Leonard E Egede

Medical University of South Carolina, Charleston, South Carolina, United States

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Publications (177)576.66 Total impact

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    ABSTRACT: We examined the association between traumatic brain injury (TBI) severity and combat exposure by race/ethnicity. We estimated logit models of the fully adjusted association of combat exposure with TBI severity in separate race/ethnicity models for a national cohort of 132 995 veterans with TBI between 2004 and 2010. Of veterans with TBI, 25.8% had served in a combat zone. Mild TBI increased from 11.5% to 40.3%, whereas moderate or severe TBI decreased from 88.5% to 59.7%. Moderate or severe TBI was higher in non-Hispanic Blacks (80.0%) and Hispanics (89.4%) than in non-Hispanic Whites (71.9%). In the fully adjusted all-race/ethnicity model, non-Hispanic Blacks (1.44; 95% confidence interval [CI] = 1.37, 1.52) and Hispanics (1.47; 95% CI = 1.26, 1.72) had higher odds of moderate or severe TBI than did non-Hispanic Whites. However, combat exposure was associated with higher odds of mild TBI in non-Hispanic Blacks (2.48; 95% CI = 2.22, 2.76) and Hispanics (3.42; 95% CI = 1.84, 6.35) than in non-Hispanic Whites (2.17; 95% CI = 2.09, 2.26). Research is needed to understand racial differences in the effect of combat exposure on mild TBI and on interventions to prevent TBI across severity levels. (Am J Public Health. Published online ahead of print June 11, 2015: e1-e7. doi:10.2105/AJPH.2014.302545).
    American Journal of Public Health 06/2015; DOI:10.2105/AJPH.2014.302545 · 4.23 Impact Factor
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    ABSTRACT: Overdispersion is a common problem in count data. It can occur due to extra population-heterogeneity, omission of key predictors, and outliers. Unless properly handled, this can lead to invalid inference. Our goal is to assess the differential performance of methods for dealing with overdispersion from several sources. We considered six different approaches: unadjusted Poisson regression (Poisson), deviance-scale-adjusted Poisson regression (DS-Poisson), Pearson-scale-adjusted Poisson regression (PS-Poisson), negative-binomial regression (NB), and two generalized linear mixed models (GLMM) with random intercept, log-link and Poisson (Poisson-GLMM) and negative-binomial (NB-GLMM) distributions. To rank order the preference of the models, we used Akaike's information criteria/Bayesian information criteria values, standard error, and 95% confidence-interval coverage of the parameter values. To compare these methods, we used simulated count data with overdispersion of different magnitude from three different sources. Mean of the count response was associated with three predictors. Data from two real-case studies are also analyzed. The simulation results showed that NB and NB-GLMM were preferred for dealing with overdispersion resulting from any of the sources we considered. Poisson and DS-Poisson often produced smaller standard-error estimates than expected, while PS-Poisson conversely produced larger standard-error estimates. Thus, it is good practice to compare several model options to determine the best method of modeling count data. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Statistical Methods in Medical Research 05/2015; DOI:10.1177/0962280215588569 · 2.96 Impact Factor
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    ABSTRACT: Although the national cost of missed workdays associated with diabetes has been estimated previously, we use the most recent available national data and methodology to update the individual and national estimates for the U.S population. We identified 14,429 employed individuals ≥ 18 years of age in 2011 Medical Expenditure Panel Survey (MEPS) data. Diabetes and missed workdays were based on self-report, and cost was based on multiplying the daily wage rate for each individual by the number of missed days. Adjusted total national burden of missed workdays associated with diabetes was calculated using a novel two-part model to simultaneously estimate the association of diabetes with the number and cost of missed workdays. The unadjusted annual mean 2011 cost of missed workdays was $277 (95 % CI 177.0-378.0) for individuals with diabetes relative to $160 (95 % CI $130-$189) for those without. The incremental cost of missed workdays associated with diabetes was $120 (95 % CI $30.7-$209.1). Based on the US population in 2011, the unadjusted national burden of missed workdays associated with diabetes was estimated to be $2.7 billion, while the fully adjusted incremental national burden was estimated to be $1.1 billion. We provide more precise estimates of the cost burden of diabetes due to missed workdays on the U.S population. The high incremental and total cost burden of missed workdays among Americans with diabetes suggests the need for interventions to improve diabetes care management among employed individuals.
