Blood test often incorrectly estimates blood sugar control in Black adults
Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes
The levels of glycemic control associated with the lowest risk of dementia in people with type 2 diabetes are unknown. This knowledge is critical to inform patient-centered glycemic target setting. To examine the associations between cumulative exposure to various ranges…
Development and Validation of a Diabetic Retinopathy Risk Stratification Algorithm
Although diabetic retinopathy is a leading cause of blindness worldwide, diabetes-related blindness can be prevented through effective screening, detection, and treatment of disease. The study goal was to develop risk stratification algorithms for the onset of retinal complications of diabetes,…
Data-driven classification of health status of older adults with diabetes: The diabetes and aging study
We set out to identify empirically-derived health status classes of older adults with diabetes based on clusters of comorbid conditions which are associated with future complications. We conducted a cohort study among 105,786 older (≥65 years of age) adults with type…
Validation of a Hypoglycemia Risk Stratification Tool Using Data From Continuous Glucose Monitors
This cohort study uses data from continuous glucose monitoring to validate a hypoglycemia risk stratification tool.
Racial and Ethnic Differences in Medication Initiation Among Adults Newly Diagnosed with Type 2 Diabetes
Given persistent racial/ethnic differences in type 2 diabetes outcomes and the lasting benefits conferred by early glycemic control, we examined racial/ethnic differences in diabetes medication initiation during the year following diagnosis. Among adults newly diagnosed with type 2 diabetes (2005-2016),…
Relaxed Glycemic Control and the Risk of Infections in Older Adults with Type 2 Diabetes
Older adults with poorly controlled type 2 diabetes (T2D) have a higher risk of infection than patients with good glycemic control. However tight glycemic control (e.g., A1C under 7%) in older adults has other risks. In a longitudinal cohort of…
Health Economic Analysis of Automated Insulin Delivery Systems
Safely administering insulin to manage blood glucose is challenging for people with type 1 diabetes (T1D). Artificial pancreas or automated insulin delivery (AID) systems mimic pancreatic function by measuring blood glucose (using real-time continuous glucose monitoring), calculating insulin requirements, and…
Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes
Continuous glucose monitoring (CGM) is indicated in poorly controlled insulin-treated patients with type 2 diabetes (T2D) to improve glycemic control and reduce the risk of hypoglycemia, but the benefits of CGM for lower risk patients have not been well studied.…
Association of Low-Density Lipoprotein Testing after an Atherosclerotic Cardiovascular Event with Subsequent Statin Adherence and Intensification
This study aimed to evaluate associations between outpatient low-density lipoprotein cholesterol (LDL-C) testing and subsequent statin adherence and intensification in patients after an atherosclerotic cardiovascular (ASCVD) event. This was a longitudinal study of adult members of Kaiser Permanente Northern California…
Economic analysis of automated insulin delivery (AID) systems
Our aim is to determine if automated insulin delivery (AID) systems provide good value compared with standard insulin delivery. We will support the external validation of a computer simulation model (Swedish National Diabetes Register T1D model) which will then be…
Comparison of cognitive function in older adults with type 1 diabetes, type 2 diabetes, and no diabetes: results from the Study of Longevity in Diabetes (SOLID)
The incidence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing. Life expectancy is improving in T1D, resulting in a growing population of elderly adults with diabetes. While it is well established that older adults with…
Quantifying Racial/ethnic Differences in the Relationship Between Glucose Concentrations and Hemoglobin A1c
Physicians rely on hemoglobin A1c (A1C), an integrated measure of glycemia (blood glucose), to make treatment decisions for patients with diabetes. There is evidence that, given comparable glycemia, A1C results in African Americans can be significantly higher than in whites…
Comparative effectiveness of intermittently scanned continuous glucose monitors among patients with basal-bolus insulin-treated type 2 diabetes
This study will characterize patients selected by their providers for intermittently-scanned, continuous glucose monitor (isCGM) initiation and estimate the effect of isCGM initiation (relative to non-initiators) on clinical outcomes. We hypothesize that 1) among basal-bolus insulin treated, type 2 diabetes…
Developing and Testing Automatic Models of Patient Communicative Health Literacy Using Linguistic Features: Findings from the ECLIPPSE study
Patients with diabetes and limited health literacy (HL) may have suboptimal communication exchange with their health care providers and be at elevated risk of adverse health outcomes. These difficulties are generally attributed to patients' reduced ability to both communicate and…
Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study
The substantial expansion of secure messaging (SM) via the patient portal in the last decade suggests that it is becoming a standard of care, but few have examined SM use longitudinally. We examined SM patterns among a diverse cohort of…
Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes
Continuous glucose monitoring (CGM) is recommended for patients with type 1 diabetes; observational evidence for CGM in patients with insulin-treated type 2 diabetes is lacking. To estimate clinical outcomes of real-time CGM initiation. Exploratory retrospective cohort study of changes in…
Continuous glucose monitors help patients manage type 2 diabetes
Association of Type 1 Diabetes and Hypoglycemic and Hyperglycemic Events and Risk of Dementia
To determine whether severe hypoglycemic and hyperglycemic events are associated with longitudinal dementia risk in older adults with type 1 diabetes. A longitudinal cohort study followed 2,821 members of an integrated healthcare delivery system with type 1 diabetes from 1997-2015.…
Validity of a Computational Linguistics-Derived Automated Health Literacy Measure Across Race/Ethnicity: Findings from The ECLIPPSE Project
Limited health literacy (HL) partially mediates health disparities. Measurement constraints, including lack of validity assessment across racial/ethnic groups and administration challenges, have undermined the field and impeded scaling of HL interventions. We employed computational linguistics to develop an automated and…
Employing computational linguistics techniques to identify limited patient health literacy: Findings from the ECLIPPSE study
To develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing. With respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated…
Challenges and solutions to employing natural language processing and machine learning to measure patients’ health literacy and physician writing complexity: The ECLIPPSE study
In the National Library of Medicine funded ECLIPPSE Project (Employing Computational Linguistics to Improve Patient-Provider Secure Emails exchange), we attempted to create novel, valid, and scalable measures of both patients' health literacy (HL) and physicians' linguistic complexity by employing natural…
A Randomized Encouragement Trial to Increase Mail Order Pharmacy Use and Medication Adherence in Patients with Diabetes
Mail order pharmacy (MOP) use has been linked to improved medication adherence and health outcomes among patients with diabetes. However, no large-scale intervention studies have assessed the effect of encouraging MOP use on medication adherence. To assess an intervention to…
Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes
Diabetic ketoacidosis (DKA) is a serious complication of diabetes. DKA is associated with poorer cognition in children with type 1 diabetes (T1D), but whether this is the case in older adults with T1D is unknown. Given the increasing life expectancy…
Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes
The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared…
Severe Hypoglycemia and Cognitive Function in Older Adults With Type 1 Diabetes: The Study of Longevity in Diabetes (SOLID)
In children with type 1 diabetes (T1D), severe hypoglycemia (SH) is associated with poorer cognition, but the association of SH with cognitive function in late life is unknown. Given the increasing life expectancy in people with T1D, understanding the role…
Risk of Cardiovascular Events in Statin-Treated Patients with Type 2 Diabetes and Metabolic Dyslipidemia without Prevalent Atherosclerotic Cardiovascular Disease
The relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels and risk of incident atherosclerotic cardiovascular disease events among patients with diabetes and metabolic dyslipidemia has not been well described. We conducted an observational cohort study of statin-treated adults (ages 21-90…
Comparative Effectiveness of Real-Time Continuous Glucose Monitoring (CGM) Among Insulin-Treated Diabetes Patients from Kaiser Permanente Northern California
This study will characterize type 1 and type 2 diabetes patients initiating newly prescribed continuous glucose monitors and evaluate the impact of that initiation on key clinical and utilization-based outcomes, and whether that impact differs across clinically vulnerable subgroups.
