CV Events & Mortality in Diabetes
Few large studies have assessed the impact of cardiovascular (CV) events on mortality in patients with type 2 diabetes. To address this research gap, investigators evaluated the risk of a CV-related death in a large group of patients with type 2 diabetes at very high CV risk and in those who experienced a major non-fatal CV event . Patients who had experienced a non-fatal CV event had a higher risk of CV-related mortality. When compared with patients who did not experience a non-fatal CV event, adjusted hazard ratios for mortality were:
- 3.12 after myocardial infarction.
- 4.96 after heart failure.
- 3.08 after stroke.
Glycemic Control Reduces Retinopathy Risk
Previous research has demonstrated the positive effect of intensive glycemic control on the progression of retinopathy in patients who are newly diagnosed with diabetes. Whether this effect occurs in patients who have been diagnose with diabetes for 10 years has yet to be determined. The impact of 3.7 years of tight glycemic control on retinopathy risk was assessed in patients with type 2 diabetes for a study. Diabetic retinopathy had progressed three or more steps on the Early Treatment Diabetic Retinopathy Study scale 8 years after a baseline exam among 12.7% who achieved standard glycemic control, compared with a rate of 5.8% that was observed among those achieving more intense glycemic control.
Assessing Transitional Care Interventions for Older Diabetics
Transitional care interventions—including diabetes self-management education (DSME) and home visits—have been shown in prior studies to help improve outcomes for patients with diabetes. However, comparisons of outcomes following inpatient DSME versus inpatient DSME plus home care are lacking. For a study, patients aged 60 or older with type 2 diabetes were assigned to a transitional care educational intervention consisting of inpatient DSME or a combination of both inpatient DSME and home care for patients. Their outcomes were compared with a control group. Re-hospitalization rates at 90 days were 10% for the DSME plus home care group, 20% for the DSME-only group, and about 27% for the control group. Both intervention groups experience statistically significant decreases in A1C levels when compared with the control group, but these levels returned to baseline for the DSME-only group.
Predicting Glycemic Events in Diabetes
Few studies have examined the impact of socioeconomic factors on hospitalizations for uncontrolled hyperglycemia and hypoglycemia among patients with diabetes in the United States. For a study, researchers assessed outcomes among a nationwide inpatient sample of adults with type 1 or type 2 diabetes who were hospitalized for hyperglycemia or hypoglycemia complications. The authors observed the following hospitalization rates based on specific patient factors:
|Lowest income quartile||4.2%|
|Highest income quartile||2.9%|
|Medicaid /other insurance||7.9%/11.7%|
Patient Engagement Improves Diabetes Outcomes
The patient-centered medical home (PCMH) has previously been shown to improve quality of care through better care coordination and clinician alignment. However, little is known about the integration and impact of external coaching and engagement services into the workflow of PCMH practices, particularly among patients with diabetes. Study investigators compared outcomes among patients with type 2 diabetes and an A1C of 6.5% or higher who were enrolled in a remote behavioral counseling intervention either through a PCMH or not. No statistically significant differences between the groups were observed in A1C levels or weight at baseline or graduation from the intervention. However, both groups experienced statistically significant reductions in A1C levels and weight throughout the intervention, suggesting that a patient-centered engagement intervention can effectively manage type 2 diabetes regardless of setting.
NEWS FROM ADA 2016
MORE FROM ADA 2016