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Diabetes Self-Management Education and Training Among Privately Insured Persons with Newly Diagnosed Diabetes — United States, 2011–2012

January 25, 2015 Comments off

Diabetes Self-Management Education and Training Among Privately Insured Persons with Newly Diagnosed Diabetes — United States, 2011–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Diabetes is a complex chronic disease that requires active involvement of patients in its management (1). Diabetes self-management education and training (DSMT), “the ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care,” is an important component of integrated diabetes care (2). It is an intervention in which patients learn about diabetes and how to implement the self-management that is imperative to control the disease. The curriculum of DSMT often includes the diabetes disease process and treatment options; healthy lifestyle; blood glucose monitoring; preventing, detecting and treating diabetes complications; and developing personalized strategies for decision making (2). The American Diabetes Association recommends providing DSMT to those with newly diagnosed diabetes (1), because data suggest that when diabetes is first diagnosed is the time when patients are most receptive to such engagement (3). However, little is known about the proportion of persons with newly diagnosed diabetes participating in DSMT. CDC analyzed data from the Marketscan Commercial Claims and Encounters database (Truven Health Analytics) for the period 2009–2012 to estimate the claim-based proportion of privately insured adults (aged 18–64 years) with newly diagnosed diabetes who participated in DSMT during the first year after diagnosis. During 2011–2012, an estimated 6.8% of privately insured, newly diagnosed adults participated in DSMT during the first year after diagnosis of diabetes. These data suggest that there is a large gap between the recommended guideline and current practice, and that there is both an opportunity and a need to enhance rates of DSMT participation among persons newly diagnosed with diabetes.

The Emerging Crisis: Noncommunicable Diseases

January 15, 2015 Comments off

The Emerging Crisis: Noncommunicable Diseases
Source: Council on Foreign Relations

The gravest health threats facing low- and middle-income countries are not the plagues, parasites, and blights that dominate the news cycle and international relief efforts. They are the everyday diseases the international community understands and could address, but fails to take action against.

Once thought to be challenges for affluent countries alone, cardiovascular diseases, cancer, diabetes, and other noncommunicable diseases (NCDs) have emerged as the leading cause of death and disability in developing countries. In 2013, these diseases killed eight million people before their sixtieth birthdays in these countries. The chronic nature of NCDs means patients are sick and suffer longer and require more medical care. The resulting economic costs are high and escalating. Unless urgent action is taken, this emerging crisis will worsen in low- and middle-income countries and become harder to address.

Association Between 7 Years of Intensive Treatment of Type 1 Diabetes and Long-term Mortality

January 10, 2015 Comments off

Association Between 7 Years of Intensive Treatment of Type 1 Diabetes and Long-term Mortality
Source: Journal of the American Medical Association

Importance
Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established.

Objective
To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT) cohort.

Design, Setting, and Participants
After the DCCT (1983-1993) ended, participants were followed up in a multisite (27 US and Canadian academic clinical centers) observational study (Epidemiology of Diabetes Control and Complications [EDIC]) until December 31, 2012. Participants were 1441 healthy volunteers with diabetes mellitus who, at baseline, were 13 to 39 years of age with 1 to 15 years of diabetes duration and no or early microvascular complications, and without hypertension, preexisting cardiovascular disease, or other potentially life-threatening disease.

Interventions and Exposures
During the clinical trial, participants were randomly assigned to receive intensive therapy (n = 711) aimed at achieving glycemia as close to the nondiabetic range as safely possible, or conventional therapy (n = 730) with the goal of avoiding symptomatic hypoglycemia and hyperglycemia. At the end of the DCCT, after a mean of 6.5 years, intensive therapy was taught and recommended to all participants and diabetes care was returned to personal physicians.

Main Outcomes and Measures
Total and cause-specific mortality was assessed through annual contact with family and friends and through records over 27 years’ mean follow-up.

