Linda A. Joseph

State University of New York Downstate Medical Center, Brooklyn, New York, United States

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Publications (5)6.11 Total impact

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    ABSTRACT: Objective: To identify predictive factors for the use of sliding scale insulin (SSI) by the housestaff physicians for in-hospital management of diabetes mellitus (DM). Design: Prospective cohort study. Materials & methods: A total of 215 consecutive patients admitted to the medical or surgical wards of two urban University-affiliated hospitals, with DM as a primary or secondary diagnosis, were prospectively followed to discharge. Demographic, laboratory and clinical data were obtained from in-hospital records. A survey was administered to the primary housestaff physicians regarding the potential reasons for prescribing SSI versus proactive antihyper glycemic therapy (standing insulin dose and/or oral antidiabetic agents). Results: SSI was prescribed for 71.2% of the patients and the lowest blood glucose (BG) at which insulin was given was recorded at 150-199 mg/ dl (13.2% [of patients]), 200-249 mg/dl (81.1%) and 250-299 mg/dl (6.7%). Factors that predicted the use of SSI by housestaff physicians included the admission service, surgery versus medicine (odds ration [OR]: 6.0, 95% confidence interval: 5.5-23.3; p = 0.01), concern regarding wide swings of BG (OR: 5.56 [1.8-16.8]; p < 0.01), using the SSI results to estimate the standing dose of insulin (OR: 5.22 [1.8-14.7]; p < 0.01) and high BG on admission (OR: 3.92 [1.3-12.3]; p < 0.02). Conclusion: SSI is commonly prescribed for hospitalized patients with DM. It is more likely to be prescribed on the surgical wards compared with medical service. Perception among house staff regarding the wide swings of BG and the perception of the utility of the SSI to calculate standing-dose insulin were significant predictors for its use. Given the previous reports indicating higher in-hospital BG with the use of SSI, which leads to several complications, increased understanding of the reasons behind the use of SSI by house staff would help develop educational programs aimed at changing this practice in favor of more physiologic insulin regimens.
    Therapy 05/2006; 3(3):395-398. DOI:10.1586/14750708.3.3.395
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    ABSTRACT: Osteoporosis is a major public health problem with low bone mass affecting nearly half the women aged 50 years or older. Evidence from various studies has shown that higher body mass index (BMI) is a protective factor for bone mineral density (BMD). Most of the evidence, however, is from studies with Caucasian women and it is unclear to what extent ethnicity plays a role in modifying the effect of BMI on BMD. A cross sectional study was performed in which records of postmenopausal women who presented for screening for osteoporosis at 2 urban medical centres were reviewed. Using logistic regression, we examined the interaction of race and BMI after adjusting for age, family history of osteoporosis, maternal fracture, smoking, and sedentary lifestyle on BMD. Low BMD was defined as T-score at the lumbar spine < -1. Among 3,206 patients identified, the mean age of the study population was 58.3 ± 0.24 (Years ± SEM) and the BMI was 30.6 kg/m2. 2,417 (75.4%) were African Americans (AA), 441(13.6%) were Whites and 348 (10.9%) were Hispanics. The AA women had lower odds of having low BMD compared to Whites [Odds ratio (OR) = 0.079 (0.03–0.24) (95% CI), p < 0.01]. The odds ratio of low BMD was not statistically significant between White and Hispanic women. We examined the interaction between race and BMD. For White women; as the BMI increases by unity, the odds of low BMD decreases [OR = 0.9 (0.87–0.94), p < 0.01; for every unit increase in BMI]. AA women had slightly but significantly higher odds of low BMD compared to Whites [OR 1.015 (1.007–1.14), p <0.01 for every unit increase in BMI]. This effect was not observed when Hispanic women were compared to Whites. There is thus a race-dependent effect of BMI on BMD. With each unit increase in BMI, BMD increases for White women, while a slight but significant decrease in BMD occurs in African American women.
