1
|
Li P, Alkhuzam K, Brown J, Zhang Y, Jiao T, Guo J, Umpierrez GE, Narayan KMV, Kulshreshtha A, Pasquel FJ, Ali MK, Shao H. Association between low cognitive performance and diabetes-related health indicators across racial and ethnic groups in adults with diabetes. Diabetes Obes Metab 2024; 26:3723-3731. [PMID: 38899435 DOI: 10.1111/dom.15715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/11/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
AIM To examine the associations between low cognitive performance (LCP) and diabetes-related health indicators (including body mass index [BMI], HbA1c, systolic blood pressure [SBP], low-density lipoprotein [LDL] and self-reported poor physical health) and whether these associations vary across racial/ethnic subgroups. METHODS We identified adults aged 60 years or older with self-reported diabetes from the 2011-2014 National Health and Nutrition Examination Survey. Individuals with cognitive test scores in the lowest quartile were defined as having LCP. We used regression models to measure the associations of LCP with diabetes-related biometrics (BMI, HbA1c, SBP and LDL); and self-reported poor physical health. Moreover, we explored potential variations in these associations across racial/ethnic subgroups. RESULTS Of 873 (261 with LCP) adults with diabetes, LCP was associated with higher HbA1c, SBP and LDL (adjusted difference: 0.41%, 5.01 mmHg and 5.08 mg/dL, respectively; P < .05), and greater odds of reporting poor physical health (adjusted odds ratio: 1.59, P < .05). The association between LCP and HbA1c was consistent across racial/ethnic groups, and notably pronounced in Hispanic and Other. BMI worsened with LCP, except for non-Hispanic Black. Excluding the Other group, elevated SBP was observed in people with LCP, with Hispanic showing the most significant association. LDL levels were elevated with LCP for Hispanic and Other. Physical health worsened with LCP for both non-Hispanic Black and Hispanic. CONCLUSIONS We quantified the association between LCP and diabetes-related health indicators. These associations were more pronounced in Hispanic and Other racial/ethnic groups.
Collapse
Affiliation(s)
- Piaopiao Li
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Khalid Alkhuzam
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Joshua Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yichen Zhang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Tianze Jiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Guillermo E Umpierrez
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Division of Endocrinology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - K M Venkat Narayan
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ambar Kulshreshtha
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Francisco J Pasquel
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Endocrinology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Hui Shao
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Auzanneau M, Seufert J, Zimny S, Haak T, Zeyfang A, Gölz S, Hugenberg I, Pavel M, Rosenbauer J, Holl RW. Regional socioeconomic deprivation associated with the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in adults with type 2 diabetes in Germany. Diabetes Obes Metab 2024; 26:4116-4120. [PMID: 38982585 DOI: 10.1111/dom.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024]
Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Zimny
- Department of General Internal Medicine, Endocrinology and Diabetes, Helios Klinik Schwerin, Schwerin, Germany
| | - Thomas Haak
- Diabetes Centre Mergentheim, Bad Mergentheim, Germany
| | - Andrej Zeyfang
- Department of Internal Medicine, Geriatric Medicine, Palliative Medicine and Diabetology, medius Klinik Ostfildern-Ruit and Nürtingen, Ostfildern, Germany
| | - Stefan Gölz
- Amedes MVZ für Diabetologie, Esslingen, Germany
| | - Inge Hugenberg
- RoMed clinic Prien am Chiemsee, Prien am Chiemsee, Germany
| | - Marianne Pavel
- Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Rosenbauer
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Centre (DDZ), Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| |
Collapse
|
3
|
Sherrill CH, Hwang AY. Use of Cardioprotective Antidiabetic Medications in Adults With and Without Cardiovascular Disease, 2015 to March 2020. Ann Pharmacother 2024; 58:248-254. [PMID: 37323006 DOI: 10.1177/10600280231178886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Certain glucagon-like peptide-1 receptor (GLP-1) agonists and sodium-glucose cotransporter-2 inhibitors (SGLT2-inhibitors) can reduce cardiovascular risk in individuals with type 2 diabetes and cardiovascular disease (CVD). However, these medications can be expensive, potentially limiting their use. Objectives: The primary objective was to characterize the use of cardioprotective GLP-1 agonists and SGLT2-inhibitors among adults with diabetes with and without CVD. The secondary objective was to investigate the association of socioeconomic factors and health care utilization with the use of these medications. METHODS Adults aged ≥20 years old with self-reported diabetes, A1c ≥6.5%, or fasting glucose ≥126 mg/dL were identified using the 2015 to March 2020 National Health and Nutrition Examination Survey. The primary outcome was the use of cardioprotective GLP-1 agonists or SGLT2-inhibitors compared in individuals with and without CVD. Secondary analyses included identification of socioeconomic factors and health care utilization associated with the use of cardioprotective antidiabetic medications, stratified by CVD status. Weighted analyses were conducted to account for the complex survey design. RESULTS Use of cardioprotective antidiabetic medications was higher in adults with CVD compared to those without CVD (7.8% vs. 4.6%, P = 0.02), which was driven by the use of cardioprotective SGLT2-inhibitors (4.6% versus 1.9%, P = 0.002). Lower income level and less frequent health care visits within the past year were associated with lower likelihood of using these medications. CONCLUSION AND RELEVANCE Despite preferential use in individuals with diabetes and CVD, the prevalence of cardioprotective antidiabetic medication use remains relatively low. Disparities in use appear to exist based on income level and health care utilization.
