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David Marrero, PhD

Endocrinology

J.O. Richey Professor of Medicine; Professor of Medicine
Director, Diabetes Translational Research Center

Academic Office

Health Info and Translational Sci, Suite 1140
410 W 10th St
Indianapolis IN 46202-3002 Map

Contact Information

Phone: (317) 278-0905
Email:

Bio

Dr. Marrero received a B.A. (1974), M.A. (1978) and Ph.D. (1982) in Social Ecology from the University of California, Irvine. He joined the IU School of Medicine in 1984 and became the J.O. Ritchey Professor of Medicine in 2004. He was a member of the Diabetes Research & Training Center and served as Director of the Diabetes Prevention and Control Division. He is currently the Director of the Diabetes Translational Research Center. Dr. Marrero is an expert in the field of clinical trails in diabetes and translation research which moves scientific advances obtained in clinical trails into the public health sector. He helped design the Diabetes Prevention Program and the TRIAD study, which evaluated strategies to improve diabetes care delivery in managed care settings. His research interests include strategies for promoting diabetes prevention, care settings, improving diabetes care practices used by primary care providers, and the use of technology to facilitate care and education. Dr. Marrero was twice awarded the Allene Von Son Award for Diabetes Patient Education Tools by the American Association of Diabetes Educators, nominated to Who’s Who in Medicine and Health care in 2000, served as Associate Editor for Diabetes Care (1997-2002) and is currently the Associate Editor for Diabetes Forecast. He was selected as Alumni of the Year for University of California Irvine in 2006 and The Outstanding Educator in Diabetes in 2008 by the American Diabetes Association.

Research Interests

Health care delivery; Technology and disease management; Psychological and social coping with disease

Clinical Interests

Diabetes, obesity, coping

Education and Training

Ecology California, University Of (Irv 1982
Ecology California, University Of (Irv 1978
Ecology California, University Of (Irv 1974

Publications (31)¹

Depressive symptoms, antidepressant medication use, and new onset of diabetes in participants of the diabetes prevention program and the diabetes prevention program outcomes study.
Journal: Psychosomatic medicine
Authors: Marrero DG; Ma Y; de Groot M; Horton ES; Price DW; Barrett-Connor E; Carnethon MR; Knowler WC; Diabetes Prevention Program Research Group;
Publication Date: 2015 Apr

Abstract

To assess in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study whether diagnosis of diabetes predicted elevated depressive symptoms (DS) or use of antidepressant medicine (ADM) following diagnosis; whether diabetes status or duration had significant effect on DS or ADM use; and to determine the associations between A1C, fasting plasma glucose (FPG), normalization of FPG, and DS or ADM use after diagnosis.
View details for PubMedID 25775165
A Translational Worksite Diabetes Prevention Trial Improves Psychosocial Status, Dietary Intake, and Step Counts among Employees with Prediabetes: A Randomized Controlled Trial.
Journal: Preventive medicine reports
Authors: Miller CK; Weinhold K; Marrero DG; Nagaraja HN; Focht BC;
Publication Date: 2015

Abstract

Few worksite trials have examined the impact of diabetes prevention interventions on psychological and behavioral outcomes. Thus, the impact of a worksite lifestyle intervention on psychosocial outcomes, food group intake, and step counts for physical activity (PA) was evaluated.
View details for PubMedID 25798374
Rationale and design of a comparative effectiveness trial to prevent type 2 diabetes in mothers and children: The ENCOURAGE healthy families study.
Journal: Contemporary clinical trials
Authors: Hannon TS; Carroll AE; Palmer KN; Saha C; Childers WK; Marrero DG;
Publication Date: 2014 Nov 29

