A Task Analysis Study of DECIDE For African American Patients With Type 2 Diabetes

Objective: Type 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in US adults with T2DM based on transient elastography (TE) and identify factors associated with these conditions. Research Design and Methods: This is a cross-sectional study of US adults with T2DM participating in the 2017-2018 cycle of the National Health and Nutrition Examination Survey who were evaluated by TE. Hepatic steatosis and fibrosis were diagnosed by the median value of Controlled Attenuation Parameter (CAP) and Liver Stiffness Measurement (LSM), respectively. Results: Among the 825 patients with reliable TE exams, 484 (53.7%) were assessed using the M probe and 341 (46.3%) using the XL probe. Liver steatosis (CAP≥274 dB/m), advanced fibrosis (LSM≥9.7 Kpa) and cirrhosis (LSM≥13.6 Kpa) were present in 73.8% (95% CI 68.5%-78.5%), 15.4% (95% CI 12.2%-19.0%) and 7.7% (95% CI 4.8%-11.9%) of patients, respectively. Mean age of patients with advanced fibrosis and cirrhosis was 63.7 ± 2.2 years and 57.8 ± 1.6 years, respectively. In the multivariable logistic regression model, body mass index (BMI), non-African American ethnicity and alanine aminotransferase levels were independent predictors of steatosis, while BMI, non-African American ethnicity, aspartate aminotransferase and gamma-glutamyltranspeptidase levels were independent predictors of advanced fibrosis. Conclusions: Prevalence of both liver steatosis and fibrosis are high in patients with T2DM from the US and obesity is a major risk factor. Our results support the screening of these conditions among diabetic patients.

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A Diabetes Management Program for African American Women With Type 2 Diabetes

The Diabetes Educator ◽

10.1177/014572170002600508 ◽

2000 ◽

Vol 26 (5) ◽

pp. 796-805 ◽

Cited By ~ 41

Author(s):

Thomas C. Keyserllng ◽

Alice S. Ammerman ◽

Carmen D. Samuel-Hodge ◽

Allyson F. Ingram ◽

Anne H. Skelly ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

African American ◽

Randomized Trial ◽

African American Women ◽

Diabetes Management ◽

Self Care ◽

American Women ◽

Phone Calls

PURPOSE this paper describes a clinic and community-based diabetes intervention program designed to improve dietary, physical activity, and self-care behaviors of older African American women with type 2 diabetes. It also describes the study to evaluate this program and baseline characteristics of participants. METHODS The New Leaf... Choices for Healthy Living With Diabetes program consists of 4 clinic-based health counselor visits, a community intervention with 12 monthly phone calls from peer counselors, and 3 group sessions. A randomized, controlled trial to evaluate the effectiveness of this intervention is described. RESULTS Seventeen focus groups of African American women were used to assessed the cultural relevance/acceptability of the intervention and measurement instruments. For the randomized trial, 200 African American women with type 2 diabetes were recruited from 7 practices in central North Carolina. Mean age was 59, mean diabetes duration was 10 years, and participants were markedly overweight and physically inactive. CONCLUSIONS Participants found this program to be culturally relevant and acceptable. Its effects on diet, physical activity, and self-care behaviors will be assessed in a randomized trial.

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