Diabetes In African Americans Research Articles

Factors influencing the mortality risk of heart failure in patients receiving antineoplastic immunotherapy: A national inpatient database study 2016-2020.

e24011 Background: Immunotherapy is increasingly being used for management of solid and lymphoproliferative tumors due to their more desirable side effect profile as compared to traditional cancer therapies. However, these medications are associated with cardiac complications and little is known about the factors influencing the prognosis in these patients. Methods: This is a retrospective analysis of the National Inpatient Database from 2016 to 2020 using the International Classification of Diseases (ICD) 10 codes performed with STATA BE 18.0. Chi square test was used for crude analysis and multivariate logistic regression was performed to assess the risk of inpatient death among cancer patients with heart failure receiving immunotherapy. Results were adjusted for potential confounders like age, gender, race, hypertension, diabetes, coronary artery disease, smoking, and alcohol consumption. Multicollinearity of the model was assessed using Variance Inflation Factor (VIF) post-estimation test. Results: Out of 5166 cancer patients receiving immunotherapy with a mean age of 43.63 土 26.33 years and 41% females, 45 patients had heart failure. Logistic regression showed that heart failure was significantly associated with mortality (LR 𝜒² 38.74, p value < 0.001) on adjusting for potential confounders. Although the effect size was small, increased age (OR 1.025, CI 1.01-1.04) had a significantly higher risk of mortality. Patients belonging to the female gender and white, hispanic, and asian races had a lower risk of mortality while those belonging to the african american race and those with coronary artery disease had a higher mortality risk, although not statistically significant. Diabetes and alcohol consumption had a fourfold and sixfold increased risk of mortality respectively. Hypertension and smoking that are known to increase mortality risk in heart failure patients showed a paradoxically protective effect in this cohort. Conclusions: This study highlights the importance of risk stratification and prognostication among patients with heart failure receiving antineoplastic immunotherapy. Increased age, african american race, diabetes, alcohol consumption, and coronary artery disease have shown an increased mortality risk in these patients. [Table: see text]

Risk Factors of Failure to Discharge Before “Two Midnights” in Outpatient-Designated Total Hip Arthroplasty

Introduction: The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only list but continued to classify admissions as inpatient if they include two midnights, complicating care if an outpatient THA requires extended hospitalization. This study evaluates risk factors of patients undergoing outpatient-designated THA with a length of stay (LOS) ≥ 2 days. Methods: A total of 17,063 THA procedures designated as outpatient in the National Surgical Quality Improvement Program database between 2015 and 2020 were stratified by LOS < 2 days (n = 2,294, 13.4%) and LOS ≥ 2 days (n = 14,765, 86.6%). Demographics, comorbidities, and outcomes were compared by univariate analysis. Multivariable regression analysis identified predictors of LOS ≥ 2 days. Results: Outpatients with extended LOS were older (mean 65.3 vs. 63.5 years; P < 0.01); were more likely to have body mass index (BMI) > 35 (24.0 vs. 17.8%; P < 0.01); and had higher incidences of smoking (15.1% vs. 10.3%; P < 0.01), diabetes (15.4% vs. 9.9%; P < 0.01), chronic obstructive pulmonary disease (4.4% vs. 2.3%; P < 0.01), and hypertension (57.6% vs. 49.2%; P < 0.01). Patients with LOS ≥ 2 days had a higher incidence of surgical site infection (P < 0.01), hospital readmission (P < 0.01), and revision surgery (P < 0.01) over 30 days. Multivariable analysis demonstrated advanced age, female sex, African American race, Hispanic ethnicity, diabetes, smoking, and hypertension were independent risk factors for LOS ≥ 2 days. Conclusion: Despite removal from the inpatient-only list, a subset of outpatient THA remains at risk of an extended LOS. This study informs surgeons on the relevant risk factors of extended stay, enabling early inpatient preauthorization.

Polygenic Risk for Type 2 Diabetes in African Americans.

