07% vs 1.29%; and Hispanics, 1.69% vs 1.33%; P = NS for all). However, the MOF rates were higher for Caucasians and Hispanics with DM than for African Americans with DM (P < 0.01). In a multivariable model controlled for age, body mass index, sex, and previous MOF, DM was a statistically significant predictor of MOFs only for Caucasians and Hispanics [hazard ratio (HR), 1.23; 95% CI, 1.02 to 1.48; P = 0.026] but not for African Americans (HR, 0.92; 95% CI, 0.68 to 1.23; P = 0.56). Conclusions Hispanics had a DM-related fracture risk similar to that of Caucasians, but AAs did not have an additional fracture risk conferred by DM.

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Haffner, S. M., M. P. Stern, H. P. Hazuda, M. Rosenthal, J. A. Knapp, and R. M. Malina. "Role of Obesity and Fat Distribution in Non-insulin-dependent Diabetes Mellitus in Mexican Americans and Non-Hispanic Whites." Diabetes Care 9, no. 2 (March 1, 1986): 153–61. http://dx.doi.org/10.2337/diacare.9.2.153.

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Tee Lu, Hou, Rusli Bin Nordin, and Aizai Azan Bin Abdul Rahim. "Influence of Race in the Association of Diabetes and Heart Failure." US Cardiology Review 12, no. 1 (February 28, 2018): 17–21. http://dx.doi.org/10.15420/usc.2017:24:2.

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Heart failure is a global public health problem with high mortality and readmission rates. Race and ethnicity are useful concepts when attempting to understand differential health risks and health disparities. With cardiovascular diseases accounting for most deaths globally, eliminating racial disparities in cardiac care has become a new challenge in cardiology. Significant racial differences exist in patients with heart failure. African American patients in the US have a significantly higher incidence of heart failure, lower ejection fraction and are younger at presentation compared to White, Hispanic and Chinese American patients. These findings are explained by a higher burden of risk factors such as diabetes mellitus, hypertension, obesity and lower household incomes among African Americans. The authors believe that these findings are applicable to other racial groups across the globe. The prevalence of predisposing risk factors probably has a stronger influence on the incidence of heart failure than the racial factor alone. The interaction between race and diabetes mellitus has important public health implications for the management and prevention of heart failure.

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Khan, Hafiz, Aamrin Rafiq, Komaraiah Palle, Mohammad Faysel, Kemesha Gabbidon, Mohammed Chowdhury, and P. Hemachandra Reddy. "Sex Differences in Cardiovascular Disease and Cognitive Dysfunction in Rural West Elderly Texans." Journal of Alzheimer's Disease Reports 5, no. 1 (March 19, 2021): 213–26. http://dx.doi.org/10.3233/adr-200278.

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Background: The prevalence of cognitive dysfunction increases in elderly due to cardiovascular disease related risk factors in rural communities like West Texas. Objective: The purpose of this study was to find risk factors of cardiovascular disease (CVD) related to cognitive dysfunction and their impact on elderly adults in rural West Texans. Methods: Statistical methods such as Pearson’s chi-squared and a multinomial logistic regression were utilized to analyze data. We used SPSS software to detect and understand the nature of the risk factors. Results: A summary of statistics was obtained by using Pearson’s chi-squared test for categorical variables. CVD, diabetes mellitus, and depression were significantly associated with cognitive dysfunction for both males and females (p = 0.0001), whereas anxiety was found to be significantly associated with cognitive dysfunction for females (p = 0.0001). Age group and race/ethnicity were significantly associated with cognitive dysfunction for both males and females (p = 0.0001). By performing a multinomial logistic regression method and controlling for confounders, the significant risk factors (p < 0.05)— age (65– 84 years), diabetes, and memory loss for age-associated cognitive impairment; diabetes for cognitive impairment no dementia; age (65– 84, ≥85 years), CVD, diabetes, depression, memory loss, non-Hispanic Whites, and Black/African-Americans for mild cognitive impairment; and age, memory loss, non-Hispanic Whites, Black/African-Americans, and male gender were found for dementia. Conclusion: CVD related risk factors in developing cognitive dysfunction exist and integrating such risk variables may guide relevant policy interventions to reduce Alzheimer’s incidence or dementia in rural communities in West Texans.

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Samant, Hrishikesh, Kapil Kohli, Krunal Patel, Runhua Shi, Paul Jordan, James Morris, Annie Schwartz, and Jonathan Steven Alexander. "Clinical Presentation of Hepatocellular Carcinoma in African Americans vs. Caucasians: A Retrospective Analysis." Pathophysiology 28, no. 3 (August 31, 2021): 387–99. http://dx.doi.org/10.3390/pathophysiology28030026.

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Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008–2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.

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Malamug, Lou Rose, Rudruidee Karnchanasorn, Raynald Samoa, and Ken C. Chiu. "The Role ofHelicobacter pyloriSeropositivity in Insulin Sensitivity, Beta Cell Function, and Abnormal Glucose Tolerance." Scientifica 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/870165.

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Infection, for example,Helicobacter pylori(H. pylori), has been thought to play a role in the pathogenesis of type 2 diabetes mellitus (T2DM). Our aim was to determine the role ofH. pyloriinfection in glucose metabolism in an American cohort. We examined data from 4,136 non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican Americans (MA) aged 18 and over from the NHANES 1999-2000 cohort. We calculated the odds ratios for states of glucose tolerance based on theH. pyloristatus. We calculated and compared homeostatic model assessment insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in subjects without diabetes based on theH. pyloristatus. The results were adjusted for age, body mass index (BMI), poverty index, education, alcohol consumption, tobacco use, and physical activity. TheH. pyloristatus was not a risk factor for abnormal glucose tolerance. After adjustment for age and BMI and also adjustment for all covariates, no difference was found in either HOMA-IR or HOMA-B in all ethnic and gender groups except for a marginally significant difference in HOMA-IR in NHB females.H. pyloriinfection was not a risk factor for abnormal glucose tolerance, nor plays a major role in insulin resistance or beta cell dysfunction.

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Yashkin, Arseniy, Igor Akushevich, and Anatoliy Yashin. "Determinants of Adherence to ADA Type II Diabetes Mellitus Guidelines: Implications for Longevity." Innovation in Aging 4, Supplement_1 (December 1, 2020): 225. http://dx.doi.org/10.1093/geroni/igaa057.725.

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Abstract The aim of this study was to identify the differences in terms of demographics, socioeconomic status and overall levels of morbidity-related health burden between population strata characterized by high levels of adherence to American Diabetes Association screening guidelines and their low-adherence counterparts. Factor analysis was used to create a single continuous measure of adherence which was stratified and analyzed using the Cox proportional hazards model to identify adherence levels associated with protective effects for mortality. Based on the results, the entire population of Health and Retirement Study respondents newly diagnosed with diabetes mellitus, type II was then stratified into four levels of adherence – excellent, sufficient, insufficient, poor – based on the strength of the protective effect associated with that level of the adherence factor and compared. Mortality in the group associated with excellent adherence was 41 to 57 percentage points lower than among their counterparts. High levels of adherence were associated with White and Hispanic race, low morbidity burden, high education and economic status, and low levels of functioning limitations. Based on race-specific survival function estimates we found that the life expectancy at age 65 of an individual newly diagnosed with type II diabetes mellitus could be improved from 14.97 to 19.64 years for whites, 13.36 to 19.58 years for African Americans and 14.92 to 21.28 for Hispanics if average adherence levels are increased to the highest levels observed in our study. Finally, we found that adherence levels were improving over the 1991-2015 period suggesting successful diabetes awareness efforts.

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Watt, Gordon P., Susan P. Fisher-Hoch, Mohammad H. Rahbar, Joseph B. McCormick, Miryoung Lee, Audrey C. Choh, Sadagopan Thanikachalam, and Mohan Thanikachalam. "Mexican American and South Asian population-based cohorts reveal high prevalence of type 2 diabetes and crucial differences in metabolic phenotypes." BMJ Open Diabetes Research & Care 6, no. 1 (March 2018): e000436. http://dx.doi.org/10.1136/bmjdrc-2017-000436.

