المؤلفون: Jennifer L. Maizel, Michael J. Haller, David M. Maahs, Ananta Addala, Rayhan A. Lal, Stephanie L. Filipp, Matthew J. Gurka, Sarah Westen, Brittney N. Dixon, Lauren Figg, Melanie Hechavarria, Keilecia G. Malden, Ashby F. Walker

المصدر: Journal of Clinical & Translational Endocrinology, Vol 36, Iss , Pp 100337- (2024)

مصطلحات موضوعية: Diabetes, COVID-19, Coronavirus, Pandemic, Health Equity, Health Disparities, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Background: People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for underserved communities including racial/ethnic minorities and people with lower socioeconomic status. However, limited research has examined COVID-19 outcomes specifically affecting underserved communities with diabetes. Methods: From November 2021 to July 2022, adults with insulin-requiring diabetes at federally qualified health centers in Florida and California (n = 450) completed surveys examining COVID-19 outcomes and demographics. Surveys assessed COVID-19 severity, vaccination uptake, mask-wearing habits, income changes, and healthcare access changes. Surveys also included the full Coronavirus Anxiety Scale (CAS-19). Descriptive statistics were computed for all outcomes. Between-group comparisons for state and race/ethnicity were evaluated via Chi-Squared, Fisher’s Exact, Cochran-Mantel-Haenszel, One-Way ANOVA, and t-tests. Logistic regression determined factors associated with COVID-19 vaccination uptake. Data were self-reported and analyzed cross-sectionally. Results: Overall, 29.7 % reported contracting COVID-19; of those, 45.3 % sought care or were hospitalized. Most (81.3 %) received ≥ 1 vaccine. Hispanics had the highest vaccination rate (91.1 %); Non-Hispanic Blacks (NHBs) had the lowest (73.9 %; p =.0281). Hispanics had 4.63x greater vaccination odds than Non-Hispanic Whites ([NHWs]; 95 % CI = [1.81, 11.89]). NHWs least often wore masks (18.8 %; p

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2214623724000085Test; https://doaj.org/toc/2214-6237Test

الوصول الحر: https://doaj.org/article/d87b246775904b07a88028dcb6b64c00Test

المؤلفون: Yuhao Huang, Jeffrey B. Wang, Jonathon J. Parker, Rajat Shivacharan, Rayhan A. Lal, Casey H. Halpern

المصدر: Nature Communications, Vol 14, Iss 1, Pp 1-11 (2023)

مصطلحات موضوعية: Science

الوصف: Abstract Mounting evidence demonstrates that the central nervous system (CNS) orchestrates glucose homeostasis by sensing glucose and modulating peripheral metabolism. Glucose responsive neuronal populations have been identified in the hypothalamus and several corticolimbic regions. However, how these CNS gluco-regulatory regions modulate peripheral glucose levels is not well understood. To better understand this process, we simultaneously measured interstitial glucose concentrations and local field potentials in 3 human subjects from cortical and subcortical regions, including the hypothalamus in one subject. Correlations between high frequency activity (HFA, 70–170 Hz) and peripheral glucose levels are found across multiple brain regions, notably in the hypothalamus, with correlation magnitude modulated by sleep-wake cycles, circadian coupling, and hypothalamic connectivity. Correlations are further present between non-circadian (ultradian) HFA and glucose levels which are higher during awake periods. Spectro-spatial features of neural activity enable decoding of peripheral glucose levels both in the present and up to hours in the future. Our findings demonstrate proactive encoding of homeostatic glucose dynamics by the CNS.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2041-1723Test

الوصول الحر: https://doaj.org/article/32019ae803b84a60a1caccf3ee748eb5Test

المؤلفون: Ananta Addala, Stephanie L. Filipp, Lauren E. Figg, Claudia Anez-Zabala, Rayhan A. Lal, Matthew J. Gurka, Michael J. Haller, David M. Maahs, Ashby F. Walker, for the Project ECHO Diabetes Research Team, Michael Haller, Eleni Sheehan, Angelina Bernier, Sarah Westen, Hannah Stahmer, William Troy Donahoo, Xanadu Roque, Gabby Malden, Melanie Hechavarria, David Maahs, Rayhan Lal, Lauren Figg, Katarina Yabut, Noor Alramahi, Ana Cortes, Dessi Zaharieva, Marina Basina, Katie Judge, Lety Wilke, Korey Hood, Jessie Wong, Jason Wang, Suruchi Bhatia, Eugene Lewit

المصدر: Frontiers in Endocrinology, Vol 13 (2022)

مصطلحات موضوعية: equity, primary care provider education, disparities, health, type 1 diabetes, tele-education, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: IntroductionIn the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.MethodsPCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar’s tests.ResultsPCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.DiscussionPCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2022.1066521/fullTest; https://doaj.org/toc/1664-2392Test

الوصول الحر: https://doaj.org/article/1a5a25ac84384bc4a54d00c751d57234Test

المؤلفون: Caitlin L. Maikawa, Peyton C. Chen, Eric T. Vuong, Leslee T. Nguyen, Joseph L. Mann, Andrea I. d'Aquino, Rayhan A. Lal, David M. Maahs, Bruce A. Buckingham, Eric A. Appel

