A1c Testing Research Articles

Comorbidity Management in Black Women Diagnosed with Breast Cancer: the Role of Primary Care in Shared Care.

Black women are more likely to have comorbidity at breast cancer diagnosis compared with White women, which may account for half of the Black-White survivor disparity. Comprehensive disease management requires a coordinated team of healthcare professionals including primary care practitioners, but few studies have examined shared care in the management of comorbidities during cancer care, especially among racial/ethnic minorities. To examine whether the type of medical team composition is associated with optimal clinical care management of comorbidities. We used the Women's Circle of Health Follow-up Study, a population-based cohort of Black women diagnosed with breast cancer. The likelihood of receiving optimal comorbidity management after breast cancer diagnosis was compared by type of medical team composition (shared care versus cancer specialists only) using binomial regression. Black women with a co-diagnosis of diabetes and/or hypertension at breast cancer diagnosis between 2012 and 2016 (N = 274). Outcome-optimal clinical care management of diabetes (i.e., A1C test, LDL-C test, and medical attention for nephropathy) and hypertension (i.e., lipid screening and prescription for hypertension medication). Main predictor-shared care, whether the patient received care from both a cancer specialist and a primary care provider and/or a medical specialist within the 12months following a breast cancer diagnosis. Primary care providers were the main providers involved in managing comorbidities and 90% of patients received shared care during breast cancer care. Only 54% had optimal comorbidity management. Patients with shared care were five times (aRR: 4.62; 95% CI: 1.66, 12.84) more likely to have optimal comorbidity management compared with patients who only saw cancer specialists. Suboptimal management of comorbidities during breast cancer care exists for Black women. However, our findings suggest that shared care is more beneficial at achieving optimal clinical care management for diabetes and hypertension than cancer specialists alone.

The Value of Laboratory Information Augmenting a Managed Care Organization's Comprehensive Diabetes Care Efforts in New Mexico.

The National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set on Comprehensive Diabetes Care requires patients with diabetes obtain a hemoglobin A1c (Hb A1c) and urine albumin-to-creatinine ratio (ACR) test every year. To improve these measures, managed care organizations (MCOs) rely on claim and prescription data to identify members for care management. TriCore Reference Laboratories collaborated with Blue Cross Blue Shield of New Mexico (BCBSNM) to determine if laboratory information would augment BCBSNM's diabetes care management services. In January 2018, BCBSNM provided its Medicaid enrollment file to TriCore for identifying members and determining their diabetes status by evaluating their recent Hb A1c results. Of the 6,138 members with diabetes, a random sample of 600 was extracted, and half were provided to BCBSNM to perform care management from January 18 to May 1, 2018. Completion of Hb A1c and ACR were measured. Significantly more (P = 0.03) study group members (25%) than control group members (18%) received an Hb A1c test. The study group (14%) also received more ACR tests than the control group (9%; P = 0.07). We then calculated the monetary penalty to which New Mexico Medicaid MCOs are subject, leading to the identification of additional value ($3,693,000) that clinical laboratories provide beyond the cost per test. Clinical laboratories play a critical role in healthcare, and this article demonstrates an approach for laboratories to collaborate with MCOs in their care management efforts. In addition, we calculate the value of this novel collaboration, which may play an integral role in laboratories' pursuit of value-based care.

Trends and socioeconomic disparities in diabetes prevalence and quality of care among Israeli children; 2011-2018

BackgroundDespite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time.MethodsWe used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2–17 years in 2011–2018 (2018: N = 2,404,856). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). We used logistic regression to assess the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1c > 9%), and assessed whether these changed over time.ResultsDiabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67–3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40–0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18–0.34). Disparities were especially apparent among children aged 2–9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018.ConclusionsWhile poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.