African Americans (AAs) have been underrepresented in polygenic risk score (PRS) studies. Herein, we integrated genome-wide data from multiple observational studies on type 2 diabetes (T2D), encompassing a total of 101,987 AAs, to train and optimize an AA focused T2D PRS (PRSAA), using a Bayesian polygenic modeling method (PRS-CS). We further tested the score in three independent studies with a total of 7,275 AAs. We then compared the PRSAA to other published scores. Results show that a 1 standard deviation increase in the PRSAA was associated with 40%-60% increase in the odds of T2D (OR=1.60, 95% CI 1.37-1.88; OR=1.40, 95% CI 1.16-1.70; and OR=1.45, 95% CI 1.30-1.62) across three testing cohorts. These models captured 1.0%-2.6% of the variance (R2) in T2D on the liability scale. The positive predictive values (PPV) for three calculated score thresholds (the top 2%, 5% 10%) ranged from 14% to 35%. The PRSAA, in general, performed similarly to existing T2D PRS. Larger datasets remain needed to continue to evaluate the utility of within-ancestry scores in the AA population.

Serum Bicarbonate Is Associated with Bone Density Among Adults with Type 2 Diabetes: Results from the African American Diabetes Heart Study

Serum Bicarbonate Is Associated with Bone Density Among Adults with Type 2 Diabetes: Results from the African American Diabetes Heart Study

Quantifying association and disparities between diabetes complications and COVID-19 outcomes: A retrospective study using electronic health records.

Despite established relationships between diabetic status and an increased risk for COVID-19 severe outcomes, there is a limited number of studies examining the relationships between diabetes complications and COVID-19-related risks. We use the Adapted Diabetes Complications Severity Index to define seven diabetes complications. We aim to understand the risk for COVID-19 infection, hospitalization, mortality, and longer length of stay of diabetes patients with complications. We perform a retrospective case-control study using Electronic Health Records (EHRs) to measure differences in the risks for COVID-19 severe outcomes amongst those with diabetes complications. Using multiple logistic regression, we calculate adjusted odds ratios (OR) for COVID-19 infection, hospitalization, and in-hospital mortality of the case group (patients with diabetes complications) compared to a control group (patients without diabetes). We also calculate adjusted mean difference in length of stay between the case and control groups using multiple linear regression. Adjusting demographics and comorbidities, diabetes patients with renal complications have the highest odds for COVID-19 infection (OR = 1.85, 95% CI = [1.71, 1.99]) while those with metabolic complications have the highest odds for COVID-19 hospitalization (OR = 5.58, 95% CI = [3.54, 8.77]) and in-hospital mortality (OR = 2.41, 95% CI = [1.35, 4.31]). The adjusted mean difference (MD) of hospital length-of-stay for diabetes patients, especially those with cardiovascular (MD = 0.94, 95% CI = [0.17, 1.71]) or peripheral vascular (MD = 1.72, 95% CI = [0.84, 2.60]) complications, is significantly higher than non-diabetes patients. African American patients have higher odds for COVID-19 infection (OR = 1.79, 95% CI = [1.66, 1.92]) and hospitalization (OR = 1.62, 95% CI = [1.39, 1.90]) than White patients in the general diabetes population. However, White diabetes patients have higher odds for COVID-19 in-hospital mortality. Hispanic patients have higher odds for COVID-19 infection (OR = 2.86, 95% CI = [2.42, 3.38]) and shorter mean length of hospital stay than non-Hispanic patients in the general diabetes population. Although there is no significant difference in the odds for COVID-19 hospitalization and in-hospital mortality between Hispanic and non-Hispanic patients in the general diabetes population, Hispanic patients have higher odds for COVID-19 hospitalization (OR = 1.83, 95% CI = [1.16, 2.89]) and in-hospital mortality (OR = 3.69, 95% CI = [1.18, 11.50]) in the diabetes population with no complications. The presence of diabetes complications increases the risks of COVID-19 infection, hospitalization, and worse health outcomes with respect to in-hospital mortality and longer hospital length of stay. We show the presence of health disparities in COVID-19 outcomes across demographic groups in our diabetes population. One such disparity is that African American and Hispanic diabetes patients have higher odds of COVID-19 infection than White and Non-Hispanic diabetes patients, respectively. Furthermore, Hispanic patients might have less access to the hospital care compared to non-Hispanic patients when longer hospitalizations are needed due to their diabetes complications. Finally, diabetes complications, which are generally associated with worse COVID-19 outcomes, might be predominantly determining the COVID-19 severity in those infected patients resulting in less demographic differences in COVID-19 hospitalization and in-hospital mortality.

