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J C Konen

Publications and source records attributed to J C Konen.

At least 19 recordsLinked to original sources
PubMed2001

Quality of diabetes care among low-income patients in North Carolina.

BACKGROUND: Diabetes is a leading cause of death and disability, disproportionately affecting most ethnic minority groups, people of low socioeconomic status, the elderly, and people in rural areas. Despite the availability of evidence-based clinical recommendations, barriers exist in the delivery of appropriate diabetes care. The purpose of this study is to examine the level of diabetes care among low-income populations in North Carolina. METHODS: Baseline medical record abstractions were performed (N=429) on diabetic patients at 11 agencies serving low-income populations (community health centers, free clinics, primary care clinics, and public health clinics) across the state participating in a quality-of-diabetes-care initiative. Data were collected for four process (measurement of glycosylated hemoglobin and lipids, dilated eye examination, nephropathy assessment) and two outcome (glycemic and lipid control) measures based on the Diabetes Quality Improvement Project (DQIP) and the Health Plan Employer Data and Information Set (HEDIS), and three additional indicators (blood pressure measurement and control, and lower limb assessment). Compliance rates to individual measures were calculated overall and by demographic and health characteristics. RESULTS: Diabetes care compliance rates ranged from 77.9% for blood pressure testing to 3.3% for complete foot examinations. Differences in care were observed by age, insulin use, and prevalent disease. CONCLUSIONS: This study indicates low compliance with diabetes care guidelines in underserved North Carolinians, and inconsistency of care according to some demographic and health characteristics. These results stress the need for quality improvement initiatives that enhance the level of care received by patients with diabetes, particularly those most vulnerable to diabetes and its complications.

Aged↗
PubMed2000

Measurement feasability of advanced glycated end-products from skin samples after antioxidant vitamin supplementation in patients with type 2 diabetes.

PURPOSE: To determine the feasibility of measuring advanced glycated end-products (AGEs)from skin samples and to evaluate the effects of a combination of vitamins E and C on measures of glycemic control and AGEs in patients with type 2 diabetes mellitus. METHODS: Twenty-two patients with type 2 diabetes from a Family Medicine clinic were randomly assigned to receive a daily dietary supplement containing either a combination of 400 mg of vitamin E and 500 mg of vitamin C or matching placebo for a period of one year. AGEs were measured from skin samples taken from the buttock. RESULTS: Nineteen subjects completed this one-year pilot study. There were no major problems found in measuring AGEs from skin samples taken from the butttock. Neither the treatment or placebo group had significant changes in glycemic control, protein glycosylation or AGEs. DISCUSSION: Skin samples taken from the buttock area may be an appropriate site for the determination of AGE levels as this procedure appeared to be well-tolerated. Daily vitamin E and C supplementation did not improve measures of glycemic control or AGE levels in this small sample of patients with type 2 diabetes. Because antioxidant vitamins are inexpensive and free of side effects, additional research using a variety of antioxidant vitamin combinations and dosing regimens is needed.

Adult↗
PubMed1999

Abnormal urinary protein excretion in African Americans with type 2 diabetes mellitus.

The purpose of this investigation was to determine the prevalence and correlates of abnormal urinary albumin excretion and to examine the possible additive effects of cardiovascular risk factors on urinary albumin excretion in African Americans with type 2 diabetes mellitus. One hundred fifty-one African-American subjects who met WHO criteria for type 2 diabetes were included in this cross-sectional analysis. Subjects were identified through computerized medical records from a family medicine clinic and a community health center. Urinary albumin excretion ratios (UAER) were determined from overnight samples. The prevalence of abnormal urinary protein excretion was 51%. Of those with abnormal protein excretion, 36% had microalbuminuria and 15% had macroalbuminuria. Diabetes duration, waist to hip ratio, blood pressure, and total- and LDL cholesterol were significantly higher in subjects with macroalbuminuria. Regression analysis indicated that mean arterial blood pressure, diabetes duration and total cholesterol were independently associated with UAER. Mean UAER significantly increased with the addition of one or more syndrome X risk factors to pure diabetes. Our results indicate that African Americans with type 2 diabetes mellitus have a high prevalence of abnormal urinary protein excretion, which is associated with a clustering of additional cardiovascular risk factors. The fact that this increased risk was associated with hypertension indicates that screening for albuminuria in this population is essential and that a majority of African Americans with diabetes may be at risk for developing cardiovascular complications.

