Diabetes-related Measures Research Articles

Diabetes, glycemic profile and risk of vitiligo: A Mendelian randomization study.

Previous observational studies have shown that vitiligo usually co-manifests with a variety of dysglycemic diseases, such as Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM). Mendelian randomization (MR) analysis was performed to further evaluate the causal association between fasting plasma glucose, glycosylated hemoglobin (HbA1c), T1DM, T2DM and vitiligo. We used aggregated genome-wide association data from the Integrative Epidemiology Unit (IEU) online database of European adults vitiligo; HbA1c data were from IEU. Fasting blood glucose data were obtained from the European Bioinformatics Institute (EBI). T1DM and T2DM data were from FinnGen. We used bidirectional two-sample and multivariate MR analyses to test whether dysglycemic measures (fasting blood glucose, HbA1c), diabetes-related measures (T1DM, T2DM) are causatively associated with vitiligo. Inverse variance weighting (IVW) method was used as the main test method, MR-Egger, Weighted mode and Weighted median were used as supplementary methods. We found no statistically significant evidence to support a causal association between dysglycemic traits and vitiligo, but in the correlation analysis of diabetic traits, our data supported a positive causal association between T1DM and vitiligo (p=0.018). In the follow-up multivariate MR analysis, our results still supported this conclusion (p=0.016), and suggested that HbA1c was not a mediator of T1DM affecting the pathogenesis of vitiligo. No reverse causality was found in any of the reverse MR Analyses of dysglycemic traits and diabetic traits. Our findings support that T1DM is a risk factor for the development of vitiligo, and this conclusion may explain why the co-presentation of T1DM and vitiligo is often seen in observational studies. Clinical use of measures related to T1DM may be a new idea for the prevention or treatment of vitiligo.

Development of a new health-related quality of life measure for people with diabetes who experience hypoglycaemia: the Hypo-RESOLVE QoL

Aims/hypothesisValid and reliable patient-reported outcome measures are vital for assessing disease impact, responsiveness to healthcare and the cost-effectiveness of interventions. A recent review has questioned the ability of existing measures to assess hypoglycaemia-related impacts on health-related quality of life for people with diabetes. This mixed-methods project was designed to produce a novel health-related quality of life patient-reported outcome measure in hypoglycaemia: the Hypo-RESOLVE QoL.MethodsThree studies were conducted with people with diabetes who experience hypoglycaemia. In Stage 1, a comprehensive health-related quality of life framework for hypoglycaemia was elicited from semi-structured interviews (N=31). In Stage 2, the content validity and acceptability of draft measure content were tested via three waves of cognitive debriefing interviews (N=70 people with diabetes; N=14 clinicians). In Stage 3, revised measure content was administered alongside existing generic and diabetes-related measures in a large cross-sectional observational survey to assess psychometric performance (N=1246). The final measure was developed using multiple evidence sources, incorporating stakeholder engagement.ResultsA novel conceptual model of hypoglycaemia-related health-related quality of life was generated, featuring 19 themes, organised by physical, social and psychological aspects. From a draft version of 76 items, a final 14-item measure was produced with satisfactory structural (χ2=472.27, df=74, p<0.001; comparative fit index =0.943; root mean square error of approximation =0.069) and convergent validity with related constructs (r=0.46–0.59), internal consistency (α=0.91) and test–retest reliability (intraclass correlation coefficient =0.87).Conclusions/interpretationThe Hypo-RESOLVE QoL is a rigorously developed patient-reported outcome measure assessing the health-related quality of life impacts of hypoglycaemia. The Hypo-RESOLVE QoL has demonstrable validity and reliability and has value for use in clinical decision-making and as a clinical trial endpoint.Data availabilityAll data generated or analysed during this study are included in the published article and its online supplementary files (https://doi.org/10.15131/shef.data.23295284.v2).Graphical

Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management andsocio-demographics.

To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes. A quantitative study with a cross-sectional survey design. Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N=145) participated in the study. The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.