Metabolomic profiling of glucose homeostasis in African Americans: the Insulin Resistance Atherosclerosis Family Study (IRAS-FS)

IntroductionAfrican Americans are at increased risk for type 2 diabetes.ObjectivesThis work aimed to examine metabolomic signature of glucose homeostasis in African Americans.MethodsWe used an untargeted liquid chromatography-mass spectrometry metabolomic approach to comprehensively profile 727 plasma metabolites among 571 African Americans from the Insulin Resistance Atherosclerosis Family Study (IRAS-FS) and investigate the associations between these metabolites and both the dynamic (SI, insulin sensitivity; AIR, acute insulin response; DI, disposition index; and SG, glucose effectiveness) and basal (HOMA-IR and HOMA-B) measures of glucose homeostasis using univariate and regularized regression models. We also compared the results with our previous findings in the IRAS-FS Mexican Americans.ResultsWe confirmed increased plasma metabolite levels of branched-chain amino acids and their metabolic derivatives, 2-aminoadipate, 2-hydroxybutyrate, glutamate, arginine and its metabolic derivatives, carbohydrate metabolites, and medium- and long-chain fatty acids were associated with insulin resistance, while increased plasma metabolite levels in the glycine, serine and threonine metabolic pathway were associated with insulin sensitivity. We also observed a differential ancestral effect of glutamate on glucose homeostasis with significantly stronger effects observed in African Americans than those previously observed in Mexican Americans.ConclusionWe extended the observations that metabolites are useful biomarkers in the identification of prediabetes in individuals at risk of type 2 diabetes in African Americans. We revealed, for the first time, differential ancestral effect of certain metabolites (i.e., glutamate) on glucose homeostasis traits. Our study highlights the need for additional comprehensive metabolomic studies in well-characterized multiethnic cohorts.

ODP203 Health Questionnaires are a Positive Behavioral Modifier In Patients with Impaired Blood Sugar In the African American Population.

Abstract Type 2 diabetes and its complications have a higher incidence in African Americans as compared to other racial groups (1). As per the American Diabetes Association, the prevalence of diabetes in non-Hispanic African American patients is 11.7% compared to 7.5% in non-Hispanic white patients. However, few studies have explored what can be done to spark a positive behavioral change leading to lower blood sugar. The purpose of this study is to evaluate if a patient filling out a health questionnaire has any impact on his or her habits by enhancing self-management and awareness to reduce HbA1c. Methods In an outpatient urban clinic, a prospective randomized study was conducted with African American patients with prediabetes with HbA1c 5.6 to 6.7. Patients were randomly assigned to either a survey group or a control group who did not take a survey. The survey included demographic information, weight, diabetes mellitus complication awareness, exercise frequency 3-5 days/week, eating habits, and self-perception. The patients in the survey group filled a follow-up survey 3-6 months later. Results The survey group had 50 respondents and 46 respondents who took the post-survey compared to the control group for which there were 50 respondents with 47 respondents in the control follow-up. In the survey group, 54% were males with an average age of 57 years. In the survey group, on followup HbA1c decreased (6.1 vs 5.7 p<0. 021), BMI decreased (32 vs 29.1 p<0.562), exercise frequency 3-5 days/week increased (10% to 35% p=0. 041), awareness of diabetic complication improved (15 to 74% p=0. 029), willingness to see a dietician increased (28% to 60% p=0. 038), and probability of reading nutrition labels increased (16% to 38% p=0. 058). In the control group, 58% were males with an average age of 56 years. In the control group, on followup HbA1c increased (6.1 vs 6.2), BMI increased (32 vs 33), exercise frequency 3-5 days/week increased (13% to 19% p=0.820), awareness of diabetic complication improved (12%to 16% p=0.673), willingness to see a dietician increased (29% to 38% p=0.340), and probability of reading nutrition labels increased (14% to 19% p=0.646). Conclusion Health questionnaires served as a positive behavioral modifier and helped patients identify and correct their harmful lifestyle habits. Patients in the survey group showed larger amounts of positive change compared to patients in the control group. Reference: (1) Marshall MC Diabetes in African Americans. Postgraduate Medical Journal2005;81: 734-740. Presentation: No date and time listed

Nontargeted and Targeted Metabolomic Profiling Reveals Novel Metabolite Biomarkers of Incident Diabetes in African Americans.

