This study examined the effects of a mindful eating intervention on health-related outcomes. Thirty-six obese, post-menopausal women were randomized to a 6-week mindful eating and living (MEAL) intervention or an active control group (CONT), consisting of nutritional counseling, goal setting, and group support. Additionally, there were ten monthly refreshers. Weight, body mass index (BMI), waist-hip ratio (WHR), binge eating, interleukin-6 (IL-6), and C-reactive protein (CRP) were assessed at baseline and four follow-up periods up to 1 year. Multilevel analyses showed that the MEAL group had reductions in weight, BMI, WHR, binge eating, IL-6, and CRP, and the CONT group had reductions in weight, BMI, and binge eating. The reductions in IL-6 and CRP were greater for the MEAL as compared with the CONT group. This study suggests that a mindfulness-based eating intervention may have various health benefits in post-menopausal women who are obese.

Introduction One in three people will be diagnosed with diabetes by 2050, and the proportion will likely be higher among Native Americans. Diabetes control is currently suboptimal in underserved populations despite a plethora of new therapies. Patient empowerment is a key determinant of diabetes control, but such empowerment can be difficult to achieve due to resource limitation and cultural, language and health literacy barriers. We describe a home-based educational intervention using Community Health Representatives (CHRs), leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control. Methods Sixty participants with type 2 diabetes (T2D) completed a baseline evaluation including physical exam, Point of Care (POC) testing, and the Patient Activation Measure (PAM) survey. Participants then underwent a one hour group didactic session led by Community Health Representatives (CHRs) who subsequently carried out monthly home-based educational interventions to encourage healthy lifestyles, including diet, exercise, and alcohol and cigarette avoidance until follow up at 6 months, when clinical phenotyping and the PAM survey were repeated. Results PAM scores were increased by at least one level in 35 (58%) participants, while 24 participants who started at higher baseline score did not change. Six months after intervention, mean levels of A1C decreased by 0.7 ± 1.2%; fasting blood glucose decreased by 24.0 ± 38.0 mg/dl; BMI decreased by 1.5 ± 2.1 kg/m2; total cholesterol decreased by 12.0± 28.0 mg/dl; and triglycerides decreased by 52.0 ± 71.0 mg/dl. All of these changes were statistically significant (p<0.05). Conclusion This six month, CHR led and community-oriented educational intervention helps inform standards of practice for the management of diabetes, engages diabetic populations in their own care, and reduces health disparities for the underserved population of Zuni Indians. Trial Registration ClinicalTrials.gov NCT02339311

Increased adiposity and direct effects of glucocorticoid excess on muscle, liver, and β-cells are responsible for the high prevalence of impaired glucose tolerance (IGT) and type 2 diabetes in patients with Cushing syndrome (CS) (1,2). In the SEISMIC study, the glucocorticoid receptor antagonist mifepristone improved glucose tolerance and produced weight loss over 24 weeks in CS patients (3). Using oral glucose tolerance test data from SEISMIC, our goal was to assess whole-body insulin sensitivity (Matsuda index), β-cell function (insulinogenic index, homeostasis model assessment-β [HOMA-β]), disposition index (4,5), weight (WT), and waist circumference (WC) over time. Complete data in patients not receiving insulin were available in 19 patients, 8 with diabetes and/or IGT (C-DM) and 11 with hypertension only (C-HT).Within-group comparisons for change over time were analyzed with a mixed-effects repeated measures two-way ANOVA with cohort (C-DM and C-HT), time, and cohort by time interaction as fixed effects; unpaired Student t tests were used to assess differences between groups …

PURPOSE:The purpose of this study is to determine whether an innovative interactive distance training program is an effective modality to train community health workers (CHWs) to become members of the diabetes health care team. The University of New Mexico Health Sciences Center has developed a rigorous diabetes training program for CHWs involving both distance and hands-on learning as part of Project ECHO™ (Extension for Community Healthcare Outcomes).METHODS:Twenty-three diverse CHW participants from across New Mexico were enrolled in the first training session. Participants completed surveys at baseline and at the end of the program. They attended a 3-day hands-on training session, followed by weekly participation in tele/video conferences for 6 months. Wilcoxon signed-rank statistics were used to compare pre- and posttest results.RESULTS:Participants demonstrated significant improvements in diabetes knowledge (P = .002), diabetes attitudes (P = .04) and confidence in both clinical and nonclinical skills (P < .001 and P = .04, respectively). Additionally, during focus group discussions, participants reported numerous benefits from participation in the program.CONCLUSIONS:Community health worker participation in the Project ECHO diabetes training program resulted in significant increases in knowledge, confidence, and attitudes in providing care to patients with diabetes. Studies are ongoing to determine whether the training has a positive impact on patient outcomes.

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases.

The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of New Mexico Health Sciences Center as a platform to deliver complex specialty medical care to underserved populations through an innovative educational model of team-based interdisciplinary development. Using state-of-the-art telehealth technology, best practice protocols, and case-based learning, ECHO trains and supports primary care providers to develop knowledge and self-efficacy on a variety of diseases. As a result, they can deliver best practice care for complex health conditions in communities where specialty care is unavailable. ECHO was first developed for the management of hepatitis C virus (HCV), optimal management of which requires consultation with multidisciplinary experts in medical specialties, mental health, and substance abuse. Few practitioners, particularly in rural and underserved areas, have the knowledge to manage its emerging treatment options, side effects, drug toxicities, and treatment-induced depression. In addition, data were obtained from observation of ECHO weekly clinics and database of ECHO clinic participation and patient presentations by clinical provider. Evaluation of the ECHO program incorporates an annual survey integrated into the ECHO annual meeting and routine surveys of community providers about workplace learning, personal and professional experiences, systems and environmental factors associated with professional practice, self-efficacy, facilitators, and barriers to ECHO. The initial survey data show a significant improvement in provider knowledge, self-efficacy, and professional satisfaction through participation in ECHO HCV clinics. Clinicians reported a moderate to major benefit from participation. We conclude that ECHO expands access to best practice care for underserved populations, builds communities of practice to enhance professional development and satisfaction of primary care clinicians, and expands sustainable capacity for care by building local centers of excellence.

Sleep apnea is a common respiratory sleeping disorder characterized by recurring hypoxia and is linked to cardiovascular diseases such as coronary artery disease, heart failure, and hypertension. To model sleep apnea, rats were exposed to intermittent hypoxia (IH) (20 short exposures per hr to 5% O2, 5% CO2 8 hr/day for up to 21 days). We previously reported that 14 days of IH causes endothelin-dependent hypertension and augments vasoconstrictor sensitivity to endothelin-1 (ET-1). In addition, clinical studies suggest a strong association between sleep apnea and diabetes. We therefore performed glucose tolerance tests (GTT) and measured circulating stress hormones to determine if intermittent hypoxia also causes diabetes like conditions in lean rats. We found that after 7 or 14 days of IH, there is no difference in GTT results compared to the same rats at day 0. On day 14, plasma levels of PAI-1 were not different (Sham vs IH 0.48±0.08 vs 0.94±0.15 ng/ml, p=0.15). Therefore 14 days of IH in healthy, lean rats does not appear to cause insulin resistance or other symptoms of diabetes.