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ObjectivePrevalence of type 2 diabetes varies by region and ancestry. However, most guidelines for the prevention of diabetes mellitus (DM) are based on European or non-Hispanic white populations. Two ethnic minority populations—Mexican Americans (MAs) in Texas, USA, and South Indians (SIs) in Tamil Nadu, India—have an increasing prevalence of DM. We aimed to understand the metabolic correlates of DM in these populations to improve risk stratification and DM prevention.Research design and methodsThe Cameron County Hispanic Cohort (CCHC; n=3023) served as the MA sample, and the Population Study of Urban, Rural, and Semi-Urban Regions for the Detection of Endovascular Disease (PURSE; n=8080) served as the SI sample. Using design-based methods, we calculated the prevalence of DM and metabolic comorbidities in each cohort. We determined the association of DM with metabolic phenotypes to evaluate the relative contributions of obesity and metabolic health to the prevalence of DM.ResultsIn the CCHC (overall DM prevalence 26.2%), good metabolic health was associated with lower prevalence of DM, across age groups, regardless of obesity. In PURSE (overall prevalence 27.6%), probability of DM was not strongly associated with metabolic phenotypes, although DM prevalence was high in older age groups irrespective of metabolic health.ConclusionOur study provides robust, population-based data to estimate the prevalence of DM and its associations with metabolic health. Our results demonstrate differences in metabolic phenotypes in DM, which should inform DM prevention guidelines in non-European populations.

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Brown, Alison G. M., Nancy Kressin, Norma Terrin, Amresh Hanchate, Jillian Suzukida, Sucharita Kher, Lori Lyn Price, et al. "The Influence of Health Insurance Stability on Racial/Ethnic Differences in Diabetes Control and Management." Ethnicity & Disease 31, no. 1 (January 21, 2021): 149–58. http://dx.doi.org/10.18865/ed.31.1.149.

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Objective: This study examined whether health insurance stability was associated with improved type 2 diabetes mellitus (DM) control and reduced racial/ethnic health disparities.Methods: We utilized electronic medical record data (2005-2013) from two large, urban academic health systems with a racially/ethnically diverse patient population to examine insurance coverage, and three DM outcomes (poor diabetes control, A1c ≥8.0%; very poor diabetes control A1c >9.0%; and poor BP control, ≥ 130/80 mm Hg) and one DM management outcome (A1c monitoring). We used generalized estimating equations adjusting for age, sex, comorbidities, site of care, education, and income. Additional analysis examined if insurance stability (stable public or private insurance over the six-month internal) moderates the impact of race/ethnicity on DM outcomes.Results: Nearly 50% of non-Hispanic (NH) Whites had private insurance coverage, compared with 33.5% of NH Blacks, 31.5% of Asians, and 31.1% of Hispanics. Overall, and within most racial/ ethnic groups, insurance stability was associated with better glycemic control compared with those with insurance switches or always being uninsured, with uninsured NH Blacks having significantly worse BP control. More NH Black and Hispanic patients had poorly controlled (A1c≥8%) and very poorly controlled (A1c>9%) diabetes across all insurance stability types than NH Whites or Asians. The interaction between insurance instability and race/ethnic groups was statistically significant for A1c monitoring and BP control, but not for glycemic control.Conclusion: Stable insurance coverage was associated with improved DM outcomes for all racial / ethnic groups, but did not eliminate racial ethnic disparitiesEthn Dis. 2021;31(1):149-158; doi:10.18865/ed.31.1.149

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Armstrong, David G., Lawrence A. Lavery, Robert P. Wunderlich, and Andrew J. M. Boulton. "Skin Temperatures as a One-time Screening Tool Do Not Predict Future Diabetic Foot Complications." Journal of the American Podiatric Medical Association 93, no. 6 (November 1, 2003): 443–47. http://dx.doi.org/10.7547/87507315-93-6-443.

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This prospective longitudinal study assessed whether baseline mean skin temperature measurements are useful in predicting the most common foot-related complications of diabetes mellitus. We evaluated the mean of baseline skin temperatures taken bilaterally from six plantar sites in 1,588 patients with diabetes. There was no difference in skin temperature based on neuropathy, foot laterality, or foot risk category or between people with and without foot deformity and elevated plantar foot pressure. Whereas people with Charcot’s arthropathy had slightly but significantly higher mean temperatures (84.8° ± 3.5° F versus 82.5° ± 4.7° F), this was not true for those who developed ulcers or infections or who underwent amputations. The presence of vascular disease was not associated with lower skin temperatures. Mexican Americans (83.0° ± 4.6° F) and blacks (83.6° ± 4.5° F) had higher mean skin temperatures at baseline than did non-Hispanic whites (81.8° ± 4.6° F). Baseline measurement of nonfocal mean skin temperatures is not an effective means of screening people for future events. Regular assessment of skin temperatures, using the contralateral site as a physiologic control, may be a better use of this technology. (J Am Podiatr Med Assoc 93(6): 443-447, 2003)

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Janania Martinez, Michelle, Tyler William Snedden, Juan Garza, Prathibha Surapaneni, Snegha Ananth, Jeremy Rawlings, Dave Gregorio, et al. "A closer look at Hispanics with follicular lymphoma in a majority-minority community." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e20047-e20047. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e20047.

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e20047 Background: Follicular Lymphoma (FL) is the most common type of indolent non-Hodgkin lymphoma. It is most commonly diagnosed in non-Hispanics (NH) and is well characterized in this population. Hispanics (HI) on the other hand have been historically underrepresented in clinical trials and observational studies. Some studies suggest that there are differences in age, clinical presentation, treatment patterns and outcomes in HI. The aim of our study was to determine demographics and clinical characteristics of FL patients and compare outcomes between HI and NH. To our knowledge, this is the largest cohort of FL patients from a single academic institution that serves predominantly HI. Methods: We retrospectively analyzed 123 patients with FL; all received care between 2008-2018. Key variables included age, gender, race/ ethnicity, comorbidities, insurance status, stage, treatment received, outcome at 3 and 5 years and vitality status in 2018. Continuously distributed outcomes were summarized with mean/standard deviation and categorical outcomes with frequencies/percentages. Significance of associations between categorical outcomes was assessed with Pearson’s Chi Square or Fisher’s Exact test. All statistical testing was two-sided with a significance level of 5%. Results: We identified 123 patients with diagnosis of FL, 71 HI (58%), 49 NH (40%), 3 unspecified (2%); 88% Caucasian, 5% African American, 4% Asian, 3% other; 56% females and 44% males. Median age at diagnosis was 56.31 (SD 11.97). Funding source was commercial insurance N = 55 (45%), Medicare N = 40(33%), hospital payment plan N = 20 (16%), unfunded N = 5 (4%) and Medicaid N = 3 (2%). Most prevalent co-morbidities were HTN 40% and diabetes mellitus 20%; 40% had no co-morbidities. At diagnosis ECOG of 0-1 was seen in 116 (94%); 21 were Stage I (17%), 19 Stage II (15%), 40 Stage III (33%), and 43 Stage IV (35%). FLIPI score was 0-1 in 43 patients (35%), 2 in 32 (26%), 3 in 23 (19%), not documented in 25 (20%). Median PFS was 1287.10 days (SD 879.18). At 3 year follow up there was: complete/ partial response in 76% HI vs 84% NH; disease progression in 18% vs 3%; death in 6% vs 3%, respectively (p-value = 0.739). At 5 year follow up: complete/partial response in 76% HI vs 86% NH; disease progression in 14% vs 10%; death 10% vs 3%, respectively (p-value = 0.62). At the end of 2018, 88% HI were alive compared to 95% NH, [p-value = 0.457]. Conclusions: Contrary to existing data, our study found that HI with FL have no difference in outcome when compared to NH. This could be explained by our prevalently HI population, but further studies are needed.

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Nemin, Chen, Christina Caruso, Alvaro Alonso, Vimal K. Derebail, Abhijit V. Kshirsagar, Richey Sharrett, Nigel S. Key, et al. "Association of Sickle Cell Trait with Measures of Cognitive Function and Dementia in African Americans." Blood 132, Supplement 1 (November 29, 2018): 1099. http://dx.doi.org/10.1182/blood-2018-99-109832.

