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William J. Blot - One of the best experts on this subject based on the ideXlab platform.
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association of oral microbiota with lung cancer risk in a Low Income Population in the southeastern usa
Cancer Causes & Control, 2021Co-Authors: Jiajun Shi, William J. Blot, Jirong Long, Wei Zheng, Xiaoou Shu, Yaohua Yang, Hua Xie, Xiaofei Wang, Regina Courtney, Qiuyin CaiAbstract:PURPOSE Oral microbiome plays an important role in oral health and systemic diseases, including cancer. We aimed to prospectively investigate the association of oral microbiome with lung cancer risk. METHODS We analyzed 156 incident lung cancer cases (73 European Americans and 83 African Americans) and 156 individually matched controls nested within the Southern Community Cohort Study. Oral microbiota were assessed using 16S rRNA gene sequencing in pre-diagnostic mouth rinse samples. Paired t test and the permutational multivariate analysis of variance test were used to evaluate lung cancer risk association with alpha diversity or beta diversity, respectively. Conditional logistic regression models were used to evaluate the association of individual bacterial abundance or prevalence with lung cancer risk. RESULTS No significant differences were observed for alpha or beta diversity between lung cancer cases and controls. Abundance of families Lachnospiraceae_[XIV], Peptostreptococcaceae_[XI], and Erysipelotrichaceae and species Parvimonas micra was associated with decreased lung cancer risk, with odds ratios (ORs) and 95% confidence intervals (CIs) of 0.76 (0.59-0.98), 0.80 (0.66-0.97), 0.81 (0.67-0.99), and 0.83 (0.71-0.98), respectively (all p < 0.05). Prevalence of five pre-defined oral pathogens were not significantly associated with overall lung cancer risk. Prevalence of genus Bacteroidetes_[G-5] and species Alloprevotella sp._oral_taxon_912, Capnocytophaga sputigena, Lactococcus lactis, Peptoniphilaceae_[G-1] sp._oral_taxon_113, Leptotrichia sp._oral_taxon_225, and Fretibacterium fastidiosum was associated with decreased lung cancer risk, with ORs and 95% CIs of 0.55 (0.30-1.00), 0.36 (0.17-0.73), 0.53 (0.31-0.92), 0.43 (0.21-0.88), 0.43 (0.19-0.94), 0.57 (0.34-0.99), and 0.54 (0.31-0.94), respectively (all p < 0.05). Species L. sp._oral_taxon_225 was significantly associated with decreased lung cancer risk in African Americans (OR [95% CIs] 0.28 [0.12-0.66]; p = 0.00012). CONCLUSION Results from this study suggest that oral microbiota may play a role in the development of lung cancer.
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prospective study of plasma levels of coenzyme q10 and lung cancer risk in a Low Income Population in the southeastern united states
Cancer Medicine, 2021Co-Authors: Chris Shidal, Hyung-suk Yoon, William J. Blot, Wei Zheng, Xiaoou Shu, Adrian A Franke, Qiuyin CaiAbstract:BACKGROUND Coenzyme Q10 (CoQ10) is a ubiquitous molecule in living organisms serving as a cofactor in energy production. Epidemiological studies have reported Low CoQ10 levels being associated with an increased risk of various cancers. We conducted the first study to evaluate the association of CoQ10 concentrations with lung cancer risk. METHODS A nested case-control study including 201 lung cancer cases and 395 matched controls from the Southern Community Cohort Study was conducted. Plasma CoQ10 levels were measured using high-performance liquid chromatography with photo-diode array detection. Conditional logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between plasma CoQ10 levels and lung cancer risk. RESULTS Plasma CoQ10 concentration was inversely associated with the risk of lung cancer. After adjusting for age, sex, race, and socioeconomic status, the OR (95% CI) comparing the third to first tertile was 0.57 (0.36-0.91, P for trend = 0.02). Further adjustments for smoking, alcohol, chronic obstructive pulmonary disease, and body mass index attenuated the point estimate slightly (OR = 0.60, 95% CI = 0.34-1.08, P for trend = 0.11), comparing third to first tertiles. Stratified analyses identified a significant inverse association between plasma CoQ10 levels and lung cancer risk in current smokers, but not in former/never smokers. The association was more evident in cases who were diagnosed within 1 year of blood draw than in cases diagnosed after 1 year. CONCLUSIONS Low plasma CoQ10 was significantly associated with increased lung cancer risk, particularly among current smokers. The stronger association seen shortly folLowing the blood draw suggests that CoQ10 may be related to disease progression.
