External Barriers to Diabetes Care: Addressing Personal and Health Systems Issues

Zgibor, Janice C.; Songer, Thomas J.

doi:10.2337/diaspect.14.1.23

Cited by 100 publications

(84 citation statements)

References 36 publications

(23 reference statements)

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“…Recently, a small number of computer-based or electronic management systems have been reported to improve diabetes care (9 -11). However, many barriers are recognized in providing this care system into the community health care system (12,13). Diabetes care means managing vulnerable patients with chronic disease consistently in the outpatient setting.…”

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confidence: 99%

Establishment of Blood Glucose Monitoring System Using the Internet

et al. 2004

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OBJECTIVE -The Internet is used worldwide as a communication tool. To improve the quality of diabetes control, we investigated the effectiveness of an Internet-based blood glucose monitoring system (IBGMS) on controlling the changes in HbA 1c levels.RESEARCH DESIGN AND METHODS -We conducted a randomized clinical trial involving 110 patients who visited the outpatient clinic at the Kangnam St. Mary's Hospital for 3 months. The study subjects were treated with IBGMS for 12 weeks, and the control group received the usual outpatient management over the same period. HbA 1c and other laboratory tests were performed twice, once at the beginning of the study and again at the end of the study.RESULTS -The test results from the beginning of the study established that there were no significant differences between the two groups with respect to age, sex, diabetes duration, BMI, blood pressure, HbA 1c , and other laboratory data. On follow-up examination 12 weeks later, HbA 1c levels were significantly decreased from 7.59 to 6.94% within the intervention group (P Ͻ 0.001). At the end of the study, HbA 1c levels in the intervention group were significantly lower than in the control group after adjusting the baseline HbA 1c (6.94 vs. 7.62%; P Ͻ 0.001, respectively). Among patients with baseline HbA 1c Ͻ7.0%, the patients in the intervention group had lower HbA 1c than those in the control group (6.38 vs. 6.99%; P Ͻ 0.05). Among the patients with a baseline HbA 1c Ն7.0%, the difference between the two groups appeared more obvious: HbA 1c levels at the end of the study were 8.12%.CONCLUSIONS -This new IBGMS resulted in a significant reduction of HbA 1c during the study period. We propose that this IBGMS be used as a method for improving diabetes control. Diabetes Care 27:478 -483, 2004T he importance of tight blood glucose control for the subsequent prevention of diabetes complication is well established (1,2). In addition, improving glucose control will also reduce the enormous economic burden associated with the disease (3,4). Therefore, various strategies for diabetes management have been designed to improve the quality and efficiency of care for patients with diabetes. To promote adherence for patients and providers to follow practical guidelines, studies have been carried out to establish educational programs for patients and health care workers. Other studies, including giving feedback to the providers as well as programs that remind providers and their patients of these guidelines, have been experimented with (5-8). Recently, a small number of computer-based or electronic management systems have been reported to improve diabetes care (9 -11). However, many barriers are recognized in providing this care system into the community health care system (12,13). Diabetes care means managing vulnerable patients with chronic disease consistently in the outpatient setting. Chin et al. (13) reported that providers in health care centers indicated a need to enhance behavioral changes in diabetic patients to improve the health care de...

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Establishment of Blood Glucose Monitoring System Using the Internet

et al. 2004

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“…Rural women with disabilities may face additional cost, a lack of transportation, and other barriers to treatment for chronic diseases (The Rural Women's Work Group, 2006). Among patients with diabetes, rural residents do not receive the same services for diabetes care as their urban counterparts (Dansky & Dirani, 1998;Zgibor & Songer, 2001). Lack of rural/urban differences in our study might suggest that VHA patients with disability may not face some of the access barriers such as availability of necessary providers as a result of access to the VHA system of Community Based Outpatient Clinics (Weeks, Mahar, & Wright, 2005) in many areas.…”

Section: Discussionmentioning

confidence: 99%

Diabetes care among veteran women with disability

Tseng

Sambamoorthi

Tiwari

et al. 2006

Women's Health Issues

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Objective-The primary objective of this study was to analyze predictors of diabetes care consistent with performance standards among women Veterans Health Administration (VHA) clinic users with disability enrollment status.Methods-This is a retrospective cohort study using VHA and Medicare files of VHA clinic users with diabetes. Diabetes care measures consisted of annual testing for hemoglobin A 1c (>9%) and LDL-C (HbA 1c ), low-density lipoprotein cholesterol (LDL-C), and poor HbA 1c (≥130 mg/dL) control in fiscal year 2000. Chi-square tests and logistic regressions were used to assess subgroup differences in diabetes care. Independent variables included demographic characteristics and physical and psychiatric comorbidities.Population-Study population was based on veteran women <65 years of age who used VHA clinics; we identified 2,344 women as having coexisting disability and diabetes and 2,766 women with diabetes and without disability.Findings-Among veteran women with diabetes and disability, 65% received ≥1 HbA 1c test, and 54% received a LDL-C test; 25% and 30% had poor HbA 1c and LDL-C control, respectively. In logistic regressions, none of the independent variables had significant effects on poor HbA 1c or LDL-C control, except that African Americans were more likely to have poor HbA 1c control than whites. Significant age effects were noted in rates of HbA 1c and LDL testing. Comparison of diabetes care measures between women with and without disability indicated that those with disability were more likely to receive HbA 1c and LDL-C tests; no significant differences in HbA 1c and LDL-C control were noted.Conclusions-Disability status of women veterans was not a barrier to diabetes care consistent with performance standards. Our findings suggest that to improve diabetes care, subgroup-specific interventions, rather than a global approach, are warranted.

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“…In addition to specialized educator availability, other barriers that may limit the amount of preventive or follow-up care patients receive include cost of care, access to care (e.g., because of rural location or lack of transportation), appointment-scheduling constraints, time away from work, and low level of education. 6 Disease management may be able to bridge some of this gap. In fact, a growing number of health plans are trying to manage their diabetes population through in-house disease management programs, with the intent of improving health outcomes and reducing the population's risk of developing serious long-term complications.…”

Section: The Role Of Disease Management In Diabetes Carementioning

confidence: 99%

The Role of Disease Management in Diabetes Care

Benson¹

2010

Diabetes Spectrum

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External Barriers to Diabetes Care: Addressing Personal and Health Systems Issues

Cited by 100 publications

References 36 publications

Establishment of Blood Glucose Monitoring System Using the Internet

Establishment of Blood Glucose Monitoring System Using the Internet

Diabetes care among veteran women with disability

The Role of Disease Management in Diabetes Care

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