Albuminuria↗
PubMed1998

Body fat, fat distribution, and psychosocial factors among patients with Type 2 diabetes mellitus.

Diabetes, a risk factor for cardiovascular disease, requires lifestyle modifications (diet, exercise, weight loss). The relations between body mass index, waist-hip ratio (WHR), and psychosocial indicators, such as affect and stress, among 302 diabetic patients from a clinic and a neighborhood health center were analyzed. Data included stress and mood scale responses, body size (height, weight, and WHR) and potential confounders (physical activity, energy intake, and diabetes duration). In univariate analyses, body mass index was positively associated with stress and inversely associated with positive affect only in women. Multiple regression analyses indicated that stress was associated with body mass index and negative mood was associated with the WHR. The findings suggested that stress and affect may be important correlates of body fat among women with Type 2 diabetes, leading to more complications. Healthcare providers can help women with Type 2 diabetes lose weight and lower the risk of cardiovascular disease by recognizing and helping them deal with these psychosocial issues.

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PubMed1997

Women's cardiovascular health.

Significant coronary artery disease is uncommon in premenopausal women, but it is the leading cause of death among postmenopausal women. This article briefly discusses atherosclerotic disease in women, including the effects of menopause and estrogen, the role of cholesterol, hypertension, exercise and weight control, smoking cessation, and diabetes mellitus. The role of screening and testing for coronary artery disease and carotid artery stenosis is discussed. Recommendations for prevention and patient education are included in each section.

Adult↗
PubMed1996

Symptoms and complications of adult diabetic patients in a family practice.

OBJECTIVES: To determine the frequency of common symptoms and complications amoung adult patients with either non-insulin-dependent or insulin-dependent diabetes mellitus and to examine associations of these problems with vascular disease risk factors. DESIGN: Cross-sectional determination of the prevalence of symptoms, complications, and risk factors among adult patients with diabetes, and a case-control design of a subsample of those case patients with non-insulin-dependent diabetes mellitus who were age-, race-, and sex- matched 2:1 to adult control patients with hypertension. SETTING: A large family practice ambulatory care unit in which the patients were demographically representative of the Piedmont region of North Carolina. PATIENTS: Three hundred thirty-six adults participated; of these participants, 223 case patients had non-insulin-dependent diabetes mellitus and 23 case patients had insulin-dependent diabetes mellitus. An additional 90 control patients were selected who had hypertension but did not have diabetes. MAIN OUTCOME MEASURES: Frequencies and odds ratios of symptoms and complications that were categorized by diabetic type, another chronic disease (eg hypertension), or vascular risk factors (eg, the duration of diabetes, levels of glycosylated hemoglobin, fasting blood glucose, total cholesterol, and high-density lipoprotein cholesterol, or mean arterial blood pressures). METHODS: Standardized medical histories, physical examinations and anthropometric and serum chemistry studies were done. Microalbuminuria was measured by unrinary albumin excretion ratios. RESULTS: Results: Symptoms of polydipsia, fatigability or cold intolerance, palpitations, dyspnea, orthostasis, indigestion, frequent urination, male impotence, blurred vision, paresthesias, forgetfulness occurred in more that one third of the adult diabetic patients as did complications of hypertension, microalbuminuria, peripheral neuropathy, and hypercholesterolemia. Those patients with non-insulin-dependent diabetes mellitus were more likely than those with insulin-dependent diabetes mellitus to have recent symptoms of polydipsia, chest pains, shortness of breath, orthostasis, light-headedness, and vaginal discharge. They were also more likely to have hypertension and hypercholesterolemia, but less likely to have dipstick proteinuria. Patients with non-insulin-dependent diabetes mellitus were more likely than those with hypertension alone to have a variety of general, cardiovascular, and neurologic symptoms and more likely to have peripheral vascular disease, neuropathy, retinopathy, and proteinuria. Regardless of the diabetic type, nearly half of the patients had microalbuminuria. The presence of symptoms was often associated with the duration of diabetes and poor glycemic control as were complications, but complications were often also associated with dyslipidemias and an elevated mean arterial pressure. CONCLUSIONS: Previous studies have documented such a wide variety of symptoms and complications, but these studies have been based on those patients who attended specialized referral settings. Our findings show that these problems are surprisingly common among adult diabetic patients who are cared for in a primary care setting. The fact that nearly half of the patients had microalbuminuria suggests that the onset of significant vascular complications had already begun in most of these patients. The occurrence of symptoms of depression, anxiety, panic, and forgetfulness were unexpectedly common and may have adversely affected the ability of diabetic patients to comply with the intended therapy.