    Journal of General Internal Medicine 05/2015; DOI:10.1007/s11606-015-3338-y · 3.42 Impact Factor
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    ABSTRACT: Study Objective To determine the effect of tacrolimus trough concentrations on clinical outcomes in kidney transplantation, while assessing if African-American (AA) race modifies these associations.DesignRetrospective longitudinal cohort study of solitary adult kidney transplants.SettingLarge tertiary care transplant center.PatientsAdult solitary kidney transplant recipients (n=1078) who were AA (n=567) or non-AA (n=511).ExposureMean and regressed slope of tacrolimus trough concentrations. Subtherapeutic concentrations were lower than 8 ng/ml.Measurements and Main ResultsAA patients were 1.7 times less likely than non-AA patients to achieve therapeutic tacrolimus concentrations (8 ng/ml or higher) during the first year after kidney transplant (35% vs 21%, respectively, p<0.001). AAs not achieving therapeutic concentrations were 2.4 times more likely to have acute cellular rejection (ACR) as compared with AAs achieving therapeutic concentrations (20.8% vs 8.5%, respectively, p<0.01) and 2.5 times more likely to have antibody-mediated rejection (AMR; 8.9% vs 3.6%, respectively, p<0.01). Rates of ACR (8.3% vs 6.7%) and AMR (2.0% vs 0.9% p=0.131) were similar in non-AAs compared across tacrolimus concentration groups. Multivariate modeling confirmed these findings and demonstrated that AAs with low tacrolimus exposure experienced a mild protective effect for the development of interstitial fibrosis/tubular atrophy (IF/TA; hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.47–1.32) with the opposite demonstrated in non-AAs (HR 2.2, 95% CI 0.90–5.1).Conclusion In contradistinction to non-AAs, AAs who achieve therapeutic tacrolimus concentrations have substantially lower acute rejection rates but are at risk of developing IF/TA. These findings may reflect modifiable time-dependent racial differences in the concentration-effect relationship of tacrolimus. Achievement of therapeutic tacrolimus trough concentrations, potentially through genotyping and more aggressive dosing and monitoring, is essential to minimize the risk of acute rejection in AA kidney transplant recipients.
    Pharmacotherapy 05/2015; DOI:10.1002/phar.1591 · 2.20 Impact Factor
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    ABSTRACT: Blacks with lung cancer (LC) experience higher mortality because they present with more advanced disease and are less likely to undergo curative resection for early stage disease. The National Lung Screening Trial (NLST) demonstrated improved LC mortality by screening high-risk patients with low-dose computed tomography (LDCT). The benefit of LDCT screening in Blacks is unknown. Examine results of the NLST by race Methods: Secondary analysis of a randomized trial (NCT00047385) performed in 33 US centers. Overall and lung cancer specific mortality Main Results: Screening with LDCT reduced LC mortality in all racial groups but more so in Blacks (HR 0.61 vs 0.86). Smoking increased the likelihood of death from LC and when stratified by race Black smokers were twice as likely to die compared to White smokers (HR 4.10 vs 2.25). Adjusting for socio-demographic and behavioral characteristics, Blacks experienced higher all-cause mortality than Whites (HR 1.35; 95% CI, 1.22-1.49), however Blacks screened with LDCT had a reduction in all-cause mortality. Blacks were younger, more likely to be current smokers, had more co-morbidities, and fewer years of formal education than Whites (P<0.05). Blacks screened with LDCT had decreased mortality from lung cancer. However the demographics associated with improved LC survival were less commonly found in Blacks. The overall mortality in the NLST was higher for Blacks than Whites, but improved in Blacks screened suggesting that this subgroup may have had improved access to care. To realize the reductions in mortality from LC screening, dissemination efforts need to be tailored to meet the needs of this community.