Abstract

The number of youth with type 2 diabetes (T2D) is expected to quadruple over 4 decades. Gestational diabetes mellitus (GDM) is also increasing and is linked with development of T2D in women, and greater risk for T2D in adolescents exposed to GDM. Despite the increasing prevalence of T2D, approaches to prevent diabetes in high-risk youth and families are rare. To address this, we are conducting the Encourage Health Families Study (ENCOURAGE). This is a randomized trial evaluating the comparative effectiveness and costs of an adaptation of the Diabetes Prevention Program (DPP) directed at mothers who had GDM or prediabetes and their children. The intervention is a group-based lifestyle program which we developed and implemented in partnership with the YMCA. We are comparing the ENCOURAGE intervention targeted to 1) mothers who have had GDM or prediabetes, and 2) mothers who have had GDM or prediabetes along with their school-aged children. This manuscript provides 1) the rationale for a targeted approach to preventing T2D and the interventions, 2) description of the translation of the DPP curriculum, and 3) the study design and methodology. The primary aims are to determine if participation leads to 1) weight loss in high-risk mothers, and 2) youth having healthier weights and lifestyle habits. We will also evaluate costs associated with each approach. These data are essential to build a translation model of T2D prevention that is both realistic and feasible to address this growing problem in both youth and adults.
View details for PubMedID 25457793
An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data.
Journal: Journal of the American Medical Informatics Association : JAMIA
Authors: Dixon BE; Jabour AM; Phillips EO; Marrero DG;
Publication Date: 2013 Sep 27

Abstract

The aim of this study was to describe an integrated informatics approach to aggregating and displaying clinically relevant data that can identify problems with medication adherence and facilitate patient-provider communication about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a personal health record. The data are integrated to inform clinician-patient discussions about medication adherence. Whereas prior research on assessing patterns of medication adherence focused on a single approach using the EHR, pharmacy data, or patient-entered data, we present an approach that integrates multiple electronic data sources increasingly found in practice. Medication adherence is a complex challenge that requires patient and provider team input, necessitating an integrated approach using advanced EHR, clinical decision support, and patient-controlled technologies. Future research should focus on integrated strategies to provide patients and providers with the right combination of informatics tools to help them adequately address the challenge of adherence to complex medication therapies.
View details for PubMedID 24076751
Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: the RAPID Study.
Journal: Contemporary clinical trials
Authors: Ackermann RT; Finch EA; Schmidt KK; Hoen HM; Hays LM; Marrero DG; Saha C;
Publication Date: 2013 Oct 29

Abstract

Reaching Out and Preventing Increases in Diabetes (RAPID) is a community-based randomized trial evaluating the comparative costs and effectiveness of a group-based adaption of the DPP lifestyle intervention developed and implemented in partnership with the YMCA. RAPID enrolled adult primary care patients, with BMI 24 kg/m(2) or higher and abnormal glucose metabolism (HbA1c 5.7-6.9% or fasting plasma glucose 100-125 mg/dL). 509 participants were enrolled and randomized to one of two groups: standard clinical advice plus free-of-charge access to a group-based adaption of the DPP offered by the Y, versus standard clinical advice alone. Key outcomes for future analysis will include differences in body weight and other cardiovascular risk factors over a 24-month intervention period. At baseline, RAPID participants had a mean (SD) age of 51 ± 12.1 years, weight of 225.1 ± 56.2 lbs, and BMI of 36.9 ± 8.6 kg/m(2). 70.7% were women, 57.2% were African American, 35.4% were non-Hispanic White, and 3.2% were Hispanic. Mean HbA1c was 6.05 ± 0.34%. Additionally, 55.4% of participants had a baseline systolic blood pressure of =130 mmHg, 33.1% had a total blood cholesterol exceeding 200mg/dL, and 74% reported a household income of <$25,000. The RAPID Study successfully randomized a large cohort of participants with a wide distribution of age, body weight, and race who are at high risk for developing type 2 diabetes.
View details for PubMedID 24177413
Impact of diagnosis of diabetes on health-related quality of life among high risk individuals: the Diabetes Prevention Program outcomes study.
Journal: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Authors: Marrero D; Pan Q; Barrett-Connor E; de Groot M; Zhang P; Percy C; Florez H; Ackermann R; Montez M; Rubin RR; DPPOS Research Group;
Publication Date: 2013 May 26