المصدر: Advanced Science, Vol 8, Iss 21, Pp n/a-n/a (2021)

مصطلحات موضوعية: amylin, diabetes, drug delivery, hormones, insulin, Science

الوصف: Abstract Dual‐hormone replacement therapy with insulin and amylin in patients with type 1 diabetes has the potential to improve glucose management. Unfortunately, currently available formulations require burdensome separate injections at mealtimes and have disparate pharmacokinetics that do not mimic endogenous co‐secretion. Here, amphiphilic acrylamide copolymers are used to create a stable co‐formulation of monomeric insulin and amylin analogues (lispro and pramlintide) with synchronous pharmacokinetics and ultra‐rapid action. The co‐formulation is stable for over 16 h under stressed aging conditions, whereas commercial insulin lispro (Humalog) aggregates in 8 h. The faster pharmacokinetics of monomeric insulin in this co‐formulation result in increased insulin–pramlintide overlap of 75 ± 6% compared to only 47 ± 7% for separate injections. The co‐formulation results in similar delay in gastric emptying compared to pramlintide delivered separately. In a glucose challenge, in rats, the co‐formulation reduces deviation from baseline glucose compared to insulin only, or separate insulin and pramlintide administrations. Further, comparison of interspecies pharmacokinetics of monomeric pramlintide suggests that pharmacokinetics observed for the co‐formulation will be well preserved in future translation to humans. Together these results suggest that the co‐formulation has the potential to improve mealtime glucose management and reduce patient burden in the treatment of diabetes.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2198-3844Test

الوصول الحر: https://doaj.org/article/d3a19ef54cb54dc096bc079b397dbf97Test

المؤلفون: Rayhan A. Lal, Andrew R. Hoffman

المصدر: Archives of Endocrinology and Metabolism, Vol 63, Iss 6, Pp 601-607 (2020)

مصطلحات موضوعية: Growth hormone, recombinant human growth hormone, pharmacology, review, drug development, Medicine, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: ABSTRACT Growth hormone therapy with daily injections of recombinant human growth hormone has been available since 1985, and is shown to be safe and effective treatment for short stature in children and for adult growth hormone deficiency. In an effort to produce a product that would improve patient adherence, there has been a strong effort from industry to create a long acting form of growth hormone to ease the burden of use. Technologies used to increase half-life include depot formulations, PEGylated formulations, pro-drug formulations, non-covalent albumin binding growth hormone and growth hormone fusion proteins. At present, two long acting formulations are on the market in China and South Korea, and several more promising agents are under clinical investigation at various stages of development throughout the world. Arch Endocrinol Metab. 2019;63(6):601-7

وصف الملف: electronic resource

العلاقة: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000900601&tlng=enTest; https://doaj.org/toc/2359-4292Test

الوصول الحر: https://doaj.org/article/34f9cf7e2c0341098f3e85b042a4d9faTest

المؤلفون: Rayhan A. Lal, Caitlin L. Maikawa, Dana Lewis, Sam W. Baker, Anton A. A. Smith, Gillie A. Roth, Emily C. Gale, Lyndsay M. Stapleton, Joseph L. Mann, Anthony C. Yu, Santiago Correa, Abigail K. Grosskopf, Celine S. Liong, Catherine M. Meis, Doreen Chan, Joseph P. Garner, David M. Maahs, Bruce A. Buckingham, Eric A. Appel

المصدر: Clinical and Translational Medicine, Vol 11, Iss 4, Pp n/a-n/a (2021)

مصطلحات موضوعية: automated insulin delivery, diabetes, open‐source closed loop, Medicine (General), R5-920

الوصف: Abstract Understanding how automated insulin delivery (AID) algorithm features impact glucose control under full closed loop delivery represents a critical step toward reducing patient burden by eliminating the need for carbohydrate entries at mealtimes. Here, we use a pig model of diabetes to compare AndroidAPS and Loop open‐source AID systems without meal announcements. Overall time‐in‐range (70–180 mg/dl) for AndroidAPS was 58% ± 5%, while time‐in‐range for Loop was 35% ± 5%. The effect of the algorithms on time‐in‐range differed between meals and overnight. During the overnight monitoring period, pigs had an average time‐in‐range of 90% ± 7% when on AndroidAPS compared to 22% ± 8% on Loop. Time‐in‐hypoglycemia also differed significantly during the lunch meal, whereby pigs running AndroidAPS spent an average of 1.4% (+0.4/−0.8)% in hypoglycemia compared to 10% (+3/−6)% for those using Loop. As algorithm design for closed loop systems continues to develop, the strategies employed in the OpenAPS algorithm (known as oref1) as implemented in AndroidAPS for unannounced meals may result in a better overall control for full closed loop systems.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2001-1326Test

الوصول الحر: https://doaj.org/article/b08f806168ca4c878812280d3471a23aTest

المؤلفون: Dessi P. Zaharieva, Dale Morrison, Barbora Paldus, Rayhan A. Lal, Bruce A. Buckingham, David N. O’Neal

