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Research Studies is a compilation of published research articles funded by 大象APPor authored by 大象APPresearchers.

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1 to 25 of 391 Research Studies Displayed
Young RA, Blair S, Teigen K
Ambulatory medication safety events in high-risk patients with diabetes before and after a COVID-19 clinic slowdown.
This study鈥檚 objective was to assess possible changes in medication safety over the mandatory pre-/post- COVID-19 clinic slowdown in a high-risk population of patients with diabetes seen at a safety net clinic. A retrospective chart review of all patient encounters 1 year before and after the slowdown was conducted. The study cohort were all patients with poorly controlled diabetes established pre-COVID who were prescribed 4+ medications. The high-risk cohort consisted of 59 patients out of 762 total patients with diabetes. There were a similar number of patient encounters, cancellations and no-shows pre- and post-pandemic. There was no change in the number of prescribed medications pre-/post-slowdown, but more potential adverse medication events. Of all abstracted medication-related problems, the majority were in diabetic medications (73.1%), and of those, most involved insulin (75.4%). Over the 2-year period there were 11 preventable adverse drug events, all involved insulin, and were often affected by patient work system challenges such as self-administration and timing.
AHRQ-funded; HS027277.
Citation: Young RA, Blair S, Teigen K . Ambulatory medication safety events in high-risk patients with diabetes before and after a COVID-19 clinic slowdown. J Patient Saf 2025 Jun 1; 21(4):240-45. doi: 10.1097/pts.0000000000001352..
Keywords: Medication: Safety, Medication, Patient Safety, Diabetes, COVID-19, Ambulatory Care and Surgery
Morrow EL, Spieker AJ, Greevy RA
Demographic, clinical, psychosocial, and behavioral predictors of continuous glucose monitor use in adults with type 2 diabetes.
This study examined demographic, clinical, psychosocial, and behavioral predictors of continuous glucose monitors (CGM) use in adults with type 2 diabetes. The authors conducted a longitudinal observational study comprised of a secondary analysis of data collected in a larger trial with 245 community-dwelling adults with type 2 diabetes recruited from primary care. Over a 15-month period, 37.1% of participants started CGM. Predictors in bivariate models included younger age, higher socioeconomic status, insulin use, higher HbA1c, and more diabetes distress. Using a single multivariable model, only younger age, insulin use, and higher socioeconomic status were significant predictors. Neither diabetes self-care behaviors nor diabetes self-efficacy significantly predicted CGM use. Of participants who tried a CGM, 14.3% stopped, with cost being the most-cited reason.
AHRQ-funded; HS026122.
Citation: Morrow EL, Spieker AJ, Greevy RA . Demographic, clinical, psychosocial, and behavioral predictors of continuous glucose monitor use in adults with type 2 diabetes. J Gen Intern Med 2025 May; 40(6):1333-39. doi: 10.1007/s11606-024-09101-1.
Keywords: Diabetes, Chronic Conditions, Patient Self-Management
Narindrarangkura P, Dejhansathit S, Khan U
Developing and evaluating SEE-Diabetes: a patient-centered educational decision support system for diabetes care.
This feasibility study evaluated the effectiveness of Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered educational tool that was designed to promote shared decision-making for diabetes management in older adults. SEE-Diabetes showed considerable promise in improving interactions between patients and providers and presented an innovative approach to diabetes management for older adults.
AHRQ-funded; HS028032.
Citation: Narindrarangkura P, Dejhansathit S, Khan U . Developing and evaluating SEE-Diabetes: a patient-centered educational decision support system for diabetes care. J Eval Clin Pract 2025 Feb; 31(1):e14234. doi: 10.1111/jep.14234.
Keywords: Diabetes, Patient-Centered Healthcare, Chronic Conditions, Shared Decision Making, Patient and Family Engagement, Patient Self-Management
Dai J, Chang J, Choi JM
Trends in anti-diabetic medication use, severe hyperglycaemia and severe hypoglycaemia among American Indian and Alaska Native Peoples, 2009-2013.
