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3. Inpatient diabetes management.

Author

Demidowich, Andrew P., Stanback, Camille, and Zilbermint, Mihail

Subjects
*EMERGENCY room visits, *LENGTH of stay in hospitals, *DISCHARGE planning, *INSULIN therapy, *INTENSIVE care units
Abstract

Diabetes mellitus is currently approaching epidemic proportions and disproportionately affects patients in the hospital setting. In the United States, individuals living with diabetes represent over 17 million emergency department visits and 8 million admissions annually. The management of these patients in the hospital setting is complex and differs considerably from the outpatient setting. All patients with hyperglycemia should be screened for diabetes, as in‐hospital hyperglycemia portends a greater risk for morbidity, mortality, admission to an intensive care unit, and increased hospital length of stay. However, the definition of hyperglycemia, glycemic targets, and strategies to manage hyperglycemia in the inpatient setting can vary greatly depending on the population considered. Moreover, the presenting illness, changing nutritional status, and concurrent hospital medications often necessitate thoughtful consideration to adjustments of home diabetes regimens and/or the initiation of new insulin doses. This review article will examine core concepts and emerging new literature surrounding inpatient diabetes management, including glycemic targets, insulin dosing strategies, noninsulin medications, new diabetes technologies, inpatient diabetes management teams, and discharge planning strategies, to optimize patient safety and satisfaction, clinical outcomes, and even hospital financial health. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Hair cortisol in the evaluation of Cushing syndrome

Author

Hodes, Aaron, Lodish, Maya B, Tirosh, Amit, Meyer, Jerrold, Belyavskaya, Elena, Lyssikatos, Charalampos, Rosenberg, Kendra, Demidowich, Andrew, Swan, Jeremy, Jonas, Nichole, Stratakis, Constantine A, and Zilbermint, Mihail

Subjects
Clinical Research, Adolescent, Adult, Child, Cushing Syndrome, Female, Hair, Humans, Hydrocortisone, Hydroxysteroids, Male, Middle Aged, Young Adult, Hair cortisol, Cortisol, Cushing syndrome, Cushing disease, Children, Adolescence, Clinical Sciences, Paediatrics and Reproductive Medicine, Endocrinology & Metabolism
Abstract

PurposeHair cortisol evaluation has been used to help detect patients with suspected Cushing syndrome. Our goal was to correlate segmental hair cortisol with biochemical testing in patients with Cushing syndrome and controls. This study was a prospective analysis of hair cortisol in confirmed Cushing syndrome cases over 16 months.MethodsThirty-six subjects (26.5 ± 18.9 years, 75% female, and 75% Caucasian) were analyzed by diurnal serum cortisol, 24 h urinary free cortisol corrected for body surface area (UFC/BSA), and 24 h urinary 17-hydroxysteroids corrected for creatinine (17OHS/Cr). Thirty patients were diagnosed with Cushing syndrome, and six were defined as controls. 3-cm hair samples nearest to the scalp, cut into 1-cm segments (proximal, medial, and distal), were analyzed for cortisol by enzyme immunoassay and measured as pmol cortisol/g dry hair. Hair cortisol levels were compared with laboratory testing done within previous 2 months of the evaluation.ResultsProximal hair cortisol was higher in Cushing syndrome patients (266.6 ± 738.4 pmol/g) than control patients (38.9 ± 25.3 pmol/g) (p = 0.003). Proximal hair cortisol was highest of all segments in 25/36 (69%) patients. Among all subjects, proximal hair cortisol was strongly correlated with UFC/BSA (r = 0.5, p = 0.005), midnight serum cortisol (r = 0.4, p = 0.03), and 17OHS/Cr, which trended towards significance (r = 0.3, p = 0.06).ConclusionsAmong the three examined hair segments, proximal hair contained the highest cortisol levels and correlated the most with the initial biochemical tests for Cushing syndrome in our study. Further studies are needed to validate proximal hair cortisol in the diagnostic workup for Cushing syndrome.

