OBJECTIVE -Understanding how individuals weigh the quality of life associated with complications and treatments is important in assessing the economic value of diabetes care and may provide insight into treatment adherence. We quantify patients' utilities (a measure of preference) for the full array of diabetes-related complications and treatments.RESEARCH DESIGN AND METHODS -We conducted interviews with a multiethnic sample of 701 adult patients living with diabetes who were attending Chicago area clinics. We elicited utilities (ratings on a 0 -1 scale, where 0 represents death and 1 represents perfect health) for hypothetical health states by using time-tradeoff questions. We evaluated 9 complication states (e.g., diabetic retinopathy and blindness) and 10 treatment states (e.g., intensive glucose control vs. conventional glucose control and comprehensive diabetes care [i.e., intensive control of multiple risk factors]). CONCLUSIONS -End-stage complications have the greatest perceived burden on quality of life; however, comprehensive diabetes treatments also have significant negative quality-of-life effects. Acknowledging these effects of diabetes care will be important for future economic evaluations of novel drug combination therapies and innovations in drug delivery. RESULTS Diabetes Care 30:2478-2483, 2007D iabetes significantly increases an individual's risk of developing multiple microvascular and cardiovascular complications, and the risk of these complications can be significantly reduced with intensive and comprehensive diabetes care (1). Current recommendations for the ideal risk factor targets (e.g., A1C Ͻ7%) and specific therapies (e.g., prophylactic aspirin) for diabetes care reflect the findings of multiple clinical trials (2-4).Although intensive and comprehensive diabetes care may generate significant health benefits, the current level of adoption of comprehensive diabetes care is incomplete. Quality-of-care studies indicate that there has been a steady rise in the proportion of patients taking beneficial medications such as aspirin and that there have been reductions in the proportion of patients with poor risk factor control (5). At the same time, large proportions of patients continue to have poor glycemic (20%), blood pressure (33%), and cholesterol control (40%) (5). These ongoing deficiencies have led to a large public investment in diabetes quality improvement programs (6).The success of these quality improvement efforts depends, in part, on whether or not patients are willing to take the multiple medications that comprise comprehensive diabetes care. Patients' willingness to adopt this care is likely to be determined, in part, by their perceptions of the relative quality-of-life effects of complications and treatments (7,8). These perceptions are also critical for economic evaluations of quality improvement efforts and treatment innovations. The development of combination drugs such as the polypill, a proposed treatment combining an aspirin, a diuretic, an ACE inhibitor, a -blocker, fo...
The polypeptide product of the Ion (capR) gene was identified and partially purified from bacterial strains homozygous for the capR' or capR9 (ochre mutation) alleles cloned with pSC1O1. A 94,000-dalton polypeptide was identified as the Ion (capR) gene product. Studies ofbinding to DNA cellulose columns and nitrocellulose filters indicate that the capR+ and capR9 proteins bind DNA.capR (ion) mutants of Escherichia coli K-12 are sensitive to UV light and ionizing radiation, and they overproduce capsular polysaccharide (colanic acid), as well as 10 enzymes involved in colanic acid synthesis (1). After irradiation, capR strains form nonseptate filaments that die (24). capR mutants of E. coli K-12 are very likely mutant in the same gene as is E. coli B (5), a radiation-sensitive strain ofbacteria discovered by Witkin (6). capR mutants also exhibit a reduced capacity to degrade abnormal (7-9) as well as normal (10) proteins. The use of in vitro cloning techniques permitted us to clone the capR+ (lon+ gene on an 8,200,000-dalton EcoRI DNA fragment (11,12). The capR+ plasmids (pBZ201 and pBZ203) specified two new polypeptides in minicells and maxicells (recA, uvrA, phr; ref. 13) having Mrs of 94,000 and 67,000 as determined by NaDodSOJ polyacrylamide gel electrophoresis. Plasmids containing recessive capR mutations were deficient in synthesis of94,000-dalton (dal)-polypeptide in maxicells, and a plasmid containing a dominant capR allele (capR9) overproduced a polypeptide with the same electrophoretic mobility as the 94-kDal one (12). These observations suggested that the 94-kDal species was the capR gene product that was defective in autoregulation in the strain containing the capR9 allele. However, in the absence of data showing that the capR9 form of the polypeptide was altered, another plausible interpretation is that the recessive and dominant mutations were in the capR gene that regulates synthesis of a second gene that specifies the 94-kDal polypeptide. In the present study, we partially purified the 94-kDal polypeptide from capR+ and capR9 homogenotes. Biochemical evidence is presented showing that the native form of the capR+-specified 94-kDal polypeptide is altered in the capR9 mutant and thus the capR (Ion) gene is the structural gene for it. The purified capR+ and capR9 proteins each bind to DNA with certain differences that are presented below.MATERLILS AND METHODS Buffers. Buffer A was 100 mM K2HPO4-KH2PO4, pH 6.5/ 10 mM 2-mercaptoethanol/1 mM EDTA/20% glycerol (vol/ vol). Buffer B was 10 mM Tris HCI, pH 7.1 at 25°C/1 mM 2-mercaptoethanol/1 mM EDTA/20% glycerol (voVvol) 20 mM NaCl. Buffer C was 20 mM Tris HCl, pH 7.5 at 25°C/50 mM NaCl/5 mM MgCl2/0. 1 mM EDTA/1 mM dithiothreitoV20% glycerol (vol/vol Growth of Bacteria and Preparation of Cell-Free Extracts. Bacteria were grown in complex medium at 370C to --2 X 108 bacteria per ml, isotope was added, and growth was continued to stationary phase. Bacteria were harvested, washed, and suspended in buffer A, disrupted by sonic oscillation, and centri...
OBJECTIVE—To evaluate ethnic differences in medication concerns (e.g., side effects and costs) that may contribute to ethnic differences in the adoption of and adherence to type 2 diabetes treatments. RESEARCH DESIGN AND METHODS—We conducted face-to-face interviews from May 2004 to May 2006 with type 2 diabetic patients ≥18 years of age (N = 676; 25% Latino, 34% non-Hispanic Caucasian, and 41% non-Hispanic African American) attending Chicago-area clinics. Primary outcomes of interest were concerns regarding medications and willingness to take additional medications. RESULTS—Latinos and African Americans had higher A1C levels than Caucasians (7.69 and 7.54% vs. 7.18%, respectively; P < 0.01). Latinos and African Americans were more likely than Caucasians to worry about drug side effects (66 and 49% vs. 39%, respectively) and medication dependency (65 and 52% vs. 39%, respectively; both P < 0.01). Ethnic minorities were also more likely to report reluctance to adding medications to their regimen (Latino 12%, African American 18%, and Caucasian 7%; P < 0.01). In analyses adjusted for demographics, income, education, and diabetes duration, current report of pain/discomfort with pills (odds ratio 2.43 [95% CI 1.39–4.27]), concern regarding disruption of daily routine (1.97 [1.14–3.42]), and African American ethnicity (2.48 [1.32–4.69]) emerged as major predictors of expressed reluctance to adding medications. CONCLUSIONS—Latinos and African Americans had significantly more concerns regarding the quality-of-life effects of diabetes-related medications than Caucasians. Whether these medication concerns contribute significantly to differences in treatment adoption and disparities in care deserves further exploration.
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