Predicting the readability of physicians’ secure messages to improve health communication using novel linguistic features: Findings from the ECLIPPSE study
Low literacy skills impact important aspects of communication, including health-related information exchanges. Unsuccessful communication on the part of physician or patient contributes to lower quality of care, is associated with poorer chronic disease control, jeopardizes patient safety and can lead…
Sleep Quality and Cognitive Function in Type 1 Diabetes: Findings From the Study of Longevity in Diabetes (SOLID)
The objective was to examine the association between sleep quality and global and domain-specific cognitive function among older individuals with type 1 diabetes (T1D). We evaluated 695 individuals with T1D aged 60 years or above who participated in the baseline…
Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes
Among older individuals with type 2 diabetes, those with poor health have greater risk and derive less benefit from tight glycemic control with insulin. To examine whether insulin treatment is used less frequently and discontinued more often among older individuals…
Secure Messaging with Physicians by Proxies for Patients with Diabetes: Findings from the ECLIPPSE Study
Little is known about patients who have caregiver proxies communicate with healthcare providers via portal secure messaging (SM). Since proxy portal use is often informal (e.g., sharing patient accounts), novel methods are needed to estimate the prevalence of proxy-authored SMs.…
Personalizing care for older patients with diabetes
Optimizing Medical Decision-Making for Older Patients with Type 2 Diabetes
Medicare-age patients with type 2 diabetes are projected to double in the next 25 years and have high rates of complications and adverse drug events. However, older patients are largely excluded from the major clinical trials of diabetes care. This…
Opportunities to encourage mail order pharmacy delivery service use for diabetes prescriptions: a qualitative study
Medication non-adherence is a major contributor to poor outcomes in diabetes. Previous research has shown an association between use of mail order pharmacy delivery and better medication adherence, but little is known about the barriers and facilitators to mail order…
Visual outcomes after cataract surgery in patients with type 2 diabetes
To assess the relation between diabetic retinopathy (DR) severity, duration of diabetes, insulin dependence, and preoperative hemoglobin A1c (HbA1c) with visual outcome after phacoemulsification for cataract in patients with type 2 diabetes. Kaiser Permanente Northern California, USA. Retrospective case series.…
The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (the Diabetes & Aging Study)
To examine for a legacy effect of early glycemic control on diabetic complications and death. This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997-2013, average follow-up 13.0 years, N =…
Using natural language processing and machine learning to classify health literacy from secure messages: The ECLIPPSE study
Limited health literacy is a barrier to optimal healthcare delivery and outcomes. Current measures requiring patients to self-report limitations are time-consuming and may be considered intrusive by some. This makes widespread classification of patient health literacy challenging. The objective of…
Predicting and Reducing Future Health Disparities for U.S. Adults with Diabetes
The clinical and financial impact of diabetes-related interventions and policies may not be quantifiable without the use of simulation models that reflect the long-term course of disease and its complications. Models of diabetes complications are used by healthcare delivery systems…
Review of Metformin Use for Type 2 Diabetes Prevention
Prediabetes is prevalent and significantly increases lifetime risk of progression to type 2 diabetes. This review summarizes the evidence surrounding metformin use for type 2 diabetes prevention. Articles published between 1998 and 2017 examining metformin use for the primary indication…
Traumatic brain injury associated with dementia risk among people with type 1 diabetes
To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D). We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old…
Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes
Individuals with type 1 diabetes have experienced an increase in life expectancy; yet, it is unknown what level of glycemic control is ideal for maintaining late-life brain health. We investigated the association of long-term glycemic control with dementia in older…
Language barriers and LDL-C/SBP control among Latinos with diabetes
Language barriers in healthcare are associated with worse glycemic control among Latino patients with limited English proficiency and diabetes. We examined the association of patient-physician language concordance with lipid (low-density lipoprotein cholesterol [LDL-C]) and systolic blood pressure (SBP) control. Retrospective…
Risk of Incident Atherosclerotic Cardiovascular Disease Events by Achieved Atherogenic Lipid Levels Among 62,428 Statin-Treated Individuals With Diabetes Mellitus
The relevance of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) goals for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among patients with diabetes was assessed. This retrospective cohort study included patients with type 2 diabetes, age 21 to…
Eating with others and meal location are differentially associated with nutrient intake by sex: The Diabetes Study of Northern California (DISTANCE)
Though eating with others is often a social behavior, relationships between social contexts of eating and nutrient intake have been underexplored. This study evaluates how social aspects of eating - frequencies of eating meals with others, meals prepared at home,…
Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes
In clinical trials of patients with type 2 diabetes, long-acting insulin analogs modestly reduced the risk of nocturnal hypoglycemia compared with human neutral protamine Hagedorn (NPH) insulin, but cost 2 to 10 times more. Outcomes in clinical practice may differ…
Adherence to Cardio-protective Medications Prescribed for Secondary Prevention after an Acute Coronary Syndrome Hospitalization Compared to Usual Care
Secondary prevention after an acute coronary syndrome (ACS) hospitalization is critical to prevent additional morbidity and mortality. While poor adherence to prescribed cardio-protective medications is a known problem;1;2 it is unknown whether an ACS event might motivate patients to achieve…
Improved Cardiovascular Risk Factors Control Associated with a Large-Scale Population Management Program Among Diabetes Patients
Optimal cardiovascular risk factors control among individuals with diabetes remains a challenge. We evaluated changes in glucose, lipid, and blood pressure control among diabetes patients after implementation of a large-scale population management program, known as Preventing Heart Attacks and Strokes…
Food Insecurity, Food “Deserts,” and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis
Both food insecurity (limited food access owing to cost) and living in areas with low physical access to nutritious foods are public health concerns, but their relative contribution to diabetes management is poorly understood. This was a prospective cohort study.…
Depression in type 1 diabetes and risk of dementia
Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk.…
Effect of Out-of-Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE)
To estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Electronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during…
The Bidirectional Association Between Depression and Severe Hypoglycemic and Hyperglycemic Events in Type 1 Diabetes
Severe hyperglycemia and hypoglycemia ("severe dysglycemia") are serious complications of type 1 diabetes (T1D). Depression has been associated with severe dysglycemia in type 2 diabetes but has not been thoroughly examined specifically in T1D. We evaluated bidirectional associations between depression…
Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use
Hypoglycemia-related emergency department (ED) or hospital use among patients with type 2 diabetes (T2D) is clinically significant and possibly preventable. To develop and validate a tool to categorize risk of hypoglycemic-related utilization in patients with T2D. Using recursive partitioning with…
Hypoglycemia Patients and Transport by EMS in Alameda County, 2013-15
To estimate the rate, characteristics, and dispositions of hypoglycemia events among persons who received care from Alameda County, California, Emergency Medical Services (EMS). This study was based on data for 601,077 Alameda County EMS encounters during 2013-15. Subjects were defined…
Association Between Neighborhood Supermarket Presence and Glycated Hemoglobin Levels Among Patients With Type 2 Diabetes Mellitus
We estimated associations between neighborhood supermarket gain or loss and glycemic control (assessed by glycated hemoglobin (HbA1c) values) in patients from the Kaiser Permanente Northern California Diabetes Registry (n = 434,806 person-years; 2007-2010). Annual clinical measures were linked to metrics from a…
Food Environment and Weight Change: Does Residential Mobility Matter?: The Diabetes Study of Northern California (DISTANCE)
Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual…
High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network
Seven-year surveillance study (2005-2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. SH events were identified via any primary or principal diagnosis from emergency department or…
Beyond the Great Recession: Was the Foreclosure Crisis Harmful to the Health of Individuals With Diabetes?
