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Background: The Stay at Home order in Colorado and The Stay Safe at Home order in California during COVID-19 pandemic have forced a majority of the endocrinologists/diabetologists to adapt to providing diabetes care remotely through telehealth. This may provide increased access to diabetes health care in certain settings. However, health care disparities continue to challenge availability of diabetes technologies for underprivileged communities. We report our experience with two patients providing diabetes care effectively and preventing hospital admissions by using telehealth. Methods: Two adult patients with type 1 diabetes (T1D): one new onset and the other one with established T1D are presented where telehealth facilitated by Clarity Software and the "Share" feature with the use of Dexcom G6 continuous glucose monitoring (CGM) for management of diabetic ketosis and hyperglycemia. Results: Both patients were managed effectively virtually despite higher risk of diabetic ketoacidosis (DKA). Shared glucose data through CGM facilitated frequent insulin dose adjustments, increased fluid and carbohydrate intake, and prevented hospital admissions in both cases. In the case of new onset patient with T1D, most of the education was done remotely by certified diabetes care and education specialists. Conclusion: Acute diabetes complication like DKA increases morbidity and mortality in addition to adding cost to the health care system. The current pandemic of COVID-19 has allowed newer ways (with the help of newer technologies) to manage high-risk patients with T1D and DKA through telehealth and may result in lasting benefits to people with T1D. [ABSTRACT FROM AUTHOR]

To collect consumer demographics, utilization, satisfaction, and eating and physical activity behavior information from customers using two newly established farmers' markets in low income urban communities in East and South Los Angeles. From April 1, 2007 through June 3, 2009, farmers' market customers completed a short, anonymous survey. The data analysis included a descriptive analysis of key variables and examined the number of new and repeat customers over time to track the rate of farmers' market use over time. Setting: The East Los Angeles Farmers' Market and the Watts Healthy Farmers' Market. Subjects: 415 farmers' market customers from East Los Angeles and 1,374 from South Los Angeles. The demographic profile of farmers' market consumers were primarily Latina women earning less than $22,000 per year with less than 12 years of education who reported some level of food insecurity. Most customers lived within 4 miles of the markets with repeat customers shopping twice a month or more. Overall, customers reported high satisfaction with the farmers' markets in each community and the majority reported positive changes in physical activity and eating behaviors since using the market. Many consumers reported they wanted to see additional items sold at the market, including prepared foods, non-food items and other products not allowed to be sold at certified farmers' markets. [ABSTRACT FROM AUTHOR]

The author reflects on the experiences at the Type 1 Clinic in Los Angeles, California in providing care. The clinic was designed to meet and treat patients with type 1 diabetes in the setting of poverty and psychosocial stress. According to the author, teaching simple self-care to diabetics improves their quality of life. However, she claims that recession took a toll on the clinic and affected its practices and services. Because of this, the clinic implemented a rule where one positive aspect of a patient's life is celebrated.

Community-based interventions were developed for two low-income areas, East Los Angeles (ELA, Latino) and South Los Angeles (SLA, African American/Latino), using community advisory boards and resident interviews. 90% of residents in each community live under 185% of the federal poverty level. Pre-intervention data was collected via a 30-minute random digit dial phone survey to assess baseline variables related to diabetes and obesity. Data is reported on 502 adults and 269 children. In our survey, adult BMIs were consistent with national trends. However, the children were heavier with 13% at risk for overweight and 35% overweight in ELA. SLA children were even heavier at 24% and 40%, respectively. Most adults (71%) had a perception that their children were normal weight but calculated child BMIs were much higher. Over 63% of adults tried losing weight in the past 12 months with only 2 utilizing a program such as Weight Watchers or seeing a dietitian. Individuals less than 50 years of age had poorer eating habits than those 50 years of age or older (P<.001). ELA adults (12.7%) and SLA adults (16.3%) reported a diagnosis of diabetes, which is 3% higher than national trends. Those with diabetes had a higher mean BMI (33.2±9.2) compared to those without (28.2±6.1) and were more likely (P<.001) to have other health conditions (e.g. hypertension). Additionally, US born were more likely to have diabetes than those who lived in the US less than 10 years (P=.044). Individuals with diabetes exhibited healthier eating patterns than those without diabetes but did not exercise more (P<.001). Adults who had eaten fast food one or more times the day prior to being surveyed (35%) were more likely to be US born or lived in the US 10 or more years (P=.001) and were more concerned about their weight (P=.03) but had less healthy eating patterns (P<.001). 52% of ELA adults and 49% in SLA worried about running out of food in the past 12 months, and 38% of ELA and 46% of SLA residents actually ran out of food. In conclusion, diabetes in adults and obesity in children are issues confronting low-income areas in LA. These baseline data should allow for comparison as community based initiatives designed to prevent diabetes and obesity are implemented. [ABSTRACT FROM AUTHOR]

