Medical Benefits Research Articles

Initiating continuous glucose monitoring is associated with improvements in glycemic control and reduced health care resource utilization for people with diabetes in a large US-insured population: A real-world evidence study.

To examine the real-world impact of continuous glucose monitoring (CGM) use on glycemic management and health care resource utilization (HCRU) in people with diabetes in a large US-insured population. This retrospective observational study used Aetna administrative claims data from a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and with coverage for medical and pharmacy benefits. The index date was the first CGM pharmacy or medical claim observed between January 1, 2019, and December 31, 2021. Change in hemoglobin A1c was calculated using values from 3 months before and the latest values 10-12 months after the index date. HCRU was measured 12 months before and after the index date. Data were analyzed by the following patient groups: type 1 diabetes, type 2 diabetes (T2D) on intensive insulin therapy, T2D on basal-only insulin therapy, and T2D not on insulin therapy. Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) were analyzed. Beneficiaries with available A1c data (n = 1,063) showed a significant improvement in A1c after CGM initiation (-0.7%, P < 0.0001), including -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (P < 0.0001 for both). This study showed that CGM use was associated with clinically meaningful improvements in A1c and reduced HCRU, suggesting potential for population-level clinical benefits, especially for patients not using insulin.

Flavonoids and Other Phenolic Compounds for Physiological Roles, Plant Species Delimitation, and Medical Benefits: A Promising View

Flavonoids and Other Phenolic Compounds for Physiological Roles, Plant Species Delimitation, and Medical Benefits: A Promising View

Nuts and Bolts of Dental Medicaid Managed Care

North Carolina has adopted managed care for administration of its Medicaid program for management of medical benefits. The North Carolina Medicaid dental program, however, continues to be administered through a traditional fee-for-service model. This article addresses what a managed care model for Medicaid dental could look like in North Carolina.

NCOG-01. VOCATIONAL STATUS OF PATIENTS WITH GLIOMA AT 5 YEARS AFTER DIAGNOSIS

Abstract BACKGROUND Glioma (WHO grade 2-3) commonly affects adults, with a mean age at diagnosis of 41 years old. Given the demographic age of these brain tumor (BT) survivors, employment is the primary source of income, medical benefits, and financial stability. Unfortunately, job performance problems can occur at any time after diagnosis. This study aims to describe the vocational status and symptoms of these patients approximately five years following diagnosis. METHODS The study employed a cross-sectional cohort design among persons with glioma treated with radiation approximately 5 years from the original diagnosis. Vocational-Independence Scale was used to ascertain employment status. Patients were asked about their experience returning to work after treatment. Symptoms were measured using the MDASI-BT Module. RESULTS Thirty-nine participants completed the study. The median age was 44 years old (range 26-78). Nineteen were diagnosed with oligodendroglioma, 18 with astrocytoma. Thirty-seven (95%) were working full-time at the time of diagnosis. Approximately five years following diagnosis, only 49% of participants are employed, working at least 15 hours per week (n=19). The remainder are unemployed (n=15, 39%), in a volunteer position (n=2, 5.1%), or working &amp;lt;15 hours per week (n=3, 7.7%). Interview data suggest those who are unemployed (n=9, 23%), retired early (n=2, 5%), or had reduced roles (n=11, 28%), were unable to return to prior roles due to symptoms they were experiencing 1-2 years after treatment. The frequently reported symptoms were fatigue (n=29, 74%), sleep disturbance (n = 24, 62%), distress (n = 25, 64%), drowsiness (n = 26, 67%), sadness (n = 25, 64%), issues with speaking (n = 25, 64%), short-term memory issues (n=35, 90%), and difficulty with concentration (n=20, 74%). CONCLUSION In addition to financial stability, employment is a valuable contributor to the quality of life, maintenance of identity, and physical and emotional health. Future research should examine and evaluate interventions that promote the return to work or engagement in the community.