The housing foreclosure crisis was harmful to the financial well-being of many households. In the present study, we investigated the health effects of the housing foreclosure crisis on glycemic control within a population of patients with diabetes. We hypothesized that…
Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan
Enrollment in high-deductible health plans is increasing out-of-pocket spending. But innovative plans that pair deductibles with value-based insurance designs can help preserve low-cost access to high-value treatments for patients by aligning coverage with clinical value. Among adults in high-deductible health…
Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes
Medication adherence is essential to diabetes care. Patient-physician language barriers may affect medication adherence among Latino individuals. To determine the association of patient race/ethnicity, preferred language, and physician language concordance with patient adherence to newly prescribed diabetes medications. This observational…
Association of Patient-Physician Language Concordance and Glycemic Control for Limited-English Proficiency Latinos With Type 2 Diabetes
Providing culturally competent care to the growing number of limited-English proficiency (LEP) Latinos with diabetes in the United States is challenging. To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care…
Preferences, Management and Outcomes in the Oldest Patients with Diabetes
The aim of this study is to develop, pilot and conduct a survey among older diabetes patients (75 years of age or older) or their caregiver surrogates to collect data on: 1) self-management barriers (e.g., poor functional status, financial barriers,…
Development and Validation of a Novel Coding Algorithm for Identification of Severe Hypoglycemic Events in Ambulance Records
Severe hypoglycemia (SH) is one of the most prevalent diabetes complications and a critical public health concern; 25% of hospitalizations for adverse drug events is due to SH. Existing surveillance does not capture SH occurring in pre-emergency settings (e.g., treat…
Severe Hypoglycemia: Ascertainment, Surveillance and Pharmacovigalence
Diabetes medications are commonly used to reduce high blood sugar, but their use can sometimes lead to dangerously low blood sugar. “Severe hypoglycemia” (SH), defined as low blood sugar for which the patient requires assistance, has emerged as one of…
Pragmatic Risk Score to Identify Patients at Risk of Severe Hypoglycemia
A two-year study to develop and validate a pragmatic risk scoring tool to predict severe hypoglycemic (SH) events among patients with diabetes. This tool will be developed for use by clinicians to identify patients at high risk for SH, defined…
The Next Frontier in Diabetes Communication: Promoting Health Literacy in the Era of Secure Messaging
In this study, we will examine how diabetes patients with limited health literacy interact with their healthcare providers via secure messages (emails). We will employ computational linguistics and qualitative methods to develop and validate a novel "linguistic complexity profile” (LCP)…
Depressive symptoms and adherence to cardiometabolic therapies across phases of treatment among adults with diabetes: the Diabetes Study of Northern California (DISTANCE)
Among adults with diabetes, depression is associated with poorer adherence to cardiometabolic medications in ongoing users; however, it is unknown whether this extends to early adherence among patients newly prescribed these medications. This study examined whether depressive symptoms among adults…
The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging
Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients' literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from…
Changes in Medication Use After Dementia Diagnosis in an Observational Cohort of Individuals with Diabetes Mellitus
To assess changes in medication use after a diagnosis of dementia in individuals with type 2 diabetes mellitus. Difference-in-differences analysis of changes in the number of dispensed chronic medications between individuals with and without newly diagnosed dementia. Integrated healthcare delivery…
Ten-year hemoglobin A1c trajectories and outcomes in type 2 diabetes mellitus: The Diabetes & Aging Study
To classify trajectories of long term HbA1c values in patients after diagnosis of type 2 diabetes and examine each trajectory's associations with subsequent microvascular and macrovascular events and mortality. A longitudinal follow-up of 28,016 patients newly diagnosed with type 2…
Identifying Spanish Language Competent Physicians: The Diabetes Study of Northern California (DISTANCE)
Language barriers negatively impact health care access and quality for US immigrants. Latinos are the second largest immigrant group and the largest, fastest growing minority. Health care systems need simple, low cost and accurate tools that they can use to…
Police-Recorded Crime and Perceived Stress among Patients with Type 2 Diabetes: the Diabetes Study of Northern California (DISTANCE)
While stress has been linked to poor health outcomes, little is known about the impact of objective measures of neighborhood crime on stress in patients with chronic disease. Using the Kaiser Permanente Diabetes Study of Northern California (DISTANCE), we examined…
Trans-ethnic Meta-Analysis and Functional Annotation Illuminates the Genetic Architecture of Fasting Glucose and Insulin
Knowledge of the genetic basis of the type 2 diabetes (T2D)-related quantitative traits fasting glucose (FG) and insulin (FI) in African ancestry (AA) individuals has been limited. In non-diabetic subjects of AA (n = 20,209) and European ancestry (EA; n…
Is a reduction in distance to nearest supermarket associated with BMI change among type 2 diabetes patients?
We examined whether residing within 2 miles of a new supermarket opening was longitudinally associated with a change in body mass index (BMI). We identified 12 new supermarkets that opened between 2009 and 2010 in 8 neighborhoods. Using the Kaiser…
Communication Barriers and the Clinical Recognition of Diabetic Peripheral Neuropathy in a Diverse Cohort of Adults: The DISTANCE Study
The purpose of this study was to explore communication barriers as independent predictors and potential mediators of variation in clinical recognition of diabetic peripheral neuropathy (DPN). In this cross-sectional analysis, we estimated the likelihood of having a DPN diagnosis among…
Associations of perceived neighborhood safety and crime with cardiometabolic risk factors among a population with type 2 diabetes
Little is known about how neighborhood crime may relate to health in diabetes patients. We examined associations between individuals' perceptions of neighborhood safety or violent crime and stress, physical activity, body mass index (BMI) or hemoglobin A1c (HbA1c) in a…
Ethnic Differences in Risk of Coronary Heart Disease in a Large Contemporary Population
Racial/ethnic differences in diabetes and cardiovascular disease are well documented, but disease estimates are often confounded by differences in access to quality health care. The objective of this study was to evaluate the ethnic differences in risk of future coronary…
Financial Strain and Medication Adherence among Diabetes Patients in an Integrated Health Care Delivery System: The Diabetes Study of Northern California (DISTANCE)
To examine self-reported financial strain in relation to pharmacy utilization adherence data. Survey, administrative, and electronic medical data from Kaiser Permanente Northern California. Retrospective cohort design (2006, n = 7,773). We compared survey self-reports of general and medication-specific financial strain…
Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups
Online patient portals are being widely implemented; however, no studies have examined whether portals influence health behaviors or outcomes similarly across patient racial/ethnic subgroups. We evaluated longitudinal changes in statin adherence to determine whether racial/ethnic minorities initiating use of the…
Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events
For more than a decade, the presence of diabetes has been considered a coronary heart disease (CHD) "risk equivalent". The objective of this study was to revisit the concept of risk equivalence by comparing the risk of subsequent CHD events…
Severe Hypoglycemia Requiring Medical Intervention in a Large Cohort of Adults With Diabetes Receiving Care in U.S. Integrated Health Care Delivery Systems: 2005-2011
Appropriate glycemic control is fundamental to diabetes care, but aggressive glucose targets and intensive therapy may unintentionally increase episodes of hypoglycemia. We quantified the burden of severe hypoglycemia requiring medical intervention in a well-defined population of insured individuals with diabetes…
Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes
Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences…
No Spillover Effect of the Foreclosure Crisis on Weight Change: The Diabetes Study of Northern California (DISTANCE)
The emerging body of research suggests the unprecedented increase in housing foreclosures and unemployment between 2007 and 2009 had detrimental effects on health. Using data from electronic health records of 105,919 patients with diabetes in Northern California, this study examined…
Metabolic Dyslipidemia and Risk of Coronary Heart Disease in 28,318 Adults With Diabetes Mellitus and Low-Density Lipoprotein Cholesterol <100 mg/dl
The risk of future coronary heart disease (CHD) in subjects with diabetes and "metabolic dyslipidemia" (high triglyceride [TGs] and low high-density cholesterol levels) remains a matter of concern. Little is known regarding the risk of CHD for this phenotype with…
Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality? Lessons From the SUPREME-DM Cohort Study
Examining trends in cardiovascular events and mortality in US health systems can guide the design of targeted clinical and public health strategies to reduce cardiovascular events and mortality rates. We conducted an observational cohort study from 2005 to 2011 among…
An algorithm to identify medication nonpersistence using electronic pharmacy databases
