This document has been developed as an expert consensus document by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), in collaboration with the American Academy of Neurology (AAN), the American College of Physicians (ACP), the American Geriatrics Society (AGS), the American Society of Hypertension (ASH), the American Society of Nephrology (ASN), the American Society for Preventive Cardiology (ASPC), the Association of Black Cardiologists (ABC), and the European Society of Hypertension (ESH). Expert consensus documents are intended to inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. Topics chosen for coverage by expert consensus documents are so designed because the evidence base, the experience with technology, and/or clinical practice are not considered sufficiently well developed to be evaluated by the formal ACCF/AHA practice guidelines process. Often the topic is the subject of considerable ongoing investigation. Thus, the reader should view the expert consensus document as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice. When feasible, expert consensus documents include indications or contraindications. Typically, formal recommendations are not provided in expert consensus documents as these documents do not formally grade the quality of evidence, and the provision of “Recommendations” is felt to be more appropriately within the purview of the ACCF/AHA practice guidelines. However, recommendations from ACCF/AHA practice guidelines and ACCF appropriate use criteria are presented where pertinent to the discussion. The writing committee is in agreement with these recommendations. Finally, some topics covered by expert consensus documents will be addressed subsequently by the ACCF/AHA …

ACCF/AHA Expert Consensus Document ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents

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ACCF/AHA 2011 expert consensus document on hypertension in the elderly: A report of the american college of cardiology foundation task force on clinical expert consensus documents

ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension

Decades of research have demonstrated that diabetes affects racial and ethnic minority and low-income adult populations in the U.S. disproportionately, with relatively intractable patterns seen in these populations’ higher risk of diabetes and rates of diabetes complications and mortality (1). With a health care shift toward greater emphasis on population health outcomes and value-based care, social determinants of health (SDOH) have risen to the forefront as essential intervention targets to achieve health equity (2–4). Most recently, the COVID-19 pandemic has highlighted unequal vulnerabilities borne by racial and ethnic minority groups and by disadvantaged communities. In the wake of concurrent pandemic and racial injustice events in the U.S., the American College of Physicians, American Academy of Pediatrics, Society of General Internal Medicine, National Academy of Medicine, and other professional organizations have published statements on SDOH (5–8), and calls to action focus on amelioration of these determinants at individual, organizational, and policy levels (9–11).

In diabetes, understanding and mitigating the impact of SDOH are priorities due to disease prevalence, economic costs, and disproportionate population burden (12–14). In 2013, the American Diabetes Association (ADA) published a scientific statement on socioecological determinants of prediabetes and type 2 diabetes (15). Toward the goal ofunderstanding and advancing opportunities for health improvement among the population with diabetes through addressing SDOH, ADA convened the current SDOH and diabetes writing committee, prepandemic, to review the literature on 1 ) associations of SDOH with diabetes risk and outcomes and 2 ) impact of interventions targeting amelioration of SDOH on diabetes outcomes. This article begins with an overview of key definitions and SDOH frameworks. The literature review focuses primarily on U.S.-based studies of adults with diabetes and on five SDOH: socioeconomic status (education, income, occupation); neighborhood and physical environment (housing, built environment, toxic environmental …

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Social Determinants of Health and Diabetes: A Scientific Review.

Diabetes is one of the fastest growing chronic diseases globally and in the United States. Although preventable, type 2 diabetes accounts for 90 % of all cases of diabetes worldwide and continues to be a source of increased disability, lost productivity, mortality, and amplified health-care costs. Proper disease management is crucial for achieving better diabetes-related outcomes. Evidence suggests that higher levels of social support are associated with improved clinical outcomes, reduced psychosocial symptomatology, and the adaptation of beneficial lifestyle activities; however, the role of social support in diabetes management is not well understood. The purpose of this systematic review is to examine the impact of social support on outcomes in adults with type 2 diabetes.

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The Impact of Social Support on Outcomes in Adult Patients with Type 2 Diabetes: A Systematic Review

A pilot study was conducted to assess the feasibility and potential efficacy of a couples focused diabetes intervention in which a collaborative problem-solving approach to diabetes self-care was promoted. Couples (N = 44), in which one partner had Type 2 diabetes and was in poor blood glucose control were randomly assigned to one of three groups: a couples intervention, an individual intervention, or individual diabetes education. The intervention included goal-setting, dietary behavior change, and a focus on emotions. For those in the couples arm, this was done within the framework of promoting collaborative communication between the partners. All intervention contacts were over the telephone to increase reach. Results showed that both the individual and couples interventions yielded meaningful clinical improvements in medical outcomes. Diabetes education also resulted in improved blood glucose control. Despite the small number, mixed-model regression analyses found statistically significant treatment effects for total cholesterol. This pilot demonstrates the feasibility and potential efficacy of a telephone intervention for Type 2 diabetes patients and their partners. Information from implementing this pilot led to refinement and further development of the intervention, which is being assessed in a larger, more comprehensive trial.