Quality of Life Based Health Economics Research on Pharmaceutical Intervention in Cancer Chemotherapy

The adverse chapter of cancer chemotherapy negatively impact QOL, and pharmacists play a key role in improving QOL by providing optimal drug therapy through pharmaceutical interventions. Although outpatient cancer chemotherapy is now common, the impact of pharmaceutical interventions from a QOL perspective has not been thoroughly studied. Therefore, this study investigated the impact and cost-effectiveness of pharmaceutical interventions on QOL using the EuroQol 5 Dimension (EQ-5D) and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD). The study was conducted between 2013 and 2015 on 39 patients who underwent their first outpatient chemotherapy for breast cancer at Gifu Municipal Hospital. The results showed that pharmaceutical interventions improved social relationship QOL in patients experiencing fatigue during the first cycle and enhanced psychological QOL in patients with adverse events of nausea during the second cycle. Furthermore, the maximum incremental cost-effectiveness ratio (ICER) was found to be 1.3 million yen per quality-adjusted life years (QALY) according to cost utility analysis. The pharmaceutical interventions by pharmacists in outpatient cancer chemotherapy improve QOL, and the ICER remains well below the Japanese threshold, signifying clear medical and economic benefits.

Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017

Abstract Aims The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea. Methods To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables. Results The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female. Conclusions Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health &amp; Welfare, Republic of Korea (No. HC23C016500). Key messages • The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. • In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Decriminalizing and Legalizing Cannabis for Clinical Benefits in Malaysia: Perspective Among Pharmacists (A Qualitative Study)

ABSTRACT Cannabis, often criticized, has active compounds that indicate multiple medical benefits. However, before the potential decriminalization and legalization of medical cannabis, pharmacists play a crucial role in the decision-making for personalized therapy and evidence-based medicine. This study investigates pharmacists’ perspectives on medical cannabis, covering medical use, societal impact, research, legality, and regulation. This study was conducted through semi-structured interviews with pharmacists from different sectors. Interviews were conducted with 16 pharmacists, with 4 from each sector: industry, academia, community, and hospital. There was a consensus on the need for streamlined research before potential decriminalization and legalization of cannabis, highlighting concerns about abuse and misuse despite its benefits. With that in mind, all participants agree that there is a need to update the current legislation and regulations to better control the use and distribution of medical cannabis. Several participants also called to attention that education plays an important role in the potential decriminalization of medical cannabis, with cannabis-related stigma being a potential deterrent for not only the public but also healthcare professionals. As medical cannabis is a new subject in Malaysia, this study could ignite further multidisciplinary human-related research with strict regulations which will ultimately result in evidence-based medicine.

Temporal trend in quality indicators of diabetes care performance among persons with type 2 diabetes in primary care practice: a serial cross-sectional analytical study, 2013/14 to 2021/22.

Although the national-based policy implemented an initiative program to offer diabetes care management in Thailand, there are limited time trends of evidence to gauge whether the quality of diabetes care in primary care practice is improving. As such, we aimed to identify temporal trends in the quality of diabetes care performance among type 2 diabetes mellitus (T2DM) patients in primary care practice. Using assembled patient-level data from a suburban community in northern Thailand, this serial retrospective cross-sectional analytical study obtained adult T2DM patients from nine consecutive fiscal years 2013/14 (n = 976) to 2021/22 (n = 1,242). Based on international and national guidelines recommended, nine quality indicators were examined, namely, smoking cessation, hemoglobin A1c monitoring, foot and eye examinations, albuminuria testing, statin prescription, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription for chronic kidney disease (CKD)/albuminuria, and blood pressure and glycemic control. Rates and time trends achieved in each quality indicator performance were estimated. Differences in the rates of patients who met each quality indicator across reimbursement schemes were explored. From 2013/14 to 2021/22, all quality indicators have increased over time (p for trend <0.05) except for smoking cessation, which remained steady. In 2021/22, only three out of nine quality indicators (i.e., smoking cessation, annual HbA1c monitoring, and annual foot examination) were successfully met at 70% or greater. Differences in quality indicators of diabetes performance were observed, particularly those under the Civil Servant Medical Benefit Scheme compared with other health insurance counterparts. For overall time trends analysis (compared with 2013/14), significant relative changes in the fiscal year 2021/22 were found in the annual foot examination (adjusted 12.1% increase; p = 0.048), annual albuminuria testing (adjusted 12.1% increase; p = 0.048), and ACEI/ARB prescription for persons with CKD or albuminuria (adjusted 22.2% increase; p = 0.025). Among adult T2DM patients from 2013/14 to 2021/22, overall quality indicators for diabetes performance have substantially improved over time. However, health inequity regarding diabetes care performance was found across different reimbursement schemes. Sustainable policy implementation and innovative strategies to narrow health inequity are warranted to optimize diabetes care in primary care practice.