Identifying priority and bright spot areas for improving diabetes care: a geospatial approach

The objective of this study was to describe a novel geospatial methodology for identifying poor-performing (priority) and well-performing (bright spot) communities with respect to diabetes management at the ZIP Code...

Analysis of Healthy Coping Feedback Messages from Diabetes Mobile Apps: Validation Against an Evidence-Based Framework.

In this study, we focused on Healthy Coping, a key principle of ADCES7 Self-Care Behaviors® (ADCES7®) that enables people with diabetes to achieve health goals for self-care. We aimed to validate Healthy Coping-related feedback messages from diabetes mobile apps against the framework based on behavioral change theories. We searched apps using the search terms: "diabetes," "blood sugar," "glucose," and "mood" from iTunes and Google Play stores. We entered a range of values on 3 Healthy Coping domains: (1) diabetes-related measures including blood glucose, blood pressure, HbA1c, weight, (2) physical exercise/activity, and (3) mood to generate feedback messages. We used a framework by adopting validated behavioral change theory-based models to evaluate the feedback messages against 3 dimensions of timing, intention, and content (feedback purpose and feedback response). The feedback purposes in this study were categorized into 7 purposes; warning, suggestion, self-monitoring, acknowledging, reinforcement, goal setting, and behavior contract. We identified 1,749 apps from which 156 diabetes mobile apps were eligible and generated 473 feedback messages. The majority of generated feedback messages were related to blood sugar measurement. Only feedback messages on blood sugar under diabetes-related measures and mood domains encompassed all 7 feedback purposes under the content dimension. Many feedback messages neither supported Healthy Coping domains nor followed the behavioral theory-based framework. It is important that feedback messages be structured around the dimensions of the behavioral theory-based framework to promote behavior change. Furthermore, our framework had the generalizability that can be used in other clinical areas.

Improving Management of Type 2 Diabetes Using Home-Based Telemonitoring: Cohort Study.

BackgroundDiabetes is present in 10.5% of the US population and accounts for 14.3% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes including glycemic control and clinical events tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record.ObjectiveThis study aims to evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care.MethodsWe evaluated glycemic control and other diabetes-related measures after 1 year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, hemoglobin A1c (HbA1c), creatinine, estimated glomerular filtration rate, and insulin use in a usual care group after 1 year. Digital medicine patients completed questionnaires online, received medication management and lifestyle recommendations from a clinical pharmacist or advanced practice provider and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth-enabled glucose meter that transmitted data directly to the electronic medical record.ResultsAfter 1 year, usual care patients demonstrated no significant changes in HbA1c (mean 7.3, SE 1.7 to mean 7.3, SE 1.6; P=.41) or changes in the proportion of patients with HbA1c≥9.0 (n=117, 15% to n=113, 14%; P=.51). Digital medicine patients demonstrated improvements in HbA1c (mean 7.3, SE 1.5 to mean 6.9, SE 1.2; P<.001) and significant changes in the proportion of patients with HbA1c≥9.0 (n=107, 14% to n=49, 6%; P<.001), diabetes distress (n=198, 26% to n=122, 16%; P<.001), and hypoglycemic episodes (n=313, 41.1% to n=91, 11.9%; P<.001).ConclusionsA digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. The use of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy.

553-P: The Type 1 Diabetes High-Fidelity Wraparound (T1D HFW) Program: An Option for the Management of High-Risk Youth?

