Direct and indirect costs of diabetes mellitus in Mali: A case-control study.

Background: Diabetes mellitus (DM) is one of the most burdensome chronic diseases and is associated with shorter lifetime, diminished quality of life and economic burdens on the patient and society as a result of healthcare, medication, and reduced labor market participation. We aimed to estimate the direct (medical and non-medical) and indirect costs of DM and compare them with those of people without DM (ND), as well as the cost predictors.

Methods And Findings: Observational retrospective case-control study performed in Mali.

Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.

Background: Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.

Methods: To ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008-2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa.

Direct and indirect costs associated to type 2 diabetes and its complications measured in a social security institution of Argentina.

Objectives: To estimate direct and indirect costs of care of type 2 diabetes (T2DM) and its complications in Argentina, and compare them with those recorded in people without diabetes (ND).

Methods: Observational retrospective case-control study performed in one institution of the Social Security System of Argentina. Participants were identified and randomly selected from the Institution's electronic medical records.

Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina.

Aim: To compare the socioeconomic status (SES) of people with type 2 diabetes (T2DM) in Argentina (Córdoba) with and without major chronic complications of diabetes, with that recorded in persons without diabetes matched by age and gender.

Methods: For this descriptive and analytic case-control study, potential candidates were identified from the electronic records of one institution of the Social Security System of the city of Córdoba. We identified and recruited 387 persons each with T2DM with or without chronic complications and 774 gender- and age-matched persons without T2DM (recruitment rate, 83%).

Initial nonadherence, primary failure and therapeutic success of metformin monotherapy in clinical practice.

Objective: To document the extent to which drug naïve patients with diabetes continued newly initiated metformin monotherapy, and who subsequently experienced primary failure or therapeutic success.

Research Design And Methods: Using an observational longitudinal cohort design, we identified all 3116 type 2 diabetes patients who initiated metformin monotherapy as their first-ever anti-hyperglycemic drug in 2004-2006. We defined initial nonadherence as having occurred in the first 6 months if a patient (1) received only a single metformin dispense, (2) received less than a 90 day supply, or (3) switched to a second anti-hyperglycemic agent.

Vitamin E reduces cardiovascular disease in individuals with diabetes mellitus and the haptoglobin 2-2 genotype.

Aims: Individuals with both diabetes mellitus (DM) and the Haptoglobin (Hp) 2-2 genotype are at increased risk of cardiovascular disease. As the antioxidant function of the Hp 2-2 protein is impaired, we sought to test the pharmacogenomic hypothesis that antioxidant vitamin E supplementation would provide cardiovascular protection to Hp 2-2 DM individuals.

Materials & Methods: We determined the Hp genotype on DM participants from two trials (HOPE and ICARE) and assessed the effect of vitamin E by Hp genotype on their common prespecified outcome, the composite of stroke, myocardial infarction and cardiovascular death.

Secondary failure of metformin monotherapy in clinical practice.

OBJECTIVE We sought to document the secondary failure rate of metformin monotherapy in a clinical practice setting and to explore factors that predict therapeutic failure. RESEARCH DESIGN AND METHODS We studied 1,799 type 2 diabetic patients who, between 2004 and 2006, lowered their A1C to <7% after initiating metformin monotherapy as their first-ever anti-hyperglycemic drug. We examined all A1C values recorded through 31 December 2008 (2-5 years of follow-up), defining secondary failure as a subsequent A1C > or =7.

Frequency of obtaining national cholesterol education program adult treatment panel III goals for all major serum lipoproteins after initiation of lipid altering therapy.

Statin treatment targeting low-density lipoprotein (LDL) cholesterol is widely used for cardiovascular risk reduction, but many statin users still face greatly elevated risks. Some experts advocate additional therapy that targets high-density lipoprotein (HDL) cholesterol. However, the size of the patient group that could benefit from HDL cholesterol or triglyceride therapy has not been reported.

Successes and challenges of insulin therapy for type 2 diabetes in a managed-care setting.

