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Ajrouche S, Louis L, Esvan M, Chapron A, Garlantezec R, Allory E. HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019. BMC Endocr Disord 2024; 24:72. [PMID: 38769550 PMCID: PMC11103828 DOI: 10.1186/s12902-024-01601-9] [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: 03/27/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Diabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme. METHOD The historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner's practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation. RESULTS HbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation. CONCLUSIONS These results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).
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Affiliation(s)
- Sarah Ajrouche
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Lisa Louis
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Maxime Esvan
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Anthony Chapron
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Ronan Garlantezec
- CHU de Rennes, Univ Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), Irset - UMR_S 1085, Rennes, 35000, France
| | - Emmanuel Allory
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France.
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France.
- LEPS (Laboratoire Educations et Promotion de la Santé), University of Sorbonne Paris Nord, UR 3412, Villetaneuse, F-93430, France.
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Bonnet JB, Nicolet G, Papinaud L, Avignon A, Duflos C, Sultan A. Effects of social deprivation and healthcare access on major amputation following a diabetic foot ulcer in a French administrative area: Analysis using the French claim data. Diabet Med 2022; 39:e14820. [PMID: 35213066 DOI: 10.1111/dme.14820] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
AIM The link between social deprivation and the development of diabetic foot ulcer (DFU) is still widely debated. The study objective was to evaluate the relationship between lower limb amputation, social deprivation level, and inequalities in access to care service among people with DFU. This regional pilot study was conducted at the living area level and based on the French National Health Data System (SNDS). METHODS We conducted a retrospective cohort study using hospital and primary care claim data in the Languedoc-Roussillon region. DFUs were determined using an original algorithm of care consumption or hospital diagnosis. The primary end point was amputation at 1 year. Secondary end points were mortality at 1 year and impact of potential access to care on amputation. RESULTS We included 15,507 people from 2015 to 2017. Amputation and mortality rates were 17.5 and 117 per 1000 person-years. The least precarious living areas showed better prognoses (relative risk = 0.46; 95% CI 0.27-0.66). Territorial accessibility to a private-practice nurse, unlike physician accessibility, was associated with better results on major outcomes (p = 0.004). CONCLUSION This is the first study using SNDS to study the care pathway of DFU management within and outside the hospital. High social deprivation in a living areas seems to be associated with more major amputations after a DFU.
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Affiliation(s)
- Jean-Baptiste Bonnet
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, INSERM, CHU, University of Montpellier, Montpellier, France
- Endocrinology-Diabetes-Nutrition Department, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Guillaume Nicolet
- Clinical Research and Epidemiology Unit, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Laurence Papinaud
- Information Systems Unit at the Regional Medical Office of the Assurance Maladie, Montpellier, France
| | - Antoine Avignon
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, INSERM, CHU, University of Montpellier, Montpellier, France
- Endocrinology-Diabetes-Nutrition Department, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Claire Duflos
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, INSERM, CHU, University of Montpellier, Montpellier, France
- Clinical Research and Epidemiology Unit, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Ariane Sultan
- Endocrinology-Diabetes-Nutrition Department, CHU Montpellier, University of Montpellier, Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
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Bijlsma-Rutte A, Rutters F, Elders PJM, Bot SDM, Nijpels G. Socio-economic status and HbA 1c in type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2018; 34:e3008. [PMID: 29633475 DOI: 10.1002/dmrr.3008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 01/12/2023]
Abstract
Up until now, differences in HbA1c levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA1c levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA1c levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA1c levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA1c levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12 mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36 mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA1c levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA1c levels in people with type 2 diabetes.