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food intake of folate folic acid and other b vitamins with lung cancer risk in a Low Income Population in the southeastern united states
European Journal of Nutrition, 2020Co-Authors: William J. Blot, Yumie Takata, Xiaoou Shu, Maciej S Buchowski, Heather Munro, Wanqing Wen, Mark Steinwandel, Margaret K Hargreaves, Qiuyin CaiAbstract:PURPOSE: We prospectively examined associations of lung cancer risk with food intake of B vitamins involved in one-carbon metabolism and the use of folic acid-containing supplements among a Low-Income Population of black and white adults in the Southeastern US. METHODS: Within the Southern Community Cohort Study, we included 1064 incident lung cancer cases among 68,236 participants aged 40–79 years at study enrollment. Food intake and the use of folic acid-containing supplements were assessed using a validated food frequency questionnaire at study enrollment. Multivariate Cox regression was used to estimate hazards ratios (HRs) and the 95% confidence intervals (CIs). RESULTS: Folate and/or folic acid intake from food were not associated with lung cancer risk; HRs (95% CI) for highest compared with Lowest quartile were 1.08 (0.91–1.29) for total dietary folate, 1.00 (0.84–1.19) for food folate, and 1.09 (0.91–1.30) for food folic acid, respectively. Similarly, no associations were observed after stratifying by sex, race and smoking status, except for a positive association with total dietary folate intake among black women (HR 1.46, 95% CI 1.04–2.05 for the highest quartile compared with the Lowest quartile, P trend = 0.02). Neither the use of folic acid-containing supplements nor food intake of vitamin B₆, vitamin B₁₂ and riboflavin were associated with lung cancer risk. CONCLUSIONS: Our findings do not support a protective effect of folate or folic acid for lung cancer prevention in a Low-Income Population of black and white adults in the Southeastern US. Our finding of a positive association with total dietary folate intake among black women needs to be interpreted with caution and replicated in other studies.
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Association of oral health with lung cancer risk in a Low-Income Population of African Americans and European Americans in the Southeastern United States.
Lung Cancer, 2018Co-Authors: Hyung-suk Yoon, Jirong Long, Wei Zheng, William J. BlotAbstract:Abstract Objectives Previous studies have suggested that poor oral health might increase the risk of lung cancer among European- and Asian- descendants. The association has not been investigated among African Americans or socially disadvantaged Populations. In this nested case-control study, we investigated whether oral health was associated with lung cancer risk among a Low-Income Population of African Americans and European Americans in the Southeastern United States. Materials and methods A total of 403 incident lung cancer cases and 1612 matched controls from the Southern Community Cohort Study were included. Multivariate conditional logistic regression models were fitted to evaluate the risk of lung cancer linked to tooth loss, tooth decay, and history of periodontal disease. Results Tooth loss was significantly associated with an increased risk of lung cancer: the odds ratio (OR) of more than 10 teeth lost was 1.64 (95% CI: 1.00, 2.69). Tooth decay was also significantly associated with increased lung cancer risk; those with ≥ 6 decaying teeth had an OR of 1.65 (1.18, 2.31). An increased lung cancer risk was significantly associated with a history of periodontal disease among African Americans (OR = 1.56, 95% CI: 1.05, 2.31) and heavy smokers (OR = 2.05, 95% CI: 1.38, 3.05). Conclusion Poor oral health is associated with increased lung cancer risk, and this association appears to vary by race and smoking behavior among a Low-Income Population of African Americans and European Americans in the Southeastern United States.