    American Journal of Respiratory and Critical Care Medicine 04/2015; DOI:10.1164/rccm.201502-0259OC · 11.99 Impact Factor
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    ABSTRACT: To assess differences among USA ethnic groups in psychological status of adult family members (FMs) and their involvement with the diabetes of another adult. Data are from the FM survey of the USA DAWN2 study, including 105 White non-Hispanics, 47 African Americans, 46 Hispanic Americans and 40 Chinese Americans. All FMs lived with and cared for an adult with diabetes. Analysis of covariance controlled for respondent and patient characteristics to assess ethnic group differences (P<0.05). Multiple regression analyses identified significant (P<0.05) independent correlates of psychological outcomes. FM psychological outcomes measured include well-being, quality of life (QoL), impact of diabetes on life domains, diabetes distress, and burden. NCT01507116. White non-Hispanics reported less diabetes burden and distress, more negative life impact, and lower well-being than FMs from ethnic minority groups. African Americans reported the highest well-being and lowest negative life impact, Chinese Americans reported the most diabetes burden, Hispanic Americans reported the highest distress. There were no ethnic group differences in QoL. Ethnic minority FMs reported having more involvement with diabetes, greater support success, and more access to a diabetes support network than White non-Hispanics. Higher FM diabetes involvement was associated with negative psychological outcomes, while diabetes education, support success and diabetes support network size were associated with better psychological outcomes. Potential limitations are the sample sizes and representativeness. Minority ethnic FMs experienced both advantages and disadvantages in psychological outcomes relative to each other and to White non-Hispanics. Ethnic minority FMs had more involvement in diabetes care, support success and support from others, with the first associated with worse and the latter two with better psychological outcomes. Additional studies are needed with larger samples and broader representation of ethnic groups to better understand these associations and identify areas for intervention.
    Current Medical Research and Opinion 04/2015; DOI:10.1185/03007995.2015.1043251 · 2.37 Impact Factor
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    ABSTRACT: Approximately 1 in 3 adults with diabetes have CKD. However, there are no recent national estimates of the association of CKD with medical care expenditures in individuals with diabetes. Our aim is to assess the association of CKD with total medical expenditures in US adults with diabetes using a national sample and novel cost estimation methodology. Data on 2,053 adults with diabetes in the 2011 Medical Expenditure Panel Survey (MEPS) was analyzed. Individuals with CKD were identified based on self-report. Adjusted mean health services expenditures per person in 2011 were estimated using a two-part model after adjusting for demographic and clinical covariates. Of the 2,053 individuals with diabetes, approximately 9.7% had self-reported CKD. Unadjusted mean expenditures for individuals with CKD were $20,726 relative to $9,689.49 for no CKD. Adjusted mean expenditures from the 2-part model for individuals with CKD were $8473 higher relative to individuals without CKD. Additional significant covariates were Hispanic/other race, uninsured, urban dwellers, CVD, stroke, high cholesterol, arthritis, and asthma. The estimated unadjusted total expenditures for individuals with CKD were estimated to be in excess of $43 billion in 2011. We showed that CKD is a significant contributor to the financial burden among individuals with diabetes, and that minorities and the uninsured with CKD may experience barriers in access to care. Our study also provides a baseline national estimate of CKD cost in Diabetes by which future studies can be used for comparison. Published by Elsevier Ireland Ltd.
    Diabetes research and clinical practice 04/2015; 109(1). DOI:10.1016/j.diabres.2015.04.011 · 2.54 Impact Factor
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    Clara E. Dismuke, Rebekah J. Walker, Leonard E. Egede
    Global journal of health science 04/2015; 7(6). DOI:10.5539/gjhs.v7n6p156
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    ABSTRACT: Investigations into personal factors influencing quality of life are important for those developing strategies to support patients with diabetes. This study aimed to investigate the influence of meaning of illness on quality of life in patients with type 2 diabetes. Veterans from primary care clinics in the southeastern United States completed a questionnaire including questions from the validated 5-scale Meaning of Illness Questionnaire (MIQ). Unadjusted and adjusted linear regression models investigated the physical and mental components of quality of life with the 5 MIQ factors. The sample comprised 302 Black and White veterans. The physical component of quality of life (PCS) was positively associated with type of stress/attitude of harm (β=2.43, CI: 0.94 to 3.93) and challenge/motivation/hope (β=3.02, CI: 0.40 to 5.64) after adjustment, whereas the mental component of quality of life (MCS) was positively associated with the degree of stress/change in commitment (β=2.58, CI: 0.78 to 4.38), and negatively associated with challenge/motivation/hope (β=-2.55, CI: -4.99 to -0.11). Attitudes of challenge, motivation and hope had opposite effects on mental and physical components of quality of life in this sample of veterans. Additionally, whereas, the type of stress and attitude towards harm or loss was associated with the physical component, the degree of stress and change in commitments was associated with the mental component. This suggests addressing the meaning of an illness may be complex but is an important consideration in improving both physical and mental components of quality of life in patients with type 2 diabetes. Copyright © 2015. Published by Elsevier Inc.
