Although the primary care setting offers an innovative option for weight loss interventions, there is minimal research examining this type of intervention with low-income minority women. Further, there is a lack of research on the long-term effects of these programs. The purpose of this investigation was to examine the weight loss maintenance of low-income African-American women participating in a primary care weight management intervention. A randomized controlled trial was conducted with overweight and obese women (N = 144) enrolled at two primary care clinics. Women received a 6-month tailored weight loss intervention delivered by their primary care physician and completed follow-up assessments 9, 12, and 18 months following randomization. The weight loss maintenance of the tailored intervention was compared to a standard care comparison group. The weight loss of intervention participants (−1.52 ± 3.72 kg) was significantly greater than that of standard care participants (0.61 ± 3.37 kg) at month 9 (P = 0.01). However, there was no difference between the groups at the 12-month or 18-month follow-ups. Participants receiving a tailored weight loss intervention from their physician were able to maintain their modest weight loss up to 3-6 months following treatment. Women demonstrated weight regain at the 18-month follow-up assessment, suggesting that more intensive follow-up in the primary care setting may be needed to obtain successful long-term weight loss maintenance.

Background Several prospective studies have evaluated the association between body mass index (BMI) and death risk among patients with diabetes; however, the results have been inconsistent. Methods and Results We performed a prospective cohort study of 19,478 African American and 15,354 white patients with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of different levels of BMI stratification with all-cause mortality. During a mean follow up of 8.7 years, 4,042 deaths were identified. The multivariable-adjusted (age, sex, smoking, income and type of insurance) hazard ratios (HRs) for all-cause mortality associated with BMI levels (18.5–22.9, 23–24.9, 25–29.9, 30–34.9 [reference group], 35–39.9, and ≥40 kg/m2) at baseline were 2.12 (95% confidence interval [CI] 1.80–2.49), 1.74 (1.46–2.07), 1.23 (1.08–1.41), 1.00, 1.19 (1.03–1.39), and 1.23 (1.05–1.43) for African Americans, and 1.70 (1.42–2.04), 1.51 (1.27–1.80), 1.07 (0.94–1.21), 1.00, 1.07 (0.93–1.23), and 1.20 (1.05–1.38) for whites, respectively. When stratified by age, smoking status, patient types or use of anti-diabetic drugs, a U-shaped association was still present. When BMI was included in the Cox model as a time-dependent variable, the U-shaped association of BMI with all-cause mortality risk did not change. Conclusions The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30–34.9 kg/m2.

The healing rate of forefoot ulcerations in patients with diabetes using alternative off-loading methods or a total contact cast appeared to be comparable when the method was selected based on location of ulcer, patient age, and duration of ulceration.

Posterolateral spinal fusion is the standard treatment for lumbar compression fractures. Adult adipose tissue-derived stem cells (ASCs) promote osteogenesis in vivo and in vitro. The hypothesis tested in this study was that syngeneic and allogeneic ASCs on a biomaterial scaffold composed of tricalcium phosphate and collagen I will accelerate spinal fusion in a rat model. ASCs from male Fischer or ACI rats were loaded onto scaffolds (53,571 cells/mm 3 ) and cultured in stromal media for 48 h. Male Fisher rats were assigned to 4 cohorts (n ¼ 14/cohort) after bilateral decortication of the L4 and L5 transverse processes: (1) No treatment; (2) scaffold only; (3) scaffold þ syngeneic ASCs; or (4) scaffold þ allogeneic ASCs. Half of each cohort was harvested 4 or 8 weeks after surgery. Spinal fusion was evaluated with radiographs, microcomputed tomography, and light microscopy. Callus did not form in spines without scaffolds. There were no significant differences in callus formation among scaffold cohorts 4 weeks after surgery. Callus formation was more mature in both ASC cohorts versus scaffold alone 8 weeks after surgery based on microstructure as well as radiographic and microcomputed tomographic evidence of active bone formation. Inflammatory cell infiltrate was significantly lower in both ASC cohorts (syngeneic ¼ 18.3 AE 0.85%; allogeneic ¼ 23.5 AE 2.33%) versus scaffold alone (46.8 AE 11.8%) 4 weeks after surgery. Results of this study support syngeneic and allogeneic ASC acceleration of posterior lumbar spinal fusion in a rat model. ß