This retrospective analysis examined patterns in anti-diabetic medication use and acute diabetes complications among American Indian and Alaska Native adults with type 2 diabetes. Researchers analyzed data from 39,183 adults who used Indian Health Service or Tribal health services between 2009-2013. During this period, usage of metformin increased from 56.0% to 60.5%, insulin from 31.4% to 35.9%, and dipeptidyl peptidase-4 inhibitors from 1.4% to 9.0%. Conversely, sulfonylurea use decreased from 40.3% to 32.9% and thiazolidinedione use declined sharply from 31.6% to 8.8%. Concurrently, rates of severe hypoglycemia fell from 1.6% to 0.8% and severe hyperglycemia from 2.0% to 1.6%.
AHRQ-funded; 2902006-00020-I.
Citation: Dai J, Chang J, Choi JM . Trends in anti-diabetic medication use, severe hyperglycaemia and severe hypoglycaemia among American Indian and Alaska Native Peoples, 2009-2013. Diabetes Obes Metab 2025 Jan; 27(1):328-37. doi: 10.1111/dom.16021.
Keywords: Diabetes, Medication, Racial and Ethnic Minorities
Warnick JL, Darling KE, Swartz Topor L
Barriers to healthy behaviors: perspectives from teens with comorbid type 1 diabetes and overweight/obesity, caregivers, and pediatric endocrinologists.
This study鈥檚 objective was to understand barriers to engaging in healthy lifestyle behaviors among adolescents with comorbid Type 1 diabetes (T1D) and overweight/obesity, their caregivers, and pediatric endocrinologists. Participants completed individual, semi-structured interviews. The results revealed three thematic barriers to healthy lifestyle behaviors and identified perceived limitations to engaging in recommended healthy behaviors concurrent with diabetes management.
AHRQ-funded; HS02707.
Citation: Warnick JL, Darling KE, Swartz Topor L . Barriers to healthy behaviors: perspectives from teens with comorbid type 1 diabetes and overweight/obesity, caregivers, and pediatric endocrinologists. J Pediatr Psychol 2024 Dec; 49(12):874-81. doi: 10.1093/jpepsy/jsae086..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Obesity, Caregiving
Marcotte LM, Wheat CL, Rao M
Evaluating equity in a national virtual care management intervention: delivery and outcomes by race/ethnicity among veterans with hypertension and diabetes.
The objective of this study was to evaluate whether the Preventive Health Inventory (PHI), a virtual care management intervention implemented in the Veterans Health Administration (VHA), was delivered equitably among racial/ethnic groups. Researchers used data from the VHA Corporate Data Warehouse among veterans enrolled in primary care nationally. Their findings suggested that the PHI intervention was deployed equitably across race/ethnicity groups without significantly impacting most existing inequities in hypertension and diabetes.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Wheat CL, Rao M . Evaluating equity in a national virtual care management intervention: delivery and outcomes by race/ethnicity among veterans with hypertension and diabetes. Health Serv Res 2024 Dec; 59(6):e14352. doi: 10.1111/1475-6773.14352.
Keywords: Diabetes, Blood Pressure, Racial and Ethnic Minorities, Disparities, Primary Care, Telehealth, Health Information Technology (HIT)
Hadley SM, Michelson KA
Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study.
This study investigated delayed diabetes diagnoses leading to diabetic ketoacidosis in pediatric patients. The study examined 11,716 cases of children under 19 with first-time diabetes diagnoses who developed ketoacidosis. Approximately 2.9% experienced diagnostic delays, defined as emergency department discharge within two weeks before ketoacidosis diagnosis. The investigation revealed that delayed diagnoses occurred more frequently among younger patients, those from areas with lower child opportunity indices, and non-Hispanic Black children. Patients with delayed diagnoses experienced higher rates of medical complications and required more intensive care.
AHRQ-funded; HS026503.
Citation: Hadley SM, Michelson KA . Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study. Diagnosis 2024 Nov 1; 11(4):416-21. doi: 10.1515/dx-2024-0024.
