Gestational diabetes knowledge improves with interactive online training modules.

Background: The risk of developing type 2 diabetes mellitus (T2DM) is up to 50% among women with gestational diabetes mellitus (GDM). However, diabetes education during and after pregnancy is limited. To bridge this gap, our team developed four training modules on GDM for nurses and community health workers.

A Randomized Controlled Trial Testing the Effects of a Social Needs Navigation Intervention on Health Outcomes and Healthcare Utilization among Medicaid Members with Type 2 Diabetes.

Health systems are increasingly assessing and addressing social needs with referrals to community resources. The objective of this randomized controlled trial was to randomize adult Medicaid members with type 2 diabetes to receive usual care ( = 239) or social needs navigation ( = 234) for 6 months and compare HbA1c (primary outcome), quality of life (secondary outcome), and other exploratory outcomes with -tests and mixed-effects regression. Eligible participants had an HbA1c test in claims in the past 120 days and reported 1+ social needs.

Effectiveness and Safety of Different Estradiol Regimens in Transgender Females: A Randomized Controlled Trial.

Background: A goal of gender-affirming hormone therapy (GAHT) for transgender women is to use estradiol to suppress endogenous production of testosterone. However, the effects of different estradiol regimens and route of administration on testosterone suppression is unknown. This is the first open-label randomized trial comparing different GAHT regimens for optimal estradiol route and dosing.

The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study.

Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients.

Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data.

Effectiveness and Safety of Different Estradiol Regimens in Transgender Women (TREAT Study): Protocol for a Randomized Controlled Trial.

Background: Current guidelines for gender-affirming hormone therapy (GAHT) for transgender women are mostly based on clinical experience from experts in the field and treatments used on postmenopausal women. While care is currently provided with the best available evidence, there is a critical gap in knowledge about the safest and most effective estradiol routes of administration for GAHT in transgender women; this statement is supported by the World Professional Association for Transgender Health on their Standards of Care for the Health of Transgender and Gender Diverse People, version 8. Furthermore, the reported rates of cardiometabolic adverse events in transgender women highlight the importance of investigating changes in lipoproteins, glucose, and insulin sensitivity, among other markers while receiving GAHT.

Gestational diabetes knowledge improves with interactive online training modules: a pre-post analysis.

Background: The risk of developing type 2 diabetes mellitus (T2DM) is up to 50% among women with gestational diabetes mellitus (GDM). GDM also increases risks for pre-term birth, macrosomia, fetal hypoglycemia, and C-section delivery. Education for expectant mothers with GDM about nutrition, exercise, and the risks of developing T2DM after delivery enhances the probability of postpartum diabetes screening.

Food insecurity, SNAP participation and glycemic control in low-income adults with predominantly type 2 diabetes: a cross-sectional analysis using NHANES 2007-2018 data.

Introduction: Diabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are integral to glycemic control. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity, but it is not clear how this affects glycemic control in T2D.

Barriers and facilitators to diabetes screening and prevention after a pregnancy complicated by gestational diabetes.

Objective: Gestational diabetes mellitus (GDM) is increasing in the United States, with higher rates among minoritized racial and ethnic populations and lower income populations. GDM increases risk for type 2 diabetes (T2DM), and postpartum diabetes screening and prevention are imperative. This qualitative study examines barriers and facilitators to postpartum T2DM screening and prevention among non-privately insured individuals with a history of GDM in a state prior to Medicaid expansion.

The adoption of social determinants of health documentation in clinical settings.

Objective: To understand the frequency of social determinants of health (SDOH) diagnosis codes (Z-codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care.

Data Sources: EHR data and qualitative interviews with health care providers and stakeholders.

Study Design: An explanatory sequential mixed methods design first examined the use of Z-codes within the EHR and qualitatively examined barriers to documenting SDOH.

Adverse Pregnancy Outcomes and Postpartum Care as a Pathway to Future Health.

Adverse pregnancy outcomes (APOs) collectively represent the leading causes of maternal and neonatal morbidity and mortality. Beyond the potentially devastating impact of APOs during pregnancy and the puerperium, women diagnosed with APOs have a 2-fold to 4-fold increased risk of future cardiovascular disease. Fortunately, APOs occur at an opportune time, in early-adulthood to mid-adulthood, when primary and secondary prevention strategies can alter the disease trajectory and improve long-term health outcomes.

Constructing an Adapted Cascade of Diabetes Care Using Inpatient Admissions Data: Cross-sectional Study.