Influence of sexual orientation on diabetes management in US adults with diabetes

AimAlthough the risk of developing diabetes is high among US sexual minorities (SM) (lesbian, gay, bisexual), little is known about diabetes management in this population. We examined the impact of sexual orientation on current US diabetes management levels in a geographically diverse sample of people with diabetes (PWD). MethodAdult PWDs were identified from the 2015–2018 cross-sectional Behavioural Risk Factor Surveillance System surveys. We determined the unadjusted percentage and the adjusted odds ratios (OR) of noncompliance with American Diabetes Association (ADA) diabetes management measures (< 1 eye exam annually, < 1 foot exam annually, < 1 blood glucose check daily, < 2 A1C tests annually, no receipt of annual flu vaccination, never receiving pneumococcal vaccination, never taking a diabetes management course) in PWDs by SM status. ResultsUnadjusted analyses revealed a high level of noncompliance with diabetes management among SMs and especially for annual flu vaccination (40.1–52.3%) and diabetes management education (38.4–48.4%). Compared to heterosexuals, lesbian women were more noncompliant for most and bisexual men and bisexual women for all diabetes management measures. We observed that SMs had slightly higher adjusted levels of noncompliance than heterosexuals only for annual foot exams (OR: 1.09, 95% confidence interval (CI): 0.81–1.46) and diabetes management education (OR: 1.06, 95% CI: 0.81–1.41). ConclusionsHigh levels of noncompliance with ADA diabetes management guidelines in SM PWDs indicates a need for additional efforts to elucidate the factors that contribute to noncompliance in SMs, information that can be used to develop appropriate interventions to improve diabetes management for this population.

User Engagement Among Diverse Adults in a 12-Month Text Message-Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial.

BackgroundText message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited.ObjectiveThe aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement.MethodsWe recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency.ResultsThe participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income <US $25,000. The median response rate to interactive texts was 91% (IQR 75%-97%) over 12 months. Engagement gradually declined throughout the intervention but remained high. Engagement did not differ by age, gender, education, income, diabetes duration, insulin status, health literacy, or numeracy. Black race and worse baseline medication adherence and HbA1c were each associated with lower engagement, although the effects were small. Nearly half of the participants chose to continue receiving daily texts for the last 6 months of the intervention. Participants who continued daily text messages said they wanted to continue experiencing benefits to their health, whereas those who chose fewer texts said that the daily texts had helped them create routines and they no longer needed them as often. Engagement was not impacted by receiving coaching or by participants’ chosen text frequency.ConclusionsWell-designed interactive text messages can engage diverse patients in a self-care intervention for at least 1 year. Variation in and reasons for frequency preference suggest that offering a frequency choice may be important to users’ engagement.

Limited Agreement between Classifications of Diabetes and Prediabetes Resulting from the OGTT, Hemoglobin A1c, and Fasting Glucose Tests in 7412 U.S. Adults

This investigation was designed to determine the degree of concordance resulting from tests of fasting plasma glucose (FPG) and hemoglobin A1c (A1c) compared to the oral glucose tolerance test (OGTT) for detecting prediabetes and diabetes in undiagnosed adults. Another objective was to measure concordance within subsamples of women and men, and within three age groups. Lastly, the value of combining the FPG and A1c for detecting diabetes was compared to the OGTT. A total of 7412 randomly selected adults from the National Health and Nutrition Examination Survey (NHANES) were included. With outcomes classified as normal, prediabetes, or diabetes, according to standard guidelines, overall test agreements were low. With an OGTT diagnosis of diabetes, concordance was only 34% for the A1c assessment and 44% for the FPG assay. Delimited to older adults, agreement between the OGTT and A1c was only 25%, and between the OGTT and FPG, concordance was only 33.5%. Given the large percentage of discordant results associated with the FPG and A1c, clinicians should be cautious about employing these tests as lone assessments. Using both the FPG and A1c helped with accurately diagnosing diabetes and normal glycemia, but not prediabetes. The OGTT is a good choice to reduce misdiagnosis.

