Researchers at the Palo Alto Medical Foundation Research Institute (PAMFRI) have received a five-year, $3 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to study physical activity among individuals with type 2 diabetes.
Type 2 diabetes is the most common form of diabetes and affects 25.8 million people in the United States – nearly one in 10 Americans. If current trends continue, it is estimated that one in three American adults will have diabetes by the year 2050.
Lifestyle changes, such as diet and exercise, are an essential part of maintaining a healthy lifestyle, and preventing and controlling diabetes. The current American Diabetes Association (ADA) guidelines recommend that individuals with type 2 diabetes engage in at least 150 minutes of moderate-intensity aerobic physical activity every week, as well as strength training three times per week. Current studies show that nearly 70 percent of individuals with type 2 diabetes do not exercise at recommended levels – or at all.
“There is clearly a need to extend physical activity interventions into the clinical setting,” says Latha Palaniappan, M.D., associate investigator at the Palo Alto Medical Foundation Research Institute and principal investigator for this study.
The Initiate and Maintain Physical Activity in Clinics (IMPACT) study will examine an innovative structured group exercise program within the clinic.
“This study will help patients with diabetes get active and stay active. We have an important opportunity to improve the care of diabetes nationwide, with innovative science here at the Palo Alto Medical Foundation,” said Dr. Palaniappan.
The IMPACT Study will fill an important research gap by making physical activity an essential part of type 2 diabetes management, establishing it within a health care setting and empowering patients to initiate and maintain physical activity recommendations long-term.
This study, starting in January 2014, will enroll approximately 300 patients with type 2 diabetes. Adults interested in participating should contact: IMPACT@pamfri.org for more information.
Findings presented at the American Heart Association Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Session
A study conducted at the South Asian Heart Center at El Camino Hospital in Mountain View, Calif., and the Palo Alto Medical Foundation showed that providing culturally competent coaching to South Asian patients may be an effective way to reduce their risk for developing coronary artery disease. The findings were presented as a poster at the American Heart Association Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism Conference in New Orleans, March 19-22, 2013.
“Coronary artery disease affects the South Asian Community four times more than the general population, even for lifelong vegetarians who do not smoke and are not overweight,” said Powell Jose, M.D., division of Patient Outcomes and Clinical Research, Palo Alto Medical Foundation Research Institute, and poster presenter. “Diet and lifestyle counseling had not been previously validated in the South Asian population, which makes these results even more encouraging as we continue to address this community’s increased risk for coronary artery disease.”
The study examined 703 patients at the South Asian Heart Center who opted to enroll in the Heart Health Coaching program and were either partially coached (n=145) or fully coached (n=558) for an entire year. A third group (n=33) consisted of patients who did not participate in the program. The level of coaching was dependent on participant receptivity to phone calls or e-mails from trained volunteers throughout the year who provided culturally competent health education on diet, physical activity and stress reduction. To measure the physical impact of the coaching, fasting lipids were obtained and measured with mean differences calculated from baseline and the last available follow-up lab test.
Study results showed that in the fully coached group, there were significant improvements (p<0.001 for all) in total cholesterol (TC) (-5.5±28.4mg/dl); LDL (-4.1±24.3); HDL (1.9±6.4); triglycerides(-16.1±67.3); and TC/HDL ratio(-0.31±0.83). The partially coached group demonstrated reductions in total cholesterol (-5.2±27.8, p=0.03); LDL (-8.1±28.0mg/dl, p<0.001); and TC/HDL ratio (-0.42±1.01, p<0.001) with a trend towards increased HDL (4.9±31.3, p=0.06). Non-coached participants did not have any statistically significant differences for any lipid measurement. There were also no significant differences in mean age (43, 42 and 43), mean BMI (25.8, 26.5 and 26.2), or baseline lipid values across the three groups (completers, partial completers, and non-completers, respectively).
“From a clinical standpoint, for every one mg decrease in LDL, there is a two percent decrease in that person’s risk of a cardiovascular event, which further emphasizes the importance of the coaching,” said César Molina, M.D., FACC, founder and medical director of the South Asian Heart Center at El Camino Hospital. “Physicians have limited time to provide patients with this type of detailed follow-through, so coaching can prove to be an effective resource for them to achieve improved outcomes in their patients.”
A secondary analysis examined lipid values and BMI in 492 South Asian participants (21.7% women) who completed the program with a comparison control consisting of South Asians with no prior exposure to theSouth Asian Heart Center or the coaching program, created using electronic health record data from a healthcare organization within the same geographic region. The analysis showed that baseline characteristics were similar, yet for those who participated in the coaching program, there was an improvement in the lipid profile and BMI, with significant reductions in total cholesterol (-2.33mg/dL, p=0.001); LDL (-1.45 mg/dL, p=0.04); HDL (1.16, mg/dL, p<0.0001); Triglycerides (-9.61, p=0.002); TC/HDL ratio(-0.15, p<0.0001); and BMI (-0.12, p=0.005) versus those who had never come into contact with the program or the Center.