Medical and health benefits of noise reduction at Intensive Care Units

Introduction: The presence of excessive noise poses a significant risk to the overall well-being and health of individuals. The presence of elevated noise levels within Intensive Care Units (ICUs) has the potential to exert detrimental effects on both the well-being of patients and the healthcare personnel. The aim of this study: This study aims to gather knowledge about the effects of noise pollution on patient’s wellbeing within Intensive Care Units, analyze various investigations around the world and discuss the possible preventive methods of reducing noise and thus sleep disturbances. Materials and methods: This review was based on available data collected in the PubMed database and Google Scholar web search engine using the key words Intensive Care Unit, sleep deprivation, noise pollution Conclusions: Intensive Care Unit noise disrupts patient’s sleep, communication, and increases stress, potentially leading to medical errors and longer recovery times. Addressing this issue is vital, aligning with patient-centered care and holistic therapy trends. Solutions include architectural changes, quieter equipment, staff education, clinical guidelines, and providing earplugs and eye masks for patient comfort. Noise negatively impacts sleep, causing circadian disruptions, cognitive impairments, and health issues. Identifying and mitigating noise sources can significantly enhance patient well-being and treatment outcomes.

Vitamin D and Neurological Health: Unraveling Risk Factors, Disease Progression, and Treatment Potential.

This study explores the complex link between vitamin D and neurological illnesses, focusing on how vitamin D affects possible risk factors, therapeutic applications, and the trajectory of the disease. An epidemiological study has linked vitamin D insufficiency to several neurological conditions, including Parkinson's disease, Alzheimer's disease, and multiple sclerosis. It is hypothesized that immunomodulatory and anti-inflammatory properties of vitamin D contribute to its neuroprotective effects. Two major mechanisms in dementia include neuroinflammation and oxidative stress. Adequate levels of vitamin D have been shown in both animal models and human studies to enhance both clinical outcomes and the duration of illness in those who have it. Other ways that vitamin D contributes to its therapeutic potential include the production of neurotrophic factors, control over neurotransmitter synthesis, and preservation of the blood-brain barrier. Despite the encouraging outcomes, research is still being conducted to determine the optimal dosage and long-term benefits of vitamin D supplementation on brain function. In order to furnish precise directives and clarify the processes behind the neuroprotective impacts of vitamin D, future research must focus on large-scale randomized controlled studies. . This study highlights the significance of maintaining adequate levels of vitamin D as a modifiable risk factor for neurological disorders. Further study is also required to comprehend the possible medical benefits of this vitamin fully.

Indian hidden tuber “Ram Kand Mool” (Maerua oblongifolia A. Rich): Cultivation, phytochemistry and potential applications—A comprehensive review

AbstractRam Kand Mool (Maerua oblongifolia A. Rich) is a little tree or shrub. It grows easily from seed or cuttings and requires minimal care. The leaves and roots of Maerua oblongifolia A. Rich have most commonly been used for ages. This shrub has a mythological importance in Indian beliefs. Maerua oblongifolia A. Rich has many ethnobotanical uses. Maerua oblongifolia A. Rich contains various phytochemicals, including terpenoids, flavonoids, phenolic acids, and alkaloids. These phytochemicals have antioxidant, anti‐inflammatory, antibacterial, and anticancer properties. Traditional medical practices use it to treat inflammation, pain, infections, skin diseases, and gastrointestinal concerns. Maerua oblongifolia A. Rich may be used in pharmaceutical, nutritional, and personal care products. It is useful in the kitchen, medical cabinet, and cosmetics sector. The information compiled indicates that Ram Kand Mool has enormous potential for utilization as a functional food and various other value‐added products. Pre‐treatments are needed to remove the anti‐nutritional factors present in it. This article describes the nutritional and medicinal benefits of Maerua oblongifolia A. Rich in detail. The information about the medicinal usage of Ram Kand Mool in traditional medical practices and nutritional benefits have been comprehensively compiled in this article.