Despite advances in management, many young adolescents with T1D continue to struggle. Psychosocial factors play a major role. The T1D HFW Program is an innovative strategy to improve the adherence to medical regimens, including self-management and self-efficacy in high-risk youth. It is based on HFW, an evidence-based behavioral health concept described as a structured, team-based and individualized process that includes members who have experience either living with or raising a child with T1D. The aim of this pilot study is to test the feasibility and impact of this intervention in youth 11 to 16 years with T1D followed in a large academic diabetes center who are struggling with their management as defined by poor glycemic control and/or repeated emergency room visits and/or hospitalizations. Outcomes include assessment for behavioral, psychosocial and diabetes related measures with validated instruments. Seventeen youth enrolled and participated so far (58% females, 58% Caucasian, 23% African American, mean age 14±1.4 years, T1D duration 7.5±3.5 years, HbA1c at entry 10.3±2.3%, 65% with a deterioration in HbA1c, 45% prior diabetes related hospitalizations). A significant percent (57%) reported at least one traumatic experience including bullying (66%), witnessing violence (50%), physical/emotional abuse (33%). To date, eight families have transitioned out of the program after a mean of 6.5 months with 62.5% showing improvement and 25% no deterioration in HbA1c. Youth scoring positive for moderate depression on the PHQ-9 went from 27% to 9%. 1/3 of youth indicated positive results for generalized anxiety by the Screen for Child Anxiety Disorders (SCARED) with no change upon finishing the program. 60% of caregivers indicated a positive score on the Diabetes Distress Scale at start, which decreased to 20%. The T1D HFW program through personalized plans with identified support systems may be a promising strategy for youth struggling with T1D. Disclosure J. Schreiber: None. A. G. Nevin: None. L. Jones: None. M. W. Payne: None. K. C. Nash: None. R. Muzumdar: None. I. Libman: Advisory Panel; Self; Novo Nordisk. Funding Children’s Hospital of Pittsburgh Foundation

Higher Compared to Lower Protein Show Favourable Effects on Weight Loss and Fat Mass – A Systematic Review and Meta-Analysis

ObjectivesOur objective was to conduct a systematic review and meta-analysis of the effects of higher versus lower dietary protein consumption on obesity and diabetes related measures in adults, using the most up-to-date evidence from randomised controlled trials (RCTs). MethodsA systematic search with predefined keywords was conducted in PubMed, Scopus, and Web of Science up to January 2020 and subsequently updated in November 2020. Adult populations (age range: 23 to 68 years; mean body mass index (BMI): 33 ± 3.3 kg/m2) were included and the percentage of men/women was 35%/65%. Data were independently extracted with the use of standard forms in “Covidence” and with double data-entry checks. Random effects meta-analyses were conducted to pool the standardised mean differences (SMD) and 95% confidence intervals (CI). The main study outcomes were weight loss, fat mass, BMI, waist circumference, fasting glucose, fasting insulin and glycated haemoglobin (HbA1c). ResultsFifty-seven articles reporting on 54 trials were included, with 2185 and 2159 participants in the higher protein (HP) and lower protein (LP) groups, respectively. The mean daily energy intakes were 1764 ± 455 kcal in the HP group and 1768 ± 462 kcal in the LP group. The percentage of protein, carbohydrate, and total fat of the total daily energy intake (E%) were 28%, 41% and 30% in the HP group and 18%, 54% and 28% in the LP group. Significant effects of the HP compared to LP diets were found for weight loss (pooled SMD –0.13, 95% CI: –0.23, –0.04) and fat mass (pooled SMD –0.14, 95% CI: –0.25, –0.04), with small to moderate heterogeneity. This is equivalent to a greater weight loss of 0.67 kg (95% CI: –1.14, –0.19) and a greater reduction in fat mass of 0.57 kg (95% CI: –0.95, –0.19) after the HP compared to LP diets. No significant differences were found for the other study outcomes. ConclusionsThis meta-analysis of 54 trials showed that higher (28 E%) compared to lower protein diets (18 E%) had small but favourable effects on weight loss and fat mass, which are relevant indicators for the development of obesity and its complications. Funding SourcesNone.