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neighborhood deprivation predicts heart failure risk in a Low Income Population of blacks and whites in the southeastern united states
Circulation-cardiovascular Quality and Outcomes, 2018Co-Authors: Elvis A Akwo, Justin M Bachmann, Edmond K Kabagambe, William J. Blot, Thomas J Wang, Deepak K Gupta, Frank E Harrell, Loren LipworthAbstract:Background Recent data suggest that neighborhood socioeconomic environment predicts heart failure (HF) hospital readmissions. We investigated whether neighborhood deprivation predicts risk of incident HF beyond individual socioeconomic status in a Low-Income Population. Methods and Results Participants were 27 078 whites and blacks recruited during 2002 to 2009 in the SCCS (Southern Community Cohort Study), who had no history of HF and were using Centers for Medicare or Medicaid Services. Incident HF diagnoses through December 31, 2010, were ascertained using International Classification of Diseases , Ninth Revision, codes 428.x via linkage with Centers for Medicare or Medicaid Services research files. Participant residential information was geocoded and census tract determined by a spatial join to the US Census Bureau TIGER/Line Shapefiles. The neighborhood deprivation index was constructed using principal components analysis based on census tract-level socioeconomic variables. Cox models with Huber–White cluster sandwich estimator of variance were used to investigate the association between neighborhood deprivation index and HF risk. The study sample was predominantly middle aged (mean, 55.5 years), black (69%), female (63%), Low Income (70% earned 50% of participants lived in the most deprived neighborhoods (third neighborhood deprivation index tertile). Over median folLow-up of 5.2 years, 4300 participants were diagnosed with HF. After adjustment for demographic, lifestyle, and clinical factors, a 1 interquartile increase in neighborhood deprivation index was associated with a 12% increase in risk of HF (hazard ratio, 1.12; 95% confidence interval, 1.07–1.18), and 4.8% of the variance in HF risk (intraclass correlation coefficient, 4.8; 95% confidence interval, 3.6–6.4) was explained by neighborhood deprivation. Conclusions In this Low-Income Population, scant neighborhood resources compound the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors. Improvements in community resources may be a significant axis for curbing the burden of HF.
Qiuyin Cai - One of the best experts on this subject based on the ideXlab platform.
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association of oral microbiota with lung cancer risk in a Low Income Population in the southeastern usa
Cancer Causes & Control, 2021Co-Authors: Jiajun Shi, William J. Blot, Jirong Long, Wei Zheng, Xiaoou Shu, Yaohua Yang, Hua Xie, Xiaofei Wang, Regina Courtney, Qiuyin CaiAbstract:PURPOSE Oral microbiome plays an important role in oral health and systemic diseases, including cancer. We aimed to prospectively investigate the association of oral microbiome with lung cancer risk. METHODS We analyzed 156 incident lung cancer cases (73 European Americans and 83 African Americans) and 156 individually matched controls nested within the Southern Community Cohort Study. Oral microbiota were assessed using 16S rRNA gene sequencing in pre-diagnostic mouth rinse samples. Paired t test and the permutational multivariate analysis of variance test were used to evaluate lung cancer risk association with alpha diversity or beta diversity, respectively. Conditional logistic regression models were used to evaluate the association of individual bacterial abundance or prevalence with lung cancer risk. RESULTS No significant differences were observed for alpha or beta diversity between lung cancer cases and controls. Abundance of families Lachnospiraceae_[XIV], Peptostreptococcaceae_[XI], and Erysipelotrichaceae and species Parvimonas micra was associated with decreased lung cancer risk, with odds ratios (ORs) and 95% confidence intervals (CIs) of 0.76 (0.59-0.98), 0.80 (0.66-0.97), 0.81 (0.67-0.99), and 0.83 (0.71-0.98), respectively (all p < 0.05). Prevalence of five pre-defined oral pathogens were not significantly associated with overall lung cancer risk. Prevalence of genus Bacteroidetes_[G-5] and species Alloprevotella sp._oral_taxon_912, Capnocytophaga sputigena, Lactococcus lactis, Peptoniphilaceae_[G-1] sp._oral_taxon_113, Leptotrichia sp._oral_taxon_225, and Fretibacterium fastidiosum was associated with decreased lung cancer risk, with ORs and 95% CIs of 0.55 (0.30-1.00), 0.36 (0.17-0.73), 0.53 (0.31-0.92), 0.43 (0.21-0.88), 0.43 (0.19-0.94), 0.57 (0.34-0.99), and 0.54 (0.31-0.94), respectively (all p < 0.05). Species L. sp._oral_taxon_225 was significantly associated with decreased lung cancer risk in African Americans (OR [95% CIs] 0.28 [0.12-0.66]; p = 0.00012). CONCLUSION Results from this study suggest that oral microbiota may play a role in the development of lung cancer.