Objective: Although insulin is the most effective diabetes medication for lowering blood glucose, how insulin is used in clinical practice and how well patients respond to insulin therapy over the course of several years has not been documented. Our objective was to describe glycemic control, side-effects and dose titration over 7 years among persons starting insulin in a health plan that has long used a treatment algorithm similar to the current American Diabetes Association/European Association for the Study of Diabetes (ADA-EASD) algorithm for the management of hyperglycemia.

Research Design And Methods: Patients (n = 2417) who initiated insulin therapy between 1 January 1999 and 31 December 2004 were followed for a mean of 49.

Validating the Framingham Offspring Study equations for predicting incident diabetes mellitus.

Background: Investigators from the Framingham Offspring Study (FOS) recently proposed a new simple point score for estimating 8-year diabetes mellitus (DM) risk.

Objectives: To validate prediction models and to compare DM risk estimated by the point score with observed DM incidence.

Study Design: Longitudinal observational cohort study.

Normal fasting plasma glucose and risk of type 2 diabetes diagnosis.

Purpose: The study compares the risk of incident diabetes associated with fasting plasma glucose levels in the normal range, controlling for other risk factors.

Methods: We identified 46,578 members of Kaiser Permanente Northwest who had fasting plasma glucose levels less than 100 mg/dL between January 1, 1997, and December 31, 2000, and who did not previously have diabetes or impaired fasting glucose. After assigning subjects to 1 of 4 categories (<85, 85-89, 90-94, or 95-99 mg/dL), we followed them until they developed diabetes, died, or left the health plan, or until April 30, 2007.

Contemporary analysis of secondary failure of successful sulfonylurea therapy.

Objective: To revise older estimates of secondary failure that may no longer describe the contemporary pattern of sulfonylurea (SU) monotherapy and to identify predictors of such failure.

Methods: We identified 4,091 patients who achieved hemoglobin A1c (A1C) <8% within 1 year after initiation of SU therapy as their first-ever antihyperglycemic drug after January 1, 1996. The study subjects underwent follow-up until they added or switched antihyperglycemic medication, had A1C > or =8%, or terminated health plan membership or until December 31, 2004.

Progression from newly acquired impaired fasting glusose to type 2 diabetes.

Objective: We sought to estimate the rate of progression from newly acquired (incident) impaired fasting glucose (IFG) to diabetes under the old and new IFG criteria and to identify predictors of progression to diabetes.

Research Design And Methods: We identified 5,452 members of an HMO with no prior history of diabetes, with at least two elevated fasting glucose tests (100-125 mg/dl) measured between 1 January 1994 and 31 December 2003, and with a normal fasting glucose test before the two elevated tests. All data were obtained from electronic records of routine clinical care.

Treatment escalation and rise in HbA1c following successful initial metformin therapy.

Objective: To describe secondary failure of initial metformin therapy in patients who achieved initial HbA(1c) (A1C) <8% and to identify predictors of failure.

Research Design And Methods: We identified 1,288 patients who achieved A1C <8% within 1 year of initiating metformin as their first-ever antihyperglycemic drug. Subjects were followed until they added/switched antihyperglycemics, they terminated health plan membership, or 31 December 2004.

Higher medical care costs accompany impaired fasting glucose.

Objective: The purpose of this study was to estimate medical costs associated with elevated fasting plasma glucose (FPG) and to determine whether costs differed for patients who met the 2003 (> or = 100 mg/dl) versus the 1997 (> or = 110 mg/dl) American Diabetes Association (ADA) cut point for impaired fasting glucose.

Research Design And Methods: We identified 28,335 patients with two or more FPG test results of at least 100 mg/dl between 1 January 1994 and 31 December 2003. Those with evidence of diabetes before the second test were excluded.

The incidence of congestive heart failure associated with antidiabetic therapies.

Background: Increased risk for CHF in persons with type 2 diabetes is well established. Our objectives were to estimate the CHF risk associated with specific therapies for diabetes and to determine the differences in incidence rates of CHF associated with adding various antidiabetic agents.

Methods: Subjects were members of the Kaiser Permanente Northwest (KPNW) diabetes registry as of 1 January 1998, with no prior history of CHF (n = 8063).