Interaction between sex and rurality on the prevalence of diabetes in Guyana: a nationally representative study

IntroductionDiabetes prevalence has never been measured in Guyana. We conducted a nationally representative cross-sectional study to estimate the prevalence of diabetes and pre-diabetes, and the association between sex and diabetes.Research...

The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies.

Gestational diabetes mellitus (GDM) is associated with adverse pregnancy complications. Accurate screening and diagnosis of gestational diabetes are critical to treatment, and in a pandemic scenario like coronavirus disease 2019 needing a simple test that minimises prolonged hospital stay. We undertook a meta-analysis on the screening and diagnostic accuracy of the haemoglobin A1c (HbA1c) test in women with and without risk factors for gestational diabetes. Unlike the oral glucose tolerance test, the HbA1c test is simple, quick and more acceptable. There is a growing body of evidence on the accuracy of HbA1c as a screening and diagnostic test for GDM. We searched Medline, Embase and Cochrane Library and selected relevant studies. Accuracy data for different thresholds within the final 23 included studies (16 921 women) were pooled using a multiple thresholds model. Summary accuracy indices were estimated by selecting an optimal threshold that optimises either sensitivity or specificity according to different scenarios. HbA1c is more useful as a specific test at a cut-off of 5.7% (39 mmol/mol) with a false positive rate of 10%, but should be supplemented by a more sensitive test to detect women with GDM.

Feasibility of neonatal haemoglobin A1C as a biomarker for retinopathy of prematurity

Introduction Retinopathy of prematurity (ROP) is a potentially serious eye disorder affecting very preterm infants. Non-proliferative ROP (NP-ROP), also known as Early Stage ROP, is characterized by deficient retinal angiogenesis. Proliferative ROP (P-ROP), also known as Late Stage ROP, is characterized by pathologic angiogenesis. The use of neonatal haemoglobin A1C as a biomarker for ROP has not yet been evaluated. Materials and methods We modified the Haemoglobin A1C assay for use with neonatal dried blood spots (DBS) and then assessed A1C levels via Elisa immunoassay on DBS from 43 preterm infants (with gestational ages 26–28 weeks). We measured A1C on DBS collected at <1 week and 4 weeks of chronological age. Results Compared to matched counterparts without ROP, there is significantly lower HbA1c in infants who develop NP-ROP, this occurs at Week 4 (p=0.004), but is not seen at Week 1; there is significantly higher HbA1c in infants with P-ROP, this occurs both at Week 1 (p<0.05) and Week 4 (p=0.005). Conclusions The A1C test, modified for use with DBS, is a feasible biomarker for ROP; low A1C is a potential biomarker for non-proliferative ROP and high A1C is for proliferative ROP.

1177-P: Impact of Proactive Strategies by a Large Self-Insured Employer on Engagement in the Diabetes Prevention Program (DPP)

Since 2015, the University of Michigan has offered the DPP at no out-of-pocket cost to its employees, dependents, and retirees with prediabetes (pDM). We assessed the yield of 3 proactive engagement strategies. In strategy A, 6,734 adults with no previous diagnosis of diabetes (DM) but with a claims diagnosis of pDM or A1c 5.7-6.4% were identified and mailed letters encouraging them to enroll in a DPP. In strategy B, 5,219 adults with no previous diagnosis of DM or pDM who were at high-risk for pDM or DM based on age, sex, and claims data on obesity, hypertension, and dyslipidemia were identified and mailed letters encouraging them to get an A1c test. In strategy C, 29,878 employees not targeted by strategies A or B were sent emails encouraging them to take an online risk test and, if positive, to get an A1c test. In general, individuals identified by strategies A and B were older, had higher BMIs, and were more likely to have cardiovascular (CV) risk factors or CV disease than those identified by strategy C. Of those targeted by strategy A, 649 (10%) enrolled in a DPP. Those who enrolled were more likely to be older, female, and to have a higher BMI than those who did not enroll. Of those targeted by strategies B and C, 1,402 (27%) and 3,768 (13%), respectively, had A1c tests or received new diagnoses of pDM or DM within 1-year of receiving the letter/email. In general, those who had A1c tests or were diagnosed with pDM or DM were more likely to be female, non-White, to have a higher BMI, and to have more CV risk factors or CV disease than those not tested or diagnosed. Of individuals tested in response to strategies B and C, 561 (40%) and 583 (15%) were diagnosed with pDM and 68 (12%) and 5 (1%) enrolled in a DPP. Together, these 3 complimentary strategies to encourage engagement in a DPP had a yield of 9% among individuals with pDM, which is substantially greater than the ∼0.0001% yield observed when passive strategies are employed, but not high enough to have a substantial impact on the population incidence of DM. Disclosure L.N. McEwen: None. K. Joiner: None. R. Bergmans: None. T.E. Hurst: None. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp &amp; Dohme Corp. Funding National Institutes of Heath (1R01DK109995)