Nontargeted metabolomics methods have increased potential to identify new disease biomarkers, but assessments of the additive information provided in large human cohorts by these less biased techniques are limited. To diversify our knowledge of diabetes-associated metabolites, we leveraged a method that measures 305 targeted or "known" and 2,342 nontargeted or "unknown" compounds in fasting plasma samples from 2,750 participants (315 incident cases) in the Jackson Heart Study (JHS)-a community cohort of self-identified African Americans-who are underrepresented in omics studies. We found 307 unique compounds (82 known) associated with diabetes after adjusting for age and sex at a false discovery rate of <0.05 and 124 compounds (35 known, including 11 not previously associated) after further adjustments for BMI and fasting plasma glucose. Of these, 144 and 68 associations, respectively, replicated in a multiethnic cohort. Among these is an apparently novel isomer of the 1-deoxyceramide Cer(m18:1/24:0) with functional geonomics and high-resolution mass spectrometry. Overall, known and unknown metabolites provided complementary information (median correlation ρ = 0.29), and their inclusion with clinical risk factors improved diabetes prediction modeling. Our findings highlight the importance of including nontargeted metabolomics methods to provide new insights into diabetes development in ethnically diverse cohorts.

Alzheimer's disease: a step closer to understanding type 3 diabetes in African Americans.

Alzheimer's disease (AD) is the fourth leading cause of death in the United States and the most common cause of adult-onset dementia. Recent results suggest an increased prevalence and severity in African Americans compared to Caucasians. Our understanding of the potential mechanism(s) underlying this ethnicity difference is limited. We previously described ethnicity-related differences in levels of neurodegenerative proteins and cytokines/chemokines in the BA21 region of African Americans and Caucasians with AD. Here, similar multiplex assays were used to examine those endpoints in patient postmortem cerebrospinal fluid (CSF). Additionally, we measured levels of C-peptide, ghrelin, gastric inhibitory polypeptide (GIP), glucagon-like peptide-1 (GLP-1), glucagon, insulin, leptin, PAI-1, resistin, and visfatin using a human diabetes 10-plex assay. The cytokine and chemokine assays revealed that levels of 26 chemokines or cytokines differed significantly with ethnicity, and three of those were significantly associated with gender. The neurodegenerative disease panel indicated that levels of soluble RAGE were significantly elevated in African Americans compared to Caucasians. All measures in the diabetes disease panel assay were significantly elevated in African Americans: ghrelin, GIP, GLP-1, glucagon, insulin, and visfatin. Through peripheral sample analysis, these results provide further evidence that ethnicity is critically involved in the manifestation of AD.

Genome-wide association study of vitamin D concentrations and bone mineral density in the African American-Diabetes Heart Study.

Relative to European Americans, African Americans have lower 25-hydroxyvitamin D (25OHD) and vitamin D binding protein (VDBP) concentrations, higher 1,25-dihydroxyvitamin D (1,25(OH)2D3) concentrations and bone mineral density (BMD), and paradoxically reduced burdens of calcified atherosclerotic plaque (subclinical atherosclerosis). To identify genetic factors contributing to vitamin D and BMD measures, association analysis of >14M variants was conducted in a maximum of 697 African American-Diabetes Heart Study participants with type 2 diabetes (T2D). The most significant association signals were detected for VDBP on chromosome 4; variants rs7041 (β = 0.44, SE = 0.019, P = 9.4x10-86) and rs4588 (β = 0.17, SE = 0.021, P = 3.5x10-08) in the group-specific component (vitamin D binding protein) gene (GC). These variants were found to be independently associated. In addition, rs7041 was also associated with bioavailable vitamin D (BAVD; β = 0.16, SE = 0.02, P = 3.3x10-19). Six rare variants were significantly associated with 25OHD, including a non-synonymous variant in HSPG2 (rs116788687; β = -1.07, SE = 0.17, P = 2.2x10-10) and an intronic variant in TNIK (rs143555701; β = -1.01, SE = 0.18, P = 9.0x10-10), both biologically related to bone development. Variants associated with 25OHD failed to replicate in African Americans from the Insulin Resistance Atherosclerosis Family Study (IRASFS). Evaluation of vitamin D metabolism and bone mineral density phenotypes in an African American population enriched for T2D could provide insight into ethnic specific differences in vitamin D metabolism and bone mineral density.

