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Tag: University of Washington School of Medicine and UW Medicine

  • Heavy drinking, handgun-carrying linked among rural youth

    Heavy drinking, handgun-carrying linked among rural youth

    Newswise — In the rural United States, an adolescent who drinks heavily has a 43% greater probability of carrying a handgun in the following year, according to a study published this month in The Journal of Rural Health.

    “While there has been a lot of research on this correlation in urban areas, little is known about the association between alcohol use, particularly heavy drinking, and handgun carrying in rural areas,” said lead author Alice Ellyson, an acting assistant professor of pediatrics at the University of Washington School of Medicine and investigator in UW Medicine’s  Firearm Injury & Policy Research Program.

    “Our study establishes a clear link between these two behaviors in rural areas, and there are evidence-based prevention programs to address both,” she said. Heavy drinking was defined as consuming five or more alcoholic drinks in a row at least once in the previous two weeks. 

    The study involved a longitudinal sample of 2,002 youth ages 12 to 26 in 12 rural communities in seven states, including Washington. Survey responses were collected annually from 2004 to 2019 starting with children who were in fifth/sixth grades.

    The authors say their findings can inform strategies to discourage drinking and thereby decrease the likelihood of handgun-carrying among youth and young adults in rural areas. The findings, coupled with existing evidence-based approaches, might also offer key tactics to lower the homicide and suicide rates among adolescents in rural areas, the study concluded.

    The association between heavy drinking and gun-carrying also was evident (38% greater) among young adults ages 19 to 26, noted senior author Dr. Ali Rowhani-Rahbar, a professor of epidemiology at the UW School of Public Health and pediatrics at the UW School of Medicine. He is also the UW Bartley Dobb Professor for the Study and Prevention of Violence and the interim director of the UW Medicine’s Firearm Injury & Policy Research Program at the University of Washington School of Medicine.

    The study did not break out the differences between male and female respondents nor did it address the respondents’ likelihood of firing the handgun, Rowhani-Rahbar said.

    He added that a major strength of the study was its longitudinal design, which allowed for the examination of handgun carrying after alcohol use.

    Understanding youth behaviors associated with carrying a firearm has significant safety implications. In 2020, suicide and homicide were among the leading causes of death among U.S. individuals ages 12-26 years. About 91% of homicides and 52% of suicides among this age group involved a firearm, the study noted.

    Recent evidence suggests that rural adolescents may start carrying a handgun earlier and carry with a higher frequency and duration than their urban counterparts. Handgun-carrying is associated with bullying, physical violence, and other risk factors for violence, the study notes.

    Preventing or delaying handgun-carrying among rural adolescents may be an important strategy for preventing firearm-related harm, authors noted.

    During young adulthood (ages 19-26), the association between alcohol use and heavy drinking were generally similar to adolescence.

    On this point, Ellyson said she was surprised that the association between heavy drinking and handgun-carrying was similar and sustained between adolescent and young adult respondents. She expected the association to weaken more or disappear with age.

    She identified Communities That Care as a key program for preventing these behaviors and their consequences in rural areas. The program helps communities take a broad approach to preventing problem behaviors among youth.

    “It has a good track record reducing alcohol consumption and violence in randomized controlled trials, and it is an evidence-based program designed for rural communities,” she said.

    For adolescents, the message is simple: Don’t drink alcohol or carry a handgun. Young adults, however, will need a more nuanced message, Ellyson said.

    “Both alcohol use and handgun-carrying become legal in young adulthood. We want to use a harm reduction approach for young adults who engage in both behaviors (drinking and handgun carrying) so they are done in a safe way,” she said.

    The study did not look into the why of this correlation, or whether the handgun was fired or crimes committed later. That will be for the next study, Rowhani-Rahbar said.

    An earlier study by Ellyson and colleagues found six distinct patterns of when and how often individuals in a rural area carry a handgun. In these communities, young people carry handguns at more than twice the rate of their counterparts in urban settings.  Because alcohol use is also more common among rural youth, prevention programs focusing on them are important.

    The studies were funded by the Centers for Disease Control and Prevention.

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    University of Washington School of Medicine and UW Medicine

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  • Study looks at Achilles’ heel of insulin pump technology

    Study looks at Achilles’ heel of insulin pump technology

    Newswise — “No one had done a human study on what happened to the skin under these sites until now,” said UW Medicine’s Dr. Irl Hirsch.

    Since the insulin pump started widespread use in the early 1980s, it’s become the option of choice for type 1 diabetes patients to manage their glucose levels in a way that doesn’t require testing their blood sugar and injecting insulin multiple times daily.

