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Articles by K. Weinger
Total Records ( 4 ) for K. Weinger
  A. M. Jacobson , A. D. Paterson , C. M. Ryan , P. A. Cleary , B. H. Waberski , K. Weinger , G. Musen , W. Dahms , M. Bayless , N. Silvers , J. Harth , A. P. Boright and The DCCT/EDIC Research Group
  Aims  Specific polymorphisms of the apolipoprotein E (APOE) and angiotensin-converting enzyme (ACE) genes appear to increase risk for Alzheimer's disease and cognitive dysfunction in the general population, yet little research has examined whether genetic factors influence risk of cognitive dysfunction in patients with Type 1 diabetes. The long-term follow-up of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) population provides an opportunity to examine if specific genetic variations in APOE and ACE alter risk for cognitive decline.
Methods  Neurocognitive function in Type 1 diabetic subjects from the DCCT/EDIC study was assessed at DCCT entry and re-assessed approximately 18 years later, using a comprehensive cognitive test battery. Glycated haemoglobin (HbA 1c ) and the frequency of severe hypoglycaemic events leading to coma or seizures were measured over the 18-year follow-up. We determined whether the APO ε4 and ACE intron 16 indel genotypes were associated with baseline cognitive function and with change over time, and whether they conferred added risk in those subjects experiencing severe hypoglycaemic events or greater glycaemic exposure.
Results  None of the APOE or ACE polymorphisms were associated with either baseline cognitive performance or change in cognition over the 18-year follow-up. Moreover, none of the genotype variations altered the risk of cognitive dysfunction in those subjects with severe hypoglycaemic episodes or high HbA 1c .
  In this sample of young and middle-aged adults with Type 1 diabetes, APO ε4 and ACE D alleles do not appear to increase risk of cognitive dysfunction.
  M. D. Ritholz , A. Atakov-Castillo , M. Beste , E. A. Beverly , A. Leighton , K. Weinger and H. Wolpert
  Aims  To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes.

Methods  Twenty adult patients (aged 45 ± 15 years, diabetes duration 25 ± 19 years, 50% female) followed at our site in the multi-centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into three groups: Glycated haemoglobin (HbA1c) Responders who demonstrated an improvement in glycaemic control with continuous glucose monitoring (baseline HbA1c≥ 7.0%, HbA1c reduction greater than or equal to 0.5%), Hypoglycaemia Responders (baseline HbA1c < 7.0%) who demonstrated decreased time < 3.9 mmol/l while remaining within target HbA1c, and HbA1c Non-Responders (baseline HbA1c≥ 7.0%, HbA1c reduction less than 0.5%). Subjects participated in semi-structured interviews focusing on their psychosocial experiences with continuous glucose monitoring.

Results  Three major themes were identified that differentiated Responders (including both the HbA1c and Hypoglycaemia groups) from Non-Responders: (i) coping with frustrations-Responders used self-controlled rather than emotions-based coping when faced with continuous glucose monitoring frustrations; (ii) use of information-Responders used retrospective pattern analysis, not just minute-by-minute data analysis, in glycaemic management; (iii) ‘significant other’/spousal involvement-Responders endorsed interest, encouragement and participation by their loved ones. Both Responders and Non-Responders expressed body image concerns when wearing continuous glucose monitoring devices.

Conclusions  This qualitative study points to the importance of coping skills, retrospective review of data, and ‘significant other’ involvement in the effective use of continuous glucose monitoring. These findings will inform clinical initiatives to improve patient selection and training in the use of this new technology and have served as the basis for development of quantitative surveys to be used in clinical practice.

  E. A. Beverly , L. A. Wray , C. J. Chiu and K. Weinger
  Aims  To explore older patients' perceived impact of chronic co-morbid conditions on Type 2 diabetes self-management.

Methods  We used purposive sampling to select 32 mentally alert community-dwelling adults, aged 60 years or older, diagnosed with Type 2 diabetes and at least one other chronic health condition to participate in focus groups. We summarized the discussions following each focus group and identified codes to describe the overarching themes.

Results  We conducted eight 90-min focus groups, each consisting of two to six patients. Three themes emerged. (i) Diabetes complications as a motivator: managing co-morbid conditions made health an important focal point in the lives of older patients. Most patients acknowledged the positive effect complications had on their diabetes self-management by motivating them to pay greater attention to their diabetes to diminish the progression of these complications. (ii) Prioritizing health conditions: patients reported prioritizing health conditions and selectively attending to the management of those conditions based on perceived severity or importance. Further, many patients perceived some conditions as more serious than others and admitted to prioritizing another health condition over their diabetes. (iii) Emotional impact of co-morbidity management: patients described feeling frustrated, confused, and overwhelmed in response to conflicting treatment recommendations, particularly for diet, physical activity and medication regimens.

Conclusions  Complications and co-morbidities may have differential impacts on the diabetes self-management of older patients. Addressing the perceived impact of co-morbidity on diabetes self-management may improve patients' outcomes; however, the most effective method of utilizing this information in clinical practice needs to be examined.

  M. N. Munshi , M. Hayes , I. Iwata , Y. Lee and K. Weinger
  Aims  To examine whether different aspects of executive function as measured by different assessment tools are associated with glycaemic control and other clinical characteristics in older adults with Type 2 diabetes.

Methods  We performed a cross-sectional study of older adults aged ≥ 70 years with Type 2 diabetes at a tertiary care diabetes centre. The Dysexecutive Questionnaire was used to measure self-reported executive dysfunction. Objective tests of executive functions included a modified clock drawing test (Clock-in-a-Box), Trail Making Tests (parts A and B) and verbal fluency. Demographic and clinical information was collected using questionnaires and surveys. Glycaemic control was measured by HbA1c.

Results  We evaluated 145 patients [average age 77 ± 5 years, diabetes duration 15 ± 11 years, mean HbA1c 56 ± 11 mmol/mol (7.3 ± 1.1%)]. Poor performances on objective tests (low scores on Clock-in-a-Box and verbal fluency; and high scores on Trail Making Tests A and B) but not on the subjective test (the Dysexecutive Questionnaire), were associated with poor glycaemic control (r = −0.23, P < 0.005; r = −0.17, P < 0.04; r = 0.20, P < 0.01, r = 0.22, P < 0.008, r = −0.07, P < 0.42, respectively). In a multiple regression model (r2 = 0.39), high Dysexecutive Questionnaire scores were associated with higher diabetes-related distress (P < 0.0004), depressive symptoms (P < 0.004), number of falls (P < 0.009), fear of falling (P < 0.01), less years of education (P < 0.0007) and fewer medications (P < 0.001).

Conclusions  On the one hand, in older adults, executive dysfunction detected by objective tests is associated with poor glycaemic control and may be considered before prescribing complex treatment regimens. On the other hand, self-reported executive dysfunction is associated with risk and fear of falls, and more affective symptoms, which may indicate higher awareness of subtle deficits.

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