Identifying patients who are medication nonpersistent (fail to refill in a timely manner) is important for healthcare operations and research. However, consistent methods to detect nonpersistence using electronic pharmacy records are presently lacking. We developed and validated a nonpersistence algorithm…
Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study
The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. An observational study was conducted among 115,538 diabetes patients, aged ³60, in an integrated health…
Reach and Validity of an Objective Medication Adherence Measure Among Safety Net Health Plan Members with Diabetes: A Cross-Sectional Study
With the expansion of Medicaid and low-cost health insurance plans among diverse patient populations, objective measures of medication adherence using pharmacy claims could advance clinical care and translational research for safety net care. However, safety net patients may experience fluctuating…
Prevalence of chronic kidney disease among individuals with diabetes in the SUPREME-DM Project, 2005-2011
Diabetes is a leading cause of chronic kidney disease (CKD). Different methods of CKD ascertainment may impact prevalence estimates. We used data from 11 integrated health systems in the United States to estimate CKD prevalence in adults with diabetes (2005-2011),…
Does Food Vendor Density Mediate the Association Between Neighborhood Deprivation and BMI?: A G-computation Mediation Analysis
In previous research, neighborhood deprivation was positively associated with body mass index (BMI) among adults with diabetes. We assessed whether the association between neighborhood deprivation and BMI is attributable, in part, to geographic variation in the availability of healthful and…
Preventable Major Cardiovascular Events Associated With Uncontrolled Glucose, Blood Pressure, and Lipids and Active Smoking in Adults With Diabetes With and Without Cardiovascular Disease: A Contemporary Analysis
The objective of this study was to assess the incidence of major cardiovascular (CV) hospitalization events and all-cause deaths among adults with diabetes with or without CV disease (CVD) associated with inadequately controlled glycated hemoglobin (A1C), high LDL cholesterol (LDL-C),…
Health Care System-level Factors Associated With Performance on Medicare STAR Adherence Metrics in a Large, Integrated Delivery System
The Centers for Medicare and Medicaid Services provide significant incentives to health plans that score well on Medicare STAR metrics for cardiovascular disease risk factor medication adherence. Information on modifiable health system-level predictors of adherence can help clinicians and health…
Impact of a Pharmacy Benefit Change on New Use of Mail Order Pharmacy among Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)
To assess the impact of a pharmacy benefit change on mail order pharmacy (MOP) uptake. Race-stratified, random sample of diabetes patients in an integrated health care delivery system. In this natural experiment, we studied the impact of a pharmacy benefit…
Patients who self-monitor blood glucose and their unused testing results
To investigate the prevalence, predictors, and costs associated with unused results from self-monitoring of blood glucose (SMBG). Observational cohort study. We studied 7320 patients with type 2 diabetes mellitus who were not prescribed insulin and who reported SMBG. Patients reported…
Low-frequency and rare exome chip variants associate with fasting glucose and type 2 diabetes susceptibility
Fasting glucose and insulin are intermediate traits for type 2 diabetes. Here we explore the role of coding variation on these traits by analysis of variants on the HumanExome BeadChip in 60,564 non-diabetic individuals and in 16,491 T2D cases and…
Trends in Diabetes Incidence Among 7 Million Insured Adults, 2006-2011: The SUPREME-DM Project
An observational cohort analysis was conducted within the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) DataLink, a consortium of 11 integrated health-care delivery systems with electronic health records in 10 US states. Among nearly 7 million adults aged 20…
Medicare Star excludes diabetes patients with poor CVD risk factor control
CMS recently added medication adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics to its Medicare Star quality measures. These CMS metrics exclude patients with
Social Support and Lifestyle vs. Medical Diabetes Self-Management in the Diabetes Study of Northern California (DISTANCE)
In chronic illness self-care, social support may influence some health behaviors more than others. Examine social support's association with seven individual chronic illness self-management behaviors: two healthy "lifestyle" behaviors (physical activity, diet) and five more highly skilled and diabetes-specific (medical)…
Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study
To estimate the incidence of remission in adults with type 2 diabetes not treated with bariatric surgery and to identify variables associated with remission. We quantified the incidence of diabetes remission and examined its correlates among 122,781 adults with type…
Update on Health Literacy and Diabetes
Inadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes. We reviewed 79 articles covering 3…
Associations Between Antidepressant Adherence and Shared Decision-Making, Patient-Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE)
Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care. While patient-provider communication patterns have been associated with adherence for cardiometabolic medications, it is unknown whether interpersonal aspects of care impact antidepressant medication adherence. To determine whether…
Prescription medication burden in patients with newly diagnosed diabetes: A SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study
To understand the burden of medication use for patients with newly diagnosed diabetes both before and after diabetes diagnosis and to identify subpopulations of patients with newly diagnosed diabetes who face a relatively high drug burden. Retrospective cohort study. 11…
National Trends in US Hospital Admissions for Hyperglycemia and Hypoglycemia Among Medicare Beneficiaries, 1999 to 2011
The increasing intensity of diabetes mellitus management over the past decade may have resulted in lower rates of hyperglycemic emergencies but higher rates of hospital admissions for hypoglycemia among older adults. Trends in these hospitalizations and subsequent outcomes are not…
Depression and All-Cause Mortality in Persons with Diabetes Mellitus: Are Older Adults at Higher Risk? Results from the Translating Research Into Action for Diabetes Study
To compare the strength of the association between depression and mortality between elderly and younger individuals with diabetes mellitus. A survival analysis conducted in a longitudinal cohort study of persons with diabetes mellitus to test the association between depression and…
Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)
Social risk factors for hypoglycemia are not well understood. Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and…
Racial/ethnic differences in dementia risk among older type 2 diabetes patients: The Diabetes and Aging Study
OBJECTIVE Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanatory factors among older diabetic patients.…
Use of the Refill Function Through an Online Patient Portal is Associated With Improved Adherence to Statins in an Integrated Health System
Online patient portals are being widely implemented, but their impact on health behaviors are not well-studied. To determine whether statin adherence improved after initiating use of the portal refill function. Observational cohort study within an integrated health care delivery system.…
Rates of Complications and Mortality in Older Patients With Diabetes Mellitus: The Diabetes and Aging Study
In the coming decades, the population of older adults with type 2 diabetes mellitus is expected to grow substantially. Understanding the clinical course of diabetes in this population is critical for establishing evidence-based clinical practice recommendations, identifying research priorities, allocating…
Medicare star excludes diabetes patients with poor CVD risk factor control
CMS recently added medication adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics to its Medicare Star quality measures. These CMS metrics exclude patients with
Spatial pattern of body mass index among adults in the diabetes study of Northern California (DISTANCE)
The role that environmental factors, such as neighborhood socioeconomics, food, and physical environment, play in the risk of obesity and chronic diseases is not well quantified. Understanding how spatial distribution of disease risk factors overlap with that of environmental (contextual)…
Severe Diabetic Retinal Disease and Dementia Risk in Type 2 Diabetes
Persons with type 2 diabetes are at an increased risk of dementia compared to those without, but the etiology of this increased risk is unclear. Cerebral microvascular disease may mediate the link between diabetes and dementia. Given the anatomical and…
The DISTANCE model for collaborative research: distributing analytic effort using scrambled data sets
Data-sharing is encouraged to fulfill the ethical responsibility to transform research data into public health knowledge, but data sharing carries risks of improper disclosure and potential harm from release of individually identifiable data. The study objective was to develop and…
Glycemic Control and Urinary Incontinence in Women with Diabetes Mellitus
Although many studies have shown that diabetes increases the risk for urinary incontinence, it is unclear whether poor glycemic control in women with diabetes is associated with incontinence. This study aims to determine the relationship between the hemoglobin A1c (HbA1c)…
Self-Reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD
To examine the association between physical functioning and mortality in people with type 2 diabetes, and determine if this association differs by race/ethnicity in managed care. We studied 7894 type 2 diabetic patients in Translating Research Into Action for Diabetes…
Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study
Although patients with type 2 diabetes are twice as likely to develop dementia as those without this disease, prediction of who has the highest future risk is difficult. We therefore created and validated a practical summary risk score that can…
