The Weill Cornell Heart to Heart Community Outreach Campaign (H2H) is a free outreach program that provides mobile health screenings. The program brings medical and nursing faculty and students to the underserved, uninsured communities of New York City. Participants are screened for diabetes and heart disease risk factors through onsite exams, including point of care blood tests. If an abnormality is found, they receive a medical consultation to offer personalized advice and referrals to free/low-cost clinics when needed. The goal is to help underserved individuals understand their cardiometabolic health and to promote early intervention. This article describes the development of the program, including factors that were essential to the collaboration, challenges faced, barriers to implementation, and its evolution throughout the first 12 years. The program has benefited from strong foundational program leadership, effective inter-institutional collaboration, and maintaining community trust.

This study aimed to investigate the mechanisms by which the association between maternal hyperglycemia and postnatal high-fat diet (HFD) exposure compromises metabolic parameters and hepatic autophagy in adult female pups. For this, Sprague Dawley rats, female pups from nondiabetic (control = FC) or diabetic (FD) mothers, were fed a standard diet (SD) or HFD from weaning until adulthood (n minimum = 5 rats/group): FC/SD, FC/HFD, FD/SD, and FD/HFD. In adulthood, these rats were tested with the oral glucose tolerance test, euthanized, and serum biochemistry parameters were analyzed. Liver samples were collected to evaluate cytokines, redox status, and protein expression autophagy and apoptosis markers. Histomorphometric analyses and an assessment of lipofuscin accumulation were also performed to reflect incomplete autolysosomal digestion. The FC/HFD, FD/SD, and FD/HFD groups showed glucose intolerance and an increased number of hepatocytes. Furthermore, FD/SD and FD/HFD rats showed hyperlipidemia and insulin resistance. Adaptations in hepatic redox pathways were observed in the FD/SD group with increased antioxidant defense marker activity. The FD/SD group also exhibited increased autophagy protein expression, such as p-AMPK, LC3-II/LC3-I, and p62/SQSTM1, lipofuscin accumulation, and caspase-3 activation. After exposure to HFD, the adult female pups of diabetic rats had a reduced p-AMPK and LC3-II/LC3-I ratio, the presence of steatosis, oxidative stress, and inflammation. The reduction of autophagy, stimulated by HFD, may be of vital importance for the susceptibility to metabolic dysfunction-associated fatty liver disease induced by maternal diabetes.

This project evaluated the outcomes of acceptance and commitment therapy (ACT)-informed interventions for individuals with Type 1 or Type 2 diabetes mellitus experiencing mental health distress related to their condition or self-management burden. A within-subjects design evaluated the effectiveness of ACT-informed interventions using pre- and post-psychological wellbeing and diabetes specific outcome measures and HbA1C data. The interventions were part of the Croydon Community Diabetes service which began in October 2020. Fifty-six service users completed psychological wellbeing outcome measures (PHQ-9, GAD-7 and CORE-10) and 38 of these service users fully completed the diabetes specific measure (either DDS or the PAID). Thirty-nine service users had HbA1C data before the start of treatment and following the end of treatment. Wilcoxon’s signed rank test was used to analyse psychological outcomes and HbA1c data. Descriptive statistics were used for diabetes specific measures due to small sample sizes. Statistically significant reductions in levels of depression, generalised anxiety, and general psychological distress were found following ACT-informed interventions. Statistically significant reductions were also observed for HbA1c readings. Although inferential statistics were not used, the data highlighted that n=21 and n=14 reported reduction in scores on the DDS and PAID, respectively. Preliminary evidence suggests that ACT-informed interventions in an NHS community diabetes clinic for a sample of people living with Type 1 or Type 2 diabetes are associated with improved psychological wellbeing and diabetes distress.

Key learning aims

1. (1) To learn about the current evidence base and missing gaps in research on the use of acceptance and commitment therapy (ACT) for people living with Type 1 or Type 2 diabetes mellitus.

2. (2) To provide clinicians with an example of brief individualised ACT informed psychological interventions based on a sample of people living with diabetes in South London.

3. (3) To learn about the implementation of ACT informed psychological interventions in a naturalistic evaluation of a community Diabetes NHS service that reflects realistic treatment delivery.

