Community-Based Diabetes Awareness Strategy With Detection and Intervention: The Mobile Diabetes Education Center.

To prevent diabetes and increase equitable access to health care screenings, Touro University California has created and implemented a community outreach program called the Mobile Diabetes Education Center (MOBEC). This program is a joint effort that also involves Sutter Health, the California Department of Public Health, Kaiser Permanente, the Solano County Department of Public Health, and community-based organizations, focusing on advancing health equity in Solano County's at-risk populations. This article reports on the services and initial successes of MOBEC. With its strong community collaboration, MOBEC has helped to raise awareness of diabetes and ensure access to much-needed health screenings and education. This model can potentially be used as a blueprint for similar efforts nationwide to address the health care needs of medically underserved communities.

Associations between diabetes-related distress and predicted cardiovascular complication risks in patients with type 2 diabetes.

CONTEXT: Diabetes-related distress (DRD) is experienced by nearly 50% of people with diabetes at any given time in their diagnosis. The effects of low socioeconomic status (SES) and lacking access to resources can increase DRD. In addition, cardiovascular (CV) complications associated with diabetes are associated with higher DRD scores. OBJECTIVES: This study evaluated the associations between DRD and predicted CV risks in participants with type 2 diabetes. METHODS: This cross-sectional study included 234 individuals with low SES who were Medi-Cal (California version of Medicaid) beneficiaries and sought medical care at a safety-net clinic system. The Problem Areas in Diabetes (PAID) questionnaire assessed DRD levels. The United Kingdom Prospective Diabetes Study Risk Engine was utilized to predict 10-year risks for coronary heart disease (CHD), fatal CHD, stroke, and fatal stroke. A multivariate linear regression model was constructed between the two variables, including other variables to control for potential confounding factors, for assessing the associations. RESULTS: After controlling for potential confounders, participants' total PAID questionnaire scores were significantly associated with their 10-year predicted fatal CHD risks (B=0.060, 95% CI: [0.00084, 0.12], p=0.047). CONCLUSIONS: After controlling for covariates, DRD levels exhibited a significant association with increased 10-year predicted fatal CHD risks in patients with type 2 diabetes and lower SES. Screening for DRD and provision of appropriate psychosocial interventions may reduce the risks of CHD in those with type 2 diabetes.

Consumption of Non-nutritive Sweeteners and Risk for Type 2 Diabetes: What Do We Know, and Not?

PURPOSE OF REVIEW: The article explores the relationship between non-nutritive sweetener consumption and the risk of developing type 2 diabetes through reviewing meta-analyses and systematic reviews, as well as clinical trials and observational studies. RECENT FINDINGS: The data overall has yet to show a strong and clear link between consumption of non-nutritive sweeteners and the development of type 2 diabetes. However, several observational studies have shown a positive relationship between these two variables, with a stronger association found among women. Regarding non-nutritive sweeteners that are currently commercially available, there is not one specific non-nutritive sweetener that appears to be more strongly associated with the development of type 2 diabetes than other non-nutritive sweeteners. There is still much to be learned regarding non-nutritive sweeteners and their potential link to metabolic disorders. Further research is needed to identify the long-term impacts of non-nutritive sweetener consumption and identify the nuances in terms of risk of developing type 2 diabetes concerning specific non-nutritive sweeteners.

Erratum. Diabetic Gastroparesis: A Review. Diabetes Spectrum 2020;33:290-297 (https://doi.org/10.2337/ds19-0062).

[This corrects the article on p. 290 in vol. 33, PMID: 32848351.].

Associations Between Social Support and Diabetes-Related Distress in People With Type 2 Diabetes Mellitus.

