Mean A1C Levels Research Articles

Nurse-Led Mobile Phone Intervention to Promote Self-Management in Type 2 Diabetes in Ghana: A Randomized Controlled Trial.

The purpose of the study was to test the effectiveness of a nurse-led mobile phone intervention (NMPI) on glycemic variability and self-management among people living with type 2 diabetes (T2DM) in Ghana. In this randomized controlled trial, the intervention group received a 3-month NMPI program plus standard care, and the control group received standard care alone in a tertiary health care setting. Ninety-eight participants (baseline A1C > 7%) were randomized 1:1 to either NMPI or standard care group. The primary study outcomes were changes in A1C testing and self-management assessed using the Summary of Diabetes Self-Care Activities tool at baseline and end of the study. The intervention group had statistically significant improvement in their mean A1C level from baseline to the end of the study. In comparison, the control group also had improvement in their mean A1C level but was not statistically significant. Consistently, the intervention participants had better statistically significant improvements in self-management behaviors than the control group. There was a medium, negative correlation between A1C changes and overall self-care changes for the intervention group, whereas that of the control group was smaller. Study findings have shown that a tailored NMPI program in addition to standard care could improve glycemic variability and self-management among people living with poorly managed T2DM in Ghana better than standard care alone.

Effectiveness of Trained Community Lay Workers on Glycemic Control, Knowledge, and Self-Efficacy Among Agricultural Workers with Diabetes in the Texas Panhandle

Systemic health barriers, economic challenges, and lack of follow-up care exacerbate self-management of chronic diseases like diabetes among Hispanic agricultural workers. The primary objective of this pilot project was to determine the benefit of using community coaches to decrease A1C levels and increase diabetes knowledge among agricultural workers with diagnosed diabetes in the Texas Panhandle. A longitudinal study design with two phases was used to create, deliver, and evaluate a diabetes coaching program. Phase 1 was the development of the program and community coaches training (n = 4). In Phase 2, the coaches then delivered the program over 12 weeks to thirteen clients. Phase 1: All coaches were Hispanic females, 28.3 (SD 3.8) years of age, half had at most a high school education level and the other half had a vocational certification (n = 4). Mean DKQ-24 score was 54.2% (SD = 29.7) at baseline and 75.0% (SD = 31.4) after training (t (4) = 4.6, P < 0.05). We observed a very large difference between mean baseline and exit DKQ-24 scores relative to the pooled standard deviation, resulting in an effect size estimate of 0.59 indicative of a medium to large learning effect. Phase 2: Clients were Hispanic Spanish-speaking, predominantly female (55%), 44.4 (SD 6.8) years of age with at most a high school level of education (88.9%) and occupations varied from dairy farm worker (33.3%), meat processing worker (33.3%), and other agriculture or manufacturing position (33.3%). The mean SKILLD score was 40.0% (SD = 28.7) at baseline, increasing to 72.2% (SD = 25.4) at 12 weeks upon completion of the coaching program (t (9) = 2.956, P < 0.05). We observed a very large difference between mean baseline and exit SKILLD scores relative to the pooled standard deviation, resulting in an effect size estimate of 1.13 indicative of a large learning effect. The mean A1C levels at baseline screening was 8.3% (SD = 3.0) and 7.6% (SD = 3.0) at exit screening, representing a 0.7% decrease (p = 0.4730). No statistically significant differences were observed between depression (p = 0.786) or anxiety (p = 1.000) measures at baseline compared to exit. Training and coaching programs for hard-to-reach agricultural and meat processing workers must be culturally, linguistically, and literacy appropriate for both coaches and clients. The program must be feasible and sustainable, focus on empowering community members, capitalize on technological advances and persisting new-normals from the COVID-19 pandemic as well as dismantle common systemic barriers to health and understanding lived-experiences of agricultural working populations in rural regions.

A retrospective comparison between intensive and nonintensive insulin regimens in type 2 diabetes mellitus.

This study compared the outcomes between intensive and nonintensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type-2-diabetes-mellitus (T2DM) patients requiring insulin therapy. A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and nonintensive insulin therapy (79 patients) were conducted. No significant differences were found when the intensive and nonintensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the nonintensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively. Both intensive and nonintensive insulin therapies improved the baseline glycemic parameters but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.