4. (4) Through the limitations discussed in this paper, we provide future suggestions for psychologists working in diabetes care for evaluating their service in a naturalistic setting. This includes the collection of data through various sources such as the use of physical health measures and therapy process measures.

Understanding beliefs, values, and preferences of patients is a tenet of contemporary health sciences. This application was motivated by the analysis of multiple partially ordered set (poset) responses from an inventory on layman beliefs about diabetes. The partially ordered set arises because of two features in the data—first, the response options contain a Don’t Know (DK) option, and second, there were two consecutive occasions of measurement. As predicted by the common sense model of illness, beliefs about diabetes were not necessarily stable across the two measurement occasions. Instead of analyzing the two occasions separately, we studied the joint responses across the occasions as a poset response. Few analytic methods exist for data structures other than ordered or nominal categories. Poset responses are routinely collapsed and then analyzed as either rank ordered or nominal data, leading to the loss of nuanced information that might be present within poset categories. In this paper we developed a general class of item response models for analyzing the poset data collected from the Common Sense Model of Diabetes Inventory. The inferential object of interest is the latent trait that indicates congruence of belief with the biomedical model. To apply an item response model to the poset diabetes inventory, we proved that a simple coding algorithm circumvents the requirement of writing new codes such that standard IRT software could be directly used for the purpose of item estimation and individual scoring. Simulation experiments were used to examine parameter recovery for the proposed poset model.

Objectives: Low- and middle-income countries face increasing burden of noncommunicable chronic diseases due to rapid population aging. The Objectives of this study is to estimate the association of co-occurring depression and diabetes with healthcare services utilization in the Brazilian population aged 50 years andolder.

Methods: This is an analysis using baseline data of the ELSI-Brazil study. Measurements used were self-reported previous diagnosis for diabetes and a cut-off point of 4 on the CES-D-8 score for depression. Any medical consultations, specialist consultations and hospitalizations in the previous 12 months were assessed for measuring health services use. Logistic regression was used to estimate the association of having depression, diabetes, or both, compared to having none of the conditions with healthcare services utilization.

Results: In a final sample of 8303 participants, the adjusted odds ratios (95%CI) in the depression only group (27.9%), in the diabetes only group (9.7%), and in the depression and diabetes group (5.8%), for any medical consultations were 1.2 (1.01-1.42), 3.39 (2.4-4.79) and 3.12 (1.82-5.35); for specialist consultations, 1.05 (0.91-1.21), 1.34 (1.07-1.68) and 1.13 (0.86-1.49); and for hospitalizations, 1.42 (1.1-1.84), 1.42 (1.02-1.96) and 3.1 (2.12-4.54), respectively. All models were adjusted for sex, age, education, marital status, insufficient physical activity, current drinking and smoking, obesity and number of other diseases and conditions.

Conclusions: Those with diabetes seemed more likely to have any or specialized medical consultations. However, those with the depression and diabetes comorbidity were more likely than any other group to have been admitted to a hospital in the last year, which is distressing and costly. Screening for depression could be incorporated into diabetes usual care to reduce related complications and hospitalizations.

Funding: This study did not receive any funding. Authors: Ferri and Lima-Costa are recipient of CNPq research productive fellowship.

Epidemiological and clinical trial evidence indicates that n-6 polyunsaturated fatty acid (PUFA) intake is cardioprotective. Nevertheless, claims that n-6 PUFA intake promotes inflammation and oxidative stress prevail. This narrative review aims to provide health professionals with an up-to-date evidence overview to provide the requisite background to address patient/client concerns about oils containing predominantly unsaturated fatty acids (UFA), including MUFA and PUFA. Edible plant oils, commonly termed vegetable oils, are derived from vegetables, nuts, seeds, fruits and cereal grains. Substantial variation exists in the fatty acid composition of these oils; however, all are high in UFA, while being relatively low in saturated fatty acids (SFA), except for tropical oils. Epidemiological evidence indicates that higher PUFA intake is associated with lower risk of incident CVD and type 2 diabetes mellitus (T2DM). Additionally, replacement of SFA with PUFA is associated with reduced risk of CVD and T2DM. Clinical trials show higher intake of UFA from plant sources improves major CVD risk factors, including reducing levels of atherogenic lipids and lipoproteins. Importantly, clinical trials show that increased n-6 PUFA (linoleic acid) intake does not increase markers of inflammation or oxidative stress. Evidence-based guidelines from authoritative health and scientific organisations recommend intake of non-tropical vegetable oils, which contain MUFA and n-6 PUFA, as part of healthful dietary patterns. Specifically, vegetable oils rich in UFA should be consumed instead of rich sources of SFA, including butter, tallow, lard, palm and coconut oils.