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prospective study of plasma levels of coenzyme q10 and lung cancer risk in a Low Income Population in the southeastern united states
Cancer Medicine, 2021Co-Authors: Chris Shidal, Hyung-suk Yoon, William J. Blot, Wei Zheng, Xiaoou Shu, Adrian A Franke, Qiuyin CaiAbstract:BACKGROUND Coenzyme Q10 (CoQ10) is a ubiquitous molecule in living organisms serving as a cofactor in energy production. Epidemiological studies have reported Low CoQ10 levels being associated with an increased risk of various cancers. We conducted the first study to evaluate the association of CoQ10 concentrations with lung cancer risk. METHODS A nested case-control study including 201 lung cancer cases and 395 matched controls from the Southern Community Cohort Study was conducted. Plasma CoQ10 levels were measured using high-performance liquid chromatography with photo-diode array detection. Conditional logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between plasma CoQ10 levels and lung cancer risk. RESULTS Plasma CoQ10 concentration was inversely associated with the risk of lung cancer. After adjusting for age, sex, race, and socioeconomic status, the OR (95% CI) comparing the third to first tertile was 0.57 (0.36-0.91, P for trend = 0.02). Further adjustments for smoking, alcohol, chronic obstructive pulmonary disease, and body mass index attenuated the point estimate slightly (OR = 0.60, 95% CI = 0.34-1.08, P for trend = 0.11), comparing third to first tertiles. Stratified analyses identified a significant inverse association between plasma CoQ10 levels and lung cancer risk in current smokers, but not in former/never smokers. The association was more evident in cases who were diagnosed within 1 year of blood draw than in cases diagnosed after 1 year. CONCLUSIONS Low plasma CoQ10 was significantly associated with increased lung cancer risk, particularly among current smokers. The stronger association seen shortly folLowing the blood draw suggests that CoQ10 may be related to disease progression.