In public healthcare systems uninsured patients with diabetes are increasingly common. In order to improve outcomes, the Department of Health Services in Los Angeles County initiated a pilot diabetes disease management program in East Los Angeles, in an area where 90% of adults live below 185% of the federal poverty level. To control costs in the diabetes program patients are graduated back to their PCP after 6 months or when the A1C is <8%, whichever comes first. Patients am asked to return yearly for an annual assessment. This prospective study was designed to follow patients enrolled in the program and randomized to continuous follow-up or discharge at 6 months. Eighty-one patients were randomized to continuous (CONT) and 82 to episodic (EPI) follow-up. All patients were Latino, the majority from Mexico. Spanish was the most most common primary language (81% in CONT/88% in EPI). Seven years was the average time spent in school, and ∼25% had no formal education. The average age was 55 yrs, and duration of diabetes 11 yrs. Half were on SA's, 75% were on metformin, 23% on pioglitazone and 33% on insulin (patients were on one or more agent). The initial A1C was 8.9(2.0)(mean)(stdev)and was not different between groups. At 6 months, when both groups were receiving the same care, there was no difference in A1C's [7.9(1.8)CONT vs 7.7(1.6)EPI]. At one and two years the A1C's were also not significantly different in the two groups. At 6 months 65%(CONT) and 71%(EPI) patients acheived an A1C of <8% (the target for referral back to primary care). Approximately 60% of patients in both groups had A1C levels <8% at 12 and 24 months. Many fewer reached an A1C of <7% (CONT = 32% at 6 mos, 28% at 12 mos and 16% at 24 mos; EPI = 30% at 6 mos, 38% at 12 mos and 26% at 24 mos, p = NS). Therefore, improvements in A1C levels are possible in an underserved Latino population. Patients did as well when seen episodically as when seen continuously in the program. When analyzed based on A1C level achieved, rather than treatment group, those who reached an A1C of <7% had fewer ER/walk-in visits than did those with higher A1C levels (p=0.0319). Thus, increasingly cost-effective models for diabetes care can be developed, maximally utilizing limited resources and reducing costly urgent care visits. [ABSTRACT FROM AUTHOR]

Health care providers serving vulnerable patients in Los Angeles have developed programs intended to increase diabetes control through more-intensive patient education and engagement. We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as "bad" cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less labor-intensive and potentially less expensive than the care team intervention. The challenge is to understand the essential aspects of these interventions; refine their design so that they are more cost-effective and fiscally feasible; and identify long-term health and cost effects [ABSTRACT FROM AUTHOR]

Purpose: This study examined how race-ethnicity, nativity, and education interact to influence disparities in cardiovascular (CV) health, a new concept defined by the American Heart Association. We assessed whether race-ethnicity and nativity disparities in CV health vary by education and whether the foreign-born differ in CV health from their U.S.-born race-ethnic counterparts with comparable education., Methods: We used data from the 2009 California Health Interview Survey to determine the prevalence of optimal CV health metrics (based on selected American Heart Association guidelines) among adults ages 25 and older (n = 42,014). We examined the interaction between education and ethnicity-nativity, comparing predicted probabilities of each CV health measure between U.S.-born and foreign-born White, Asian, and Latino respondents., Results: All groups were at high risk of suboptimal physical activity levels, fruit and vegetable and fast food consumption, and overweight/obesity. Those with greater education were generally better off except among Asian respondents. Ethnicity-nativity differences were more pronounced among those with less than a college degree. The foreign-born respondents exhibited both advantages and disadvantages in CV health compared with their U.S.-born counterparts that varied by ethnicity-nativity., Conclusions: Education influences ethnicity-nativity disparities in CV health, with most race-ethnic and nativity differences occurring among the less educated. Studies of nativity differences in CV health should stratify by education in order to adequately address SES differences., (Copyright © 2013 Elsevier Inc. All rights reserved.)