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Lee YM, Lin PR, Sia HK. Oral antidiabetic therapy versus early insulinization on glycemic control in newly diagnosed type 2 diabetes patients: a retrospective matched cohort study. Sci Rep 2024; 14:15491. [PMID: 38969701 PMCID: PMC11226661 DOI: 10.1038/s41598-024-66468-1] [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] [Received: 02/29/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Abstract
Our study aims to compare the efficacy of oral antidiabetic therapy to early insulinization on glycemic control among newly diagnosed type 2 diabetes patients in real-world clinical practice. A retrospective cohort study conducted at a medical center in Taiwan analyzed 1256 eligible patients from January 2007 to December 2017. Propensity score matching resulted in well-balanced groups of 94 patients each in the oral antidiabetic drug (OAD) and early insulinization cohorts. Glycemic outcomes were assessed in both groups. Patients exclusively using OAD showed consistently lower glycated hemoglobin (HbA1c) levels at 3, 12, 24, and 36 months compared to insulin users. At later periods, 77.7% of OAD users achieved glycemic control versus 64.9% of insulin users, with a marginally significant difference. Subgroup analyses suggested a trend favoring well-controlled diabetes in the OAD group, though not statistically significant. Our study finds oral antidiabetic therapy is not inferior to early insulinization for glycemic control in newly diagnosed type 2 diabetes patients, irrespective of initial HbA1c levels. This supports oral therapy as a rational treatment option, even in cases with elevated HbA1c at diagnosis.
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Affiliation(s)
- Yang-Ming Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
- Department of Endocrinology and Metabolism, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500, Taiwan.
| | - Pei Ru Lin
- Big Data Center, Changhua Christian Hospital, Changhua, 500, Taiwan
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, 500, Taiwan
| | - Hon-Ke Sia
- Department of Endocrinology and Metabolism, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Kassavin D, Mota L, Ostertag-Hill CA, Kassavin M, Himmelstein DU, Woolhandler S, Wang SX, Liang P, Schermerhorn ML, Vithiananthan S, Kwoun M. Amputation Rates and Associated Social Determinants of Health in the Most Populous US Counties. JAMA Surg 2024; 159:69-76. [PMID: 37910120 PMCID: PMC10620677 DOI: 10.1001/jamasurg.2023.5517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/07/2023] [Indexed: 11/03/2023]
Abstract
Importance Social Determinants of Health (SDOH) have been found to be associated with health outcome disparities in patients with peripheral artery disease (PAD). However, the association of specific components of SDOH and amputation has not been well described. Objective To evaluate whether individual components of SDOH and race are associated with amputation rates in the most populous counties of the US. Design, Setting, and Participants In this population-based cross-sectional study of the 100 most populous US counties, hospital discharge rates for lower extremity amputation in 2017 were assessed using the Healthcare Cost and Utilization Project State Inpatient Database. Those data were matched with publicly available demographic, hospital, and SDOH data. Data were analyzed July 3, 2022, to March 5, 2023. Main outcome and Measures Amputation rates were assessed across all counties. Counties were divided into quartiles based on amputation rates, and baseline characteristics were described. Unadjusted linear regression and multivariable regression analyses were performed to assess associations between county-level amputation and SDOH and demographic factors. Results Amputation discharge data were available for 76 of the 100 most populous counties in the United States. Within these counties, 15.3% were African American, 8.6% were Asian, 24.0% were Hispanic, and 49.6% were non-Hispanic White; 13.4% of patients were 65 years or older. Amputation rates varied widely, from 5.5 per 100 000 in quartile 1 to 14.5 per 100 000 in quartile 4. Residents of quartile 