Innovative mobile app solution for facial nerve rehabilitation: a usability analysis.

Facial palsy after vestibular schwannoma surgery is temporary in many cases but can significantly affect patients' quality of life. Physical training-initially guided and subsequently performed by the patient-is of paramount importance for recovery of facial nerve function. The introduction of medical application software (apps) might improve therapy by maintaining motivation for daily home-based training and surveilling patients' rehabilitation progress. We developed a mobile app, "FACEsemper", for home-based facial nerve rehabilitation. This app guides patients through a daily training program comprising six variable exercises, each performed in three repetitions. The app allows the user to customize the exercise intensity for different facial areas and includes a reminder function for daily training. Additional features include photo documentation, a calendar function, training report generation, and the possibility of direct communication with the attending physician. The app's usability was prospectively investigated with 27 subjects, including 8 physicians, 9 patients with facial palsy and 10 healthy subjects, over a two-week period. Usability was assessed using various self-rating questionnaires (i.e., mHealth App Usability Questionnaire, MAUQ; System Usability Scale, SUS; Visual Aesthetics of Apps Inventory, VisAAI) and scores were compared across the groups. The participants reported an average smartphone use of 12.19 years and completed a mean number of 290 ± 163 facial exercises during the study period. Patients used the app significantly more frequently than the other two groups (p = 0.017). The average total scores of the questionnaires were: MAUQ 5.67/7, SUS 89.6/100, VisAAI 5.88/7 and specific rating 6.13/7. In particular, the simplicity of use and craftsmanship of the app were rated very highly. Usability scores did not significantly differ between groups. A primary limitation identified was malfunction of the daily reminder feature in some Android versions. This usability study demonstrated a positive user experience and excellent usability of the FACEsemper app. However, some limitations and areas for improvement were identified. As a next step, the app should be evaluated in a large patient cohort with facial palsy to determine its potential medical benefits for facial rehabilitation compared to traditional training methods.

Trends in anti-diabetic medication use, severe hyperglycaemia and severe hypoglycaemia among American Indian and Alaska Native Peoples, 2009-2013.

Type 2 diabetes (T2D) and its complications disproportionally affect American Indian and Alaska Native (AI/AN) peoples. Prescribing decisions for anti-diabetic medications are complicated and require balancing medication benefits, costs and side effects. Little is known about trends in anti-diabetic medication use as well as acute diabetes complications among AI/AN adults. Here, we examined patterns and trends in anti-diabetic medication use and rates of hospital admissions or emergency department (ED) visits due to severe hypoglycaemia and hyperglycaemia among AI/AN adults with T2D. We conducted a retrospective analysis of Indian Health Service (IHS) Improving Health Care Delivery Data Project. A total of 39 183 AI/AN adults aged ≥18 years with T2D who used IHS or Tribal health services during any of the fiscal years (FYs) 2009-2013 were included. Utilization rates of each class of anti-diabetic medications and rates of severe hypoglycaemia and severe hyperglycaemia in emergency room and/or inpatient discharge diagnoses were calculated for each year. Longitudinal statistical models were fitted to examine time trends of anti-diabetic medication use and complications. During 2009-2013, use of metformin (56.0%-60.5%), insulin (31.4%-35.9%) and dipeptidyl peptidase-4 inhibitors (1.4%-9.0%) increased, whereas the use of sulfonylureas (40.3%-32.9%) and thiazolidinediones (TZDs, 31.6%-8.8%) decreased significantly. Trends in severe hypoglycaemia (1.6%-0.8%) and severe hyperglycaemia (2.0%-1.6%) declined gradually. There were significant changes in the utilization of different anti-diabetic medication classes during 2009-2013 among AI/AN adults with T2D. Concurrently, there were significant reductions in severe hypoglycaemia and severe hyperglycaemia.

