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Achieving A1C Goals: Back to the Basics

Achieving A1C Goals: Back to the Basics

Among the nearly 26 million Americans with diabetes, approximately half have not achieved an American Association of Clinical Endocrinologists (AACE)-recommended A1C goal of 6.5% or less. To address this issue, AACE and the American College of Endocrinology developed the Blood Sugar Basics: Get to Your Goals program. The program consists of an array of customizable tools and resources—available online and as hard copy materials—to encourage and empower patients with type 2 diabetes to know the importance of their A1C and work with their healthcare providers to set and achieve individualized blood sugar goals. A Helpful Resource Diabetes and its management can seem complex and overwhelming to patients, particularly for the newly diagnosed. “Patients need to understand that diabetes is a serious disease,” says Etie Moghissi, MD, FACP, FACE, the physician advisor for the Blood Sugar Basics program. “However, it’s important that they know that diabetes can be managed effectively when they’re engaged in their care.” To that end, the program—through its online home at www.bloodsugarbasics.com—provides downloadable checklists, tips for everyday management, videos, questions for patients to ask their providers, a quiz to test patients’ A1C knowledge, and more. In-depth information is provided on the importance of diet, exercise, medication (if prescribed), and monitoring and preventing symptoms. The resource also informs patients on hypoglycemia and how to avoid it. The resources fall under three overarching missions: 1. Gather intelligence. “The program provides recommendations for controlling A1C and setting specific goals so that patients can have informed discussions with their providers,” explains Dr. Moghissi. 2. Finalize a strategy. “Patients should know how to achieve their A1C goals with lifestyle changes and...
Medication Non-Adherence in Diabetes: A Look at Costs

Medication Non-Adherence in Diabetes: A Look at Costs

Oral medications and insulin are cornerstones of diabetes man­agement, but as many as one-third of patients with the disease fail to derive optimal benefit from therapy due to medication non-adherence (MNA). Studies have also linked MNA with higher disease-related, inpatient, and emergency department utilization and costs. Unfortunately, many MNA analyses focusing on cost have been limited by small sample size, an absence of precise adherence measures, or cross-sectional design, among other limitations. In an issue of Diabetes Care, my colleagues and I published an article designed to overcome previous research limitations and add to our existing knowledge on the effects of MNA on cost. In our study, we used a multivariate, generalized, linear, mixed model in order to account for shared correlations among cost variables. We then estimated the inpatient, outpatient, and pharmacy-related costs in a group of more than 740,000 veterans in the United States with type 2 diabetes over a 5-year period. Inpatient Costs: A Key Driver According to our findings, the costs of MNA among patients with diabetes are quite large and appear to be mostly driven by inpatient expenditures. All annual cost categories increased by about 3% per year. MNA was associated with 37% lower pharmacy costs and 7% lower outpatient costs but 41% higher inpatient costs. The potential cost savings that might be achieved from improving medication adherence are substantial. Based on sensitivity analyses, improving adherence for MNA patients would lead to annual estimated cost savings that range between $661 million and $1.16 billion. Wanted: More Successful Interventions The findings from our study are significant to both health services researchers and healthcare policy makers....
Diabetes & Fracture Hospitalization Risk

Diabetes & Fracture Hospitalization Risk

Published research has indicated that people with type 2 diabetes are at increased risk for bone fractures. The link between diabetes and fracture risk, however, has historically depended upon the location of the fracture being investigated. Few large, community-based studies of fracture risk have explored possible associations of diagnosed diabetes, undiagnosed diabetes, and fracture risk. “The risk of fracture-related hospitalizations was higher among adults with diagnosed diabetes than those without the disease.” In an effort to fill the void in available research, my colleagues and I conducted a study that compared the risk of fracture-related hospitalization in people without diabetes to those with diagnosed and undiagnosed diabetes. We also examined associations of diabetes medication use and chronic hyperglycemia with fracture risk. Our study—published in Diabetes Care—used data from the NIH-funded Atherosclerosis Risk in Communities Study, a community-based population. Diabetes Increases Risks Results from our investigation showed that the risk of fracture-related hospitalizations was higher among adults with diagnosed diabetes than those without the disease. The risk of fracture-related hospitalization was nearly twice as high for people with diagnosed diabetes. These findings remained even after adjusting for important risk factors, such as age, sex, BMI, physical activity, and smoking. Conversely, fracture risk was similar between people with undiagnosed diabetes and those without the disease. Importantly, our analysis also revealed that fracture risk was higher in people with diagnosed diabetes who were treated with insulin. The risk was also higher in those with A1C levels of 8% or higher when compared with those who had A1Cs lower than 8%. The associations of diagnosed diabetes and fracture risk did not differ by...
Women & Diabetes: A Call to Action

Women & Diabetes: A Call to Action

Nearly half of all adults with diabetes in the United States are women, and the risk of cardiovascular disease (CVD)—the most common complication of diabetes—is more serious among women than men. Recent reports suggest that gender disparities exist in terms of access to care and receipt of preventive services (Table 1). Among people with diabetes who have had a heart attack, women have lower survival rates and a poorer quality of life than men. “It’s important to identify women with diabetes and those at high risk for the disease so that we can provide the necessary interventions to improve outcomes,” says Elizabeth Barrett-Connor, MD, FACP, FAHA. Early interventions and access to preventive care services are important for reducing diabetes risk as well as risks for developing other diseases, most importantly CVD. A Paucity of Data on CVD & Women About 40 years ago, few cohort studies of CVD included women, and fewer still included diabetes or glycemia as risk factors. In 1985, a review of hyperglycemia as a risk factor for coronary heart disease (CHD) was published. It included 29 prospective studies of glycemia and heart disease risk, adjusting for cholesterol, smoking, and blood pressure. It found an independent association between hyperglycemia and CHD in five of 13 cohort studies. Glycemia was not associated with CVD outcomes in studies using fasting plasma glucose or casual glucose levels. “Alarmingly, only four of these 29 studies included women,” says Dr. Barrett-Connor. “Another study, published in 1999, reviewed glucose and incident cardiovascular events, but of the 20 studies that were analyzed, only two included women. These large analyses highlight the fact that...
Enhancing Diabetes Knowledge in Patients

Enhancing Diabetes Knowledge in Patients

The National Diabetes Education Program (NDEP) was established, in part, to improve treatment and outcomes for people with diabetes by increasing knowledge of A1C, blood pressure (BP), and LDL cholesterol; together, these components make up the “ABCs” of diabetes. Few studies, however, have explored patient knowledge of their ABC levels and the association between having this knowledge and adhering to treatment recommendations for each of the ABC components. ABC Diabetes Knowledge From Patients Still Lacking In Diabetes Care, my colleagues and I had a study published in which we sought to assess patient knowledge of ABC levels and the association between this knowledge and meeting the ABC target goals. We also evaluated the association between specific demographic and diabetes-related factors and ABC knowledge. The purpose was to see if these data could help physicians and researchers identify high-risk patients who had particularly low knowledge.   According to our findings, knowledge of the ABCs was suboptimal. Among patients with diabetes, our data showed that: 48% could report their last A1C level. 63% could report their BP level. 22% could report their last LDL level. Knowledge was lower among Mexican Americans when compared with non-Hispanic whites and in people with less income and education. Having routine foot exams performed by physicians in the past year was associated with higher A1C knowledge. Nearly 20% of study participants reported that their healthcare provider did not specify an A1C goal. About three of every five participants reported that they were not informed of their BP or LDL cholesterol goals (47% and 41%, respectively). Significant Implications on Controlling Diabetes Physician communication of the ABC goals...
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