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Affiliation(s)
- Anne Bijlsma-Rutte
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Sandra D M Bot
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
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Andersen JA, Gibbs L. Does insulin therapy matter? Determinants of diabetes care outcomes. Prim Care Diabetes 2018; 12:224-230. [PMID: 29223467 DOI: 10.1016/j.pcd.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate adherence to care standards for people with diabetes (PWDs) on insulin therapy versus PWDs who are not on insulin therapy, controlling for social determinants. RESEARCH DESIGN AND METHODS Utilizing the United States 2015 Behavioral Risk Factor Surveillance System Survey, this study used logistic regression analyses to estimate differences in self-care behaviors, healthcare provider quality of care, and diabetic complications for individuals on insulin therapy and individuals not on insulin therapy. RESULTS PWDs on insulin therapy are more likely to adhere to self-care measures (self-glucose checks [OR: 7.57], self-foot checks [OR: 1.27], diabetes class participation [OR: 1.96]), adherence to provider care standards (diabetes-related doctor visits [OR: 1.24], comprehensive foot exam [OR: 1.80], dilated eye exam [OR: 1.34]), and to self-report diabetic complications (retinopathy [OR: 2.77], kidney disease [OR:2.14]), controlling for sociodemographic variables. CONCLUSION PWDs on insulin and their healthcare providers are more likely to meet the treatment goals set by the American Diabetes Association. PWDs on insulin therapy may have better overall relationships with providers due to a reduction in stigmatization based on the social construction of diabetes.
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Affiliation(s)
- Jennifer A Andersen
- Dept. of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, P.O. Box 880324, Lincoln, NE 68588-0324, United States.
| | - Larry Gibbs
- Dept. of Sociology and Anthropology, Southern Oregon University, 1250 Siskiyou Blvd., Ashland, OR 97520, United States
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Ong SE, Koh JJK, Toh SAES, Chia KS, Balabanova D, McKee M, Perel P, Legido-Quigley H. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS One 2018; 13:e0195086. [PMID: 29596495 PMCID: PMC5875848 DOI: 10.1371/journal.pone.0195086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. METHODS AND FINDINGS A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. CONCLUSIONS This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.
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Affiliation(s)
- Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Jin S, Baek JH, Suh S, Jung CH, Lee WJ, Park C, Yang HK, Cho JH, Lee B, Kim JH. Factors associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes: A prospective cohort study. J Diabetes Investig 2017; 9:549-557. [PMID: 28796932 PMCID: PMC5934262 DOI: 10.1111/jdi.12728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/23/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION We aimed to identify factors independently associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes, in terms of glycemic control and the rate of severe hypoglycemia. MATERIALS AND METHODS This was a prospective cohort study of 466 adult patients with type 1 diabetes from five tertiary referral hospitals who registered for a national reimbursement program for blood glucose strips and were then followed-up for 12 months. Factors associated with a > 5% reduction in glycated hemoglobin (HbA1c) and decreased rate of severe hypoglycemia (SH) at 12 months from baseline were evaluated. RESULTS At the end of the 12 months of follow up, 158 of 466 patients (33.9%) achieved >5% reduction in HbA1c, and 47 of 111 patients (42.3%) had a decreased rate of SH relative to baseline. Higher HbA1c (P < 0.001), lower total daily insulin dose at baseline (P = 0.048) and an increase in self-monitoring of blood glucose (SMBG) frequency during follow up (P = 0.001) were independently associated with >5% reduction in HbA1c. A higher SMBG frequency (P < 0.001), higher rate of SH at baseline (P = 0.029) and lack of hypoglycemic unawareness (P = 0.044) were independently associated with an increase in the frequency of SMBG during follow up. Higher SMBG frequency at baseline (P < 0.001) was independently associated with a decreased rate of SH. CONCLUSIONS Several factors, including higher SMBG frequency at baseline, were independently associated with reduced HbA1c and a decreased rate of severe hypoglycemia, showing that patients with these characteristics derive the most benefit from reimbursement of blood glucose test strips.
