Type 2 Diabetes Mellitus Respondents Research Articles

Association of Health Literacy and Nutritional Status Assessment with Glycemic Control in Adults with Type 2 Diabetes Mellitus.

While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m2) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R2 = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.

Consumption of Purple Soy Tofu in Improving Hyperglycemia Condition and Nutritional Intake to Type-2 Diabetes Mellitus Respondents

Diabetes Mellitus (DM) is a chronic metabolic disorder disease, caused by the insufficiency and ineffectiveness of insulin utilizing and then result in insulin resistance. This study purposed to identify the effect of purple tofu intervention, which made from black soybean in improving hyperglycemic conditions and nutritional intake of type 2 diabetes mellitus (T2DM). An intervention of purple soy tofu was performed for 28 days with 20 subjects, divided into two groups (control and treated group), and selected purposively. Eighty-five grams of tofu was served with additional vegetable broth in the intervention group, while people in the control group did not accept any treatment. There was a significant improvement in hyperglycemia and nutritional intake of diabetics (p &lt;0.05) at the end of the intervention. Analysis of fasting blood glucose levels of respondents to purple tofu decreased from 224.7±92.45 to 170.2±68.15; plasma insulin levels increased from 0.29±0.08 to 0.39±0.11. Our findings suggested that purple tofu interventions improved the condition of hyperglycemia in T2DM respondents through the elevating of plasma insulin levels.

Association of Weight Loss and Medication Adherence Among Adults With Type 2 Diabetes Mellitus: SHIELD (Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes)

BackgroundAdherence to prescribed diabetes medications is suboptimal, which can lead to poor glycemic control and diabetic complications. Treatment-related weight gain is a side effect of some oral antidiabetic agents and insulin, which may negatively affect adherence to therapy. ObjectiveThis study investigated whether adults with type 2 diabetes mellitus (T2DM) who lost weight had better medication adherence than those who gained weight. MethodsWeight change over 1 year (2007 to 2008) was assessed among respondents in the US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Weight loss of >1.0%, ≥3%, and ≥5% of weight was compared with weight gain of ≥1.0%. Medication adherence was assessed using the Morisky 4-item questionnaire for medication-taking behavior, with lower scores representing better adherence. ResultsThere were 746 T2DM respondents who lost >1.0%, 483 who lost ≥3%, 310 who lost ≥5%, and 670 who gained ≥1.0% of weight. Each weight-loss group had significantly lower Morisky scores than the weight-gain group; mean scores of 0.389 versus 0.473 (P = 0.050) for the >1.0% weight-loss group, 0.365 versus 0.473 (P = 0.026) for the ≥3% weight-loss group, and 0.334 versus 0.473 (P = 0.014) for the ≥5% weight-loss group. Significantly fewer respondents who lost weight had received insulin, sulfonylurea, or thiazolidinedione therapy (57%) compared with respondents who gained weight (64%) (P = 0.002). Demographics, exercise habits, and dieting were similar between weight-loss and weight-gain groups. ConclusionsT2DM respondents with weight loss had significantly better medication adherence and were less likely to be on treatment regimens that increase weight than T2DM respondents with weight gain. These findings suggest that strategies that lead to weight loss, including use of diabetes medications associated with weight loss, may improve medication adherence.

Abstract 50: Cardiovascular Event Rates Among Adults with Type 2 Diabetes Mellitus at Risk of Cardiovascular Events in the Large Population-based Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD)