African American Ethnicity, Hypertension, Diabetes, and Arthritis Independently Predict Co-occurring Depression and Obesity among Community-dwelling Older Adult Alabamians

ABSTRACT Although obesity and depression are quite common among older adults, surprisingly published literature has not examined factors associated with co-occurring depression and obesity among older adults. The knowledge that fills this gap would be advantageous for public health social workers and other health professionals who provide health care and public health services to older adults. The objectives of this study were to access the prevalence of and independent predictors of co-occurring depression and obesity among older adults in the state of Alabama. A retrospective analysis was conducted using a statewide survey of Alabamian community-dwelling older adults (n = 1,166). Binomial logistic regression was used to examine predictors of co-occurring depression and obesity. The prevalence of co-occurring depression and obesity among older adults was 16%. In the multivariate analysis, African American ethnicity (OR = 1.505, CI: 1.019–2.223), hypertension (OR = 1.593, CI: 1.050–2.416), diabetes (OR = 1.768, CI: 1.188–2.632), and arthritis (OR = 1.640, CI: 1.096–2.454) were positively associated with co-occurring depression and obesity). Older age (OR = 0.963, CI: 0.942–0.985) and higher levels of physical activity (OR = 1.640, CI: 1.096–2.454) were negatively associated with co-occurring depression and obesity. There is a need for the development and implementation of suitable interventions to prevent and manage co-occurring depression and obesity among older adults, particularly older adults with arthritis, hypertension, diabetes, or of African American ethnicity.

Using Health Coaching to Improve Glycemic Control in African-American Diabetics: An Integrative Review

Using Health Coaching to Improve Glycemic Control in African-American Diabetics: An Integrative Review

An assessment of baseline risk factors for peripartum maternal critical care interventions

Background Maternal morbidity presents a growing challenge to the American healthcare system and increasing numbers of patients are requiring higher levels of care in pregnancy. Identifying patients at high risk for critical care interventions, including intensive care unit admission, during delivery hospitalizations may facilitate appropriate multidisciplinary planning and lead to improved maternal safety. Baseline risk factors for critical care in pregnancy have not been well-described previously. Objective This study assesses baseline factors associated with critical care interventions that were present at admission for delivery. Study design This is a secondary analysis of a multicenter observational registry of pregnancy after prior uterine surgery and primary cesarean delivery. All women with known gestational age were included. The primary outcome measure was a composite of critical care interventions that included postpartum intensive care unit admission, mechanical ventilation, central intravenous access, and arterial line placement. Risk for this critical care outcome measure was compared by selected baseline and obstetric characteristics known at the time of hospital admission, including maternal age, pre-pregnancy BMI, race, maternal co-morbidities, parity, and plurality. We evaluated these potential predictors and fit a multivariable logistic regression model to ascertain the most significant risk factors for critical care during a delivery hospitalization. Results 73,096 of 73,257 women in the parent trial met inclusion criteria, of whom 505 underwent a critical care intervention (0.7%). In the adjusted model, heart disease [aOR = 10.05, CI = 6.97 − 14.49], renal disease [aOR = 2.78, CI = 1.49 − 5.18], and connective tissue disease [aOR = 3.27, CI = 1.52 − 6.99], as well as hypertensive disorders of pregnancy [aOR = 2.04, CI = 1.31 − 3.17] were associated with the greatest odds of critical care intervention [p < .01] (Table 2). Other predictors associated with increased risk included maternal age, African American race, smoking, diabetes, asthma, anemia, nulliparity, and twin pregnancy. Conclusion In this cohort, women with cardiac disease, renal disease, connective tissue disease and preeclampsia spectrum disorders were at increased risk for critical care interventions. Obstetric providers should assess patient risk routinely, ensure appropriate maternal level of care, and create multidisciplinary plans to improve maternal safety and reduce risk.

1577-P: How Does Military Service Impact Risk for Diabetes in African Americans with a History of Adverse Childhood Experiences?