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Affiliation(s)
- Sang‐Man Jin
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jong Ha Baek
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
- Division of Endocrinology and MetabolismDepartment of Internal MedicineGyeongsang National University Changwon HospitalChangwonKorea
| | - Sunghwan Suh
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDong‐A University Medical CenterDong‐A University College of MedicineBusanKorea
| | - Chang Hee Jung
- Division of Endocrinology and MetabolismDepartment of Internal MedicineAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Woo Je Lee
- Division of Endocrinology and MetabolismDepartment of Internal MedicineAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Cheol‐Young Park
- Division of Endocrinology and MetabolismDepartment of Internal MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | - Hae Kyung Yang
- Department of Endocrinology and MetabolismSeoul St. Mary's HospitalThe Catholic University of KoreaSeoulKorea
| | - Jae Hyoung Cho
- Department of Endocrinology and MetabolismSeoul St. Mary's HospitalThe Catholic University of KoreaSeoulKorea
| | - Byung‐Wan Lee
- Division of Endocrinology and MetabolismDepartment of Internal MedicineYonsei University College of MedicineSeoulKorea
| | - Jae Hyeon Kim
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
- Department of Clinical Research Design and EvaluationSamsung Advanced Institute for Health Sciences and TechnologySungkyunkwan UniversitySeoulKorea
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Xie Y, Agiro A, Bowman K, DeVries A. Lowering Cost Share May Improve Rates of Home Glucose Monitoring Among Patients with Diabetes Using Insulin. J Manag Care Spec Pharm 2017; 23:884-891. [PMID: 28737991 PMCID: PMC10397879 DOI: 10.18553/jmcp.2017.23.8.884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Not much is known about the extent to which lower cost share for blood glucose strips is associated with persistent filling. OBJECTIVE To evaluate the relationship between cost sharing for blood glucose testing strips and continued use of testing strips. METHODS This is a retrospective observational study using medical and pharmacy claims data integrated with laboratory hemoglobin A1c (A1c) values for patients using insulin and blood glucose testing strips. Diabetic patients using insulin who had at least 1 fill of blood glucose testing strips between 2010 and 2012 were included. Patients were divided into a low cost-share group (out-of-pocket cost percentage of total testing strip costs over a 1-year period from the initial fill < 20%; n = 3,575) and a high cost-share group (out-of-pocket cost percentage ≥ 20%; n = 3,580). We compared the likelihood of continued testing strip fills after the initial fill between the 2 groups by using modified Poisson regression models. RESULTS Patients with low cost share had higher rates of continued testing strip fills compared with those with high cost share (89% vs. 82%, P < 0.001). Lower cost share was associated with greater probability of continued fills (adjusted risk ratio [aRR] = 1.05, 95% CI = 1.03-1.07, P < 0.001). Other patient characteristics associated with continued fills included type 1 diabetes diagnosis, types of insulin regimens, and health insurance plan type. In a subset analysis of patients whose A1c values at baseline were above the target level (8%) set by the National Committee for Quality Assurance guidelines, we saw a slight increase in magnitude of relationship between cost share and continued fills (RR = 1.06, 95% CI = 1.03-1.10, P < 0.01). CONCLUSIONS There was a statistically significant association between cost share for testing strips and continued blood glucose self-monitoring. Among patients not achieving A1c control at baseline, there was an increase in the magnitude of relationship. Lowering cost share for testing strips can remove a barrier to persistence in diabetes self-management. DISCLOSURES Funding for this study was provided by Anthem, which had no role in the study design, data interpretation, or preparation or review of the manuscript. The decision to publish was strictly that of the authors. Xie, Agiro, and DeVries are employees of HealthCore, a wholly owned subsidiary of Anthem. Bowman is an employee of Anthem. Study concept and design were contributed by all the authors. Xie took the lead in data collection, along with Agiro, and data interpretation was performed by all the authors. The manuscript was written by Xie and Agiro, along with DeVries, and revised by Xie, Agiro, and Devries, along with Bowman.
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Gonzalez-Zacarias AA, Mavarez-Martinez A, Arias-Morales CE, Stoicea N, Rogers B. Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus. Front Public Health 2016; 4:195. [PMID: 27672634 PMCID: PMC5018496 DOI: 10.3389/fpubh.2016.00195] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 01/27/2023] Open
Abstract
Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.
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Affiliation(s)
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Hunter Buskey RN, Mathieson K, Leafman JS, Feinglos MN. The Effect of Blood Glucose Self-Monitoring Among Inmates With Diabetes. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:343-54. [PMID: 26276137 DOI: 10.1177/1078345815599782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing prevalence and risk of complications from diabetes necessitate patient participation and attentiveness to select appropriate foods, perform regular physical activity, and be active in diabetes management and self-maintenance. Diabetes is often largely asymptomatic; consequently, early diagnosis and treatment are necessary. Inmates are a unique population challenged by the increased prevalence of chronic conditions including diabetes. Diabetes standards for inmates contain diagnostic and treatment management guidelines that incorporate personal glucose monitoring for insulin users. In December 2009, the Federal Bureau of Prisons initiated a program to distribute glucose meters to insulin-dependent inmates to facilitate self-monitoring blood glucose. The purpose of this study was to evaluate the effect of these glucose meters on hemoglobin A1c levels.
