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Moshel S, Klang S, Nikname R, Bar Shalom K, Albukrek D, Zacay G. Automated versus manual prior authorization for diabetes mellitus drugs: A retrospective study from Israel. Digit Health 2023; 9:20552076231203889. [PMID: 37780061 PMCID: PMC10540583 DOI: 10.1177/20552076231203889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Drug prior authorization (PA) imposes a bureaucratic and economic burden on healthcare service providers and payers. A novel automated PA system may improve these drawbacks. Methods An historical cohort study from a large health maintenance organization in Israel, comparing manual versus automated PA mechanisms for diabetes mellitus (DM) drugs: sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogs (GLP1-A). We compared patients with DM, whose first drug applications were approved using the automated system, with similar patients whose first drug applications were approved by manual PA. The primary endpoint was the time elapsed from application approval to prescription filling (accessibility time). Secondary endpoints included the prescription filling rate at 7 and 30 days. Results In total, 1371 automated approved prescriptions and 1240 manually approved prescriptions were included in the analysis. Median accessibility time was one day (interquartile range (IQR) 0-5) with automated PA for both GLP1-A and SGLT2i, compared with four days (IQR 1-9) and three days (IQR 1-8), respectively, with the manual PA (p < 0.001). Eighty-four percent of GLP1-A automated PA approvals were filled within seven days compared with 70% with manual PA (p < 0.001). Similar results were seen with SGLT2i (80% vs. 72%, p < 0.008). No differences were observed at 30 days post-approval. Using logistic regression, odds for GLP1-A and SGLT2i prescription filling within seven days were 2.36 and 1.53 folds higher (respectively) with automated PA (p < 0.01). Conclusions Automated PA system improved access time to SGLT2i/GLP1-A seven days post-approval compared to manual PA.
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Affiliation(s)
- Shai Moshel
- Meuhedet Health Services, Tel Aviv, Israel
- Department of Health System Management, Peres Academic Center, Rehovot, Israel
| | - Shmeul Klang
- School of Public Health, University of Haifa, Haifa, Israel
| | | | | | | | - Galia Zacay
- Meuhedet Health Services, Tel Aviv, Israel
- Department of Family Medicine, Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
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Walalangi RGM, Legi NN, Ondang O, Tomastola YA, Harikedua VT, Pesak E, Ranti IN, Montol AB, Paruntu OL, Robert D, Sineke J, Kereh PS, Sahelangi O. Diet Compliance, Blood Glucose Levels, and Hospitalization Duration of Type II Diabetes Mellitus Patients with Hypertension Complications in the Pancaran Kasih General Hospital, Manado. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUD: Diabetes mellitus is an assembly of symptoms that arise in a person caused by increased blood sugar levels due to insulin deficiency, both absolute and relative. The highest prevalence in North Sulawesi is in Tomohon City (4.8%) then Manado City (3.2%).
AIM: This study aimed to determine the correlation between dietary compliance with blood glucose levels and duration of hospitalization of type 2 diabetes mellitus (T2DM) patients with hypertension complications in the Pancaran Kasih General Hospital, Manado.
METHOD: This research was observational with a cross-sectional design. The population in this study were all patients with type 2 diabetes who were hospitalized and 34 people involved as a sample through purposive sampling technique.
RESULTS: The results showed that 88.2% of respondents with not normal blood glucose did not adhere to the diet. Fisher’s test obtained p = 0.011 (p < 0.05), indicated a significant correlation between dietary compliance with blood glucose levels. About 82.4% of patients did not adhere to the diet with a long day of hospitalization and p = 0.027 (p < 0.05). It indicated a significant correlation between dietary compliance and length of stay.
CONCLUSION: This study concluded a correlation between dietary compliance with blood glucose levels and dietary compliance and length of stay for T2DM patients with hypertension complications.
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Zhu Y, Chiang C, Wang L, Brock G, Milks MW, Cao W, Zhang P, Zeng D, Donneyong M, Li L. A multistate transition model for statin-induced myopathy and statin discontinuation. CPT Pharmacometrics Syst Pharmacol 2021; 10:1236-1244. [PMID: 34562311 PMCID: PMC8520747 DOI: 10.1002/psp4.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
The overarching goal of this study was to simultaneously model the dynamic relationships among statin exposure, statin discontinuation, and potentially statin-related myopathic outcomes. We extracted data from the Indiana Network of Patient Care for 134,815 patients who received statin therapy between January 4, 2004, and December 31, 2008. All individuals began statin treatment, some discontinued statin use, and some experienced myopathy and/or rhabdomyolysis while taking the drug or after discontinuation. We developed a militate model to characterize 12 transition probabilities among six different states defined by use or discontinuation of statin and its associated myopathy or rhabdomyolysis. We found that discontinuation of statin therapy was common and frequently early, with 44.4% of patients discontinuing therapy after 1 month, and discontinuation is a strong indicator for statin-induced myopathy (risk ratio, 10.8; p < 0.05). Women more likely than men (p < 0.05) and patients aged 65 years and older had a higher risk than those aged younger than 65 years to discontinue statin use or experience myopathy. In conclusion, we introduce an innovative multistate model that allows clear depiction of the relationship between statin discontinuation and statin-induced myopathy. For the first time, we have successfully demonstrated and quantified the relative risk of myopathy between patients who continued and discontinued statin therapy. Age and sex were two strong risk factors for both statin discontinuation and incident myopathy.
