Is Glycemic Control Improving in U.S. Adults?

Hoerger, Thomas J.; Segel, Joel E.; Gregg, Edward W.; Saaddine, Jinan B.

doi:10.2337/dc07-1572

Cited by 439 publications

(302 citation statements)

References 13 publications

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“…These rates are also similar to rates from HIVuninfected patients with diabetes who participated in the 2003-2004 National Health and Nutrition Examination Survey (NHANES, 44% and 24%). 11 When assessed together, results from our study and Adeyemi et al suggest that HIV-infected patients with diabetes have similar rates of inadequate glycemic control as HIV-uninfected patients with diabetes.…”

Section: Discussionmentioning

confidence: 76%

“…9,10 studies, only two studies have estimated this prevalence in HIV-infected patients. [11][12][13][14][15] Furthermore, while age, number of years since diabetes diagnosis, insurance status, hyperlipidemia, body mass index (BMI), and poor self-care have been associated with inadequate glycemic control in the general diabetic population, no study has explored these associations in HIV-infected patients with diabetes. [16][17][18] HIV-infected patients with diabetes have unique potential cofactors for inadequate glycemic control, including the use of specific antiretroviral medications.…”

mentioning

confidence: 99%

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Glycemic Control in HIV-Infected Patients with Diabetes Mellitus and Rates of Meeting American Diabetes Association Management Guidelines

Satlin

Hoover

Glesby

2011

AIDS Patient Care and STDs

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Limited data exist on the prevalence of inadequate glycemic control and rates of meeting American Diabetic Association (ADA) management guidelines in HIV-infected adults with diabetes mellitus. We conducted a retrospective cross-sectional study of 142 HIV-infected adults with type 2 diabetes at an urban academic HIV clinic during 2008. We estimated the prevalence of and assessed associations with inadequate glycemic control, defined as hemoglobin A 1c !7.5% for !50% of quarters over the year, and determined rates of meeting ADA clinical goals. Ninety-two percent of patients received antiretroviral therapy. The prevalence of inadequate glycemic control was 33% (95% confidence interval [CI] 25%-42%). Compared to patients with adequate control, those with inadequate control had fewer years since HIV diagnosis (12.7 versus 15.1, p ¼ 0.01), increased use of insulin (60% versus 20%, p < 0.001) or any diabetic medication (98% versus 85%, p ¼ 0.02), and higher triglyceride levels (238 versus 168 mg/dL, p ¼ 0.008). Rates of achieving ADA goals were 42% for blood pressure, 66% for low-density lipoprotein cholesterol (LDL-C), 33% for high-density lipoprotein cholesterol, and 31% for triglycerides. Thirty-six percent of patients who did not meet the LDL-C goal received statin therapy. Forty-seven percent of patients were screened for retinopathy and 19% of patients without preexisting renal disease were screened for nephropathy. In conclusion, the prevalence of inadequate glycemic control in HIV-infected patients with diabetes is similar to published data from the general population. Suboptimal rates of meeting ADA blood pressure and lipid goals and adherence to screening guidelines demonstrate need for further clinician and patient education.

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Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 99%

Glycemic Control in HIV-Infected Patients with Diabetes Mellitus and Rates of Meeting American Diabetes Association Management Guidelines

Satlin

Hoover

Glesby

2011

AIDS Patient Care and STDs

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“…Many diabetes patients have poor control of glucose and associated cardiovascular disease (CVD) risk factors [1,2]. While the causes of inadequate management are complex [3,4], the problem is due in part to recognition relatively late in the natural history of glucose intolerance [5].…”

Section: Introductionmentioning

confidence: 99%

Glucose challenge test screening for prediabetes and undiagnosed diabetes

et al. 2009

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Aims/hypothesis Diabetes prevention and care are limited by lack of screening. We hypothesised that screening could be done with a strategy similar to that used near-universally for gestational diabetes, i.e. a 50 g oral glucose challenge test (GCT) performed at any time of day, regardless of meal status, with one 1 h sample. Methods At a first visit, participants had random plasma and capillary glucose measured, followed by the GCT with plasma and capillary glucose (GCTplasma and GCTcap, respectively). At a second visit, participants had HbA 1c measured and a diagnostic 75 g OGTT. ResultsThe 1,573 participants had mean age of 48 years, BMI 30.3 kg/m 2 and 58% were women and 58% were black. Diabetes (defined by WHO) was present in 4.6% and prediabetes (defined as impaired glucose tolerance [2 h glucose 7.8-11.1 (140-199 mg/dl) with fasting glucose ≤6.9 (125 mg/dl)] and/or impaired fasting glucose with plasma glucose 6.1-6.9 mmol/l [110-125 mg/dl]) in 18.7%. The GCTplasma provided areas under the receiver-operatingcharacteristic curves of 0.90, 0.82 and 0.79 for detection of diabetes, diabetes or prediabetes, and prediabetes, respectively, all of which were higher than GCTcap, random and capillary glucose, and HbA 1c (p<0.02 for all). The perfor- mance of GCTplasma was unaffected by time after meals or time of day, and was better in blacks than whites, but otherwise comparable in men and women, and in groups with differing prevalence of glucose intolerance. GCTplasma screening would cost approximately US$84 to identify one person with previously unrecognised diabetes or prediabetes. Conclusions/interpretation GCT screening for prediabetes and previously unrecognised diabetes would be accurate, convenient and inexpensive. Widespread use of GCT screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications.

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“…[27][28][29][30] In fact, nearly one half of diabetes patients have hemoglobin A 1c levels above target. 31 Frustration to meet recommended glycemic and behavioral goals may be reflected in new or existing emotional difficulties that further hamper patients' efforts to manage diabetes. 27,[32][33][34][35][36][37][38] Similarly, physicians are often frustrated by patients' difficulties integrating self-care into their lifestyles.…”

mentioning

confidence: 99%