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Affiliation(s)
| | | | | | - Mark N Feinglos
- Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center, Durham, NC, USA
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Chen CM, Chang Yeh M. The experiences of diabetics on self-monitoring of blood glucose: a qualitative metasynthesis. J Clin Nurs 2014; 24:614-26. [DOI: 10.1111/jocn.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Chen-Mei Chen
- Department of Nursing; Chang Gung University of Science and Technology; Taipei Taiwan
- Department of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Mei Chang Yeh
- Department of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
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Gillani SW, Sulaiman SAS, Sundram S, Victor SC, Abdullah AH. Clinical critics in the management of diabetes mellitus. Health (London) 2012. [DOI: 10.4236/health.2012.48085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gonzalez AB, Salas D, Umpierrez GE. Special considerations on the management of Latino patients with type 2 diabetes mellitus. Curr Med Res Opin 2011; 27:969-79. [PMID: 21385020 DOI: 10.1185/03007995.2011.563505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Latinos are the largest minority population in the United States, and are characterized by higher rates of obesity and diabetes compared to Whites. The prevalence of diagnosed diabetes in Latinos is two-fold higher than in Caucasians, and Latinos suffer from higher rates of diabetic complications and mortality. As the diabetes epidemic continues to expand and exert greater socioeconomic strain on national healthcare systems, the success of global and national healthcare initiatives for diabetes prevention and improvement of care will depend upon strategies targeted specifically toward this population. Essential to such strategies is an understanding of success factors unique to the Latino population for diabetes prevention and achievement of optimal treatment outcomes. METHODS A PubMed search was conducted for literature describing type 2 diabetes and its complications in Latinos. Specifically, we sought data describing epidemiology, disparities, management considerations, and success factors in this population. RESULTS The title search yielded more than 2000 articles, 80 of which were deemed directly relevant to this review. The inherent limitations of this subjective selection process are acknowledged. CONCLUSIONS A number of studies have highlighted various ethnic disparities in Latinos with diabetes including higher HbA1c levels, greater rates of obesity and metabolic syndrome, and a larger proportion of individuals with inadequate access to care. While relatively fewer studies describe success factors for redressing cultural disparities in diabetes, the current body of literature supports primary care strategies aimed at effective provider-patient relationships and culturally tailored education and lifestyle modification regimens. Further research demonstrating effective, culturally tailored practices that are suitable to the primary care setting would be of value to providers treating Latinos with diabetes.
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Evans K, Coresh J, Bash LD, Gary-Webb T, Köttgen A, Carson K, Boulware LE. Race differences in access to health care and disparities in incident chronic kidney disease in the US. Nephrol Dial Transplant 2011; 26:899-908. [PMID: 20688771 PMCID: PMC3108345 DOI: 10.1093/ndt/gfq473] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/10/2010] [Accepted: 07/12/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The contribution of race differences in access to health care to disparities in chronic kidney disease (CKD) incidence in the United States is unknown. METHODS We examined race differences in usual source of health care, health insurance and CKD incidence among 3883 Whites and 1607 Blacks with hypertension or diabetes enrolled in the Atherosclerosis Risk in Communities Study. In multivariable analyses, we explored the incremental contribution of access to health care in explaining Blacks' excess CKD incidence above and beyond other socioeconomic, lifestyle and clinical factors. RESULTS Compared with Whites, Blacks had poorer access to health care (3 vs 0.3% with no usual source of health care or health insurance, P < 0.001) and experienced greater CKD incidence (14.7 vs 12.0 cases per 1000 person-years, P < 0.001). Blacks' excess risk of CKD persisted after adjusting for demographic, socioeconomic, lifestyle and clinical factors [hazard ratio (HR) (95% confidence interval (95% CI)) = 1.21 (1.01-1.47)]. Adjustment for these factors explained 64% of the excess risk among Blacks. The increased risk for CKD among Blacks was attenuated after additional adjustment for race differences in access to health care [HR (95% CI) = 1.19 (0.99-1.45)], which explained an additional 10% of the disparity. Conclusions. In this population at risk for developing CKD, we found that poorer access to health care among Blacks explained some of Blacks' excess risk of CKD, beyond the excess risk explained by demographic, socioeconomic, lifestyle and clinical factors. Improved access to health care for high-risk individuals could narrow disparities in CKD incidence.
