- Professional overview
Dr. Chyun's expertise on cardiac-related outcomes, psychosocial and behavioral factors, quality of life in older adults with type 2 diabetes mellitus, and cardiovascular nursing and chronic disease epidemiology has provided a unique opportunity to expand the understanding of cardiovascular disease (CVD) in older adults through multiple studies. Findings have made a significant contribution to knowledge of cardiac autonomic neuropathy and asymptomatic heart disease, and have been incorporated into American Diabetes Association clinical practice recommendations. She has lectured and consulted nationally and internationally on topics related to type 2 diabetes and CVD. As an active member of the American Heart Association, Dr. Chyun has represented nursing on interdisciplinary committees focusing on prevention, epidemiology, diabetes, and older adults.
A Culturally competent intervention of education and care for black women with type 2 diabetesD’Eramo Melkus, G., Spollett, G., Jefferson, V., Chyun, D., Tuohy, B., Robinson, T., & Kaisen, A. (2004). Applied Nursing Research, 17, 10-20, 10.1016/j.apnr.2003.10.009
A single-item approach to screening elders for oral health assessment.Chia-Hui Chen, C., Chyun, D. A., Li, C. Y., & McCorkle, R. Nursing research, 56, 332-8, 10.1097/01.NNR.0000289504.30037.d8
Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important.
Acute myocardial infarction in the elderly with diabetesChyun, D., Vaccarino, V., Murillo, J., Young, L.H., & Krumholz, H.M. (2002). Heart & Lung: The Journal of Acute and Critical Care, 31, 327-339, 10.1067/mhl.2002.126049
Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus.Chyun, D., Vaccarino, V., Murillo, J., Young, L. H., & Krumholz, H. M. (2002). American journal of critical care : an official publication, American Association of Critical-Care Nurses, 11, 504-19,
To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non-insulin- or insulin-treated diabetes.
Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial.Young, L. H., Wackers, F. J., Chyun, D. A., Davey, J. A., Barrett, E. J., Taillefer, R., … (2009). JAMA, 301, 1547-55, 10.1001/jama.2009.476
Coronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But the utility of screening patients with type 2 diabetes for asymptomatic CAD is controversial.
Coping as a Mediator in the Relationships of Spiritual Well-Being to Mental Health in Black Women with Type 2 DiabetesNewlin, K., Melkus, G.D., Peyrot, M., Koenig, H.G., Allard, E., & Chyun, D. (2011). The International Journal of Psychiatry in Medicine, 40, 439-459, 10.2190/pm.40.4.g
Denial and compliance in adults with asthma.McGann, E. F., Sexton, D., & Chyun, D. A. (2008). Clinical nursing research, 17, 151-70; discussion 171-3, 10.1177/1054773808320273
A descriptive study examining the relationship of denial of illness and compliance with inhaled controller asthma medications is conducted with 51 adults taking inhaled asthma controller medications. Affective and cognitive denial are assessed with the Levine Denial of Illness Scale. Severity is determined by portable spirometry; compliance is measured for 2 weeks with DOSER, a microelectronic monitor. The mean percent compliance rate for inhaled controller medications is 36%, with only 10.4% of the participants demonstrating optimal compliance (>80%). Although cognitive denial is not significantly associated with compliance, those in the suboptimal compliance group do have significantly higher information avoidance subscale scores (M = 1.88; p = .02). Affective denial is inversely correlated with compliance (r = -.31; p = .05) and is significantly higher in the suboptimal compliance group (M = 11.51; p =.05). These study findings suggest that affective denial may be a contributor to suboptimal compliance.
Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association.Marwick, T. H., Hordern, M. D., Miller, T., Chyun, D. A., Bertoni, A. G., Blumenthal, R. S., … (2009). Circulation, 119, 3244-62, 10.1161/CIRCULATIONAHA.109.192521
Grandparenthood status and health outcomes in midlife African American women with type 2 diabetes.Balukonis, J., Melkus, G. D., & Chyun, D. (2008). Ethnicity & disease, 18, 141-6,
To describe grandparenthood status and determine the relationship between grandparenthood status, metabolic control, and psychosocial factors in African American women with type 2 diabetes.
New definition and natural history of patients with diffuse pulmonary arteriovenous malformations: twenty-seven-year experience.Pierucci, P., Murphy, J., Henderson, K. J., Chyun, D. A., & White, R. I., Jr (2008). Chest, 133, 653-61, 10.1378/chest.07-1949
Patients with diffuse pulmonary arteriovenous malformations (PAVM), a small but important subset of the PAVM population, have significant morbidity and mortality rates.
Physiological and behavioral factors related to physical activity in black women with type 2 diabetes mellitus.Allen, N. A., Melkus, G. D., & Chyun, D. A. (2011). Journal of transcultural nursing : official journal of the Transcultural Nursing Society / Transcultural Nursing Society, 22, 376-85, 10.1177/1043659611414143
To describe relationships among physical activity (PA), physiological factors, and psychological factors in Black women with type 2 diabetes mellitus (T2DM).
