The social networks intervention showed improved integration of patients within their existing networks leading to a greater reduction in HbA1c and blood glucose, as well as improved behaviour mediating outcomes.
Objective: The NHLBI Family Heart Study (FHS) genome-wide linkage scan identified a region of chromosome 7q with a logarithm of odds score of 4.9 for body mass index (BMI). Design: We report the results of fine mapping the linkage peak using 1020 single nucleotide polymorphisms (SNPs) to test for association to obesity in families exhibiting linkage to chromosome 7. Association observed in linked families (284 obese cases/ 381 controls) was examined in an independent set of unrelated FHS participants (172 obese cases/308 controls) to validate the observed association. Two dichotomous obesity phenotypes were studied based on clinical BMI cutoffs and the sex-specific distribution of both BMI and leptin levels. Results: Using a P-value of 0.01 as criteria for association in the linked families, a P-value of 0.05 as criteria for association in the unrelated sample, and requiring consistency in the direction of the effect of the minor allele between the two samples, we identified two coding SNPs in the NYD-SP18 gene with minor alleles increasing the risk of obesity. Adjustment for exercise, smoking and FTO genotype did not influence the result in linked families, but improved the result in the unrelated sample. Carrying a minor allele of the nonsynonymous SNP rs6971091 conferred an odds ratio of at least 2 for obesity defined by both BMI and leptin levels. Conclusion: The effect of the NYD-SP18 SNP on obesity was larger than the effect of FTO in FHS families. Publicly available results from genome-wide association studies support the association between NYD-SP18 and BMI. The NYD-SP18 gene is described as testes development related, but little is known about the gene's function or the mechanism by which it may influence risk for obesity.
Cardiovascular health disparities continue to pose a major public health problem. We evaluated the effect of education administered within social networks on the improvement of hypertension in 248 African Americans compared to historical controls. Patients formed clusters with peers and attended monthly hypertension education sessions. We assessed the likelihood of reaching goal below predefined SBP and DBP thresholds as well as the absolute reduction in SBP and DBP, controlling for diabetes, smoking, baseline hypertension, and demographics. The intervention group was more likely to have ever reached treatment goal at 12 months follow-up (OR=1.72, P=0.11). At 18 months of follow-up, the MVP group had a statistically significant larger drop in SBP (−4.82 mmHg, P<0.0001) and DBP (−3.37 mmHg, P=0.01) than the control. The clustering of patients in social networks around hypertension education has a positive impact on the management of hypertension in minority populations and may help address cardiovascular health disparities.
The American Diabetes Association and European Association for the Study of Diabetes issued a new patient-centered approach for the management of hyperglycemia in patients with Type 2 diabetes. With a focus on older adults and the elderly, the authors explored the alignment of elements of the suggested framework with patients' reports of receiving combination or monotherapy using US national survey data (National Health and Nutrition Examination Survey 2001-2010) and a physician survey. Combination therapy was positively associated with age (range: 1.56-1.63; p = 0.04-0.07), obesity (odds ratio [OR]: 1.40; p = 0.01), HbA(1c) ≥7.0 (OR: 2.00; p < 0.01), number of years of living with diabetes (OR: 1.02 per year; p = 0.01) and hyperlipidemia (OR: 1.36; p = 0.02). An interaction term between years of living with diabetes and comorbidities >1 pointed to a trend of those with comorbidities >1 to be less probable to report combination therapy (OR: 0.98; p = 0.07) per additional year of diabetes history. Results suggest that sicker, older patients might benefit from more aggressive therapy, in the context of diabetes prevalence, this is expected to continue rising in that population.
OBJECTIVES: Diabetes group education programs have shown better clinical outcomes than one-on-one programs. That effect often subsides when the program is discontinued. We explore the impact of a novel intervention, in a largely African-American population with diabetes. We assess the impact of leveraging patients' natural social networks on measures of social efficacy and cohesion, with the assumption that those variables will support behavior change and mitigate modifiable risk factors. METHODS: Intervention patients (P2P ®) were asked to recruit peers, form small clusters, and attended monthly diabetes education sessions. Control patients were recruited, educated and followed up individually. P2P ® patients engaged in interactive educational sessions within their cluster. HbA1c, blood glucose, functional status (SF-12), self-efficacy (General Self-Efficacy Scale), cohesion (Perceived Cohesion Scale), social network characteristics (Social Network Index), and disease knowledge (Diabetes Knowledge Test) were recorded at baseline and followed up at 3-months. RESULTS: Among the 136 patients recruited in the study, intervention patients' (68) scores were lower on the number of active social network domains (1.1 vs.1.4, P=0.09), network diversity (5.6 vs. 5.9, P=0.30), and number of people in network (11.0 vs. 12.3, P=0.21) than controls (68), at baseline. Other baseline characteristics were evenly distributed between arms. After 3 months of followup, the intervention group had a statistically significantly greater increase in values for active social network domains (1.1, P<0.01), diversity (4.52, P<0.01), and contacts (0.84, P<0.01) than the control group. At the second follow-up, (only 22 patients have reached that point so far) social network index values improved even further from baseline (3.1, 10.8, and 1.0, respectively), compared to the controls. CONCLUSIONS: The P2P ® social networks intervention is showing improved social efficacy and integration of patients within their existing networks. These results inform the translation of diabetes education to a sustainable diabetes self-management behavior at the community level.
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