Inpatient to outpatient transfer of diabetes care: perceptions of barriers to postdischarge followup in urban African American patients.

Objectives: To determine potential obstacles to postdischarge followup of hospitalized diabetes patients and to inform planning to better ensure continuity of service when care is transferred from inpatient to outpatient settings.

Design: Surveys of hospital inpatients.

Setting: Urban hospital

Patients: Inpatients with diabetes mellitus.

Description and preliminary evaluation of a Multiagent Intelligent Dosing System (MAIDS) to manage combination insulin-oral agent therapy in type 2 diabetes.

Background: Computer decision support systems are potentially effective methods for adjusting insulin, but current models do not take into account simultaneous changes of more than one agent. We describe the development of the Multiagent Intelligent Dosing System (MAIDS, Dimensional Dosing Systems, Wexford, PA) for predicting glycemic outcome in response to concurrent dose adjustments in oral hypoglycemic agents and insulin.

Methods: Retrospective data from a patient cohort with type 2 diabetes who had simultaneous changes in insulin and metformin were analyzed.

Limited health care access impairs glycemic control in low income urban African Americans with type 2 diabetes.

Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56% women; 89% African American; average age, 50 years; 95% with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.

An endocrinologist-supported intervention aimed at providers improves diabetes management in a primary care site: improving primary care of African Americans with diabetes (IPCAAD) 7.

Objective: Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes.

Research Design And Methods: A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center.

Clinical inertia contributes to poor diabetes control in a primary care setting.

Purpose: The purpose of this study was to determine whether "clinical inertia"-inadequate intensification of therapy by the provider-could contribute to high A1C levels in patients with type 2 diabetes managed in a primary care site.

Methods: In a prospective observational study, management was compared in the Medical Clinic, a primary care site supervised by general internal medicine faculty, and the Diabetes Clinic, a specialty site supervised by endocrinologists. These municipal hospital clinics serve a common population that is largely African American, poor, and uninsured.