Pandangan Masyarakat Aceh tentang Penggunaan Ganja

This study aims to explore the views of the Acehnese people regarding the use of marijuana, with a special focus on the perspectives of traditional leaders and clergy in the region. Aceh, known for its strict application of sharia law, has a distinctive view of prohibited substances, including marijuana. This research method uses a qualitative approach with in-depth interview techniques with traditional leaders and clergy as well as literature studies to strengthen their views on the legality, social impact, and moral implications of cannabis use. The results of this study show that medically, marijuana can overcome long-term pain, mental health problems, slow the development of cancer cells, and improve symptoms of epilepsy and multiple sclerosis. However, there are health risks such as mental health problems, testicular cancer, and respiratory diseases if used. In Indonesia law, marijuana is considered a drug with a high addictive effect and is prohibited from use. By teaching the community and working with law enforcement, Acehnese traditional and religious leaders play an important role in preventing marijuana abuse. In general, although marijuana has potential medical benefits, marijuana use in Indonesia must continue to be controlled and restricted to prevent abuse. If the legalization of medical marijuana is discussed, the benefits and risks should be carefully considered, with strict regulation to reduce its adverse effects.

Cosmeceuticals are the product of cosmetics that are biologically active ingredient that impersonates to medical or drug benefits. But the daily use of synthetic results in many side effects and need of organic lip balms is roaring in the society. In the

Cosmeceuticals are the product of cosmetics that are biologically active ingredient that impersonates to medical or drug benefits. But the daily use of synthetic results in many side effects and need of organic lip balms is roaring in the society. In the present study we, aimed to formulate organic lip balm using natural ingredients. Lip balm has been formulated using Golden shower flower, red cabbage, honey, ghee, beeswax, vitamin E and coconut oil. Various parameters such as stability, melting point, spreadability, pH, were evaluated for the evaluation of lip balm. pH was found to be 6 and melting point was 60°C 65°C for cassia lip balm and red cabbage lip balm respectively. On preforming skin irritation test the formulation was found to be not irritant, and formulation was observed to be stable. Lip balm from above ingredients could be a better option for daily use to a small extend for minor lip issues.

Antidepressant Herbal Plants: An Updated Review

The symptoms of this illness include mood swings, protracted melancholy, disinterest, and diminished cognitive performance. These symptoms give the patient discomfort and have a substantial negative impact on their capacity to function and lead fulfilling personal, social, and professional lives. Depression treatment has to be comprehensive and involve medicine. For several centuries, herbal chemicals have been the subject of scientific inquiry, and ongoing studies are being conducted to explore their possible medical benefits. Herbs used in traditional medicine have been shown to be highly beneficial in lowering depression and its symptoms as well as enhancing patient function. Plants are used in biology and medicine in a variety of ways. They are an excellent resource for the creation of innovative drugs due to their high levels of safety, accessibility, availability, tolerance, and low levels of toxicity. Depression is caused by a multitude of variables, such as inflammation, brain-derived neurotropic factor (BDNF), hypothalamic-pituitary-adrenal (HPA) axis, and monoamine neurotransmitters (dopamine, serotonin (5-HT), noradrenaline, and 5-HT). Herbal medicines have gained a lot of attention lately since they are less costly and have less adverse effects than traditional depression treatments. Recent years have seen a significant amount of study on the possible application of sedative and antidepressant plants. The primary emphasis of this review has been herbal medications with antidepressant properties. Keywords: Depression, herbal medications. Herb, antidepressant plants

