Influence of Health Care Providers on the Development of Diabetes Complications

Zgibor, Janice C.; Songer, Thomas J.; Kelsey, Sheryl F.; Drash, Allan L.; Orchard, Trevor J.

doi:10.2337/diacare.25.9.1584

Cited by 54 publications

(37 citation statements)

References 27 publications

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“…In a study in patients with type 1 diabetes, the longer the proportion of diabetes duration spent in specialist care, the lower the risk of overt nephropathy (risk ratio 0.43, 95% CI 0.21 -0.88), neuropathy (risk ratio 0.54, 95% CI 0.35 -0.83) and coronary artery disease (risk ratio 0.65, 95% CI 0.37 -1.1). This trend was independent of diabetes duration, demographic characteristics, healthcare practices and physiological risk factors (31). Thus, specialist rather than general diabetes care may result in better glycaemic control and a lower incidence of some diabetes complications.…”

Section: Healthcare System-related Barriersmentioning

confidence: 82%

Treating to goal: challenges of current management

Barnett

2004

European Journal of Endocrinology

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Extensive evidence supports the benefits of treating to glycated haemoglobin (HbA 1c ) goal, both in terms of health and economic outcomes. As shown by the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT), the risk of patients with type 2 diabetes developing vascular complications is strongly correlated with HbA 1c levels and the duration of poor glycaemic control. Moreover, good glycaemic control significantly reduces the risk of complications. In controlled clinical trials, a number of pharmacological agents have been shown to significantly reduce HbA 1c levels in patients with type 2 diabetes. However, the reality is that most patients with type 2 diabetes have HbA 1c levels above the recommended target levels. Although there are regional differences in the average HbA 1c level, poor glycaemic control is a universal problem that will continue to grow in line with the rapidly increasing prevalence of type 2 diabetes. Barriers to good blood glucose control are present in almost every aspect of diabetes care. Furthermore, in patients with type 2 diabetes, therapy-, patient-and/or healthcare system-related barriers are compounded by an ongoing decline in beta-cell function that is characteristic of the progressive nature of the disease. Therapy-related barriers include reduced long-term efficacy with oral agents, fear of hypoglycaemia and a variety of issues related to flexibility and convenience that encourage poor compliance with therapy. From the patient perspective, issues relating to lifestyle, education, psychology and the environment can prevent optimum diabetes self-management. Poor access to and/or use of specialist healthcare resources also has a negative effect on treatment outcomes. These barriers to glycaemic control need to be overcome so that the established benefits of reducing glucose to normal or near-normal levels can be experienced by more people with type 2 diabetes.European Journal of Endocrinology 151 T3-T7

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Section: Healthcare System-related Barriersmentioning

confidence: 82%

Treating to goal: challenges of current management

Barnett

2004

European Journal of Endocrinology

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“…Despite a large proportion of subjects having regular health care (at least one visit per year), control remained suboptimal throughout (5), which may represent a breakdown in communication between provider and patient. Previous studies assessing type of health care provider accessed by EDC participants indicated that at exam 6, ϳ50% of the cohort reported receiving care from a diabetes specialist (13,28); thus, it is unlikely that type of provider played a significant role in the results.…”

Section: Correlates Of Awareness and Treatmentmentioning

confidence: 93%

Has Control of Hypercholesterolemia and Hypertension in Type 1 Diabetes Improved Over Time?