553-P: Brain Microstructural Tissue Changes in Patients with Controlled and Uncontrolled Type 2 Diabetes

Patients with type 2 diabetes mellitus (T2DM) show brain tissue changes in mood and cognitive control sites. However, it is unclear whether brain microstructural tissue changes differ between patients with controlled (hemoglobin A1c [A1C] &amp;lt;7%) and uncontrolled (A1C ≥ 7%) T2DM. Diffusion tensor imaging (DTI) based mean diffusivity (MD) measures water molecular motion within tissue and shows microstructural changes by values reduced in acute and increased in chronic pathological conditions. Methods: We collected DTI and A1C data from 37 T2DM patients (15 controlled; age 56.4±6.8 years, BMI 29.2±6.2 kg/m2, diabetes duration 6.0±4.8 years, A1C 6.2±0.4%, 7 female; 22 uncontrolled; age 57.2±7.4 years, BMI 30.5±5.1 kg/m2, diabetes duration 15.0±9.0 years, A1C 8.2±1.3%, 14 female) and 12 healthy controls (age 54.3±8.2 years, BMI 25.9±4.6 kg/m2, A1C 5.2±0.4%, 5 male) using a 3.0-Tesla magnetic resonance imaging scanner and point-of-care A1C testing. Whole-brain MD maps were calculated, normalized to a common space, smoothed, and compared between groups (controlled T2DM patients vs. healthy controls; uncontrolled T2DM patients vs. healthy controls) using ANCOVA (SPM12; covariates, age and sex; uncorrected threshold, p&amp;lt;0.005). Results: No significant differences appeared between groups in age or sex. Mean duration of diabetes was significantly different between controlled and uncontrolled T2DM patients (p &amp;lt;0.001). Uncontrolled T2DM patients showed increased MD values in multiple brain areas, including the cingulate, insula, para-hippocampal, hippocampus, cerebellum, basal-forebrain, prefrontal, frontal, and temporal cortices over controlled T2DM patients and healthy controls. Conclusion: Uncontrolled T2DM patients show widespread chronic brain microstructural changes in areas that are involved in mood and cognition regulation. The findings support tight glycemic control to prevent further brain tissue damages in patients with T2DM. Disclosure S.E. Choi: None. B. Roy: None. M. Freeby: Research Support; Self; Abbott, Novo Nordisk Inc. M.A. Woo: None. R. Kumar: None. Funding National Institutes of Health (R01NR017190)

1630-P: Receipt of Type 1 Diabetes Care by Physician Specialty during Adolescence and Young Adulthood