CONTEXT: Diabetes is a complex, chronic condition and managing it can have psychosocial implications for patients, including an impact on relationships with their loved ones and physical wellness. The necessary modifications to daily behaviors can be very overwhelming, thus leading to diabetes-related distress. OBJECTIVE: To investigate the association between diabetes-related distress and perceived social support among people with type 2 diabetes. METHODS: This cross-sectional study surveyed a population with a lower socioeconomic status (Medi-Cal recipients, which are only given to low-income individuals) in Solano County, California. Patients who had type 2 diabetes mellitus, who were between 40 and 80 years old, and who had a medical appointment in the clinic(s) at least once between December 2015 and December 2016 were included. Patients who could not understand or speak English and patients whose primary care clinicians declined their participation in the study were excluded from the study. Each study participant was recruited at the end of their medical appointment, and the survey instrument in paper form was administered. The Problem Areas in Diabetes (PAID) scale, which indicates diabetes-related distress, and Multidimensional Scale of Perceived Social Support (MSPSS) with 3 subscales (family, friends, and significant others) were used in this study. Multiple linear regression models were used to analyze the associations between PAID and MSPSS surveys. RESULTS: For the 101 participants included in our study, multiple linear regression models showed statistically significant association between total MSPSS scores and total PAID scores (ß = -.318; 95% CI, .577, -.0581; P=.017) as well as between MSPSS family subscale scores and total PAID scores (ß= -.761; 95% CI, -1.35, -.168; P=.012). Among the 3 MSPSS subscales, higher perceived support from family members was found to be significantly associated with lower total PAID scores (ß= -.761; 95% CI, -1.35, -.168; P=.012). CONCLUSION: Our findings suggest that a higher level of perceived social support experienced was associated with lower diabetes-related distress among patients with type 2 diabetes. Osteopathic physicians have a central role in providing comprehensive, patient-centered, holistic care, and the attention to social support in chronic disease management can help remove barriers in providing optimal care.

Associations Between Diabetes-Related Distress and Cardiovascular Complication Risks in Patients With Type 2 Diabetes and Lower Socioeconomic Status: A Pilot Study.

The purpose of this pilot study was to assess the associations between diabetes-related distress and predicted 10-year risks for cardiovascular complications in a lower-socioeconomic-status population with type 2 diabetes. Diabetes-related distress was found to be significantly associated with the predicted 10-year risk for coronary heart disease in the studied population. In addition, the association between the predicted 10-year risk for stroke and diabetes-related distress was also statistically significant among individuals with lower occupational status scores. Based on these results, primary care providers are encouraged to integrate a psychosocial assessment into their clinical practices in diabetes management. Identification of diabetes-related distress might be an additional means to increase patient engagement in diabetes management and to help address patients' risks of cardiovascular complications, especially in safety-net clinics serving socioeconomically disadvantaged populations.

What we know--and don't--about non-nutritive sweeteners.

Here's what's known about the safety of these sweeteners and their effect on weight, appetite, and the risk for type 2 diabetes.

Can Osteopathic Medical Students Accurately Measure Abdominal Aortic Dimensions Using Handheld Ultrasonography Devices in the Primary Care Setting?

CONTEXT: The US Preventive Services Task Force (USPSTF) recommends a 1-time ultrasonography (US) screening for abdominal aortic aneurysm (AAA) to reduce AAA-specific mortality in men aged 65 to 75 years who have ever smoked. A 2015 study concluded that less than 50% of at-risk primary care patients are screened for AAA. To increase screening rates, it would be beneficial to train other health care professionals in accurately measuring abdominal aortic dimensions. OBJECTIVE: To determine whether osteopathic medical students can use handheld US machines to measure abdominal aortic diameters as accurately as an experienced US technologist. METHODS: Three osteopathic medical students underwent 8 hours of US training with a board-certified radiologist to measure abdominal aortic dimensions using a handheld US device. After the training, students independently conducted AAA US screenings at a clinic on participants meeting USPSTF AAA screening criteria. Transverse and anteroposterior measurements were taken at 3 sites: celiac axis, inferior to the renal arteries, and superior to the iliac bifurcation. A US technologist then measured the participants' aortic diameters in the radiology department at another facility. The measurements from both reports were then compared using a 2-sample t test. RESULTS: The aortic diameter was measured in 16 participants with a mean (SD) body mass index of 26.7 (3.6). The mean (SD) difference between novice and expert measurement of the abdominal aorta was -0.15 (0.23) cm. No statistically significant difference was found between the US measurements completed by students and a US technologist (t=-1.38, P=.09). None of the participants met the criteria for AAA (>3.0 cm), with the largest abdominal aorta scanned by experts measuring 2.86 cm. CONCLUSION: When properly trained, osteopathic medical students can accurately measure abdominal aortic diameters using a handheld US device. Training more medical students in ultrasonography would offer increased screening opportunities and possibly reduce AAA-related mortality. Further studies are needed to assess the ability of osteopathic medical students to accurately measure AAAs, as no participants in this study met the criteria for AAA.