المصدر: Diabetes Spectrum. 36:127-136

مصطلحات موضوعية: Endocrinology, Diabetes and Metabolism, Internal Medicine

الوصف: Regular exercise is essential to overall cardiovascular health and well-being in people with type 1 diabetes, but exercise can also lead to increased glycemic disturbances. Automated insulin delivery (AID) technology has been shown to modestly improve glycemic time in range (TIR) in adults with type 1 diabetes and significantly improve TIR in youth with type 1 diabetes. Available AID systems still require some user-initiated changes to the settings and, in some cases, significant pre-planning for exercise. Many exercise recommendations for type 1 diabetes were developed initially for people using multiple daily insulin injections or insulin pump therapy. This article highlights recommendations and practical strategies for using AID around exercise in type 1 diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::4de402ddf4ae191996f92a8c888bc575Test
https://doi.org/10.2337/dsi22-0018Test

المؤلفون: Gregory P. Forlenza, Rayhan A. Lal

المصدر: Diabetes Technol Ther

مصطلحات موضوعية: Blood Glucose, Pancreas, Artificial, Medical Laboratory Technology, Endocrinology, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Endocrinology, Diabetes and Metabolism, Humans, Hypoglycemic Agents, Insulin, Review Article

الوصف: Combining technologies including rapid insulin analogs, insulin pumps, continuous glucose monitors, and control algorithms has allowed for the creation of automated insulin delivery (AID) systems. These systems have proven to be the most effective technology for optimizing metabolic control and could hold the key to broadly achieving goal-level glycemic control for people with type 1 diabetes. The use of AID has exploded in the past several years with several options available in the United States and even more in Europe. In this article, we review the largest studies involving these AID systems, and then examine future directions for AID with an emphasis on usability.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4a1ca51960f38abcd665c72f939836b5Test
https://pubmed.ncbi.nlm.nih.gov/35099302Test

المؤلفون: Rayhan A. Lal, Holly Robinson, Stefanie Lanzinger, Kellee M. Miller, Saira Pons Perez, Robert Kovacic, Peter Calhoun, Fiona Campbell, Andrea Naeke, David M. Maahs, Reinhard W. Holl, Justin Warner

المصدر: Diabetes Technology & Therapeutics. 24:628-634

مصطلحات موضوعية: Blood Glucose, Glycated Hemoglobin, Technology, Medical Laboratory Technology, Diabetes Mellitus, Type 1, Endocrinology, Blood Glucose Self-Monitoring, Endocrinology, Diabetes and Metabolism, Humans, Infant, Prospective Studies, Registries, Child

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::187e2ecf99d27c81d87abad270692166Test
https://doi.org/10.1089/dia.2022.0095Test

المؤلفون: Sarah Hanes, John Lum, Brandon Arbiter, Ryan R. Bailey, Rayhan A. Lal, Korey K. Hood, Monica S. Lanning, Jessie J. Wong, Sakinah C. Suttiratana, Adrienne Dunlap, Diana Naranjo

المصدر: Diabetes Technol Ther

مصطلحات موضوعية: Blood Glucose, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, MEDLINE, Qualitative property, Technical support, Endocrinology, Insulin Infusion Systems, Pregnancy, Medicine, Humans, Hypoglycemic Agents, Insulin, Glycemic, media_common, business.industry, Blood Glucose Self-Monitoring, Original Articles, Discontinuation, Loop (topology), Medical Laboratory Technology, Diabetes Mellitus, Type 1, Family medicine, Observational study, Female, Worry, business

الوصف: BACKGROUND: Loop is an open-source automated insulin dosing system that allows users unrivaled control over system settings that affect future glucose prediction. Thousands use Loop, but little is known about those who discontinue. METHODS: In a large observational study, 874 Loop participants completed surveys and provided glycemic data, 46 (5.3%) of those self-identified as discontinuing Loop use during the observation window, 45 completed a discontinued use survey, 22 provided system settings data, and 19 participated in semistructured interviews about their discontinuation. Qualitative data were transcribed, coded, and analyzed. RESULTS: Older age and not trusting Loop were associated with discontinued use, although no other demographic or clinical characteristics were significant correlates. The most endorsed reasons were “I decided to try something else” (27.8%) followed by “It just didn't help as much as I thought it would” (22.2%). Qualitative analyses revealed prominent themes centered upon mental and emotional burden and adjusting settings. Other reasons for discontinued use included fear of disapproval of Loop use from diabetes provider, barriers to acquiring component devices, a desire to try new/different technologies, concerns that Loop could not accommodate specific exercise or low insulin dose regimens, and worry about Loop use during pregnancy. It was noted that burdens might be alleviated by enhanced technical assistance and expert guidance. CONCLUSIONS: Although the majority of individuals in the Loop observational study continued use, those who discontinued reported similar challenges. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users. Clinical Trial Registration: clinicaltrials.gov (NCT03838900).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fdabb155738b13cee8f46f8f1c25c8fdTest
https://pubmed.ncbi.nlm.nih.gov/34780283Test