4 (vs 1) counties were more likely to be African American (27.0% vs 7.9%, P < .001), have diabetes (10.6% vs 7.9%, P < .001), smoke (16.5% vs 12.5%, P < .001), be unemployed (5.8% vs 4.6%, P = .01), be in poverty (15.8% vs 10.0%, P < .001), be in a single-parent household (41.9% vs 28.6%, P < .001), experience food insecurity (16.6% vs 12.9%, P = .04), or be physically inactive (23.1% vs 17.1%, P < .001). In unadjusted linear regression, higher amputation rates were associated with the prevalence of several health problems, including mental distress (β, 5.25 [95% CI, 3.66-6.85]; P < .001), diabetes (β, 1.73 [95% CI, 1.33-2.15], P < .001), and physical distress (β, 1.23 [95% CI, 0.86-1.61]; P < .001) and SDOHs, including unemployment (β, 1.16 [95% CI, 0.59-1.73]; P = .03), physical inactivity (β, 0.74 [95% CI, 0.57-0.90]; P < .001), smoking, (β, 0.69 [95% CI, 0.46-0.92]; P = .002), higher homicide rate (β, 0.61 [95% CI, 0.45-0.77]; P < .001), food insecurity (β, 0.51 [95% CI, 0.30-0.72]; P = .04), and poverty (β, 0.46 [95% CI, 0.32-0.60]; P < .001). Multivariable regression analysis found that county-level rates of physical distress (β, 0.84 [95% CI, 0.16-1.53]; P = .03), Black and White racial segregation (β, 0.12 [95% CI, 0.06-0.17]; P < .001), and population percentage of African American race (β, 0.06 [95% CI, 0.00-0.12]; P = .03) were associated with amputation rate. Conclusions and Relevance Social determinants of health provide a framework by which the associations of environmental factors with amputation rates can be quantified and potentially used to guide interventions at the local level.
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Affiliation(s)
- Daniel Kassavin
- Division of Vascular Surgery, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Lucas Mota
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Monica Kassavin
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - David U. Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- School of Urban Public Health, City University of New York at Hunter College, New York, New York
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- School of Urban Public Health, City University of New York at Hunter College, New York, New York
| | - Sophie X. Wang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marc L. Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Moon Kwoun
- Division of Vascular Surgery, Cambridge Health Alliance, Cambridge, Massachusetts
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Verbič MD, Brvar M, Kos MK. Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:195-210. [PMID: 37307369 DOI: 10.2478/acph-2023-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/14/2023]
Abstract
A non-interventional retrospective study in ambulatory patients was conducted at the emergency department of the Division of internal medicine. In 2 months, 266 suspected adverse drug reactions (ADRs) were identified in 224/3453 patients (6.5 %). In 158/3453 patients (4.6 %), an ADR was the reason for emergency department visit and in 49 patients (1.4 %), ADRs led to hospitalisation. A causality assessment algorithm was developed, which included Naranjo algorithm and levels of ADR recognition by the treating physician and the investigators. Using this algorithm, 63/266 ADRs (23.7 %) were classified as "certain", whereas using solely the Naranjo score calculation, only 19/266 ADRs (7.1 %) were assessed as "probable" or "certain", and the rest of ADRs (namely, 247/266 = 92.9 %) were assessed as "possible". There were 116/266 (43.6 %) ADRs related to potential drug-drug interactions (DDIs), stated in at least one of the literature sources used. Based on the causality relationship, the rate of the clinically expressed DDIs was 19.0 %, or 12/63 "certain" ADR cases. Of these, 10 cases presented serious DDI-related ADRs. In summary, ADR causality assessment based exclusively on Naranjo algorithm demonstrated low sensitivity at an ambulatory emergency setting. Additional clinical judgment, including the opinion of the treating physician, proved necessary to avoid under-rating of the causality relationship, and enabled the determination of clinically expressed DDIs.