Abstract

The purpose of this study is to assess if diagnosis of type 2 diabetes affected health-related quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration.
View details for PubMedID 23709097
Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report.
Journal: Diabetes care
Authors: Marrero DG; Ard J; Delamater AM; Peragallo-Dittko V; Mayer-Davis EJ; Nwankwo R; Fisher EB;
Publication Date: 2013 Feb
Promotion and tenure for community-engaged research: an examination of promotion and tenure support for community-engaged research at three universities collaborating through a Clinical and Translational Science Award.
Journal: Clinical and translational science
Authors: Marrero DG; Hardwick EJ; Staten LK; Savaiano DA; Odell JD; Comer KF; Saha C;
Publication Date: 2013 Apr 19

Abstract

Community-engaged health research, an approach to research which includes the participation of communities, promotes the translation of research to address and improve social determinants of health. As a way to encourage community-engaged research, the National Institutes of Health required applicants to the Clinical and Translational Science Award (CTSA) to include a community engagement component. Although grant-funding may support an increase in community-engaged research, faculties also respond to the rewards and demands of university promotion and tenure standards. This paper measures faculty perception of how three institutions funded by a CTSA support community-engaged research in the promotion and tenure process.
View details for PubMedID 23751026
Improving medication adherence for chronic disease using integrated e-technologies.
Journal: Studies in health technology and informatics
Authors: Dixon BE; Jabour AM; Phillips EO; Marrero DG;
Publication Date: 2013

Abstract

Diabetes mellitus (DM) is a chronic disease affecting more than 285 people worldwide and the fourth leading cause of death. Increasing evidence suggests that many DM patients have poor adherence with prescribed medication therapies, impacting clinical outcomes. Patients' barriers to medication adherence and the extent to which barriers contribute to poor outcomes, however, are not routinely assessed. We designed a dashboard for an electronic health record system to integrate DM disease and medication data, including patient-reported barriers to adherence. Processes to support routine capture of data from patients are also being explored. The dashboard is being evaluated at multiple ambulatory clinics to examine whether integrated electronic tools can support patient-centered decision-making processes involving complex medication regimens for DM and other chronic diseases.
View details for PubMedID 23920703
Contracting and monitoring relationships for adolescents with type 1 diabetes: a pilot study.
Journal: Diabetes technology & therapeutics
Authors: Carroll AE; DiMeglio LA; Stein S; Marrero DG;
Publication Date: 2011 Mar 15

Abstract

Adolescents are developmentally in a period of transition-from children cared for by their parents to young adults capable of self-care, independent judgment, and self-directed problem solving. We wished to develop a behavioral contract for adolescent diabetes management that addresses some negotiable points of conflict within the parent-child relationship regarding self-monitoring and then assess its effectiveness in a pilot study as part of a novel cell phone-based glucose monitoring system.
View details for PubMedID 21406011
The perceived impact of disclosure of pediatric HIV status on pediatric antiretroviral therapy adherence, child well-being, and social relationships in a resource-limited setting.
Journal: AIDS patient care and STDs
Authors: Vreeman RC; Nyandiko WM; Ayaya SO; Walumbe EG; Marrero DG; Inui TS;
Publication Date: 2010 Oct