HbA1c and Risk of Severe Hypoglycemia in Type 2 Diabetes: The Diabetes and Aging Study
We examined the association between HbA1c level and self-reported severe hypoglycemia in patients with type 2 diabetes. Type 2 diabetic patients in a large, integrated healthcare system, who were 30-77 years of age and treated with glucose-lowering therapy, were asked…
Safety and effectiveness of mail order pharmacy use in diabetes
Although research suggests that mail order pharmacy use is associated with greater medication adherence and cardiovascular disease risk factor control, no research has examined the potential impact of mail order pharmacy use on patient safety and utilization. To compare safety…
Patient-provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study
Patient-provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user…
Obesity and the Food Environment: Income and Ethnicity Differences Among People With Diabetes: The Diabetes Study of Northern California (DISTANCE)
It is unknown whether any association between neighborhood food environment and obesity varies according to individual income and/or race/ethnicity. The objectives of this study were to test whether there was an association between food environments and obesity among adults with…
Association Between Estimated GFR, Health-Related Quality of Life, and Depression Among Older Adults With Diabetes: The Diabetes and Aging Study
BACKGROUND: Although chronic kidney disease (CKD) is a highly prevalent condition among older adults with diabetes, the associations between health-related quality of life (HRQoL) and severity of CKD in this population are not well understood. The objective of this study…
Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases
OBJECTIVE: To propose a unifying set of definitions for prescription adherence research utilizing electronic health record prescribing databases, prescription dispensing databases, and pharmacy claims databases and to provide a conceptual framework to operationalize these definitions consistently across studies. METHODS: We…
Neighborhood Deprivation and Change in BMI Among Adults With Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE)
To compare associations between neighborhood deprivation and measures of BMI change among adults with type 2 diabetes. Using data from the Kaiser Permanente Diabetes Study of Northern California (DISTANCE) survey, we estimated the association between neighborhood deprivation and two measures…
Differences in the clinical recognition of depression in diabetes patients; the diabetes study of northern california (DISTANCE)
It is unknown to what extent the gap between need and care for depression among patients with diabetes differs across racial/ethnic groups. We compared, by race/ethnicity, the likelihood of clinical recognition of depression (diagnosis or treatment) of patients who reported…
Impaired Fasting Glucose and Impaired Glucose Tolerance Have Distinct Lipoprotein and Apolipoprotein Changes: The Insulin Resistance Atherosclerosis Study
CONTEXT: Cardiovascular risk is increased in individuals with impaired glucose tolerance (IGT) and impaired fasting glucose (IFG); however, those with IGT appear to be at greater risk. Lipoprotein abnormalities occur also in the prediabetic state. OBJECTIVE: The authors examined lipoprotein…
Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes; The Diabetes Study of Northern California (DISTANCE)
Previous studies have reported that health literacy limitations are associated with poorer disease control for chronic conditions, but have not evaluated potential associations with medication adherence. To determine whether health literacy limitations are associated with poorer antidepressant medication adherence. Observational…
Patient reported interpersonal processes of care and perceived social position: The Diabetes Study of Northern California (DISTANCE)
A patient's sense of his/her standing in the social hierarchy may impact interpersonal processes of care (IPC) within the patient-provider encounter. We investigated the association of perceived social position with patient-reported IPC. We used survey data from the Diabetes Study…
Elevated Rates of Diabetes in Pacific Islanders and Asian Subgroups: The Diabetes Study of Northern California (DISTANCE)
OBJECTIVE: We estimated the prevalence and incidence of diabetes among specific subgroups of Asians and Pacific Islanders (APIs) in a multiethnic U.S. population with uniform access to care. RESEARCH DESIGN AND METHODS: This prospective cohort analysis included 2,123,548 adult members…
Communication and Medication Refill Adherence: The Diabetes Study of Northern California
BACKGROUND: Poor medication refill adherence contributes to poor cardiometabolic control and diabetes outcomes. Studies linking communication between patients and health care providers to adherence often use self-reported adherence and have not explored differences across communication domains or therapeutic indications. METHODS:…
Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study
BACKGROUND: Reducing symptom burden is paramount at the end-of-life, but typically considered secondary to risk factor control in chronic disease, such as diabetes. Little is known about the symptom burden experienced by adults with type 2 diabetes and the need…
Is the physical functioning of older adults with diabetes associated with the processes and outcomes of care? Evidence from Translating Research Into Action for Diabetes (TRIAD)
AIMS: To examine the relationship between physical function limitations and diabetes self-management, processes of care and intermediate outcomes in adults >/= 65 years of age with Type 2 diabetes. METHODS: We studied 1796 participants 65 years of age and older…
Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients: Translating Research Into Action for Diabetes (TRIAD)
OBJECTIVE: To examine demographic, socioeconomic, and biological risk factors for all-cause, cardiovascular, and noncardiovascular mortality in patients with type 2 diabetes over 8 years and to construct mortality prediction equations. RESEARCH DESIGN AND METHODS: Beginning in 2000, survey and medical…
Ethnic Differences in Appointment-Keeping and Implications for the Patient-Centered Medical Home-Findings from the Diabetes Study of Northern California (DISTANCE)
OBJECTIVE: To examine ethnic differences in appointment-keeping in a managed care setting. DATA SOURCES/STUDY SETTING: Kaiser Permanente Diabetes Study of Northern California (DISTANCE), 2005-2007, n = 12,957. STUDY DESIGN: Cohort study. Poor appointment-keeping (PAK) was defined as missing >1/3 of…
Place matters: Neighborhood deprivation and cardiometabolic risk factors in the Diabetes Study of Northern California (DISTANCE)
While neighborhood deprivation is associated with prevalence of chronic diseases, it is not well understood whether neighborhood deprivation is also associated with cardiometabolic risk factors among adults with chronic disease. Subjects (n = 19,804) from the Diabetes Study of Northern…
Association of Depression With Increased Risk of Dementia in Patients With Type 2 Diabetes: The Diabetes and Aging Study
CONTEXT: Although depression is a risk factor for dementia in the general population, its association with dementia among patients with diabetes mellitus has not been well studied. OBJECTIVE: To determine whether comorbid depression in patients with type 2 diabetes increases…
Getting Under the Skin of Clinical Inertia in Insulin Initiation: The Translating Research Into Action for Diabetes (TRIAD) Insulin Starts Project
PURPOSE: The purpose of this cross-sectional study is to explore primary care providers' (PCPs) perceptions about barriers to initiating insulin among patients. Studies suggest that many patients with poorly controlled type 2 diabetes do not receive insulin initiation by PCPs.METHODS:…
Evaluation of risk equations for prediction of short-term coronary heart disease events in patients with long-standing type 2 diabetes: the translating research into action for diabetes (triad) study
ABSTRACT: BACKGROUND: To evaluate the U.K. Prospective Diabetes Study (UKPDS) and Framingham risk equations for predicting short-term risk of coronary heart disease (CHD) events among adults with long-standing type 2 diabetes, including those with and without preexisting CHD. METHODS: Prospective…
Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)
OBJECTIVE: We examined provider-level factors and reported discrimination in the healthcare setting. METHODS: With data from the Diabetes Study of Northern California (DISTANCE) - a race-stratified survey of diabetes patients in Kaiser Permanente Northern California - we analyzed patient-reported racial/ethnic…
The Comparative Effectiveness of Mail Order Pharmacy Use vs. Local Pharmacy Use on LDL-C Control in New Statin Users
BACKGROUND: Mail order pharmacies are commonly used to deliver CVD risk factor medications. Previous studies have shown that mail order pharmacy use is associated with greater medication adherence; however, no studies have examined whether mail order pharmacy use is related…
Ethnic differences in the development of albuminuria: the DISTANCE study
Objectives: To determine whether ethnic differences in the incidence of albuminuria are present in patients with diabetes, and to identify social, behavioral, and provider factors that explain ethnic differences. Study Design: Survey follow-up design with a race-stratified baseline survey (2005-2006)…
Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)
BACKGROUND: Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. OBJECTIVE: To…
Cross-sectional and longitudinal changes of glucose effectiveness in relation to glucose tolerance: the insulin resistance atherosclerosis study
OBJECTIVE: Glucose effectiveness (S(G)), the capacity of glucose to enhance its own disposition, is an independent predictor of future diabetes. However, there are data on cross-sectional and longitudinal changes of S(G) and its components, basal insulin effect on S(G) (BIE)…
Correlates of quality of life in older adults with diabetes: the diabetes & aging study
OBJECTIVE: To evaluate associations between health-related quality of life (HRQL) and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes. RESEARCH DESIGN AND METHODS: A race-stratified random sample of 6,317 adults with type 2 or type 1 diabetes,…
Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD)
OBJECTIVE: To determine the frequency that diabetes is reported on death certificates of decedents with known diabetes and describe trends in reporting over 8 years. RESEARCH DESIGN AND METHODS: Data were obtained from 11,927 participants with diabetes who were enrolled…
Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study
OBJECTIVE: To identify the range of glycemic levels associated with the lowest rates of complications and mortality in older diabetic patients. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study (2004-2008) of 71,092 patients with type 2 diabetes, aged…
Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access
The authors investigated use of the internet-based patient portal, kp.org, among a well-characterized population of adults with diabetes in Northern California. Among 14,102 diverse patients, 5671 (40%) requested a password for the patient portal. Of these, 4311 (76%) activated their…
Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study
BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification.…
Adherence to laboratory test requests by patients with diabetes: the Diabetes Study of Northern California (DISTANCE)
OBJECTIVES: To estimate rates and predictors of clinical laboratory test completion by patients with diabetes after provider referral. STUDY DESIGN: Prospective cohort study. METHODS: Among 186,306 adult members with diabetes in Kaiser Permanente Northern California, we searched the electronic medical…
Competing demands for time and self-care behaviors, processes of care, and intermediate outcomes among people with diabetes: Translating Research Into Action for Diabetes (TRIAD)
OBJECTIVE: To determine whether competing demands for time affect diabetes self-care behaviors, processes of care, and intermediate outcomes. RESEARCH DESIGN AND METHODS: We used survey and medical record data from 5,478 participants in Translating Research Into Action for Diabetes (TRIAD)…
Elderly Diabetes Patients with Very Low Glucose Levels Have Slightly Increased Risk of Death
A new study of older diabetes patients has found that well-controlled blood sugar levels were associated with a lower risk of major complications such as heart attacks, amputation and kidney disease, but the very lowest blood sugar levels were associated…
Heterogeneity of diabetes outcomes among asians and pacific islanders in the US; the diabetes study of northern california (DISTANCE)
OBJECTIVE: Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated. RESEARCH DESIGN AND METHODS: We…
Triglycerides and amputation risk in patients with diabetes: ten-year follow-up in the DISTANCE study
OBJECTIVE: To determine the association between triglyceride levels and lower-extremity amputation (LEA) risk in a large diabetic cohort. RESEARCH DESIGN AND METHODS: This is a 10-year survey follow-up study (from 1995-2006) of 28,701 diabetic patients with a baseline triglyceride measure.…
Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE)
BACKGROUND: A significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown. OBJECTIVE: To assess the association between limited English proficiency (LEP) and glycemic control…
Correlates of patient-reported racial/ethnic health care discrimination in the Diabetes Study of Northern California (DISTANCE)
OBJECTIVES: We examined possible determinants of self-reported health care discrimination. METHODS: We examined survey data from the Diabetes Study of Northern California (DISTANCE), a race-stratified sample of Kaiser diabetes patients. Respondents reported perceived discrimination, and regression models examined socioeconomic, acculturative,…
Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study
AIM: The broad objective of this study was to examine multiple dimensions of depression in a large, diverse population of adults with diabetes. Specific aims were to measure the association of depression with: (1) patient characteristics; (2) outcomes; and (3)…
The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study
OBJECTIVE: To assess the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions. METHODS: Cross-sectional survey of 8638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency…
Thiazolidinediones and fractures: evidence from translating research into action for diabetes
BACKGROUND: Thiazolidinedione (TZD) treatment has been associated with fractures. The purpose of this study was to examine the association between TZD treatment and fractures in type 2 diabetic patients. METHODS: Using data from Translating Research into Action for Diabetes, a…
Disposition index, glucose effectiveness, and conversion to type 2 diabetes: the Insulin Resistance Atherosclerosis Study (IRAS)
OBJECTIVE: Disposition index (DI) and glucose effectiveness (S(G)) are risk factors for diabetes. However, the effect of DI and S(G) on future diabetes has not been examined in large epidemiological studies using direct measures. RESEARCH DESIGN AND METHODS: Insulin sensitivity…
Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE)
BACKGROUND: Little is known about the frequency of significant hypoglycemic events in actual practice. Limited health literacy (HL) is common among patients with type 2 diabetes, may impede diabetes self-management, and thus HL could increase the risk of hypoglycemia. OBJECTIVE:…
A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study (IRAS)
OBJECTIVE: A1C is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose for detecting at-risk individuals is not well known. RESEARCH…
Thiazolidinediones, cardiovascular disease and cardiovascular mortality: translating research into action for diabetes (TRIAD)
BACKGROUND: Studies have associated thiazolidinedione (TZD) treatment with cardiovascular disease (CVD) and questioned whether the two available TZDs, rosiglitazone and pioglitazone, have different CVD risks. We compared CVD incidence, cardiovascular (CV), and all-cause mortality in type 2 diabetic patients treated…
Social disparities in dental insurance and annual dental visits among medically insured patients with diabetes: the Diabetes Study of Northern California (DISTANCE) Survey
INTRODUCTION: People with diabetes are at increased risk of periodontal disease and tooth loss. Healthy People 2010 set a goal that 71% or more of people with diabetes should have an annual dental exam. METHODS: We assessed dental insurance and…
Race/ethnicity, social support, and associations with diabetes self-care and clinical outcomes in NHANES
PURPOSE: The purpose of this study was to evaluate how social support and race/ethnicity were associated with diabetes self-care behaviors and clinical outcomes. METHODS: Using the cross-sectional 2005-2006 National Health and Nutrition Examination Survey (NHANES), the authors examined white, black,…
Barriers to insulin initiation: the translating research into action for diabetes insulin starts project
OBJECTIVE: Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription. RESEARCH DESIGN AND METHODS: We surveyed insulin-naive patients with poorly controlled type 2 diabetes, already treated with…
The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study
BACKGROUND: Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes. OBJECTIVE: We evaluated the association between number of prescription medications…
Characteristics of insured patients with persistent gaps in diabetes care services: the Translating Research into Action for Diabetes (TRIAD) study
BACKGROUND: Although preventing diabetes complications requires long-term management, little is known about which patients persistently fail to get recommended care. OBJECTIVE: To determine the frequency and correlates of persistent, long-term gaps in diabetes care. METHOD: : The study population included…
Mail-order pharmacy use and adherence to diabetes-related medications
OBJECTIVE: To investigate whether patients who use mail-order pharmacies were more likely to have good medication adherence than patients who use local pharmacies. STUDY DESIGN: Cross-sectional investigation. METHODS: We conducted cross-sectional analyses of patients from the Kaiser Permanente Northern California…
Ethnic differences in anemia among patients with diabetes mellitus: the Diabetes Study of Northern California (DISTANCE)
To examine ethnic differences in hemoglobin testing practices and to test the hypothesis that ethnicity is an independent predictor of anemia among patients with diabetes mellitus. We conducted a panel study to assess the rate of hemoglobin testing during 1999-2001…
Insulin resistance, beta-cell dysfunction, and conversion to type 2 diabetes in a multiethnic population: the Insulin Resistance Atherosclerosis Study
OBJECTIVE: Insulin resistance and beta-cell function are major predictors of type 2 diabetes, but studies using direct methods of insulin resistance and secretion are few and relatively small. Furthermore, the strength of these associations has not been tested in different…
The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE)
Internet-based patient portals are intended to improve access and quality, and will play an increasingly important role in health care, especially for diabetes and other chronic diseases. Diabetes patients with limited health literacy have worse health outcomes, and limited health…
Diabetes and poor disease control: is comorbid depression associated with poor medication adherence or lack of treatment intensification?
OBJECTIVE: To hypothesize that patients with comorbid depression and diabetes and poor disease control will have poorer adherence to disease control medication and less likelihood of physician intensification of treatment. Many patients with diabetes fail to achieve American Diabetes Association…
New prescription medication gaps: a comprehensive measure of adherence to new prescriptions
OBJECTIVE: Describe a novel approach to comprehensively summarize medication adherence. DATA SOURCES/STUDY SETTING: Kaiser Permanente Northern California Diabetes Registry (n approximately 220,000) STUDY DESIGN: In a new prescription cohort design (27,329 subjects prescribed new medications), we used pharmacy utilization data…
Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?