“Study results showed that even partial coaching could have health benefit for patients, as seen with improved total cholesterol and LDL levels,” said Ashish Mathur, executive director, South Asian Heart Center at El Camino Hospital. “Our heart health coaches are non-medically trained volunteers who monitor and motivate over phone and email, making this a cost-effective method for risk reduction in a vulnerable population. We hope to use these findings to enhance our own coaching program and provide guidance to other communities facing similar challenges, not just inCalifornia, but nationally and across the world.”
About the South Asian Heart Center
The South Asian Heart Center at El Camino Hospital is the first major non-profit devoted to combating the growing epidemic of heart disease among people from Bangladesh, India, Pakistan, Nepal and Sri Lanka through a unique preventative program. Offered at a minimal, subsidized cost, the Center assesses the risk for heart disease and diabetes using an advanced screening process that keys in on risk factors specific to this population, and helps participants manage and mitigate their risk through education, nutrition counseling, lifestyle recommendations, and case-managed follow-up.
About El Camino Hospital
El Camino Hospital is an acute-care, 443-bed, nonprofit and locally governed organization with campuses in Mountain View and Los Gatos, Calif. In addition to state-of-the-art emergency departments, key medical specialties include heart and vascular, cancer care, urology, orthopedic and spine, genomic medicine, and the only Women’s Hospital in Northern California. The hospital is recognized as a national leader in the use of health information technology and wireless communications, and has been awarded the Gold Seal of Approval from The Joint Commission as a Primary Stroke Center, as well as back-to-back ANCC Magnet Recognitions for Nursing Care. To learn more, visit their website, find them on Facebook, follow on Twitter, or view videos on YouTube.
About Palo Alto Medical Foundation
Founded in 1930, the Palo Alto Medical Foundation for Health Care, Research and Education (PAMF) is a not-for-profit health care organization dedicated to enhancing the health of people in our communities. PAMF is a nationally recognized leader patient-centered care, and a pioneer in e-health and innovation. Part of the Sutter Health network of care, PAMF’s 1,100 affiliated physicians and 4,300 employees serve approximately 800,000 patients at its medical centers and clinics in Alameda, San Mateo, Santa Clara and Santa Cruz counties. PAMF’s South Asian Health Program (PRANA – Prevention and Awareness for South Asians), helps improve South Asian health and reduces disease risk through culturally tailored programs, health related resources and educational services. For more information, visit: www.pamf.org, visit the PAMF blog, and follow PAMF on Twitter and Facebook.
El Camino Hospital
Palo Alto Medical Foundation
Every year, users of Statistical Analysis System (SAS) software meet at the international SAS Global Forum. This year, Beinan Zhao, MS, senior statistician at the Palo Alto Medical Foundation Research Institute (PAMFRI), will present recent research at the 2013 SAS Global Forum, taking place April 29 to May 1, in San Francisco, Calif.
At this year’s conference, Zhao will be receiving a Junior Professional Award for her work on an abstract titled “Estimating Patient Adherence to Medication with Electronic Health Records Data and Pharmacy Claims Combined.”
Zhao has conducted statistical analysis and data management using SAS software in health policy, patient outcomes and clinical research studies as a member of the DISCOVER team at PAMFRI. Her work focuses on utilizing de-identified data from Electronic Heath Records (EHRs) in chronic disease epidemiology research. She is examining racial/ethnic disparities with regards to type 2 diabetes and cardiovascular risk factors for the Pan-Asian Cohort Study (PACS). PACS is a five-year study funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and led by PAMFRI’s Latha Palaniappan, M.D. which is researching diabetes and its risk factors among Asian American subgroups.
Zhao has developed a series of comprehensive measurements for patient medication adherence, which is fundamental in understanding patient behavior in taking medications and its relationship to disease outcomes.
Through the PACS study, the DISCOVER team is comparing the efficacy of oral drugs for treatment of type 2 diabetes among Asian subgroups. It is well known that type 2 diabetes manifests differently in racial/ethnic groups, who may respond differently to the same pharmacotherapy. The PACS cohort allows for comparative effectiveness research on diabetes medications among Asian subgroups, as well as the ability to study existing preferences for certain drugs among patients and physicians.
The Palo Alto Medical Foundation Research Institute (PAMFRI) will present recent findings at the upcoming American College of Cardiology (ACC) Annual Scientific Sessions, taking place March 9-11, 2013 in San Francisco, California.
Two abstracts authored by Powell Jose, M.D., a research physician at PAMFRI, were designated as “Best Poster,” representing approximately the top three percent scoring percentile of poster acceptances.
The first abstract, titled “Variation in Hypertension Prevalence among Asian American Subgroups: Results from PACS (Pan-Asian Cohort Study),” demonstrates significant heterogeneity in hypertension prevalence among Asian-American subgroups, particularly among Filipino and Japanese Americans. The Pan-Asian Cohort Study is a five-year study funded by the National Institutes of Health (NIH) and led by Latha Palaniappan, M.D., lead investigator at PAMFRI. The study is examining diabetes and its risk factors among Asian American subgroups.
