Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study.

This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.

Pharmacotherapy of Type 2 Diabetes Mellitus: Navigating Current and New Therapies.

The keys to optimal glycemic control in patients with type 2 diabetes are early diagnosis and interventions that include lifestyle changes and pharmacotherapy. This review discusses therapeutic goals and current options for treatment of type 2 diabetes.

Correction to: HRQOL in Diverse Ethnic Groups with Diabetes: Findings from the 2014 BRFSS.

The following corrections to this article as originally published should be noted:In the first sentence of the abstract, "non-Hispanic Whites, non-Hispanic Blacks, and Hispanics adults with diabetes" should read "non-Hispanic White, non-Hispanic Black, and Hispanic adults with diabetes".

A Mechanistic Model of Gut-Brain Axis Perturbation and High-Fat Diet Pathways to Gut Microbiome Homeostatic Disruption, Systemic Inflammation, and Type 2 Diabetes.

Type 2 diabetes (T2D) is a highly prevalent metabolic disease, affecting nearly 10% of the American population. Although the etiopathogenesis of T2D remains poorly understood, advances in DNA sequencing technologies have allowed for sophisticated interrogation of the human microbiome, providing insight into the role of the gut microbiome in the development and progression of T2D. An emerging body of research reveals that gut-brain axis (GBA) perturbations and a high-fat diet (HFD), along with other modifiable and nonmodifiable risk factors, contribute to gut microbiome homeostatic imbalance. Homeostatic imbalance or disruption increases gut wall permeability and facilitates translocation of endotoxins (lipopolysaccharides) into the circulation with resultant systemic inflammation. Chronic, low-grade systemic inflammation ensues with pro-inflammatory pathways activated, contributing to obesity, insulin resistance (IR), pancreatic ß-cell decline, and, thereby, T2D. While GBA perturbations and HFD are implicated in provoking these conditions, prior mechanistic models have tended to examine HFD and GBA pathways exclusively without considering their shared pathways to T2D. Addressing this gap, this article proposes a mechanistic model informed by animal and human studies to advance scientific understanding of (1) modifiable and nonmodifiable risk factors for gut microbiome homeostatic disruption, (2) HFD and GBA pathways contributing to homeostatic disruption, and (3) shared GBA and HFD pro-inflammatory pathways to obesity, IR, ß-cell decline, and T2D. The proposed mechanistic model, based on the extant literature, proposes a framework for studying the complex relationships of the gut microbiome to T2D to advance study in this promising area of research.

HRQOL in Diverse Ethnic Groups with Diabetes: Findings from the 2014 BRFSS.

OBJECTIVE: The study's objective is to examine differences in mental and physical health-related quality of life (HRQOL) in non-Hispanic White, non-Hispanic Black, and Hispanic adults with diabetes. DESIGN: A secondary analysis of 2014 Behavioral Risk Factor Surveillance System (BRFSS) data was conducted. A total of 26 states participated in the 2014 BRFSS core and optional diabetes models (n = 17,923). HRQOL was measured by the number of mentally and physically unhealthy days during the past month, respectively. A series of regression models were developed to assess differences in HRQOL without and with inclusion of demographic (age, marital status, income, gender, and education) and diabetes-related (depression, sleep time, insulin use, complications, age of diabetes diagnosis, BMI, smoking, and exercise) factors. RESULTS: In the fully adjusted models (inclusion of demographic and diabetes-related factors), non-Hispanic Whites had more mentally (ß = 0.88, p = 0.03) and physically (ß = 1.35, p = 0.01) unhealthy days per month compared to Hispanics. Non-Hispanic Blacks (ß = 1.42, p < 0.01) also had more mentally unhealthy days per month in relation to Hispanics when adjusting for demographic and diabetes-related factors. Depression emerged as a potent predictor of mentally (ß = 8.60; p < 0.0001) and physically (ß = 4.43; p < 0.0001) unhealthy days in the multivariate models. CONCLUSION: Non-Hispanic Black and White adults with diabetes may be more vulnerable to poor HRQOL compared to their Hispanic counterparts. Increased, widened application of diabetes interventions targeting depression appears warranted to improve HRQOL outcomes.

Combined Diabetes Prevention and Disease Self-Management Intervention for Nicaraguan Ethnic Minorities: A Pilot Study.

BACKGROUND: Informed by formative community-based participatory research (CBPR), we developed a combined model of diabetes prevention and self-management. OBJECTIVES: To assess the feasibility, acceptability, and preliminary efficacy of our CBPR-inspired model. METHODS: A mixed methods study was conducted using a pre-experimental design. The setting was a church-based clinic located on Nicaragua's rural Atlantic coast. Miskitos and Creoles with or at risk for diabetes were sampled. Preliminary efficacy was assessed with A1C, weight, and quality of life (QOL) measures at baseline, 3 months, and 6 months. An open-ended survey assessed intervention satisfaction. The 8-week, registered nurse (RN)-led intervention emphasized knowledge acquisition and behavioral strategies for dietary, physical activity, and medication regimen adherence. Paired t tests were computed to assess preliminary efficacy. Content analysis was conducted to assess intervention acceptability. RESULTS: A total of 42 participants were enrolled. For participants completing follow-up data collection (n = 33), mean A1C improved from 8.8% to 8.3% (t = -2.19; p = .04) from baseline to 3 months. Among participants with a baseline A1C of greater than 7.5% (n = 24), the mean A1C decreased from 9.7% to 9.0% from baseline to 3 months (t = -2.86; p = .01), and to 8.7% at 6 months (t = -3.00; p = .01). Nonsignificant weight changes were observed. Mental health QOL improved, on average from baseline to 3 months (t = 2.20; p = .04) and 6 months (t = 4.7; p < .01) for the sample. An increase in mean physical health QOL was observed from baseline to 3 months (t = 2.91; p < .01). The intervention was found to be acceptable. Study feasibility was good, with successful research capacitation and achievement of sampling goals. CONCLUSIONS: Findings suggest our novel intervention holds promise for wider application to reduce diabetes burden among Nicaraguan ethnic minorities.

Therapeutic options for lowering LDL-C in type 2 diabetes: a nurse practitioner's perspective.

PURPOSE: The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management. DATA SOURCES: The evidence used in developing this review included evidence-based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines. CONCLUSIONS: Lowering LDL-C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid-lowering agents remain good options. IMPLICATIONS FOR PRACTICE: Achieving LDL-C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self-management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.