Deborah A Chyun

Abstract

OBJECTIVE - The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - Participants enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study underwent repeat adenosine-stress myocardial perfusion imaging 3 years after initial evaluation. Patients with intervening cardiac events or revascularization and those who were unable or unwilling to repeat stress imaging were excluded. RESULTS - Of the initial 522 DIAD patients, 358 had repeat stress imaging (DIAD-2), of whom 71 (20%) had ischemia at enrollment (DIAD-1). Of 287 patients with normal DIAD-1 studies, 259 (90%) remained normal in DIAD-2, whereas 28 (10%) developed new ischemia in DIAD-2. Of the 71 patients with abnormal DIAD-1 studies, 56 (79%) demonstrated resolution of ischemia, whereas 15 (21%) remained abnormal. During this 3-year interval, medical treatment was intensified, with more patients using statins, aspirin, and ACE inhibitors than at baseline. Patients with resolution of ischemia had significantly greater increases in these medications than patients who developed new ischemia (P = 0.04). CONCLUSIONS - Thus, the majority of asymptomatic patients with type 2 diabetes demonstrated resolution of ischemia upon repeat stress imaging after 3 years. This resolution was associated with more intensive treatment of cardiovascular risk factors.

Abstract

BACKGROUND:: 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. OBJECTIVES:: The objective of this article was to evaluate usefulness of the item: "Do you have regular dental checkups?" as a means to decide whether an oral health assessment or further referral is indicated. Answering no is postulated as a positive predictor of poor oral health and need for care. METHODS:: This study was a secondary analysis of a nutritional survey of 240 community-dwelling elders. Examiner-rated Kayser-Jones Brief Oral Health Status Examination; self-reported General Oral Health Assessment Index; number of remaining teeth; and pattern of checkups (regular vs. irregular) were evaluated by a trained gerontological nurse practitioner during an in-home assessment. RESULTS:: A dental visit within the past year for any reason was reported by 132 subjects (55.0%), but only 81 (33.8%) reported some sort of regular dental checkups. For dentate elders (n ≤ 147), an irregular checkup was associated with lower educational level, Protestant faith, and Black race. People with irregular checkups scored significantly lower on all three oral indices. The negative predictive values and likelihood ratio negative values ranged 98.7-100.0% and 0.00-0.98, respectively, indicating that this item of interest is valid for ruling-out dentate subjects with good oral health. For edentulous elders (n ≤ 93), the item was less effective. DISCUSSION:: A single item, "Do you have regular dental checkups?" can be used effectively to rule out dentate elders with good oral health and identify those who are in need of further oral health assessment or referrals.

Abstract

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. χ2 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≤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.

Abstract

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.

Abstract

Although short- and long-term outcomes in individuals with DM following ACS, PCI, and CABG have improved over the past decade, CVD continues to be an important cause of morbidity and mortality in this population. Nursing has a critical role in the prevention of CVD, and in the early detection of symptomatic and asymptomatic CHD. Following ACS, PCI, or CABG, ongoing assessment for new ischemia, HF, or renal insufficiency, and specific complications of ACS or revascularization is crucial. Long-term prevention of recurrent ischemia, ACS, HF, and death necessitates multifactorial CHD risk factor reduction, along with aggressive glucose control, in all individuals with DM.