Keywords: Healthcare Cost and Utilization Project (HCUP), Diabetes, Children/Adolescents, Diagnostic Safety and Quality
Wen T, Friedman AM, Gyamfi-Bannerman C
Diabetic ketoacidosis and adverse outcomes among pregnant individuals with pregestational diabetes in the United States, 2010-2020.
This study鈥檚 objective was to assess the frequency of, risk factors for, and adverse outcomes associated with diabetic ketoacidosis (DKA) at delivery hospitalization among individuals with pregestational diabetes (type 1 and 2 diabetes mellitus) and secondarily to evaluate the frequency of and risk factors for antepartum and postpartum hospitalizations for DKA. The authors conducted a serial, cross-sectional study using the 大象APPHCUP Nationwide Readmissions Database from 2010 to 2020 to evaluate outcomes of pregnant individuals with pregestational diabetes hospitalized for delivery. The exposures were sociodemographic and clinical risk factors for DKA, and DKA. Of 392,796 deliveries in individuals with pregestational diabetes, there were 4,778 cases of DKA at delivery hospitalization. The frequency of DKA at delivery hospitalization was 1.2%, and the mean annual percentage change was 10.8%. Diabetic ketoacidosis during delivery hospitalization was associated with an increased risk of nontransfusion severe maternal morbidity (SMM), critical care procedures, cardiac complications, acute renal failure, and transfusion, as well as preterm birth and hypertensive disorders of pregnancy.
AHRQ-funded; HS028822.
Citation: Wen T, Friedman AM, Gyamfi-Bannerman C . Diabetic ketoacidosis and adverse outcomes among pregnant individuals with pregestational diabetes in the United States, 2010-2020. Obstet Gynecol 2024 Nov 1; 144(5):579-89. doi: 10.1097/aog.0000000000005667.
Keywords: Healthcare Cost and Utilization Project (HCUP), Diabetes, Women, Adverse Events, Maternal Health, Outcomes
Sneed NM, Kelley R, Turner H
The development and testing of a single-arm feasibility and acceptability study of a whole foods diet intervention for adults with prediabetes and their offspring.
The objective of this single-arm, pre-post experimental study was to assess the feasibility of a whole foods diet for adults with prediabetes and their offspring. Families received menus and grocery delivery, counseling by a registered dietitian, and optional focus group sessions. The findings indicated that a whole foods diet that provided dietary support was feasible for families at risk for type-2 diabetes.
AHRQ-funded; HS026122.
Citation: Sneed NM, Kelley R, Turner H . The development and testing of a single-arm feasibility and acceptability study of a whole foods diet intervention for adults with prediabetes and their offspring. Pilot Feasibility Stud 2024 Oct 23; 10(1):130. doi: 10.1186/s40814-024-01554-9.
Keywords: Diabetes, Nutrition
Aguilera A, Ar茅valo Avalos M, Xu J
Effectiveness of a digital health intervention leveraging reinforcement learning: results from the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation (DIAMANTE) randomized clinical trial.
A digital health study examined whether individualized text messages guided by reinforcement learning could boost physical activity among adults with diabetes and depression symptoms. Between January 2020 and June 2022, participants were recruited from four San Francisco clinics and online venues, then randomly divided into three groups: one receiving a weekly mood message, another receiving randomly assigned daily messages, and an adaptive group whose daily texts were tailored using reinforcement learning. Over the 24-week study, the adaptive group鈥檚 daily step counts increased, while control and random messaging groups showed smaller gains or declines, including individuals recruited both in person and online.
AHRQ-funded; HS025429.
Citation: Aguilera A, Ar茅valo Avalos M, Xu J . Effectiveness of a digital health intervention leveraging reinforcement learning: results from the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation (DIAMANTE) randomized clinical trial. J Med Internet Res 2024 Oct 8; 26:e60834. doi: 10.2196/60834..
Keywords: Diabetes, Behavioral Health, Health Information Technology (HIT), Patient Self-Management, Chronic Conditions
Venkatesh KK, Yee LM, Wu J
Diet quality, community food access, and glycemic control among nulliparous individuals with diabetes.