1161-P: Patterns of Diabetes Distress (DD) and Glycemic Outcomes in Teens with Type 1 Diabetes (T1D)

Background: DD distracts from T1D self-management, contributing to suboptimal glycemia. Yet, DD can change day-to-day and over time. We compared A1c trends in teens with increasing vs. decreasing DD over time. Methods: At baseline, 6, 12, and 18 months, participants (N=301) ages 13-17 years completed the Problem Areas in Diabetes Survey—Pediatric scale; higher scores indicate more DD with ≥41 indicating elevated DD. We identified three trajectories: participants with low baseline DD, who then reported persistent high DD; participants with high baseline DD, who then had persistent low DD levels; all others. Mean A1c levels were compared at baseline and 18 months. Results: At baseline, participants (49% male, 78% white) were 15.0±1.3 years old with T1D duration 6.5±3.7 years; 59% used insulin pumps; 12% used CGM; A1c was 8.5±1.1%. Twenty-six participants (9%) had elevated DD at baseline and then low DD at subsequent time points; A1c did not change significantly from 0 to 18 months for these participants (p=.33). Thirty-five participants (12%) had low DD at baseline and then elevated DD at subsequent time points; A1c increased significantly from 0 to 18 months for these participants (p=.01). The remaining participants (n=240) had varying levels of DD with no significant change in A1C (p=.05). Conclusion: Adolescents who initially had low DD and reported increasing DD over time may be at risk for worsening glycemic outcomes. Disclosure K.Wentzell: None. L.J.Tinsley: None. L.K.Volkening: None. D.E.Mcgill: Employee; Vertex Pharmaceuticals Incorporated. B.J.Anderson-thomas: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. Funding National Institutes of Health (T32DK007260); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095273); JDRF (2-SRA-2014-253-M-B)

Effects of COVID-19 pandemic lockdown on the metabolic control of type 2 diabetes mellitus in patients.

The effects of the COVID-19 pandemic on the control of diabetes mellitus in patients are largely unknown. In this study we aimed to analyze the impact of the pandemic and the ensuing lockdown on the management of type 2 diabetes mellitus. A total of 7,321patients with type 2 diabetes mellitus (4,501 from the pre-pandemic period, 2,820 from the post-pandemic period) were studied retrospectively. The admission of patients with diabetes melitus (DM) decreased significantly during the pandemic (4,501 pre-pandemic vs. 2,820 post-pandemic; p < 0.001). The mean age of patients was statistically lower (51.5 ± 14.0 vs. 49.7 ± 14.5 years; p < 0.001), and the mean glycated hemoglobin (A1c) level was significantly higher (7.9% ± 2.4% vs. 7.3% ± 1.7%; p < 0.001) in the post-pandemic period than in the pre-pandemic. The female/male ratio was similar in both periods (59.9%/40.1% for pre-pandemic, 58.6%/41.4% for post-pandemic; p = 0.304). As calculated by month the pre-pandemic rate of women was higher only in January (53.1% vs. 60.6%, p = 0.02). Mean A1c levels were higher in the postpandemic period than in the same month of the previous year, excluding July and October (p = 0.001 for November, p < 0.001 for others). Postpandemic patients admitted to the outpatient clinic were significantly younger than prepandemic visits for July (p = 0.001), August (p < 0.001) and December (p < 0.001). The lockdown had detrimental effects on blood sugar management in patients with DM. Hence, diet and exercise programs should be adapted to home conditions, and social and psychological support should be provided to patients with DM.

