Faculty Bibliography

INTRODUCTION/BACKGROUND:Communities disproportionately burdened by adverse neighborhood-level social and structural factors may experience greater vulnerability to environmental exposures, contributing to health inequities, including adverse COVID-19. We assessed the effects of chronic air pollution on COVID-19 morbidities in NYC and examined whether these effects varied by neighborhood-level vulnerability. METHODS:)) was assigned using residential ZIP Code (NYC Community Air Survey; 2009-2019). Modified Poisson regression estimated risk of acute respiratory distress syndrome (ARDS), pneumonia, ventilation, and dialysis, and Cox regression estimated risk of discharge, adjusting for age, sex, BMI, smoking, asthma, diabetes, and hypertension. We assessed effect modification by neighborhood-level environmental vulnerability index (NEVI) tertiles. RESULTS:and pneumonia's relationship was stronger in individuals within higher NEVI tertiles (T1: aRR: 1.13, 95%CI: 1.02-1.25; T2: aRR: 2.11, 95%CI: 1.73-2.56; T3: aRR: 6.36, 95%CI: 4.71-8.60). DISCUSSION/CONCLUSIONS:Differences in neighborhood-level social and structural factors contribute to unequal health burdens associated with air pollution. Public health resources targeted toward neighborhoods with greater environmental vulnerability can encourage population-level pandemic preparedness.

OBJECTIVES/OBJECTIVE:Edentulism and diabetes mellitus (DM) are frequently seen among older adults. However, the joint effect of edentulism and DM on mortality was understudied. We aim to examine the joint effect of edentulism and DM on all-cause mortality and to what extent the joint effect varies by race/ethnicity. METHODS:Analysis of US Health and Retirement Study (HRS) data (2006-2018) included 11,813 non-Hispanic Whites, 2216 non-Hispanic Blacks, and 1337 Hispanics aged ≥ 50 years old. Mortality data came from the National Death Index or HRS surveys. Edentulism was self-reported and DM was determined by self-reported diagnosis, medication use, or glycosylated hemoglobin. Cox proportional-hazard models with inverse probability treatment weighting were applied. RESULTS:During mean follow-up of 9.6 years, 2874 Whites, 703 Blacks, and 441 Hispanics died. DM was associated with higher mortality across all groups (Whites: HR = 1.43, 95% CI = 1.25-1.64; Blacks: HR = 1.62, 95% CI = 1.28-2.04; Hispanics: HR = 1.46, 95% CI = 1.07-1.99). However, edentulism predicted higher mortality only in Whites (HR = 1.65, 95% CI = 1.51-1.80). Having both conditions showed highest mortality risk in all groups (Whites: HR = 2.31, 95% CI = 1.56-3.42; Blacks: HR = 1.94, 95% CI = 1.45-2.59; Hispanics: HR = 1.77, 95% CI = 1.16-2.70), with a significant additive interaction observed only in Whites (relative excess risk due to interaction = 0.22, p < 0.05). CONCLUSIONS:DM and edentulism pose an additive risk for mortality in Whites, and there are racial/ethnic differences in edentulism-related mortality.