    Journal of diabetes and its complications 04/2015; 29(5). DOI:10.1016/j.jdiacomp.2015.04.006 · 1.93 Impact Factor
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    ABSTRACT: Inadequate health literacy has been associated with poorer health behaviors and outcomes in individuals with diabetes or depression. This study was conducted to examine the associations between inadequate health literacy and behavioral and cardiometabolic parameters in individuals with type 2 diabetes and to explore whether these associations are affected by concurrent depression. The authors used cross-sectional data from a study of 343 predominantly African Americans with type 2 diabetes. Inadequate health literacy was significantly and modestly associated with diabetes knowledge (r = -0.34) but weakly associated with self-efficacy (r = 0.16) and depressive symptoms (r = 0.24). In multivariate regression models, there were no associations between health literacy and A1c, blood pressure, or body mass index or control of any of these parameters. There was no evidence that depression was an effect-modifier of the associations between health literacy and outcomes. Although inadequate health literacy was modestly associated with worse knowledge and weakly associated with self-efficacy, it was not associated with any of the cardiometabolic parameters the authors studied. Because this study showed no association between health literacy and behavioral and cardiometabolic outcomes, it is unseemly and premature to embark on trials or controlled interventions to improve health literacy for the purposes of improving patient-related outcomes in diabetes.
    Journal of Health Communication 03/2015; 20(5):1-8. DOI:10.1080/10810730.2015.1012235 · 1.61 Impact Factor
  • Clara E. Dismuke, Leonard E. Egede
    Global journal of health science 02/2015; 7(5). DOI:10.5539/gjhs.v7n5p183
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    ABSTRACT: Purpose: The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. Methods: Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. Results: Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. Conclusion: In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches.
    Global journal of health science 02/2015; 7(5):171-182. DOI:10.5539/gihs.v7n5p171
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    ABSTRACT: The purpose of this study was to assess the relationship between meaning of illness, diabetes knowledge, self-care understanding, and behaviors in a group of individuals with type 2 diabetes. Patients diagnosed with type 2 diabetes completed questionnaires with measures for diabetes knowledge, self-care understanding, diet adherence, and control problems based on the validated Diabetes Care Profile, as well as a 5-factor Meaning of Illness Questionnaire (MIQ) measure. Linear regression investigated the associations between self-care outcomes and the 5 MIQ factors. After adjustment for possible confounders, both diabetes self-care understanding and diet adherence were negatively and significantly associated with little effect of illness. Control problems were negatively associated with degree of stress/change in commitments. Diabetes knowledge was not significantly associated with meaning of illness. Aspects of the meaning attributed to illness were significantly associated with self-care in patients with type 2 diabetes. Therefore, cognitive appraisals may explain variances observed in self-care understanding and behaviors. Based on these results, it is important to understand the negative effect that diabetes could have when promoting self-care understanding and diet adherence. In addition, it shows that helping patients address the stress and changing commitments that result from diabetes may help decrease the amount of diabetes control problems, even if there is little effect on diabetes understanding. Taking these differences into account may help in creating more personalized and effective self-care education plans. © 2015 The Author(s).
