A5036743289- Diabetes Management and Research
- Diabetes Treatment and Management
- Pancreatic function and diabetes
- Diabetes and associated disorders
- Diabetes Management and Education
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Metabolism, Diabetes, and Cancer
- Diet and metabolism studies
- Cardiovascular Function and Risk Factors
- Diabetes, Cardiovascular Risks, and Lipoproteins
- Pharmaceutical studies and practices
- Medication Adherence and Compliance
- Mobile Health and mHealth Applications
- Cardiovascular and exercise physiology
- Pharmacology and Obesity Treatment
- Health Systems, Economic Evaluations, Quality of Life
- Diet, Metabolism, and Disease
- Pain Mechanisms and Treatments
- Muscle metabolism and nutrition
- Botulinum Toxin and Related Neurological Disorders
- Biosimilars and Bioanalytical Methods
- Pharmaceutical Practices and Patient Outcomes
- Patient-Provider Communication in Healthcare
- Cardiac pacing and defibrillation studies
- Heart Rate Variability and Autonomic Control
University of California, San Diego
2016-2025
San Francisco VA Medical Center
1998-2023
Veterans Health Administration
1992-2022
Prevention Group
2022
University of San Diego
2018
VA San Diego Healthcare System
2001-2017
University of California System
2017
Intarcia Therapeutics (United States)
2017
Yale Cancer Center
2016
Hospital Español
2016
Obesity is characterized by decreased rates of skeletal muscle insulin-mediated glucose uptake (IMGU). Since IMGU equals the product arteriovenous difference (AVGd) across and blood flow into muscle, reduced and/or tissue activity can lead to IMGU. To examine this issue, we studied six lean (weight 68 +/- 3 kg, mean SEM) obese (94 kg) men. The insulin dose-response curves for whole body leg were constructed using euglycemic clamp balance techniques over a large range serum concentrations. In...
In vivo glucose uptake can occur via two mechanisms, namely, insulin-mediated (IMGU) and non-insulin-mediated (NIMGU). Although the principal tissue sites for IMGU are skeletal muscle, NIMGU at a given serum concentration not known. To examine this issue, rates of whole body (Rd) were measured basal during clamp studies performed euglycemia (approximately 90 mg/dl) hyperglycemia 220 in six lean healthy men. Studies hyperinsulinemia 70 microU/ml) somatostatin-induced insulinopenia to measure...
The objective of this study was to evaluate the efficacy and safety tramadol in treating pain diabetic neuropathy.The neuropathy is a major cause morbidity among these patients treatment, as with other small-fiber neuropathies, often unsatisfactory. Tramadol centrally acting analgesic for use moderate moderately severe pain.This multicenter, outpatient, randomized, double-blind, placebo-controlled, parallel-group consisted washout/screening phase, during which all analgesics were...
To achieve tight glycemic control in type 2 diabetic patients, it may be advantageous to introduce insulin therapy much earlier the disease course (1). Unfortunately, many patients are reluctant begin and delay starting for significant periods of time (2,3). Recent evidence suggests that more than one-quarter refuse once is prescribed (4). Little actually known about this phenomenon, often termed “psychological resistance” (PIR), how common be, or why feel way. Therefore, we developed...
Patients with non-insulin-dependent diabetes metlitus (NIDDM) exhibit decreased rates of skeletal muscle insulin-mediated glucose uptake (IMGU). Because IMGU is equal to the product arteriovenous difference (AVGΔ) across and blood flow (F) into (IMGU = AVGΔ × F), reduced tissue permeability and/or insulin delivery can potentially lead IMGU. The components were studied in six obese NIDDM subjects (103 ± 9 kg) compared those previously determined lean (weight 68 3 kg), (94 normal tolerance....
Despite U.S. Food and Drug Administration (FDA) approval of over 40 new treatment options for type 2 diabetes since 2005, the latest data from National Health Nutrition Examination Survey show that proportion patients achieving glycated hemoglobin (HbA1c) <7.0% (<53 mmol/mol) remains around 50%, with a negligible decline between periods 2003-2006 2011-2014. The Healthcare Effectiveness Data Information Set reports even more alarming rates, only about 40% 30% HbA1c in commercially insured...
OBJECTIVE Insulin adjustments to maintain glycemic control in individuals with type 1 diabetes often lead wide glucose fluctuations, hypoglycemia, and increased body weight. Dapagliflozin, an insulin-independent sodium–glucose cotransporter 2 (SGLT2) inhibitor, increases glucosuria reduces hyperglycemia diabetes. The primary objective of this study was assess short-term safety dapagliflozin combination insulin; secondary objectives included pharmacokinetic, pharmacodynamic, efficacy...
Previous research has found that the percentage of US adults with diabetes achieving a glycated hemoglobin (HbA1c) target <7.0% currently available treatments been fairly constant from 2003 to 2010, remaining at just over 50% [1]. The objective this study was compare most recent data (2011-2014) earlier track progress on HbA1c achievement, for both general and inferred individualized targets based age presence complications.Data 2677 self-reported National Health Nutrition Examination Survey...