CORRELATION OF DIABETES MELLITUS AND DYSLIPIDEMIA WITH OBESITY IN INFERTILE FEMALES: A CROSS SECTIONAL STUDY

Aims: To study the prevalence of infertility in obese or overweight females and its association with Dyslipidemia and Diabetes mellitus. Materials And Methods: The study was performed on 160 infertile women between age 18-45 years who attended Obstetrics and Gynaecology OPD and Medicine OPD in Swaroop Rani Hospital, Prayagraj.The duration of study was from December 2019 to March 2021.Patients were divided into lean/normal weight females and obese/overweight females based on BMI. Results: Out of total 200 patients 40 were excluded and remaining 160 were divided in two groups, Group 1: lean or normal weight infertile women(N1 =63) and Group 2: obese /overweight infertile women(N2= 97) Mean age of controls and cases were found to be comparable(31.54±2.82 vs 31.22±2.97 years) with p =0.50. Mean BMI of control group was found to be 20.23±1.39 kg/m2 as compared to cases with mean BMI 27.77±2.86 kg/m2 which was signicantly higher with p=&lt;.001. Mean W:H ratio in cases and controls was found to be 0.83±0.05 and o.74±0.04 respectively with p-value= &lt;0.001. Mean A1C levels in cases was signicantly higher than in the control group (5.91±0.91% vs 4.61±0.58%) with p=&lt;.001. Mean S, Triglycerides levels in cases was signicantly higher than in the control group. (160.4±96.9 vs 110.2±15.8) with p=&lt;.001. Mean S.Cholesterol levels in cases was signicantly higher than in the control group. (165.1±41.06 vs 100±22.1) with p=&lt;.001. Mean S.VLDL levels in cases was signicantly higher than in the control group (43.9±18.94 vs 54.9±14.07) with p=&lt;.001.Mean S.LDL levels in cases was signicantly higher than in the control group (64.16±22.4 vs 54.33±16.17) with p=&lt;.002. Mean S.HDL levels in control was higher than in the case group. (78.65±6.86 vs 40.77±12.83) with p=&lt;.001. Conclusion: The prevalence of obesity in infertile females at a tertiary care centre was 60.62 %. Positive association of obesity was found with dyslipidemia and diabetes mellitus(A1C -5.91±0.91% vs 4.61±0.58% with p=&lt;.001)in obese females. Most of the females were in the range of impaired glucose tolerance phase which could be reversed by dietary modication and early intervention

Marked Improvement in A1C Levels After Initiation of Intermittently Scanned Continuous Glucose Monitoring Is Maintained Over 4 Years in Patients With Type 1 Diabetes.

This study aimed to demonstrate the effectiveness of long-term use of intermittently scanned continuous glucose monitoring (isCGM) in adult patients with type 1 diabetes. In this retrospective real-world study, 689 patients with type 1 diabetes who were >18 years of age and using isCGM were identified from the electronic patient records in North Karelia, Finland. A1C data were collected before and after the initiation of isCGM. The primary outcome was a change in the mean A1C over time after isCGM started. The greatest reductions in the mean A1C levels were observed 6 months (-0.54% [-5.9 mmol/mol], P <0.001) and 12 months (-0.42% [-4.6 mmol/mol], P <0.001) after the initiation of isCGM. Reduction in A1C remained significant for 4 years, although the mean reduction in A1C was -0.18% (-2.05 mmol/mol) (P = 0.009) at 48 months compared with baseline. In a subgroup analysis, patients with a baseline A1C >9% (75 mmol/mol) benefited the most from initiation of isCGM (reduction -0.97% [-10.6 mmol/mol], P <0.001, at 12 months and -0.92% [-10.1 mmol/mol], P <0.001, at 48 months). Neither sex nor age at the start of isCGM were correlated with A1C reduction. Use of isCGM improves A1C levels significantly in adult patients with type 1 diabetes. Significant reduction in A1C persisted over 4 years of use, although the effect diminished over time.

The effect of laparoscopic sleeve gastrectomy on type 2 diabetes remission outcomes in patients with body mass index between 25 kg/m 2 and 32.5 kg/m 2

BackgroundThe effect of laparoscopic sleeve gastrectomy (LSG) in the treatment of type 2 diabetes (T2D) patients with body mass index (BMI is calculated by dividing weight in kilograms by height in meters squared) higher than 25 kg/m2 but lower than 32.5 kg/m2, especially in East Asian population characterized by abdominal obesity, are still unclear. This study aims to explore the effect of LSG in T2D patients with BMI higher than 25 kg/m2 but lower than 32.5 kg/m2. MethodsA total of 49 T2D patients with BMI(25–32.5 kg/m2) treated successfully with LSG were included in our study. The effect of LSG on T2D remission outcomes at 12 and 24 months after operation was analyzed. ResultsAll patients were treated successfully with LSG without conversion. The mean preoperative body weight,BMI, fasting plasma glucose, glycosylated hemoglobin (A1c) and fasting C-peptide were 81.7 ± 10.0 kg, 29.1 ± 2.4 kg/m2, 10.4 ± 3.9 mmol/L,8.2 ± 1.5%, and 2.3 ± 1.1 nmol/L,respectively.The age, duration of diabetes and ABCD score were 48.6 ± 9.6 years,6.6 ± 5.1 years, and 2.9 ± 1.5. The mean fasting plasma glucose,A1c, and C-peptide levels were significantly decreased at 12 and 24 months after operation. At postoperative 24 months, 18 out of 49 patients (36.7%) reached diabetes complete remission (A1c levels≤6.0%).14 out of 49 patients (28.6%) reached partial remission (6.0% < A1c levels<6.5%). 8 out of 49 patients (16.3%) reached notable improvement (6.5% < A1c levels<7%). At 24 months after LSG, the complete remission rate of T2D patients with a BMI of 25–27.5 kg/m2 was 35.3%, the complete remission rate of patients with a BMI of 27.5–30 kg/m2 was 11.1%, and the complete remission rate of patients with a BMI of 30–32.5 kg/m2 was 47.8%.At postoperative 24 months, the complete remission rate of T2D patients with ABCD score≤2 was 5.0%, the complete remission rate of patients with ABCD score 3 to 4 was 52.4%, and the complete remission rate of patients with ABCD score≥5 was 75.0%. ConclusionOur study demonstrates that LSG could result in a significant effect on T2D in patients with BMI 30–32.5 kg/m2. In addition, our study indicates that higher ABCD score can predict a better diabetes remission outcome in diabetes patients with BMI ≤32.5 kg/m2.