Abstract

In resource-limited settings, beliefs about disclosing a child's HIV status and the subsequent impacts of disclosure have not been well studied. We sought to describe how parents and guardians of HIV-infected children view the impact of disclosing a child's HIV status, particularly for children's antiretroviral therapy (ART) adherence. A qualitative study was conducted using involving focus groups and interviews with parents and guardians of HIV-infected children receiving ART in western Kenya. Interviews covered multiple aspects of the experience of having children take medicines. Transcribed interview dialogues were coded for analysis. Data were collected from 120 parents and guardians caring for children 0–14 years (mean 6.8 years, standard deviation [SD] 6.4); 118 of 120 had not told the children they had HIV. Children's caregivers (parents and guardians) described their views on disclosure to children and to others, including how this information-sharing impacted pediatric ART adherence, children's well-being, and their social relationships. Caregivers believed that disclosure might have benefits such as improved ART adherence, especially for older children, and better engagement of a helping social network. They also feared, however, that disclosure might have both negative psychological effects for children and negative social effects for their families, including discrimination. In western Kenya, caregivers' views on the risks and benefits to disclosing children's HIV status emerged a key theme related to a family's experience with HIV medications, even for families who had not disclosed the child's status. Assessing caregivers' views of disclosure is important to understanding and monitoring pediatric ART.
View details for PubMedID 20836704
Using a cell phone-based glucose monitoring system for adolescent diabetes management.
Journal: The Diabetes educator
Authors: Carroll AE; DiMeglio LA; Stein S; Marrero DG;
Publication Date: 2010 Nov 24

Abstract

Mobile technology may be useful in addressing several issues in adolescent diabetes management.
View details for PubMedID 21106908
Training YMCA wellness instructors to deliver an adapted version of the Diabetes Prevention Program lifestyle intervention.
Journal: The Diabetes educator
Authors: Finch EA; Kelly MS; Marrero DG; Ackermann RT;
Publication Date: 2009 Mar-Apr

Abstract

The purpose of this article is to describe efforts to develop and administer a formal curriculum to train community workers to deliver a group-based adaptation of the Diabetes Prevention Program (DPP) lifestyle intervention in YMCA settings. The DPP demonstrated that a structured diet and physical activity intervention that achieves and maintains modest weight loss for overweight adults with impaired glucose tolerance can significantly reduce the development of diabetes. Although tens of millions of American adults could benefit from access to the DPP lifestyle intervention, there currently is no available model for nationwide dissemination of this highly beneficial and cost-effective approach to diabetes prevention. A description of 2 ongoing randomized pilot studies provides information about the feasibility and effectiveness of future efforts to apply this new training curriculum on a national scale.
View details for PubMedID 19321808
Reliability and validity of an instrument for assessing patients' perceptions about medications for diabetes: the PAM-D.
Journal: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Authors: Monahan PO; Lane KA; Hayes RP; McHorney CA; Marrero DG;
Publication Date: 2009 Jul 16

Abstract

To evaluate the reliability and validity of the Perceptions About Medications for Diabetes (PAM-D) instrument.
View details for PubMedID 19609723
The prevention of type 2 diabetes: an overview.
Journal: Journal of diabetes science and technology
Authors: Marrero DG;
Publication Date: 2009 Jul 1

Abstract

Type 2 diabetes mellitus is one of the major public health threats in the United States today, reaching epidemic rates. Epidemiological evidence suggests a strong link between obesity and the risk of developing diabetes. Increasing evidence demonstrates that lifestyle interventions can significantly delay or possibly prevent the onset of type 2 diabetes in persons with increased risk. Despite these findings, there remain important barriers to the translation of this research to the public health. These include identifying persons with an increased risk for developing the disease and the lack of easily accessible, cost-effective intervention programs. At least one study, however, has effectively implemented an evidenced-based intervention in community settings, suggesting that it may be possible to develop a model for the national scalability of primary prevention in the United States.
View details for PubMedID 20144325
A novel application of the Problem Areas in Diabetes (PAID) instrument to improve glycemic control and patient satisfaction.
Journal: The Diabetes educator
Authors: Chawla A; Saha C; Marrero DG;
Publication Date: 2009 Dec 3

Abstract

The purpose of this study was to use the Problem Areas in Diabetes (PAID) instrument in a novel manner and assess whether providing primary care physicians the results of the questionnaire completed by their patients immediately prior to a clinical encounter would result in improvement in a patient's glycemic control and/or postencounter satisfaction score.
View details for PubMedID 19959745
Factors sustaining pediatric adherence to antiretroviral therapy in western Kenya.
Journal: Qualitative health research
Authors: Vreeman RC; Nyandiko WM; Ayaya SO; Walumbe EG; Marrero DG; Inui TS;
Publication Date: 2009 Dec