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Abstract Background: The prevalence of cerebral small vessel disease (CSVD) and its associated complication of cognitive decline is significantly higher amongst African Americans than non-Hispanic Whites. Sickle cell anemia or sickle cell disease has been associated with a 30-45% increased prevalence of CSVD which presents as silent cerebral infarcts and impaired cognitive function. However, the association between sickle cell trait (heterozygosity for the sickle cell mutation) and cognitive decline or dementia has not been reported. Hypothesis: African Americans with SCT will have a significantly higher incidence and prevalence of cognitive impairment and dementia compared to those without SCT. Methods: We studied African Americans participants enrolled in the community-based prospective Atherosclerosis Risk in Communities (ARIC) study. SCT genotype status was determined using Taqman® genotyping from blood samples collected at baseline. Data from cognitive assessments at visits 2, 4 and 5, and an MRI performed at visit 5 were used for analysis. Using linear regression models for visit 2 cognitive measures and visit 5 brain MRI outcomes, a generalized estimating equation (GEE) for cognitive change, and Cox models for the incidence of dementia, we determined whether SCT was associated with a higher risk for cognitive dysfunction, global and regional brain volumes, and dementia. Results: Distribution of traditional risk factors for cognitive decline were not significantly different between participants with SCT (N = 176) and those without SCT (N = 2,532). In multivariable, cross-sectional analyses of 2,708 participants, those participants with SCT compared to those without SCT did not show a statistically significant difference in the global or domain-specific cognitive function scores at baseline. Participants with SCT did not experience a faster 20-year cognitive decline compared to participants without SCT. Also, participants with SCT had larger parietal cortical volume (100.5 cm3 vs. 97.9 cm3, diff. = 2.67 (0.24, 5.11) cm3, p = 0.03), and lower incidence of dementia (HR = 0.63 95% CI = 0.38, 1.05) compared to those without SCT. Participants with a co-inheritance of the apolipoprotein E (APOE) ε4 risk allele and SCT (N = 63) had worse scores on the digit symbol substitution test (DSST) at baseline (z-score = -0.08 (-0.26, 0.09), Pinteraction = 0.05) and over time (z-score = -0.12 (-0.38, 0.14), Pinteraction = 0.04), compared to those with the APOE ε4 risk allele who do not have SCT (N = 113). SCT was associated with 2-fold increased risk of dementia among participants with diabetes mellitus and a 55% reduction in risk of dementia among those without diabetes mellitus (Pinteraction = 0.01). Conclusions: SCT was not an independent risk factor for prevalent or incident cognitive decline, but it could potentially interact with and modify other risk factors for dementia and cognitive dysfunction. Disclosures Key: UniQure BV: Research Funding.

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Ridberg, Ronit, Morgan Smith, Ronli Levi, Elaine Waxman, and Hilary Seligman. "Efficacy of Augmented Food Pantry Services in Addressing Food Insecurity." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 271. http://dx.doi.org/10.1093/cdn/nzaa043_122.

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Abstract Objectives Almost 1 in 9 Americans obtain food from a food bank or food pantry every year to help make ends meet. Despite this scope and scale, the efficacy of the charitable food system at alleviating food insecurity is still unclear. This study aimed to determine whether food distributed at food pantries as part of a comprehensive diabetes self-management support program, changed food security status for adults with diabetes. Methods This is a secondary, prespecified analysis of a larger randomized, controlled study (the FAITH-DM trial) conducted in 27 food pantries in Detroit MI; Houston, TX; and Oakland, CA (2015–2018). We screened 5329 adults for diabetes, and individually randomized 568 participants with hemoglobin A1c (HbA1c) 7.5% or greater to an immediate 6-month intervention (including bimonthly food, diabetes education, health care referral and glucose monitoring) or to receive the intervention after a 6-month delay (cross-over design). For this analysis, primary outcome was food insecurity, measured at baseline, 6 months and 12 months, using the 10-item USDA food security modules scaled as a continuous Rasch score and then compared using difference-in-differences analyses. Results Participants were racially/ethnically diverse (51% Latino/Hispanic, 33% African American), with a mean age of 55 (range 23–86) and predominantly female (69%). In both trial phases, food security scores improved for individuals receiving the intervention and worsened for those not receiving the intervention. On a 12-point Rasch scale, differences between groups ranged from 0.627 points in Phase 1 (95% CI: –1.16, –0.099, P = .02) to 0.879 in Phase 2 (95% CI: –1.46, –0.303, P = 0.003). Conclusions Preliminary results of this cross-over design suggest a causal relationship between healthy food interventions at food banks and improving food security for adults with diabetes. Funding Sources Funding for the Feeding America Intervention Trial for Health—Diabetes Mellitus (FAITH-DM) was provided by Feeding America, the Laura and John Arnold Foundation, the Urban Institute via a Robert Wood Johnson Foundation grant, National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award P30DK092924, and Centers for Disease Control and Prevention under award 3U48DP004998–01S1. Support for RAR by HRSA QSCERT-PC Program (grant no. T32HP30037).

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Shah, Silvi, Anthony C. Leonard, Kathleen Harrison, Karthikeyan Meganathan, Annette L. Christianson, and Charuhas V. Thakar. "Mortality and Recovery Associated with Kidney Failure due to Acute Kidney Injury." Clinical Journal of the American Society of Nephrology 15, no. 7 (June 17, 2020): 995–1006. http://dx.doi.org/10.2215/cjn.11200919.

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Background and objectivesAKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.Design, setting, participants, & measurementsUsing the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.ResultsMean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0–3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3–6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.ConclusionsKidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

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Mani, Vishnu R., Aleksandr Kalabin, Sebastian C. Valdivieso, Max Murray-Ramcharan, and Brian Donaldson. "New York Inner City Hospital COVID-19 Experience and Current Data: Retrospective Analysis at the Epicenter of the American Coronavirus Outbreak." Journal of Medical Internet Research 22, no. 9 (September 18, 2020): e20548. http://dx.doi.org/10.2196/20548.

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Background In the midst of the coronavirus disease pandemic, emerging clinical data across the world has equipped frontline health care workers, policy makers, and researchers to better understand and combat the illness. Objective The aim of this study is to report the correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and the mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We did a review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and nonintubated, and subgrouped to alive and deceased. A comprehensive analysis using the following parameters were performed: age, sex, ethnicity, BMI, comorbidities, inflammatory markers, laboratory values, cardiac and renal function, electrocardiogram (EKG), chest x-ray findings, temperature, treatment groups, and hospital-acquired patients with SARS-CoV-2. Results A total of 184 patients were included in our study with ages ranging from 28-97 years (mean 64.72 years) and including 73 females (39.67%) and 111 males (60.33%) with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), and 1 Caucasian (0.54%), with a mean of 1.70 comorbidities. Overall, the mortality rate was 17.39% (n=32), 16.30% (n=30) of our patients required mechanical ventilation, and 11.41% (n=21) had hospital-acquired SARS-CoV-2 infection. Pertinent and statistically significant results were found in the intubated versus nonintubated patients with confirmed SARS-CoV-2 for the following parameters: age (P=.01), BMI (P=.07), African American ethnicity (P<.001), Hispanic ethnicity (P=.02), diabetes mellitus (P=.001), creatinine (P=.29), blood urea nitrogen (BUN; P=.001), procalcitonin (P=.03), C-reactive protein (CRP; P=.007), lactate dehydrogenase (LDH; P=.001), glucose (P=.01), temperature (P=.004), bilateral pulmonary infiltrates in chest x-rays (P<.001), and bilateral patchy opacity (P=.02). The results between the living and deceased subgroups of patients with confirmed SARS-CoV-2 (linking to or against mortality) were BMI (P=.04), length of stay (P<.001), hypertension (P=.02), multiple comorbidity (P=.045), BUN (P=.04), and EKG findings with arrhythmias or blocks (P=.02). Conclusions We arrived at the following conclusions based on a comprehensive review of our study group, data collection, and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature, EKG findings with sinus tachycardia, and bilateral diffuse pulmonary infiltrates on the chest x-rays. Those intubated exhibited increased disease severity with significantly elevated levels of serum procalcitonin, CRP, LDH, mean glucose, creatinine, and BUN. Mortality was strongly correlated with BMI, African American ethnicity, hypertension, presence of multiple comorbidities (with a mean of 2.32), worsening renal function with acute kidney injury or acute chronic kidney injury, and EKG findings of arrhythmias and heart blocks.

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Janania Martinez, Michelle, Juan F. Garza, Tyler W. Snedden, Prathibha Surapaneni, Snegha Ananth, Jeremy Rawlings, David J. Gregorio, et al. "Impact of Co-Morbidities on Outcome in a Predominantly Hispanic Population of Hodgkin and Non-Hodgkin Lymphoma Patients." Blood 134, Supplement_1 (November 13, 2019): 2204. http://dx.doi.org/10.1182/blood-2019-129442.