BACKGROUND:Continuous advancements in diabetes technologies have improved self-management for people with type 1 diabetes. Continuous glucose monitoring and automated insulin delivery systems have enhanced the quality of life and glycemic outcomes while reducing severe hypoglycemia and diabetes ketoacidosis hospitalizations. Despite these benefits, racial inequities in the use of advanced diabetes technology (ADT) persist. OBJECTIVE:This study aims to develop and evaluate a best practice advisory (BPA) within the electronic medical record (EMR) to reduce racial and ethnic disparities in ADT use. We hypothesize that an EMR-based BPA designed to standardize the prescribing of ADTs will minimize racial and ethnic disparities in ADT adoption or progression in use among pediatric and adult people with type 1 diabetes. METHODS:The Best Practice Advisories to Reduce Inequities in Technology Use (BPA-TECH) study will use a nonrandomized matched pair intervention design. Phase 1 will use qualitative methods to develop and refine the BPA, including focus groups and surveys of health care providers and people with type 1 diabetes or their caregivers. Phase 2 will evaluate the effectiveness of the BPA through a controlled before-after study of people with type 1 diabetes seen at 7 T1D Exchange Quality Improvement Collaborative (T1DX-QI) centers, with control people with type 1 diabetes matched from nonintervention T1DX-QI centers. The baseline and postintervention periods will be the 12 months before and 12 months after deployment of the BPA at the intervention centers, respectively. Eligibility criteria include people with type 1 diabetes aged ≥2 years with an EMR diagnosis of T1D during the baseline period. The primary outcome is the progression in ADT use from the baseline to postintervention periods. RESULTS:), severe hypoglycemic events, and diabetes ketoacidosis events will be collected via the T1DX-QI coordinating center. The study is powered to detect a between-group difference of 15% in the proportion of patients in the intervention and control groups in meeting the primary endpoint. We anticipate the completion of this study by May 2027. CONCLUSIONS:The BPA-TECH study aims to leverage health IT to address racial and ethnic disparities in ADT use among people with type 1 diabetes. By standardizing the approach to ADT prescribing for people with type 1 diabetes, the BPA-TECH has the potential to promote equity in diabetes management and improve clinical outcomes. The outcomes of this study will inform future efforts to reduce health care disparities. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT06931275; https://clinicaltrials.gov/search?term=NCT06931275. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:DERR1-10.2196/71038.

BACKGROUND/OBJECTIVES/OBJECTIVE:Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is rapidly becoming the most prevalent form of chronic liver disease in both pediatric and adult populations. It encompasses a wide spectrum of liver abnormalities, ranging from simple fat accumulation to severe conditions such as inflammation, fibrosis, cirrhosis, and liver cancer. Major risk factors for MASLD include obesity, insulin resistance, type 2 diabetes, and hypertriglyceridemia. METHODS:This narrative review employed a comprehensive search of recent literature to identify the latest studies on the relationship between MAFLD and obesity, the health consequences and the latest treatment options to prevent long-term damage to the liver and other organs. Additionally, the article presents perspectives on diagnostic biomarkers. RESULTS:Childhood obesity is linked to a multitude of comorbid conditions and remains a primary risk factor for adult obesity. This abnormal fat accumulation is known to have long-term detrimental effects into adulthood. Scientific evidence unequivocally demonstrates the role of obesity-related conditions, such as insulin resistance, dyslipidemia, and hyperglycemia, in the development and progression of MASLD. Oxidative stress, stemming from mitochondrial dysfunction, is a leading factor in MASLD. This review discusses the interconnections between oxidative stress, obesity, dyslipidemia, and MASLD. CONCLUSIONS:Atherogenic dyslipidemia, oxidative stress, inflammation, insulin resistance, endothelial dysfunction, and cytokines collectively contribute to the development of MASLD. Potential treatment targets for MASLD are focused on prevention and the use of drugs to address obesity and elevated blood lipid levels.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a quality improvement initiative to reduce barriers to insulin pump initiation for people with type 1 diabetes.

As the learning health network known as the T1D Exchange Quality Improvement Collaborative (T1DX-QI) has expanded on a significant scale to provide care for more than 120,000 people since its inception in 2016, assessing the quality improvement (QI) culture and monitoring clinical outcome improvements of participating centers has become vital to understanding the network's progress and success. Centers participating in the T1DX-QI complete regular QI culture self-assessments to quantify four evidence-based areas of culture: QI team structure, QI foundation, QI capacity, and QI success. This study builds on a previous baseline analysis to demonstrate self-reported improvements in T1DX-QI centers' QI culture from 2021 to 2022 and summarizes QI successes experienced by participating centers.

There is an increasing prevalence of non-communicable chronic diseases (NCCDs) like obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM), hypertension, allergic asthma, and neuro-developmental/psychiatric problems in many parts of the world. A suboptimal lifestyle as an adult is often blamed for the occurrence of NCCDs. This review discusses the developmental origin of health and disease theory and how suboptimal nutrition in intrauterine life and the establishment of a suboptimal gut microbiome during infancy can influence the predisposition to NCCDs.