Collapse
Affiliation(s)
- Christina H Sherrill
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, USA
| | - Andrew Y Hwang
- Department of Pharmacy Practice, School of Pharmacy, MCPHS University, Boston, MA, USA
| |
Collapse
|
4
|
Li N, Panchal R, Giannouchos T, Pan RJ, Nguyen D, Nohavec R, Britton L, Chaiyakunapruk N, Biskupiak J, Wilson A, Brixner D. The impact of a statewide insulin copay cap policy for insured patients with diabetes in Utah. J Manag Care Spec Pharm 2024; 30:112-117. [PMID: 38308630 PMCID: PMC10839465 DOI: 10.18553/jmcp.2024.30.2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
BACKGROUND Insulin affordability is a huge concern for patients with diabetes in the United States. On March 30, 2020, Utah signed House Bill 207 into law, aimed at capping copayments for insulin at $30 for a 30-day supply. The bill was enacted on January 1, 2021. OBJECTIVE To assess patient basal insulin adherence, out-of-pocket costs, health plan costs, total costs on insulin, and hemoglobin A1c (A1c) in prepolicy vs postpolicy periods. METHODS This study is a retrospective analysis using data from a regional health plan in Utah from October 1, 2019, to September 30, 2021. Inclusion criteria were fully enrolled members of all ages, under commercial insurance, with at least 1 fill for any type of insulin in both the preperiod and the postperiod. Adherence was measured by proportion of days covered (PDC). Paired t-tests and Wilcoxon sign rank tests were conducted to compare the health and economic outcomes. RESULTS Out of 24,150 commercially insured individuals, a total of 244 patients were included. Across all 244 patients, there was a significant decline in monthly median out-of-pocket costs of insulin by 58.5% (P < 0.001), whereas the monthly median health plan costs of insulin increased by 22.0% (P < 0.001). The total monthly costs of insulin (the sum of out-of-pocket and health plan costs) were unchanged (P = 0.115). Only 74 patients with enough basal insulin fills in both periods were included in the analysis for PDC changes. PDC change was not statistically significant (P = 0.43). Among the 74 patients with PDC calculations, 29 patients had A1c recorded in both periods. The change in A1c was not statistically significant (P = 0.23). CONCLUSIONS An insulin copayment max of $30 in Utah demonstrated lower patient out-of-pocket costs, subsidized by the health plan. PDC did not change, and HbA1c did not improve. An assessment of a longer period and on a larger population is needed.
Collapse
Affiliation(s)
- Niying Li
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens
| | - Rupesh Panchal
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
- University of Utah Health Plans, Murray
| | - Theodoros Giannouchos
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
| | - Raymond J. Pan
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
| | - Danielle Nguyen
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
| | - Robert Nohavec
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens
- University of Utah Health Plans, Murray
| | - Laura Britton
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens
- University of Utah Health Plans, Murray
| | - Nathorn Chaiyakunapruk
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
- Informatics, Decision Enhancement, and Analytics Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Healthcare System, UT
| | - Joseph Biskupiak
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
| | | | - Diana Brixner
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
| |
Collapse
|
5
|
Isaksen AA, Sandbaek A, Skriver MV, Bjerg L. Glucose-lowering drug use in migrants and native Danes with type 2 diabetes: Disparities in combination therapy and drug types. Diabetes Obes Metab 2023; 25:3307-3316. [PMID: 37550891 DOI: 10.1111/dom.15230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
AIM To examine disparities in glucose-lowering drug (GLD) usage between migrants and native Danes with type 2 diabetes (T2D). MATERIALS AND METHODS In a nationwide, register-based cross-sectional study of 253 364 individuals with prevalent T2D on December 31, 2018, we examined user prevalence during 2019 of (i) GLD combination therapies and (ii) individual GLD types. Migrants were grouped by origin (Middle East, Europe, Turkey, Former Yugoslavia, Pakistan, Sri Lanka, Somalia, Vietnam), and relative risk (RR) versus native Danes was computed using robust Poisson regression to adjust for clinical and socioeconomic characteristics. RESULTS In 2019, 34.7% of native Danes received combination therapy, and prevalence was lower in most migrant groups (RR from 0.78, 95% confidence interval CI 0.71-0.85 [Somalia group] to 1.00, 95% CI 0.97-1.04 [former Yugoslavia group]). Among native Danes, the most widely used oral GLD was metformin (used by 62.1%), followed by dipeptidyl peptidase-4 inhibitors (13.3%), sodium-glucose cotransporter-2 inhibitors (11.9%) and sulphonylureas (5.2%), and user prevalence was higher in most migrant groups (RR for use of any oral GLD: 0.99, 95% CI 0.97-1.01 [Europe group] to 1.09, 95% CI 1.06-1.11 [Sri Lanka group]). Furthermore, 18.7% of native Danes used insulins and 13.3% used glucagon-like peptide-1 receptor agonists (GLP-1RAs), but use was less prevalent in migrants (RR for insulins: 0.66, 95% CI 0.62-0.71 [Sri Lanka group] to 0.94, 95% CI 0.89-0.99 [Europe group]; RR for GLP-1RAs: 0.29, 95% CI 0.22-0.39 [Somalia group] to 0.95, 95% CI 0.89-1.01 [Europe group]). CONCLUSIONS Disparities in GLD types and combination therapy were evident between migrants and native Danes. Migrants were more likely to use oral GLDs and less likely to use injection-based GLDs, particularly GLP-1RAs, which may contribute to complication risk and mortality among this group.
Collapse
Affiliation(s)
- Anders Aasted Isaksen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Annelli Sandbaek
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
- Research Unit for General Practice, Aarhus, Denmark
| | | | - Lasse Bjerg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|