A prospective cohort study investigated associations between diet quality, community food access, and glycemic control among nulliparous individuals with pregestational diabetes. The research analyzed 151 pregnant individuals from eight U.S. medical centers between 2010-2013, examining both individual diet quality using the Healthy Eating Index-2010 and community-level food access. Diet quality was assessed through food frequency questionnaires covering periconceptional dietary intake, while community food access was determined using U.S. Department of Agriculture data. Glycemic control was measured via hemoglobin A1c levels in early pregnancy. The study evaluated relationships between dietary factors and glycemic control while accounting for demographic and socioeconomic variables, providing insights into nutrition's role in diabetes management during early pregnancy.
AHRQ-funded; HS028822.
Citation: Venkatesh KK, Yee LM, Wu J . Diet quality, community food access, and glycemic control among nulliparous individuals with diabetes. Prim Care Diabetes 2024 Oct; 18(5):506-10. doi: 10.1016/j.pcd.2024.06.011..
Keywords: Nutrition, Diabetes, Women
Hegland TA, Fang Z, Bucher K
大象APPAuthor: Hegland TA, Fang Z
GLP-1 medication use for type 2 diabetes has soared.
This data brief article disscues AHRQ鈥檚 Medical Expenditure Panel Survey Household Component (MEPS-HC) data for GLP-1 medication use. According to data from the MEPS-HC, by 2022 approximately 1 in 5 adults with type 2 diabetes in the US were already using the class of medications called glucagon-like peptide 1 (GLP-1) receptor agonists.
AHRQ-authored.
Citation: Hegland TA, Fang Z, Bucher K . GLP-1 medication use for type 2 diabetes has soared. JAMA 2024 Sep 24; 332(12):952-53. doi: 10.1001/jama.2024.18219..
Keywords: Medical Expenditure Panel Survey (MEPS), Medication, Diabetes
Brady PW, Ruddy RM, Ehrhardt J, PW, Ruddy RM, Ehrhardt J
Assessing the Revised Safer Dx Instrument(庐) in the understanding of ambulatory system design changes for type 1 diabetes and autism spectrum disorder in pediatrics.
The purpose of this ambulatory safety study was to assess whether the Revised Safer Dx instrument may be helpful in identifying diagnostic missed opportunities in the care of children with type 1 diabetes (T1D) and autism spectrum disorder (ASD). The authors reviewed two months of emergency department (ED) encounters for all patients at their tertiary care site with T1D and a sample for patients with ASD over a 15-month period, and applied the Revised Safer Dx instrument to each diagnostic journey. They did not identify any potentially missed opportunities to improve diagnosis in T1D but did find found two potential missed opportunities in ASD. They concluded that future research should consider prospectively collected data as well as development or adaptation of tools like the Safer Dx.
AHRQ-funded; HS026644.
Citation: Brady PW, Ruddy RM, Ehrhardt J, PW, Ruddy RM, Ehrhardt J . Assessing the Revised Safer Dx Instrument(庐) in the understanding of ambulatory system design changes for type 1 diabetes and autism spectrum disorder in pediatrics. Diagnosis 2024 Aug 1; 11(3):266-72. doi: 10.1515/dx-2023-0166..
Keywords: Children/Adolescents, Autism, Diabetes, Patient Safety, Diagnostic Safety and Quality, Quality Improvement, Quality of Care
Anderson KE, Chaiyakunapruk N, Gutierrez EJ
State out-of-pocket caps on insulin costs: no significant increase in claims or utilization.
This study evaluated whether state-level caps on insulin out-of-pocket spending change insulin usage among commercially insured enrollees. The study included 33,134 people aged 18-64 with type 1 diabetes or who used insulin to manage type 2 diabetes with commercial insurance coverage that was subject to state-level oversight and was included in the 25 percent sample of the IQVIA PharMetrics database during 2018-2021. Insulin out-of-pocket caps did not significantly increase quarterly insulin claims for enrollees with type 1 or type 2 diabetes. State-level caps on insulin out-of-pocket spending for commercial enrollees did not significantly increase insulin use.
AHRQ-funded; HS029202.