Patients with type 2 diabetes have increased risks for dyslipidaemia and subsequently for developing vascular complications. A recent meta-analysis found that cetoleic acid (C22:1n-11) rich fish oils resulted in lower cholesterol concentration in rodents. The aim was to investigate the effect of consuming fish oils with or without cetoleic acid on serum cholesterol concentration in diabetic rats and to elucidate any effects on cholesterol metabolism. Eighteen male Zucker Diabetic Sprague Dawley rats were fed diets containing herring oil (HERO) or anchovy oil (ANCO) or a control diet with soyabean oil for 5 weeks. The HERO diet contained 0·70 % cetoleic acid, with no cetoleic acid in the ANCO diet. The HERO and ANCO diets contained 0·35 and 0·37 wt% EPA + DHA, respectively. Data were analysed using one-way ANOVA. The serum total cholesterol concentration was 14 % lower in the HERO group compared with ANCO and Control groups (P = 0·023). The HERO group had a higher faecal excretion of bile acids (P = 0·0036), but the cholesterol production in the liver, the hepatic secretion of VLDL and the liver’s capacity to take up cholesterol were similar to controls. The ANCO diet did not affect the serum cholesterol concentration, but the hepatic cholesterol biosynthesis, the clearance of lipoprotein cholesterol and the excretion of bile acids in faeces were higher than in the Control group. To conclude, consumption of herring oil, but not of anchovy oil, led to a lower cholesterol concentration in a type 2 diabetes rat model.

Adenylate kinases (AKs) are important enzymes involved in cellular energy metabolism. Among AKs, AK5 (adenylate kinase 5), a cytosolic protein, is emerging as a significant contributor to various diseases and cellular processes. This comprehensive review integrates findings from various research groups on AK5 since its discovery, shedding light on its multifaceted roles in nucleotide metabolism, energy regulation, and cellular differentiation. We investigate its implications in a spectrum of diseases, including autoimmune encephalitis, epilepsy, neurodegenerative disorders such as Alzheimer’s and Parkinson’s, diabetes, lower extremity arterial disease, celiac disease, and various cancers. Notably, AK5’s expression levels and methylation status have been associated with cancer progression and patient outcomes, indicating its potential as a prognostic indicator. Furthermore, AK5 is implicated in regulating cellular processes in breast cancer, gastric cancer, colorectal carcinoma, prostate cancer, and colon adenocarcinoma, suggesting its relevance across different cancer types. However, a limitation lies in the need for more robust clinical validation and a deeper understanding of AK5’s precise mechanisms in disease pathogenesis, despite its association with various pathophysiological conditions. Nonetheless, AK5 holds promise as a therapeutic target, with emerging evidence suggesting its potential in therapy development.

In underserved communities across New York City, uninsured adults encounter a greater risk of cardiovascular disease (CVD) and diabetes. The Heart-to-Heart Community Outreach Program (H2H) addresses these disparities by screening for CVD risk factors, identifying healthcare access barriers, and fostering community engagement in translational research at the Weill Cornell Medicine Clinical and Translational Science Award (CTSA) hub. Screening events are hosted in partnership with faith-based institutions. Participants provide a medical history, complete a survey, and receive counseling by clinicians with referrals for follow-up care. This study aims to quantify H2H screening participant health status; identify socioeconomic, health access, and health-related barriers disproportionately promoting the onset of CVD and diabetes; and develop long-term community partnerships to enable underserved communities to influence activities across the translational research spectrum at our CTSA hub. The population served is disproportionately non-white, and uninsured, with many low-income and underserved individuals. The program was developed in partnership with our Community Advisory Board to empower this cohort to make beneficial lifestyle changes. Leveraging partnerships with faith-based institutions and community centers in at-risk New York City neighborhoods, H2H addresses the increasing burden of diabetes and CVD risk factors in vulnerable individuals while promoting community involvement in CTSA activities, serving as a model for similar initiatives.