Odds Of Poor Glycemic Control Research Articles

PHS5 - Impact of a pharmacy-based diabetes management program on glycemic control in an inpatient general medicine population

A pharmacy-based inpatient diabetes management program was evaluated to determine if improved glycemic control could be achieved in a general medicine patient population. A retrospective chart review of 151 patients with blood glucose (BG) values outside the range 70-180 mg/dL was conducted. Observations for the baseline group (n=84) were derived from July 2010 and for the intervention group (n=67 ) in October 2010. The odds of poor glycemic control for patients in the intervention versus baseline groups were assessed by multivariate generalized estimating equations. These methods were also used to assess patient characteristics associated with poor glycemic control. Across all patients, no evidence was observed indicating the pharmacy program decreased the proportion of days spent out of the targeted blood glucose range [70-180 mg/dL: OR 0.91 (95% CI: 0.83 – 1.02); 70-250 mg/dL: OR 1.03 (95% CI: 0.88 – 1.24)]. However, the subgroup of patients whose admission blood glucose was less than 200 mg/dL (55% of intervention group) experienced a significant reduction in days out of range for both ranges [70-180 mg/dL (OR: 0.72, 95% CI: 0.61– 0.88) and 70-250 mg/dL (OR: 0.5, 95% CI: 0.33 – 0.71)]. No improvement in glycemic control was observed in patients with an admission BG 200 mg/dL or greater. These patients had more disease- and social-related factors associated with poor glycemic control. A subpopulation, patients whose admission glucose was less than 200 mg/dL, experienced improvement in glycemic control in the pharmacy-based program. The remaining patients were generally more complicated from a disease-state and social perspective and experienced no improvement. These patients may require a more intense, multi-disciplinary approach that is better matched to the constellation of factors responsible for their condition.

Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence.

Youth with type 1 diabetes mellitus are at risk for poor glycemic control as they age into adulthood. The aim of this study was to describe sociodemographic and clinical correlates of poor glycemic control associated with the transfer of care from pediatric to adult diabetes providers among a cohort of youth with type 1 diabetes diagnosed in adolescence. Analyses included 185 adolescent participants with recently diagnosed type 1 diabetes in the SEARCH for Diabetes in Youth Study with pediatric care at baseline who were age ≥18 years at follow-up. Demographic and clinical factors were measured by survey and laboratory results. Survival analysis was used to estimate the age of transition. Logistic regression analysis assessed the association of demographic and clinical factors with the transition of care and poor glycemic control at follow-up. Fifty-seven percent of participants had transitioned to adult diabetes care providers by the follow-up visit. The estimated median age of transition of care was 20.1 years (95% confidence interval 19.8-20.4). Older age, lower baseline glycosylated hemoglobin, and less parental education were independently associated with increased odds of transition. The odds of poor glycemic control at follow-up were 2.5 times higher for participants who transitioned to adult care compared with those who remained in pediatric care. Transferring from pediatric to adult care, experienced by more than half the sample, was associated with an increased risk of poor glycemic control at follow-up. These findings suggest that young adults need additional support when moving to adult care.

Risk factors for hospital-acquired ‘poor glycemic control’: a case–control study

To determine the patient and hospital characteristics associated with severe manifestations of 'poor glycemic control'-a 'no-pay' hospital-acquired condition defined by the US Medicare program based on hospital claims related to severe complications of diabetes. A nested case-control study. California acute care hospitals from 2005 to 2006. All cases (n= 261) with manifestations of poor glycemic control not present on admission admitted to California acute care hospitals from 2005 to 2006 and 261 controls were matched (1:1) using administrative data for age, sex, major diagnostic category and severity of illness. The adjusted odds ratio (OR) for experiencing poor glycemic control. Deaths (16 vs. 9%, P= 0.01) and total costs ($26,125 vs. $18,233, P= 0.026) were significantly higher among poor glycemic control cases. Risk-adjusted conditional logistic regression revealed that each additional chronic condition increased the odds of poor glycemic control by 12% (OR: 1.12, 95% CI: 1.04-1.22). The interaction of registered nurse staffing and hospital teaching status suggested that in non-teaching hospitals, each additional nursing hour per adjusted patient day significantly reduced the odds of poor glycemic control by 16% (OR: 0.84, 95% CI: 0.73-0.96). Nurse staffing was not significant in teaching hospitals (OR: 0.98, 95% CI: 0.88-1.11). Severe poor glycemic control complications are relatively rare but meaningful events with disproportionately high costs and mortality. Increasing nurse staffing may be an effective strategy in reducing poor glycemic control complications particularly in non-teaching hospitals.

Language Barriers, Physician-Patient Language Concordance, and Glycemic Control Among Insured Latinos with Diabetes: The Diabetes Study of Northern California (DISTANCE)

BACKGROUNDA significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown.OBJECTIVETo assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician.DESIGNCross-sectional, observational study using data from the 2005–2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%).KEY RESULTSThe unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53–1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04–2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03–3.80).CONCLUSIONSLanguage barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent predictor for poor glycemic control among insured US Latinos with diabetes, an association not observed when care is provided by language-concordant physicians. Future research should determine if strategies to increase language-concordant care improve glycemic control among US Latinos with LEP.