Published
2017

16. Increasing Frequency of Hemoglobin A1C Measurements in Hospitalized Patients With Diabetes: A Quality Improvement Project Using Lean Six Sigma

Author

Khan, Sara Atiq, primary, Demidowich, Andrew P., additional, Tschudy, Megan M., additional, Wedler, Joyce, additional, Lamy, Wilson, additional, Akpandak, Iniuboho, additional, Alexander, Lee Ann, additional, Misra, Isha, additional, Sidhaye, Aniket, additional, Rotello, Leo, additional, and Zilbermint, Mihail, additional

Published
2023
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19. Genetic Characteristics of Aldosterone-Producing Adenomas in Blacks

Author

Nanba, Kazutaka, Omata, Kei, Gomez-Sanchez, Celso E., Stratakis, Constantine A., Demidowich, Andrew P., Suzuki, Mari, Thompson, Lester D. R., Cohen, Debbie L., Luther, James M., Gellert, Lan, Vaidya, Anand, Barletta, Justine A., Else, Tobias, Giordano, Thomas J., Tomlins, Scott A., and Rainey, William E.

Published
2019
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20. Colchicine effects on the gut microbiome in adults with metabolic syndrome.

Author

KISIMBA, Celine M., DONAHUE, Jack L., CHIVUKULA, Krishna Karthik, SUBRAMANIAN, Poorani, MISTRY, Shreni D., WOLSKA, Anna, REMALEY, Alan T., YANOVSKI, Jack A., and DEMIDOWICH, Andrew P.

Subjects
GUT microbiome, METABOLIC syndrome, RIBOSOMAL DNA, TYPE 2 diabetes, INSULIN resistance, COLCHICINE, GENE amplification
Abstract

Obesity-induced inflammation plays a substantial role in the development of insulin resistance and type 2 diabetes. The altered gut flora in obesity can also contribute to metabolic dysregulation and systemic inflammation. However, it remains unclear how dysregulation of systemic inflammation in obesity affects the gut microbiome. We hypothesized that colchicine's systemic anti-inflammatory effects in obesity would be associated with improvements in gut microbial diversity. We conducted a secondary analysis of a double-blind randomized placebo-controlled trial, in which 40 adults with obesity, high C-reactive protein (CRP) (≥2.0 mg/L), insulin resistance (homeostatic model of insulin resistance: HOMA-IR ≥2.6 mg/L), and metabolic syndrome (MetS) were randomized to three months of colchicine 0.6 mg or placebo tablets twice daily. Serum and stool samples were collected at baseline and final visit. Gut microbiota composition was characterized from stool DNA by dual-index amplification and sequencing of 16S ribosomal RNA. Pre- and post-intervention stool samples were available for 15 colchicine- and 12 placebo-treated subjects. Circulating high sensitivity CRP (hsCRP), interleukin-6, resistin, white blood count, and neutrophils were significantly decreased in the colchicine arm as compared to placebo. However, changes in stool microbiome alpha diversity, as assessed by the Chao1, Shannon, and Pielou indices, were not significant between groups. Amplicon sequence variant counts were unchanged among all examined phyla or families. Oscillibacter was the only genus to demonstrate even a nominally significant change. Among adults with obesity and MetS, colchicine significantly improved systemic inflammation. However, this anti-inflammatory effect was not associated with significant changes in the gut microbiome. Further studies are warranted to investigate this relationship. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Immunomodulatory effects of colchicine on peripheral blood mononuclear cell subpopulations in human obesity: Data from a randomized controlled trial

Author

Patel, Tushar P., primary, Levine, Jordan A., additional, Elizondo, Diana M., additional, Arner, Brooke E., additional, Jain, Arad, additional, Saxena, Ankit, additional, Lopez‐Ocasio, Maria, additional, Dagur, Pradeep K., additional, Famuyiwa, Olufisola, additional, Gupta, Suryaa, additional, Sarrafan‐Chaharsoughi, Zahra, additional, Biancotto, Angelique, additional, McCoy, J. Philip, additional, Demidowich, Andrew P., additional, and Yanovski, Jack A., additional