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food intake of folate folic acid and other b vitamins with lung cancer risk in a Low Income Population in the southeastern united states
European Journal of Nutrition, 2020Co-Authors: William J. Blot, Yumie Takata, Xiaoou Shu, Maciej S Buchowski, Heather Munro, Wanqing Wen, Mark Steinwandel, Margaret K Hargreaves, Qiuyin CaiAbstract:PURPOSE: We prospectively examined associations of lung cancer risk with food intake of B vitamins involved in one-carbon metabolism and the use of folic acid-containing supplements among a Low-Income Population of black and white adults in the Southeastern US. METHODS: Within the Southern Community Cohort Study, we included 1064 incident lung cancer cases among 68,236 participants aged 40–79 years at study enrollment. Food intake and the use of folic acid-containing supplements were assessed using a validated food frequency questionnaire at study enrollment. Multivariate Cox regression was used to estimate hazards ratios (HRs) and the 95% confidence intervals (CIs). RESULTS: Folate and/or folic acid intake from food were not associated with lung cancer risk; HRs (95% CI) for highest compared with Lowest quartile were 1.08 (0.91–1.29) for total dietary folate, 1.00 (0.84–1.19) for food folate, and 1.09 (0.91–1.30) for food folic acid, respectively. Similarly, no associations were observed after stratifying by sex, race and smoking status, except for a positive association with total dietary folate intake among black women (HR 1.46, 95% CI 1.04–2.05 for the highest quartile compared with the Lowest quartile, P trend = 0.02). Neither the use of folic acid-containing supplements nor food intake of vitamin B₆, vitamin B₁₂ and riboflavin were associated with lung cancer risk. CONCLUSIONS: Our findings do not support a protective effect of folate or folic acid for lung cancer prevention in a Low-Income Population of black and white adults in the Southeastern US. Our finding of a positive association with total dietary folate intake among black women needs to be interpreted with caution and replicated in other studies.
Jean Caron - One of the best experts on this subject based on the ideXlab platform.
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a descriptive study of the prevalence of psychological distress and mental disorders in the canadian Population comparison between Low Income and non Low Income Populations
Chronic Diseases in Canada, 2010Co-Authors: Jean CaronAbstract:Objective: This descriptive study compares rates of high psychological distress and mental disorders between Low-Income and non-Low-Income Populations in Canada. Methods: Data were collected through the Canadian Community Health Survey – Mental Health and Well-being (CCHS 1.2), which surveyed 36 984 Canadians aged 15 or over; 17.9% (n = 6620) was classified within the Low-Income Population using the Low Income Measure. The K-10 was used to measure psychological distress and the CIDI for assessing mental disorders. Results: One out of 5 Canadians reported high psychological distress, and 1 out of 10 reported at least one of the five mental disorders surveyed or substance abuse. Women, single, separated or divorced respondents, non-immigrants and Aboriginal Canadians were more likely to report suffering from psychological distress or from mental disorders and substance abuse. Rates of reported psychological distress and of mental disorders and substance abuse were much higher in Low-Income Populations, and these differences were statistically consistent in most of the sociodemographic strata.
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a descriptive study of the prevalence of psychological distress and mental disorders in the canadian Population comparison between Low Income and non Low Income Populations
Chronic Diseases in Canada, 2010Co-Authors: Jean CaronAbstract:OBJECTIVE: This descriptive study compares rates of high psychological distress and mental disorders between Low-Income and non-Low-Income Populations in Canada. METHODS: Data were collected through the Canadian Community Health Survey - Mental Health and Well-being (CCHS 1.2), which surveyed 36 984 Canadians aged 15 or over; 17.9% (n = 6620) was classified within the Low-Income Population using the Low Income Measure. The K-10 was used to measure psychological distress and the CIDI for assessing mental disorders. RESULTS: One out of 5 Canadians reported high psychological distress, and 1 out of 10 reported at least one of the five mental disorders surveyed or substance abuse. Women, single, separated or divorced respondents, non-immigrants and Aboriginal Canadians were more likely to report suffering from psychological distress or from mental disorders and substance abuse. Rates of reported psychological distress and of mental disorders and substance abuse were much higher in Low-Income Populations, and these differences were statistically consistent in most of the sociodemographic strata. CONCLUSION: This study helps determine the vulnerable groups in mental health for which prevention and promotion programs could be designed.
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A descriptive study of the prevalence of psychological distress and mental disorders in the Canadian Population: comparison between Low-Income and non-Low-Income Populations.