BACKGROUND: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. OBJECTIVE: To examine associations…
Identifying risk factors for racial disparities in diabetes outcomes: the translating research into action for diabetes study
BACKGROUND: Versus whites, blacks with diabetes have poorer control of hemoglobin A1c (HbA1c), higher systolic blood pressure (SBP), and higher low-density lipoprotein (LDL) cholesterol as well as higher rates of morbidity and microvascular complications. OBJECTIVE: To examine whether several mutable…
Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus
CONTEXT: Although acute hypoglycemia may be associated with cognitive impairment in children with type 1 diabetes, no studies to date have evaluated whether hypoglycemia is a risk factor for dementia in older patients with type 2 diabetes. OBJECTIVE: To determine…
Treatment intensification and risk factor control: toward more clinically relevant quality measures
BACKGROUND: Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. OBJECTIVE: To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and…
Predictors of sustained walking among diabetes patients in managed care: the Translating Research into Action for Diabetes (TRIAD) study
BACKGROUND: Although patients with diabetes may benefit from physical activity, few studies have examined sustained walking in this population. OBJECTIVE: To examine the factors associated with sustained walking among managed care patients with diabetes. DESIGN: Longitudinal, observational cohort study with…
Why don’t diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification
BACKGROUND: Despite the availability of effective hypertension, hyperlipidemia, and hyperglycemia therapies, target levels of systolic blood pressure (SBP), LDL-cholesterol (LDL-c), and hemoglobin A1c control are often not achieved. OBJECTIVE: To examine the relative importance of patient medication nonadherence versus clinician…
The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry
BACKGROUND: Alcohol consumption is a common behavior. Little is known about the relationship between alcohol consumption and glycemic control among people with diabetes. OBJECTIVE: To evaluate the association between alcohol consumption and glycemic control. DESIGN: Survey follow-up study, 1994-1997, among…
Perception of neighborhood problems, health behaviors, and diabetes outcomes among adults with diabetes in managed care: the Translating Research Into Action for Diabetes (TRIAD) study
OBJECTIVE: Recent data suggest that residential environment may influence health behaviors and outcomes. We assessed whether perception of neighborhood problems was associated with diabetes behaviors and outcomes. RESEARCH DESIGN AND METHODS: This cross-sectional analysis included 7,830 diabetic adults enrolled in…
Race/ethnicity and economic differences in cost-related medication underuse among insured adults with diabetes: the Translating Research Into Action for Diabetes Study
OBJECTIVE: To examine racial/ethnic and economic variation in cost-related medication underuse among insured adults with diabetes. RESEARCH DESIGN AND METHODS: We surveyed 5,086 participants from the multicenter Translating Research Into Action for Diabetes Study. Respondents reported whether they used less…
Educational disparities in rates of smoking among diabetic adults: the translating research into action for diabetes study
OBJECTIVES: We assessed educational disparities in smoking rates among adults with diabetes in managed care settings. METHODS: We used a cross-sectional, survey-based (2002-2003) observational study among 6538 diabetic patients older than 25 years across multiple managed care health plans and…
Understanding the gap between good processes of diabetes care and poor intermediate outcomes: Translating Research into Action for Diabetes (TRIAD)
BACKGROUND: Performance of diabetes clinical care processes has improved recently, but control of hemoglobin A1c (A1c) and other vascular disease risk factors has improved more slowly. OBJECTIVES: To identify patient factors associated with control of vascular disease risk factors among…
Glycemic response to newly initiated diabetes therapies
OBJECTIVE: The glycemic response to antihyperglycemic therapies for type 2 diabetes has been thoroughly evaluated in randomized controlled trials, but inadequately studied in real-world settings. STUDY DESIGN: We studied glycemic response among 15 126 type 2 diabetic patients who initiated…
Agreement between self-reports and medical records was only fair in a cross-sectional study of performance of annual eye examinations among adults with diabetes in managed care
BACKGROUND: Despite consensus about the importance of measuring quality of diabetes care and the widespread use of self-reports and medical records to assess quality, little is known about the degree of agreement between these data sources. OBJECTIVES: To evaluate agreement…
Minimum incidence of primary cervical dystonia in a multiethnic health care population
BACKGROUND: The two existing estimates of the incidence of primary cervical dystonia were based on observations in relatively ethnically homogeneous populations of European descent. OBJECTIVE: To estimate the minimum incidence of primary cervical dystonia in the multiethnic membership of a…
Risk factors for mortality among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study
OBJECTIVE: We sought to examine demographic, socioeconomic, and biological predictors of all-cause, cardiovascular, and noncardiovascular mortality in patients with diabetes. RESEARCH DESIGN AND METHODS: Survey, medical record, and administrative data were obtained from 8,733 participants in the Translating Research Into…
Effect of cost-sharing changes on self-monitoring of blood glucose
OBJECTIVE: To study the effect of cost-sharing policy changes on utilization of test strips for self-monitoring of blood glucose. STUDY DESIGN: A legislative mandate (January 1, 2000) required California health plans to cover diabetes supplies, including those for self-monitoring of…
Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study
BACKGROUND: Our understanding of social disparities in diabetes-related health behaviors is incomplete. The purpose of this study was to determine if having less education is associated with poorer diabetes-related health behaviors. METHODS: This observational study was based on a cohort…
The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care: the Translating Research Into Action for Diabetes (TRIAD) Study
OBJECTIVE: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS: Using cross-sectional data, we examined the quality of diabetes care…
Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis
OBJECTIVE: Among individuals with diabetes, a comparison of HbA(1c) (A1C) levels between African Americans and non-Hispanic whites was evaluated. Data sources included PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health, the Cochrane Library, the Combined Health…
Who is tested for diabetic kidney disease and who initiates treatment? The Translating Research Into Action For Diabetes (TRIAD) Study
OBJECTIVE: We examined factors associated with screening for albuminuria and initiation of ACE inhibitor or angiotensin receptor blocker (ARB) treatment in diabetic patients. RESEARCH DESIGN AND METHODS: We conducted surveys and medical record reviews for 5,378 patients participating in a…
Longitudinal study of new and prevalent use of self-monitoring of blood glucose
OBJECTIVE: We sought to assess longitudinal association between self-monitoring of blood glucose (SMBG) and glycemic control in diabetic patients from an integrated health plan (Kaiser Permanente Northern California). RESEARCH DESIGN AND METHODS: Longitudinal analyses of glycemic control among 1) 16,091…
Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours
AIMS: Our aim was to examine the associations of alcohol consumption with six diabetes self-care behaviours. METHODS: We determined levels of alcohol consumption and examined associations between alcohol consumption and six self-care behaviours in 65 996 adults with diabetes who…
Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes
OBJECTIVES: We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients. METHODS: We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in…
Cost-utility analysis in a UK setting of self-monitoring of blood glucose in patients with type 2 diabetes
BACKGROUND: Self-monitoring of blood glucose (SMBG) in type 2 diabetes patients has been shown in meta-analyses of randomized trials to improve HbA(1c) by approximately 0.4% when compared to no SMBG. However, the cost of testing supplies is high, improvements in…
Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus
BACKGROUND: Poorly controlled cardiovascular risk factors are common. Evaluating whether physicians respond appropriately to poor risk factor control in patients may better reflect quality of care than measuring proportions of patients whose conditions are controlled. OBJECTIVES: To evaluate therapy modifications…
Role of self-monitoring of blood glucose in glycemic control
OBJECTIVE: To examine the role of self-monitoring of blood glucose (SMBG) in the management of diabetes mellitus. METHODS: Current trends and published evidence are reviewed. RESULTS: Despite the widespread evidence that lowering glycemic levels reduces the risks of complications in…
Prediction of type 2 diabetes mellitus with alternative definitions of the metabolic syndrome: the Insulin Resistance Atherosclerosis Study
BACKGROUND: In addition to predicting cardiovascular disease (CVD) morbidity and mortality, the metabolic syndrome is strongly associated with the development of type 2 diabetes mellitus (DM), itself an important risk factor for CVD. Our objective was to compare the ability…
Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study
OBJECTIVE: To examine racial/ethnic and socioeconomic variation in diabetes care in managed-care settings. RESEARCH DESIGN AND METHODS: We studied 7,456 adults enrolled in health plans participating in the Translating Research Into Action for Diabetes study, a six-center cohort study of…
Current evidence regarding the value of self-monitored blood glucose testing
Many people with diabetes are falling short of attaining or maintaining glycemic goals. Self-monitoring of blood glucose (SMBG) is among the many strategies proposed to address the problem. SMBG complements hemoglobin A1c (HbA1c) testing by providing specific information regarding the…
Pioglitazone initiation and subsequent hospitalization for congestive heart failure
AIMS: Thiazolidinediones (TZD) have been associated with an expansion in plasma volume and the development of peripheral oedema. A recent study reported an association between the use of TZDs and development of congestive heart failure (CHF). The objective of this…
Abdominal obesity predicts declining insulin sensitivity in non-obese normoglycaemics: the Insulin Resistance Atherosclerosis Study (IRAS)
AIM: Cross-sectional studies have demonstrated a relationship between obesity and insulin sensitivity (S(I)); however, there is a lack of evidence from longitudinal studies. METHODS: The Insulin Resistance Atherosclerosis Study (IRAS) estimated S(I) (x10(-4)/min.microU/ml) directly using a frequently sampled intravenous glucose…
Achieving good glycemic control: initiation of new antihyperglycemic therapies in patients with type 2 diabetes from the Kaiser Permanente Northern California Diabetes Registry
OBJECTIVE: To compare the effectiveness of antihyperglycemic therapies in type 2 diabetic patients with poor glycemic control (baseline glycosylated hemoglobin [HbA1C] > 8%). STUDY DESIGN: Longitudinal (cohort) study. METHODS: Study patients were 4775 type 2 diabetic patients who initiated new…
Case-control single-marker and haplotypic association analysis of pedigree data
Related individuals collected for use in linkage studies may be used in case-control linkage disequilibrium analysis, provided one takes into account correlations between individuals due to identity-by-descent (IBD) sharing. We account for these correlations by calculating a weight for each…
Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high-risk clinical and ethnic groups with diabetes
BACKGROUND: Diabetes causes 45% of incident end-stage renal disease (ESRD). Risk of progression is higher in those with clinical risk factors (albuminuria and hypertension), and in ethnic minorities (including blacks, Asians, and Latinos). Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor…
Differences in insulin resistance in nondiabetic subjects with isolated impaired glucose tolerance or isolated impaired fasting glucose
Both impaired glucose tolerance (IGT) (as defined by the 1985 World Health Organization criteria) and impaired fasting glucose (IFG) (as defined by the 1997 American Diabetes Association criteria) represent intermediate metabolic states between normal and diabetic glucose homeostasis. Cardiovascular disease…
Tuberculosis in California dialysis patients
SETTING: Kaiser Permanente Northern California dialysis registry. OBJECTIVE: To examine the incidence of tuberculosis disease (TB) in a large, insured population of dialysis patients and to describe the disease characteristics and outcomes of these cases. DESIGN: Cohort study of all…
High rates of co-occurrence of hypertension, elevated low-density lipoprotein cholesterol, and diabetes mellitus in a large managed care population
OBJECTIVE: To examine prevalence and co-occurrence of diabetes mellitus (DM), hypertension (HT), and elevated low-density lipoprotein cholesterol (dyslipidemia, or DL) in a managed care population. STUDY DESIGN: Period prevalence study. PATIENTS AND METHODS: The study population included all adults (age…
Missed appointments and poor glycemic control: an opportunity to identify high-risk diabetic patients
OBJECTIVE: When patients miss scheduled medical appointments, continuity and effectiveness of healthcare delivery is reduced, appropriate monitoring of health status lapses, and the cost of health services increases. We evaluated the relationship between missed appointments and glycemic control (glycosylated hemoglobin…
Low insulin sensitivity (S(i) = 0) in diabetic and nondiabetic subjects in the insulin resistance atherosclerosis study: is it associated with components of the metabolic syndrome and nontraditional risk factors?