For a sample of continuously-insured adolescents/young adults (AYA, ages 13-26) with T1D enrolled in a national managed care plan from 2013-2016 (16,500 person-years among 8,694 AYA), we describe frequency of medical visits, types of physicians (specialist vs. primary care; pediatric vs. adult) delivering care, and receipt of recommended diabetes monitoring tests. Over 75% of all outpatient visits for 13 year olds (yo) were to pediatric physicians, declining to 2.5% of visits for 26yo; access to specialty care declined from 82% of 13yo to 68% of 26yo. Those receiving ≥twice yearly A1c tests declined from 83% of 13yo to 60% of 26yo, while receiving annual LDL or microalbumin tests rose from 51% of 13yo to 60% of 26yo. Those not accessing specialty care were the least likely to receive recommended tests (A1c odds ratio [OR]:0.26, 95%CI:0.23-0.29; LDL OR:0.61, 95%CI:0.55-0.67; microalbumin OR:0.50, 95%CI:0.46-0.56). Those receiving the majority of care from adult specialists had lower odds of receiving recommended tests (A1c OR:0.61, 95%CI:0.54-0.69; microalbumin OR:0.90, 95%CI:0.82-0.99) compared to those receiving care from pediatric specialists. Despite continuous insurance, many AYA don’t access any specialty care and are less likely to receive routine diabetes monitoring tests as a result. There is large variation in physician types visited by AYA and measurable differences in testing by specialty type. Disclosure L.E. Wisk: None. M. Landrum: None. C. Fu: None. A. Chien: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116932 to L.E.W.); Agency for Healthcare Research and Quality (U19HS024072 to A.C.)

Community pharmacists expand point-of-care testing

Point-of-care testing (POCT) in pharmacies has grown from A1C and cholesterol screenings to testing for infectious diseases such as hepatitis C virus. POCT by pharmacists for influenza and streptococcal pharyngitis infection has been especially well received, along with the ability of pharmacists in certain states to dispense needed medications when those tests come back positive. Because of ease of access, the community pharmacy is an ideal choice to provide this service. An example of how POCT can be implemented in the community pharmacy is demonstrated by eTrueNorth. This Texas-based company has partnered with numerous community pharmacies to help expand clinical services through Clinical Laboratory Improvement Amendments (CLIA)–waived POCT, wellness screenings, and preventive health services. The cofounders—Michael McEntee, a clinical laboratory professional, and Coral May, a registered nurse with health plan experience—used their vision of leveraging the most accessible health professional, pharmacists, to provide clinical services for patients. “Pharmacists’ education, training, and clinical knowledge are invaluable assets, and when combined with patient access, makes them uniquely positioned to meet the needs of a changing health care environment,” said May. POCT assays are waived under CLIA of 1988, and pharmacists who offer POCT must register with CMS as a CLIA-waived laboratory. More than 120 tests are considered CLIA waived. “CLIA-waived POCT allows pharmacists to provide patients with clinical information on the efficacy of their medications (e.g. statins, antihypertensives) as well as screening for undiagnosed conditions,” May added. The model is twofold. The first part focuses on working with pharmacy partners to help them establish CLIA-waived laboratories within the pharmacy. The second part focuses on contracting with organizations whose employees can benefit from clinical services provided in a pharmacy setting. Establishment within the pharmacy setting requires meeting regulatory compliance with national, state, and county (in California) requirements. May noted that her company provides guidance on the application process for a CLIA Certificate of Waiver, state laboratory license (if required), laboratory director requirements, and testing personnel requirements. “CLIA-waived POCT allows pharmacists to provide patients with clinical information on the efficacy of their medications as well as screening for undiagnosed conditions.” In addition, training is provided on all aspects of waived testing, from analyzer use to quality control requirements. Pharmacists have access to support via telephone from trained laboratory professionals if a question should arise while working in the pharmacy. Numerous organizations have partnered with eTrueNorth to offer their employees an alternative site for wellness screening. It is estimated that approximately 35% of eligible employees are unable to participate in a screening offered at their employer location and seek alternative testing sites. An organization’s employees can enter their zip code on the eTrueNorth website to search for participating pharmacies in their area that provide the list of services they need, such as a lipid profile, glucose, and administration of flu shots or common vaccines. After selecting their preferred location, the patient receives a voucher with details on the location they selected and any pretest instructions. The voucher allows for convenient access and payment to a pharmacy providing services. Upon completion and documentation of the services, eTrueNorth bills the organization and reimburses the pharmacy partner for services provided. This model eliminates many of a pharmacy’s billing and reimbursement challenges. In the second half of 2020, eTrueNoth expects to launch programs to health plan members who have gaps in their recommendations for evidence-based care. For example, a plan member who has diabetes may not have had an A1C test to monitor their glycemic control or may need to have a dilated retinal exam to screen for retinopathy. “Working with the health plan and pharmacy partners, we’re able to catch the patient at the pharmacy counter and provide services to meet their needs,” said May. By working with the payer, the plan can improve the patient’s quality scores, provide the patient’s physician with information for clinical follow-up, and strengthen the role of the pharmacist as a critical member of the health care team. Expanded clinical services in the retail setting allow conversations between pharmacists and patients to be further enhanced by focusing on all aspects of health, from preventive medicine to medication adherence to improved clinical outcomes.