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Affiliation(s)
- Kira Evans
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Barnichon C, Ruivard M, Philippe P, Vidal P, Teissonière M. [Type 2 diabetes and universal health care for low-income groups: a case-control study]. Rev Med Interne 2011; 32:467-71. [PMID: 21292357 DOI: 10.1016/j.revmed.2010.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 12/13/2010] [Accepted: 12/31/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE In 2007 in France, type 2 diabetes involved 2.5 million people, and 4.5 million patients received free healthcare coverage under the universal healthcare coverage program (CMU) for low-income households. An optimal glycemic control and adequate diabetes monitoring can reduce the incidence of complications. The objective of this study was to compare the diabetes care of low-income patients (as defined by CMU coverage) with the rest of the population. METHODS A retrospective case-control study (non-CMU and CMU) over a one-year period of glycemic control for both populations through private laboratory data (number and values of HbA1c) and of individuals monitoring through data from the regional health insurance public institute. RESULTS Regarding glycemic control, 154 patients were included. The number of annual HbA1c tests was similar between CMU and non-CMU patients. The mean HbA1c value was higher for CMU patients (8.7% versus 8%; P<0.01). Regarding monitoring, 1254 patients were included. Over a one-year period, the number of HbA1c tests, lipid profile tests, serum creatinine measures and cardiology consultations were similar across groups. However, CMU patients benefited from less microalbuminuria testing (P<0.001), ophthalmologic monitoring visits (P<0.01), endocrinology consultations (P<0.01), and from more general physician consultations (P<0.001). CONCLUSIONS Receiving CMU health coverage was associated with a poorer glycemic control and lesser specialized monitoring than that was observed in control patients. Across the population, follow-up recommendations are far from being implemented satisfactorily.
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Affiliation(s)
- C Barnichon
- Département de médecine générale, faculté de médecine, 28, place Henri-Dunant, BP 38, 63001 Clermont-Ferrand cedex 1, France
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Vallis M, Dunbar P, Tay L, Nash A. Evaluation of a Nova Scotia Diabetes Assistance Program for People with Type 2 Diabetes. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)51009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Grogan M, Jenkins M, Sansing VV, MacGregor J, Brooks MM, Julien-Williams P, Amendola A, Abbott JD. Health insurance status and control of diabetes and coronary artery disease risk factors on enrollment into the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. DIABETES EDUCATOR 2010; 36:774-83. [PMID: 20584997 DOI: 10.1177/0145721710374653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine measures of chronic disease severity and treatment according to insurance status in a clinical trial setting. METHODS Baseline insurance status of 776 patients with type 2 diabetes and stable coronary artery disease (CAD) enrolled in the United States in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was analyzed with regard to measures of metabolic and cardiovascular risk factor control. RESULTS Compared with patients with private or public insurance, the uninsured were younger, more often female, and less often white non-Hispanic. Uninsured patients had the greatest burden of CAD. Patients with public insurance were treated with the greatest number of medications, had the greatest self-reported functional status, and the lowest mean glycosylated hemoglobin and low-density lipoprotein (LDL) cholesterol values. Overall, for 5 measured risk factor targets, the mean number above goal was 2.49 ± 1.18. After adjustment for demographic and clinical variables, insurance status was not associated with a difference in risk factor control. CONCLUSIONS In the BARI 2D trial, we did not observe a difference in baseline cardiovascular risk factor control according to insurance status. An important observation, however, was that risk factor control overall was suboptimal, which highlights the difficulty in treating type 2 diabetes and CAD irrespective of insurance status.
