Diabetes

Using data from the All of Us Research Program, this project aims to examine cardiometabolic measurements across different ethnic/racial groups in order to set a foundation for future funding for All of Us research. This project was funded by the University of Arizona Office of Research, Innovation, and Impact. 

We are using genetics to better understand the pathophysiological intersect of type-2 diabetes and cardiovascular disease, and to better understand how and in whom statin use may lead to a higher risk of developing type-2 diabetes. This project is funded by the National Institutes of Health.  Other collaborators on this project include Alexis Frazier-Wood, Craig Stump, and Jose Ordovas. 

Currently 1 in 9 Arizonan has T2D. African-American, Hispanics, American Indians and Asian-Americans, that account for 40% of Arizona residents, are about twice as likely to have T2D as are Whites. In 2008, 9,883 hospitalizations in Arizona were due to diabetes that make diabetes one of most costly diseases. Treatment regime for T2D is rather complex. After failure of diet and lifestyle efforts, step-wise addition of glucose-lowering medications is the usual course of T2D therapy. The decision of prescribing subsequent medications in the best sequence after initiation of the generally agreed upon initial oral medication (metformin) is strikingly challenging due to the unclear advantages of 2, 3, 4 and 5 drug regimens and the increased potential for adverse effects. Right now, most T2D treatments guidance are designed for the average patient. But one size doesn't fit all, and treatments that are very successful for some patients don't work for others. In addition, there are also new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications and the ideal target goals for therapy.
Comparative effectiveness studies are the traditional tools to preform comparisons. However, it is impossible due to its complexity, cost and length of the study. In this proposal, we focus on developing a data-driven paradigm to understand the medication treatment heterogeneity effects of T2D and to provide an evidence-based treatment guidance that is tailored to subgroups of patients sharing similar characteristics (precision medicine). Our data-driven approach will be based on the study of Veteran Healthcare Database, using the VA Informatics and Computing Infrastructure (VINCI). The clinical data includes the longitudinal data profiles starting from the year 2000.

Located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona and funded by the state tax on tobacco products, The Arizona Smokers’ Helpline (ASHLine) is one of over 50 quitlines across the United States. Established in 1995, it is also one of the oldest and most seasoned quit lines in existence.  As a member of the North American Quitline Consortium, ASHLine is actively engaged in collaborations, research, evaluation and quality improvement to assure all Arizonans have access to high quality, evidence-based tobacco cessation services and support. Nationally, quit rates reported among North American quit lines vary, averaging around 30%.  The Arizona Smokers’ Helpline (ASHLine) has been helping people quit tobacco since its inception in 1995. We are a comprehensive quitline, offering free telephone (both reactive and proactive) and web-based quit services and four to twelve weeks Nicotine Replacement Therapy (NRT). In addition, we have fax and electronic provider referral program and provide free training and technical assistance to healthcare providers and community partners statewide. The Arizona Smokers’ Helpline (ASHLine) is a service entity well-positioned to contribute to ongoing tobacco control efforts by providing effective, evidence-based support to individuals in their effort to end tobacco use.

Residents of rural communities and Latinos continue to experience significant health disparities for chronic disease such as diabetes and cardiovascular disease.  The residents in these communities have significant disparities due to multiple social determinants of health including but not limited to a lack of access to opportunities for physical activity and other resources necessary to prevent chronic disease. Bike Ajo is a community-campus coalition with diverse membership including community health. Bike Ajo’s goal is to create a sustainable cycling hub that educates, trains, provides resources, and builds health-based partnerships within the Ajo community. The asset-based coalition includes community residents, Desert Senita Community Health Center, International Sonoran Desert Institute, Ajo Chamber of Commerce, Arizona Planning Association, Mel and Enid Zuckerman College of Public Health, UA Department of Mexican American studies, Pima County Parks & Recreation, Pima County Health Department, and Pima County Department of Transportation. The Bike Ajo works to increase access to environments promoting physical activity opportunities through the creation of the1) Bike Ajo Cycling Hub (ReaCH); and 2) expanding community-clinic linkages to chronic disease prevention resources for Desert Senita Community Health Center patients.  Successes, lessons learned, and process/implementation strategies will be shared through the Arizona REACH network as well as at local and national conferences.  Digital stories will be utilized to help community members tell their own compelling stories of the personal impact of inequities in public health. This project was funded by the National Center for Chronic Disease Prevention and Health Promotion and the Arizona Chapter of the American Planning Association. 

Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs.  Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence.  A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools.  This study aims to evaluate:  (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system;  (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program’s implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation.  Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma.  This project will provide critical information regarding the program’s value, feasibility, and sustainability within communities with large asthma burden.  In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations.  With this information, policymakers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health. Funding for this study came from the National Heart, Lung, and Blood Institute. Also, this study is supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp and product donation from Thayer Medical Corporation.

Abstract not available. 

I will obtain publically available data from several studies in different ethnic/racial groups, and use data mining procedures to develop prediction models of type-2 diabetes risk from genetic markers. Career Development - This K01 grant also has a major career development component for which I am taking courses, going to workshops and conferences, and attending research seminars.

This is a service contract to provide evaluation for a HRSA-funded Rural Health Outreach Grant awarded to Mariposa Community Health Center to provide patient centered clinical and community services to people with diabetes in Santa Cruz County. The model integrates clinical care, telenutrition classes, peer education classes, and community services.  Evaluation is focusing on improving HbA1C and other health indicators among the patient population with HbA1C of 8.0 or higher.