How self-stigma affects patient activation in persons with type 2 diabetes: a cross-sectional study

ObjectivesSelf-stigma is associated with lower patient activation levels for self-care in persons with type 2 diabetes mellitus (T2DM). However, the causal pathway linking self-stigma with patient activation for self-care has...

Prevalence of sarcopenia in sample of Iraqi patients with type 2 diabetes mellitus: A hospital based study

Background and aimsDamage to the skeletal muscles, with a pronounced and accelerated decline in muscle quality have been described as a new complication of diabetic patients, so this study was conducted to assess the prevalence of sarcopenia in sample of Iraqi patients with type 2 diabetes mellitus. MethodsThis was a case-control study conducted at Baghdad Teaching Hospital from September 2018 to April 2019. Participants were men and women aged between (40–70) years with type 2 diabetes mellitus diagnosed by an Internist/Endocrinologist doctor and on treatment for at least 6 months earlier. Sixty-five patients and 65 matched healthy controls in age, gender and body mass index were studied. Diagnosis of sarcopenia was done according to revised European consensus on the definition and diagnosis of sarcopenia 2018. Glycemic control was evaluated by mean of hemoglobin A1c (HbA1c) test. ResultsThe mean age of the patients was 57.0 ± 7.7 years, and mean disease duration was 7.2 ± 6.0 years. The prevalence of sarcopenia was 10 (15.4%) in diabetic patients and 5 (7.7%) in controls while the prevalence of presarcopenia was 7 (10.8%) in diabetic patients and 3 (4.6%) in controls (p-value = 0.133).: The mean age of the patients was 57.0 ± 7.7 years, and mean disease duration was 7.2 ± 6.0 years. The prevalence of sarcopenia was 10 (15.4%) in diabetic patients and 5 (7.7%) in controls while the prevalence of presarcopenia was 7 (10.8%) in diabetic patients and 3 (4.6%) in controls (p-value = 0.133). ConclusionsPatients with type 2 diabetes mellitus had a higher prevalence of sarcopenia compared with healthy controls although statistically was not significant.

Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults.