Objectives: This study ascertained the incidence and time to first non-fatal myocardial infarction (MI), stroke, heart bypass surgery, or angioplasty among adults with type 2 diabetes mellitus (T2DM) at high risk for cardiovascular disease (CVD) over 3 and 5 years using a large US population based study. Methods: A retrospective cohort study used data from the US population-based SHIELD, a 5-year prospective survey-based study of adults with and without T2DM. Respondents with T2DM were stratified into 2 cohorts: (1) established CVD cohort, with age ≥40 years, prior MI, prior stroke, atherosclerosis, or peripheral vascular disease, and (2) multiple risk factors cohort (men ≥55 years and women ≥60 years and ≥1 risk factors of hyperlipidemia, hypertension, currently smoking, without prior history of CVD). Proportion of respondents self-reporting a new MI, stroke, angioplasty, or heart bypass surgery was calculated and multivariate discrete logistic hazards models for 3 and 5 years of follow-up were developed. Results: Among 2122 T2DM respondents, 56.5% had established CVD (mean age = 65 years, 45% male); 43.5% had no established CVD but multiple risk factors (mean age = 68 years, 49% male). The established CVD cohort had a new MI, stroke, or revascularization event rate of 26.3% during a 3 year follow-up period and 31.2% during the 5 years of follow-up. For the multiple risk factors cohort, 18.8% within 3 years and 26.0% within 5 years had an incident MI, stroke, or revascularization. After adjusting for gender, age, obesity, duration of diabetes, and comorbidities, the risk of incident MI was 2.1 times higher (95% CI: 1.6-2.8) within 3 years and 1.9 times higher (1.5-2.4) within 5 years of follow-up among the established CVD cohort than multiple risk factors cohort (p&lt;0.001). Risk of incident stroke was 2.2 (1.4-3.5) and 1.8 (1.2-2.7) times higher within 3 and 5 years, respectively, after adjustment among the established CVD cohort than multiple risk factors cohort (p &lt;0.01). Risk of incident heart bypass surgery was 2.6 (1.7-4.2) and 2.5 (1.7-3.8) times higher, and risk of incident angioplasty was 3.9 (2.7-5.9) and 3.2 (2.3-4.5) times higher within 3 and 5 years, respectively, among the established CVD cohort than multiple risk factors cohort (p &lt;0.001). Conclusions: T2DM individuals at risk for CVD events had significant incidence of MI, stroke, and revascularization in this large US population-based study. T2DM adults with established CVD are at higher risk of CVD events than those with no CVD but have multiple risk factors.

Self-reported hypoglycemia and impact on quality of life and depression among adults with type 2 diabetes mellitus

AimsThis study evaluated the rate of self-reported hypoglycemia and examined the association of hypoglycemia with quality of life and depression among adults with type 2 diabetes mellitus (T2DM). MethodsRespondents to the 2008 US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) survey were asked the number of times they experienced hypoglycemia in the past 4 weeks and past 12 months. Respondents also completed the short form-12 (SF-12) questionnaire and the patient health questionnaire (PHQ-9). T2DM respondents reporting at least 1 hypoglycemic episode were compared with T2DM respondents who did not report hypoglycemia in the previous 12 months. ResultsOf 2718 T2DM respondents, 23% reported experiencing hypoglycemia in the past 12 months. Respondents reporting hypoglycemia (n=627) had significantly lower (p<0.001) SF-12 scores for both physical health (mean±SD: 37.4±12.7 versus 40.9±12.7) and mental health (50.1±11.7 versus 52.4±10.1) compared with those without hypoglycemia (n=2091). Mean PHQ-9 scores were significantly higher (p<0.001) among respondents reporting hypoglycemia (5.2±5.8), compared with respondents who did not report hypoglycemia (3.9±5.0), indicating greater depression burden. ConclusionSelf-reported hypoglycemia was prevalent among individuals with T2DM and associated with lower health-related quality of life, and greater burden of depression.

Change in health status (EQ-5D) over 5 years among individuals with and without type 2 diabetes mellitus in the SHIELD longitudinal study

BackgroundHealth-related quality of life studies among adults with type 2 diabetes mellitus, using the EQ-5D, have been short term and have not assessed change over years. This study assessed the change in health status and health-related quality of life over 5 years among individuals with and without diabetes.MethodsRespondents to the US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) completed the EuroQol-5D (EQ-5D) at baseline (2004) and 5 years later (2009). Visual analog scale (VAS) score and health index score were computed at baseline and year 5, and the change over 5 years was measured for individuals with type 2 diabetes mellitus (T2DM) and those without diabetes, and T2DM adults with and without diabetic complications. Linear regression models were used to determine change in EQ-5D score, controlling for age, gender, race, education, household income, and body mass index (BMI).ResultsThere was significantly greater decline in the EQ-5D index score in the T2DM group (-0.031 [SD 0.158]), compared with those without diabetes (-0.016 [0.141], p = 0.001). Compared with respondents without diabetes, those with T2DM had a larger reduction in EQ-5D index score, after controlling for demographics (p = 0.001). EQ-5D VAS score declined over 5 years for both groups: -1.42 (18.1) for the T2DM group, and -0.63 (15.8) for the group without diabetes, but the between-group difference was not significant either before (p = 0.09) or after (p = 0.12), controlling for demographics. T2DM respondents with diabetic complications had a greater decline in EQ-5D scores than T2DM respondents without complications (p < 0.05).ConclusionOver a 5-year period, health status of respondents with T2DM declined significantly compared with those with no diabetes, indicating that the burden of the disease has a long-term detrimental impact. This decline in health status is likely to impact utility scores (fewer quality-adjusted life years) for economic evaluations.