Chronic diseases in Canada, 2010Co-Authors: Jean Caron, Aihua LiuAbstract:Objective This descriptive study compares rates of high psychological distress and mental disorders between Low-Income and non-Low-Income Populations in Canada. Methods Data were collected through the Canadian Community Health Survey - Mental Health and Well-being (CCHS 1.2), which surveyed 36 984 Canadians aged 15 or over; 17.9% (n = 6620) was classified within the Low-Income Population using the Low Income Measure. The K-10 was used to measure psychological distress and the CIDI for assessing mental disorders. Results One out of 5 Canadians reported high psychological distress, and 1 out of 10 reported at least one of the five mental disorders surveyed or substance abuse. Women, single, separated or divorced respondents, non-immigrants and Aboriginal Canadians were more likely to report suffering from psychological distress or from mental disorders and substance abuse. Rates of reported psychological distress and of mental disorders and substance abuse were much higher in Low-Income Populations, and these differences were statistically consistent in most of the sociodemographic strata. Conclusion This study helps determine the vulnerable groups in mental health for which prevention and promotion programs could be designed.
Nancy E. Adler - One of the best experts on this subject based on the ideXlab platform.
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effects of pre and postnatal maternal stress on infant temperament and autonomic nervous system reactivity and regulation in a diverse Low Income Population corrigendum
Development and Psychopathology, 2017Co-Authors: Nicole R Bush, Karen Jonesmason, Michael Coccia, Zoe K Caron, Abbey Alkon, Melanie Thomas, Kim Colemanphox, Pathik D Wadhwa, Barbara A Laraia, Nancy E. AdlerAbstract:Author(s): Bush, Nicole R; Jones-Mason, Karen; Coccia, Michael; Caron, Zoe; Alkon, Abbey; Thomas, Melanie; Coleman-Phox, Kim; Wadhwa, Pathik D; Laraia, Barbara A; Adler, Nancy E; Epel, Elissa S | Abstract: We examined the prospective associations of objective and subjective measures of stress during pregnancy with infant stress reactivity and regulation, an early-life predictor of psychopathology. In a racially and ethnically diverse Low-Income sample of 151 mother-infant dyads, maternal reports of stressful life events (SLE) and perceived stress (PS) were collected serially over gestation and the early postpartum period. Infant reactivity and regulation at 6 months of age was assessed via maternal report of temperament (negativity, surgency, and regulation) and infant parasympathetic nervous system physiology (respiratory sinus arrhythmia [RSA]) during the Still Face Paradigm. Regression models predicting infant temperament showed higher maternal prenatal PS predicted Lower surgency and self-regulation but not negativity. Regression models predicting infant physiology showed higher numbers of SLE during gestation predicted greater RSA reactivity and weaker recovery. Tests of interactions revealed SLE predicted RSA reactivity only at moderate to high levels of PS. Thus, findings suggest objective and subjective measures of maternal prenatal stress uniquely predict infant behavior and physiology, adjusting for key pre- and postnatal covariates, and advance the limited evidence for such prenatal programming within high-risk Populations. Assessing multiple levels of maternal stress and offspring stress reactivity and regulation provides a richer picture of intergenerational transmission of adversity.
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effects of pre and postnatal maternal stress on infant temperament and autonomic nervous system reactivity and regulation in a diverse Low Income Population
Development and Psychopathology, 2017Co-Authors: Nicole R Bush, Karen Jonesmason, Michael Coccia, Zoe K Caron, Abbey Alkon, Melanie Thomas, Kim Colemanphox, Pathik D Wadhwa, Barbara A Laraia, Nancy E. AdlerAbstract:We examined the prospective associations of objective and subjective measures of stress during pregnancy with infant stress reactivity and regulation, an early-life predictor of psychopathology. In a racially and ethnically diverse Low-Income sample of 151 mother-infant dyads, maternal reports of stressful life events (SLE) and perceived stress (PS) were collected serially over gestation and the early postpartum period. Infant reactivity and regulation at 6 months of age was assessed via maternal report of temperament (negativity, surgency, and regulation) and infant parasympathetic nervous system physiology (respiratory sinus arrhythmia [RSA]) during the Still Face Paradigm. Regression models predicting infant temperament showed higher maternal prenatal PS predicted Lower surgency and self-regulation but not negativity. Regression models predicting infant physiology showed higher numbers of SLE during gestation predicted greater RSA reactivity and weaker recovery. Tests of interactions revealed SLE predicted RSA reactivity only at moderate to high levels of PS. Thus, findings suggest objective and subjective measures of maternal prenatal stress uniquely predict infant behavior and physiology, adjusting for key pre- and postnatal covariates, and advance the limited evidence for such prenatal programming within high-risk Populations. Assessing multiple levels of maternal stress and offspring stress reactivity and regulation provides a richer picture of intergenerational transmission of adversity.
