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Different information sources yield widely varied prevalence and expenditure estimates. Although claims data provided a more objective means for identifying AD cases, survey report identified more cases, and pharmacy data also are an important source for case ascertainment. Using any single source will underestimate the prevalence and associated cost of AD. The wide range of AD cases identified by using different data sources demands caution interpreting cost-of-illness studies using single data sources.

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BackgroundTo evaluate real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD).MethodsCross-sectional analysis of patients with type 2 diabetes seen at Cleveland Clinic from 2005 to 2016, divided into two cohorts: with-CVD and without-CVD. Patient demographics and antidiabetic medications were recorded in December 2016; department encounters included all visits from 1/1/2016 to 12/31/2016. Comorbidity burden was assessed by the diabetes complications severity index (DCSI) score.ResultsOf 95,569 patients with type 2 diabetes, 40,910 (42.8%) were identified as having established CVD. Patients with CVD vs. those without were older (median age 69.1 vs. 58.2 years), predominantly male (53.8% vs. 42.6%), and more likely to have Medicare insurance (69.4% vs. 35.3%). The with-CVD cohort had a higher proportion of patients with a DCSI score ≥ 3 than the without-CVD cohort (65.0% vs. 10.3%). Utilization rates of glucagon-like peptide-1 receptor agonists and sodium–glucose co-transporter-2 inhibitors were low in both with-CVD (4.1 and 2.5%) and without-CVD cohorts (5.4 and 4.1%), respectively. The majority of patient visits (75%) were seen by a primary care provider. During the 1-year observation period, 81.9 and 62.0% of patients with type 2 diabetes and CVD were not seen by endocrinology or cardiology, respectively.ConclusionsThese data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen.

Objectives The purpose of this study was to assess atherosclerotic cardiovascular disease (ASCVD) prevalence, antidiabetes medication usage and physician specialty encounters among individuals with type 2 diabetes mellitus (T2DM) in the United States during 2015. Design Retrospective, cross‐sectional analysis. Patients Adults with T2DM in a large US administrative claims database. Patients were divided into ASCVD and non‐ASCVD groups. Subgroup analyses were conducted for three age groups (18‐44, 45‐64 and 65+ years). Results Of 1 202 596 patients with T2DM, 45.2% had established ASCVD. About 40% of T2DM patients with ASCVD had visited a cardiologist during 2015, compared to 11% in the non‐ASCVD group. The use of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose co‐transporter 2 inhibitors (SGLT‐2is) was low overall (<12%), and even lower in the ASCVD group (<9%). The prevalence of ASCVD was 15%, 36% and 71% in the 18‐44, 45‐64 and 65+ year age groups, respectively. GLP‐1RA and SGLT‐2i use was ≤5% in the 65+ subgroup, regardless of ASCVD status. Conclusions These real‐world data showed a high prevalence of ASCVD among T2DM patients, and confirmed, as a baseline assessment, low use of GLP‐1RAs and SGLT‐2is in these at‐risk patients prior to the 2017 American Diabetes Association guidelines recommending use of agents with proven cardiovascular benefits.

Although theory posits a multidimensional structure of resilience, studies have supported a unidimensional solution for data obtained from the commonly used Connor–Davidson Resilience Scale (CD-RISC). This study investigated the latent structure of CD-RISC responses in a sample of postsecondary students with disabilities. Furthermore, the validity of CD-RISC scores was examined with respect to career optimism and well-being. The analyses were conducted using confirmatory factor analysis and exploratory structural equation modeling (ESEM). Results supported a bifactor-ESEM representation of the CD-RISC data that accounts for construct-relevant multidimensionality in scores due to the presence of general and specific factors and the fallibility of indicators as pure reflections of the constructs they measure. Although three specific factors showed meaningful residual specificity over and above the general factor, two specific factors were weakly defined with little meaningful residual specificity. However, these factors may retain some utility in the bifactor-ESEM model insofar as they control for limited levels of residual covariance in items. Evidence was also obtained for relations of the general and substantively interpretable specific factors with career optimism and well-being. The results of the study provide validation data for the CD-RISC and clarify recent research converging on seemingly disparate unidimensional and multidimensional solutions.

Objective:The aim of this study was to quantify the relationship between workers’ body mass index and work productivity within various occupations.Methods:Data from two administrations (2014 and 2015) of the United States (US) National Health and Wellness Survey, an Internet-based survey administered to an adult sample of the US population, were used for this study (n = 59,772). Occupation was based on the US Department of Labor's 2010 Standardized Occupation Codes. Outcomes included work productivity impairment and indirect costs of missed work time.Results:Obesity had the greatest impact on work productivity in Construction, followed by Arts and Hospitality occupations. Outcomes varied across occupations; multivariable analyses found significant differences in work productivity impairment and indirect costs between normal weight and at least one obesity class.Conclusion:Obesity differentially impacted productivity and costs, depending upon occupation.