Background: The diabetes mellitus cascade of care has been constructed to evaluate diabetes care at a population level by determining the percentage of individuals diagnosed and linked to care as well as their reported glycemic control.

Objective: We sought to adapt the cascade of care to an inpatient-only setting using the electronic health record (EHR) data of 81,633 patients with type 2 diabetes.

Methods: In this adaptation, linkage to care was defined as prescription of diabetes medications within 3 months of discharge, and control was defined as hemoglobin A (HbA) below individual target levels, as these are the most reliably captured items in the inpatient setting.

Understanding Gestational Diabetes, Future Diabetes Risk, and Diabetes Prevention: A Qualitative Study of Patient, Provider, and Staff Perspectives.

Gestational diabetes mellitus (GDM) increases type 2 diabetes risk; however, postpartum diabetes screening rates are low. Using semi-structured interviews and focus groups, this study investigates the understanding of GDM and its relationship to future diabetes risk and diabetes prevention among patients with public or no insurance ( = 36), health care providers ( = 21), and clinic staff ( = 9) from Federally Qualified Health Centers. Five main themes emerged: ) general understanding of GDM diagnosis with focus on neonatal complications; ) variable recall of diet, exercise, and weight recommendations; ) overwhelming medication and self-monitoring routines; ) short-term focus of type 2 diabetes risk and screening; and ) limited understanding of all options for diabetes prevention.

10-year weight loss outcomes after Roux-en-Y gastric bypass and attendance at follow-up visits: a single-center study.

Background: Long-term durability of weight loss is a prerequisite for a greater acceptance of bariatric surgery.

Objectives: To examine long-term weight trajectory in patients undergoing Roux-en-Y gastric bypass (RYGB) and determine factors predicting long-term follow-up and weight outcomes.

Setting: University hospital.

Medication Adherence and Characteristics of Patients Who Spend Less on Basic Needs to Afford Medications.

Introduction: Among individuals with low income, cost is a well-established barrier to medication adherence. Spending less on basic needs to pay for medication is a particularly concerning cost-coping strategy and may be associated with worse health outcomes. The aims of this study were (1) to describe the demographic and health status characteristics of those who report spending less on basic needs to pay for medication, and (2) to understand the associated psychosocial and financial challenges of these individuals.

Social Needs, Chronic Conditions, and Health Care Utilization among Medicaid Beneficiaries.

Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data.

Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes.

The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.

Factors Associated With Postpartum Diabetes Screening in Women With Gestational Diabetes and Medicaid During Pregnancy.

Introduction: Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Loss of health coverage after pregnancy, as occurs in states that did not expand Medicaid, limits access to guideline-driven follow-up care and fosters health inequity. This study aims to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion.

Obesity-related multimorbidity and risk of cardiovascular disease in the middle-aged population in the United States.

To investigate the prevalence of obesity-related multimorbidity (co-occurrence of ≥2 obesity-related chronic diseases, ORCDs) and the risk of cardiovascular disease in the presence of multimorbidity in middle-aged adults in the United States. National Health and Nutrition Examination Survey data from 2007 to 2016 were used. Target ORCDs included hypertension (H), diabetes (D), coronary heart disease (C), and stroke (S).

Maternal Race/Ethnicity and Postpartum Diabetes Screening: A Systematic Review and Meta-Analysis.

Fifty percent of women with gestational diabetes mellitus (GDM) may progress to type 2 diabetes with highest risk among black women. This study aims to characterize postpartum diabetes screening rates among U.S.

Postpartum diabetes screening among low income women with gestational diabetes in Missouri 2010-2015.

Background: Gestational diabetes increases risk for type 2 diabetes seven-fold, creating a large public health burden in a young population. In the US, there are no large registries for tracking postpartum diabetes screening among women in under-resourced communities who face challenges with access to care after pregnancy. Existing data from Medicaid claims is limited as women often lose this coverage within months of delivery.

Prenatal counseling on type 2 diabetes risk, exercise, and nutrition affects the likelihood of postpartum diabetes screening after gestational diabetes.

Objective: Screening rates for type 2 diabetes after a pregnancy with gestational diabetes are inadequate. We aimed to determine how prenatal counseling on exercise, nutrition, and type 2 diabetes risk affects postpartum screening for diabetes.

Methods: Using Pregnancy Risk Assessment Monitoring System data from Colorado (2009-2011) and Massachusetts (2012-2013), we performed multivariable logistic regression to examine the relationship between prenatal counseling and postpartum screening.