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Affiliation(s)
- Yuxi Zhu
- Division of BiostatisticsCollege of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Chien‐Wei Chiang
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Lei Wang
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Guy Brock
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - M. Wesley Milks
- Department of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Weidan Cao
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Pengyue Zhang
- BiostatisticsSchool of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Donglin Zeng
- Department of BiostatisticsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Macarius Donneyong
- Division of Pharmacy Practice and ScienceCollege of PharmacyThe Ohio State UniversityColumbusOhioUSA
| | - Lang Li
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
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Hazard D, von Cube M, Kaier K, Wolkewitz M. Predicting Potential Prevention Effects on Hospital Burden of Nosocomial Infections: A Multistate Modeling Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:830-838. [PMID: 34119081 DOI: 10.1016/j.jval.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Hospital-acquired infections (HAIs) place a substantial burden on health systems. Tools are required to quantify the change in this burden as a result of a preventive intervention. We aim to estimate how much a reduction in the rate of hospital-acquired infections translates into a change in hospital mortality and length of stay. METHODS Using multistate modelling and competing risks methodology, we created a tool to estimate the reduction in burden after the introduction of a preventive effect on the infection rate. The tool requires as inputs the patients' length of hospital stay, patients' infection information (status, time), patients' final outcome (discharged alive, dead), and a preventive effect. We demonstrated the methods on both simulated data and 3 published data sets from Germany, France, and Spain. RESULTS A hypothetical prevention that cuts the infection rate in half would result in 21 lives and 2212 patient-days saved in French ventilator-associated pneumonia data, 61 lives and 3125 patient-days saved in Spanish nosocomial infection data, and 20 lives and 1585 patient-days saved in German nosocomial pneumonia data. CONCLUSIONS Our tool provides a quick and easy means of acquiring an impression of the impact a preventive measure would have on the burden of an infection. The tool requires quantities routinely collected and computation can be done with a calculator. R code is provided for researchers to determine the burden in various settings with various effects. Furthermore, cost data can be used to get the financial benefit of the reduction in burden.
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Affiliation(s)
- Derek Hazard
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
| | - Maja von Cube
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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Horsburgh S, Sharples K, Barson D, Zeng J, Parkin L. Patterns of metformin monotherapy discontinuation and reinitiation in people with type 2 diabetes mellitus in New Zealand. PLoS One 2021; 16:e0250289. [PMID: 33882106 PMCID: PMC8059805 DOI: 10.1371/journal.pone.0250289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Aim To describe the patterns of discontinuation and reinitiation in new users of metformin monotherapy in New Zealand, overall and according to person- and healthcare-related factors. Materials and methods We created a cohort (n = 85,066) of all patients in New Zealand with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 from the national data collections, and followed them until the earlier of their death or 31 December 2015. Discontinuation was defined as a gap in possession of metformin monotherapy of ≥90 days. We explored patterns of discontinuation and reinitiation using competing risks methods. Results After 1 year of follow-up, 28% of cohort members had discontinued metformin monotherapy at least once; the corresponding figures after 2 and 5 years were 37% and 46%. The proportions who reinitiated metformin monotherapy within 1, 2, and 5 years of their first discontinuation were 23%, 49%, and 73%. Discontinuation after the first reinitiation was common (48% after 1 year). Discontinuation and reinitiation varied by age, ethnicity, and other person- and healthcare-related factors. Discussion Our findings highlight the dynamic nature of metformin monotherapy use, show that substantial periods of non-use are common, and identify priority populations for interventions to facilitate adherence.