Quality of Life, Depression, and Healthcare Resource Utilization among Adults with Type 2 Diabetes Mellitus and Concomitant Hypertension and Obesity: A Prospective Survey.

Background. This study compared quality of life, depression, and healthcare resource utilization among adults with type 2 diabetes mellitus (T2DM) and comorbid hypertension (HTN) and obesity with those of adults reporting T2DM alone. Methods. Respondents to the US SHIELD survey self-reported their height, weight, comorbid conditions, hospitalizations, and outpatient visits and completed the Short Form-12 (SF-12) and Patient Health Questionnaire (PHQ-9). Respondents reporting T2DM and HTN and obesity (body mass index, BMI, ≥30 kg/m2) were compared with a T2DM-alone group. Results. Respondents with T2DM, HTN, and obesity (n = 1292) had significantly lower SF-12 Physical and Mental Component Summary scores (37.3 and 50.9, resp.) than T2DM-alone respondents (n = 349) (45.8 and 53.5, resp., P < 0.0001). Mean PHQ-9 scores were significantly higher among T2DM respondents with comorbid HTN and obesity (5.0 versus 2.5, P < 0.0001), indicating greater depression burden. Respondents with T2DM, HTN, and obesity had significantly more resource utilization with respect to physician visits and emergency room visits but not hospitalizations than respondents with T2DM alone (P = 0.03). Conclusions. SHIELD respondents with comorbid conditions of T2DM, HTN, and obesity reported greater healthcare resource utilization, more depression symptoms, and lower quality of life than the T2DM-alone group.

Impact of Regular Exercise and Attempted Weight Loss on Quality of Life among Adults with and without Type 2 Diabetes Mellitus.

Objective. To examine the association between exercising regularly and trying to lose weight, and quality of life among individuals with and without type 2 diabetes mellitus (T2DM). Methods. Respondents to the US SHIELD baseline survey reported whether they had tried to lose weight during the previous 12 months and whether they exercised regularly for >6 months. Respondents completed the SF-12 quality-of-life survey one year later. Differences between T2DM respondents (n = 2419) and respondents with no diabetes (n = 6750) were tested using t-tests and linear regression models adjusting for demographics, body mass index (BMI), and diabetes status. Results. After adjustment, exercising regularly was significantly associated with higher subsequent physical and mental component scores (P < .001). After adjustment, trying to lose weight was not associated with higher physical component scores (P = .87), but was associated with higher mental component scores (P = .01). Conclusion. Respondents who reported exercising regularly had significantly better physical and mental quality of life, compared with respondents who did not exercise regularly. Despite exercising regularly, respondents with T2DM had significantly worse quality of life, compared with respondents without diabetes who exercised regularly.

Impact of type 2 diabetes mellitus on prescription medication burden and out-of-pocket healthcare expenses

Aims The number of prescription medications and out-of-pocket expenses of individuals with type 2 diabetes mellitus (T2DM) were evaluated to assess the economic burden of diabetes. Methods The self-reported number of prescription medications and out-of-pocket healthcare expenses were evaluated from respondents of the United States SHIELD study with and without a diagnosis of T2DM. Medications included monotherapy and combination therapy; combination tablets were counted as one agent. Analysis of variance and multivariate linear regression models adjusted for age, gender, prescription insurance coverage, and household income. Results Of the T2DM respondents ( n = 3551), 40% were on 1 prescription antidiabetic agent (7% insulin alone), 26% were on 2 agents, 8% were on ≥3 agents, with a mean of 1.3 antidiabetic agents. After adjusting for age, gender, insurance coverage, and income, respondents with T2DM had a significantly larger total number of prescriptions (6.2) and higher out-of-pocket expenses for both annual medical ($1158) and monthly prescription ($144) expenses, compared with respondents without T2DM ( n = 8686) (4.1 prescriptions, $925 annual medical, $118 monthly prescription) ( p < 0.01). Conclusions Increased out-of-pocket medical and medication costs in T2DM are due to the use of both antidiabetic agents and other medications for treatment of comorbid conditions.

Trends in Method of Diagnosis of Type 2 Diabetes Mellitus: Results from SHIELD.