Citation: Anderson KE, Chaiyakunapruk N, Gutierrez EJ . State out-of-pocket caps on insulin costs: no significant increase in claims or utilization. Health Aff 2024 Aug; 43(8):1137-46. doi: 10.1377/hlthaff.2024.00118.
Keywords: Healthcare Costs, Health Insurance, Diabetes, Medication
Abel ED, Gloyn AL, Evans-Molina C
Diabetes mellitus-progress and opportunities in the evolving epidemic.
The authors discuss a perspective on recent advances in understanding the pathophysiology and treatment of diabetes and its complications. The strong association between obesity and type 2 diabetes (T2D) involves pathways regulated by the central nervous system that govern food intake and energy expenditure as well as integrate inputs from peripheral organs and the environment. Risk of developing diabetes or complications from it represents interactions between genetic susceptibility and environmental factors, including the availability of nutritious food and other social determinants of health.
AHRQ-funded; HS028822.
Citation: Abel ED, Gloyn AL, Evans-Molina C . Diabetes mellitus-progress and opportunities in the evolving epidemic. Cell 2024 Jul 25; 187(15):3789-820. doi: 10.1016/j.cell.2024.06.029..
Keywords: Diabetes
Jacobs J, Labellart P, Margellos-Anast H
Improving Diabetes Equity and Advancing Care (IDEA) to optimize team-based care at a safety-net health system for Black and Latine patients living with diabetes: study protocol for a sequential, multiple assignment, randomized trial.
This paper describes a study protocol to randomize interventions for Black/Latine patients living with diabetes. This study will examine the implementation of diabetes self-management training (DSMT), remote glucose monitoring (RGM), and tailored support from a community health worker (CHW) to improve outcomes. This study will aim to (1) evaluate the appropriateness; (2) measure fidelity; and (3) compare the effectiveness of varying the combination and sequence of three interventions. Eligible Black and Latine patients will be recruited using patient lists extracted from an electronic medical record system. After screening and informed consent, patients will be randomized to either DSMT or RGM. After 6 months patients will complete 2 assessments and HbA1c values will be reviewed. Patients then will be categorized as 鈥渞esponders鈥 who have an HbA1c that has improved by at least one percentage point or 鈥渘onresponders鈥. Nonresponders will be randomized to either switch study arms or to work with a CHW. At 6 months the participants will complete the 2 assessments again and their HbA1c values rereviewed. Twelve patient focus groups will be formed, two for each intervention path along with staff interviews.
AHRQ-funded; HS029431.
Citation: Jacobs J, Labellart P, Margellos-Anast H . Improving Diabetes Equity and Advancing Care (IDEA) to optimize team-based care at a safety-net health system for Black and Latine patients living with diabetes: study protocol for a sequential, multiple assignment, randomized trial. Trials 2024 Jul 24; 25(1):504. doi: 10.1186/s13063-024-08346-9..
Keywords: Diabetes, Racial and Ethnic Minorities, Disparities
Rikin S, Bauman L, Arnaoudova I
Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study.
Researchers conducted an efficacy-implementation pilot study of multidisciplinary, proactive electronic consultation (MPE) for type 2 diabetes (T2D) and chronic kidney disease (CKD) for primary care provider (PCP)-patient dyads at an academic health system. They interviewed PCPs and specialists to assess feasibility, acceptability, and appropriateness of MPE and analyzed responses to identify major themes. Prescription data were extracted from electronic health records to assess preliminary effectiveness to increase guideline-directed medical therapies (GDMTs). They concluded that MPE was an acceptable and appropriate health system strategy to identify and address gaps in GDMT among patients with T2D and CKD. PCPs raised feasibility concerns which could be improved with program enhancements.
AHRQ-funded; HS028877.
Citation: Rikin S, Bauman L, Arnaoudova I . Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study. BMJ Open Diabetes Res Care 2024 May 6; 12(3). doi: 10.1136/bmjdrc-2024-004155..
Keywords: Diabetes, Kidney Disease and Health, Chronic Conditions, Guidelines, Health Information Technology (HIT)
Kirkendall ES, Brady PW, Corathers SD
Safer type 1 diabetes care at home: SEIPS-based process mapping with parents and clinicians.