OBJECTIVE: To determine the meaning of S(i) = 0 derived from the frequently sampled intravenous glucose tolerance test. RESEARCH DESIGN AND METHODS: The issue of assessing insulin resistance in large studies is important because the most definitive method ('gold standard'),…
Health behaviors and quality of care among Latinos with diabetes in managed care
OBJECTIVES: We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care. METHODS: Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in…
Out-of-pocket costs and diabetes preventive services: the Translating Research Into Action for Diabetes (TRIAD) study
OBJECTIVE: Despite the increased shifting of health care costs to consumers, little is known about the impact of financial barriers on health care utilization. This study investigated the effect of out-of-pocket expenditures on the utilization of recommended diabetes preventive services.…
Use of antibiotics is not associated with decreased risk of myocardial infarction among patients with diabetes
OBJECTIVE: To study the relationship between exposure to antibiotic treatment and risk of subsequent myocardial infarction (MI) in patients with diabetes. RESEARCH DESIGN AND METHODS: A case-control design was used to assess the effect of previous antibiotic exposure in diabetes…
Diabetes and progression of carotid atherosclerosis: the insulin resistance atherosclerosis study
OBJECTIVE: We sought to determine the rate of progression of carotid atherosclerosis in persons with normal glucose tolerance, impaired glucose tolerance, and undiagnosed and diagnosed type 2 diabetes. METHODS AND RESULTS: The Insulin Resistance Atherosclerosis Study (IRAS) is an observational…
Differences in LDL oxidizability by glycemic status: the insulin resistance atherosclerosis study
OBJECTIVE: To investigate differences in LDL oxidizability by glycemic status within the Insulin Resistance Atherosclerosis Study cohort. RESEARCH DESIGN AND METHODS: LDL oxidizability (lag time and oxidation rate) after exposure to copper was compared among 352 subjects with normal glucose…
Metabolic predictors of 5-year change in weight and waist circumference in a triethnic population: the insulin resistance atherosclerosis study
Insulin resistance, insulin secretion, and glucose tolerance may predict weight change. A total of 1,194 adults aged 39-69 years at baseline (46% with normal glucose tolerance according to World Health Organization criteria, 23% with impaired glucose tolerance, and 31% with…
Ethnic and racial differences in diabetes care: The Insulin Resistance Atherosclerosis Study
OBJECTIVE: Diabetes and its complications disproportionately affect African Americans and Hispanics. Complications could be prevented with appropriate medical care. We compared five processes of care and three outcomes of care among African Americans, Hispanics, and non-Hispanic whites. RESEARCH DESIGN AND…
Current use of unopposed estrogen and estrogen plus progestin and the risk of acute myocardial infarction among women with diabetes: the Northern California Kaiser Permanente Diabetes Registry, 1995-1998
BACKGROUND: Little is known about hormone replacement therapy (HRT) and risk for myocardial infarction (MI) in diabetic women. We examined associations of current HRT, estrogen dosage, and time since HRT initiation with risk of acute MI in diabetic women. METHODS…
Is insulin sensitivity a causal intermediate in the relationship between alcohol consumption and carotid atherosclerosis?: the insulin resistance and atherosclerosis study
OBJECTIVE: A J-shaped association has been demonstrated between alcohol consumption and atherosclerosis. Insulin resistance, also a risk factor for atherosclerosis, has been shown to have a similar J-shaped association with alcohol intake. This raises the question of whether insulin sensitivity…
Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study
Factor analysis, a multivariate correlation technique, has been used to provide insight into the underlying structure of metabolic syndrome, which is characterized by physiological complexity and strong statistical intercorrelation among its key variables. The majority of previous factor analyses, however,…
Ethnic disparities in diabetic complications in an insured population
CONTEXT: Higher rates of microvascular complications have been reported for minorities. Disparate access to quality health care is a common explanation for ethnic disparities in diabetic complication rates in the US population. Examining an ethnically diverse population with uniform health…
Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes
OBJECTIVE: To develop and validate a prediction rule for identifying diabetic patients at high short-term risk of complications using automated data in a large managed care organization. RESEARCH DESIGN AND METHODS: Retrospective cohort analyses were performed in 57,722 diabetic members…
Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry
PURPOSE: We sought to evaluate the effectiveness of self-monitoring blood glucose levels to improve glycemic control. SUBJECTS AND METHODS: A cohort design was used to assess the relation between self-monitoring frequency (1996 average daily glucometer strip utilization) and the first…
Hormone replacement therapy is associated with better glycemic control in women with type 2 diabetes: The Northern California Kaiser Permanente Diabetes Registry
OBJECTIVE: In women with diabetes, the changes that accompany menopause may further diminish glycemic control. Little is known about how hormone replacement therapy (HRT) affects glucose metabolism in diabetes. The aim of this study was to examine whether HbA(1c) levels…
Glycemic control and heart failure among adult patients with diabetes
BACKGROUND: Glycemic control is associated with microvascular events, but its effect on the risk of heart failure is not well understood. We examined the association between hemoglobin (Hb) A(Ic) and the risk of heart failure hospitalization and/or death in a…
Insulin secretion, obesity, and potential behavioral influences: results from the Insulin Resistance Atherosclerosis Study (IRAS)
BACKGROUND: This work was conducted to evaluate associations of insulin secretion with overall and central obesity, dietary fats, physical activity, and alcohol. METHODS: A frequently sampled intravenous glucose tolerance test (FSIGT) was used to assess acute insulin response to glucose…
Examining the impact of missing data on propensity score estimation in determining the effectiveness of self-monitoring of blood glucose (SMBG)
In many health services applications, research to determine the effectiveness of a particular treatment cannot be carried out using a controlled clinical trial. In settings such as these, observational studies must be used. Propensity score methods are useful tools to…
Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes
OBJECTIVE: Self-monitoring of blood glucose (SMBG) is a cornerstone of diabetes care, but little is known about barriers to this self-care practice. RESEARCH DESIGN AND METHODS: This cross-sectional study examines SMBG practice patterns and barriers in 44,181 adults with pharmacologically…
Excess maternal transmission of type 2 diabetes. The Northern California Kaiser Permanente Diabetes Registry
OBJECTIVE: To assess excess maternal transmission of type 2 diabetes in a multiethnic cohort. Previous studies have reported higher prevalence of diabetes among mothers of probands with type 2 diabetes than among fathers. This analysis is vulnerable to biases, and…
Ischemic heart disease and stroke mortality in African-American, Hispanic, and non-Hispanic white men and women, 1985 to 1991
We compare recent trends in ischemic heart disease (IHD) and stroke mortality in California among the 6 major sex-racial or -ethnic groups. Rates of age-specific and -adjusted mortality were calculated for persons aged 35 and older during the years 1985…