The second abstract came from the Causes of Asian American Mortality Understood by Socio-Economic Status (CAUSES) Study, another NIH-funded study awarded to Dr. Palaniappan and her team at PAMFRI to examine causes of death among Asian American subgroups using national mortality records. The abstract, titled “Differences in Coronary Heart Disease Mortality Rates Among Asian American Subgroups; Results from the CAUSES Study,” showed higher rates of death due to coronary heart disease among Asian Indians and Filipinos compared to other racial/ethnic groups.
“Both of these analyses underscore the importance of studying Asian American subgroups separately and not aggregated as is commonly done in epidemiologic surveys,” said Dr. Jose. “Research must avoid masking the significant heterogeneity that exists in cardiovascular risk factors and outcomes. Hopefully these abstracts call attention to the need for more research of direct treatment and prevention efforts to reduce health disparities among diverse communities.”
Visit the Palo Alto Medical Foundation Research Institute (PAMFRI) website for more information on the PACS and CAUSES studies, as well as other innovative research being done at PAMFRI. Read more PAMFRI news in the PAMF newsroom.
Researchers at the Palo Alto Medical Foundation Research Institute (PAMFRI) have received an award from the American Diabetes Association to support a minority undergraduate intern in the area of diabetes research. The grant funds the one-year internship that began in February 2013 and finances support for an undergraduate minority student to gain valuable hands-on experience in diabetes research.
Perri Smith, a Stanford University student majoring in Human Biology, will join PAMRI’s Latha Palaniappan, M.D., M.S. and her research team, to study gestational diabetes among Asian Americans. Ms. Smith has previously participated in research at PAMFRI through the Stanford Human Biology Research Exploration Program.
Gestational diabetes occurs when women develop high blood glucose levels during pregnancy. Women with gestational diabetes may have increased perinatal health risks and are also at increased risk for the development of type 2 diabetes later in life.
Research has shown that Asian Americans have the highest rates of gestational diabetes in the United States, yet there is limited information regarding the racial/ethnic differences in gestational diabetes among Asian American subgroups (Asian Indians, Chinese, Filipino, Japanese, Korean and Vietnamese). The Gestational Diabetes Study at PAMFRI seeks to better understand specific racial/ethnic differences in risk factors for gestational diabetes, problems associated with gestational diabetes, and the progression of women to type 2 diabetes following a pregnancy complicated by gestational diabetes.
“The minority undergraduate internship award will allow us to support undergraduate research while working to gain a better understanding of the predictors and problems associated with gestational diabetes among Asian Americans,” said Dr. Palaniappan.
The Gestational Diabetes Study will fill an important knowledge gap for racial/ethnic differences in gestational diabetes and provide targeted research directions and the evidence needed to develop clinical interventions, and public health guidance for gestational diabetes among Asian Americans.
Can healthier eating improve asthma control? That question will be explored in a new pilot study of the DASH diet in not-well-controlled adult asthma. The research is a collaborative project with physician researchers at the Palo Alto Medical Foundation Research Institute, Kaiser Permanente Northern California, and Stanford University School of Medicine.
Beginning in February 2013, patients in select Bay Area medical centers of the Permanente Medical Group will be recruited to participate. The study will continue through May 2014. The two-year study received a grant award of $708,000 from the National Institutes of Health.
Rigorous research on the effect of a healthy eating pattern on asthma control among adults is lacking. This pilot study aims to provide preliminary outcome and feasibility data necessary to design and conduct a full-scale randomized controlled trial that will determine the efficacy of Dietary Approaches to Stop Hypertension (DASH) as adjunct therapy to standard care for adults with uncontrolled asthma.
DASH is a dietary pattern recommended by the U.S. Department of Agriculture based on its proven cardiovascular benefits, in particular for lowering blood pressure. Its effect in controlling adult asthma, however, has never been rigorously tested. “Rigorously testing the hypothesis that the DASH dietary pattern will lead to improvements in asthma control among adults is potentially highly important scientifically and to clinical management of asthma patients,” says Peg Strub, M.D., chief of the Department of Allergy, Asthma and Immunology of the Kaiser Permanente San Francisco Medical Center, and a study co-investigator.
In this initial study, 90 eligible and consenting adults with uncontrolled asthma will be enrolled and randomly assigned to receive usual care or usual care plus a DASH intervention. Changes in participants’ asthma status will be evaluated through self-reporting and clinical examination over a six-month period. The study also will examine changes in inflammatory markers important to asthma pathophysiology and whether they help define the intervention effect on disease control.
“This well-designed clinical trial pilot study of a dietary approach to treating adult asthma, coupled with innovative translational laboratory investigations, has high potential for direct impact on daily care for asthma patients and on our understanding of therapeutic contributions of nutrition to the disease,” states study co-investigator Kari Nadeau, M.D., Ph.D., director of the Allergy Clinics of the Stanford Medical Center and Lucile Packard Children’s Hospital.
“By evaluating a healthy eating pattern approach to improving asthma control, this collaborative study could guide medical providers to refine clinical guidelines and public health recommendations,” explains Jun Ma, M.D., Ph.D., lead investigator from the Palo Alto Medical Foundation Research Institute. “If dietary modifications do improve asthma control, that’s great news for the more than 18 million American adults living with the disease.”