OBJECTIVEClinical trials to date have not provided definitive evidence regarding the effects of glucose lowering with coronary heart disease (CHD) risk among diabetic patients.RESEARCH DESIGN AND METHODSWe prospectively investigated the association of HbA1c at baseline and during follow-up with CHD risk among 17,510 African American and 12,592 white patients with type 2 diabetes.RESULTSDuring a mean follow-up of 6.0 years, 7,258 incident CHD cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of HbA1c at baseline (<6.0 [reference group], 6.0–6.9, 7.0–7.9, 8.0–8.9, 9.0–9.9, 10.0–10.9, and ≥11.0%) were 1.00, 1.07 (95% CI 0.97–1.18), 1.16 (1.04–1.31), 1.15 (1.01–1.32), 1.26 (1.09–1.45), 1.27 (1.09–1.48), and 1.24 (1.10–1.40) (P trend = 0.002) for African Americans and 1.00, 1.04 (0.94–1.14), 1.15 (1.03–1.28), 1.29 (1.13–1.46), 1.41 (1.22–1.62), 1.34 (1.14–1.57), and 1.44 (1.26–1.65) (P trend <0.001) for white patients, respectively. The graded association of HbA1c during follow-up with CHD risk was observed among both African American and white diabetic patients (all P trend <0.001). Each one percentage increase of HbA1c was associated with a greater increase in CHD risk in white versus African American diabetic patients. When stratified by sex, age, smoking status, use of glucose-lowering agents, and income, this graded association of HbA1c with CHD was still present.CONCLUSIONSThe current study in a low-income population suggests a graded positive association between HbA1c at baseline and during follow-up with the risk of CHD among both African American and white diabetic patients with low socioeconomic status.

The association of estimated GFR with cardiovascular diseases risk among type 2 diabetes patients was unclear. We prospectively investigated the race-specific association of estimated GFR with the risk of coronary heart disease and stroke among 11 940 White and 16 451 African American patients. During mean follow up of 6.1–6.8 years, 6 647 coronary heart disease and 2 750 stroke incident cases were identified. Age- and sex-adjusted hazard ratios of coronary heart disease associated with baseline estimated GFR (≥90, 75–89, 60–74, 30–59, and 15–29 mL/min/1.73 m2) were 1.00, 1.04 (95% CI 0.95–1.14), 1.13 (1.02–1.26), 1.37 (1.22–1.53), and 2.07 (1.58–2.71) (Ptrend<0.001) for African Americans, and 1.00, 1.09 (0.99–1.19), 1.10 (0.99–1.21), 1.31 (1.18–1.46), and 2.18 (1.66–2.85) (Ptrend<0.001) for whites, respectively. Significantly increased stroke risk was observed among both African American and white participants with estimated GFR<60 mL/min/1.73 m2. When using the updated mean values of estimated GFR, these significant associations became stronger. Participants with mildly decreased estimated GFR (60–89 mL/min/1.73 m2) during follow-up were also at significantly higher risk of coronary heart disease and stroke. The present study demonstrated that even mildly reduced estimated GFR at baseline (<75 mL/min/1.73 m2) and during follow-up (<90 mL/min/1.73 m2) increased risk of incident coronary heart disease and stroke among both African American and white type 2 diabetes patients.

Aims/hypothesis Sex differences in macrovascular disease, especially in stroke are observed across studies of epidemiology. We studied a large sample of patients with type 2 diabetes to better understand the relationship between glycemic control and stroke risk. Methods We prospectively investigated the sex-specific association between different levels of HbA1c and incident stroke risk among 10,876 male and 19,278 female patients with type 2 diabetes. Results During a mean follow up of 6.7 years, 2,949 incident cases of stroke were identified. The multivariable-adjusted hazard ratios (HRs) of stroke associated with different levels of HbA1c at baseline (<6.0%, 6.0–6.9% [reference group], 7.0–7.9%, 8.0–8.9%, 9.0–9.9%, and ≥10.0%,) were 0.96 (95% confidence interval [CI] 0.80, 1.14), 1.00, 1.04 (0.85, 1.28), 1.11 (0.89, 1.39), 1.10 (0.86, 1.41), and 1.22 (0.92, 1.35) (P trend =0.66) for men, and 1.03 (0.90, 1.18), 1.00, 1.09 (0.94, 1.26), 1.19 (1.00, 1.42), 1.32 (1.09, 1.59), and 1.42 (1.23, 1.65) (P trend <0.001) for women, respectively. The graded association of HbA1c during follow-up with stroke risk was observed among women (P trend=0.066). When stratified by race, with glucose-lowering agents or not, this graded association of HbA1c with stroke was still present among women. When stratified by age, the adjusted HRs were significantly higher in women older than 55 years compared to younger women. Conclusions/interpretation The current study suggests a graded association between HbA1c and the risk of stroke among women with type 2 diabetes. Poor control of blood sugar has a stronger effect in diabetic women older than 55 years.

A history of GDM is a strong predictor of subsequent type 2 diabetes among Louisiana women, especially among African American women.