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BACKGROUND Evidence suggests that co-morbidities at diagnosis can influence treatment decisions and outcomes in lymphoma patients. Considering the bimodal presentation of Hodgkin Lymphoma (HL) and that the majority of Non-Hodgkin lymphoma (NHL) patients are over 65 years of age, it can be especially challenging to manage them as older patients have a higher number of co-morbidities. Studies have shown that comorbidity is associated with an inferior outcome and a lower likelihood of receiving treatment with curative intent. It must also be noted that older adults with significant co-morbidities are often excluded from clinical trials due to co-morbidities and that Hispanics (HI) have been historically underrepresented. There is a need to take a closer look at this precise patient population. The main objective of our study was to determine the common co-morbidities and their impact on outcome in a prevalently Hispanic population with both HL and NHL at the only NCI designated Cancer Center of South Texas. To our knowledge this is the largest cohort of HL patients from a single academic institution that serves primarily Hispanics. METHODS We located and retrospectively analyzed a total of 616 patients with diagnosis of Lymphoma (HL and NHL) by International Classification of Diseases (ICD) codes and identified 477 patients who met criteria for inclusion; the patients all received care at UT Health San Antonio, between 2008-2018. Key variables for each patient included age, gender, race/ ethnicity, comorbidities, and vitality status in 2018. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. The significance of variation in the mean with disease category was assessed with one way ANOVA and the significance of associations between categorical outcomes was assessed with Pearson's Chi Square or Fisher's Exact test as appropriate. Multivariate logistic regression was used to model binary outcomes in terms of covariates and indicators of disease. All statistical testing was two-sided with a significance level of 5%. R1 was used throughout. The study was approved by the local Institutional Review Board. The findings will be available to patients, funders and medical community through traditional publishing and social media. RESULTS We identified 477 patients with HL and NHL, 262 were Hispanic (HI) [55%], 205 non-Hispanic (NH) [43%], 10 not specified [2%]; there were 232 females (49%) and 245 males (51%). Co-morbidities that were identified and analyzed were: Diabetes Mellitus (DM), Hypertension (HTN), Chronic Kidney Disease (CKD), Coronary Artery Disease (CAD) and Congestive Heart Failure (CHF). The most common co-morbidity across all lymphoma subtypes was HTN. More than or equal to 50% of patients with Burkitt's, CTCL, Hodgkin's, Plasmablastic lymphoma, T cell lymphoma had no co-morbidities. In order to determine outcome, we took into consideration vitality status at the end of 2018. When comparing HI vs NH and adjusting for individual co-morbidities (HTN, DM, CAD, CHF, CKD) there is a trend towards a higher risk of poor outcome in NH patients when compared to HI (OR 1.17, CI 0.51-2.69, p-value= 0.7176). When we looked at patients who had both CAD and CHF and adjusted for other co-morbidities the trend remained with a higher risk for poor outcome in NH (OR 1.29, CI 0.57-2.91, p-value=0.53456). Looking at patients with a combination of CAD, CHF, CKD and DM (adjusting for other individual co-morbidities) there was also a trend towards poor outcome in NH (OR 1.26, CI 0.57-2.78, p-value= 0.569316). Overall, patients with CKD had an increased risk of poor outcome (OR 15.13, CI 1.5-153.13, p-value=0.0214) as well as patients with four co-morbidities including CAD, CHF, CKD and DM2 (OR 4.89, CI 1.68-14.23, p-value=0.003597). The absence of co-morbidities shows a trend towards a better outcome (OR 0.77, CI 0.19-3.17, p-value=0.721). CONCLUSION Within the limitations of sample size, our study demonstrates that in the prevalently Hispanic population of our institution, the presence of both CKD on its own as well as CKD with multiple co-morbidities (CKD, CAD, CHF, DM2) increases the risk of poor outcome. There is a trend towards a higher risk of poor outcome in the NH population with co-morbidities when compared to HI but further studies are needed. Disclosures No relevant conflicts of interest to declare.

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Segal, Jodi B., and Alison R. Molterno. "Platelet Counts Vary by Ethnicity, Sex, and Age: Analysis of NHANES III Data." Blood 104, no. 11 (November 16, 2004): 3937. http://dx.doi.org/10.1182/blood.v104.11.3937.3937.

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Abstract Background: The possibility of variation in platelet count by age and genetic background has not been examined. Identification of subpopulations with elevated platelet counts, within what is traditionally considered a normal range, may identify a group with excessive morbidity or mortality. Furthermore, platelet count differences may suggest populations in which genetic polymorphisms in regulatory proteins such as the thrombopoietin receptor influence platelet production. We hypothesized that there were differences in platelet count by ethnicity, sex and age not explained by environmental factors. Objective: To demonstrate differences in mean platelet counts by ethnicity, sex, and age while controlling for variables known to influence platelet count. Methods and Design: We used data from the National Health, Nutrition and Examination Survey III (NHANES III), which is a multistage probability sample of the United States population with data collected between 1988 and 1994. Using appropriate weighting for the complex sampling design, the geometric mean platelet count was calculated for the total population and the population stratified by ethnicity, sex, and age, while controlling for C-reactive protein, white blood cell count, iron-deficiency, serum folate, markers of alcohol intake, presence of hepatitis B or C antibodies, and diabetes mellitus. Other potential influences, such as medications, were found not to affect the predicted counts and not included in the models. Results: The lowest mean platelet counts were among whites (259 K/ml [95% C.I. 255–264 K/ml]) and the highest were in non-Hispanic blacks (275 K/ml [95% C.I. 270–280 K/ml]) with Mexican-Americans having intermediate values (266 K/ml [95% C.I. 261–272 K/ml]), when controlled for age and sex. Older men and women of each ethnicity consistently had lower mean platelet counts, with 60–69 years olds having mean counts approximately 7 K/ml lower than young adults (p=0.015) and 70–90 year olds having mean counts 19 K/ml lower than young adults (p<0.001). Even with controlling for iron deficiency, women had significantly higher platelet counts than men (273 K/ml [95% C.I. 269 – 278]) versus 251 K/ml [95% C.I. 245 – 256]) Conclusion: Mean platelet counts differ by ethnicity, sex, and age and these differences are not explained by covariates known to influence platelet count. This suggests that genetic influences on the platelet count are operative. These data also suggest that there may be a hormonal regulation of platelet count. The decline with age may reflect decreased stem cell function with age; alternatively, there may be a survival advantage to having a lower platelet count. Longitudinal studies of platelet count with aging are indicated.

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Alvarez, Ofelia, and Brenda Montane. "Is Screening for Microalbuminuria Warranted in Children with Sickle Cell Hemoglobinopathies?." Blood 104, no. 11 (November 16, 2004): 1674. http://dx.doi.org/10.1182/blood.v104.11.1674.1674.

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Abstract Renal impairment occurs in adults and children with sickle cell disease. Microalbuminuria (MA) defined as albumin excretion >2.9 mg/dl in random urine sample or 30–300 mg in 24 hour urine collection is an early, sensitive indicator for glomerulopathy in both diabetes mellitus and sickle cell disease. Therefore, we conducted a universal screening in our patients (pts) with sickle cell hemoglobinopathies in order to identify the prevalence of MA and other indicators of early renal impairment. Children and young adults with hemoglobin SS, SC, Sβ+thalassemia and Sβ0thalassemia, ages 4–21 years (yrs), had urinalyses and random urine measurements for protein, microalbumin, and creatinine. All were in good state of health, free of pain, and without prior diagnosis of renal dysfunction when the samples were obtained. Serum electrolytes, creatinine, osmolality, and 24-hour urine collection for protein, microalbumin, β2-microglobulin, creatinine, and electrolytes were done in pts with abnormal urine samples. There were 101screened pts (53 males; 76 SS, 20 SC, 3Sβ0, and 2 Sβ +). Nineteen pts had MA detected by random urine. MA was confirmed in 24-hour samples in 46% of studied pts. In addition to MA, tubular proteinuria (increased β2-microglobulin) was detected in 1 pt, isolated hematuria in 3 and increased urine protein/creatinine (>0.2) in 4. From the MA+ pts, 15 had SS (19.7% of SS group) and 4 had SC (20% SC group). 25% of children 10 yrs of age or older had MA (mean± standard deviation MA 2.83±3.94), as compared to 6% of younger children (mean 1.21±0.80), (p=0.02). African Americans had lower incidence of MA (11.4%), compared to other children of Haitian (21.3%), Hispanic Caribbean (25%), and other Caribbean (28.5%) descent (p=not significant [NS]). There was no correlation between MA and history of stroke, acute chest syndrome/asthma, brief use of non-steroidal anti-inflammatory medications, hemoglobin or white cell values. From the subgroup of 16 pts on hydroxyurea, 11 were 10 yrs of age or older; of these, 5 (45.5%) had MA, compared to 21% of the same age non-treated group (p=NS). We analyzed the effect of age at onset of chronic transfusions and presence of MA. Six transfused pts had MA (age at start of transfusion 8.6–13.5 yrs, mean 11 yrs; mean MA 5.3±3.4), while there were 15 MA free pts (age 0.8–12.4 yrs, mean 7 yrs; mean MA 1.4±0.6), suggesting that early age at start of chronic transfusions may be protective for MA (p=0.0004). We conclude that: (1) urine screening of children with sickle cell hemoglobinopathies 10 yrs or older is recommended, (2) chronic transfusions starting at an early age may protect against MA, and (3) validity of random versus 24-hour urine collections in determining MA should be further investigated. Studies to further define the risk factors, prognosis, and intervention in children with sickle cell hemoglobinopathies are warranted.