Recruitment of black women with type 2 diabetes into a self-management intervention trial.Newlin, K., Melkus, G. D., Jefferson, V., Langerman, S., Womack, J., & Chyun, D. (2006). Ethnicity & disease, 16, 956-62,
The purpose of this study was to evaluate the relationship of recruitment methods to enrollment status in Black women with type 2 diabetes screened for entry into a randomized clinical trial (RCT). Using a cross-sectional study design with convenience sampling procedures, data were collected on recruitment methods to which the women responded (N=236). Results demonstrated that the RCT had a moderate overall recruitment rate of 46% and achieved only 84% of its projected accrual goal (N=109). Chi-square analysis demonstrated that enrollment outcomes varied significantly according to recruitment methods (P=.05). Recruitment methods such as community health fairs (77.8%), private practice referrals (75.0%), participant referrals (61.5%), community clinic referrals (44.6%), community advertising and marketing (40.9%), and chart review (40.4%) demonstrated variable enrollment yields. Results confirm previous findings that indicate that Black Americans may be successfully recruited into research studies at moderate rates when traditional recruitment methods are enhanced and integrated with more culturally sensitive methods. Lessons learned are considered.
Relationships of religion and spirituality to glycemic control in Black women with type 2 diabetes.Newlin, K., Melkus, G. D., Tappen, R., Chyun, D., & Koenig, H. G. Nursing research, 57, 331-9, 10.1097/01.NNR.0000313497.10154.66
Although religion and spirituality are prominent in the lives of Black women with type 2 diabetes (T2DM), there is little research on the relationships of religion and spirituality to glycemic control (GC) in this population.
Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study.Wackers, F. J., Chyun, D. A., Young, L. H., Heller, G. V., Iskandrian, A. E., Davey, J. A., … (2007). Diabetes care, 30, 2892-8, 10.2337/dc07-1250
The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes.
Self-rated competency and education/programming needs for Care of the Older Adult with Cardiovascular Disease: a survey of the members of the Council of Cardiovascular Nursing.Holm, K., Chyun, D., & Lanuza, D. M. The Journal of cardiovascular nursing, 21, 363-6,
An online survey, Care of the Older Adult with Cardiovascular Disease (COA-CVD), was used to describe self-rated competency in the care of the aging adult with cardiovascular disease and subsequently determine the future education and programming needs of the Council of Cardiovascular Nursing. Respondents indicated that developing relationships, patient teaching, and assessment were areas where they felt most competent. The areas of highest priority for future programming included assessment of the older adult, diagnosis of health status, deriving a plan of care, implementing a treatment plan, patient teaching, and ensuring quality care. Most stated that content relative to the care of the older adult should be available at the annual meeting, Scientific Sessions of the American Heart Association, followed by self-study modules (65%), local and regional conferences (64%), and stand-alone national conferences (53%). The conclusions are that the Council of Cardiovascular Nursing and its membership need to address the importance of care of aging adults with cardiovascular disease and stroke in future programming. Although the Scientific Sessions of the American Heart Association is an appropriate venue, efforts can be directed toward developing self-study modules and local and regional conferences. As always, there is a need to work collaboratively with the other councils of the American Heart Association and other nursing organizations who view the care of the older adult as a high priority.
The association of psychological factors, physical activity, neuropathy, and quality of life in type 2 diabetes.Chyun, D. A., Melkus, G. D., Katten, D. M., Price, W. J., Davey, J. A., Grey, N., … Wackers, F. J. (2006). Biological research for nursing, 7, 279-88, 10.1177/1099800405285748
The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p = .0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.
The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes.D'Eramo Melkus, G., Chyun, D., Vorderstrasse, A., Newlin, K., Jefferson, V., & Langerman, S. (2010). Biological research for nursing, 12, 7-19, 10.1177/1099800410369825
An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 +/- 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p < .0001). Systolic blood pressure (p =.01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group x time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.
Validation of dietary intake data in black women with type 2 diabetes.Amend, A., Melkus, G. D., Chyun, D. A., Galasso, P., & Wylie-Rosett, J. (2007). Journal of the American Dietetic Association, 107, 112-7, 10.1016/j.jada.2006.10.004
The validity of baseline dietary intake data in women participating in a culturally competent intervention study for black women with type 2 diabetes was assessed. The relationship of sociodemographic and physiologic factors with underreporting of dietary intake was determined. Criterion validity of dietary intake, which had been assessed using the Nutritionist Five Collection Form, a combination of a standard 2-day dietary recall and a modified, culturally appropriate food frequency questionnaire, was determined. Data were analyzed using First Data Bank Nutritionist Five (version 2.3, 2000, First Data Bank, San Bruno, CA) software. Validation of baseline dietary data in 109 women was performed by calculating the ratio of energy intake to resting metabolic rate. Chi(2) and t tests were used to assess relationships between underreporting and sociodemographic and physiologic factors. Mean ratio of energy intake to resting metabolic rate was 1.46 (+/-0.4). Using a lower limit of 1.35, the prevalence of underreporting was 46.8%. Underreporting was significantly associated with body mass index (P< or =0.001) and waist circumference (P<0.001). Use of this combined dietary recall and modified food frequency questionnaire might, therefore, provide more accurate dietary assessment in this population. Additional modification and validity testing is warranted in this and other populations.