Published
2023
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25. A Randomized Controlled Trial to Prevent Depression and Ameliorate Insulin Resistance in Adolescent Girls at Risk for Type 2 Diabetes

Author

Shomaker, Lauren B., Kelly, Nichole R., Pickworth, Courtney K., Cassidy, Omni L., Radin, Rachel M., Shank, Lisa M., Vannucci, Anna, Thompson, Katherine A., Armaiz-Flores, Sara A., Brady, Sheila M., Demidowich, Andrew P., Galescu, Ovidiu A., Courville, Amber B., Olsen, Cara, Chen, Kong Y., Stice, Eric, Tanofsky-Kraff, Marian, and Yanovski, Jack A.

Published
2016
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28. Physical activity-correlated changes in plasma enzyme concentrations in fragile sarcolemmal muscular dystrophies

Author

Blank, Paul S., primary, Golding, Adriana E., additional, Benavides, Ivonne Morales, additional, Waters, Hang, additional, Mekhedov, Elena, additional, Bezrukov, Ludmila, additional, Wachter, Rebecca D., additional, Mikhailenko, Irina, additional, Brown, Robert H., additional, Bönnemann, Carsten G., additional, Demidowich, Andrew P., additional, Jain, Minal S., additional, Yanovski, Jack A., additional, and Zimmerberg, Joshua, additional

Published
2022
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30. Effects of colchicine on lipolysis and adipose tissue inflammation in adults with obesity and metabolic syndrome

Author

Levine, Jordan A., primary, Sarrafan‐Chaharsoughi, Zahra, additional, Patel, Tushar P., additional, Brady, Sheila M., additional, Chivukula, K. Karthik, additional, Miller, Emily, additional, Han, Jung Min, additional, Periwal, Vipul, additional, Wolska, Anna, additional, Remaley, Alan T., additional, Dagur, Pradeep K., additional, Biancotto, Angelique, additional, Babyak, Ashley, additional, Fantoni, Giovanna, additional, Yanovski, Jack A., additional, and Demidowich, Andrew P., additional

Published
2022
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34. Effects of Colchicine on Measures of Lipolysis in Adults With Obesity

Author

Sarrafan-Chaharsoughi, Zahra, primary, Levine, Jordan A, additional, Patel, Tushar P, additional, Brady, Sheila M, additional, Chivukula, K Karthik, additional, Miller, Emily, additional, Han, Jung Min, additional, Periwal, Vipul, additional, Remaley, Alan T, additional, Babyak, Ashley, additional, Fantoni, Giovanna, additional, Biancotto, Angelique, additional, Yanovski, Jack A, additional, and Demidowich, Andrew P, additional

Published
2021
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35. Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

Author

Shelton, Carter, primary, Demidowich, Andrew P., additional, Motevalli, Mahsa, additional, Sokolinsky, Sam, additional, MacKay, Periwinkle, additional, Tucker, Cynthia, additional, Abundo, Cora, additional, Peters, Eileen, additional, Gooding, Roliette, additional, Hackett, Margaret, additional, Wedler, Joyce, additional, Alexander, Lee Ann, additional, Barry, Luvenia, additional, Flynn, Mary, additional, Rios, Patricia, additional, Fulda, Constance Lulu, additional, Young, Michelle F., additional, Kahl, Barbara, additional, Pummer, Eileen, additional, Mathioudakis, Nestoras N., additional, Sidhaye, Aniket, additional, Howell, Eric E., additional, Rotello, Leo, additional, and Zilbermint, Mihail, additional

Published
2021
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36. Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

Author

Najmi, Urooj, primary, Haque, Waqas Zia, additional, Ansari, Umair, additional, Yemane, Eyerusalem, additional, Alexander, Lee Ann, additional, Lee, Christina, additional, Demidowich, Andrew P., additional, Motevalli, Mahsa, additional, Mackay, Periwinkle, additional, Tucker, Cynthia, additional, Notobartolo, Cindy, additional, Sartippour, Poroshat, additional, Raynor, Jennifer, additional, and Zilbermint, Mihail, additional