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Promoting couples collaboration in type 2 diabetes: the diabetes support project pilot data.

OBJECTIVES: To test the feasibility, acceptability, and effect of a senior center–based behavioral counseling lifestyle intervention on systolic blood pressure (BP).



DESIGN: A pre-post design pilot trial of behavioral counseling for therapeutic lifestyle changes in minority elderly people with hypertension. Participants completed baseline visit, Visit 1 (approximately 6 weeks postbaseline), and a final study Visit 2 (approximately 14 weeks postbaseline) within 4 months.



SETTING: The study took place in six community-based senior centers in New York City with 65 seniors (mean age 72.29±6.92; 53.8% female; 84.6% African American).



PARTICIPANTS: Sixty-five minority elderly people.



INTERVENTION: Six weekly and two monthly “booster” group sessions on lifestyle changes to improve BP (e.g., diet, exercise, adherence to prescribed antihypertensive medications).



MEASUREMENTS: Primary outcome was systolic BP (SBP) measured using an automated BP monitor. Secondary outcomes were diastolic BP (DBP), physical activity, diet, and adherence to prescribed antihypertensive medications.



RESULTS: There was a significant reduction in average SBP of 13.0±21.1 mmHg for the intervention group (t(25)=3.14, P=.004) and a nonsignificant reduction in mean SBP of 10.6±30.0 mmHg for the waitlist control group (t(29)=1.95, P=.06). For the intervention group, adherence improved 26% (t(23)=2.31, P=.03), and vegetable intake improved 23% (t(25)=2.29, P=.03).



CONCLUSION: This senior center–based lifestyle intervention was associated with a significant reduction in SBP and adherence to prescribed antihypertensive medications and diet in the intervention group. Participant retention and group attendance rates suggest that implementing a group-counseling intervention in senior centers is feasible.

A Senior Center–Based Pilot Trial of the Effect of Lifestyle Intervention on Blood Pressure in Minority Elderly People with Hypertension

Type 2 diabetes (T2DM) studies report that marital/family support relates to glycemic control, adherence, and quality of life. Yet, there are few reports on couples-focused interventions. This study aims to describe the challenges faced and lessons learned in the implementation of a theoretically based, couples intervention. Three hundred fifty couples (one partner has T2DM in poor glycemic control) are randomized to a couples intervention, individual intervention, or enhanced usual care. All contacts are by telephone to increase reach. The medical (e.g., glycemic control), psychosocial (e.g., diabetes distress), and behavioral (e.g., regimen adherence) outcomes were measured. Challenges in recruitment, assessment, and intervention with couples are described, with suggestions about how to address them. Findings concerning the efficacy and cost-effectiveness of the couples intervention, its effect on partners, and possible mechanisms of demonstrated changes, are anticipated in 2013. Interventionists need specific skills to work with couples to promote communal coping and increase the likelihood of an efficacious couples intervention.

Challenges and lessons learned in the development and implementation of a couples-focused telephone intervention for adults with type 2 diabetes: the Diabetes Support Project

OBJECTIVE Family-partner support has been associated with better blood glucose control, self-care adherence, and quality of life in adult patients with Type 2 diabetes (T2D). "Miscarried helping" has described interactions between youth with chronic diseases and their family members, in which a family member is helpful, but efforts are perceived as negative by the patient. Miscarried helping has not, however, been measured in adults with diabetes, which was the purpose of our study. METHOD Data from a randomized clinical trial (n = 268) were analyzed to establish the psychometric properties and correlates of an adaptation of a measure of miscarried helping developed in pediatric populations, for use with adults with T2D. RESULTS The Helping for Health Inventory-Couples Version (HHI-C) was found to have three underlying factors and demonstrated adequate internal consistency across time (α at baseline = .86, 4 months = .87, 8 months = .86, and 12 months = .83) and showed high test-retest reliability (p < .01) over a 12-month period. Convergent validity was partially supported, because baseline HHI-C was positively associated with maladaptive conflict resolution strategies (p = .03) and negatively associated with adaptive conflict resolution strategies (p = .04) and diabetes knowledge (p < .01). The HHI-C did not correlate with body mass index or hemoglobin A1c, a measure of glycemic control. The HHI-C was positively associated with diabetes distress (p < .01) and depressive symptoms (p = .01). DISCUSSION This study is the 1st known reporting of the psychometric properties of a measure of miscarried helping for adults with T2D. This valid measure of miscarried helping could be useful in future studies evaluating novel, relationship-based approaches to assist adults with T2D in disease management. (PsycINFO Database Record

Kasandra Scales

Papers

Promoting couples collaboration in type 2 diabetes: the diabetes support project pilot data.

A Senior Center–Based Pilot Trial of the Effect of Lifestyle Intervention on Blood Pressure in Minority Elderly People with Hypertension

Challenges and lessons learned in the development and implementation of a couples-focused telephone intervention for adults with type 2 diabetes: the Diabetes Support Project

"Miscarried helping" in adults with Type 2 diabetes: Helping for Health Inventory-Couples.