Fear of hypoglycemia in patients with type 2 diabetes: The role of interoceptive accuracy and prior episodes of hypoglycemia

ObjectiveFear of hypoglycemia (FoH) is a limiting factor for diabetes self-management and can have detrimental effects on quality of life. However, relatively little is known about its underlying mechanisms. In line with findings on patients with anxiety disorders, we hypothesized that interoceptive accuracy (IA) might be positively linked to FoH in patients with type 2 diabetes (T2DM). Methods133 patients with T2DM were screened according to the extreme quartiles of the Hypoglycemia Fear Survey worry subscale (HFS-W). Overall, 66 participants (HFS-W<4; HFS-W>17) were included in the present study. Participants completed questionnaires on sociodemographic and diabetes-related measures. Accuracy of heartbeat perception was assessed using the mental tracking task. ResultsContrary to expectations, IA did not differ significantly between patients with low and high FoH. A linear regression analysis demonstrated that the experience of mild hypoglycemia (β=0.32, p≤0.01) and its interaction with IA (β=−0.26, p=0.040) were significant predictors of FoH, indicating that low IA and a history of experiencing mild hypoglycemia are positively associated with FoH. ConclusionOur findings suggest a positive association of low IA in combination with prior episodes of hypoglycemia and FoH in patients with T2DM. The results are in line with recent findings on IA in patients with chronic somatic symptom distress more generally and contribute to our understanding of the relations between interoception, body related fears, and physical symptom perception.

Use of Complementary Health Approaches Among Diverse Primary Care Patients with Type 2 Diabetes and Association with Cardiometabolic Outcomes: From the SF Bay Collaborative Research Network (SF Bay CRN).

To describe use of complementary health approaches (CHAs) among patients with type 2 diabetes, and independent associations between CHA use and Hemoglobin A1c (A1C) and lower-density lipoprotein (LDL) cholesterol. Participants were enrolled onto the SMARTSteps Program, a diabetes self-management support program conducted between 2009 and 2013 in San Francisco. At the 6-month interview, CHA use in the prior 30 days was estimated using a 12-item validated instrument. Demographic and diabetes-related measures A1C were assessed at baseline and 6-month followup. AIC and LDL values were ascertained from chart review over the study period. Medication adherence was measured using pharmacy claims data at 6 and 12 months. Patients (n = 278) completed 6-month interviews: 74% were women and 71.9% were non-English speaking. Any CHA use was reported by 51.4% overall. CHA modalities included vitamins/nutritional supplements (25.9%), spirituality/prayer (21.2%), natural remedies/herbs (24.5%), massage/acupressure (11.5%), and meditation/yoga/tai chi (10.4%). CHA costs per month were $43.86 (SD = 118.08). Nearly one third reported CHA (30.0%) specifically for their type 2 diabetes. In regression models, elevated A1C (>8.0%) was not significantly associated with overall CHA use (odds ratio [OR] = 1.78; 95% confidence interval [CI], 0.7 to 4.52) whereas elevated LDL was (OR = 3.93; 95% CI, 1.57 to 9.81). With medication adherence added in exploratory analysis, these findings were not significant. CHA use is common among patients with type 2 diabetes and may be associated with poor cardiometabolic control and medication adherence.

Symptoms of anxiety and depression in type 2 diabetes: Associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study

ObjectiveTo determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex. Research design and methodsA cross-sectional analysis using data from 2035 adults with Type 2 diabetes in the Nord-Trøndelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex. ResultsDepression was associated with a lower likelihood of avoiding saturated fats (OR=0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR=1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR=1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR=1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR=5.00 [95% CI: 1.15, 8.23). ConclusionsSymptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes.

Psychological distress of children with early-onset type 1 diabetes and their mothers' well-being.

Few studies have focused on the psychological adjustment of pre-adolescent children with type 1 diabetes. This study examined psychosocial functioning in nine- and 10-year-old children with early-onset type 1 diabetes, and their mothers, and associations between psychosocial functioning and diabetes management. The mothers of 63 children with early-onset diabetes and 86 healthy children evaluated their own psychosocial functioning, and their child's, with standardised rating scales. We used general linear models to analyse the children's behaviour problems and the mothers' well-being. Associations between the children's behaviour problems, diabetes-related measures and the mothers' well-being were studied with partial correlations. Children with diabetes had more internalising problems than the controls (p = 0.001), and these were associated with poor glycaemic control at the early stage of the illness (p = 0.033) and the use of insulin pumps in girls (p = 0.004). Mothers in the diabetes group had more child-related stress than the controls (p < 0.001), and poorer well-being was associated with the children's behavioural problems (p < 0.024). Children with early-onset diabetes faced an increased risk of internalising problems in middle childhood. The mothers' psychological distress was associated with children's behaviour problems rather than their diabetes.