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Affiliation(s)
- Matej Dobravc Verbič
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
| | - Miran Brvar
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 2University of Ljubljana, Faculty of Medicine, Centre for Clinical Physiology Ljubljana, Slovenia
| | - Mojca Kerec Kos
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
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Mantri N, Lu M, Zaroff JG, Risch N, Hoffmann T, Oni-Orisan A, Lee C, Iribarren C. Torsade de pointes: A nested case-control study in an integrated healthcare delivery system. Ann Noninvasive Electrocardiol 2021; 27:e12888. [PMID: 34547155 PMCID: PMC8739596 DOI: 10.1111/anec.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background TdP is a form of polymorphic ventricular tachycardia which develops in the setting of a prolonged QT interval. There are limited data describing risk factors, treatment, and outcomes of this potentially fatal arrhythmia. Objective Our goals were as follows: (1) to validate cases presenting with Torsade de Pointes (TdP), (2) to identify modifiable risk factors, and (3) to describe the management strategies used for TdP and its prognosis in a real‐world healthcare setting. Methods Case–control study (with 2:1 matching on age, sex, and race/ethnicity) nested within the Genetic Epidemiology Research on Aging (GERA) cohort. Follow‐up of the cohort for case ascertainment was between January 01, 2005 and December 31, 2018. Results A total of 56 cases of TdP were confirmed (incidence rate = 3.6 per 100,000 persons/years). The average (SD) age of the TdP cases was 74 (13) years, 55 percent were female, and 16 percent were non‐white. The independent predictors of TdP were potassium concentration <3.6 mEq/L (OR = 10.6), prior history of atrial fibrillation/flutter (OR = 6.2), QTc >480 ms (OR = 4.4) and prior history of coronary artery disease (OR = 2.6). Exposure to furosemide and amiodarone was significantly greater in cases than in controls. The most common treatment for TdP was IV magnesium (78.6%) and IV potassium repletion (73.2%). The in‐hospital and 1‐year mortality rates for TdP cases were 10.7% and 25.0% percent, respectively. Conclusions These findings may inform quantitative multivariate risk indices for the prediction of TdP and could guide practitioners on which patients may qualify for continuous ECG monitoring and/or electrolyte replacement therapy.
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Affiliation(s)
- Neha Mantri
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Meng Lu
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Jonathan G Zaroff
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Neil Risch
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas Hoffmann
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Akinyemi Oni-Orisan
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente, Oakland, CA, USA
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The benefits of daily exercise on blood glucose levels and affect among adults with type 1 diabetes. J Behav Med 2020; 43:1056-1061. [PMID: 32385784 DOI: 10.1007/s10865-020-00158-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to investigate the concurrent and lagged effects of daily exercise on daily blood glucose level and affect among persons with type 1 diabetes (T1D). 199 persons with T1D (Mage = 46.82) completed a 14-day diary in which they reported on their engagement in moderate to vigorous exercise for 30 min and positive and negative affect. Daily blood glucose (BG) was gathered through study-provided glucometers. Multilevel modeling examined the effects of daily variability in (within-person effects) and average levels of (between-person effects) daily exercise on BG and affect. On days when persons with T1D reported they exercised moderately to vigorously for 30 min, they had lower mean BG, higher risk for low BG, lower negative affect, and higher positive affect on the same day as well as lower mean BG on the following day. Engaging in daily exercise is important in managing daily blood glucose and affect among persons with T1D, but can be complicated by hypoglycemia.
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Joo EY, Lee JE, Kang HS, Park SG, Hong YH, Shin YL, Sohn M. Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes. Diabetes Metab J 2018; 42:480-487. [PMID: 30113142 PMCID: PMC6300445 DOI: 10.4093/dmj.2018.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control. METHODS Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires. RESULTS Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039). CONCLUSION Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.
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Affiliation(s)
- Eun Young Joo
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Ji Eun Lee
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.
| | - Hee Sook Kang
- Diabetes Endocrinology Center, Inha University School of Medicine, Incheon, Korea
| | - Shin Goo Park
- Department of Occupational & Evironmental Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Young Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Min Sohn
- Department of Nursing, Inha University College of Medicine, Incheon, Korea
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Raoufi AM, Tang X, Jing Z, Zhang X, Xu Q, Zhou C. Blood Glucose Monitoring and Its Determinants in Diabetic Patients: A Cross-Sectional Study in Shandong, China. Diabetes Ther 2018; 9:2055-2066. [PMID: 30206902 PMCID: PMC6167299 DOI: 10.1007/s13300-018-0499-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The aim of this study was to explore the status of blood glucose monitoring and its determinants in diabetic patients in Shandong Province, China. METHODS This was a cross-sectional survey conducted from 31 August to 12 October 12, in Shandong Province. A multi-stage stratified cluster sampling method was used to select participants. A total of 2183 diabetic patients were included in the analysis. Frequencies and proportions were used to describe the data, and multiple binary logistic regressions were performed to determine factors associated with blood glucose monitoring. RESULTS Of the participants, 51.4% tested their blood glucose level more than once a month. The multivariate logistic regression model showed that seven variables were significantly associated with the frequency of blood glucose monitoring: education level, residence, household income, self-reported health, physical examination, anti-diabetic drug or insulin injection, and comorbidity. CONCLUSIONS The level of blood glucose monitoring among diabetic patients in Shandong Province is low. Based on these results we recommend that the cost of blood glucose monitoring by professionals in laboratories be reimbursed or at least reduced and that diabetic patients be encouraged to undergo regular physical examinations.