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Affiliation(s)
- Simon Horsburgh
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
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Horsburgh S, Barson D, Zeng J, Sharples K, Parkin L. Adherence to metformin monotherapy in people with type 2 diabetes mellitus in New Zealand. Diabetes Res Clin Pract 2019; 158:107902. [PMID: 31672501 DOI: 10.1016/j.diabres.2019.107902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
AIM To describe adherence to metformin monotherapy in New Zealanders with type 2 diabetes mellitus (T2DM) initiating pharmacological treatment for the first time. METHODS We created a cohort of all New Zealanders with T2DM commencing metformin monotherapy between 1 January 2006 and 30 September 2014 using national data collections and followed them until the end of 2015. We obtained data on person- and health-related characteristics at metformin initiation from these collections and calculated medication possession ratios from pharmacy dispensing data. Regression modelling was used to assess changes in adherence over time. RESULTS We identified 85,066 people with T2DM who initiated metformin monotherapy. Lower adherence to metformin monotherapy was associated with time since initiating metformin, younger age and being of Māori or Pacific ethnicity. Higher adherence was associated with receiving more non-diabetic medications, a history of CVD and recent cancer registration. CONCLUSIONS Our findings are consistent with international literature and highlight groups of people who experience poor adherence over time. Understanding the drivers of lower adherence in Māori and Pacific peoples is a particular priority given the high prevalence of T2DM in these populations.
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Affiliation(s)
- Simon Horsburgh
- Pharmacoepidemiology Research Network, University of Otago, New Zealand; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
| | - David Barson
- Pharmacoepidemiology Research Network, University of Otago, New Zealand; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Jiaxu Zeng
- Pharmacoepidemiology Research Network, University of Otago, New Zealand; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, New Zealand; Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand; Department of Mathematics and Statistics, University of Otago, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, University of Otago, New Zealand; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
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Backer V, Stensen L, Sverrild A, Wedge E, Porsbjerg C. Objective confirmation of asthma diagnosis improves medication adherence. J Asthma 2017; 55:1262-1268. [PMID: 29278942 DOI: 10.1080/02770903.2017.1410830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The impact of diagnostic work-up in asthma management on medication redemption and probably also drug adherence is largely unknown, but we hypothesized that a confirmed diagnosis of asthma in a hospital-based out-patient clinic increases the willingness to subsequent medication redemption in a real life setting. METHODS In a retrospective register-based study, 300 medical records of patients referred with possible asthma during one year were examined, of whom 171 had asthma (57%). One-year data on dispensed medicine was collected using the Danish Registry of Medicinal Product Statistics. Patients who had a positive asthma (e.g. bronchial challenge) were classified as verified asthma, whereas unverified asthma refers to doctor's diagnosis of asthma with negative or no diagnostic tests performed. RESULTS 111 (65%) had a verified diagnosis and patients with verified asthma were more frequently prescribed new therapy compared to those with unverified asthma (88.9% vs. 65.0%, respectively, p < 0.001). No difference was found in first time redemption of prescriptions (72% vs. 64%, respectively, p = 0.3), whereas the second (52% vs. 27%, p = 0.001) and third or more asthma redeemed prescriptions (37% vs. 17%, p = 0.006) showed increased redemption of prescription and probably adherence in the verified compared with the unverified patients with asthma. Furthermore, the use of inhaled corticosteroid (ICS) was calculated as Percent Days Covered (PDC), which was higher in the verified group compared with the non-verified asthma group (88% vs. 30%, p = 0.004). CONCLUSION Objective verification of a diagnosis of asthma using asthma tests was associated with an improved redemption of prescription.
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Affiliation(s)
- V Backer
- a Department of Respiratory Medicine , Bispebjerg University hospital , Copenhagen , Denmark
| | - L Stensen
- a Department of Respiratory Medicine , Bispebjerg University hospital , Copenhagen , Denmark
| | - A Sverrild
- a Department of Respiratory Medicine , Bispebjerg University hospital , Copenhagen , Denmark
| | - E Wedge
- a Department of Respiratory Medicine , Bispebjerg University hospital , Copenhagen , Denmark
| | - C Porsbjerg
- a Department of Respiratory Medicine , Bispebjerg University hospital , Copenhagen , Denmark
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Jensen ML, Jørgensen ME, Hansen EH, Aagaard L, Carstensen B. Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation. PLoS One 2017; 12:e0179546. [PMID: 28665996 PMCID: PMC5493299 DOI: 10.1371/journal.pone.0179546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/31/2017] [Indexed: 12/01/2022] Open
Abstract
AIMS Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study. METHODS Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression. RESULTS Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment for all six medicine groups (rate ratio ranging 0.79 95%CI [0.72-0.87] to 0.89 95%CI [0.82-0.96] per already prescribed medicine), but once patients were in treatment, polypharmacy was not associated with recurrence of gaps in supply of medication, and polypharmacy was associated with lower risk of discontinuation (rate ratio ranging 0.93 95%CI [0.86-1.00] to 0.96 95%CI [0.93-0.99] per prescribed medicine). Other identified risk factors for slow initiation, poor implementation, and discontinuation were diabetes duration, younger age, and Turkish/Pakistani origin. DISCUSSION This study showed that a risk factor does not necessarily have the same association with all three elements of adherence (initiation, implementation and discontinuation), and that efforts supporting patients introduced to more complex drug combinations should be prioritized.