Assessing hyperglycemia avoidance in people with Type 1 diabetes

SUMMARY: Aims: People with anxieties related to high blood glucose may engage in avoidance behaviors that increase their risk of hypoglycemia. Conversely, reduced concern about hyperglycemia could impair diabetes control. We developed the Hyperglycemia Avoidance Scale (HAS) to assess the extent of potentially problematic avoidant attitudes and behaviors in people with Type 1 diabetes (T1D). Materials & Methods: The HAS was administered to 501 people with T1D (mean age: 43 years). Data analysis included Exploratory Factor Analysis (EFA) using polychoric correlations and Item Response Theory. Relationships between the HAS and other diabetes-related measures were examined. Results: The EFA supported a 22-item, four-factor solution with excellent item reliability for all factors. HAS factors were found to be predictive of prospective S Hand prospective driving mishaps. Higher HbA1c values were also significantly related to the HAS. Pump users reported significantly greater avoidance of hyperglycemia than the...

Cross-sectional analysis of glucose metabolism in Friedreich Ataxia

ObjectivesTo evaluate the relationship between disease features in Friedreich ataxia and aberrant glucose metabolism. MethodsFasting glucose, fasting insulin and random HbA1C were obtained in 158 patients with Friedreich ataxia. Regression analysis evaluated glucose, insulin, and homeostatic model assessment (HOMA) of insulin resistance (IR) and beta-cell function (ß) in relation to age, BMI, sex, and genetic severity. Categorical glucose values were analyzed in relation to other FRDA-associated disease characteristics. ResultsIn the FRDA cohort, age and GAA repeat length predicted fasting glucose and HbA1c levels (accounting for sex and BMI), while insulin and HOMA-IR were not predicted by these parameters. Within the cohort, average BMI was consistently lower than the national average by age and was marginally associated with insulin levels and HOMA-IR. Within juvenile subjects, insulin and HOMA-IR were predicted by age. Controlling for age and genetic severity, diabetes-related measures were not independent predictors of any quantitative measure of disease severity in FRDA. Glucose handling properties were also predicted by the presence of a point mutation, with 40% of individuals heterozygous for point mutations having diabetes, compared to 4.3% of subjects who carried two expanded GAA repeats. InterpretationIn FRDA, aberrant glucose metabolism is linked to increasing age, longer GAA repeat length on the shorter allele, frataxin point mutations, and increasing BMI. The effect of age to some degree may be mediated through changes in BMI, with increasing age associated with increases in BMI, and with HOMA-IR and insulin increases in children.

Ethnic differences and socio-demographic predictors of illness perceptions, self-management, and metabolic control of type 2 diabetes

ObjectivesThis study investigated ethnic differences in diabetes-specific knowledge, illness perceptions, self-management, and metabolic control among black-African, black-Caribbean,and white-British populations with type 2 diabetes. The study also examined associations between demographic/disease characteristics and diabetes-specific knowledge, illness perceptions, self-management, and metabolic control in each of the three ethnic groups.DesignCross-sectionalSettingDiabetes/retinal screening clinics in Hackney and Brent, London.MethodsBlack-African, black-Caribbean and white-British populations with type 2 diabetes were asked to participate. Questionnaires measuring demographic/disease characteristics, diabetes-specific knowledge, self-management, and illness perceptions were used for data collection. Data for glycated hemoglobin (HbA1c) and microvascular complications were obtained from medical records. Ethnic differences in diabetes-related measures were estimated using analysis of variance/covariance. Multiple regression techniques were used to determine relationships between demographic/disease characteristics and measured diabetes-related outcomes.ResultsThree hundred and fifty-nine patients participated in the study. White-British participants had high diabetes-specific knowledge compared to their black-African and black-Caribbean counterparts. Black-Africans reported better adherence to self-management recommendations than the other ethnic groups. Compared to the white-British patients, black-African and black-Caribbean participants perceived diabetes as a benign condition that could be cured. Educational status and treatment category were determinants of diabetes-specific knowledge in all three ethnic groups. However, different demographic/disease characteristics predicted adherence to self-management recommendations in each ethnic group.ConclusionClearly, there is disease (diabetes) knowledge-perception variation between different ethnic groups in the UK which may partly influence overall disease outcome. It is plausible to recommend screening, identifying, and dispelling misconceptions about diabetes among ethnic minority patients by health care professionals as well as emphasizing the importance of self-management in managing chronic diseases such as diabetes.