Real-World Effectiveness of Once-Weekly Semaglutide From a US Commercially Insured and Medicare Advantage Population

PurposePatients managing type 2 diabetes mellitus (T2DM) often require combination therapy to meet their blood glucose control targets. With limited real-world evidence focused on the use of glucagon-like peptide 1 receptor agonist (GLP-1RA) therapies, the objective of this study was to describe the association between semaglutide once weekly (OW) initiation and changes in hemoglobin A1c (A1c) levels. MethodsThis retrospective, descriptive cohort study used the HealthCore Integrated Research Environment (HIRE) to examine commercially insured and Medicare Advantage patients who had T2DM while taking semaglutide OW from December 1, 2017, to April 30, 2019. The first semaglutide OW prescription fill was defined as the study index date. Changes in mean A1c levels and A1c target attainment were evaluated among an intention-to-treat (ITT) population (overall group). Furthermore, a persistent population (PP) analysis on the same outcomes was performed that was limited to ITT patients who were observed to continue to use semaglutide OW at the time of the postindex A1c measurement. In addition, these outcomes were explored in patients stratified based on prior use of GLP-1RA therapy (experienced vs naive) and baseline A1c values >9% (75 mmol/mol). FindingsA total of 1888 patients were identified in the overall ITT group. The mean change in the overall ITT group between preindex and postindex A1c values was −0.9% percentage points (−9.8 mmol/mol) (mean preindex A1c, 8.2% [66.1 mmol/mol]) and −1.1 percentage points (−12.0 mmol/mol) (mean preindex A1c, 8.2% [66.1 mmol/mol]) in the PP subgroup (all P < 0.001). Among the subgroup of patients with a baseline A1c value >9% (75 mmol/mol), percentage point changes in A1c were −2.2 (−24.0 mmol/mol) and −2.4 (−26.2 mmol/mol) (all P < 0.001). When accounting for prior GLP-1RA use, the GLP-1RA–naive stratum had double the mean reduction in A1c compared with the GLP-1RA–experienced stratum (−1.2 [−13.1 mmol/mol] vs −0.6 [−6.6 mmol/mol] percentage points). ImplicationsSemaglutide OW is associated with clinically and statistically significant A1C reduction and increases in reaching A1 targets using real-world data, even in GLP-1RA–experienced patients, despite more frequent use of insulin or sodium glucose transport protein 2 inhibitors in this group. Target A1c attainment significantly increased overall and within all subgroups and strata, with approximately half of all patients attaining an A1c value <7% (53 mmol/mol) and three-quarters attaining an A1c value <8% (64 mmol/mol).

Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial.

The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

A retrospective comparison between intensive and non-intensive insulin regimens in type 2 diabetes mellitus

Background This study compared the outcomes between intensive and non-intensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type 2 diabetes mellitus (T2DM) patients requiring insulin therapy. Methods A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and non-intensive insulin therapy (79 patients) were conducted. Results No significant differences were found when the intensive and non-intensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the non-intensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively. Conclusions Both intensive and non-intensive insulin therapies improved the baseline glycemic parameters, but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.