Abstract

Antiretroviral therapy (ART) requires nearly perfect adherence to be effective. Although 90% of HIV-infected children live in Africa, there are limited data on pediatric adherence from this multicultural continent.We conducted a qualitative study to identify key factors contributing to pediatric ART adherence. Ten focus group discussions (N = 85) and 35 individual interviews were conducted with parents and guardians of HIV-infected children receiving ART in western Kenya. Interviews covered multiple aspects of the experience of having children take ART and factors that inhibited or facilitated medication adherence. Constant comparison, progressive coding, and triangulation methods were used to arrive at a culturally contextualized, conceptual model for pediatric ART adherence derived from the descriptions of the lived experience in this resource-limited setting. Child care, including sustained ART adherence, depends on interacting cultural and environmental determinants at the levels of the individual child, parent/caregiver, household, community, health care system, and society.
View details for PubMedID 19949221
Changes in health state utilities with changes in body mass in the Diabetes Prevention Program.
Journal: Obesity (Silver Spring, Md.)
Authors: Ackermann RT; Edelstein SL; Narayan KM; Zhang P; Engelgau MM; Herman WH; Marrero DG; Diabetes Prevention Program Research Group;
Publication Date: 2009 Apr 23

Abstract

Health utilities are measures of health-related quality of life (HRQL) used in cost-effectiveness research. We evaluated whether changes in body weight were associated with changes in health utilities in the Diabetes Prevention Program (DPP) and whether associations differed by treatment assignment (lifestyle intervention, metformin, placebo) or baseline obesity severity. We constructed physical (PCS-36) and mental component summary (MCS-36) subscales and short-form-6D (SF-6D) health utility index for all DPP participants completing a baseline 36-item short form (SF-36) HRQL assessment (N = 3,064). We used linear regression to test associations between changes in body weight and changes in HRQL indicators, while adjusting for other demographic and behavioral variables. Overall differences in HRQL between treatment groups were highly statistically significant but clinically small after 1 year. In multivariable models, weight change was independently associated with change in SF-6D score (increase of 0.007 for every 5 kg weight loss; P < 0.001), but treatment effects independent of weight loss were not. We found no significant interaction between baseline obesity severity and changes in SF-6D with changes in body weight. However, increases in physical function (PCS-36) with weight loss were greater in persons with higher baseline obesity severity. In summary, improvements in HRQL are associated with weight loss but not with other effects of obesity treatments that are unrelated to weight loss. Although improvements in the SF-6D did not exceed commonly reported thresholds for a minimally important difference (0.04), these changes, if causal, could still have a significant impact on clinical cost-effectiveness estimates if sustained over multiple years.
View details for PubMedID 19390518
Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study.
Journal: American journal of preventive medicine
Authors: Ackermann RT; Finch EA; Brizendine E; Zhou H; Marrero DG;
Publication Date: 2008 Oct

Abstract

The Diabetes Prevention Program (DPP) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes, but there is little information about the feasibility of offering such an intervention in community settings. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA.
View details for PubMedID 18779029
Overcoming patient barriers to initiating insulin therapy in type 2 diabetes mellitus.
Journal: Clinical cornerstone
Authors: Marrero DG;
Publication Date: 2008

Abstract

Data from clinical trials underscore the fact that loss of beta-cell function and insulin hyposecretion are progressive in type 2 diabetes. To achieve adequate glycemic control, most patients will eventually require insulin. Addition of insulin to sulfonylurea therapy, when maximal sulfonylurea does not adequately maintain fasting plasma glucose levels at < 108 mg/dL, has been found to be more effective than initiating insulin therapy after oral agents have failed to maintain glycemic control. Nonetheless, both patients and providers are reluctant to begin insulin therapy. Research has shown that providers often delay modification of the diabetes treatment regimen because they believe their patients would be concerned about starting insulin therapy. In addition, they are concerned about patient nonadherence to nonpharmacologic and pharmacologic therapy. There are multiple reasons for patient nonadherence to insulin therapy; however, patients must be made to understand, early in the course of the disease, the progressive nature of type 2 diabetes and that exogenous insulin is an additional therapeutic option to help them achieve and maintain adequate glycemic control.
View details for PubMedID 19410163
Adapting the Diabetes Prevention Program lifestyle intervention for delivery in the community: the YMCA model.
Journal: The Diabetes educator
Authors: Ackermann RT; Marrero DG;
Publication Date: 2007 Jan-Feb