Food Insecurity in Relation to Changes in Hemoglobin A1c, Self-Efficacy, and Fruit/Vegetable Intake During a Diabetes Educational Intervention

OBJECTIVE Food insecurity is hypothesized to make diabetes self-management more difficult. We conducted a longitudinal assessment of food insecurity with several diabetes self-care measures.RESEARCH DESIGN AND METHODSWe conducted a secondary, observational analysis of 665 low-income patients with diabetes, all of whom received self-management support as part of a larger diabetes educational intervention. We analyzed baseline food insecurity (measured by the U.S. Department of Agriculture Food Security module) in relation to changes in hemoglobin A1c (HbA1c) as well as self-reported diabetes self-efficacy and daily fruit and vegetable intake. We examined longitudinal differences using generalized estimating equation linear regression models, controlling for time, age, sex, race, income, and intervention arm.RESULTSOverall, 57% of the sample had an income <$15,000. Participants who were food insecure (33%) were younger, had less income, and were more likely to be unemployed compared with participants who were food secure. At baseline, those who were food insecure had higher mean HbA1c values (8.4% vs. 8.0%) and lower self-efficacy and fruit and vegetable intake than those who were food secure (all P < 0.05). Compared with food-secure individuals, participants who were food insecure had significantly greater improvements in HbA1c over time (0.38% decrease compared with 0.01% decrease; P value for interaction <0.05) as well as in self-efficacy (P value for interaction <0.01). There was no significant difference in HbA1c by food security status at follow-up.CONCLUSIONSParticipants experiencing food insecurity had poorer diabetes-related measures at baseline but made significant improvements in HbA1c and self-efficacy. Low-income patients who were food insecure may be particularly receptive to diabetes self-management support, even if interventions are not explicitly structured to address finances or food security challenges.

Pharmacist-Physician Collaboration for Diabetes Care: The Diabetes Initiative Program

Multiple complications can arise secondary to poor control of glucose, blood pressure, and cholesterol in a patient with diabetes. To evaluate the effect of a pharmacist-physician collaboration on attainment of diabetes-related measures of control. This was a prospective, multicenter, cohort study. Patients were enrolled from 7 practice sites throughout Tennessee if they had been diagnosed with type 2 diabetes, were aged 18 years or older with a life expectancy greater than 1 year, and were English speaking. Pregnant women were excluded. Patients were followed for 12 months following enrollment by informed consent. The pharmacist-physician collaboration method was established prior to study initiation. Primary outcomes included hemoglobin A1c (A1C), number of patients with A1C less than 7%, and percentage of patients with A1C greater than 9%. Of the 206 patients enrolled, the mean age was 59.73 years, and most were male (59.71%) and white (66.02%). The A1C was reduced by an average of 1.16% (p < 0.0001). The proportion of patients with A1C less than 7% increased from 12.75% at baseline to 36.76% at study conclusion (p = 0.0002). The proportion of patients with A1C greater than 9% decreased from 34.15% to 16.50%, (p < 0.0001). Pharmacist-physician collaborative management at multiple practice locations and types of setting (eg, private, academic, Veterans Affairs medical center) has a positive impact on glycemic control and diabetes-related health maintenance. This was accomplished without increasing the total number of antihyperglycemic agents prescribed and without an increase in patient-reported episodes of hypoglycemia.