Published
2021
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41. Depressive symptoms in adolescent girls at-risk for type 2 diabetes and their parents

Author

Shomaker, Lauren B., primary, Cox, Shelby, additional, Lehman, Devon P., additional, Kelly, Nichole R., additional, Thompson, Katherine A., additional, Mehari, Rim M., additional, Brady, Sheila M., additional, Galescu, Ovidiu A., additional, Demidowich, Andrew P., additional, Chen, Kong Y., additional, Tanofsky-Kraff, Marian, additional, and Yanovski, Jack A., additional

Published
2019
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43. Associations of the melanocortin 3 receptor C17A + G241A haplotype with body composition and inflammation in African‐American adults

Author

Demidowich, Andrew P., primary, Parikh, Viraj J., additional, Dedhia, Nicket, additional, Branham, Rachel E., additional, Madi, Samar A., additional, Marwitz, Shannon E., additional, Roberson, Robin B., additional, Uhlman, Andrew J., additional, Levi, Noah J., additional, Mi, Sarah J., additional, Jun, Joo Yun, additional, Broadney, Miranda M., additional, Brady, Sheila M., additional, and Yanovski, Jack A., additional

Published
2019
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45. Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Author

Mandel, Samantha R., primary, Langan, Susan, additional, Mathioudakis, Nestoras Nicolas, additional, Sidhaye, Aniket R., additional, Bashura, Holly, additional, Bie, Jun Y., additional, Mackay, Periwinkle, additional, Tucker, Cynthia, additional, Demidowich, Andrew P., additional, Simonds, William F., additional, Jha, Smita, additional, Ebenuwa, Ifechukwude, additional, Kantsiper, Melinda, additional, Howell, Eric E., additional, Wachter, Patricia, additional, Golden, Sherita Hill, additional, and Zilbermint, Mihail, additional

Published
2019
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46. Prevention of Insulin Resistance in Adolescents at Risk for Type 2 Diabetes with Depressive Symptoms: One-Year Follow-up of a Randomized Trial

Author

Shomaker, Lauren B., Kelly, Nichole R., Radin, Rachel M., Cassidy, Omni L., Shank, Lisa M., Brady, Sheila M., Demidowich, Andrew P., Olsen, Cara H., Chen, Kong Y., Stice, Eric, Tanofsky-Kraff, Marian, and Yanovski, Jack A.

Subjects
Male, Adolescent, Cognitive Behavioral Therapy, Depression, Comorbidity, Article, Diabetes Mellitus, Type 2, Patient Education as Topic, Outcome Assessment, Health Care, Psychotherapy, Group, Humans, Female, Insulin Resistance, Follow-Up Studies
Abstract

Depression is associated with poor insulin sensitivity. We evaluated the long-term effects of a cognitive behavioral therapy (CBT) program for prevention of depression on insulin sensitivity in adolescents at risk for type 2 diabetes (T2D) with depressive symptoms.One-hundred nineteen adolescent females with overweight/obesity, T2D family history, and mild-to-moderate depressive symptoms were randomized to a 6-week CBT group (n = 61) or 6-week health education (HE) control group (n = 58). At baseline, posttreatment, and 1 year, depressive symptoms were assessed, and whole body insulin sensitivity (WBISI) was estimated from oral glucose tolerance tests. Dual energy X-ray absorptiometry assessed fat mass at baseline and 1 year. Primary outcomes were 1-year changes in depression and insulin sensitivity, adjusting for adiposity and other relevant covariates. Secondary outcomes were fasting and 2-hr insulin and glucose. We also evaluated the moderating effect of baseline depressive symptom severity.Depressive symptoms decreased in both groups (P.001). Insulin sensitivity was stable in CBT and HE (ΔWBISI: .1 vs. .3) and did not differ between groups (P = .63). However, among girls with greater (moderate) baseline depressive symptoms (N = 78), those in CBT developed lower 2-hr insulin than those in HE (Δ-16 vs. 16 μIU/mL, P.05). Additional metabolic benefits of CBT were seen for this subgroup in post hoc analyses of posttreatment to 1-year change.Adolescent females at risk for T2D decreased depressive symptoms and stabilized insulin sensitivity 1 year following brief CBT or HE. Further studies are required to determine if adolescents with moderate depression show metabolic benefits after CBT.