The effect of metabolic control, self-efficacy, and quality of life on emotional eating in the adolescents with type 1 diabetes mellitus

The purpose was to investigate the effects of metabolic control, self-efficacy, and quality of life on emotional eating in the adolescents with type 1 diabetes mellitus. This was a descriptive, cross-sectional, and correlational study. A total of 107 adolescents participated. Data were collected using the Pediatric Quality of Life Inventory™ 3.0 Diabetes Module, the Diabetes Management Self-Efficacy Scale, and the Emotional Eating Scale. The relationships among emotional eating, metabolic control, self-efficacy, and quality of life were assessed using bivariate correlation analyses. Multiple regression analysis was used to analyze the data. The adolescents with diabetes ranged in age from 11 to 18 years. The mean duration of diabetes was 5.42 ± 3.35 years. Mean A1C levels were 9.29 ± 1.38%, far above the recommended level. When the correlation between emotional eating and self-efficacy was studied in the adolescents, there was a significant positive moderate correlation of self-efficacy with emotional eating. There was a significant negative moderate correlation between quality of life and emotional eating, but no significant correlation between A1C and emotional eating. As a result of the study, it was found that self-efficacy and quality of life of adolescents with type 1 diabetes have an effect on emotional eating, while A1C values of adolescents have no effect on emotional eating. In future studies, it is recommended to add other factors that may affect the emotional eating behaviors of adolescents with diabetes and also to make different studies with a higher number of samples.

Evaluating the impact of onsite diabetes education teams in primary care on clinical outcomes

BackgroundTo evaluate the impact of integrating diabetes education teams in primary care on glycemic control, lipid, and blood-pressure management in type 2 diabetes patients.MethodsA historical cohort design was used to assess the integration of teams comprising nurse and dietitian educators in 11 Ontario primary-care sites, which delivered individualized self-management education. Of the 771 adult patients with A1C ≥ 7% recruited, 487 patients attended appointments with the diabetes teams, while the remaining 284 patients did not. The intervention’s primary goal was to increase the proportion of patients with A1C ≤7%. Secondary goals were to reduce mean A1C, low-density lipoprotein, total cholesterol-high density lipoprotein, and diastolic and systolic blood pressure, as recommended by clinical-practice guidelines.ResultsAfter 12 months, a higher proportion of intervention-group patients reached the target for A1C, compared with the control group. Mean A1C levels fell significantly among all patients, but the mean reduction was larger for the intervention group than the control group. Although more intervention-group patients reached targets for all clinical outcomes, the between-group differences were not statistically significant, except for A1C.ConclusionsNurse and dietitian diabetes-education teams can have a clinically meaningful impact on patients’ ability to meet recommended A1C targets. Given the study’s historical cohort design, results are generalizable and applicable to day-to-day primary-care practice. Longer follow-up studies are needed to investigate whether the positive outcomes of the intervention are sustainable.

Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients

Abstract Background Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. So, screening is helpful for early diagnosis. Objectives The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Methods The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. All selected patients have been subjected to ABI assessment using the Doppler. It was found that the prevalence of PAD among ESRD patients is 26% of which 80.8% had bilateral PAD and 19.2% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD than males. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was &amp;gt; 5.3. Conclusion Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level &amp;gt; 5.3 is significantly correlating with the risk of PAD.

Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients

Abstract Background Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. so, screening is helpful for early diagnosis. Objectives The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Aim of Study The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Patients and Methods The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. Patients who refused the test, above 60 years old, or diabetic have been excluded from the study. All selected patients have been subjected to complete history taking, full clinical examination including extremities examination, Lab workup including; CBC, liver function test, kidney function test, A1C level, lipid profile, Resting 12 lead ECG, Echocardiography to assess systolic function, valvular disease, and resting SWMA, and ABI assessment using the Doppler. Patients then were divided into two groups; control group who has negative PAD with ABI &amp;gt; 0.9 and study group who has PAD with ABI ≤ 0.9. Results It was found that the prevalence of PAD among ESRD patients is 26%. Regarding the laterality; 21% had bilateral PAD and the rest 5% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD that males. 55% of patients were females and the other 45% were males. 36.4% of females studied had positive ABI but only 13.3% of studied males found positive for PAD. The p value was 0.017. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was &amp;gt; 5.3. This means that patients who have A1C &amp;gt; 5.3 should be paid more attention and be screened because they have higher risk to develop PAD. Conclusion Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level &amp;gt; 5.3 is significantly correlating with the risk of PAD.

