The social networks intervention showed improved integration of patients within their existing networks leading to a greater reduction in HbA1c and blood glucose, as well as improved behaviour mediating outcomes.

Cardiovascular health disparities continue to pose a major public health problem. We evaluated the effect of education administered within social networks on the improvement of hypertension in 248 African Americans compared to historical controls. Patients formed clusters with peers and attended monthly hypertension education sessions. We assessed the likelihood of reaching goal below predefined SBP and DBP thresholds as well as the absolute reduction in SBP and DBP, controlling for diabetes, smoking, baseline hypertension, and demographics. The intervention group was more likely to have ever reached treatment goal at 12 months follow-up (OR=1.72, P=0.11). At 18 months of follow-up, the MVP group had a statistically significant larger drop in SBP (−4.82 mmHg, P<0.0001) and DBP (−3.37 mmHg, P=0.01) than the control. The clustering of patients in social networks around hypertension education has a positive impact on the management of hypertension in minority populations and may help address cardiovascular health disparities.

The American Diabetes Association and European Association for the Study of Diabetes issued a new patient-centered approach for the management of hyperglycemia in patients with Type 2 diabetes. With a focus on older adults and the elderly, the authors explored the alignment of elements of the suggested framework with patients' reports of receiving combination or monotherapy using US national survey data (National Health and Nutrition Examination Survey 2001-2010) and a physician survey. Combination therapy was positively associated with age (range: 1.56-1.63; p = 0.04-0.07), obesity (odds ratio [OR]: 1.40; p = 0.01), HbA(1c) ≥7.0 (OR: 2.00; p < 0.01), number of years of living with diabetes (OR: 1.02 per year; p = 0.01) and hyperlipidemia (OR: 1.36; p = 0.02). An interaction term between years of living with diabetes and comorbidities >1 pointed to a trend of those with comorbidities >1 to be less probable to report combination therapy (OR: 0.98; p = 0.07) per additional year of diabetes history. Results suggest that sicker, older patients might benefit from more aggressive therapy, in the context of diabetes prevalence, this is expected to continue rising in that population.

OBJECTIVES: Diabetes group education programs have shown better clinical outcomes than one-on-one programs. That effect often subsides when the program is discontinued. We explore the impact of a novel intervention, in a largely African-American population with diabetes. We assess the impact of leveraging patients' natural social networks on measures of social efficacy and cohesion, with the assumption that those variables will support behavior change and mitigate modifiable risk factors. METHODS: Intervention patients (P2P ®) were asked to recruit peers, form small clusters, and attended monthly diabetes education sessions. Control patients were recruited, educated and followed up individually. P2P ® patients engaged in interactive educational sessions within their cluster. HbA1c, blood glucose, functional status (SF-12), self-efficacy (General Self-Efficacy Scale), cohesion (Perceived Cohesion Scale), social network characteristics (Social Network Index), and disease knowledge (Diabetes Knowledge Test) were recorded at baseline and followed up at 3-months. RESULTS: Among the 136 patients recruited in the study, intervention patients' (68) scores were lower on the number of active social network domains (1.1 vs.1.4, P=0.09), network diversity (5.6 vs. 5.9, P=0.30), and number of people in network (11.0 vs. 12.3, P=0.21) than controls (68), at baseline. Other baseline characteristics were evenly distributed between arms. After 3 months of followup, the intervention group had a statistically significantly greater increase in values for active social network domains (1.1, P<0.01), diversity (4.52, P<0.01), and contacts (0.84, P<0.01) than the control group. At the second follow-up, (only 22 patients have reached that point so far) social network index values improved even further from baseline (3.1, 10.8, and 1.0, respectively), compared to the controls. CONCLUSIONS: The P2P ® social networks intervention is showing improved social efficacy and integration of patients within their existing networks. These results inform the translation of diabetes education to a sustainable diabetes self-management behavior at the community level.

OBJECTIVES:Recent literature suggests an increased risk of diabetes following smoking cessation. Our objective was to compare the risk of developing diabetes among obese smokers using bupropion versus varenicline as well as other predictors during the first 3 years post-cessation. METHODS: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (2006 -2011). The cohort consisted of obese adult smokers newly initiating use of a smoking cessation medication: bupropion versus varenicline without a diabetes diagnosis at baseline. The outcome variable was time to developing diabetes following first prescription with a 3-year follow up. Chi-square tests were conducted to assess the frequency distribution of sample characteristics and association with diabetes development. Univariate survival analyses using Kaplan-Meier survival curve were conducted and log-rank test was used to assess significance. Cox Proportional Hazard (PH) regression model was carried out after evaluating PH assumption by Schoenfeld residual test. Interaction terms were included in the PH regression model if assumption was violated. RESULTS: The sample comprised of 91,899 individuals. A total of 3,668 (crude diabetes incidence rate: 13.3 per 1,000 person-years) obese smokers developed diabetes in 3 years. Abstinence at 12 months did not meet the PH assumption and interaction was created for this variable in the final Cox model. There was no statistically significant difference in diabetes risk using bupropion versus varenicline (Hazard Ratio: 1.408 95% Confidence Interval: 0.963 -2.058). Non-primary care group (1.