Faculty Bibliography

Objective: Patient education is a fundamental component of diabetes management. Few studies have evaluated the "real life" frequency and impact of diabetes education. This study, conducted in a large teaching hospital in Bronx, New York, focused on a variety of diabetes educational programs in order to assess their utilization by patients and their individual impact. Research design and methods: Face-to-face interviews were conducted with a convenience sample of patients with type 2 diabetes, both inpatient and outpatient, by registered nurses or physicians. Information about demographics, type of education provided, and patient knowledge of hemoglobin A1C (A1C), lipids, and blood pressure co1ntrol was obtained using a questionnaire. Results: Seventy-four adult patients were interviewed between January 2013 and December 2013. Education was provided to 38% of the sample with a similar distribution among inpatients (38%) and outpatients (33%). The majority received one-to-one "unstructured education." Education had no impact on knowledge and/or clinical parameters. No differences were found among the A1C values between those that received and did not receive education (A1C 8.6% vs 8.3%), or among those hospitalized (A1C 8%) versus treated as outpatients (A1C 8.4%). Similarly, LDL-cholesterol did not differ between those who received and did not receive education (85 mg/dl vs 89 mg/dl respectively). Conclusion: Despite ample availability of educational programs in a large urban teaching medical center, most patients did not receive education, and when provided, it was unstructured. We identified and discussed potential barriers that may have contributed to the underutilization and quality of education. However, there remains an opportunity to increase the use of and improve the quality of diabetes education

In an industrialized society, the increase in obesity incidence has led to an increase in premature morbidity and mortality rates. There is a relationship between body mass index (BMI) and the increased incidence of hypertension, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease, an increase in mortality. However, obese individuals with these conditions may have better outcomes than their lean counterparts, thus the term "obesity paradox." Most studies supporting this paradox are cross-sectional and do not take into account the quantity or type of adiposity, the disease severity, and comorbidities. Although BMI is an indicator of the amount of body fat, it does not differentiate between adiposity types. Adipocytes that are highly functional have good fuel storage capacity are different from adipocytes found in visceral obesity, which are poorly functioning, laden with macrophages, and causing low-grade inflammation. Individuals with high BMI may be physically fit and have a lower mortality risk when compared with individuals with a lower BMI and poorly functioning adiposity. We review the complexity of adipose tissue and its location, function, metabolic implications, and role in cardiovascular morbidity and mortality. The terminology "obesity paradox" may reflect a lack of understanding of the complex pathophysiology of obesity and the association between adiposity and cardiovascular disease.