BackgroundThe burden of diabetes is increasing in sub-Saharan Africa, including among people living with HIV. We assessed the prevalence of diabetes and the roles of HIV, antiretroviral therapy (ART) and traditional risk factors among adults in Tanzania.MethodsWe analysed diabetes-relevant baseline data from 1,947 adult participants in the CICADA study in Mwanza, Tanzania: 655 HIV-uninfected, 956 HIV-infected ART-naïve, and 336 HIV-infected persons on ART. WHO guidelines for haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were used to define diabetes and prediabetes. Risk factors were evaluated using multinomial logistic regression analysis. Relative risk ratios (RRR) were generated comparing participants with diabetes and prediabetes against the reference of those with no diabetes.ResultsMean age was 41 (SD 12) years; 59% were women. The prevalence of diabetes was 13% by HbA1c and 6% by OGTT, with partial overlap among participants identified by the two tests. Relative to HIV-uninfected, HIV-infected ART-naïve persons had increased relative risks of diabetes (HbA1c: RRR = 1.95, 95% CI 1.25–3.03; OGTT: RRR = 1.90, 95% CI 0.96–3.73) and prediabetes (HbA1c: RRR = 2.89, 95% CI 1.93–4.34; OGTT: RRR = 1.61, 95% CI 1.22–2.13). HIV-infected participants on ART showed increased risk of prediabetes (RRR 1.80, 95% CI 1.09, 2.94) by HbA1c, but not diabetes. CD4 count < 200 cell/μL at recruitment increased risk and physical activity decreased risk of diabetes by both HbA1c and OGTT.ConclusionsThe prevalence of diabetes was high, especially among HIV-infected ART-naïve adults. Being more physically active was associated with lower risk of diabetes. HbA1c and OGTT identified different participants as having diabetes or prediabetes. Overall, the finding of high burden of diabetes among HIV-infected persons suggests that health systems should consider integrating diabetes screening and treatment in HIV clinics to optimize the care of HIV patients and improve their health outcomes.

Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners' offices are associated with better glycemic control in type 2 diabetes.

Background It is not clear if point-of-care (POC) testing for hemoglobin A1c (HbA1c) is associated with glycemic control in type 2 diabetes. Methods In this cross-sectional study, we linked general practitioner (GP) data on 22,778 Norwegian type 2 diabetes patients to data from the Norwegian Organization for Quality Improvement of Laboratory Examinations. We used general and generalized linear mixed models to investigate if GP offices' availability (yes/no) and analytical quality of HbA1c POC testing (average yearly "trueness score", 0-4), as well as frequency of participation in HbA1c external quality assurance (EQA) surveys, were associated with patients' HbA1c levels during 2014-2017. Results Twenty-eight out of 393 GP offices (7%) did not perform HbA1c POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA1c levels (95% confidence interval (0.04-0.27) (1.7 mmol/mol [0.5-2.9]). GP offices participating in one or two yearly HbA1c EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA1c levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices' HbA1c POC analytical trueness score, the patients' HbA1c levels were lower by 0.04% HbA1c (-0.09, -0.001) (-0.5 mmol/mol [-1.0, -0.01]). Conclusions Novel use of validated patient data in combination with laboratory EQA data showed that patients consulting GPs in offices that perform HbA1c POC testing, participate in HbA1c EQA surveys, and maintain good analytical quality have lower HbA1c levels. Accurate HbA1c POC results, available during consultations, may improve diabetes care.

A Clinic-based Approach to Diagnosis and Management of Prediabetes in High-risk Children and Adolescents.

BackgroundType 2 diabetes (T2D) in youth is increasing in prevalence. Diabetes screening is recommended for at-risk youth but best-practice strategies for management of pediatric prediabetes are unknown. This study leverages a pediatric prediabetes clinic to assess identification of high-risk patients, the rate of clinic follow-up and progression to T2D in youth over time.MethodsRetrospective chart review of children referred to a single center for evaluation of prediabetes over a 3-year period. Measurements included hemoglobin A1c (HbA1C) and oral glucose tolerance testing. Patients were classified as normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or T2D based on 2019 American Diabetes Association criteria. Patients classified as IGT/T2D were prescribed metformin.ResultsOf the 254 patients included; 25.6% had IGT and 6.7% had T2D. The IGT/T2D groups were older and more obese than the NGT group. There was a moderate correlation between HbA1C and fasting glucose (r = 0.59, P < 0.001); HbA1C and 2-hour glucose (r = 0.63, P < 0.001). Over the 3-year study, 52 of 82 patients with IGT/T2D (63%) returned for follow-up. Four patients regained NGT; 3 of those had isolated impaired fasting glucose (100 to 102 mg/dL). Three patients (4.6%) progressed from IGT to T2D over an average of 13 ± 6.2 months. In those patients, body mass index had increased 1.7 ± 2.3 kg/m2 from baseline.ConclusionsA pediatric prediabetes clinic may allow for identification of high-risk youth but lost to follow-up rates are high. Continued weight gain is a risk factor for progression to T2D and effective weight management programs are needed.