The impact of a pharmacist-driven, collaborative practice on diabetes management in an Urban underserved population: a mixed method assessment

ABSTRACTThe objective of this manuscript is to describe the results of a pharmacist-driven, Type 2 diabetes targeted, collaborative practice within an urban, underserved federally qualified health center. Pharmacists within a primary care team managed patients with chronic illnesses utilizing a collaborative practice agreement. Pharmacists, pharmacy residents, and supervised students provided care for patients with Type 2 diabetes. The first visit incorporated past medical history, medication reconciliation, determination of adherence and patient knowledge of diabetes pathophysiology, care plan, including diet and exercise, medications, and possible complications. Pharmacists had the authority to optimize medications and order laboratory tests and referrals. Diabetes, hypertension, and medication use outcomes data were collected and analyzed to assess the impact of clinical pharmacy services. Patient and provider satisfaction were assessed via surveys and focus group interviews. Ninety-nine patients were included in the evaluation. The mean A1c level was 9.8% at baseline and 8.4% at follow-up (p< .05). There were significant improvements in patient attainment of A1c <9%, ACE Inhibitor/angiotensin receptor blocker and statin use, and tobacco cessation at follow-up (p< .05). Eleven providers who responded to the satisfaction survey answered 73% of the questions with strongly agree. The seven patients who participated in the satisfaction survey, and focus group were satisfied with the care they received from the pharmacists. The focus group highlighted similar personal goals, barriers, and interests in nutrition education. Working as part of a collaborative care team, pharmacists were able to have a significant impact on improving the health outcomes of patients with Type 2 diabetes and patient and provider perceptions of the vital role of pharmacists.

Factors Impacting Adherence to Diabetes Medication Among Urban, Low Income Mexican-Americans with Diabetes.

Mexican-Americans carry a high burden of type 2 diabetes and are disproportionately affected by diabetes related mortality and morbidity. Poor adherence to medication is an important barrier to achieving metabolic control and contributes to adverse health outcomes and health disparities. Little is known about barriers and facilitators to medication adherence among Mexican-Americans with diabetes. This is a qualitative study of semi-structured interviews with a sample of 27 adults (25 Mexican-Americans and 2 Latinos of other origin) with self-reported type 2 diabetes who were recruited as part of a church-based, randomized controlled trial for diabetes self-management education in a low-income, immigrant neighborhood of Chicago. Face-to-face, in-depth interviews were conducted (one in English and 26 in Spanish), audio-recorded, transcribed verbatim, and professionally translated. Systematic qualitative methods were used to analyze interviews. All 27 participants were Latino, and 25 were of Mexican descent. Participants' mean age was 57 years, 81% were female, 69% had an annual income less than $20,000 and 48% had no health insurance. Mean A1C level was 8.6% and mean systolic blood pressure was 125mmHg. The majority of participants (85%) reported using oral diabetes medication and 35% reported taking insulin. 76% reported being affiliated with one of the two partnering catholic churches based in the South Lawndale neighborhood of Chicago, also known as Little Village. Concerns regarding effectiveness and negative impact of diabetes medication were prevalent and expressed by 13 (48%) of 27 participants. Dissatisfaction with ineffective provider communication and not being able to pay for medication were other important barriers to adherence and were expressed by 7% and 11% of participants, respectively. Family support, for example, family members assisting in organizing medications in boxes and reminding participants to take them, was reported by 15% of participants and emerged as an important facilitator to medication adherence. There is a gap in research on factors influencing adherence to diabetes medication among Mexican-Americans. Our study suggests that concerns regarding negative impact of diabetes medication and concerns regarding effectiveness are prevalent barriers to adherence. These barriers can be addressed through educational efforts targeting patients and clinicians by specifically including content on beliefs that lead to poor adherence in diabetes self-management interventions for patients and continuing medical education for providers and by developing interventions that engage family members as a support system for medication adherence.

Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry.