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Salehi, Maryam, Daniel O. Stram, Jose A. Aparicio, Liliana Aguinada, Victoria K. Cortessis, Maximo J. Marin, Loic Le Marchand, et al. "Characteristics of and Risk Factors for Monoclonal Gammopathy of Undetermined Significance (MGUS) in the Multiethnic Cohort Study." Blood 136, Supplement 1 (November 5, 2020): 28–29. http://dx.doi.org/10.1182/blood-2020-143067.

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Background: There is a 2-3-fold excess of both monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) among African Americans (AAs) compared to non-Hispanic whites (NHWs) for unknown reasons. It is unclear if risk of progression from MGUS to MM is similar across racial/ethnic groups. We identified MGUS patients and controls from the Multiethnic Cohort (MEC), a population-based cohort study in Los Angeles and Hawaii, described characteristics of and examined risk factors for MGUS among different racial/ethnic groups. Methods: A total of 637 MEC participants with a diagnosis of MGUS by CMS billing codes and 1,065 race/ethnicity-matched MM-free and presumed MGUS-free controls were identified. Screening for monoclonal proteinemia was performed at the USC Clinical Laboratories using serum protein electrophoresis (SPEP) with reflex to immunofixation (IFX) when SPEP was abnormal. For this study, MGUS was defined as IFX positive with M-protein concentration< 3g/dL. Controls were SPEP- and IFX-negative with no history of MGUS or MM. MGUS cases who progressed to MM during a mean 8.11-year follow-up were identified by linkage with the SEER databases of the Hawaii Tumor Registry and the California Cancer Registry. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the effect of body mass index kg/m2 (BMI), diabetes or aspirin use prior to diagnosis on the risk of MGUS and progression to MM. Results: A total of 452 participants had laboratory validated MGUS. The racial/ethnic distribution was 109 AAs, 107 NHWs, 95 Latinos, 105 Japanese and 36 Hawaiian's. 58.6% were males. From the pool of laboratory-validated controls, an equal number of controls were frequency matched to cases by race/ethnicity, age and sex. Mean age at blood draw was 65 years for Hawaiians, 69 years for NHWs and Latinos, and 70 years for AAs and Japanese. The distribution of immunoglobulin (Ig) isotypes differed significantly by race/ethnicity(p=0.001) (Figure 1), with AAs having the highest proportion of IgG Kappa (48.1%) and the lowest proportion of IgM (2.8%) compared to other racial/ethnic groups (range IgG Kappa 31.8%-40%, range IgM 11.1%-28.0%). There was no difference in isotype distribution by sex (p=0.28). AAs and NHWs had the highest (mean=0.75 mg/dL ±0.6) and lowest (mean=0.53 mg/dL ±0.6) levels of M-protein, respectively, but there was no significant difference when all racial/ethnic groups were compared. Each unit of BMI (kg/m2) was associated with a 16% increase in risk of MGUS among Hawaiians (95% CI= 1.04,1.30); and a borderline increased risk ranging from 2%-7% among the other racial/ethnic groups. Neither history of aspirin use nor diabetes mellitus were significantly associated with MGUS risk. A total of 109/452 MGUS patients progressed to MM between 1 to 10 years after blood draw. Compared to NHWs, AAs (OR=2.09; 95%CI= 1.08-4.05) and Latinos (OR= 2.55, 95% CI=1.29-5.08) were more likely to progress. Progression was not significantly associated with sex (p=0.34) or BMI (p=0.12). Progressors were slightly younger than non-progressors (-1.6 years, p=0.057). A higher risk of progression was associated with IgA compared to IgG Kappa (OR=2.45; 95% CI=1.34-4.48) and an M-spike >1.5 g/dL compared to <1.5g/dL (OR=5.81, 95% CI=2.92-11.57). IgM was associated with a lower risk of progression (OR=0.03, 95% CI= 0.00-0.23). Conclusion: The distribution of MGUS isotypes and risk of progression to MM differed by race/ethnicity, with AA and Latinos more likely to progress, not explained by age at blood draw. Because we detected prevalent MGUS, lead time bias could explain racial/ethnic differences in risk. More studies with diverse populations and large sample sizes are needed to better understand the disparities in MGUS risk and progression, along with the underlying biological explanations. Disclosures No relevant conflicts of interest to declare.

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Guisado, Raul, Linda Catalli, and Karen de la Cuesta. "Abstract 3476: Factors Affecting The Incidence of Spontaneous Intracerebral Hemorrhage in a Multiracial Community in Northern California." Stroke 43, suppl_1 (February 2012). http://dx.doi.org/10.1161/str.43.suppl_1.a3476.

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INTRODUCTION: Santa Clara County, California is a multi-racial community with a large Asian and Hispanic representation (30.6% Asian, 31.8% White and 31.9% Hispanics). The annual incidence of non-traumatic intracerebral hemorrhage (ICH) in our population is higher than the national average (29.2% vs. 13%) and the proportion of Asian patients with ICH is higher than expected (46.5% vs. 30.6% ). The reasons for the higher incidence of ICH in Asian populations are not known. We conducted a retrospective review of all cases of ICH in two Primary Stroke Centers in Santa Clara County, California to test the hypothesis that certain co-morbidities may explain the higher incidence of ICH in our community. METHODS: All cases of ICH admitted to two PSCs were abstracted from the Get With The Guidelines database. Data abstracted included racial and ethnic distribution (White, African American, Asian, Pacific Islander, Native American and Hispanic), age, sex, and selected co-morbidities (diabetes mellitus, hypertension and warfarin use. FINDINGS: There were a total of 260 patients. The total number of Pacific Islanders (4), Native Americans (1) and African Americans (13) was too small for further analysis and was not included. The age and sex distribution was similar between White, Asian and Hispanic patients but White women were significantly older (p = 0.018) than males. The rate of warfarin use was similar in all three groups. There was a higher incidence of hypertension and diabetes mellitus in Asian and Hispanics compared to White subjects ( Table ). Asian and Hispanic patients with hypertension and/or diabetes mellitus were at higher risk for ICH compared to White ( Table ). CONCLUSION: In our population, the incidence of ICH is disproportionately high in Asian subjects compared to Whites and Hispanics. This increase is only partially explained by higher incidence of hypertension and diabetes mellitus in Asians. Other factors, not included in the available databases, may include the geographic origin of Asian and Hispanic subjects (East vs. South Asian, North, Central or South American) and a generational effect on co-morbidities. Future epidemiological studies should include geographic and generational, as well as racial and ethnic data.

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Choi, Sarah, Michael Liu, Latha Palaniappan, Elsie Wang, and Nathan Wong. "Abstract P440: Ethnic and Gender-specific Prevalence of Type 2 Diabetes Mellitus among Adults in the California Health Interview Survey 2009." Circulation 127, suppl_12 (March 26, 2013). http://dx.doi.org/10.1161/circ.127.suppl_12.ap440.

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Background: The ethnic and gender-specific prevalence of type 2 diabetes mellitus (DM) have not been adequately documented in past studies; in addition, Asians and Hispanics have been often treated as aggregates, making it difficult to examine subgroup differences. Methods: Using the California Health Interview Survey (CHIS) 2009 data, we identified the prevalence of DM and associated risk factors, stratified by gender, for the following ethnicities: Chinese, Filipino, South Asian, Japanese, Korean, Vietnamese, Cambodian, Mexican, Hispanic (Other), African American, and Caucasian (n=45,857, projected = 26.6 mil). Results: Among men, the age-adjusted prevalence of DM was highest in Filipinos (15.8%), Japanese (11.8%), and Mexicans (10.2%). Among women, African Americans (13.3%) and Other Hispanic (10.7%) had the highest DM prevalence. Significant gender difference was observed in Caucasians and Mexicans, where men had a higher DM prevalence than women. In multiple logistic regression adjusting for age and other clinical and lifestyle risk factors, among women, compared to Caucasians, an increased likelihood of DM was seen in Koreans (OR=4.72, p <0.01), Cambodian (OR=3.84, p <0.05), and Other Hispanic (OR=2.90, p <0.01) Among men, compared to Caucasians, DM was more likely in Filipinos (OR=6.99, p <0.01), South Asians (OR=4.69, p <0.01), and Mexicans (OR=2.82, p <0.01). Conclusion: Ethnic and gender differences in DM prevalence persist, even after adjusting for lifestyle and other risk factors. Racial/ethnic minority groups, particularly certain Asian subgroups, have the highest DM prevalence in California, despite risk factor adjustment. Different ethnic and gender- specific diabetes prevention approaches may be required.