The incidence of congestive heart failure in type 2 diabetes: an update.

Objective: The aims of this study were to update previous estimates of the congestive heart failure (CHF) incidence rate in patients with type 2 diabetes, compare it with an age- and sex-matched nondiabetic group, and describe risk factors for developing CHF in diabetic patients over 6 years of follow-up.

Research Design And Methods: We performed a retrospective cohort study of 8,231 patients with type 2 diabetes and 8,845 nondiabetic patients of similar age and sex who did not have CHF as of 1 January 1997, following them for up to 72 months to estimate the CHF incidence rate. In the diabetic cohort, we constructed a Cox regression model to identify risk factors for CHF development.

The burden of treatment failure in type 2 diabetes.

Objective: In type 2 diabetes, therapies to maintain blood glucose control usually fail after several years. We estimated the glycemic burden that accumulates from treatment failure and describe the time course and predictors of failure.

Research Design And Methods: A prospective, population-based study using retrospective observational data.

Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population.

Chronic kidney disease (CKD) afflicts up to 20 million people in the United States, but little is known about their health care costs. The authors analyzed costs and resource use associated with CKD by using National Kidney Foundation staging definitions. Patients insured through a large health maintenance organization with a laboratory finding of CKD (defined as estimated GFR between 15 and 90 ml/min per 1.

Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization.

Background: Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population.

Methods: In 1996 we identified 27 998 patients in our health plan who had estimated glomerular filtration rates of less than 90 mL/min per 1.

Diabetic retinopathy: contemporary prevalence in a well-controlled population.

Objective: To measure the extent to which modern intensified risk factor control has lessened the duration-specific prevalence of diabetic retinopathy and, therefore, has decreased the risk of blindness in Americans with type 2 diabetes.

Research Design And Methods: Intensified control of blood glucose and blood pressure has prevented diabetic retinopathy in randomized controlled trials. There is as yet no confirmation that subsequent treatment intensification in the community has had the same result.

Slow response to loss of glycemic control in type 2 diabetes mellitus.

Background: To achieve glycemic control in type 2 diabetes mellitus, the American Diabetes Association (ADA) recommends intensification of glucose-lowering therapy when the glycosylated hemoglobin (HbA1c) level exceeds 8.0%.

Objective: To study glycemic control before and after initiation of secondary antihyperglycemic therapy to better understand the pace and patterns of therapeutic failure and clinical responses to failure.

Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes.

Objective: To estimate the prevalence of diagnosed depression in a large population of individuals with type 2 diabetes, compared to a matched control group, and to estimate the extent of depression that is independently associated with diabetes.

Research Design And Methods: We compared the prevalence of diagnosed depression in all 16180 full-year health maintenance organization members in 1999 who had been diagnosed with type 2 diabetes and in 16180 comparison members without diabetes matched for age and sex. We ascertained diagnoses from the Kaiser Permanente Northwest Region's electronic medical record.

Impact of intensified dental care on outcomes in human immunodeficiency virus infection.

This study evaluated the health effects of routine and intensified dental care and disease prevention in persons with human immunodeficiency virus (HIV). We recruited 376 HIV-infected persons ages 19 to 61 with CD4 counts between 100 and 750 into a year-long two-arm randomized controlled trial. Control group subjects (n = 185) received professional dental protective treatment and checkups at baseline, 6 months, and 1 year, plus dental care.

Understanding changes in primary care clinicians' satisfaction from depression care activities during adoption of selective serotonin reuptake inhibitors.

Objectives: To describe how primary care clinicians' perceptions about depression care as a clinical activity changed during the adoption of selective serotonin reuptake inhibitors (SSRIs) in their health maintenance organization (HMO).

Study Design: Prospective study of change in primary care clinicians' level of satisfaction from depression care activities from time 1 (mid-1993) to time 2 (early 1995).

Methods: Study subjects were internal medicine and family practice physicians, physician assistants, and nurse practitioners (n = 196) in a large, not-for-profit group-model HMO.