Navigating travel with diabetes.

As the number of people who travel continues to increase, so too will the number of travelers with diabetes. This increase will come with new and more frequent requests for medical travel advice. This article equips clinicians with the tools to address patient concerns about travel and to empower patients to be prepared for emergency situations both abroad and at home. This includes encouraging patients to obtain a travel letter, bring enough supplies for the trip, and have a plan to manage time-zone changes.

Correlations Between A1C and Diabetes Knowledge, Diabetes Numeracy, and Food Security in a Vulnerable Type 2 Diabetes Population.

Type 2 diabetes is over-represented in vulnerable populations. Vulnerable patients managing diabetes are challenged with less-than-optimal processes and outcomes of care; thus, Healthy People 2020 and the American Diabetes Association have renewed the focus on social determinants of health with regard to the management of chronic diseases such as diabetes. This study explored the correlations between A1C and social and personal factors, including diabetes knowledge, diabetes numeracy, and food security. The Diabetes Numeracy Test-15, the Spoken Knowledge in Low Literacy Diabetes Scale, and the U.S. Department of Agriculture Food Security Questionnaire were administered to a Caucasian study population (n = 96) receiving diabetes care at a federally qualified health center. Although the correlation coefficients generated by the results obtained from the three questionnaires and A1C levels were generally small, a correlation coefficient of 0.46 was found between food security and A1C. An improved understanding of factors that contribute to the successful self-management of diabetes is necessary to improve diabetes outcomes in vulnerable populations.

Improving Nursing Home Compliance via Revised Antipsychotic Use Survey Tool.

OBJECTIVE: To analyze the effect of using a pharmacist-initiated antipsychotic use survey tool on improving nursing home compliance for appropriate antipsychotic use in patients with dementia. DESIGN: Prospective chart review study. SETTING: Two nursing homes in Marin County, California. PARTICIPANTS: Nursing home residents diagnosed with dementia and receiving antipsychotic medication. INTERVENTION: Pharmacist performing survey tool screening for appropriate antipsychotic use based on Centers for Medicare & Medicaid Services guidelines and using information from the survey tool as part of the pharmacist recommendations to the prescriber. MAIN OUTCOME MEASURES: Number of pharmacist recommendations indicated by the survey tool for antipsychotic gradual dose reduction (GDR) or discontinuation that are accepted by prescribers. Number and percent of residents on antipsychotic medication per nursing home prior and throughout the study period. RESULTS: Of the final 20 study population residents, 12 were survey-recommended for GDR or antipsychotic discontinuation. Within the 12 recommendations, four were accepted by prescribers from one of the two nursing homes. Decline in antipsychotic use was observed in the same nursing home throughout the seven months from 28 residents (21%) to 19 residents (14%). No significant difference in antipsychotic use before and after intervention was observed in the other nursing home. Overall feedback reported intervention helpful and requested continued pharmacist involvement. CONCLUSION: Nursing home compliance improved and antipsychotic use declined during pharmacist intervention at one nursing home. Multiple factors may be involved in pharmacist recommendation acceptance.