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Affiliation(s)
| | - Xue Tang
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Zhengyue Jing
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Xinyi Zhang
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Qiongqiong Xu
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Chengchao Zhou
- School of Public Health, Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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Nagase S, Kohguchi K, Tohyama K, Watanabe M, Iwatani Y. Interference by pralidoxime (PAM) salts in clinical laboratory tests. Clin Chim Acta 2012. [PMID: 23195028 DOI: 10.1016/j.cca.2012.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Drugs sometimes alter the results of clinical laboratory tests. We examined the effects of pralidoxime (PAM) salts, a medicine used to treat organophosphorus poisoning, on clinical laboratory test results for the first time. METHODS The effects of PAM salts on glucose (GLU) measurements were examined using a point-of-care testing (POCT) meter, four self-monitoring of blood glucose (SMBG) meters, and two biochemical autoanalyzers. The effects of PAM salts on other clinical tests were also evaluated. RESULTS The addition of PAM iodide or potassium iodide, but not of PAM chloride or potassium chloride, to blood samples increased the GLU values measured by one POCT meter and 4 SMBG meters using the enzyme electrode (hydrogen peroxidase or oxygen electrode) method. On the other hand, PAM iodide or PAM chloride, but not KI or KCl, affected the values measured at 340 nm by an autoanalyzer using absorption spectrophotometry in 8 of 14 clinical laboratory tests. The absorption spectrum of PAM changed from 294 to 338 nm due to the reaction between PAM and the alkaline buffer, a component of the measuring reagents. CONCLUSIONS PAM iodide increases the GLU values measured by the enzyme electrode method, and PAM salts affected the values measured at 340 nm by absorption spectrophotometry in many other clinical test items.
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Affiliation(s)
- Sumika Nagase
- Department of Biomedical Informatics, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Yeaw J, Lee WC, Wolden ML, Christensen T, Groleau D. Cost of Self-Monitoring of Blood Glucose in Canada among Patients on an Insulin Regimen for Diabetes. Diabetes Ther 2012; 3:7. [PMID: 22736405 PMCID: PMC3508114 DOI: 10.1007/s13300-012-0007-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION People with diabetes are at a higher risk of developing a variety of medical conditions relative to those without diabetes, resulting in increased healthcare costs. Self-monitoring of blood glucose (SMBG) is accepted as a recommended element of effective diabetes self-management. However, little is known about the real-world frequency and actual expenditures associated with SMBG, as well as the impact of SMBG costs relative to the cost of diabetes treatments. The primary objective is to evaluate the real-world utilization and costs of SMBG tests in Canada among insulin-treated diabetes patients during a 12-month follow-up period. METHODS A retrospective cohort study was conducted using the IMS Brogan Inc. Drug Plan database from July 1, 2006 through June 30, 2010. Total costs during the 12-month follow-up period were assessed, focusing on blood glucose (BG) testing strip costs, insulin therapy costs, and costs associated with oral antidiabetics medications. All prevalent patients with two or more prescriptions for insulin between January 1, 2007 and December 31, 2009 were initially included in the analysis, the first prescription serving as their index date. Depending on the insulin type(s) used, patients were subcategorized into one of four insulin regimen groups (basal, bolus, premix, or basal-bolus). RESULTS Among an initial sample of patients with two or more claims for insulin between January 1, 2007 and December 31, 2009, 142,551 met the aforementioned inclusion and exclusion criteria. An overall mean utilization of pharmacy-based blood glucose testing of approximately 1,094 strips per person per year was observed, with an average cost per testing strip of Canadian $0.79. SMBG treatment costs for insulin users ($860), specifically those associated with prescription testing strips, totaled 41.6% of the average annual pharmacy costs of diabetes-related prescriptions ($2,068). CONCLUSION This study shows that SMBG accounts for approximately 40% of the total diabetes-related pharmacy costs for insulin users.