2005

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OBJECTIVE -To determine the extent to which patients' awareness, treatment, and control of hypertension and hypercholesterolemia have changed over time and to examine factors associated with awareness and treatment in a type 1 diabetes population.RESEARCH DESIGN AND METHODS -Data from six examinations conducted over 10 years from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective study of subjects with childhood-onset (Ͻ17 years of age) type 1 diabetes diagnosed between 1950 and 1980 and followed since 1986, were analyzed. Hypertension and hypercholesterolemia were defined according to the concurrent Joint National Committee and National Cholesterol Education Program Adult Treatment Panel criteria, respectively. RESULTS -Results demonstrated that awareness of both conditions has improved; however, control is not optimal (e.g., only 32.1 and 28% of those with hypertension in 1986 -1988 and 1996 -1998 were controlled, while for hypercholesterolemia, the rates were 0 and 5.5%, respectively). Stratified by age-group (18 -29, 30 -39, and Ͼ40 years), the youngest subjects with hypercholesterolemia were least likely to be treated and controlled to goal levels. Older age and physician contact were correlates of awareness and treatment of hypertension at baseline, while presence of renal or coronary complications was also associated with awareness and treatment of both hypertension and hypercholesterolemia at the 10-year follow-up.CONCLUSIONS -There is a considerable treatment gap, particularly for hypercholesterolemia. Improved treatment of both hypertension and hypercholesterolemia are clearly needed, particularly hypercholesterolemia in younger age-groups who have not yet experienced longterm complications. Diabetes Care 28:521-526, 2005H ypertension and hypercholesterolemia are important risk factors for the development of micro-and macrovascular complications in people with diabetes. Studies examining cardiovascular events among people with type 2 diabetes demonstrate that controlling these risk factors can directly impact the occurrence of both new (1) and repeat (2) events. Additionally, data suggest that people with type 1 diabetes and renal disease may experience remission or regression of their renal disease with aggressive antihypertensive treatment (3).While primary and secondary prevention of complications should be paramount, reports of suboptimal levels of treatment and control of these risk factors are abundant in the literature. The proportion of hypertensive individuals treated and controlled in the general population range from 10 to 41% (4,5), while for people with diabetes, rates range from 11 to 23% (6 -9). For hypercholesterolemia, reports indicate that 18 -37% of those treated and at high risk for an event in the general population are controlled (10), while 16 -35% of those with diabetes are controlled (8,9). Reasons for inadequate control are often centered on lack of access to health care, yet 90% of people with diabetes have access to a health care provider and have h...

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“…4 Whether this process can be halted is open to debate despite the fact that the evidence that this produces better outcomes for patients remains patchy. [5][6][7][8] This study was designed to look, within one institution, if the number of trabeculectomies performed per year by an individual surgeon had any bearing on the success of the operation.…”

Section: Introductionmentioning

confidence: 99%

The relation of volume and outcome in trabeculectomy

Hildreth

Phelan

et al. 2006

Eye

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Background/aims Higher case volume has been associated with improved outcomes for a number of procedures. This study was designed to investigate whether this relationship existed for trabeculectomy. Methods The study was retrospective and conducted at an ophthalmic unit in the UK. All patients who had unenhanced trabeculectomy between 1996 and 2000 were identified. From their notes, the surgeon who performed the trabeculectomy was ascertained as were any unplanned interventions (eg conjunctival suturing, anterior chamber reformation, repeated attendances) within the first month of surgery. Results Two hundred and eleven trabeculectomies were performed over the study period. Twenty nine had unplanned interventions within the first postoperative month. Analysis of the data indicated that surgeons who performed less than eight operations per year had more complications than those who performed more than 10 per annum. This difference was only significant (v 2 ¼ 4.0, P ¼ 0.045) when the data were aggregated. When separated per year, although not significant, the complication rate of the lower volume group was always higher than the group performing more than 10 per year. Conclusions The results suggest that trabeculectomy can be added to the list of procedures in which larger case volume is associated with fewer early complications and potentially a better outcome. The findings, if replicated, tend to strengthen the argument for subspecialisation in glaucoma with its implications for training and revalidation.

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Influence of Health Care Providers on the Development of Diabetes Complications

Cited by 54 publications

References 27 publications

Treating to goal: challenges of current management

Treating to goal: challenges of current management

Has Control of Hypercholesterolemia and Hypertension in Type 1 Diabetes Improved Over Time?

The relation of volume and outcome in trabeculectomy

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