Adult↗
PubMed1996

Coronary heart disease risk factors in black and white patients with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To determine possible racial differences in risk factors for coronary heart disease (CHD) in black and white patients with noninsulin-dependent diabetes mellitus (NIDDM). METHODS: Study of risk factors for coronary heart disease among 308 subjects who met the WHO criteria for NIDDM. RESULTS: Both black and white patients were found to have a high prevalence of hypertension, obesity, low high density lipoprotein (HDL) cholesterol, low leisure-time physical activity levels, and an atherogenic dietary profile. Black males were more likely to have hypertension, reported a greater intake of dietary cholesterol, and had lower triglycerides, higher HDL cholesterol levels, a lower CHOL/HDL ratio, and a lower waist to hip ratio (WHR) than white males. Black females had higher mean arterial and diastolic blood pressures, had lower triglycerides, higher HDL cholesterol, a lower CHOL/HDL ratio, a higher subscapular/triceps ratio and lower reported leisure-time energy expenditure compared to white females. There were no racial differences found for obesity level. CONCLUSION: Our results indicate that racial differences in CHD risk factors exist among black and white patients with NIDDM. The complex genetic, sociocultural and environmental interactions involving CHD risk factors that contribute to the development of CHD may eventually provide clues to the etiology of the disease.

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PubMed1996

Four factors of clinical decision making: a teaching model.

For more than 25 years, Bowman Gray has been placing fourth-year students in community-based primary care settings. Upon their return to campus, the students participate in a seminar in which they discuss issues raised by their primary care experiences. In these seminars, the students have consistently identified four key factors of clinical decision making that reflect current trends in medicine: quality, cost, ethics, and legal concerns. These factors influence the practice of medicine and affect the health care of individuals and communities. The authors discuss the nature of these factors and the physician's role and obligation in clinical decision making. Physicians have two responsibilities in this decision-making model: to be the primary advocates for quality health care and to ensure that there be a balance among the weights given the four factors. While physicians must take the lead in ensuring quality care, they must work in partnership with patients, payers, lawyers, ethicists, and the government. It is up to those responsible for the education of future physicians to see that students understand all the factors of clinical decision making and how best to balance them to fulfill their future obligations to patients.

Clinical Clerkship↗
PubMed1996

Using standardized patient instructors to teach health promotion interviewing skills.

BACKGROUND: Medical students report knowledge, but inadequate skills, in health promotion and disease prevention (HPDP) technology. An established methodology using standardized patient instructors (SPIs) was adapted and tested for effectiveness in teaching HPDP. METHODS: Thirteen lay persons were trained and given profiles showing high cardiovascular risks. During their family medicine clerkship, 104 students engaged in one-to-one exercises with the SPIs. Half of these sessions were spent in the doctor-patient interview; in the other half, the SPI gave specific feedback using a validated scale. Encounters were videotaped. RESULTS: The students rated the SPI feedback as the program's most valuable aspect and the videotaping as the least valuable. The SPI feedback was rated valuable by 90%-96% of the students. The students also reported that the skills acquired were likely to be used, and they had learned "much" or "very much." As a group, students' self-assessments did not differ from the SPIs' assessments of the students. CONCLUSION: Lay SPIs are a powerful educational tool.

Adult↗
PubMed1995

Racial differences in the prevalence of microalbuminuria in hypertension.

One hundred nine patients with essential hypertension and without either diabetes mellitus or clinical proteinuria were examined to investigate possible racial differences in urinary albumin excretion rates. The black hypertensive patients were found to have significantly higher urinary albumin excretion rates compared with the white patients; in addition, a significantly greater proportion of the black patients than the white patients (32% v 14%) had microalbuminuria, defined as a urinary albumin excretion rate greater than 30 micrograms/min. These differences could not be explained by age, blood pressure, body mass index, glycosylated hemoglobin, serum creatinine, duration of hypertension, or type of hypertension treatment. Hypertensive renal failure occurs six to 18 times more frequently in blacks than in whites; to our knowledge, these data are the first to indicate that microalbuminuria may be more prevalent during the course of hypertension in black patients and thus may be an early marker for end-organ damage susceptibility among hypertensive patients.