An Evaluation of Diabetes-Related Measures of Control After 6 Months of Clinical Pharmacy Specialist Intervention

Purpose: To evaluate the effectiveness of a pharmacist management regarding the percentages of patients meeting American Diabetes Association (ADA) treatment goals for diabetes and specific Veterans Health Administration (VA) performance measures individually and in combination after 6 months of intervention. Methods: We retrospectively evaluated the electronic medical record of all new patients seen between October 1, 2007 and March 31, 2009, with an A1c >7%. Primary objectives included the percentages of patients meeting ADA treatment goals individually and in combination after 6 months in addition to the percentage meeting the 3 VA performance goals individually and in combination. Results: One-hundred and ninety-seven patients met inclusion criteria. There were 6% of patients who met all ADA goals and 79% who met all VA performance measure goals at study end. Individual goal analyses revealed 43% of patients at a goal A1c of <7%, 55% of patients were at low-density lipoprotein (LDL) goal, 45% of patients at systolic blood pressure (SBP) goal, and 51% of patients at diastolic blood pressure (DBP) goal. Evaluation for VA performance measures showed that 91% patients at goal for A1c, 55% at LDL goal, 70% at systolic BP goal, and 87% met diastolic BP goal. Conclusions: Six months of pharmacist intervention resulted in improvement in patients achieving ADA and VA performance measure goals individually and in combination.

Correlates of Dietary Intake in Youth with Diabetes: Results from the SEARCH for Diabetes in Youth Study

Objective To explore demographic, socioeconomic, diabetes-related, and behavioral correlates of dietary intake of dairy, fruit, vegetables, sweetened soda, fiber, calcium, and saturated fat in youth with diabetes. Methods Cross-sectional study of youth 10-22 years old with type 1 (T1DM, n = 2,176) and type 2 diabetes (T2DM, n = 365). Association of dietary intake, demographics, socioeconomic status, behavioral, and diabetes-related measures was explored with quantile regression. Results T1DM males had lower consumption of vegetables, fruit, and fiber, and higher consumption of soda and saturated fat than females ( P < .01). African Americans had lower dairy and higher soda intake than non-Hispanic T1DM whites ( P < .01). Soda consumption was higher in older T2DM youth than in younger participants ( P < .01). Lifestyle and physical activity patterns were also significantly associated with dietary intake. Conclusions and Implications Identified demographic and behavioral correlates may help dietitians to focus on groups of youth with diabetes who have lower adherence to a healthful diet. Diet counseling groups may be tailored according to these major determinants.

The Role of Disease Management in Diabetes Care

Approximately 16,600 health care professionals hold the title of certified diabetes educator (CDE).1 With > 24 million people living with diabetes in the United States,2 this translates into roughly one CDE for every 1,500 individuals with diabetes. Because of the chronic nature of diabetes and its associated complications, diabetes requires constant attention and regular follow-up. It is well documented that keeping blood glucose and blood pressure levels at near-normal levels significantly reduces diabetes-related complications.3,4 According to National Health and Nutrition Examination Survey data, the age-adjusted percentage of people achieving glycemic, blood pressure, and cholesterol targets (i.e., all three targets) increased from 7.0% in the period from 1999 to 2002 to 12.2% in the period between 2003 and 2006.5 Although the proportion of those achieving these three targets appears to be increasing, there remains a significant proportion of individuals with diabetes who fail to achieve recommended A1C, blood pressure, and cholesterol levels. Given the rapid rise of diabetes during the past several decades and the immense opportunity to improve diabetes-related measures, the need for health care professionals with diabetes expertise is crucial to improve the health of the population. In addition to specialized educator availability, other barriers that may limit the amount of preventive or follow-up care patients receive include cost of care, access to care (e.g., because of rural location or lack of transportation), appointment-scheduling constraints, time away from work, and low level of education.6 Disease management may be able to bridge some of this gap. In fact, a growing number of health plans are trying to manage their diabetes population through …