This study used the Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping method to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with type 1 diabetes (T1D). A transdisciplinary team of parents, safety researchers, and clinicians used SEIPS based process mapping to collect data on in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Eight of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 errors had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two had injuries due to repeated failures to administer insulin at home properly. The SEIPS-based process maps found that high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care.
AHRQ-funded; HS026644.
Citation: Kirkendall ES, Brady PW, Corathers SD . Safer type 1 diabetes care at home: SEIPS-based process mapping with parents and clinicians. Pediatr Qual Saf 2023 May-Jun; 8(3):e649. doi: 10.1097/pq9.0000000000000649..
Keywords: Patient Safety, Diabetes, Home Healthcare, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Medical Errors
Young JC, Webster-Clark M, Shmuel S
Clarifying the causal contrast: an empirical example applying the prevalent new user study design.
Using MarketScan claims data, researchers examined the impact of adding "switchers" to incident new users on the estimated hazard ratio of hospitalized heart failure between patients initiating GLP-1 receptor agonists (GLP-1 RA) and sulfonylureas (SU). The results indicated that when analyses were conducted only among incident new users, GLP-1 RA had a protective effect; however, among switchers from SU to GLP-1 RA, effect estimates shifted substantially toward the null. The researchers concluded that combining patients with varying treatment histories can result in poor confounding control and camouflage important heterogeneity.
AHRQ-funded; HS000032.
Citation: Young JC, Webster-Clark M, Shmuel S . Clarifying the causal contrast: an empirical example applying the prevalent new user study design. Pharmacoepidemiol Drug Saf 2024 Apr; 33(4):e5790. doi: 10.1002/pds.5790..
Keywords: Diabetes, Heart Disease and Health, Medication, Cardiovascular Conditions
Semere W, Karter AJ, Lyles CR
Care partner engagement in secure messaging between patients with diabetes and their clinicians: cohort study.
This study based on a previous cohort study investigated secure messaging (SM) use among older diabetes patients, exploring the impact of care partners. Analyzing data from a large healthcare system's patient portal, proxy users, mainly older and with lower education, showed higher SM engagement. They initiated SM sooner, had more exchanges, yet didn't bridge existing disparities. Proxy involvement may enhance patient-clinician communication in diabetes care, warranting further research on its impact on clinical outcomes.
AHRQ-funded; HS027844.
Citation: Semere W, Karter AJ, Lyles CR . Care partner engagement in secure messaging between patients with diabetes and their clinicians: cohort study. JMIR Diabetes 2024 Feb 9; 9:e49491. doi: 10.2196/49491.
Keywords: Diabetes, Patient and Family Engagement, Clinician-Patient Communication
Rodriguez HP, Ciemins E, Rubio K
Telemedicine use and decrements to type 2 diabetes and hypertension care during the COVID-19 pandemic.
The purpose of this study was to explore pandemic-related quality of care changes associated with telemedicine use among adults with type 2 diabetes and/or hypertension across ten health systems. The study found that telemedicine use was related with decreased odds of HbA1c and BP testing for adults with type 2 diabetes, but not HbA1c or BP control. Among hypertension-only patients, telemedicine utilization was related with decreased odds of BP testing, but not BP control. Compared to pre-pandemic telemedicine utilization, pandemic era telemedicine utilization was related with decreased odds of HbA1c and BP monitoring.
AHRQ-funded; HS024075.
Citation: Rodriguez HP, Ciemins E, Rubio K . Telemedicine use and decrements to type 2 diabetes and hypertension care during the COVID-19 pandemic. BMC Digit Health 2024 Jan 4; 2:2. doi: 10.1186/s44247-023-00056-7..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, COVID-19, Blood Pressure
Chase BA, Pocica S, Frigerio R
Mortality risk factors in newly diagnosed diabetic cardiac autonomic neuropathy.