Albuminuria↗
PubMed1995

Dietary intakes by levels of glycemic control for black and white adults with non-insulin dependent diabetes mellitus (NIDDM).

OBJECTIVES: The relationship between diet and glycemic control was examined among a racially mixed population of male and female adults with non-insulin dependent diabetes mellitus (NIDDM). METHODS: Data from 3-day dietary records and glycosylated hemoglobin (HbA1c) were analyzed for two-hundred eighty two patients of a Family Practice Ambulatory Care Unit and a community-based health center in Winston-Salem, North Carolina. Correlations were calculated for individual nutrients to determine their strength of association with glycemic control. Analyses by tertiles of HbA1c were also conducted for each race/gender group. Regression analysis was used to determine independent dietary predictors of HbA1c. RESULTS: For all subjects, energy, energy per kilogram of body weight, fat, carbohydrates saturated fat, and cholesterol were significantly correlated with HbA1c. Nutritional differences across tertile levels of HbA1c for all subjects were not significant. For black females, consumption of energy, protein and fat was significantly higher among upper tertile subjects compared to the lowest tertile; and intake of energy, protein, fat, and saturated fat was significantly correlated with HbA1c in this group. For black males, energy intake was highest among upper tertile subjects compared to those in the middle tertile, while energy per kilogram of body weight, and percent of calories from protein, were significantly correlated with HbA1c. For white males, energy intake expressed as a function of body weight was highest among subjects in the upper tertile and a significant positive correlation with HbA1c was observed. No relationship between nutritional intake and HbA1c was found among white females. Racial differences in nutrient intake were also compared for males and females in the upper tertile of HbA1c. Black females in the upper tertile consumed significantly more energy, protein, and significantly less dietary fiber per 1000 kilocalories. No significant differences were observed between black and white males in the upper tertile, although higher cholesterol consumption in black males compared to white males approached significance. Regression analysis revealed that total energy intake significantly predicted HbA1c for all subjects and all white subjects, while a similar observation was made for total fat intake among all black subjects and among black females. CONCLUSIONS: These findings confirm that diet, especially total energy, is an important contributor to glycemic control. Dietary fat is also associated with glycemic control among blacks, especially black females, who are especially prone to more dire health consequences of NIDDM. Strict monitoring of diet should lead to improved glycemic control and less mortality and morbidity in this population.

Adult↗
PubMed1995

Racial differences in psychosocial variables among adults with non-insulin-dependent diabetes mellitus.

To determine whether racial differences exist in psychosocial variables among patients with non-insulin-dependent diabetes mellitus (NIDDM), the authors administered a series of questionnaires to 211 Black and White patients of the Wake Forest Family Medicine ambulatory care unit and the Reynolds Health Center, a community health center. In general, Blacks in the study population had higher levels of external locus of control, higher levels of stress, and lower levels of family functioning compared with Whites. These differences may account partially for the disparity of diabetes control and the consequences of diabetes among Blacks. Health professionals may benefit from understanding and addressing these psychosocial variables and may be more successful in implementing intervention programs in this population by tailoring programs to the psychosocial orientation of their population.

Adaptation, Psychological↗
PubMed1993

Predicting exercise and smoking behaviors in diabetic and hypertensive patients. Age, race, sex, and psychological factors.