Abstract

The Diabetes Prevention Program (DPP) demonstrated that a structured diet and physical activity intervention that achieves and maintains modest weight loss for overweight adults with impaired glucose tolerance can significantly reduce the development of diabetes. Although tens of millions of American adults could benefit from access to the DPP lifestyle intervention, there currently is no available model for nationwide dissemination of this highly beneficial and cost-effective approach to diabetes prevention. In this article, the authors describe the evolution of adaptations to improve DPP lifestyle intervention implementation and dissemination by a strong community partner, the YMCA. They also provide information about early field research and an ongoing clinical trial that will provide information about the feasibility and effectiveness of applying this new model on a national scale.
View details for PubMedID 17272794
What adolescents with type I diabetes and their parents want from testing technology: a qualitative study.
Journal: Computers, informatics, nursing : CIN
Authors: Carroll AE; Downs SM; Marrero DG;
Publication Date: 2007 Jan-Feb

Abstract

The presence of diabetes in an adolescent can significantly affect his/her normal development. Mobile technology may offer the ability to lessen this negative impact. We wished to learn from adolescents with diabetes and their parents how monitoring systems that incorporated mobile communication technology could potentially help to reduce hassles associated with testing, improve compliance, and ease adolescent-parent conflict about testing behavior. We recruited adolescents between the ages of 13 and 18 years, living with type 1 diabetes mellitus and their parents for focus groups. Qualitative analysis of the focus group data followed a set procedure. From the discussions, the following themes were identified: issues with blood glucose monitoring and desired technology. Elements of desired technology included hardware requirements, software requirements, communication, and miscellaneous requirements. The reported needs of this end-user group can help others to leverage maximally the capabilities of new and existing technology to care for children managing chronic disease.
View details for PubMedID 17215672
Effect of adjunctive pramlintide treatment on treatment satisfaction in patients with type 1 diabetes.
Journal: Diabetes care
Authors: Marrero DG; Crean J; Zhang B; Kellmeyer T; Gloster M; Herrmann K; Rubin R; Fineberg N; Kolterman O;
Publication Date: 2007 Feb

Abstract

To assess the effect of adjunctive pramlintide treatment on treatment satisfaction in patients with type 1 diabetes treated with intensive insulin regimens.
View details for PubMedID 17259483
Does age at diabetes diagnosis influence long-term physical and behavioral outcomes?
Journal: Diabetes care
Authors: Carroll AE; Ackermann RT; Brizendine EJ; Shen C; Marrero DG;
Publication Date: 2007 Aug 6
Primary care physician treatment of low HDL: Rational approach or Pandora's Box?
Journal: Journal of clinical lipidology
Authors: Deeg MA; Jacob S; Shen J; Marrero DG;
Publication Date: 2007 Apr 20

Abstract

Guidelines for treating high low-density lipoproteins are clear, whereas guidelines for treating low high-density lipoproteins (HDL) are less so. Physicians approach to treating low HDL cholesterol is not known.
View details for PubMedID 21291682
The HealthPia GlucoPack Diabetes phone: a usability study.
Journal: Diabetes technology & therapeutics
Authors: Carroll AE; Marrero DG; Downs SM;
Publication Date: 2007 Apr