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Affiliation(s)
- Jason Yeaw
- IMS Consulting Group, 3 Lagoon Drive, Suite 230, Redwood City, CA, 94065, USA,
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Gomes T, Juurlink DN, Shah BR, Paterson JM, Mamdani MM. Blood glucose test strips: options to reduce usage. CMAJ 2010; 182:35-8. [PMID: 20026624 PMCID: PMC2802602 DOI: 10.1503/cmaj.091017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recent evidence suggests that, despite widespread use, self-monitoring of blood glucose levels has little clinical benefit in many patients with diabetes. The impact of more focused public-payer policies for the use of blood glucose test strips may be substantial. METHODS We conducted a cross-sectional analysis of annual prescription claims for test strips between 1997 and 2008 for patients in Ontario aged 65 and older with diabetes. Patients were stratified into 1 of 4 hierarchical groups according to the most intensive glucose-lowering treatment received during each calendar year. Test strip use was calculated annually for each group over the study period, and the effects of 5 hypothetical policy scenarios of more selective test strip use were assessed. RESULTS Test strip use increased by almost 250% from 1997 to 2008, with 52.6% (n = 263,513) of included patients receiving a prescription during 2008. Almost half of these patients were at low risk for drug-induced hypoglycemia. In 2008, over 117 million test strips were dispensed in Ontario; however, more focused policy scenarios could have reduced this number by between 9.5 million and 74.5 million test strips. INTERPRETATION Many people who self-monitor their blood glucose are at relatively low risk for drug-induced hypoglycemia. The economic benefits associated with more selective testing could be redirected to more effective interventions for patients with diabetes.
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Affiliation(s)
- Tara Gomes
- From the Department of Medicine (Juurlink, Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.; St. Michael’s Hospital (Mamdani) Toronto, Ont.; the Departments of Medicine (Mamdani, Juurlink, Shah), Pediatrics (Juurlink), and Health Policy, Management, and Evaluation (Mamdani, Juurlink, Shah), University of Toronto, Toronto, Ont.; the Institute for Clinical Evaluative Sciences (Gomes, Mamdani, Juurlink, Paterson, Shah), Toronto, Ont.; the Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; and the Centre for Evaluation of Medicines (Paterson), St. Joseph’s Healthcare; Hamilton, Ont
| | - David N. Juurlink
- From the Department of Medicine (Juurlink, Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.; St. Michael’s Hospital (Mamdani) Toronto, Ont.; the Departments of Medicine (Mamdani, Juurlink, Shah), Pediatrics (Juurlink), and Health Policy, Management, and Evaluation (Mamdani, Juurlink, Shah), University of Toronto, Toronto, Ont.; the Institute for Clinical Evaluative Sciences (Gomes, Mamdani, Juurlink, Paterson, Shah), Toronto, Ont.; the Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; and the Centre for Evaluation of Medicines (Paterson), St. Joseph’s Healthcare; Hamilton, Ont
| | - Baiju R. Shah
- From the Department of Medicine (Juurlink, Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.; St. Michael’s Hospital (Mamdani) Toronto, Ont.; the Departments of Medicine (Mamdani, Juurlink, Shah), Pediatrics (Juurlink), and Health Policy, Management, and Evaluation (Mamdani, Juurlink, Shah), University of Toronto, Toronto, Ont.; the Institute for Clinical Evaluative Sciences (Gomes, Mamdani, Juurlink, Paterson, Shah), Toronto, Ont.; the Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; and the Centre for Evaluation of Medicines (Paterson), St. Joseph’s Healthcare; Hamilton, Ont
| | - J. Michael Paterson
- From the Department of Medicine (Juurlink, Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.; St. Michael’s Hospital (Mamdani) Toronto, Ont.; the Departments of Medicine (Mamdani, Juurlink, Shah), Pediatrics (Juurlink), and Health Policy, Management, and Evaluation (Mamdani, Juurlink, Shah), University of Toronto, Toronto, Ont.; the Institute for Clinical Evaluative Sciences (Gomes, Mamdani, Juurlink, Paterson, Shah), Toronto, Ont.; the Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; and the Centre for Evaluation of Medicines (Paterson), St. Joseph’s Healthcare; Hamilton, Ont