Background: African Americans (AA) in the general population have double the odds for developing diabetes (DM). In addition, older age and a score of 4+ on the Adverse Childhood Experiences (ACE) inventory has been associated with increased risk for DM; education has been found to moderate risk. In addition, military service disproportionately attracts those with high ACE; however, educational opportunity is more readily available. We explored the effect of military service on the risk for developing diabetes in AA with high ACE. Methods: We analyzed 2009-2012 BRFSS data from U.S. states opting to include an ACE module (n=117,084). AA (n=8715) comprise about 9.3% of this sample after weighted for representativeness. Results: In the overall sample, age (OR= 1.04, 95% CI = 1.05-1.05), high ACE (4+; OR = 1.38, 95% CI =1.24-1.53), and being AA (OR = 2.1, 95% CI = 1.88-2.34) all significantly (p &amp;lt; .001) increase likelihood of developing DM, and education reduces it (OR = 0.80, 95% CI = 0.77-0.83; p &amp;lt; .001). Controlling for age, males are more likely to have a history of military service (OR = 23.7, 95% CI = 20.9-26.9, p &amp;lt; .001). Those with high ACE are more likely to enlist (OR = 1.66, 95% CI = 1.45-1.90, p &amp;lt; .001) and AAs are more likely to enlist (OR = 1.27, 95% CI =1.09-1.47, p &amp;lt; .01) compared to other races. Furthermore, when examining just AAs, those with military service have an increased likelihood of developing DM (OR = 1.24, 95% CI = 1.12-1.38). However, 2009-10 data show current active duty and those who served within one year may experience some protective effects; when controlling for age, they have the same or decreased DM compared to other veterans or civilians. Discussion: Military service does not buffer the risk for DM in AAs with high ACE, regardless of education. This may be partially due to an increase in ACE among those with a history of military service and the inclusion of the Veteran Administration population, which tend to have increase co-morbidities. Disclosure J.L. Wardian: None. E. Stone: None.

A Multilevel Diabetes and CVD Risk Reduction Intervention in African American Churches: Project Faith Influencing Transformation (FIT) Feasibility and Outcomes.

Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most AAs are overweight/obese, which is a primary clinical risk factor for diabetes/CVD. Using a faith-community-engaged approach, this study examined feasibility and outcomes of Project Faith Influencing Transformation (FIT), a diabetes/CVD screening, prevention, and linkage to care pilot intervention to increase weight loss in AA church-populations at 8months. Six churches were matched and randomized to multilevel FIT intervention or standard education control arms. Key multilevel religiously tailored FIT intervention components included: (a) individual self-help materials (e.g., risk checklists, pledge cards); (b) YMCA-facilitated weekly group Diabetes Prevention Program (DPP) weight loss classes; (c) church service activities (e.g., sermons, responsive readings); and (d) church-community text/voice messages to promote healthy eating and physical activity. Health screenings (e.g., weight, blood pressure, blood glucose) were held during church services to identify participants with diabetes/CVD risks and refer them to their church's DPP class and linkage to care services. Participants (N= 352 church members and community members using churches' outreach ministries) were primarily female (67%) and overweight/obese (87%). Overall, FIT intervention participants were significantly more likely to achieve a>5lb weight loss (OR = 1.6; CI = 1.24, 2.01) than controls. Odds of intervention FIT-DPP participants achieving a >5lb weight loss were 3.6 times more than controls (p< .07). Exposure to sermons, text/email messages, brochures, commitment cards, and posters was significantly related to > 5lb. weight loss. AA churches can feasibly assist in increasing reach and impact of diabetes/CVD risk reduction interventions with intensive weight loss components among at risk AA church-populations.

Abstract P189: Metabolomic Signatures Of Serum Creatinine Among Hypertensive African Americans.

