The association of diabetes specialist care with health care practices and glycemic control in patients with type 1 diabetes: a cross-sectional analysis from the Pittsburgh epidemiology of diabetes complications study.

Zgibor, Janice C.; Songer, Thomas J.; Kelsey, Sheryl F.; Weissfeld, Joel L.; Drash, A L; Becker, Dorothy J.; Orchard, Trevor J.

doi:10.2337/diacare.23.4.472

Cited by 78 publications

(62 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: 84%

“…dren's Hospital was one of the eligibility criteria, the EDC participants subsequently received their diabetes care in the general community, with ϳ50% receiving care from diabetes specialists (13). The present cross-sectional analyses represent data available for adults (age Ͼ18 years) followed for the first 10 years (six examination periods) of the EDC.…”

Section: Research Design and Methods -mentioning

confidence: 99%

See 1 more Smart Citation

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

2005

View full text Add to dashboard Cite

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...

show abstract

Section: Correlates Of Awareness and Treatmentmentioning

confidence: 84%

Section: Research Design and Methods -mentioning

confidence: 99%

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

2005

View full text Add to dashboard Cite

show abstract

“…Patient acceptance of basal/bolus insulin regimens has been slow (6,7), perhaps because of the considerable burden of multiple injections for some (8,9). Inhaled insulin may provide an alternative for the management of type 1 diabetes as part of a basal/bolus strategy in patients who are unwilling or unable to use preprandial insulin injections.…”

mentioning

confidence: 99%

Use of Inhaled Insulin in a Basal/Bolus Insulin Regimen in Type 1 Diabetic Subjects

et al. 2005

View full text Add to dashboard Cite

OBJECTIVE -Despite the demonstrated benefits of glycemic control, patient acceptance of basal/bolus insulin therapy for type 1 diabetes has been slow. We investigated whether a basal/ bolus insulin regimen involving rapid-acting, dry powder, inhaled insulin could provide glycemic control comparable with a basal/bolus subcutaneous regimen.RESEARCH DESIGN AND METHODS -Patients with type 1 diabetes (ages 12-65 years) received twice-daily subcutaneous NPH insulin and were randomized to premeal inhaled insulin (n ϭ 163) or subcutaneous regular insulin (n ϭ 165) for 6 months.RESULTS -Mean glycosylated hemoglobin (A1C) decreased comparably from baseline in the inhaled and subcutaneous insulin groups (Ϫ0.3 and Ϫ0.1%, respectively; adjusted difference Ϫ0.16% [CI Ϫ0.34 to 0.01]), with a similar percentage of subjects achieving A1C Ͻ7%. Although 2-h postprandial glucose reductions were comparable between the groups, fasting plasma glucose levels declined more in the inhaled than in the subcutaneous insulin group (adjusted difference Ϫ39.5 mg/dl [CI Ϫ57.5 to Ϫ21.6]). Inhaled insulin was associated with a lower overall hypoglycemia rate but higher severe hypoglycemia rate. The overall hypoglycemia rate (episodes/patient-month) was 9.3 (inhaled) vs. 9.9 (subcutaneous) (risk ratio [RR] 0.94 [CI 0.91-0.97]), and the severe hypoglycemia rate (episodes/100 patient-months) was 6.5 vs. 3.3 (RR 2.00 ). Increased insulin antibody serum binding without associated clinical manifestations occurred in the inhaled insulin group. Pulmonary function between the groups was comparable, except for a decline in carbon monoxideϪdiffusing capacity in the inhaled insulin group without any clinical correlates.CONCLUSIONS -Inhaled insulin may provide an alternative for the management of type 1 diabetes as part of a basal/bolus strategy in patients who are unwilling or unable to use preprandial insulin injections.

show abstract

“…Specifically, specialist care visits have been linked to improvements in blood pressure management, foot ulcers, infection, and screening for complications. These data provide additional evidence of the utility of specialty care visits (17)(18)(19). Along with intensive therapy and specialist care visits, visiting a physician at least two times per year was also positively associated with each screening test evaluated.…”

Section: Screening Frequency and Characteristicsmentioning

confidence: 83%

Does Patient Behavior or Access Factors Have the Largest Influence on Screening in Type 1 Diabetes?

et al. 2007

View full text Add to dashboard Cite

OBJECTIVE -Successful disease management is heavily influenced by access to care issues and patient behavior. Screening tests to detect chronic complications are part of diabetes management and may be influenced by access to care or patient decisions. The objective of this research was to examine how strongly access to care and patient behavior predict screening practices. RESULTS -Access-to-care issues positively predicted subsequent screening practices. Specifically, specialist care visits, number of doctor visits, and intensive insulin therapy were all strong predictors for screening use. Receipt of the recommended level of screening tests was also positively associated with the patient behavior of daily blood glucose testing. RESEARCH DESIGN AND METHODSCONCLUSIONS -The findings of this study show that access to care, in general, and access to quality diabetes care, in specific, play a key role in the use of recommended screening tests in type 1 diabetic patients. These data suggest that future efforts to improve screening practices in the type 1 diabetic population should address issues related to access to care. Diabetes Care 30:867-871, 2007D iabetes remains one of the most significant chronic illnesses affecting the U.S. population in terms of the number of people affected, related health care expenditures, and associated morbidity and mortality (1,2). Diabetic patients are at increased risk for developing chronic complications including nephropathy, retinopathy, neuropathy, peripheral vascular disease, and cardiovascular disease (2). Screening tests to detect early forms of these diseases are available, and routine screening for complications are widely recommended (3). However, currently few diabetic patients receive all recommended screening tests (4 -10).Optimal diabetes management includes components of screening and relies on a combination of patient and access factors that include provider and health care-system inputs (11). Multifaceted diabetes management programs are effective in improving glycemic control, monitoring lipid concentrations, and screening for diabetic retinopathy, foot lesions, peripheral neuropathy, and proteinuria (11). Diabetes is also unique in that a large component of disease management rests with the patient. Maintaining and monitoring glycemic control and adherence to diet, exercise, and prescribed medications are all essential daily components of diabetes management that are controlled by the patient (3).Disease management is predicated on appropriate patient self-management practices, physician adherence to evidence-based guidelines, and a health care system that facilitates these activities. Interventions that address provider feedback, provider education, provider reminders, patient education, patient reminders, and patient and provider financial incentives have been associated with improvements in provider adherence to recommended guidelines and patient outcomes (12). Interventions that address health care system factors such as central computerized tracking systems a...

show abstract

The association of diabetes specialist care with health care practices and glycemic control in patients with type 1 diabetes: a cross-sectional analysis from the Pittsburgh epidemiology of diabetes complications study.

Cited by 78 publications

References 0 publications

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

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

Use of Inhaled Insulin in a Basal/Bolus Insulin Regimen in Type 1 Diabetic Subjects

Does Patient Behavior or Access Factors Have the Largest Influence on Screening in Type 1 Diabetes?

Contact Info

Product

Resources

About