To inform the design of interventions to reduce mortality in cardiac autonomic neuropathy (CAN) patients with diabetes, researchers explored genetic variants,
clinical attributes, and autonomic testing findings present to assess possible associations with increased mortality. They reviewed the electronic medical records of patients with advanced disease at the time when CAN was diagnosed. Some clinical characteristics, as well as sex, race, ethnicity, and incidence of type 1 or type 2 diabetes mellitus were found to be similar in both survivors and non-survivors; clinical and autonomic testing characteristics were often similarly advanced in survivors and non-survivors. The researchers concluded that their analysis provided context by estimating hazard ratios relative to when CAN is objectively diagnosed and indicated that not all risk factors confer equal mortality risk. Their findings may inform both the development of guidelines for prevention and the design of larger studies to evaluate CAN mortality risk factors.
AHRQ-funded; HS024057.
Citation: Chase BA, Pocica S, Frigerio R . Mortality risk factors in newly diagnosed diabetic cardiac autonomic neuropathy. Clin Auton Res 2023 Dec; 33(6):903-07. doi: 10.1007/s10286-023-00975-5.
Keywords: Mortality, Risk, Diabetes
Michelson KA, Bachur RG, Cruz AT
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
The objectives of this study were to derive a method of automated identification of delayed diagnosis of two serious pediatric conditions in the emergency department (ED). Subjects were patients under the age of 21 who had two EDs encounters within 7 days, the second resulting in a diagnosis of new-onset diabetic ketoacidosis (DKA) or sepsis. The results showed that delayed diagnosis was present in 89鈥% of DKA patients seen twice within 7 days. 17鈥% of sepsis patients were deemed to have delayed diagnosis; the authors noted that many children with sepsis delayed diagnosis may be identified using the proposed approach with low specificity, indicating a need for manual case review. The fewer days between ED encounters was the most important characteristic associated with delayed diagnosis.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Cruz AT . Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data. Diagnosis 2023 Nov; 10(4):383-89. doi: 10.1515/dx-2023-0019..
Keywords: Diabetes, Diagnostic Safety and Quality, Sepsis
Narindrarangkura P, Alafaireet PE, Khan U
Association rule mining of real-world data: uncovering links between race, glycemic control, lipid profiles, and suicide attempts in individuals with diabetes.
The objective of this study was to use the association rule mining (ARM) technique to identify a high-risk group of suicide attempts among patients with diabetes. Cerner Real-World Data鈩 was mined using this technique. The study results indicated that patients with diabetes who were never married and had average blood glucose levels below 150 mg/dl were more likely to attempt suicide, while patients aged 60 and older who had diabetes for less than five years were less likely to attempt suicide. The authors concluded that ARM showed the potential for knowledge discovery in large multi-center electronic health records data, and the results could be used by providers during outpatient clinic visits.
Citation: Narindrarangkura P, Alafaireet PE, Khan U . Association rule mining of real-world data: uncovering links between race, glycemic control, lipid profiles, and suicide attempts in individuals with diabetes. Inform Med Unlocked 2023; 42. doi: 10.1016/j.imu.2023.101345..
Keywords: Diabetes, Behavioral Health, Risk
Schuttner L, Richardson C, Parikh T
"Low-value" glycemic outcomes among older adults with diabetes cared for by primary care nurse practitioners or physicians: a retrospective cohort study.
The objective of this retrospective cohort study was to compare patients with diabetes reassigned to nurse practitioners to those reassigned to physicians after their previous physician separated from practice in an integrated US health system. Participants were patients aged at least 65 with diabetes who were at increased risk for hypoglycemia, whose primary care physician had left the Veterans Health Administration, and who were reassigned to a new primary care provider in the following year. The results indicated that primary care nurse practitioners delivered equivalent or better rates of low-value diabetes care for older patients, compared to physicians.
AHRQ-funded; HS026369.
Citation: Schuttner L, Richardson C, Parikh T . "Low-value" glycemic outcomes among older adults with diabetes cared for by primary care nurse practitioners or physicians: a retrospective cohort study. Int J Nurs Stud 2023 Sep; 145:104532. doi: 10.1016/j.ijnurstu.2023.104532..
Keywords: Elderly, Primary Care, Diabetes, Chronic Conditions

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