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Affiliation(s)
- Mary Grogan
- The Department of Medicine, Rhode Island Hospital, Providence, Rhode Island (Ms Grogan, Dr Abbott)
| | - Margaret Jenkins
- The Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Ms Jenkins)
| | - Veronica V Sansing
- The Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sansing, Ms MacGregor, Dr Brooks)
| | - Joan MacGregor
- The Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sansing, Ms MacGregor, Dr Brooks)
| | - Maria Mori Brooks
- The Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sansing, Ms MacGregor, Dr Brooks)
| | | | - Angela Amendola
- New York University School of Medicine, New York, New York (Ms Amendola)
| | - J Dawn Abbott
- The Department of Medicine, Rhode Island Hospital, Providence, Rhode Island (Ms Grogan, Dr Abbott)
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Horton E, Cefalu WT, Haines ST, Siminerio LM. Multidisciplinary interventions: mapping new horizons in diabetes care. DIABETES EDUCATOR 2008; 34 Suppl 4:78S-89S. [PMID: 18664711 DOI: 10.1177/0145721708321s148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 20 million people in the United States, or 7% of the population, have diabetes, with health care and work-related costs estimated to be $174 billion in 2007. Obesity constitutes one of the major driving factors behind this epidemic. Most drugs currently used to treat diabetes address the primary metabolic defects in type 2 diabetes mellitus, which are insulin resistance and pancreatic islet dysfunction. Incretin augmentation therapies, such as glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase IV inhibitors, restore glucose homeostasis by addressing some of the unmet needs in diabetes therapies related to alpha-cell dysfunction and chronic beta-cell dysfunction. This new group of drugs offers certain advantages because its use is characterized by a low incidence of hypoglycemia and the absence of weight gain. Moreover, the use of fixed-dose combinations of dipeptidyl peptidase IV inhibitors with other oral antidiabetic agents seems very attractive to patients because of their reduced pill intake and minimized financial burden, which may improve adherence. An efficient strategy to slow down the epidemic of diabetes must include these emerging therapies and regimens, coupled with intensive patient education that includes information on treatment benefits and adverse effects, medication costs, and medication regimen complexity.
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Affiliation(s)
- Edward Horton
- Vice President and Director of Clinical Research, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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20
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Kwan J, Razzaq A, Leiter LA, Lillie D, Hux JE. Low Socioeconomic Status and Absence of Supplemental Health Insurance as Barriers to Diabetes Care Access and Utilization. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)23007-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karter AJ, Parker MM, Moffet HH, Ahmed AT, Chan J, Spence MM, Selby JV, Ettner SL. Effect of cost-sharing changes on self-monitoring of blood glucose. THE AMERICAN JOURNAL OF MANAGED CARE 2007; 13:408-16. [PMID: 17620036 PMCID: PMC2292835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To study the effect of cost-sharing policy changes on utilization of test strips for self-monitoring of blood glucose. STUDY DESIGN A legislative mandate (January 1, 2000) required California health plans to cover diabetes supplies, including those for self-monitoring of blood glucose. One health plan, Kaiser Permanente Northern California, initially waived established copayments and provided free test strips to members with diabetes mellitus for 2 years but later instituted a 20% coinsurance charge for a portion of their membership. METHODS A retrospective cohort design was used to study pharmacy-based estimates of test strip utilization changes during this natural experiment. Analyses included 2 cohort investigations using pretest-posttest analysis with control subjects to study transitions from a copayment period to a free test strip period and from the free test strip period to a coinsurance period. RESULTS During the copayment period, test strip utilization was inversely related to copayments for test strips. Offering free test strips did not increase utilization, even among those paying higher copayments before the policy change. Price-elastic patterns formed before and during the copayment period persisted, despite receiving free test strips for 2 years. The coinsurance, introduced after 2 years of receiving free test strips, resulted in statistically significant (but not clinically relevant) decreased utilization (approximately 1-3 fewer test strips/month). Change patterns did not differ by socioeconomic status. CONCLUSIONS Offering free test strips shifted costs from patient to health plan, without improving adherence. The introduced coinsurance slightly reduced utilization and adherence to recommendations about self-monitoring of blood glucose. Neither intervention had marked clinical effect. Cross-sectional analyses should not be used to predict utilization changes in the face of rapidly evolving benefit policies.
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Affiliation(s)
- Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, CA 94612, USA.