Medication Changes Among Older Drivers Involved in Motor Vehicle Crashes

Although older adults may use potentially driver-impairing (PDI) medications that can produce psychomotor impairment, little is known about changes to PDI medication use among older adults from the time before to the time after a motor vehicle crash (MVC). To quantify use of and changes in PDI medications among older adults before and after an MVC. This cohort study used linked Medicare claims and police-reported MVC data on 154 096 person-crashes among 121 846 older drivers. Eligible persons were drivers aged 66 years or older, involved in a police-reported MVC in New Jersey from May 1, 2007, through December 31, 2017, and with continuous enrollment in Medicare fee-for-service Parts A and B for at least 12 months and Part D for at least 120 days prior to the MVC. Data were analyzed from January 2022 to May 2024. Use of benzodiazepines, nonbenzodiazepine hypnotics, opioid analgesics, and other PDI medications in the 120 days before and 120 days after the MVC. Because each person could contribute multiple MVCs during the study period if they met eligibility criteria, the unit of analysis was the number of person-crashes. The proportion of person-crashes after which PDI medications were started, discontinued, or continued was quantified as well. Among 154 096 eligible person-crashes, the mean (SD) age of the drivers was 75.2 (6.7) years at the time of the MVC. Of 121 846 unique persons, 51.6% were women. In 80.0% of the person-crashes, drivers used 1 or more PDI medications before the crash, and in 81.0% of the person-crashes, drivers used 1 or more PDI medications after the crash. Use of benzodiazepines (8.1% before the crash and 8.8% after the crash), nonbenzodiazepine hypnotics (5.9% before the crash and 6.0% after the crash), and opioid analgesics (15.4% before the crash and 17.5% after the crash) was slightly higher after the MVC. After the MVC, drivers in 2.1% of person-crashes started benzodiazepines and 1.4% stopped benzodiazepines, drivers in 1.2% of person-crashes started nonbenzodiazepine hypnotics and 1.2% stopped nonbenzodiazepine hypnotics, and drivers in 8.4% of person-crashes started opioid analgesics and 6.3% stopped opioid analgesics. This cohort study suggests that most older drivers involved in MVCs did not use fewer PDI medications after crashes than before crashes. Qualitative research of perceived risks vs benefits of PDI medications is necessary to understand the reasons why MVCs do not appear to motivate clinicians to deprescribe PDI medications as a strategy to avert potential harms, including additional MVCs.

Bioreduction of aromatic ketones catalyzed by oak fruits (Quercus Ilex L ) fruit grown in north Algeria

The present work primarily aims to investigate and establish a method for the bioreduction of aromatic ketones to produce corresponding alcohols. This process is crucial for the production of various industrially important chemicals, including pharmaceuticals, agrochemicals, and natural products, and supports the principles of green chemistry. Additionally, this study seeks to valorize the vegetation cover in southern Algeria as a source of biochemical catalysts. Our research focused on the bioreduction of several acetophenone derivatives using the fruits of Oak (Quercus ilex L.) which is cultivated in northern Algeria. The findings indicate that these plant tissues can effectively reduce acetophenone derivatives. Specifically, a chemical yield of approximately 90% was achieved for acetophenone, while yields ranged from 60% to 75% for 4'-haloacetophenones (where X = F, Cl, and Br) and 4'-nitroacetophenone. These results demonstrate that (Quercus ilex L).fruits from northern Algeria can serve as effective biocatalysts in the reduction of aromatic ketones to their corresponding alcohols. This approach not only supports the sustainable production of pharmaceuticals but also provides significant health, environmental, economic, and medical benefits.