    The Diabetes Educator 02/2015; 41(3). DOI:10.1177/0145721715572445 · 1.92 Impact Factor
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    ABSTRACT: Thirty-day readmissions (30DRA) are a highly scrutinized measure of healthcare quality and relatively frequent among kidney transplants (KTX). Development of predictive risk models is critical to reducing 30DRA and improving outcomes. Current approaches rely on fixed variables derived from administrative data. These models may not capture clinical evolution that is critical to predicting outcomes. We directed a retrospective analysis toward: (1) developing parsimonious risk models for 30DRA and (2) comparing efficiency of models based on the use of immutable versus dynamic data. Baseline and in-hospital clinical and outcomes data were collected from adult KTX recipients between 2005 and 2012. Risk models were developed using backward logistic regression and compared for predictive efficacy using receiver operating characteristic curves. Of 1147 KTX patients, 123 had 30DRA. Risk factors for 30DRA included recipient comorbidities, transplant factors, and index hospitalization patient level clinical data. The initial fixed variable model included 9 risk factors and was modestly predictive (area under the curve, 0.64; 95% confidence interval [95% CI], 0.58-0.69). The model was parsimoniously reduced to 6 risks, which remained modestly predictive (area under the curve, 0.63; 95% CI, 0.58-0.69). The initial predictive model using 13 fixed and dynamic variables was significantly predictive (AUC, 0.73; 95% CI, 0.67-0.80), with parsimonious reduction to 9 variables maintaining predictive efficacy (AUC, 0.73; 95% CI, 0.67-0.79). The final model using dynamically evolving clinical data outperformed the model using static variables (P = 0.009). Internal validation demonstrated that the final model was stable with minimal bias. We demonstrate that modeling dynamic clinical data outperformed models using immutable data in predicting 30DRA.
    Transplantation 01/2015; DOI:10.1097/TP.0000000000000565 · 3.78 Impact Factor
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    ABSTRACT: The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations.
    Global journal of health science 01/2015; 7(2):39830. DOI:10.5539/gjhs.v7n2p119
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    ABSTRACT: Abstract Background: Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. Patients and Methods: Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. Results: The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. Conclusions: Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.
    Diabetes Technology &amp Therapeutics 12/2014; 17(4). DOI:10.1089/dia.2014.0285 · 2.29 Impact Factor
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    ABSTRACT: Stressors and depressive symptoms have been associated with medication nonadherence among adults with type 2 diabetes (T2DM). We tested whether these associations were exacerbated by obstructive family behaviors or buffered by supportive family behaviors in a sample of 192 adults with T2DM and low socioeconomic status using unadjusted and adjusted regression models. We found support for the exacerbating hypothesis. Stressors and nonadherence were only associated at higher levels of obstructive family behaviors (interaction AOR = 1.12, p = .002). Similarly, depressive symptoms and nonadherence were only associated at higher levels of obstructive family behaviors (interaction AOR = 3.31, p = .002). When participants reported few obstructive family behaviors, neither stressors nor depressive symptoms were associated with nonadherence. We did not find support for the buffering hypothesis; stressors and depressive symptoms were associated with nonadherence regardless of supportive family behaviors. Nonadherent patients experiencing stressors and/or major depressive symptoms may benefit from interventions that reduce obstructive family behaviors. Full text available at : http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s10865-014-9611-4
    Journal of Behavioral Medicine 11/2014; 38(2):363-371. DOI:10.1007/s10865-014-9611-4 · 3.10 Impact Factor
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    ABSTRACT: Compared to American Whites, African Americans have a higher prevalence of type 2 diabetes mellitus (T2DM), experiencing poorer metabolic control and greater risks for complications and death. Patient-level factors, such as diabetes knowledge, self-management skills, empowerment, and perceived control, account for >90% of the variance observed in outcomes between these racial groups. There is strong evidence that self-management interventions that include telephone-delivered diabetes education and skills training are effective at improving metabolic control in diabetes. Web-based home telemonitoring systems in conjunction with active care management are also effective ways to lower glycosylated hemoglobin A1c values when compared to standard care, and provide feedback to patients; however, there are no studies in African Americans with poorly controlled T2DM that examine the use of technology-based feedback to tailor or augment diabetes education and skills training. This study provides a unique opportunity to address this gap in the literature. We describe an ongoing 4-year randomized clinical trial, which will test the efficacy of a technology-intensified diabetes education and skills training (TIDES) intervention in African Americans with poorly controlled T2DM. Two hundred male and female AfricanAmerican participants, 21 years of age or older and with a glycosylated hemoglobin A1c level >=8%, will be randomized into one of two groups for 12 weeks of telephone interventions: (1) TIDES intervention group or (2) a usual-care group. Participants will be followed for 12 months to ascertain the effect of the interventions on glycemic control. Our primary hypothesis is that, among African Americans with poorly controlled T2DM, patients randomized to the TIDES intervention will have significantly greater reduction in glycosylated hemoglobin A1c at 12 months of follow-up compared to the usual-care group. Results from this study will add to the current literature examining how best to deliver diabetes education and skills training and provide important insight into effective strategies to improve metabolic control and hence reduce diabetes complications and mortality rates in African Americans with poorly controlled T2DM.Trial registration: This study was registered with the National Institutes of Health Clinical Trials Registry on 13 March 2014 (ClinicalTrials.gov identifier# NCT02088658).
