ABSTRACT
BACKGROUND: Diabetic education can have significant effects in improving glycemic markers in patients with diabetes. This study sought to determine if the Diabetes Boot Camp, a novel 2-hour, intensive educational program by a multidisciplinary team, was effective in lowering mean hemoglobin A1c (HgA1c) levels in diabetic patients when compared to the standard of care. METHODS: The research design was that of a retrospective cohort study. The Diabetes Boot Camp population was defined as all diabetic patients referred to the boot camp clinic from the 10 physicians referring the most patients to the clinic from August 2009-August 2010. Three control populations were randomly selected from the same physicians' diabetic patients identified in the Ochsner primary care diabetes database during the same period. Pre- and postintervention HgA1c measurements on the same patients in all groups were analyzed. Control populations studied included an overall group, patients with HgA1c >9%, and patients with HgA1c ≤9%. RESULTS: Overall, the Diabetes Boot Camp cohort showed a significant decrease in mean HgA1c of 1.25% versus 0.11% compared to the control cohort (P<0.001). In the other analyses, Diabetes Boot Camp patients with HgA1c >9% and those with HgA1c ≤9% had statistically significant reductions in HgA1c compared to the control groups (P<0.001). CONCLUSION: An intensive 2-hour multidisciplinary diabetes clinic demonstrated significant improvements in glycemic control as measured by HgA1c compared to standard care.
ABSTRACT
Cytosolic Ca(2+) signaling dynamics are important to pulmonary arterial reactivity, and alterations are implicated in pulmonary vascular disorders. Yet, adaptations in cellular Ca(2+) homeostasis and receptor-mediated Ca(2+) signaling with maturation from fetal to adult life in pulmonary arterial smooth muscle cells (PASMCs) are not known. The present study tested the hypothesis that cytosolic Ca(2+) homeostasis and receptor-generated Ca(2+) signaling adapt with maturation in sheep PASMCs. Digitalized fluorescence microscopy was performed using isolated PASMCs from fetal and adult sheep that were loaded with the Ca(2+) indicator fura 2. The results show that basal cytosolic and sarcoplasmic reticulum Ca(2+) levels are attained before birth. Similarly, Ca(2+) efflux pathways from the cytosol and basal as well as capacitative Ca(2+) entry (CCE) are also developed before birth. However, receptor-mediated Ca(2+) signaling adapts with maturation. Prominently, serotonin stimulation elicited Ca(2+) elevations in very few fetal compared with adult PASMCs; in contrast, phenylephrine elevated Ca(2+) in a similar percentage of fetal and adult PASMCs. Serotonin and phenylephrine elicited Ca(2+) increases of a similar magnitude in reactive cells of fetus and adult, supporting the assertion that inositol trisphosphate signaling is intact. Caffeine and ATP elevated Ca(2+) in equivalent numbers of fetal and adult PASMCs. However, the caffeine-induced cytosolic Ca(2+) increase was significantly greater in fetal PASMCs, whereas the ATP-elicited increase was greater in adult cells. Overall, the results of this study demonstrate selective adaptations in receptor-mediated Ca(2+) signaling, but not in cellular Ca(2+) homeostasis.
