XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Objective: Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates. Method: A screen for adult ADHD was included in a probability subsample (N=3,199) of 18–44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD. Results: The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were u...

/pdf/the-prevalence-and-correlates-of-adult-adhd-in-the-united-5fbxyszdr6.pdf

The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Measuring Health: A Guide to Rating Scales and Questionnaires

Molecular Genetics of Attention-Deficit/Hyperactivity Disorder

The purpose of this study was to describe the patterns of antidiabetic medication use and the cost of testing supplies in Canada using information collected by Saskatchewan's Drug Plan (DP) in 2001. The diabetes cohort (n = 41,630) included individuals who met the National Diabetes Surveillance System (NDSS) case definition. An algorithm was then used to identify subjects as having type 1 or type 2 diabetes. Among those identified as having type 2 diabetes (n = 37,625), 38% did not have records for antidiabetic medication in 2001. One-third of patients with type 2 diabetes received monotherapy. Metformin, alone or in combination with other medications, was the most commonly prescribed antidiabetic medication. Just over one-half of the all patients with diabetes had a DP records for diabetes testing supplies. For individuals (n = 4,005) with type 1 diabetes, 79% had a DP record for supplies, with an average annual cost of $472 ± $560. For type 2 diabetes, 50% had records for testing supplies, with an average annual cost of $122 ± $233. Those individuals with type 2 diabetes who used insulin had higher testing supply costs than those on oral antidiabetic medication alone ($359 vs $131; p < 0.001).

https://link.springer.com/content/pdf/10.1186%2F1472-6963-6-159.pdf

Utilization of diabetes medication and cost of testing supplies in Saskatchewan, 2001.

Pmh23 development and assessment of health state utilities for attention deficit/hyperactivity disorder in children using parent proxy report

Aims The objectives of this study were to compare patterns of blood glucose monitoring among patients with type 2 diabetes initiating therapy with insulin or oral medication and to examine the relationship between the quantity of prescribed monitoring strips and glycemic control. Methods Data were obtained from the UK General Practice Research Database. Patients were eligible if they were identified as having type 2 diabetes, initiated therapy with insulin or an oral agent, and had 12-month postinitiation data. Differences in patient characteristics and number of test strips prescribed between the insulin ( n =347) and oral cohorts ( n =2436) were examined. Multivariate regressions examined the relationship between quantity of monitoring and glycemic control for a subset of patients (insulin, n =245; oral, n =1795) with available glycosylated hemoglobin (HbA 1c ) data. Results During the 12-month postinitiation period, patients using insulin were prescribed approximately twice as many test strips compared with those patients using oral medication (149 vs. 78, P 1c test date had, on average, a 0.65% lower HbA 1c value ( P =.02) compared with individuals who were prescribed fewer test strips. Conclusions Results indicate significant differences in the prescription of blood glucose monitoring strips, with patients initiated on insulin prescribed almost twice as many test strips compared with patients initiated on orals. The greater number of blood glucose test strips prescribed was associated with lower HbA 1c values for insulin patients.

Patterns of blood glucose monitoring in relation to glycemic control among patients with type 2 diabetes in the UK.

Pdb16 the association between diabetes related medical costs and glycemic control: a longitudinal analysis

Objective This analysis examines how obesity affects the prescribing of insulin for individuals with type 2 diabetes and poor glycemic control. Methods Data were obtained from the UK General Practice Research Database for the years 2000–2004. Patients were eligible if they had been identified as having type 2 diabetes and had undergone at least two valid glycosylated hemoglobin (HbA 1c ) tests. Additionally, patients had to have poor glycemic control on the index date (HbA 1c >7.4), no use of insulin 6 months prior to the index date, and at least 30 months of data after the index date ( N =6468). Descriptive statistics were used to examine unadjusted differences between obese and nonobese patients. A Cox proportional hazards model was applied to examine the relationship between obesity and the relative likelihood of initiation of insulin while controlling for differences in patient characteristics, medication use, and HbA 1c levels. Results Obese individuals were significantly younger ( P P =.02), and significantly less likely to be treated with oral monotherapy ( P =.02). Controlling for a wide range of factors that may impact receipt of insulin, results revealed that obese individuals had a "hazard" of initiation of insulin significantly lower than that of nonobese patients (hazard ratio=0.814, P =.01). Conclusions Patient age, severity of illness, and prior medication use all affect whether the individual will be initially prescribed insulin. Moreover, the results of this study demonstrate that obesity is an additional critical factor in physicians' decision to begin treatment with insulin.

Kristina Secnik

Papers

Utilization of diabetes medication and cost of testing supplies in Saskatchewan, 2001.

Pmh23 development and assessment of health state utilities for attention deficit/hyperactivity disorder in children using parent proxy report

Patterns of blood glucose monitoring in relation to glycemic control among patients with type 2 diabetes in the UK.

Pdb16 the association between diabetes related medical costs and glycemic control: a longitudinal analysis

Obesity and the use of insulin: a study of patients with type 2 diabetes in the UK.