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Affiliation(s)
- Majken Linnemann Jensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, Universitetsparken 2, University of Copenhagen, Denmark
| | | | - Ebba Holme Hansen
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, Universitetsparken 2, University of Copenhagen, Denmark
| | - Lise Aagaard
- Faculty of Health, University of Southern Denmark, Odense, Denmark
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Olesen K, Jensen TM, Diaz LJ, Møller ACL, Willaing I, Lyssenko V. Sense of Coherence is associated with LDL-cholesterol in patients with type 1 diabetes - The PROLONG-Steno study. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 8:1-5. [PMID: 29067252 PMCID: PMC5651341 DOI: 10.1016/j.jcte.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/29/2017] [Indexed: 01/13/2023]
Abstract
SOC was compared to clinical biomarkers in 125 people with type 1 diabetes. No association between SOC and HbA1c was found. An independent association between high SOC and lower LDL-C was found.
Aim It is a constant challenge for people with type 1 diabetes to maintain appropriate levels of HbA1c, blood pressure and blood lipids in order to prevent or delay deleterious effects of their illness. This study sought to investigate if Sense of Coherence (SOC) is associated with clinical risk factors in people with type 1 diabetes. Methods Questionnaire data, including measure of SOC, was collected from 125 patients with long duration of type 1 diabetes and linked to electronic patient records to obtain clinical measures on HbA1c, blood pressure, and blood lipids. Linear regressions and generalized additive models were applied to explore the associations between SOC and clinical biomarkers. Results Mean age of the participants was 60.7 years (standard deviation = 10.0), 44.0% were men. Medium and high SOC were associated with lower levels of LDL-cholesterol (p = 0.005). This association was non-linear with medium and high levels of SOC being advantageous whereas low SOC was associated with elevated levels of LDL-cholesterol. Moreover, we observed non-significant tendencies to associations between low SOC and low HDL-cholesterol, and elevated HbA1c. Conclusions Findings from this study suggest that high SOC may be protective against elevated LDL-cholesterol among people with type 1 diabetes. Interventions to improve self-management among people with low SOC may prove effective to prevent deterioration of metabolic risk factors.
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Affiliation(s)
- Kasper Olesen
- Steno Diabetes Center A/S, Gentofte, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Troels Mygind Jensen
- Steno Diabetes Center A/S, Gentofte, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | | | - Ingrid Willaing
- Steno Diabetes Center A/S, Gentofte, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Valeriya Lyssenko
- Steno Diabetes Center A/S, Gentofte, Denmark.,KG Jebsen Center for Diabetes Research, University of Bergen, Bergen, Norway.,Diabetes and Endocrinology, Lund University Diabetes Center, Malmö, Sweden
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10
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Rasmussen SS, Johansen NB, Witte DR, Borch-Johnsen K, Sandbaek A, Lauritzen T, Jørgensen ME. Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study. Diabetologia 2016; 59:989-97. [PMID: 26857739 DOI: 10.1007/s00125-016-3887-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Screening programmes for type 2 diabetes inevitably find more people at high risk of developing diabetes than people with undiagnosed prevalent diabetes. We describe the incidence of diabetes for risk groups according to advancement in a screening process. METHODS In 2001-2006, a diabetes screening programme based on the Danish diabetes risk score and measures of HbA1c and glucose was carried out in Danish general practices. The present study includes 13,249 individuals with low diabetes risk scores and 22,726 with high diabetes risk scores but no diabetes according to WHO 1999 criteria. Seven incremental levels of diabetes risk were defined and followed for incident diabetes recorded in the Danish National Diabetes Register until December 2012. For each group, cumulative diabetes incidence was calculated. Incidence rates and rate ratios were estimated by Poisson regression analyses. RESULTS After 10 years of follow-up 1,164 new diabetes cases were registered. Incidence rates were 1.0, 4.2, 14.5, 28.8 and 52.6 per 1,000 person-years in individuals at low risk and in those with normal glucose tolerance, impaired fasting glucose, impaired glucose tolerance and one diabetic glucose value, respectively. For each step in the screening algorithm, the risk of developing diabetes was higher than in the previous step. CONCLUSIONS/INTERPRETATION The risk of developing clinical diabetes in people who screen negative for diabetes depends on the level of risk stratification at screening, even at lower risk levels. This risk increases markedly in the presence of impaired glucose regulation. These results can inform policy recommendations concerning prevention strategies following screening.
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Affiliation(s)
- Signe S Rasmussen
- Department of Cardiology, Nephrology and Endocrinology H, Nordsjællands University Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.
| | - Nanna B Johansen
- Steno Diabetes Center, Gentofte, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Daniel R Witte
- The Danish Diabetes Academy, Odense, Denmark
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Annelli Sandbaek
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center, Gentofte, Denmark
- Center for Health Research in Greenland, Southern Denmark University, Odense, Denmark
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