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does literacy mediate the relationship between education and health outcomes a study of a Low Income Population with diabetes
Public Health Reports, 2006Co-Authors: Dean Schillinger, Lauren R Barton, Andrew J Karter, Frances Wang, Nancy E. AdlerAbstract:dSYNOPSIS Objectives. We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients. Methods. We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in 395 diabetes patients at a U.S. public hospital. We performed path analysis to compare two competing models to explain glycemic control. The direct effects model estimated how education was related to HbA1c; the mediational model estimated the strength of the direct relationship when the additional pathway from education to literacy to HbA1c was added. Results. Both the model with a direct effect of education on HbA1c and the model with literacy as a mediator were supported by good fit to observed data. The mediational model, however, was a significant improvement, with the additional path from literacy to HbA1c reducing the discrepancy from observed data (p0.01). After including this path, the direct relationship between education and HbA1c fell to a non-significant threshold. Conclusions. In a Low-Income Population with diabetes, literacy mediated the relationship between education and glycemic control. This finding has important implications for both education and health policy.
Sundar Natarajan - One of the best experts on this subject based on the ideXlab platform.
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the mobile insulin titration intervention miti for insulin adjustment in an urban Low Income Population randomized controlled trial
Journal of Medical Internet Research, 2015Co-Authors: Natalie Levy, Victoria Moynihan, Annielyn Nilo, Karyn Singer, Lidia S Bernik, Maryann Etiebet, Yixin Fang, Sundar NatarajanAbstract:Background: Diabetes patients are usually started on a Low dose of insulin and their dose is adjusted or “titrated” according to their blood glucose levels. Insulin titration administered through face-to-face visits with a clinician can be time consuming and logistically burdensome for patients, especially those of Low socioeconomic status (SES). Given the wide use of mobile phones among this Population, there is the potential to use short message service (SMS) text messaging and phone calls to perform insulin titration remotely. Objective: The goals of this pilot study were to (1) evaluate if our Mobile Insulin Titration Intervention (MITI) intervention using text messaging and phone calls was effective in helping patients reach their optimal insulin glargine dose within 12 weeks, (2) assess the feasibility of the intervention within our clinic setting and patient Population, (3) collect data on the cost savings associated with the intervention, and (4) measure patient satisfaction with the intervention. Methods: This was a pilot study evaluating an intervention for patients requiring insulin glargine titration in the outpatient medical clinic of Bellevue Hospital Center in New York City. Patients in the intervention arm received weekday SMS text messages from a health management platform requesting their fasting blood glucose values. The clinic’s diabetes nurse educator monitored the texted responses on the platform website each weekday for alarm values. Once a week, the nurse reviewed the glucose values, consulted the MITI titration algorithm, and called patients to adjust their insulin dose. Patients in the usual care arm continued to receive their standard clinic care for insulin titration. The primary outcome was whether a patient reached his/her optimal insulin glargine dose within 12 weeks. Results: A total of 61 patients consented and were randomized into the study. A significantly greater proportion of patients in the intervention arm reached their optimal insulin glargine dose than patients in the usual care arm (88%, 29/33 vs 37%, 10/27; P <.001). Patients responded to 84.3% (420/498) of the SMS text messages requesting their blood glucose values. The nurse reached patients within 2 attempts or by voicemail 91% of the time (90/99 assigned calls). When patients traveled to the clinic, they spent a median of 45 minutes (IQR 30-60) on travel and 39 minutes (IQR 30-64) waiting prior to appointments. A total of 61% (37/61) of patients had appointment copays. After participating