    Trials 11/2014; 15(1):460. DOI:10.1186/1745-6215-15-460 · 2.12 Impact Factor
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    ABSTRACT: Objective: This study used a large sample size of black and white patients with type 2 diabetes to investigate the influence of perceived racial discrimination on biologic measures (glycemic control, blood pressure, and LDL cholesterol), the mental component of quality of life (MCS), and health behaviors known to improve diabetes outcomes. Methods: 602 patients were recruited from two adult primary care clinics in the southeastern United States. Linear regression models were used to assess the associations between perceived racial discrimination, self-care, clinical outcomes, MCS, adjusting for relevant covariates. Race-stratified models were conducted to examine differential associations by race. Results: The mean age was 61 years, with 64.9 % non-Hispanic black, and 41.6 % earning less than $20,000 annually. Perceived discrimination was significantly negatively associated with MCS (β = -0.56, 95 % CI -0.90, 0.23), general diet (β = -0.37, CI -0.65, -0.08), and specific diet (β = -0.25, CI -0.47, -0.03). In African Americans, perceived discrimination was significantly associated with higher systolic blood pressure (β = 10.17, CI 1.13, -19.22). In Whites, perceived discrimination was significantly associated with lower MCS (β = -0.51, CI -0.89, -0.14), general diet (β = -0.40, CI -0.69, -0.99), specific diet (β = -0.25, CI -0.47, -0.03), and blood glucose testing (β = -0.43, CI -0.80, -0.06).Conclusions: While no association was found with biologic measures, perceived discrimination was associated with health behaviors and the MCS. In addition, results showed a difference in influence of perceived discrimination by race.
    Endocrine 11/2014; 49(2). DOI:10.1007/s12020-014-0482-9 · 3.53 Impact Factor
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    ABSTRACT: Study design:Secondary analysis of existing data.Objective:To estimate the association of diabetes with family income in a pooled 15-year cohort of individuals with TSCI.Setting:A large specialty hospital in the southeastern United States.Methods:A total number of 1408 individuals identified with TSCI were surveyed regarding family income as well as clinical and demographic factors. Due to income being reported in censored intervals rather than individual dollar values, interval regression was used to estimate models of the association of family income with diabetes.Results:Approximately 12% of individuals with TSCI reported being diagnosed with diabetes. The most frequent family income interval in our sample was <$10 000, lower than the poverty threshold. The family income interval with the highest rate of diabetes was $15 000-$20 000. In an unadjusted model, diabetes was associated with a significant reduction of $8749 and in a fully adjusted model, diabetes was significantly associated with a reduction of $8560 in family income. Being a minority was also significantly associated with a reduction whereas educational attainment was associated with increased family income. TSCI severity was not significantly related to family income.Conclusion:Diabetes imposes an additional financial burden on individuals with TSCI an already vulnerable population with high health care costs. The burden is more pronounced in minorities with TSCI. Providers should be aware of the higher prevalence of diabetes among patients with TSCI and pursue a policy of testing early and vigilant management. Further studies are needed regarding special interventions for managing diabetes in the TSCI population.Spinal Cord advance online publication, 18 November 2014; doi:10.1038/sc.2014.200.
    Spinal Cord 11/2014; 53(2). DOI:10.1038/sc.2014.200 · 1.70 Impact Factor

Publication Stats

4k Citations
576.66 Total Impact Points


  • 2001–2015
    • Medical University of South Carolina
      • • Department of Medicine
      • • Department of Psychiatry and Behavioral Sciences
      • • Department of Rehabilitation Sciences
      • • Division of General Internal Medicine and Geriatrics
      Charleston, South Carolina, United States
  • 2010
    • Vanderbilt University
      • Department of Medicine
      Nashville, MI, United States
  • 2000
    • Greater Baltimore Medical Center
      Baltimore, Maryland, United States