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Roumeliotis, Anastasios, Bimmer E. Claessen, Samantha Sartori, Davide Cao, Won-Joon Koh, Johny Nicolas, Hanbo Qiu, et al. "Abstract 16599: Impact of Race and Ethnicity on Long Term Outcomes Post Percutaneous Coronary Intervention With Drug Eluting Stents." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.16599.

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Introduction: Cardiovascular disease is the leading cause of mortality worldwide, irrespective of race/ethnicity. Previous studies reported that minority patients with ACS have distinct clinical, genetic and socioeconomic backgrounds that may affect clinical outcomes. Hypothesis: To investigate post percutaneous coronary intervention (PCI) outcomes according to race/ethnicity in a contemporary ACS population. Methods: We included consecutive patients undergoing drug-eluting stent implantation for STEMI, non-STEMI or unstable angina (UA) between 2012-2017. The study population was stratified into Caucasian, African American, Hispanic and Asian. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, spontaneous myocardial infarction or stroke at 1 year. Results: Of the 6800 patients included, 3377 (49.7%) were Caucasian, 1408 (20.7%) Hispanic, 1156 (17.0%) Asian and 859 (12.6%) African American. Caucasians were the oldest, Hispanics and Asians had the highest prevalence of diabetes mellitus (DM) and African Americans had more insulin dependent DM and chronic kidney disease. Hispanics and African Americans had the highest STEMI rate, while Asians were more likely to present with UA, have private insurance and be discharged on aspirin and clopidogrel. Compared to Caucasians, Asians had a lower rate of MACCE at 1 year (3.9% vs. 7.1%; p<0.01) whereas Hispanics (6.2% vs. 7.1%; p-value=0.17) and African Americans (8.0% vs. 7.1%; p-value=0.38) had comparable outcomes. Differences were driven by fewer deaths in the Hispanic (2.1% vs. 4.2%; p<0.01) and Asian (1.7% vs. 4.2%; p<0.01) subgroups. Findings remained unchanged after adjusting for potential confounders [Figure]. Conclusions: Among patients undergoing PCI for ACS, Asian race is associated with favorable cardiovascular outcomes compared to Caucasian. No significant differences were observed for Hispanics and African Americans.

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Caraballo, César, Javier Valero-Elizondo, Rohan Khera, Shiwani Mahajan, Gowtham R. Grandhi, Salim S. Virani, Reed Mszar, Harlan M. Krumholz, and Khurram Nasir. "Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States." Circulation: Cardiovascular Quality and Outcomes 13, no. 2 (February 2020). http://dx.doi.org/10.1161/circoutcomes.119.006139.

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Background: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. Methods and Results: We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18–1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05–1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16–1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30–1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20–1.40]). Conclusions: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.

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Shu, Le, Kei Hang Katie Chan, Simin Liu, and Xia Yang. "Abstract 18931: Integrative Genomics Analyses Identifies Shared Regulatory Networks for Cardiovascular Disease and Type 2 Diabetes Mellitus in American Women of Caucasian, African and Hispanic Ethnicities." Circulation 132, suppl_3 (November 10, 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.18931.

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Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D) have many shared risk factors, suggesting that they have common pathophysiological mechanisms. Our recent analysis of genome wide association studies (GWAS) of both CVD and T2D in three ethnic populations revealed a number of biological pathways, such as extracellular matrix and focal adhesion, to be genetically associated with both diseases. Building on our prior work employing knowledge-driven pathways, we performed data-driven integrative genomics analyses using gene co-expression networks constructed from a multitude of tissue-specific transcriptome datasets in conjunction with GWAS for CVD, T2D, and a vascular disease phenotype (VD, representing combined CVD+T2D) in three different ethnic groups of 8155 African Americans, 3494 Hispanic Americans and 3697 Caucasian Americans participated in the national Women’s Health Initiative (WHI) study. We examined a total of 2674 coexpression networks and found that 24 modules were significantly enriched for GWAS signatures for all three disease end points (15 modules) or VD only (9 modules) across multiple cohorts at false discovery rate <5%. These modules were enriched for the previously identified pathways like focal adhesion. Further, top modules for all three diseases were enriched for genes involved in citrate cycle and G-protein coupled receptor signaling, whereas top modules for VD were related to amino acid metabolism and BMP signaling, indicating novel processes that are shared between CVD and T2D. To pinpoint key driver (KD) for these modules, we integrated Bayesian networks of adipose, brain, kidney, liver and muscle tissue, and identified highly significant KDs such as BCL6B in adipose, MALAT1 in brain, ZNF565 in kidney, GLS2 in liver and MYL2 in muscle. Among the top KDs, MALAT1, GLS2 and MYL2 have been previously implicated in CVD and T2D, whereas the others represented novel findings. In summary, by leveraging multi-ethnic GWAS data on CVD and T2D and data-driven transcriptional networks, we uncovered both known and novel regulatory mechanisms that appeared to be shared by the two vascular diseases. These network regulators revealed may serve as important targets for future experimental validation.

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Kizzee, Olivia P., and Joan C. Lo. "Abstract 14363: Clustering of Multiple Cardiometabolic Risk Factors by Race/Ethnicity and Age." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.14363.

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Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among Americans. The burden of cardiometabolic risk factor clustering in ethnic subgroups is not well described for US Asians compared to other race/ethnicities. Methods: This cross-sectional study was conducted using electronic health data for White (N=634,200), Black (N=85,156), Hispanic (N=188,071), Filipino (N=78,000) and Chinese (N=72,545) Kaiser Permanente Northern California health plan members in 2016 who were aged 40-84y and had weight status assessed. We examined the proportions of men and women in each racial/ethnic group with clustered cardiometabolic risks (CCR), defined as having diabetes, hypertension, and obesity. Diabetes mellitus (DM) was based on a clinical DM diagnosis, lab criteria, or receipt of DM pharmacotherapy. Hypertension was defined by clinical diagnosis. Obesity was characterized by WHO standard (BMI ≥30 kg/m 2 ) and Asian-specific (BMI ≥27.5 kg/m 2 ) thresholds. Results: CCR prevalence varied by race/ethnicity, age, and the BMI criteria used for obesity (standard or Asian threshold). Use of the Asian threshold resulted in Filipinos having CCR prevalence that approached Blacks and Hispanics across all age groups (Figure). The Asian criterion nearly doubled the proportion of at-risk Filipinos, particularly older adults aged 65-84y. Filipinos had more than 2x higher CCR prevalence compared to Chinese. Among all ethnic groups except for Blacks, men were more likely than women to have CCR. Conclusion: Using an Asian-specific BMI obesity threshold, Filipino-Americans have a higher prevalence of cardiometabolic risk factor clustering than Chinese-Americans, resembling that of Blacks and Hispanics. Identifying Asian ethnicity in electronic health records could help facilitate earlier metabolic assessment and management to further reduce CVD burden, which may be especially important for men.

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Gill, Clarence, Miryoung Lee, Kristina P. Vatcheva, Nahid Rianon, Beverly Smulevitz, David D. McPherson, Joseph B. McCormick, Susan P. Fisher‐Hoch, and Susan T. Laing. "Association of Visceral Adipose Tissue and Subclinical Atherosclerosis in US‐Born Mexican Americans but not First Generation Immigrants." Journal of the American Heart Association 9, no. 20 (October 20, 2020). http://dx.doi.org/10.1161/jaha.120.017373.