Published
2017

47. Depressive symptoms in adolescent girls at-risk for type 2 diabetes and their parents.

Author

Shomaker, Lauren B., Cox, Shelby, Lehman, Devon P., Kelly, Nichole R., Thompson, Katherine A., Mehari, Rim M., Brady, Sheila M., Galescu, Ovidiu A., Demidowich, Andrew P., Chen, Kong Y., Tanofsky-Kraff, Marian, and Yanovski, Jack A.

Subjects
TYPE 2 diabetes risk factors, ADIPOSE tissues, AGE distribution, BODY composition, MENTAL depression, GLUCOSE tolerance tests, INSULIN resistance, OBESITY, PARENTS, PUBERTY, QUESTIONNAIRES, RACE, RISK assessment, WOMEN'S health, BODY mass index, FAMILY history (Medicine), PHOTON absorptiometry, ADOLESCENCE
Abstract

Few studies have characterized the relation between parent's depression symptoms and adolescent's depression symptoms in adolescents at-risk for type 2 diabetes (T2D). We evaluated the associations of parental depression symptoms with the depression symptoms and metabolic functioning of adolescent offspring at-risk for T2D. One-hundred sixteen parents and adolescent girls with a family history of diabetes completed surveys of depression symptoms. Adolescents' degree of metabolic risk for T2D was estimated from body mass index (BMI; kg/m2) standard score, percent adiposity from dual-energy x-ray absorptiometry scan, and whole body insulin sensitivity index determined from glucose/insulin concentrations during a two-hour oral glucose tolerance test. Parents' and adolescents' depression symptoms were significantly associated, even after accounting for race/ethnicity, age, puberty, body composition, and parental diabetes/BMI. Adjusting for similar covariates, parent depression symptoms also were positively related to adolescents' BMI standard score and had a trend-level association with adiposity. There was an inverse relation between parental depression symptoms and adolescent insulin sensitivity, which was entirely accounted for by adolescent body composition. The associations of parental depression symptoms with more elevated depression symptoms and higher BMI in adolescents at-risk for T2D has potential implications for interventions addressing these co-morbid health conditions. [ABSTRACT FROM AUTHOR]

Published
2020
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48. Pediatric Loss-of-Control Eating and Anxiety in Relation to Components of Metabolic Syndrome

Author

Byrne, Meghan E, primary, Tanofsky-Kraff, Marian, primary, Kelly, Nichole R, primary, Grammer, Anne Claire, primary, Jaramillo, Manuela, primary, Mi, Sarah J, primary, Stojek, Monika M, primary, Shank, Lisa M, primary, Burke, Natasha L, primary, Cassidy, Omni, primary, Schvey, Natasha A, primary, Brady, Sheila M, primary, Demidowich, Andrew P, primary, Broadney, Miranda M, primary, Yanovski, Susan Z, primary, and Yanovski, Jack A, primary

Published
2018
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49. Subcutaneous adipose tissue imaging of human obesity reveals two types of adipocyte membranes: Insulin-responsive and -nonresponsive

Author

McCormick, Chad D., primary, Waters, Hang N., additional, Bezrukov, Ludmila, additional, Taginya, Roxana, additional, Parikh, Viraj, additional, Onyekaba, Ginikanwa I., additional, Levine, Jordan A., additional, Demidowich, Andrew P., additional, Yanovski, Jack A., additional, Blank, Paul S., additional, and Zimmerberg, Joshua, additional

Published
2018
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