Background: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful assisting with basic clinical interpretation CGM data. Methods: We assembled a data set 14-day 225 insulin-treated adults diabetes. Using balanced incomplete block design, 330 clinicians who were highly experienced analysis and ranked best to worst glycemia. used principal component multiple regressions develop model predict clinician ranking based on seven standard...
To define the kinetic mechanisms of insulin resistance (IR) in insulin-dependent diabetes (IDDM), we studied seven control (C) and five IDDM (glycohemoglobin, 14 ± 2%) men matched for age (36 2 vs. 37 3 yr), lean body mass (59 58 kg), leg volume (mean sem, 10.4 0.3 9.8 0.5 L). Maximal capacity (Vmax) affinity (Km) glucose uptake whole (WBGU) skeletal muscle (LGU) were measured during a 120 mU/m2·min infusion, blood was clamped at about 4, 7, 12, 21 mmol/ L. LGU = femoral arterio-venous...
OBJECTIVE The objective of this study was to estimate and explain the gap between clinical efficacy real-world (RW) effectiveness type 2 diabetes medications. RESEARCH DESIGN AND METHODS This mixed-methods quasi-experimental used retrospective claims (Optum/Humedica) compare change in HbA1c RW patients with 12 months after starting a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase 4 (DPP-4) inhibitor published findings from randomized controlled trials (RCTs)...
OBJECTIVE To assess the burden of disease for adults with type 1 diabetes in a U.S. electronic health record database by evaluating acute and microvascular complications stratified age glycemic control. RESEARCH DESIGN AND METHODS This is retrospective observational study (1 July 2014–30 June 2016) classified using validated algorithm, duration ≥24 months and, during 12-month baseline period, not pregnant having one or more insulin prescriptions HbA1c measurements. Demographic...
1,5-Anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, has been measured and used clinically in Japan for over a decade to monitor short-term glycemic control. Evaluation glucose control otherwise requires measuring plasma or glycated proteins whose levels reflect average concentration half-life protein analyzed. Hemoglobin A1c measurements blood that past 2-3 months, while fructosamine can be evaluate 10-14 days. In contrast, 1,5-AG respond within 24 h as result glucose's competitive...
OBJECTIVE—The capability of emerging glucose sensor technology to continuously monitor levels may provide ways achieve glycemic targets while reducing hypoglycemia. RESEARCH DESIGN AND METHODS—A first-generation, long-term continuous (DexCom, San Diego, CA) was implanted subcutaneously in 15 patients with type 1 diabetes. Safety, efficacy, and potential benefits were evaluated during a blinded control period study which had real-time access the data. RESULTS—The bias differences between...
While it is well accepted that the disposal of an oral glucose load (OGL) occurs primarily in skeletal muscle, mechanisms by which this are not completely elucidated. Glucose uptake (GU) muscle follows Fick principal, such GU equals products arteriovenous difference (AVGd) across and blood flow (BF) into muscle. It widely believed postprandial period both insulin increase increasing AVGd; however, a role for increments BF tolerance OGL has been established. To investigate issue, whole body...
OBJECTIVE—Routine screening of diabetic patients with echocardiography is not feasible due to its limited availability and high cost. B-type natriuretic peptide (BNP) secreted from the left ventricle in response pressure overload elevated both systolic diastolic dysfunction. RESEARCH DESIGN AND METHODS—BNP levels were compared echocardiographic findings 263 patients. Patients divided into two groups: clinical indication for (CIE) (n = 172) those without (no-CIE) 91). Cardiologists making...
We have estimated the capacity and affinity of insulin-mediated glucose uptake (IMGU) in whole body leg muscle obese non-insulin-dependent diabetics (NIDDM, n = 6) with severe hyperglycemia, glycohemoglobin (GHb 14.4 +/- 1.2%), lean controls (ln, 7) nondiabetic (ob, 7). Mean SEM weight (kg) was 67 2 (ln), 100 7 (ob), 114 11 (NIDDM), P NS between groups. NIDDM were also studied after 3 wk intensive insulin therapy, GHb post therapy 10.1 0.9, less than 0.01 vs. pretherapy. Insulin (120 mu/m2...
D iabetic foot problems, such as ulcerations, infections, and gangrene, are the most common cause of hospitalization among diabetic patients. Routine ulcer care, treatment amputations, hospitalizations cost billions dollars every year place a tremendous burden on health care system. The average healing single is $8,000, that an infected $17,000, major amputation $45,000. More than 80,000 amputations performed each patients in United States, ∼ 50% people with will develop ulcerations...
While research designed to understand the concerns about hypoglycemia among patients with diabetes has been primarily focused on investigation of fear and anxiety, recent evidence suggests a potentially important conceptually distinct element-hypoglycemic confidence. To investigate this dimension, we developed Hypoglycemic Confidence Scale (HCS); herein, describe construction validation HCS examine how key patient factors are associated hypoglycemic confidence.Items were from interviews six...