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Ciccarone Center Research
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- Meet the Authors
Diabetes & Metabolic Syndrome
To facilitate the guideline-based implementation of treatment recommendations in the ambulatory setting and to encourage participation in the multiple preventive health efforts that exist, we have organized several recent guideline updates into a simple ABCDEF approach. We would remind clinicians that evidence-based medicine is meant to inform recommendations but that synthesis of patient-specific data and use of appropriate clinical judgment in each individual situation is ultimately preferred.Published in: Journal of the American Heart AssociationRead on Pubmed
Potential implications of coronary artery calcium testing for guiding aspirin use among asymptomatic individuals with diabetes.
We conclude that CAC can help risk stratify individuals with diabetes and may aid in selection of patients who may benefit from therapies such as low-dose aspirin for primary prevention of CVD.Published in: Diabetes CareRead on Pubmed
Hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased systemic inflammation.
The goal of this study was to assess the independent and collective associations of hepatic steatosis, obesity, and the metabolic syndrome with elevated hsCRP levels. We evaluated 2,388 individuals without clinical cardiovascular disease between December 2004 and December 2006. Hepatic steatosis was diagnosed by ultrasound, and the metabolic syndrome was defined using National Heart, Lung, and Blood Institute criteria. We concluded that hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased odds of high hsCRP levels.Published in: Arteriosclerosis, Thrombosis & Vascular BiologyRead on Pubmed
The role of statins in diabetes mellitus.
Diabetes is considered a risk equivalent for coronary heart disease (CHD). The use of statins for primary and secondary prevention in patients with diabetes is well established and supported by robust data from randomized, controlled trials and national guidelines. The American Diabetes Association recommends that individuals with diabetes and a history of cardiovascular disease (CVD), as well as those > 40 years of age without CVD but with CVD risk factors, should be treated with a statin regardless of their baseline LDL cholesterol concentration. This review explains the rationale behind considering diabetes a CHD risk equivalent and summarizes the data for statin use in adults with diabetes without (primary prevention) and with (secondary prevention) established CVD. Although individuals with diabetes are at an increased risk for CVD and benefit from statin therapy, the risk of CVD in people with diabetes is heterogeneous. It therefore may be reasonable to match the intensity of statin therapy with patients' baseline CVD risk.
Pathways to quality inpatient management of hyperglycemia and diabetes: A call to action.
This paper outlines eight aspects of inpatient glucose management (four as system-based issues and four as patient-based issues) in which randomized clinical trials are needed, and urges further progress in the science of inpatient diabetes management.
Nonalcoholic fatty liver disease and serum lipoproteins: the Multi-Ethnic Study of Atherosclerosis.
This study found that, after adjustment for multiple metabolic risk factors, adiposity, and measures of insulin resistance, there may be a link between nonalcoholic fatty liver disease and dyslipidemia.
Genetic variants associated with VLDL, LDL and HDL particle size differ with race/ethnicity.
Our findings suggest that the genetic underpinnings of mean lipoprotein diameter differ by race/ethnicity. As lipoprotein diameters are modifiable, this may lead new strategies to modify lipoprotein profiles during the reduction of insulin resistance that are sensitive to race/ethnicity.
Impact of fitness versus obesity on routinely measured cardiometabolic risk in young, healthy adults.
Although fitness and obesity are independently associated with cardiometabolic risk, and their effects are additive, obesity is more strongly associated with this risk when fitness and obesity are discordant. These findings underscore the need for weight loss in obese patients and suggest an unmeasured benefit of fitness.
Endocrine and inflammatory profiles in type 2 diabetic patients with and without major depressive disorder.
This study found that diabetic patients with depression are more likely to have cardiovascular events, and different factors can determine this high association.
Metabolic syndrome risk profiles among African American adolescents: national health and nutrition examination survey, 2003-2010.
Although African-American adolescents have the highest prevalence of obesity, they have the lowest prevalence of metabolic syndrome across all definitions used in previous research. To address this paradox, we sought to develop a model of the metabolic syndrome specific to African-American adolescents. Our findings provide a plausible model of the metabolic syndrome specific to African-American adolescents. Based on this model, approximately 19% and 16% of African-American boys and girls, respectively, are at high risk for having the metabolic syndrome.
Hypoglycemia in non-critically ill, hospitalized patients with diabetes: evaluation, prevention, and management.
Hypoglycemia among hospitalized patients with diabetes is a common problem. Of the > 8 million patients admitted to US hospitals annually with a diagnosis of diabetes, up to 25% may have a low blood glucose level during hospitalization. As a widely recognized cause of acute, potentially fatal events, hypoglycemia remains a significant barrier to optimal inpatient glycemic control. Although iatrogenic hypoglycemia is associated with adverse outcomes, it may be a marker for illness rather than causal in itself. Several factors, such as administration of exogenous insulin, mismatch of insulin administration with nutrition, and the loss of normal counterregulatory responses, place patients with diabetes at higher risk for hypoglycemia than patients without diabetes. Causes and predictors of hypoglycemia in hospitalized patients with diabetes are discussed. Careful attention to contributing factors, responsiveness to changes in clinical status, and specific institutional protocols and policies can reduce the risk of hypoglycemia. Use of subcutaneous basal-bolus insulin dosing consistent with national guidelines and correction rather than sliding-scale insulin may minimize both hyper- and hypoglycemia. A majority of the literature on inpatient hypoglycemia has been limited to the critical-care setting. This review therefore focuses on hypoglycemia among non-critically ill inpatients with diabetes.
A systematic review and meta-analysis of the association between depression and insulin resistance.
This study found that a small but significant cross-sectional association was observed between depression and insulin resistance, despite heterogeneity between studies.