7525 Impact of Medicaid Policy Change on CGM Uptake in a Federally Qualified Health Center

Abstract Disclosure: W. Solorzano: None. L. Scarlett: None. K.P. Santiago Mangual: None. J. Borrell: None. B. Brumley: None. M. Tavares: None. C. Santana: None. T. Moin: None. E.M. Everett: None. Background: Despite the numerous benefits of CGMs in diabetes management, studies have consistently reported inequities in CGM use in racial-ethnic minorities, lower socioeconomic status, and with public insurance. In January 2022, a new California Medicaid policy switched coverage of CGMs from a Durable Medical Equipment benefit to a pharmacy benefit, creating less stringent insurance related criteria for CGM approval. We aim to evaluate the utilization of CGM use after the aforementioned policy change in an urban, multi-centered, federally qualified health center. Methods: We performed a retrospective study of patients with diabetes seen by diabetes NPs in three different clinics from January 1, 2022, through June 30, 2023. We excluded patients not managed on insulin. Patients were stratified by CGM status (current user, former user, never user). We used descriptive statistics to report patient demographics and clinical characteristics. Chi-squared test was used to evaluate differences between groups. We performed multivariate logistic regression to evaluate predictors of never using CGM. Results: We identified 239 patients who met inclusion criteria. They were primarily between the ages of 45-64 (60%), female (57%), Hispanic (84%), Spanish speaking (70%), and on Medicaid insurance (63%). Majority had a diagnosis of type 2 diabetes (93%) and managed on basal insulin plus other antidiabetic medication(s) (48%) with a mean HbA1c ≥ 10% (31%). At the end of the study period, 37% were current CGM users, 13% were former users and 51% were never users. Almost all (98%) of those who used CGMs started after January 2022.There was a statistically significant difference between CGM groups and treatment regimen (p = 0.000), insurance type (p = 0.000), type of diabetes (p = 0.000), and clinic site (p = 0.029). There was no statistically significant association between age, birth sex, race, primary language, or mean Hba1c. Most current and former users were/are on Freestyle Libre 2 (61% and 93%, respectively). Among never users, 55% had no discussion about CGM use documented in their charts. In an adjusted analysis, insurance type was the strongest predictor of never using CGM. Those without insurance on a county program, My Health LA (OR 15.5, 95% CI 3.7-65.6) or self-pay (OR 10.0, 95% CI 1.77-56.3) were more likely to be a never user. Conclusion: In an underserved population with diabetes, insurance status was the primary barrier to CGM use as demonstrated by the large uptake of CGM use after the policy change and that insurance status was the largest predictor of use. Additional studies are needed to evaluate other barriers impacting CGM uptake and adherence, clinical impact of CGM use, and patient experience. This will improve the utilization and adherence of this diabetes technology in this patient population who historically experiences more challenges with diabetes and obtaining optimal glycemic control. Presentation: 6/1/2024

Cardiac Effects of Renin-Angiotensin System Inhibitors in Nonproteinuric CKD.

In contrast to proteinuric chronic kidney disease (CKD), the relative cardioprotective benefits of antihypertensive medications in nonproteinuric CKD are unknown. We examined long-term cardiovascular outcomes and mortality in patients with nonproteinuric CKD treated with renin-angiotensin system inhibitors (RASIs) versus other antihypertensive medications. Among participants of the CRIC study (Chronic Renal Insufficiency Cohort) without proteinuria, we used intention-to-treat analyses with inverse probability of treatment weighting and Cox proportional hazards modeling to determine the association of RASIs versus other antihypertensive medications with a composite cardiovascular outcome (myocardial infarction, stroke, heart failure hospitalization, and death) and mortality. Secondary analyses included per-protocol analyses accounting for continuous adherence and time-updated analyses accounting for the proportion of time using RASIs during follow-up. A total of 2806 participants met the inclusion criteria. In the intention-to-treat analyses, RASIs versus other antihypertensive medications were not associated with an appreciable difference in cardiovascular events (adjusted hazard ratio [aHR], 0.94 [95% CI, 0.80-1.11]) or mortality (aHR, 1.06 [95% CI, 0.88-1.28]). In the per-protocol analyses, RASIs were associated with a lower risk of adverse cardiovascular events (aHR, 0.78 [95% CI, 0.63-0.97]) and mortality (aHR, 0.64 [95% CI, 0.48-0.85]). Similarly, in the time-updated analyses, a higher proportion of RASI use over time was associated with a lower mortality risk (aHR, 0.33 [95% CI, 0.14-0.86]). Among individuals with nonproteinuric CKD, after accounting for time-updated use, RASIs are associated with fewer cardiovascular events and a lower mortality risk compared with other antihypertensive medications. Patients with nonproteinuric CKD may benefit from prioritizing RASIs for hypertension management.