| | - Muhammad M. Mamdani
- From the Department of Medicine (Juurlink, Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.; St. Michael’s Hospital (Mamdani) Toronto, Ont.; the Departments of Medicine (Mamdani, Juurlink, Shah), Pediatrics (Juurlink), and Health Policy, Management, and Evaluation (Mamdani, Juurlink, Shah), University of Toronto, Toronto, Ont.; the Institute for Clinical Evaluative Sciences (Gomes, Mamdani, Juurlink, Paterson, Shah), Toronto, Ont.; the Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; and the Centre for Evaluation of Medicines (Paterson), St. Joseph’s Healthcare; Hamilton, Ont
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Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301:1565-72. [PMID: 19366776 PMCID: PMC2782622 DOI: 10.1001/jama.2009.460] [Citation(s) in RCA: 709] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Although acute hypoglycemia may be associated with cognitive impairment in children with type 1 diabetes, no studies to date have evaluated whether hypoglycemia is a risk factor for dementia in older patients with type 2 diabetes. OBJECTIVE To determine if hypoglycemic episodes severe enough to require hospitalization are associated with an increased risk of dementia in a population of older patients with type 2 diabetes followed up for 27 years. DESIGN, SETTING, AND PATIENTS A longitudinal cohort study from 1980-2007 of 16,667 patients with a mean age of 65 years and type 2 diabetes who are members of an integrated health care delivery system in northern California. MAIN OUTCOME MEASURE Hypoglycemic events from 1980-2002 were collected and reviewed using hospital discharge and emergency department diagnoses. Cohort members with no prior diagnoses of dementia, mild cognitive impairment, or general memory complaints as of January 1, 2003, were followed up for a dementia diagnosis through January 15, 2007. Dementia risk was examined using Cox proportional hazard regression models, adjusted for age, sex, race/ethnicity, education, body mass index, duration of diabetes, 7-year mean glycated hemoglobin, diabetes treatment, duration of insulin use, hyperlipidemia, hypertension, cardiovascular disease, stroke, transient cerebral ischemia, and end-stage renal disease. RESULTS At least 1 episode of hypoglycemia was diagnosed in 1465 patients (8.8%) and dementia was diagnosed in 1822 patients (11%) during follow-up; 250 patients had both dementia and at least 1 episode of hypoglycemia (16.95%). Compared with patients with no hypoglycemia, patients with single or multiple episodes had a graded increase in risk with fully adjusted hazard ratios (HRs): for 1 episode (HR, 1.26; 95% confidence interval [CI], 1.10-1.49); 2 episodes (HR, 1.80; 95% CI, 1.37-2.36); and 3 or more episodes (HR, 1.94; 95% CI, 1.42-2.64). The attributable risk of dementia between individuals with and without a history of hypoglycemia was 2.39% per year (95% CI, 1.72%-3.01%). Results were not attenuated when medical utilization rates, length of health plan membership, or time since initial diabetes diagnosis were added to the model. When examining emergency department admissions for hypoglycemia for association with risk of dementia (535 episodes), results were similar (compared with patients with 0 episodes) with fully adjusted HRs: for 1 episode (HR, 1.42; 95% CI, 1.12-1.78) and for 2 or more episodes (HR, 2.36; 95% CI, 1.57-3.55). CONCLUSIONS Among older patients with type 2 diabetes, a history of severe hypoglycemic episodes was associated with a greater risk of dementia. Whether minor hypoglycemic episodes increase risk of dementia is unknown.
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Affiliation(s)
- Rachel A Whitmer
- Kaiser Permanente, Division of Research, Section of Etiology and Prevention, 2000 Broadway, Oakland, CA 94612, USA.