OBJECTIVE: To predict exercise and smoking behaviors in primary care patients with chronic diseases (insulin-dependent diabetes mellitus [IDDM], non-insulin-dependent diabetes mellitus [NIDDM], and hypertension) using standardized measures of stress, affect, and family function. DESIGN: Survey by a self-administered health risk appraisal and the Family APGAR Scale (measuring family function), the Brief Encounter Psychosocial Instrument (measuring coping with psychological stress), and the Affect Balance Scale (measuring positive and negative affect). SETTINGS: Large family practice center, university medical center pediatrics clinic, and community health center. PARTICIPANTS: Volunteers meeting World Health Organization criteria for IDDM (n = 83) or NIDDM (n = 322), and volunteers with documented hypertension (n = 140). MAIN OUTCOME MEASURES: Exercise levels at or above 2510 kJ/wk; smoking status; and number of cigarettes consumed per day. RESULTS: Smoking status in all groups was lower than that measured nationally. Stepwise logistic regression showed a correlation between positive affect and higher exercise levels among patients with IDDM and NIDDM, but lower levels among hypertensives. Psychological stress correlated with current smoking among patients with IDDM. In pooled models, whites were much more likely than blacks to exercise at higher levels and to be former or nonsmokers; however, among smokers, whites consumed more cigarettes per day. Among smokers with IDDM, males were much more likely to be moderate to heavy smokers. CONCLUSIONS: Among patients with IDDM, NIDDM, and hypertension, psychosocial stress, affect, age, race, and sex differentially predict exercise and smoking behaviors. The lower-than-national prevalence of smoking in these groups may indicate increased responsiveness to the stop-smoking message. Black diabetic and hypertensive patients, in particular, may require increased health promotion efforts.

Adult↗
PubMed1993

Family function, stress, and locus of control. Relationships to glycemia in adults with diabetes mellitus.

OBJECTIVE: To determine whether glycemic control in adults with either insulin-dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) is related to perceived family function, stress/coping, affect, and locus of control. DESIGN: Cross-sectional, observational study. PARTICIPANTS: Four hundred seven subjects from a family medicine ambulatory care unit, a tertiary pediatric diabetic unit, or a public-funded community health center, all located in Winston-Salem, NC, completed a series of psychometric instruments that included the Family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve), FACES III (Family Adaptability and Cohesion Evaluation Scales) Cohesion subscale, Affect Balance Scale, Multidimensional Health Locus of Control Scales, and the Brief Encounter Psychosocial Instrument. MAIN OUTCOME MEASURE: Glycemic control was measured by fasting blood glucose levels and glycosylated hemoglobin A1C levels as well as by patients' perception of their control. RESULTS: Those with NIDDM had scores indicative of more external sources of control than those with IDDM. A greater proportion of adults with both subtypes of diabetes perceived their families to be disengaged than subjects from families without diabetes. In a bivariate analysis, family dysfunction correlated with lack of perceived glycemic control, while perceived stress and negative affect correlated with fasting glucose levels in those with NIDDM but not those with IDDM. Using multivariate discriminant analysis, adults with NIDDM in good glycemic control as measured by glycosylated hemoglobin levels had lower family cohesion and negative affect than those in poor control. Conversely, those with IDDM with acceptable glycosylated hemoglobin levels had higher family cohesion, less negative affect, fewer chance loci of control, but higher perception of inadequate coping than those in poor control. CONCLUSIONS: Knowledge of the family function, affect, locus of control, perceived stress, and coping may be useful to the family physician in the care of adults with diabetes mellitus, since these psychosocial parameters are associated with objective and perceived glycemic control.

Adaptation, Psychological↗
PubMed1993

Men's health issues.

Explore the source record for details and available documents.

Adrenergic alpha-Antagonists↗
PubMed1993

Changes in diabetic urinary transferrin excretion after moderate exercise.

Microalbuminuria following submaximal exercise testing has been proposed for detecting renal abnormalities in diabetic patients. We compared urinary transferrin and albumin excretion between eight adults with insulin dependent diabetes mellitus and eight nondiabetic controls without microalbuminuria before and after a standardized exercise challenge of only moderate intensity for 20 min. Both groups were similar for age, sex, and METs expended during treadmill walking. Urinary excretion ratios of transferrin (UTER) and albumin (UAER) did not significantly increase for nondiabetic subjects. After exercise, UTER increased on average 207% in diabetic subjects (P = 0.009) and UAER increased 209% (P = 0.046). The percent increase in UTER appears to be a function of workload intensity, while the percent increase in UAER appears less dependent on the duration of exercise. A standardized treadmill challenge of moderate intensity easily differentiated changes in urinary transferrin excretion ratios between diabetic and nondiabetic subjects. Measuring transferrin excretion may be a more sensitive parameter than albumin in studies using urinary protein excretion as a response to a provocative exercise challenge.

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