    But now, a first-of-its kind study is looking at the issue of patients “running out of real estate” due to pump sites becoming fibrotic, irritated and less effective at delivering insulin. The UW Medicine-led study was published July 14 in the journal Diabetes Care, a publication of the American Diabetes Association.

    “No one had done a human study on what happened to the skin under these sites until now,” said  senior author Dr. Irl Hirsch,  professor of medicine, Division of Metabolism, Endocrinology, and Nutrition at the University of Washington School of Medicine. He is also the diabetes treatment and teaching chair in the Department of Medicine.  

    Hirsch estimated that well over 70% of the patients with type 1 diabetes seen at the UW Medicine Diabetes Institute are on insulin pump therapy. The advances in insulin pump therapy have freed up patients from the daily routines of injections and, when connected to continuous glucose monitors, can give them precise dosing based on their blood glucose levels. However, there is an Achilles’ heel of the therapy that has not been addressed, said Hirsch.

    “It really doesn’t matter how good the technology is,” he said. “We still don’t understand what is happening with the infusion sites, much less fix it.”

    This study, performed between 2020 and 2022 (paused due to the pandemic) enrolled 30 participants from the UW Medicine Diabetes Institute. It was the first such step to answer both these questions.

    The study participants were divided into two groups: those patients using insulin pumps for 10 years or less, and those using pumps for over 20 years. Researchers expected to see more pathology – thickening of skin, damage to the subdermal layer, inflammation – in the group using the pumps for 20 years or more. That’s not what happened.

    “We found that the pathology, to our surprise, was no different when short-term user results were compared with long-term users,” he said.

    Both groups had high levels of eosinophils, disease-fighting white blood cells that usually appears in the blood to fight allergies. Generally, they assist in healing the skin and creating fibrosis.

    “This is the last thing you want at an infusing site,” Hirsch said.

    Using a non-invasive technique, called optical coherence tomography, or OCT, researchers were able to monitor blood flow and inflammation around the sites. Greater blood flow would result in quicker insuln absorption. Skin biopsies were taken at the pump infusion  sites.

    “From a bigger point of view of fibrosis, inflammation and eosinophils, we saw all this in both groups, but we don’t understand yet why it’s happening,” he said. “How much was the catheter or the insulin causing the irritation around the sites? How much was it from the preservatives or is this because of the insulin pump itself?”

    In addition, some patients move the injection site from place to place because of irritation, and other patients have no irritation at all. Yet, researchers don’t know why.

    All these questions need to be answered in future studies, he said.

    “Ninety-three percent  of those in the study complained of itching, which points to eosinophils being present, but we are also going to look at metabolomics,” he said. “The real goal of all of this is to minimize skin damage and improve the experience for our patients.”

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  • Biomarkers may help ID treatment of acute kidney injury

    Biomarkers may help ID treatment of acute kidney injury

    Newswise — Hospital inpatients who develop an acute kidney injury (AKI) generally fare poorly after being discharged, and have few options for effective treatment.  

    A UW Medicine-led study published recently in American Journal of Kidney Diseases suggests that new tests might improve this narrative.

    In the study, “about 30% of the patients that came into the hospital developed AKI, which means in a matter of hours or days, their kidneys might be failing because of reaction to drugs or contracting sepsis,” said lead author Dr. Pavan Bhatraju, an assistant professor of pulmonary and critical care medicine at the University of Washington School of Medicine.

    Causes of AKI vary. For instance, sepsis, medication and inadequate blood supply in someone who is undergoing cardiac bypass are all potential causes of kidney injury. It’s also the case that, within the kidneys, different cell types can be injured in the process of AKI, said Dr. Jonathan Himmelfarb, a professor of nephrology at the UW School of Medicine and the study’s senior author.

    “The way that we diagnose acute kidney injury today relies on a simple blood test of kidney function or a change in urine output,” Himmelfarb said. “These relatively crude diagnostic tools don’t detect the specific cause of injury or predict which individuals will be more likely to respond to a treatment or recover kidney function.”

    Unfortunately, effective medical therapies do not exist for this population of patients, Bhatraju said. In their paper, the investigators proposed a way to classify subpopulations of AKI patients with the aim of identifying therapies specific patient populations.  

    In much the same way that distinct biomarkers inform treatments of subgroups of patients with cancer or asthma, so, too, could blood- and urine-based biomarkers help identify subgroups of patients with AKI, leading to new ideas for treatments, the authors said.

    In the study, the researchers retrospectively analyzed 769 patients with AKI and 769 without the condition, and followed them for five years after hospital discharge. The researchers found two molecularly distinct AKI subgroups, or sub-phenotypes, that were associated with differing risk profiles and long-term outcomes.