Results
Vital status was ascertained for 1429 (99.2%) participants. There were 107 deaths, 64 in the conventional and 43 in the intensive group. The absolute risk difference was −109 per 100 000 patient-years (95% CI, −218 to −1), with lower all-cause mortality risk in the intensive therapy group (hazard ratio [HR] = 0.67 [95% CI, 0.46-0.99]; P = .045). Primary causes of death were cardiovascular disease (24 deaths; 22.4%), cancer (21 deaths; 19.6%), acute diabetes complications (19 deaths; 17.8%), and accidents or suicide (18 deaths; 16.8%). Higher levels of glycated hemoglobin (HbA1c) were associated with all-cause mortality (HR = 1.56 [95% CI, 1.35-1.81 per 10% relative increase in HbA1c]; P < .001), as well as the development of albuminuria (HR = 2.20 [95% CI, 1.46-3.31]; P < .001).

Conclusions and Relevance
After a mean of 27 years’ follow-up of patients with type 1 diabetes, 6.5 years of initial intensive diabetes therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy.

Announcement: Diabetes State Atlas Now Available Online

December 2, 2014 Comments off

Announcement: Diabetes State Atlas Now Available Online
Source: Morbidity and Mortality Weekly Report (CDC)

CDC’s Division of Diabetes Translation announces the launch of the Diabetes State Atlas (available at http://www.cdc.gov/diabetes/data), an interactive Internet tool for the public to view maps and charts of diabetes data and trends at the U.S. state level. Some of the features of the atlas include 1) customizable maps and graphics of diabetes surveillance data, 2) an interactive application to view state-specific trends by age and sex, and 3) downloadable maps, charts, and data tables that can be used in grant applications, reports, articles, and publications.

The Diabetes State Atlas can help state public health officials document the burden of diabetes in their states, monitor trends, identify high-risk groups and assess disparities between groups, and track progress in achieving Healthy People 2020 diabetes objectives (1).

In the United States, about 29 million persons have diabetes (2). An additional 86 million adults have prediabetes, putting them at increased risk for developing type 2 diabetes, heart disease, and stroke (2). However, persons with diabetes can take steps to control the disease and prevent complications, and those with prediabetes can prevent or delay the onset of type 2 diabetes through weight loss and physical activity (3). Information about diabetes prevention and control is available online from CDC’s Division of Diabetes Translation at http://www.cdc.gov/diabetes/home/index.html.

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

October 27, 2014 Comments off

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries (PDF)
Source: Journal of Managed Care & Specialty Pharmacy

This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition- specific medication use were associated with significant ( P < 0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension.

Diabetes Prevention and Control: Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among People at Increased Risk

September 9, 2014 Comments off

Diabetes Prevention and Control: Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among People at Increased Risk
Source: Community Preventive Services Task Force

The Community Preventive Services Task Force recommends combined diet and physical activity promotion programs for people at increased risk of type 2 diabetes based on strong evidence of effectiveness in reducing new-onset diabetes. Combined diet and physical activity promotion programs also increase the likelihood of reverting to normoglycemia (normal blood sugar) and improve diabetes and cardiovascular disease risk factors, including overweight, high blood glucose, high blood pressure, and abnormal lipid profile.

Based on the evidence, combined diet and physical activity promotion programs are effective across a range of counseling intensities, settings, and implementers. Programs commonly include a weight loss goal, individual or group sessions (or both) about diet and exercise, meetings with a trained diet or exercise counselor (or both), and individually tailored diet or exercise plans (or both). Higher intensity programs lead to greater weight loss and reduction in new-onset diabetes.

Economic evidence indicates that combined diet and physical activity promotion programs to prevent type 2 diabetes among people at increased risk are cost-effective.

Age Differences in Visits to Office-based Physicians by Patients With Diabetes: United States, 2010

August 26, 2014 Comments off

Age Differences in Visits to Office-based Physicians by Patients With Diabetes: United States, 2010
Source: National Center for Health Statistics

Key findings
Data from the National Ambulatory Medical Care Survey

  • Office-based physician visits by patients with diabetes increased 20%, from 94.4 million in 2005 to 113.3 million in 2010, but the rate did not change between 2005 and 2010.
  • The visit rate for diabetes increased with age and averaged 1,380 visits per 1,000 persons aged 65 and over in 2010.
    A majority of visits made by patients with diabetes (87%) were by those with multiple chronic conditions, and the number of chronic conditions increased with advancing age.
  • Medications were prescribed or continued at a majority of visits (85%) made by patients with diabetes, with the number of medications prescribed or continued increasing as age increased.
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