Background: The prevalence of chronic kidney disease (CKD) in African Americans (AAs) is high. Although ancestry-specific biomarkers have been identified, few translate to the clinic. Metabolomic studies may identify novel biomarkers useful for prevention, diagnosis and treatment. Methods: Plasma from 300 AA Hypertension Genetic Epidemiology Network (HyperGEN) study participants age ≥40 years with serum creatinine (SCr) &lt;2 mg/dL were assayed for an untargeted metabolomic study of SCr using an ultra-high performance liquid chromatography mass spectrometry platform (Metabolon ® ). SCr was measured using a thin-film adaptation of the amidohydrolase enzymatic method on fasting blood samples. Each metabolite was tested for normality and a rank-based inverse normal transformation was performed as appropriate. Multivariable linear regression was used to test for association between the metabolite (outcome) and SCr (exposure of interest) adjusting for age, gender, waist circumference and center. A Bonferroni correction was used to adjust for multiple testing using. The top 25 most significant metabolites were evaluated for replication in 367 participants from the African American-Diabetes Heart Study (AA-DHS). An exploratory pathway analysis was conducted among significant (p&lt; 6.0*10 -5 6.0e -5 metabolites in HyperGEN. Results: Among 300 participants from HyperGEN the mean age was 54.5 years (SD=9.5) and 58.7% were female. Mean SCr was 0.93 (SD=0.25). Eighty percent were treated for hypertension and 28% had diabetes. A total of 809 metabolites were annotated in HyperGEN samples. Of those, 391 were associated with SCr at p&lt;0.05 and 256 metabolites met the Bonferroni significance criteria (p&lt; 6.0*10 -5 ). The top SCr associated metabolites were tartonate(hydroxymalonate)(β[SE]= 2.99[0.07], p=3.98e -117 ), 1-stearoyl-GPC(18:0)(β[SE]= 2.49[0.14], p=2.28e -44 ), 2S-3R-dihydroxybutyrate)(β[SE]= 2.36[0.14],p=1.53e -40 ) and isovalerate(C5)( β[SE]= 2.30[0.15], p = 2.78e -36 ). The association of these metabolites with SCr replicated in AA-DHS [(tartonate(hydroxymalonate)(β[SE]= 0.66[0.19], p=0.001), 1-stearoyl-GPC(18:0)(β[SE]= 1.30[0.20], p=1.61 -10 ), 2S-3R-dihydroxybutyrate)(β[SE]= 1.20[0.18],p=4.69e -11 ) and isovalerate(C5)( β[SE]= 1.24[0.20], p = 1.91e -09 )]. An exploratory pathway analysis highlighted xenobiotics and the lysophospholipid pathway. Significance: Tartronate is a xenobiotic that is related to BMI, insulin resistance and adiponectin. 1-stearoyl-GPC (18:0) is a lysophospholipid metabolite found to be associated with oxidative stress. Conclusion: The current study discovered and replicated metabolites associated with SCr in a population of AAs with a high prevalence of hypertension. If validated, these could provide new insights in kidney disease pathways or aid in the treatment and prevention of CKD in the AA population.

Race affects the association of obesity measures with insulin sensitivity

Race differences in body composition and fat distribution may in part explain the differences in insulin sensitivity and the disproportionate burden of type 2 diabetes in African Americans. To determine if differences in body composition and fat distribution explain race differences in insulin sensitivity and identify obesity measures that were independently associated with insulin sensitivity. Participants were 113 lean, overweight, and obese African-American and Caucasian-American adults without diabetes. Skeletal muscle insulin sensitivity was determined using a hyperinsulinemic-euglycemic clamp (SIClamp, insulin rate:120 mU/m2/min). Subcutaneous abdominal adipose tissue (SAAT), intra-abdominal adipose tissue (IAAT), and liver fat were measured by MRI; leg fat, total fat, and lean mass were measured by DXA. Race-by-adiposity interactions were significant in cross-sectional analyses utilizing multiple linear regression models for SIClamp (P<0.05); higher BMI, fat mass, SAAT, leg fat, and liver fat were associated with lower SIClamp in Caucasian Americans but not African Americans. Race-by-IAAT interaction was not significant (P=0.65). A central fat distribution (SAAT adjusted for leg fat) was associated with lower SIClamp in African Americans (β = -0.45, SE=0.11, P<0.001) but not Caucasian Americans (β = -0.42, SE=0.30, P=0.17). A peripheral fat distribution (leg fat adjusted for IAAT/SAAT) was associated with a higher SIClamp in African Americans (β = 0.11, SE=0.05, P=0.02) but lower SIClamp in Caucasian Americans (β = -0.28, SE=0.14, P=0.049). Lean mass was inversely associated with SIClamp in African Americans (β = -0.05, SE=0.03, P=0.04) but not Caucasian Americans (β = 0.08, SE=0.05, P=0.10) in the model for leg fat. Measures of overall adiposity were more strongly associated with SIClamp in Caucasian Americans, whereas body fat distribution and lean mass showed stronger correlations with SIClamp in African Americans. Insulin sensitivity may have a genetic basis in African Americans that is reflected in the pattern of body fat distribution. These findings suggest a race-specific pathophysiology of insulin resistance, which has implications for the prevention of diabetes and related cardiometabolic diseases.

Prevalence and Predictors of Co-occurring Hypertension and Depression Among Community-Dwelling Older Adults.