    Patients in one group had higher rates of congestive heart failure, while another group had higher rates of chronic kidney disease and sepsis, Bhatraju said. The patients in the second group also had a 40% higher risk for major adverse kidney events five years later, compared with the first group, he said.

    Interestingly, Bhatraju added, age, sex, diabetes rate or major surgical procedure as the cause of AKI was not different across AKI subgroups. This finding suggests that commonly measured clinical factors may not predict the AKI subgroups, and that identification requires measurement of blood and urine biomarkers, he said.

    “We’re attempting to better understand the clinical factors and molecular drivers of acute kidney injury so that, in the long run, we can better treat the different ways that people experience this disease process,” Himmelfarb added. “We want to better understand the individual characteristics of people who get acute kidney injury so we can establish common characteristics of subgroup populations of these patients to know whose risk is relatively higher or lower, and work toward treatments specific to their needs.

    “Our paper is one step on the path to tailoring clinical trials of new therapies to the people who are most likely to respond to those therapies,” Himmelfarb said.  

    This study was supported by the supplemental American Recovery and Reinvestment Act funds through the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (grants U01DK082223, U01DK082185, U01DK082192, U01DK082183, U01DK084012 and R01DK098233) and by the NIH (K23DK116967, R01DK133177, U2CDK114886, UG3TR002158, and U01DK099923).

    University of Washington School of Medicine and UW Medicine

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  • Risks associated with control of blood sugar in the ICU

    Risks associated with control of blood sugar in the ICU

    Newswise — Efforts by hospital intensive-care unit teams to reduce glucose readings of patients with diabetes might do more harm than good, according to an analysis published today in Diabetes Care.

    Dr. Michael Schwartz, lead author and a UW Medicine endocrinologist, said he decided to study the phenomenon after talking with Dr. Irl Hirsch, a colleague who had witnessed problems emerge among his patients in the ICU. 

    Schwartz and co-authors found that, among patients with diabetes, efforts to reduce blood glucose levels to what is considered normal in a non-diabetic person may actually harm the patients by triggering a dangerous reaction.

    The article noted that relative hypoglycemia – or a decrease in glucose greater than or equal to 30% below prehospital admission levels – “has emerged as a major clinical concern because the standard glycemic target recommended for patients in the intensive care unit is associated with an increased mortality risk among some of the critically ill patients with diabetes.”

    Low blood glucose, or hypoglycemia, can be dangerous because the brain depends on a steady supply of glucose to function. When someone’s blood glucose levels fall below a level of approximately 40 mg/dL to 60 mg/dL, the sympathetic nervous system triggers the release of hormones and other chemical signals to drive blood glucose back up. This phenomenon is known as a counterregulatory response. 

    While this response can help return the blood glucose level to normal, in parallel it also increases the heart rate and blood pressure, and perhaps activates the immune system. Schwartz and others in this review suspect this counterregulatory response may be the cause of higher death rates among ICU patients with diabetes who are treated for a high glucose level.

    Patients with diabetes generally have a higher blood sugar level (100 to 200 mg/dL) than patients without diabetes, the study noted. For a patient without diabetes, normal levels are 70 to100 mg/dL

    “The target range that is established in in the ICUs doesn’t differentiate between a patient with diabetes and a patient without diabetes,” Schwartz said. To establish the best blood sugar range, he said, a randomized clinical trial would need to determine the ideal glycemic level for ICU patients with, and without, diabetes.

    People with diabetes usually have higher than normal blood sugar levels. Over time their bodies get used to these high blood sugar levels. As a consequence, when their blood sugars levels are brought into the normal range with treatment, their bodies incorrectly perceive the levels to be dangrously low, thereby triggering the counter regulatory response. Schwartz and his colleagues are studying how the body monitors and regulates blood sugar levels to try to understand how this response might be prevented or corrected.

    While the brain can clearly sense when blood sugar is too low, exactly how this occurs is not well understood.For many years, it was thought that cells responsible for monitoring and regulating blood glucose levels resided in the brain. But work by the UW Medicine researchers now indicate that blood glucose sensing neurons reside outside of the brain, located in places like the liver and along blood vessels. These sensors monitor glucose concentrations in the blood and other tissues and send signals to brain centers that then respond to changes in levels, the study noted.

    “We anticipate that future strategies aimed at reversing the underlying defect can ameliorate or even eliminate the problem of relative hypoglycemia in patients with diabetes,” the authors conclude, “To achieve this goal will require an improved understanding of how brain glucose sensing works in normal individuals and how it becomes impaired with patients with diabetes.”

    University of Washington School of Medicine and UW Medicine

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