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Background Excess visceral adipose tissue (VAT) is a primary driver for the cardiometabolic complications of obesity; VAT‐associated cardiovascular disease risk varies by race, but most studies have been done on Non‐Hispanics. This study aimed to evaluate the clinical and metabolic correlates of VAT, its association with subclinical atherosclerosis, and the factors affecting this association in Mexican Americans. Methods and Results Participants (n=527) were drawn from the Cameron County Hispanic Cohort (CCHC), on whom a carotid ultrasound to assess carotid intima media thickness and a dual‐energy X‐ray absorptiometry scan to assess for VAT were obtained. Those in the highest quartiles of VAT were more likely to have hypertension, hypertriglyceridemia, low high‐density lipoprotein, diabetes mellitus, and metabolic syndrome. Increased carotid intima media thickness was more prevalent in those in the highest quartile for VAT (57.4% versus 15.4% for the lowest quartile; P <0.001). There was a graded increase in mean carotid intima media thickness with increasing VAT, after adjusting for covariates; for every 10 cm 2 increase in VAT, there was an increase of 0.004 mm (SE=0.002; P =0.0299) in mean carotid intima media thickness. However, this association was only seen among second or higher generation US‐born Mexican Americans but not among first generation immigrants ( P =0.024). Conclusions Excess VAT is associated with indicators of metabolic disorders and subclinical atherosclerosis in Mexican Americans regardless of body mass index. However, acculturation appears to be an important modulator of this association. Longitudinal follow‐up with targeted interventions among second or higher generation Hispanics to lower VAT and improve cardiometabolic risk may help prevent premature cardiovascular disease in this cohort.

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Nadeau, Hugh C. G., Marta E. Maxted, Devika Madhavan, Stephanie L. Pierce, Maisa Feghali, and Christina Scifres. "Insulin Dosing, Glycemic Control, and Perinatal Outcomes in Pregnancies Complicated by Type-2 Diabetes." American Journal of Perinatology, October 16, 2020. http://dx.doi.org/10.1055/s-0040-1718579.

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Objective This study aimed to evaluate the prevalence of severe insulin resistance (insulin requirements ≥2 units/kg) at delivery and the relationship between severe insulin resistance, glycemic control, and adverse perinatal outcomes in pregnant women with type-2 diabetes mellitus. Study Design This is a retrospective cohort study of women with type-2 diabetes mellitus who delivered between January 2015 and December 2017 at a tertiary academic medical center. Maternal demographic information, self-monitored blood sugars, and insulin doses were abstracted from the medical record. Multivariable logistic regression was used to identify maternal baseline characteristics associated with severe insulin resistance at delivery. Results Overall 72/160 (45%) of women had severe insulin resistance. Women in the severe insulin resistance group demonstrated evidence of suboptimal glycemic control as evidenced by higher mean hemoglobin A1c (HbA1c) values (7.2 [ ± 1.1] vs. 6.6 [ ± 1.3%], p = 0.003), higher mean fasting (104.0 [ ± 17.4] vs. 95.2 [ ± 11.7 mg/dL], p < 0.001) and postprandial glucose values (132.4 [ ± 17.2] vs. 121.9 [ ± 16.9 mg/dL]), p < 0.001), and a higher percentage of total glucose values that were elevated above targets (37.7 [95% confidence interval (CI): 26.8–50] vs. 25.6 [95% CI: 13.3–41.3%], p < 0.001). Maternal HbA1c ≥6.5% and insulin use prior to pregnancy were associated with a higher prevalence of severe insulin resistance, while Hispanic ethnicity and non-White race were associated with a lower prevalence of severe insulin resistance. The rates of adverse perinatal outcomes including large for gestational age (LGA) birth weight, cesarean delivery, and hypertensive disorders of pregnancy did not differ between groups. Conclusion Severe insulin resistance is common among pregnant women with type-2 diabetes, and it is associated with suboptimal glycemic control. Future studies are necessary to develop strategies to identify women with severe insulin resistance early in pregnancy and facilitate adequate insulin dosing. Key Points

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Harris, Neil S., Kaitlin D. Weaver, Stacy G. Beal, and William E. Winter. "The Interaction between Hb A1C and Selected Genetic Factors in the African American Population in the USA." Journal of Applied Laboratory Medicine, December 25, 2020. http://dx.doi.org/10.1093/jalm/jfaa202.

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Abstract Background The global prevalence of diabetes mellitus has been growing in recent decades and the complications of longstanding type 2 diabetes continue to place a burden on healthcare systems. The hemoglobin A1c (Hb A1c) content of the blood is used to assess an individual’s degree of glycemic control averaged over 2 to 3 months. In the USA, diabetes is the seventh leading cause of death. , indigenous, people of color (BIPOC) are disproportionately affected by diabetes compared to non-Hispanic whites. There are many reports of interaction of Hb A1c and hematologic conditions that have a high prevalence in the Black population; some of these effects are contradictory and not easily explained. This review attempts to document and categorize these apparently disparate effects and to assess any clinical impact. Methods Hb A1C can be determined by a variety of techniques including cation-exchange chromatography, electrophoresis, immunoassays, and affinity chromatography. The amount of Hb A1c present in a patient specimen depends not only on blood glucose but is strongly influenced by erythrocyte survival and by structural variations in the globin chains. Sickling hemoglobinopathies are well-represented in the USA in African Americans and the effects of these hemoglobin disorders as well as G6PD deficiency is examined. Conclusion Hb A1c measurement should always be performed with a cautious approach. The laboratory scientist should be aware of possible pitfalls in unquestioningly determining Hb A1c without a consideration of hematologic factors, both inherited and acquired. This presents a challenge as often times, the laboratory is not aware of the patient’s race.

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MacDougal, Erin L., Jeffrey J. Wing, William H. Herman, Lewis B. Morgenstern, and Lynda D. Lisabeth. "Abstract TP201: Diabetes and the Risk of Death and Stroke Recurrence Following Ischemic Stroke." Stroke 47, suppl_1 (February 2016). http://dx.doi.org/10.1161/str.47.suppl_1.tp201.

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Background and Purpose: Diabetes mellitus (DM) is a well-established risk factor for ischemic stroke (IS), but the literature is inconsistent on the effect of DM on outcomes after IS. We sought to determine if DM increases the risk of mortality and recurrence after IS, and if these associations are greater in Mexican Americans (MA) than non-Hispanic whites (NHW). Methods: IS cases, all-cause mortality, and recurrent strokes were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project (2006-2012). Sociodemographics and clinical data were obtained from medical records and interviews. Cumulative mortality and stroke recurrence risk were estimated at 30 days and 1 year using Kaplan-Meier analysis and Cox proportional hazards models. Effect modification by ethnicity was examined. Results: There were 1,301 IS cases, 46% with a history of DM, median age 70 (IQR: 58-81), and 61% MA. Patients with DM were younger and more likely to be MA compared to patients without DM. Risk of 30-day and 1-year mortality was 8.4% and 20.5% for those with DM and 9.5% and 20.8% for those without DM, respectively. Risk of 30-day and 1-year stroke recurrence was 1.2% and 7.5% for those with DM and 1.5% and 5.8% for those without DM, respectively. Unadjusted, DM was not a significant predictor of mortality or recurrence (see table). After adjustment, DM predicted mortality (30-day HR=1.58, 95% CI: 0.98-2.53; 1-year HR=1.48, 95% CI: 1.10-2.00) but not stroke recurrence (1-year HR=1.28, 95% CI: 0.78-2.08). Effect modification by ethnicity was not significant (p>0.2 for all models). Conclusions: Given that patients with DM were significantly younger than patients without DM, the crude association between DM and mortality revealed no difference. However, after accounting for age and other factors, patients with DM were 50% more likely to die at 1 year after IS compared to patients without DM.

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Fanous, Nada, Fernando Bril, Eddison Godinez Leiva, Srilaxmi Kalavalapalli, Kenneth Cusi, and Romina Lomonaco. "MON-644 Prevalence of Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Type 2 Diabetes Mellitus." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.1748.

