Objective. This study examines the relationship between receiving diabetes self-management education (DSME) and having higher levels of comprehensive diabetes clinical care, a summation of up to five clinical services recommended for individuals with type 2 diabetes and those who have had type 1 diabetes for ≥ 5 years. Design. Analysis of data from a population-based, cross-sectional study. Methods. Data for this study were from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS), a statewide, random, cross-sectional survey of adults. A dichotomous comprehensive diabetes clinical care variable was constructed based on responses to questions from the BRFSS diabetes module, and a logistic regression model was fitted. Adjusted odds ratios (ORs) are reported. Results. Among Florida adults with diabetes, 51.5% had received DSME. About 51.4% of adults with diabetes who received DSME had a high level of comprehensive care compared to 31.8% of those who did not receive DSME. The OR for having a high level of comprehensive care was statistically significantly higher among adults who received DSME (OR = 2.48) compared to their counterparts who did not receive DSME. Other significant covariates were having health insurance (OR = 3.65), having graduated from high school (OR = 1.55), having a college education (OR = 2.70), being 45-64 years of age (OR = 2.31), and being ≥ 65 years of age (OR = 5.29). Conclusions. These data show that receiving DSME is positively associated with receiving higher levels of comprehensive diabetes clinical care.
Left ventricular assist device (LVAD) implantation is increasingly utilized in patients with advanced heart failure and morbid obesity. Laparoscopic sleeve gastrectomy (LSG) can facilitate weight loss in this population and can ultimately change the pharmacokinetics of heart failure therapeutics. In this study, we aimed to explore the changes in cardiovascular pharmacotherapy post LSG intervention. We conducted a retrospective observational cohort study of morbidly obese LVAD patients between 2013 and 2019 at the University of Florida with available pharmacotherapeutic data at 1 and 6 months. Thirteen post-LSG patients and 13 control subjects were included in the final analysis. In the post-LSG group, the mean body mass index decreased significantly (44 6 5 vs. 34 6 4.9, P , 0.001), and 7 patients were successfully bridged to cardiac transplantation. Only 3 patients required adjustment of their LVAD speed. Mean return to flow decreased by 8 mm Hg, despite a 45% reduction in the mean number of vasodilators per patient (1.2 vs. 0.7, P = 0.03). Mean weekly warfarin dose decreased by 35% after 6 months (32.9 6 20.9 vs. 50.7 6 26.6, P = 0.01). The use of diuretics, vasodilators, and beta-blockers was significantly reduced by 50%, 45%, and 35%, respectively. None of these changes were observed in the control group at 6-month follow-up post LVAD. In this single-center experience, weight loss post LSG is associated with decreased vasodilator, diuretic, and anticoagulant medication requirements in LVAD patients.
Carnitine is an essential cofactor for fatty acid metabolism. Deficiencies can be associated with muscle weakness, fatigue, weight loss, and cardiomyopathies. A 27-year-old woman with short bowel syndrome (SBS) presented with significant weight loss, fatigue, and muscle wasting despite adequate parenteral nutrition. Her laboratory test results revealed carnitine deficiency secondary to malnutrition. Levocarnitine supplementation was initiated with normalization of her carnitine levels. Her fatigue improved, and her weight returned to baseline. Carnitine deficiencies are seldomly reported in adults, particularly those with SBS. Carnitine deficiency should be suspected and corrected in patients with SBS and malabsorptive capacity due to surgical resection.
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