The objectives of this study were to estimate the prevalence of co-occurring hypertension and depression among community-dwelling older adults and to examine predictors of co-occurring hypertension among community-dwelling older adults. A secondary analysis was conducted from a statewide survey of community-dwelling older adults in the state of Alabama. Binomial logistic regression was used to examine predictors of co-occurring hypertension and depression. The prevalence of co-occurring hypertension and depression among community-dwelling older adults was 35%. In the multivariate analysis, non-Hispanic African American ethnicity (OR = 1.690, CI 1.221-2.341) and diabetes (OR = 1.668, CI 1.173-2.372) were positively associated with co-occurring hypertension and depression. Income ≥ $20,000 (OR = 0.544, CI 0.400-0.739), ≥ 3 meals on average per day (OR = 0.576, CI 0.429-0.774), and higher self-ratings of general health (OR = 0.728, CI 0.628-0.843) and physical activity (OR = 0.827, CI 0.694-0.986) were negatively associated with co-occurring hypertension and depression. Public health professionals and clinicians who provide care to older adults in public health, community health, and primary care settings are in ideal positions to develop intervention strategies to curb the prevalence and incidence of co-occurring hypertension and depression in this population. If intervention strategies are not implemented in these respective settings, unfortunately community-dwelling older adults of non-Hispanic African American ethnicity, with diabetes, or with low self-ratings of general health and physical activity will likely suffer from cardiovascular disease at much higher rates than their counterparts.

Association between obesity phenotypes of insulin resistance and risk of type 2 diabetes in African Americans: The Jackson Heart Study

ObjectiveTo determine whether insulin resistance (IR) measured by homeostasis model of insulin resistance (HOMA-IR) can further stratify diabetes risk in African Americans (AAs) beyond obesity and identify obese, low risk and non-obese, high risk individuals. MethodsUsing the Jackson Heart Study cohort, we categorized participants without diabetes into four phenotypes: non-obese/insulin-sensitive, non-obese/IR, obese/insulin-sensitive and obese/IR. Obesity was defined as BMI ≥ 30 or BMI 25–30 plus an increased waist circumference. IR was defined as HOMA-IR ≥ 2. We used modified Poisson regression models to estimate the incident risk-ratios (IRR) of diabetes across these phenotypes adjusting for potential confounders and HbA1c. ResultsAmong 3219 AAs without diabetes, 14.0% were non-obese/insulin-sensitive, 24.6% non-obese/IR, 6.2% obese/insulin-sensitive, and 55.3% obese/IR. The overall crude incidence rate of diabetes was 29.91 cases/1000 person-years. In fully-adjusted models, compared to the non-obese/insulin-sensitive group, the relative risk of diabetes was highest in obese/IR (IRR = 2.35; 95% CI: 1.53, 3.60), followed by non-obese/IR (IRR = 1.59; 95% CI: 1.02, 2.46), and non-significant for the obese/insulin-sensitive (IRR = 1.70; 95% CI: 0.97, 2.99) group. ConclusionsHOMA-IR can further stratify diabetes risk in AA adults beyond obesity, identifying non-obese high-risk and lower-risk obese individuals. However, diabetes risk should still be carefully monitored in obese populations despite insulin sensitivity.

Characteristics of Health-related Text Messages Preferred by Medically Underserved African-American Patients with Diabetes.

IntroductionText messaging (TM) is increasingly used by the U.S. medical practices and healthcare delivery systems, but little is known about preferences of medically underserved minority patients for TM supporting improved self-care decisions. We sought to determine the characteristics of text messages and TM programs preferred by African-American patients with diabetes in medically underserved areas.MethodsThis convergent mixed methods study employed a self-administered survey and focus group interviews. Quantitative and qualitative data were collected simultaneously, analyzed separately, and merged to provide a holistic view of the TM characteristics patients preferred. Participants (N = 36) were recruited from a medically underserved area in Memphis, Tennessee. Focus group data were uploaded into the NVivo qualitative data analysis software program, and main themes were identified. Standard frequencies were calculated for survey responses.ResultsParticipants ranged in the age of 22-74 years (M = 54.1; SD = 14.6) were predominantly female (77.8%), African-Americans (88.9%), and had at least a high school education (91.7%). A majority used mobile phones for sending (69.4%) and receiving (72.2%) text messages. Participants wanted to receive daily (44.4%) or weekly (47.2%) text messages from their healthcare provider (61.1%), or a motivational message program (33.3%). They preferred actionable messages with a positive tone and wanted options to customize message type, content, and frequency according to their preferences, goals, and needs.DiscussionMedically underserved African-American diabetes patients want customized text messages that are practical, actionable, encouraging, and from their doctor. Healthcare providers seeking to develop patient-centered TM programs for medically underserved minority patients should personalize and tailor messages according to patient preferences, health goals, and self-care needs.