    Nutrition & Metabolism 05/2005; 2(1):9. DOI:10.1186/1743-7075-2-9 · 3.26 Impact Factor
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    ABSTRACT: Objectives: To assess the effect of sliding scale insulin (SSI) use on glycemic control and length of hospital stay in patients with diabetes mellitus. Methods: A prospective cohort study of 182 patients with diabetes mellitus as a primary diagnosis or a comorbid condition admitted consecutively to the internal medicine wards over a 6-week period. Demographic, clinical and laboratory data were collected from in-patient medical records. Data were analyzed using Chi-square and independent t-tests and presented as the mean ± standard error of the mean. Results: Of the total 182 in-patients with Type 2 diabetes, 130 (71.4%) were placed on SSI (Group A) and 52 (28.6%) on standing-dose antihyperglycemic therapy without the use of SSI (Group B). While there was no difference in admission blood glucose values (mg/dl) between Group A (236 ± 14.3) and Group B (237 ± 6.4), higher average in-hospital fasting blood glucose values were recorded from Group A (168 ± 7.2) compared with Group B (139 ± 11.5), p = 0.04. Plasma glucose values at discharge were not significantly different between the two groups with an average of 172 ± 8.1 for Group A and 170 ± 18.1 for Group B. Also, there was no significant difference in the number of days of hospitalization between the two groups with an average of (7.6 ± 0.89) for Group A and (10 ± 4.7) for Group B. Conclusion: SSI use is associated with higher in-hospital blood glucose and does not offer any advantage in terms of duration of hospital stay as compared with standard-dose antihyperglycemic therapy. 2004
    Therapy 09/2004; 1(1):81-85. DOI:10.1586/14750708.1.1.81
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    ABSTRACT: Am J Hypertens (2004) 17, 47A–47A; doi: 10.1016/j.amjhyper.2004.03.114 P-40: A cross sectional and longitudinal analysis of systolic and diastolic blood pressure control in diabetic patients Linda A. Joseph1, Jonathan Castro1, Shahram Khorrami1, Geethanjali Sennimalai1, Pramodini Gosukonda1, Mrunalini Deshmukh1, Surender Arora1, John Makaryus1, Carla Casulo1, Diwakar Lingam1, Sandra D'Angelo1, Mai Mahmoud1, John J. Shin1, Gul Bahtiyar1, Amal Farag1, James R. Sowers1 and Samy I. McFarlane11Medicine, Division of Endocrinology, Diabetes and Hypertension, SUNY-Downstate, Brooklyn, NY; Kings County Hospital Center, Brooklyn, NY; Veteran Administration Hospital, Brooklyn, NY; Internal Medicine, University of Missouri, Columbia, MO, USA
    American Journal of Hypertension 04/2004; DOI:10.1016/j.amjhyper.2004.03.114 · 2.85 Impact Factor
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    ABSTRACT: To determine the percentage of patients with diabetes and hypertension who met the American Diabetes Association (ADA) treatment guidelines of a BP 130/80 mmHg.In a cross sectional study, using the 2001 ADA guidelines, we evaluated BP control in 1039 clinic patients with diabetes and Hypertension, followed at 3 different outpatient practice settings in New York City, 2 Municipal Hospitals (Kings County and Woodhull) (KCH/WH), a Veteran Administration Medical Center (Brooklyn) (VAMC), and University Hospital affiliated office- based practices, (Staten Island) (SIUH).Of the total of 1039 patients, 32.1% received care at VAMC, 48% at KCH/WH and 15% at SIUH. The mean age 60.8 ± 0.4 years (± SE), (range = 13-95), 44.8% were women, 93% had type 2 diabetes and the mean BMI was 29.5 Kg/m 2 . The mean treated systolic and diastolic BP were 141.5 ±0.7 and 77.5 ±0.4 mmHg respectively. A BP goal of

Publication Stats

37 Citations
6.11 Total Impact Points


  • 2005-2006
    • State University of New York Downstate Medical Center
      • Department of Medicine
      Brooklyn, New York, United States
  • 2004
    • University of Missouri
      • Department of Internal Medicine
      Columbia, Missouri, United States