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Khatib M, Efrat S, Deeb D. Knowledge, beliefs, and economic barriers to healthcare: a survey of diabetic patients in an Arab-Israeli town. J Ambul Care Manage 2007; 30:79-85. [PMID: 17170641 DOI: 10.1097/00004479-200701000-00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Arab Israelis experience many financial and cultural barriers to effective diabetes control. This descriptive study was conducted in an Arab-Muslim town to assess the level of knowledge, beliefs, and concerns about diabetes care, and to what extent it is affected by financial constraints. More than a third of respondents report not receiving any counseling on issues such as foot care or the effects of smoking on diabetes, misconceptions attributable to social norms are common, and more than a third forgo taking medications because of financial reasons. There is a need for interventions focused on overcoming these barriers to improve diabetes treatment and self-care in this population.
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Affiliation(s)
- Mohammad Khatib
- Galilee Society: Arab National Society for Health Research and Services, Shefa Amr, Israel.
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Johnson JA, Majumdar SR, Bowker SL, Toth EL, Edwards A. Self-monitoring in Type 2 diabetes: a randomized trial of reimbursement policy. Diabet Med 2006; 23:1247-51. [PMID: 17054603 DOI: 10.1111/j.1464-5491.2006.01973.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Self-monitoring of blood glucose is often considered a cornerstone of self-care for patients with diabetes. We assessed whether provision of free testing strips would improve glycaemic control in non-insulin-treated Type 2 diabetic patients. METHODS Adults with Type 2 diabetes, excluding those with private insurance or using insulin, were recruited through community pharmacies and randomized to receive free testing strips for 6 months or not; all patients received similar baseline education and a glucose meter. Primary outcome was change in HbA(1c) over 6 months. RESULTS We randomized 262 patients (131 intervention and 131 control subjects). Mean age was 68.4 years (sd 10.9), 48% were male, mean duration of diabetes was 8.2 years (sd 7.2), 97% used oral glucose-lowering agents and mean baseline HbA(1c) was 7.4% (sd 1.2). After 6 months, we observed no difference in HbA(1c) between intervention and control patients, after adjusting for baseline HbA(1c)[adjusted difference 0.03, 95% confidence interval (CI) -0.16, 0.22; P = 0.78]. A per protocol analysis of study completers (152/262; 60%) yielded similar results. Intervention patients reported testing 0.64 days per week more often than control subjects (95% CI 0.18, 1.10; P = 0.007), although testing was not associated with better glycaemic control (Pearson r = -0.10, P = 0.12). CONCLUSIONS Reducing financial barriers by providing free testing strips did not improve glycaemic control in patients with Type 2 diabetes not using insulin. Our results question the value of policies that reduce financial barriers to testing supplies in this population.
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Affiliation(s)
- J A Johnson
- Department of Public Health Sciences, University of Alberta, Alberta, Canada.
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Abstract
OBJECTIVE To examine the role of self-monitoring of blood glucose (SMBG) in the management of diabetes mellitus. METHODS Current trends and published evidence are reviewed. RESULTS Despite the widespread evidence that lowering glycemic levels reduces the risks of complications in patients with diabetes, little improvement in glycemic control has been noted among patients in the United States and Europe in recent years. Although SMBG has been widely used, considerable controversy surrounds its role in achieving glycemic control. The high cost of test strips has made considerations regarding appropriate recommendations for SMBG a priority, especially in light of the current climate of health-care cost-containment. Existing clinical recommendations lack specific guidance to patients and clinicians regarding SMBG practice intensity and frequency, particularly for those patients not treated with insulin. Previous studies of the association between SMBG and glycemic control often found weak and conflicting results. CONCLUSION A reexamination of the role of SMBG is needed, with special attention to the unique needs of patients using different diabetes treatments, within special clinical subpopulations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG needed to reflect the variability in glycemic patterns would facilitate more specific guideline development. Educational programs that focus on teaching patients the recommended SMBG practice, specific glycemic targets, and appropriate responses to various blood glucose readings would be beneficial. Continuing medical education programs for health-care providers should suggest ways to analyze patient SMBG records to tailor medication regimens. For transfer or communication of SMBG reports to the clinical staff, a standardized format that extracts key data elements and allows quick review by health-care providers would be useful. Because the practice of SMBG is expensive, the cost-effectiveness of SMBG needs to be carefully assessed.