in the study, patients in the intervention arm reported higher treatment satisfaction than those in the usual care arm. Conclusions: MITI is an effective way to help Low-SES patients reach their optimal insulin glargine dose using basic SMS text messaging and phone calls. The intervention was feasible and patients were highly satisfied with their treatment. The intervention was cost saving in terms of time for patients, who were able to have their insulin titrated without multiple clinic appointments. Similar interventions should be explored to improve care for Low-SES patients managing chronic disease. Trial Registration: Clinicaltrials.gov NCT01879579; https://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6YZik33L3). [J Med Internet Res 2015;17(7):e180]
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the mobile insulin titration intervention miti for insulin adjustment in an urban Low Income Population randomized controlled trial
Journal of Medical Internet Research, 2015Co-Authors: Natalie Levy, Victoria Moynihan, Annielyn Nilo, Karyn Singer, Lidia S Bernik, Maryann Etiebet, Yixin Fang, Sundar NatarajanAbstract:Background: Diabetes patients are usually started on a Low dose of insulin and their dose is adjusted or “titrated” according to their blood glucose levels. Insulin titration administered through face-to-face visits with a clinician can be time consuming and logistically burdensome for patients, especially those of Low socioeconomic status (SES). Given the wide use of mobile phones among this Population, there is the potential to use short message service (SMS) text messaging and phone calls to perform insulin titration remotely. Objective: The goals of this pilot study were to (1) evaluate if our Mobile Insulin Titration Intervention (MITI) intervention using text messaging and phone calls was effective in helping patients reach their optimal insulin glargine dose within 12 weeks, (2) assess the feasibility of the intervention within our clinic setting and patient Population, (3) collect data on the cost savings associated with the intervention, and (4) measure patient satisfaction with the intervention. Methods: This was a pilot study evaluating an intervention for patients requiring insulin glargine titration in the outpatient medical clinic of Bellevue Hospital Center in New York City. Patients in the intervention arm received weekday SMS text messages from a health management platform requesting their fasting blood glucose values. The clinic’s diabetes nurse educator monitored the texted responses on the platform website each weekday for alarm values. Once a week, the nurse reviewed the glucose values, consulted the MITI titration algorithm, and called patients to adjust their insulin dose. Patients in the usual care arm continued to receive their standard clinic care for insulin titration. The primary outcome was whether a patient reached his/her optimal insulin glargine dose within 12 weeks. Results: A total of 61 patients consented and were randomized into the study. A significantly greater proportion of patients in the intervention arm reached their optimal insulin glargine dose than patients in the usual care arm (88%, 29/33 vs 37%, 10/27; P <.001). Patients responded to 84.3% (420/498) of the SMS text messages requesting their blood glucose values. The nurse reached patients within 2 attempts or by voicemail 91% of the time (90/99 assigned calls). When patients traveled to the clinic, they spent a median of 45 minutes (IQR 30-60) on travel and 39 minutes (IQR 30-64) waiting prior to appointments. A total of 61% (37/61) of patients had appointment copays. After participating in the study, patients in the intervention arm reported higher treatment satisfaction than those in the usual care arm. Conclusions: MITI is an effective way to help Low-SES patients reach their optimal insulin glargine dose using basic SMS text messaging and phone calls. The intervention was feasible and patients were highly satisfied with their treatment. The intervention was cost saving in terms of time for patients, who were able to have their insulin titrated without multiple clinic appointments. Similar interventions should be explored to improve care for Low-SES patients managing chronic disease. Trial Registration: Clinicaltrials.gov NCT01879579; https://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6YZik33L3). [J Med Internet Res 2015;17(7):e180]