Abstract

Type I diabetes is a common chronic disease of childhood. Both the growing influence of peers and the shifting away from parental influence have been implicated as prime elements contributing to poor glycemic outcomes in adolescents. Mobile technology that can be directed towards providing self-management support and modifying potentially negative child parent interaction holds promise to improve control in adolescents with diabetes.
View details for PubMedID 17425441
Why do adolescents with type 1 diabetes and their parents participate in focus groups?
Journal: Research and theory for nursing practice
Authors: Carroll AE; Marrero DG; Swenson MM;
Publication Date: 2007

Abstract

Almost all patient-centered research is dependent on voluntary participation by participants. Many forces, however, act to either encourage or inhibit people from deciding to participate. This study explored adolescents' with type 1 diabetes and their parents' reasons for participating in a research study. We recruited adolescents with type 1 diabetes mellitus and their parents to participate in a focus group study. Qualitative analysis of the focus group data followed a set procedure: (a) audio review, (b) reading through transcriptions, (c) discussions among investigators regarding key elements of participants' perceptions, (d) determination of conceptual themes, and (e) assignment of relevant responses to appropriate thematic constructs. The 10 focus groups involved 59 participants. The three major themes that developed were giving and receiving, desire for peer socialization, and need for validation. Themes captured the reasons adolescents with type 1 diabetes and their parents decided to participate in this research. A better understanding of why people participate in research may help us to meet their needs and desires more completely. Designing research to meet these reasons will have the dual affect of increasing participation while also better serving those who choose to be studied.
View details for PubMedID 17564300
Overcoming patient barriers to initiating insulin therapy in type 2 diabetes mellitus.
Journal: Clinical cornerstone
Authors: Marrero DG;
Publication Date: 2007

Abstract

Data from clinical trials underscore the fact that loss of beta-cell function and insulin hyposecretion are progressive in type 2 diabetes. To achieve adequate glycemic control, most patients will eventually require insulin. Addition of insulin to sulfonylurea therapy, when maximal sulfonylurea does not adequately maintain fasting plasma glucose levels at <108 mg/dL, has been found to be more effective than initiating insulin therapy after oral agents have failed to maintain glycemic control. Nonetheless, both patients and providers are reluctant to begin insulin therapy. Research has shown that providers often delay modification of the diabetes treatment regimen because they believe their patients would be concerned about starting insulin therapy. In addition, they are concerned about patient nonadherence to nonpharmacologic and pharmacologic therapy. There are multiple reasons for patient nonadherence to insulin therapy; however, patients must be made to understand, early in the course of the disease, the progressive nature of type 2 diabetes and that exogenous insulin is an additional therapeutic option to help them achieve and maintain adequate glycemic control.
View details for PubMedID 18357954
How do parents perceive their adolescent's diabetes: a qualitative study.
Journal: Diabetic medicine : a journal of the British Diabetic Association
Authors: Carroll AE; Marrero DG;
Publication Date: 2006 Nov

Abstract

The developmental tasks of adolescence, combined with physical changes, can interfere with self-management behaviour. Yet little is known about how parents view these challenges as they attempt to help their children cope with diabetes. Our objective was to understand how living with an adolescent with diabetes influences parents' perceptions of their child's well-being, their relationship with their child, and how they perceive the influence of peers and school on their child's diabetes.
View details for PubMedID 17054599
An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes.
Journal: Diabetes care
Authors: Ackermann RT; Marrero DG; Hicks KA; Hoerger TJ; Sorensen S; Zhang P; Engelgau MM; Ratner RE; Herman WH;
Publication Date: 2006 Jun

Abstract

The Diabetes Prevention Program (DPP) lifestyle intervention is a cost-effective strategy to prevent type 2 diabetes, but it is unclear how this intervention could be financed. We explored whether this intervention could be offered in a way that allows return on investment for private health insurers while remaining attractive for consumers, employers, and Medicare.
View details for PubMedID 16732002
Changing patient behavior.
Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
Authors: Marrero DG;
Publication Date: 2006 Jan-Feb

Abstract

To discuss barriers and strategies relevant to initiating lifestyle modifications for the prevention and treatment of type 2 diabetes.
View details for PubMedID 16627394