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One-third of U.S. adults have prediabetes, but only 11% are aware of their condition. Many do not receive education or treatment. The purpose of this study is to understand family medicine providers' and patients' attitudes, knowledge, and behaviors regarding prediabetes and its management, to guide future management interventions. Cross-sectional surveys of providers (n = 54, 57% response rate) and patients with prediabetes (n = 148, 16.5% response rate) were administered at a large urban academic family medicine practice. Nearly all providers agree prediabetes screening is important, but over half were unaware of the national Diabetes Prevention Program (DPP) and most do not prescribe metformin to eligible patients. Over half of patients reported being told they have prediabetes but <5% had been referred to DPP and over half were unaware of medication options. In open-ended responses, providers suggested nutrition counseling resources and an improved DPP referral process to improve prediabetes care. Patients requested clear diagnosis, education on treatment options, and nutritional counseling. This study indicates that notable gaps continue to exist in provider and patient understanding and management of prediabetes, suggesting that interventions to improve prediabetes care should include more effective counseling on diagnosis and treatment and expanding access to nutrition and educational resources. [ABSTRACT FROM AUTHOR]

Hypertrophy and failure (H/F) in humans and large mammals are characterized by a change from a positive developed force-frequency relationship (+FFR) in normal myocardium to a flattened or negative developed force-frequency relationship (-FFR) in disease. Altered [Ca.sup.2+] homeostasis underlies this process, but the role of intracellular [Na.sup.+] concentration ([[[Na.sup.+]].sub.i]) in H/F and frequency-dependent contractility reserve is unclear. We hypothesized that altered [[[Na.sup.+]].sub.i] is central to the -FFR response in H/F feline myocytes. Aortic constriction caused left ventricular hypertrophy (LVH). We found that as pacing rate was increased, contraction magnitude was maintained in isolated control myocytes (CM) but decreased in LVH myocytes (LVH-M). Quiescent LVH-M had higher [[[Na.sup.+]].sub.i] than CM (LVH-M 13.3 [+ or -] 0.3 vs. CM 8.9 [+ or -] 0.2 mmol/l; P < 0.001) with 0.5-Hz pacing (LVH-M 14.9 [+ or -] 0.5 vs. CM 10.8 [+ or -] 0.4 mmol/1; P < 0.001) but were not different at 2.5 Hz (17.0 [+ or -] 0.7 vs. control 16.0 [+ or -] 0.7 mmol/1; not significant). [[[Na.sup.+]].sub.i] was altered by patch pipette dialysis to define the effect of [[[Na.sup.+]].sub.i] on contraction magnitude and action potential (AP) wave shape at slow and fast pacing rates. Using AP clamp, we showed that LVH-M require increased [[[Na.sup.+]].sub.i] and long diastolic intervals to maintain normal shortening. Finally, we determined the voltage dependence of contraction for [Ca.sup.2+] current ([I.sub.Ca])-triggered and [Na.sup.+]/[Ca.sup.2+] exchanger-mediated contractions and showed that there is a greater [[[Na.sup.+]].sub.i] dependence of contractility in LVH-M. These data show that increased [[[Na.sup.+]].sub.i] is essential for maintaining contractility at slow heart rates but contributes to small contractions at fast rates unless rate-dependent AP shortening is prevented, suggesting that altered [[[Na.sup.+]].sub.i] regulation is a critical contributor to abnormal contractility in disease. cardiac function; calcium handing

Physiological hemodynamic stress, such as aerobic exercise, is intermittent and requires an increase in [Ca.sup.2+]-dependent contractility through sympathetic nervous system activation. Pathological hemodynamic stress, such as hypertension, is persistent and requires sustained increases in cardiac function. Over time, this causes left ventricular hypertrophy (LVH)-reduced responsiveness to sympathetic stimulation. In this study, we examined the hypothesis that blunted in vivo adrenergic contractile responsiveness in pressure overload (PO)-induced cardiac hypertrophy is caused by abnormalities in the abundance and/or basal phosphorylation state of [Ca.sup.2+] regulatory proteins. PO, induced by aortic constriction, caused concentric LVH or dilated LVH. Only animals with dilation exhibited a decrease in baseline left ventricle function [fractional area change (FAC); measured with echocardiography]. All PO animals had a reduced contractile response to adrenergic agonists (increase in FAC with 40 [micro]g * [kg.sup.-1] * [min.sup.-1] dobutamine, control 0.30 [+ or -] 0.04, n = 5 vs. banded 0.10 [+ or -] 0.03, n = 10; P < 0.01). PO animals had reduced phospholamban (PLB) protein abundance (P = 0.07, not significant) and increased PLB phosphorylation at the calmodulin-dependent kinase II (CaMKII)-specific site (PLB-[Thr.sup.17] P < 0.05) but not at the protein kinase A-specific site (PLB-[Ser.sup.16]). PLB-[Thr.sup.17] phosphorylation was inversely correlated with dobutamine-induced increases in contractility in PO animals ([r.sup.2] = 0.81, P < 0.05). Continuous induction of [Ca.sup.2+] transients in isolated ventricular myocytes for 24 h increased phosphorylation at PLB-[Thr.sup.17] and diminished inotropic responsiveness and PLB-[Ser.sup.16] phosphorylation after exposure to isoproterenol (P < 0.05). These data show that reduced adrenergic responsiveness in feline PO hypertrophy and failure involves increases in basal PLB-[Thr.sup.17] phosphorylation, suggesting that activation of CaMKII in PO hypertrophy contributes to defective adrenergic reserve in compensated LVH and early heart failure. dobutamine; excitation-contraction coupling; calcium

PURPOSE: For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans. The purpose of this study was to identify patient markers of successful diabetes management among patients in an urban academic health system. METHODS: A secondary analysis of semistructured interviews was completed with 89 adults with type 1 or type 2 diabetes. Participants had a recent diabetes-related emergency department (ED) visits or hospitalization or were primary care patients with an A1C >7.5%. Interviews were conducted to saturation. Demographic data were collected via self-report and electronic medical records. Interviews were analyzed using conventional content analysis. This analysis focused on patient perceptions of successful management coded to "measuring management success." RESULTS: Although most participants cited A1C or blood glucose as a marker of successful diabetes management, they had varied understanding of these metrics. Most used a combination of targets from the following categories: 1) A1C, blood glucose, and numbers; 2) engagement in medical care; 3) taking medication and medication types; 4) symptoms; 5) diet, exercise, and weight; and 6) stress management and social support. CONCLUSION: Individuals not meeting glycemic goals and/or with recent diabetes-related ED visits or hospitalizations had varied understanding of A1C and blood glucose targets. They use multiple additional markers of successful management and had a desire for management discussions that incorporate these markers. These measures should be incorporated into their care plans along with clinical targets. [ABSTRACT FROM AUTHOR]