Longitudinal Differences in Glycemic Control by Race/Ethnicity Among Veterans With Type 2 Diabetes

To examine longitudinal differences in glycemic control between non-Hispanic white and non-Hispanic black veterans with type 2 diabetes. Retrospective cohort study. VA facility in the Southeastern United States. A 3-month person-period dataset was created for 8813 veterans with type 2 diabetes between June 1997 and May 2006. Primary outcome was mean change in hemoglobin A1c (HbA1c) over time. Secondary outcome was the odds of poor glycemic control over time (HbA1c >8%). For the primary outcome, a linear mixed model (LMM) approach was used to model the relationship of HbA1c levels and race/ethnicity over time. For the secondary outcome, generalized LMMs were used to assess whether glycemic control changed over time and whether change in glycemic control varied by racial/ethnic group. Mean age was 66.3 years, 36% were non-Hispanic black (NHB), 98% were male, 65% were married, and 50% were unemployed. Mean follow-up time was 4.4 years. Least square mean HbA1c levels from LMM adjusted for time and relevant confounders showed that NHBs had higher HbA1c values over time (mean difference of 0.54% [P < 0.001]). The final model with poor versus good glycemic control as the dependent variable, race/ethnicity as primary independent variable adjusted for time, and relevant confounders showed that NHBs were likely to have poor control compared with NHWs (OR: 1.8, 95% CI, 1.7; 2.0, P < 0.0001). NHB veterans were more likely to have higher mean HbA1c values and less likely to have good glycemic control over time compared with NHW veterans.

Factors associated with poor glycemic control among patients with Type 2 diabetes

Objectives Determine factors associated with poor glycemic control among Jordanian patients with Type 2 diabetes. Methods A systematic random sample of 917 patients was selected from all patients with Type 2 diabetes over a period of 6 months in 2008. A prestructured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviours, medication adherence, barriers to adherence, and attitude towards diabetes. Weight, height, and waist circumferences were measured. All available last readings of hemoglobin A1c (HbA1c), fasting blood sugar measurements and lipid were abstracted from patients' records. Poor glycemic control was defined as HbA1c ≥7%. Results Of the total 917 patients, 65.1% had HbA1c ≥7%. In the multivariate analysis, increased duration of diabetes (>7 years vs. ≤7years) (OR=1.99, P≤.0005), not following eating plan as recommended by dietitians (OR=2.98, P≤.0005), negative attitude towards diabetes, and increased barriers to adherence scale scores were significantly associated with increased odds of poor glycemic control. Conclusion The proportion of patients with poor glycemic control was high, which was nearly comparable to that reported from many countries. Longer duration of diabetes and not adherent to diabetes self-care management behaviors were associated with poor glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence to treatment regimen would be of great benefit in glycemic control.

Macronutrient intake and glycemic control in a population-based sample of American Indians with diabetes: the Strong Heart Study

Background: Little research has explored the association of macronutrient intake and glycated hemoglobin (HbA1c) in adults with diabetes.Objective: The objective of the study was to examine the cross-sectional association between macronutrient intake and HbA1c in diabetic American Indians.Design: A total of 1284 participants aged 47–80 y who had diabetes for ≥1 y at the second examination (1993–1995) of the Strong Heart Study were included in this study. Dietary intake was assessed by using a 24-h recall. Logistic regression models were used to evaluate the odds of poor glycemic control (HbA1c ≥ 7%) among sex-specific quintiles of macronutrient intake, after adjustment for the possible confounders age, sex, study center, body mass index, duration of diabetes, diabetes treatment, smoking, alcohol drinking, total energy intake, and physical activity.Results: Higher total fat (>25–30% of energy), saturated fatty acids (>13% of energy), and monounsaturated fatty acids (>10% of energy) and lower carbohydrate intake (<35–40% of energy) were associated with poor glycemic control. Lower fiber intake and higher protein intake were marginally associated with poor glycemic control (P for trend = 0.06 and 0.09, respectively). No significant association was found between polyunsaturated fatty acids or trans fatty acids and glycemic control in this population.Conclusions: These data suggest that a higher consumption of total fat and saturated and monounsaturated fatty acids and a lower intake of carbohydrates are associated with poor glycemic control in diabetic American Indians. Clinical trials focusing on whether modifications of macronutrient composition improve glycemic control in persons with diabetes are needed.

Predictors of poor glycemic control in adult with type 2 diabetes in South-Eastern Nigeria.

The study investigated predictors of poor glycemic control in type 2 diabetes (T2DM). Data on demographics, anthropometric and clinical parameters were collected in a cross-section survey from 140 adults with T2DM, using standard tools/instruments. Glycated hemoglobin (A1C) was assessed as a measure of glycemic control. Majority (83.3%) had poor glycemic control status of which about 95% constitute the elderly. The elderly (OR= 5.90, 95% Cl: 1.66-20.96) were more likely associated with poor glycemic control than the non-elderly (p = 0.006). Adjustment for significant predictor variables: Age, waist-hip ratio (WHR), Fasting plasma glucose (FPG) and Systolic blood pressure (SBP), although attenuated the odds (OR= 5.00, 95% CI: 1.19-20.96) of poor glycemic control, it still remained significantly (p = 0.028) higher in the elderly. Patients outside tight FPG control significantly (p = 0.001) showed poor glycemic cotrol than those within tight FPG (OR= 17.39, 95%Cl: 5.83-51.90), even with attenuated OR (OR= 10.85, 95%Cl: 3.10-37.96) and (OR=12.08, 95%Cl: 3.64-40.09) when non-significant and significant predictor variables were accounted for, respectively. Age, WHR, FPG, and SBP were significantly associated with differences in glycemic control. The elderly and FPG outside tight control showed significantly increased odds of poor glycemic control status.