Understanding the benefit versus risk of glycemic control and hypoglycemia is fundamental to the successful management of patients with T2DM. Our validated hypoglycemia model is an important step in addressing this issue and may be helpful to researchers, clinicians, and payers to determine the patients who are at the highest risk for hypoglycemia, whether a patient is experiencing events at 'higher-than-expected' rates, and the corresponding economic burden.
Purpose: The objective of this readiness project was to assess whether the physicians at a Chicagoland Family Practice are providing a level of diabetes care that meet both ADA guidelines and DPRP recognition criteria. Methods: This readiness project was conducted at Chicagoland Family Practice Clinic and involved a cross-sectional analysis of patient data collected by a review of 50 medical records. The entire sample population had diabetes. Data collection occurred in October to November 2009. Scoring for the DPRP readiness evaluation was conducted according to the DPRP clinical standards and performance scoring criteria, which include HbA1c testing and control, blood pressure (BP) control, LDL control, monitoring for nephropathy, eye examination, foot examination, and smoking status and cessation advice or treatment. HIPAA compliant data were collected. Results: There were more males (54.0%) than females. The average population age was 62.9 1 10.6 years (range, 44-85 years). The mean LDL was 83.9 6 25.5 mg/dL, with a mean HDL of 50 6 15.1 mg/dL. Only 6.3% of the DM population had an LDL greater than or equal to 130 mg/dL and 81.3% had an LDL value of less than 100 mg/dL. The results of this baseline assessment from data collected at the Chicagoland Family Practice Clinic suggest the level of diabetes care being practiced may not qualify them for DPRP recognition. The clinic would have received 70.0 points for this readiness survey based on DPRP scoring criteria. Seventy-five points are the minimum number needed to achieve recognition. Conclusions: Areas of excellence and opportunities for improvement in diabetes care were identified by use of the DPRP care domains. The physicians managed their patients' HbA1c, BP (,130/80 mm Hg), LDL (lipid control), and smoking status/advice/treatment documentation exceeded the required DPRP thresholds. The following areas were identified as opportunities for possible improvement in diabetes care: lower percentage of patients with BP .140/90 mm Hg, greater eye and foot examination documentation percentages. The implications of this project allow for this practice to focus on potential areas of quality improvement for patients with diabetes and to continue current treatment areas like lipids control. 161 Low-Density Lipoprotein (LDL) Particle Number is Heterogeneous among Persons with and Without Type 2 Diabetes and LDL Cholesterol ,100 mg/dL Ray Pourfarzib, PhD, Tara Dall, (Raleigh, NC)Synopsis: Patients with diabetes have relatively normal levels of low-density lipoprotein cholesterol (LDL-C) and elevated levels of other atherogenic lipoproteins. Differences in lipoprotein subclasses between persons with type 2 diabetes (T2DM) and persons without diabetes (NKDM) and the impact of inflammation have not been extensively examined. This study assessed variations in lipids, lipoprotein particle concentration/subclass, and inflammation by diabetes status. Purpose: To educate clinicians on lipoprotein management. Methods: Data were selected from a single laboratory database. Cases ...
Methods:The Archimedes Model is a physiologically based mathematical model that is clinically and administratively detailed and has been rigorously validated with the use of clinical trial data. To help simulate outcomes in SHTG individuals, the lipid component of the Archimedes Model was made more robust using data from individuals with TG .500 mg/dL from a managed care plan. The risk of a myocardial infarction (MI), stroke, CHD death, cardiovascular disease (CVD) death, and composite major adverse cardiovascular event (MACE) was determined from simulations using the Model. Results: The simulation randomly selected SHTG individuals from NHANES 1999-2006 and used these individuals as the basis for a simulated population of 5000 individuals. The average age at baseline was 45 years, with 68% males, 27% diabetics, mean body mass index of 30.6 kg/m 2 , blood pressure of 129/79 mmHg, total cholesterol of 265 mg/dL, high-density lipoprotein of 36.1 mg/dL, low-density lipoprotein of 85 mg/dL, triglycerides of 881 mg/dL, fasting plasma glucose of 126 mg/dL, and HbA1c of 6.1%. At 10 years and 20 years, respectively, the rate per individual at baseline of total myocardial infarctions was 14.6% and 32.5%, the rate of ischemic stroke was 3.5% and 7.9%, CHD death was 5% and 11.8%, CVD death was 7.1% and 16.7%, and the cumulative fraction of people with MACE was 16.2% and 31.5%. Conclusions: This simulation demonstrates a significant increase in the risk of future myocardial infarction, stroke, CHD death, CVD death, and MACE associated with SHTG. More precisely, SHTG individuals are more than twice as likely to experience an adverse cardiac outcome as compared with individuals with normal TG levels as based on published census data. Physicians should be aware of the need to treat SHTG levels to reduce the risk of longterm cardiovascular events.
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