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Affiliation(s)
- Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, California, USA
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Bihan H, Laurent S, Sass C, Nguyen G, Huot C, Moulin JJ, Guegen R, Le Toumelin P, Le Clésiau H, La Rosa E, Reach G, Cohen R. Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score. Diabetes Care 2005; 28:2680-5. [PMID: 16249539 DOI: 10.2337/diacare.28.11.2680] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation. RESEARCH DESIGN AND METHODS We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed. RESULTS HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors. CONCLUSIONS Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.
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Affiliation(s)
- Hélène Bihan
- Université Paris XIII (CRNH) et Services de Médicine Interne et d'Endocrinologie, Hôpital Avicenne, 93009 Bobigny Cedex, France
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Abstract
Despite the increasing prevalence of diabetes, improved understanding of the disease, and a variety of new medications, glycemic control does not appear to be improving. Self-monitoring of blood glucose (SMBG) is one strategy for improving glycemic control; however, patient adherence is suboptimal and proper education and follow-up are crucial. Patients need to understand why they are being asked to self-test, what their glycemic targets are, and what they should do based on the results of self-monitoring. Patients also must be taught proper technique and must be given specific recommendations regarding frequency and timing for self-monitoring. Situations in which SMBG is essential or should be more frequent include self-adjustment of insulin doses, changes in medications, lack of awareness of hypoglycemia, gestational diabetes, illness, or when hemoglobin A1c (HbA1c) values are above target. SMBG should include postprandial monitoring to identify glycemic excursions after meals, to indicate the need for lifestyle adjustments, and to provide patient feedback on dietary choices.
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Affiliation(s)
- Jaime Davidson
- University of Texas Southwestern Medical School, Endocrine and Diabetes Associates of Texas, Dallas, Texas 75230, USA.
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Vitzthum F, Behrens F, Anderson NL, Shaw JH. Proteomics: From Basic Research to Diagnostic Application. A Review of Requirements & Needs†. J Proteome Res 2005; 4:1086-97. [PMID: 16083257 DOI: 10.1021/pr050080b] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For several years proteomics research has been expected to lead to the finding of new markers that will translate into clinical tests applicable to samples such as serum, plasma and urine: so-called in vitro diagnostics (IVDs). Attempts to implement technologies applied in proteomics, in particular protein arrays and surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF MS), as IVD instruments have initiated constructive discussions on opportunities and challenges inherent in such a translation process also with respect to the use of multi-marker profiling approaches and pattern signatures in IVD. Taking into account the role that IVD plays in health care, we describe IVD requirements and needs. Subject to stringent costs versus benefit analyses, IVD has to provide reliable information about a person's condition, prognosis or risk to suffer a disease, thus supporting decisions on treatment or prevention. It is mandatory to fulfill requirements in routine IVD, including disease prevention, diagnosis, prognosis, and treatment monitoring or follow up among others. To fulfill IVD requirements, it is essential to (1) provide diagnostic tests that allow for definite and reliable diagnosis tied to a decision on interventions (prevention, treatment, or nontreatment), (2) meet stringent performance characteristics for each analyte (in particular test accuracy, including both precision of the measurement and trueness of the measurement), and (3) provide adequate diagnostic accuracy, i.e., diagnostic sensitivity and diagnostic specificity, determined by the desired positive and negative predictive values which depend on disease frequency. The fulfillment of essential IVD requirements is mandatory in the regulated environment of modern diagnostics. Addressing IVD needs at an early stage can support a timely and effective transition of findings and developments into routine diagnosis. IVD needs reflect features that are useful in clinical practice. This helps to generate acceptance and assists the implementation process. On the basis of IVD requirements and needs, we outline potential implications for clinical proteomics focused on applied research activities.
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Affiliation(s)
- Frank Vitzthum
- Dade Behring Marburg GmbH, Emil-von-Behring-Strasse 76, PO Box 1149, 35041 Marburg, Germany.
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Affiliation(s)
- Michele Heisler
- Ann Arbor VA Center for Practice Management and Outcomes Research and the Division of General Medicine, University of Michigan Health System, Ann Arbor 48113, USA.
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