The purpose was to test associations among stressful life events, frequency of missed insulin doses, and glycemic control in young adults with type 1 diabetes (T1D). The study was a cross-sectional descriptive secondary analysis. Data from 2,921 participants (ages 18-26 years) in the U.S. T1D Exchange Clinic Registry were analyzed. Report of a stressful life event was defined as one or more positive responses on a 17-item stressful life events index and defined as a dichotomous variable (yes or no). Frequency of missed insulin doses was measured using a single self-report item and collapsed into two levels (fewer than three times a week, three or more times a week). The glycosylated hemoglobin (A1c) level recorded at the time of enrollment was used to assess glycemic control. Nearly half (48.6%) of the participants reported having a stressful life event during the previous year. The most frequently reported stressful life events were problems at work or school (16.1%), serious arguments with family members or a close friend (15.2%), and financial problems in the family (13.8%). Compared to the participants not reporting stressful life events, those who reported stressful life events were more likely to be older, female, with a higher educational attainment level, and not working or unemployed. Those who reported a stressful life event were more likely than those who did not to say they typically missed insulin doses at least three times a week and less likely to say they typically missed insulin doses fewer than three times a week (p < .001 adjusted for age, sex, race or ethnicity, educational attainment level, duration of T1D diagnosis, and insulin delivery method). Mean A1c level was higher for the group who reported having a stressful life event in the past 12 months compared to the group who did not (8.7 ± 1.8% vs. 8.2 ± 1.6%; adjusted p < .001). The results of a mediation analysis suggest that the measure of frequency of missed insulin doses may be a mediator of the relationship between recent stressful life events and glycemic control (Sobel test: ab = .841, 95% confidence interval = 0.064-1.618). These findings suggest that, for young adults with T1D, the experience of stressful life events may increase their risk for poorer glycemic control, possibly by disrupting adherence with insulin doses. Further exploration of these relationships may allow for the potential for identifying those at risk and assisting them with more positive approaches to managing stressful events.

Improved Diabetes Control Using SMBG Pattern Management in High-Risk Minorities (HRM)

SMBG in a diabetes education program improves T2D outcomes. This study was done to evaluate if use of SMBG taught by clinical pharmacists or Certified diabetes educators improved A1C compared to diabetes classes and medication review in HRM. A pretest-posttest format was used. Subjects (n=807) were referred by providers from 5 federally qualified health centers and a practice group. HEDIS measures collected included: A1C, BP, FPG, BMI, total cholesterol (TC), LDL-C, HDL-C, and TGs. Subjects received a validated knowledge test initially, 3 months after taking a diabetes class and at study end. A psychosocial inventory was collected initially and at study end. This multi-component model was a four-arm study comparing Diabetes Classes (DC), Pharmacist Medication Management (MTM), Pattern Management (PM) using a glucose meter data management system, and control subjects who did not participate (Ctl). Subjects had at least two interventions prior to assignment to PM. 258 subjects attended the diabetes classes, 71 in the MTM arm, 44 in the PM arm, and 138 Ctls. 296 were lost due to incomplete and/or lost data. Demographics revealed 77% in the 20-64 years old range, 21% in the &amp;gt;65 age group, and 16% in the &amp;lt;20 age group, with 65% female subjects. The mix was 86% non-Hispanic black and 13% non-Hispanic white. 60% of subjects were on Medicare/Medicaid, 30% employer-insured, and 16% uninsured. Mean A1C levels in the DC group decreased from 7.93 to 7.60, 8.06 to 7.32 in the MTM group, 7.70 to 7.28 in the PM group, while Ctls increased from 7.00 to 7.36. The PM group had the greatest mean changes in multiple measures including BMI, BP, FP, TC, and TG. The MTM group had the greatest improvement in A1C. Conclusions: The PM group had the largest changes in overall measures of T2D control. There was increased diabetes knowledge and reduced ER visits. Thus, in HRM using PM from SMBG, the improvements suggested better monitoring of multiple metrics of relevance in T2D control. Disclosure I. Myers: None.

The relationship of health literacy to diabetes status differs by sex in older adults

ObjectiveLower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex. Research design and methodsWe performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose). ResultsAmong participants in the Health ABC cohort, 429 had diabetes. Mean age was 76years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p=0.02). Similar results were seen among women (14.7% versus 6.1%, p<0.01). In a model adjusting for age, race, income, education, BMI, smoking, and alcohol use, women with low versus high health literacy had a two-fold higher likelihood of diabetes (OR=2.2; 95% CI 1.1–4.3). No significant relationship was observed in men. Progressively lower categories of health literacy were associated with higher age-adjusted mean A1C and fasting blood glucose levels in women (both p for trend <0.01) but not men. ConclusionsIn this large, ethnically diverse sample of community-dwelling older adults, lower health literacy level is related to a greater likelihood of diabetes and higher A1C and fasting blood glucose levels in women–but not in men–after adjusting for age, race, and other demographic and lifestyle factors. Future studies are needed to assess mechanisms underlying this relationship and if interventions to improve health literacy are effective in reducing the burden of diabetes, particularly in women.