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Skeie S, Kristensen GBB, Carlsen S, Sandberg S. Self-monitoring of blood glucose in type 1 diabetes patients with insufficient metabolic control: focused self-monitoring of blood glucose intervention can lower glycated hemoglobin A1C. J Diabetes Sci Technol 2009; 3:83-8. [PMID: 20046652 PMCID: PMC2769849 DOI: 10.1177/193229680900300109] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Little attention has been given and few studies have been published focusing on how to optimize self-monitoring of blood glucose (SMBG) use to monitor daily therapy for persons with type 1 diabetes mellitus. This study was designed to evaluate the effect on glycated hemoglobin (A1C) of a structured intervention focused on SMBG in type 1 diabetes patients with insufficient metabolic control (A1C ≥8%) using a randomized clinical trial design. METHOD One hundred fifty-nine outpatients with type 1 diabetes on multiple injection therapy with insulin and A1C ≥8% were recruited and randomized to one group receiving a focused, structured 9-month SMBG intervention (n=59) and another group receiving regular care based on guidelines (n=64). RESULTS Glycated hemoglobin values (mean % ± standard deviation) at study start was similar: 8.65 ± 0.10 in the intervention group and 8.61 ± 0.09 in the control group. The two groups were comparable (age, gender, body mass index, complication rate, and treatment modality) at study start and had mean diabetes duration and SMBG experience of 19 and 20 years, respectively. At study end, there was decrease in A1C in the intervention group (p<.05), and the A1C was 0.6% lower compared with the control group (p<.05). No increase in the number of minor or major hypoglycemia episodes was observed in the intervention group during the study period. CONCLUSIONS A simple, structured, focused SMBG intervention improved metabolic control in patients with longstanding diabetes type 1 and A1C ≥8%. The intervention was based on general recommendations, realistic in format, and can be applied in a regular outpatient setting.
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Affiliation(s)
- Svein Skeie
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
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Hirsch IB, Bode BW, Childs BP, Close KL, Fisher WA, Gavin JR, Ginsberg BH, Raine CH, Verderese CA. Self-Monitoring of Blood Glucose (SMBG) in insulin- and non-insulin-using adults with diabetes: consensus recommendations for improving SMBG accuracy, utilization, and research. Diabetes Technol Ther 2008; 10:419-39. [PMID: 18937550 DOI: 10.1089/dia.2008.0104] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Current clinical guidelines for diabetes care encourage self-monitoring of blood glucose (SMBG) to improve glycemic control. Specific protocols remain variable, however, particularly among non-insulin-using patients. This is due in part to efficacy studies that neglect to consider (1) the performance of monitoring equipment under real-world conditions, (2) whether or how patients have been taught to take action on test results, and (3) the physiological, behavioral, and social circumstances in which SMBG is carried out. As such, a multidisciplinary group of specialists, including several endocrinologists, a health psychologist, a diabetes nurse practitioner, and a patient advocate (the Panel), discuss within this review article how the potential of SMBG might be fully realized in today's healthcare environment. The resulting recommendations cover technological, clinical, behavioral, and research considerations with the aim of achieving short- and long-term benefits, ranging from fewer hypoglycemic episodes to lower complication-related costs. The panel also made suggestions for designing future studies that increase the ability to discern optimal models of SMBG utilization for individuals with diabetes who may, or may not, use insulin.
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Affiliation(s)
- Irl B Hirsch
- Department of Medicine, University of Washington Medical Center-Roosevelt, Seattle, Washington 98105, USA.
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Revisión integral del tratamiento de la diabetes tipo 2 en atención primaria. Aspectos higienicodietéticos, educacionales y farmacológicos. ENFERMERIA CLINICA 2008; 18:41-5. [DOI: 10.1016/s1130-8621(08)70692-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Many people with diabetes are falling short of attaining or maintaining glycemic goals. Self-monitoring of blood glucose (SMBG) is among the many strategies proposed to address the problem. SMBG complements hemoglobin A1c (HbA1c) testing by providing specific information regarding the effects of diet, exercise, and medications on glycemia. Although the importance of self-monitoring is appreciated for insulin-using patients, evidence is still emerging in support of self-monitoring for patients with type 2 diabetes managed with oral agents or diet. Evaluating the available evidence requires a good understanding of the study design and methodology. Although several clinical trials involving SMBG have been insufficiently powered to detect clinically meaningful differences in HbA1c, recent meta-analyses have reproducibly supported the benefit of self-monitoring in non-insulin-treated patients. Although additional work is needed to establish optimal frequency and timing of SMBG, these studies can serve as a basis for conservative recommendations to guide patients and their healthcare providers.
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Affiliation(s)
- Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Section on Endocrinology, Diabetes and Metabolic Diseases, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
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