Aims. This study assessed whether recent screening recommendations have led to increased diagnosis of type 2 diabetes mellitus (T2DM) through routine screening. Methods. Respondents to the 2006 US SHIELD survey reported whether a physician told them they had T2DM, age at diagnosis, specialty of the physician who made the diagnosis, and whether the diagnosis was made after having symptoms, during routine screening, or when being treated for another health problem. Results. Of 3 022 T2DM respondents, 36% of respondents reported that T2DM diagnosis was made during routine screening alone, 20% after having symptoms alone, and 6% when being treated for another health problem alone. The proportion of T2DM respondents reporting a diagnosis based only on screening increased approximately 42% over a 15+-year time span (absolute increase from 31% to 44%) (P < .001), whereas symptom-based diagnosis did not change significantly (P = .10). T2DM was diagnosed primarily by family physicians (88.3%). Conclusion. These findings highlight the importance of regular screening for diabetes and the vital role of primary care physicians in recognizing individuals with T2DM.

Association of overweight and obesity with health status, weight management, and exercise behaviors among individuals with type 2 diabetes mellitus or with cardiometabolic risk factors

This investigation evaluated the role of obesity in health status and behaviors for weight management and exercise among individuals with type 2 diabetes mellitus (T2DM) or cardiometabolic risk factors. Self-reported health status, exercise behaviors, and weight management were assessed in the SHIELD study for respondents with T2DM or high risk (HR) for diabetes (ie, ≥3 of the following: abdominal obesity, body mass index [BMI] ≥28 kg/m(2), self-reported diagnosis of dyslipidemia, hypertension, or history of cardiovascular disease). Respondents were stratified into three BMI categories: <25 kg/m(2) (underweight or normal weight), 25.0-29.9 kg/m(2) (overweight), and ≥30 kg/m(2) (obese), with comparisons made using analysis of variance. Comparisons between T2DM and HR were made using chi-square tests. T2DM (n =3,918) and HR (n =5,464) groups were similar for age (mean =59 years), race (≥85% white), and obesity. Overweight (31%) or obese T2DM (18%) respondents were significantly less likely to report excellent health compared with overweight or obese HR respondents (42% and 30%, respectively), p < 0.001. There were no differences between T2DM and HR groups for exercise behaviors. More obese respondents (20% T2DM, 21% HR) were "contemplating exercising", and fewer (21%-23%) were currently "exercising regularly" compared with overweight and normal weight respondents, p < 0.001. More obese respondents (78% T2DM, 83% HR) attempted weight management than normal (28%-35%) or overweight (57%-61%) respondents, p < 0.001. Obesity was negatively associated with self-perception of current health, exercising regularly, and weight maintenance for those with or at risk for diabetes.

Out-of-pocket expenses and healthcare resource utilization among individuals with or at risk of diabetes mellitus

ABSTRACTObjective: Self-reported healthcare resource utilization (HRU), medication out-of-pocket (OOP) expenditures and impact of OOP expenses on HRU were assessed for respondents with type 2 diabetes mellitus (T2DM) or elevated cardiometabolic risk.Methods: The 5-year longitudinal SHIELD study surveyed a stratified sample of US adults with diabetes or cardiometabolic risk factors (n = 22 001). High risk (HR) was defined as having 3−5 factors: abdominal obesity, BMI ≥ 28 kg/m2, dyslipidemia, hypertension, coronary heart disease, or stroke. Low risk (LR) was ≤2 factors. HRU included physician visits, admission to healthcare facilities, and medical tests during the preceding 12 months, as well as monthly medication OOP expenditures. Respondents reported whether OOP expenditures prevented them from seeking care or purchasing medications or supplies.Results: T2DM and HR respondents were significantly more likely than LR respondents to stay overnight in a healthcare facility or to visit the emergency room. T2DM respondents reported, on average, 12 visits to healthcare professionals compared with 10 for HR and 7 for LR (p < 0.0001). Monthly OOP expenditure for prescriptions was $108 for T2DM, $92 for HR, and $52 for LR (p < 0.0001). Approximately one third of respondents indicated that OOP expenses prevented them from buying medications. Overall, 37−41% of respondents indicated that OOP costs prevented them from seeking care or purchasing supplies or medications.Limitations: Self-selection bias may have occurred since the sample was respondents to a mailed survey. Healthcare resource utilization and out-of-pocket expenses were self-reported.Conclusions: More than one third of respondents with T2DM or HR reported that out-of-pocket expenses prevented them from seeking healthcare to manage their disease, which could speed disease progression or increase severity.