Abstract P441: Oral Glucose Tolerance Test Detects Diabetes at Early Stages

Introduction: Diabetes is a significant risk factor for cardiovascular disease (CVD) and one of the leading causes of death in the USA. The progression to type 2 diabetes, as the major type, is known to be gradual and remissible by intervention at early stages. However, despite the diabetes epidemic over the past few decades in the US, diabetes detection at the early stages has received insufficient attention. Assessing which diabetes diagnostic test can detect progression to diabetes at early stages may help to improve diagnostic recommendations for the at-risk population. Hypothesis: We hypothesize that the Oral Glucose Tolerance Test (OGTT) can detect diabetes at earlier stages compared with Hemoglobin A1c (HbA1c) and Fasting Plasma Glucose (FPG) tests. Therefore, the diabetes cases which are diagnosable only by OGTT have a better CVD risk profile. Methods: We extracted diabetes cases with laboratory evidence of diabetes OGTT ≥ 200 or FPG ≥ 126 or HbA1c ≥ 6.5% who reported themselves as undiagnosed by a doctor from the National Health and Nutrition Survey (NHANES) 2005-2014. We compared the CVD risk factors in the undiagnosed diabetes group between the subgroup, which was diagnosable only by OGTT and the subgroup, which was diagnosable by HbA1c or FPG. Results: Among the total of 953 undiagnosed diabetes cases (projected to 26.4 million) from NHANES 2005-2014, 207 (6.1 million, 23%) had a normal HbA1c and FPG, but OGTT ≥ 200. After adjustment for gender and race, the subgroup who were only diagnosable by OGTT had a better glycemic profile and considerably milder insulin resistance compared with the subgroup who were diagnosable by other diagnostic tests (table). Conclusions: The results indicate that OGTT can assess diabetes at earlier stages compared with HbA1c and FPG, providing opportunities for earlier preventive strategies.

Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care.

Research demonstrates that the patient-centered medical home (PCMH) is associated with improved clinical outcomes and quality of care, and the populations that can most benefit from this model require long-term management, e.g., persons with chronic illness and behavioral health conditions. However, different populations may not benefit equally from the PCMH, and empirical evidence about the effects of this model on racial disparities is limited. Estimate the association between enrollment in National Committee for Quality Assurance (NCQA)-recognized PCMHs and racial disparities in quality of care for adults with major depressive disorder (MDD) and comorbid medical conditions. Applying a quasi-experimental instrumental variable design to account for differential selection into the PCMH, we used generalized estimating equations to determine the probability of receiving eight disease-specific quality measures. Medicaid enrollees in three states not dually enrolled in Medicare, ages 18-64 with MDD and > 1 other chronic condition. A subgroup analysis was conducted for enrollees with comorbid diabetes. Enrollment in an NCQA-recognized PCMH. Disease-specific quality indicators for MDD (e.g., antidepressant use, receipt of psychotherapy), and for diabetes, (e.g.A1c testing, LDL-C testing, retinal exams, and medical attention for nephropathy). PCMH enrollment was associated with an increase in the overall likelihood of receiving six of eight recommended services and a decrease in the likelihood of receiving any psychotherapy (4.94 percentage points, p < 0.01) and retinal exams (5.51 percentage points, p < 0.05). Although both groups improved, PCMH enrollment was associated with an exacerbation of the Black-white disparity in adequate antidepressant use by 4.20 percentage points (p < 0.01). While PCMH enrollment may improve the overall quality of care, the effect is inconsistent across racial groups and not always associated with reductions in racial disparities in quality.