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Abstract Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The more severe form is non-alcoholic steatohepatitis (NASH) which can progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). NASH is more common in patients with type 2 diabetes mellitus (T2DM). However, its true prevalence in unselected patients with T2DM in the United States remains unknown. In 2019, the American Diabetes Association recommended screening for NASH and liver fibrosis in all patients with T2DM with steatosis and/or elevated ALT. Screening focuses on liver fibrosis as associated with increased risk of cirrhosis and HCC. Still, a liver biopsy remains the gold standard to accurately assess the severity of liver disease. The aim of this study was to determine the prevalence of liver fibrosis in unselected patients with T2DM presenting to primary care or endocrinology clinics at a university hospital in the US. Secondary outcomes were to assess the prevalence of steatosis controlled attenuation parameter (CAP) and performance of vibration-controlled transient elastography (VCTE) as a non-invasive tool to identify patients with significant liver fibrosis. Patients with T2DM between ages of 21-79 and without a history of alcohol intake or other causes secondary causes of NAFLD were recruited for the study. Participants underwent screening for NAFLD at the time of their clinic visit by means of point-of-care CAP and VCTE. Initial evaluation also included obtaining patient demographics, routine chemistries, and fasting samples (on visit #2 if not fasting initially) for metabolic measurements and fibrosis biomarkers. Liver biopsies were offered to patients with a liver stiffness measurement (LSM) ≥8.0 kPa (i.e., highly likely to have moderate-to-severe fibrosis or ≥F2), or those with ≥7 kPa if AST ≥20 and had an APRI and/or FIB-4 score suggestive of being at high-risk of liver fibrosis (i.e., at least mild-to-moderate fibrosis or ≥F1). A total of 469 patients were recruited (age 59±12; 56% females; 60% non-Hispanic whites, 30% African Americans, 4% Asian; BMI 33±6 Kg/m2; A1c 7.5±1.7%; FPG 143±60 mg/dL; AST 22±11 U/L; ALT 24±17 U/L; triglycerides 156±151 mg/dL; LDL-C 88±37 mg/dL; HDL-C 47±13 mg/dL). The prevalence of NAFLD by CAP (≥280) was 67% with a mean CAP of 305±3. The prevalence of any fibrosis was 24% patients. Among those with fibrosis, 15% had moderate-to-severe fibrosis or ≥F2. In those that underwent a liver biopsy, 61% had moderate-to-severe fibrosis (F2-3). Our ongoing study demonstrates the high prevalence of liver steatosis and fibrosis in patients with T2DM. NASH is a common but under-recognized complication of T2DM that requires greater awareness among clinicians taking care of patients with diabetes. While the optimal screening strategy remains unclear, an approach based on plasma biomarkers and CAP/VCTE deserves further exploration moving forward.

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Olasoji, Esther, FRED S. SARFO, and Alexis Simpkins. "Abstract P884: Differences in Stroke Type and Stroke Risk Factors Between African Americans and Ghanaian Stroke Patients." Stroke 52, Suppl_1 (March 2021). http://dx.doi.org/10.1161/str.52.suppl_1.p884.

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Introduction: Ancestral lineage of many African Americans (AA) includes West African descent. Previous research has shown a higher prevalence of cardiovascular risk factors such as hypertension and diabetes mellitus (DM) in AA compared to other racial groups in the United States (US). Some have attributed these differences in the US population to ancestral lineage of the AA population. We sought to compare the stroke type and stroke risk factors between AA and Ghana, a country in West Africa. Methods: Data from the UFHealth institutional stroke database and the Kumasi, Ghana Stroke Survivors Registry between 01/2014 and 11/2019 provided a dataset of adult patients diagnosed with stroke from both locations. Multivariate regression analysis identified differences between country of origin, race, stroke type and clinical factors. Results: Among the 5519 patients, the median age was 66 (IQR 45 - 87), 49% woman, 16% AA, 19% Ghanaian, and 66% non-Hispanic white. In the total population, 22% had an intracerebral hemorrhage, 69% ischemic stroke, and 9% subarachnoid hemorrhage. Compared to patients in the U.S., patients from Ghana were younger (OR 1.06, 1.05-1.06 95% CI); more likely female (OR 1.66, 1.0-1.97 95% CI), hypertensive (OR 8.87, 6.46-12.17 95%CI), and more likely to consume alcohol (OR 4.25, 3.32-5.44 95% CI). Ghanaians were less likely to have DM (OR 0.81, 0.66-0.99 95% CI), smoke (OR 0.10, 0.07-0.13 95% CI), and live in an urban vs rural setting (OR 0.84, 0.71-0.99 95% CI). Compared to AA specifically, Ghanaians were younger (OR 1.02, 1.01-1.03 95% CI); more likely female (OR 1.45, 1.15-1.81 95% CI), hypertensive (OR 4.66, 3.25-6.68 95%CI), more likely to consume alcohol (OR 3.68, 2.62-5.18 95% CI); less likely to have DM (OR 0.55, 0.43-0.71 95% CI), smoke (OR 0.13, 0.08-0.19 95% CI), and less likely live in an urban vs rural setting (OR 0.66, 0.53-0.82 95% CI). Conclusion: Significant differences were found between stroke risk factors (hypertension, DM, alcohol consumption, and smoking) and race as well as country of origin. Further study of social and environmental differences between groups may elucidate the differences in stroke risk factors between AA’s and West Africans.

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Joseph, Joshua J., Aleena Bennett, Justin B. Echouffo Tcheugui, Valery S. Effoe, James Odei, Bertha Hidalgo, Akilah Dulin, et al. "Abstract 021: Higher Levels of Ideal Cardiovascular Health Are Associated With Lower Risk of Incident Type 2 Diabetes Mellitus Among Individuals With Normal Fasting Glucose but Not Impaired Fasting Glucose: The Reasons for Geographic and Racial Differences in Stroke Study." Circulation 137, suppl_1 (March 20, 2018). http://dx.doi.org/10.1161/circ.137.suppl_1.021.

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Aims/hypothesis: Ideal cardiovascular health (ICH) is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs. impaired fasting glucose [100-125 mg/dL]) remains to be clarified. We assessed the incidence of diabetes based on American Heart Association (AHA) ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Methods: This study included 7,662 non-Hispanic whites and African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003-2006), who completed the follow-up exam (2013-2016). Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 Impact Goals, based on baseline ICH components (total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI)). We categorized participants based on their total number of components that were ideal (0-1 “poor”, 2-3 “intermediate”, and 4+ “ideal”). Incident rate ratios (IRR) were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status (normal vs. impaired fasting glucose). Results: Among REGARDS participants (mean age 63.0 [SD 8.4] years, 56% female, 26% African American), there were 560 incident diabetes cases (median follow-up 9.5 years). Overall, those with 2-3 and 4+ ICH components vs. 0-1 components had 31% (IRR 0.69; 95% CI 0.61, 0.79) and 71% lower (IRR 0.29; 95% CI 0.20, 0.42) risk of diabetes, respectively. Among 5,930 participants with normal fasting glucose, these risks were 36% (IRR 0.64; 95% CI 0.52, 0.79) and 80% lower (IRR 0.20; 95% CI 0.10, 0.37), while among 1,732 participants with baseline impaired fasting glucose these risks were 8% (IRR 0.92; 95% CI 0.80,1.07) and 13% lower (IRR 0.87; 95% CI 0.58,1.30) (p for interaction by baseline glucose status <0.0001). Conclusions/interpretation: Meeting an increasing number of ideal levels of dietary intake, physical activity, smoking, blood pressure, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes for individuals with normal fasting glucose but not impaired fasting glucose. This suggests the AHA 2020 guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

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Tofovic, David, Minji Seok, Logan S. Schwarzman, Sreenivas Konda, and Noreen T. Nazir. "Abstract 17276: Impact of Cardiovascular Comorbidities on COVID-19 Infection Risk." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.17276.

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Introduction: A disproportionate amount of COVID-19 infections has occurred in minority populations and in individuals with comorbid disease. We sought to evaluate the impact of patient demographics, cardiovascular disease (CVD), and known CVD risk factors on the incidence of COVID-19 infection. Methods: Between April 1st to May 1st, 2020, 844 adult patients (mean age 51.4±17.7 years, mean BMI 29.6±8.3, 50% male) admitted for any reason and tested for COVID-19 based on CDC criteria were studied in this large, metropolitan, single-center retrospective cohort analysis. Bivariate and multivariate analysis between patient demographics, CVD, and CVD risk factors with COVID-19 were evaluated. The nonlinear effects of age on COVID-19 test results were further analyzed. Results: Prevalence of COVID-19 was 21.7%. African Americans, Latinos, and Caucasian were 463(55%), 216(25%), 165(20%) respectively. Unadjusted, diabetes mellitus (DM) was significantly related with the COVID-19 positivity (OR 1.83, 95% CI 1.30-2.58, P=0.0005), but age adjusted DM was insignificant (OR 1.35, 95% CI 0.93-1.97, P=0.12). Similar results were found with other CVD risk factors (see Tables 1,2). Stratified analysis by age groups (18-40 years, ≥40 years), DM in the younger age group was the most significant risk factor for the COVID-19 positivity (OR 4.52, 95% CI 1.95-10.52, P=0.0002) but not in older inpatients (OR 1.23, 95% CI 0.85-1.81, P=0.2763). In the older age group, Latinos were significantly higher risk for COVID-19 compared to Caucasian (OR 2.27, 95% CI 1.26-4.07, P=0.005). Conclusions: Increased resources for testing in younger individuals with DM and the Hispanic population may be merited.

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Journal articles on the topic 'Academic Diabetes Mellitus Hispanic Americans'

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