Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home.
PURPOSE We undertook this study to examine the symptoms, clinical events, and types of health care encounters that preceded the diagnosis of diabetes mellitus in adults, and to examine changes in glycemic control and cardiovascular risk factors in the fi rst year after a diabetes diagnosis.
METHODSWe conducted a historical cohort study of patients in a large multispecialty medical group in Minnesota. Among 55,121 adults who were continuously enrolled in the health plan and receiving care at the study medical group from January 1, 1993, to December 31, 1996, we identifi ed 504 who received a new diagnosis of diabetes in 1995 or 1996. Our main outcome measures were the type of symptoms at diagnosis; the clinical circumstances and type of encounter that led to diabetes diagnosis; and changes in glycemic control (assessed by hemoglobin A 1c [HbA 1c ] value), low-density lipoprotein cholesterol level, blood pressure (BP), aspirin use, and body weight in the fi rst year after diagnosis, ascertained from a detailed review of medical records.RESULTS Almost one third (32.3%) of adults with newly diagnosed diabetes had symptoms of hyperglycemia at initial diagnosis. Compared with patients who did not have hyperglycemia symptoms at diagnosis, those who did were younger and more often male, and had lower comorbidity scores and higher HbA 1c values (9.9% vs 8.1%) at diagnosis (P <.01 for each comparison). In the 12 months after diagnosis, the group as a whole had signifi cant improvements (P <.001) in HbA 1c values (from 8.8% to 7.1%), systolic blood pressure (137.5 to 133.2 mm Hg), diastolic blood pressure (80.7 to 77.3 mm Hg), weight (207.7 to 201.1 lb), and aspirin use (15.3% to 26.1%). Improvements were seen in all patient subgroups, including those defi ned by symptoms at diagnosis and by visit type at diagnosis.CONCLUSIONS Primary care practices may improve detection of undiagnosed diabetes in primary care and improve 1-year outcomes by being vigilant for symptoms of diabetes, by evaluating those at high risk for this disorder, and by instituting appropriate treatments at the time of diagnosis.
INTRODUCTIONT he prevalence of diabetes has increased rapidly during the past several decades and is expected to continue to rise.1-4 A consistent fi nding of this growing epidemic has been that 35% to 50% of cases of diabetes are undiagnosed. There may be some benefi t in detecting and treating symptomatic and screening for and treating asymptomatic undiagnosed diabetes. [5][6][7][8][9][10] Whether this would be best accomplished through more aggressive case fi nding in symptomatic persons or through opportunistic screening of asymptomatic persons is unclear, however. Several quantitative and qualitative studies suggest that a high proportion of patients have diabetes symptoms before diagnosis and that there is considerable heterogeneity in clinical and diagnostic processes that lead to a diabetes diagnosis. [11][12][13][14][15][16] The persistent fi nding that many patients are symptomatic for long periods before d...
Interventions in health plans are necessary to address constraints related to time and staff performing STD related care, keeping current with managing high-risk patients, and supporting patient adherence to provider recommendations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.