scholarly journals A Patient-Centered PaTH to Address Diabetes: Protocol for a Study on the Impact of Obesity Counseling

10.2196/12054 ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. e12054 ◽  
Author(s):  
Jennifer L Kraschnewski ◽  
Lan Kong ◽  
Erica Francis ◽  
Hsin-Chieh Yeh ◽  
Cindy Bryce ◽  
...  
Keyword(s):  
Weight Loss ◽  
Health System ◽  
Diabetes Incidence ◽  
Patient Centered ◽  
Diabetes Outcomes ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Penn State ◽  
Service Coverage ◽  
The Impact

Background Overweight and obesity are America’s number one health concern. The prevalence of obesity in the United States is greater than 36%, a rate that has doubled since 1970. As the second most preventable cause of death, obesity is a risk factor for diabetes, cardiovascular disease, stroke, and cancer, all major causes of death. Primary care clinics may be an ideal setting for weight control interventions to help manage and prevent diabetes. For this reason, the Centers for Medicare and Medicaid Services (CMS) implemented a health care procedure coding system code for intensive behavioral therapy (IBT) for obesity within primary care in 2012 to facilitate payment for addressing obesity, which was followed by broader coverage by most insurers for IBT for adults in 2013. However, the impact of this coverage on patient-centered outcomes is largely unknown. Objective The overarching goal of this study is to understand the comparative effectiveness of obesity counseling as covered by CMS and other insurers in improving weight loss for adults either with or at increased risk for type 2 diabetes. Methods This study leverages the novel infrastructure of the Patient-Centered Outcomes Research Institute–funded PaTH Clinical Data Research Network. The PaTH network is comprised of Geisinger Health System, Johns Hopkins University, Johns Hopkins Health System, Lewis Katz School of Medicine at Temple University, Temple Health System, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, University of Pittsburgh, UPMC and UPMC Health Plan, and the University of Utah. Electronic health record (EHR) data will originate from the 6 PaTH health systems. Specifically, we will (1) evaluate the impact of broader preventive service coverage for obesity screening and counseling on weight loss, diabetes incidence, and diabetes outcomes in patients with diabetes or at increased risk for diabetes (defined by body mass index [BMI] ≥25). We will determine how the annual probability of receiving obesity and/or nutritional counseling changed pre- and postpolicy across all insurers in a cohort of patients with diabetes and at high risk for diabetes. We will (2) compare patient weight loss and diabetes-related outcomes among those who receive obesity screening and counseling with those who do not, following implementation of preventive service coverage. We will examine postpolicy impact of obesity screening and counseling in a cohort of patients with diabetes and at increased risk for diabetes. Specific outcomes to be examined include weight loss, diabetes incidence, and diabetes outcomes. Exploratory outcomes will include patient-reported outcomes. Furthermore, we will determine patient characteristics, including demographics, and practice characteristics, including provider type. Results Our PCORI-funded study is underway. To date, we have obtained our second data extraction from the PaTH CDRN and are performing data editing and cleaning. Next steps include analysis of early policy change. Conclusions Given patients who are overweight are at highest risk for diabetes, improved weight management services could prevent diabetes and its negative health outcomes. Comparing weight and diabetes outcomes in 3 states using EHRs and claims data before and after this policy was implemented using the PaTH Network will allow important insight into policy effectiveness. International Registered Report Identifier (IRRID) DERR1-10.2196/12054

scholarly journals A Patient-Centered PaTH to Address Diabetes: Protocol for a Study on the Impact of Obesity Counseling (Preprint)

2018 ◽  
Author(s):  
Jennifer L Kraschnewski ◽  
Lan Kong ◽  
Erica Francis ◽  
Hsin-Chieh Yeh ◽  
Cindy Bryce ◽  
...  
Keyword(s):  
Weight Loss ◽  
Health System ◽  
Diabetes Incidence ◽  
Patient Centered ◽  
Diabetes Outcomes ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Penn State ◽  
Service Coverage ◽  
The Impact

BACKGROUND Overweight and obesity are America’s number one health concern. The prevalence of obesity in the United States is greater than 36%, a rate that has doubled since 1970. As the second most preventable cause of death, obesity is a risk factor for diabetes, cardiovascular disease, stroke, and cancer, all major causes of death. Primary care clinics may be an ideal setting for weight control interventions to help manage and prevent diabetes. For this reason, the Centers for Medicare and Medicaid Services (CMS) implemented a health care procedure coding system code for intensive behavioral therapy (IBT) for obesity within primary care in 2012 to facilitate payment for addressing obesity, which was followed by broader coverage by most insurers for IBT for adults in 2013. However, the impact of this coverage on patient-centered outcomes is largely unknown. OBJECTIVE The overarching goal of this study is to understand the comparative effectiveness of obesity counseling as covered by CMS and other insurers in improving weight loss for adults either with or at increased risk for type 2 diabetes. METHODS This study leverages the novel infrastructure of the Patient-Centered Outcomes Research Institute–funded PaTH Clinical Data Research Network. The PaTH network is comprised of Geisinger Health System, Johns Hopkins University, Johns Hopkins Health System, Lewis Katz School of Medicine at Temple University, Temple Health System, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, University of Pittsburgh, UPMC and UPMC Health Plan, and the University of Utah. Electronic health record (EHR) data will originate from the 6 PaTH health systems. Specifically, we will (1) evaluate the impact of broader preventive service coverage for obesity screening and counseling on weight loss, diabetes incidence, and diabetes outcomes in patients with diabetes or at increased risk for diabetes (defined by body mass index [BMI] ≥25). We will determine how the annual probability of receiving obesity and/or nutritional counseling changed pre- and postpolicy across all insurers in a cohort of patients with diabetes and at high risk for diabetes. We will (2) compare patient weight loss and diabetes-related outcomes among those who receive obesity screening and counseling with those who do not, following implementation of preventive service coverage. We will examine postpolicy impact of obesity screening and counseling in a cohort of patients with diabetes and at increased risk for diabetes. Specific outcomes to be examined include weight loss, diabetes incidence, and diabetes outcomes. Exploratory outcomes will include patient-reported outcomes. Furthermore, we will determine patient characteristics, including demographics, and practice characteristics, including provider type. RESULTS Our PCORI-funded study is underway. To date, we have obtained our second data extraction from the PaTH CDRN and are performing data editing and cleaning. Next steps include analysis of early policy change. CONCLUSIONS Given patients who are overweight are at highest risk for diabetes, improved weight management services could prevent diabetes and its negative health outcomes. Comparing weight and diabetes outcomes in 3 states using EHRs and claims data before and after this policy was implemented using the PaTH Network will allow important insight into policy effectiveness. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12054

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

2012 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

scholarly journals P6419Machine learning in critical care: the role of diabetes and age in acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Cenko ◽  
M Van Der Schaar ◽  
J Yoon ◽  
Z Vasiljevic ◽  
S Kedev ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Secondary Endpoint ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
The Impact

Abstract Background Patients with diabetes and non-ST elevation acute coronary syndrome (NSTE-ACS) have an increased risk of mortality and adverse outcomes following percutaneous coronary intervention (PCI). Purpose We aimed to investigate the impact of early, within 24 hours PCI compared with only routine medical treatment on clinical outcomes in a large international cohort of patients with NSTE-ACS and diabetes. Methods We identified 1,250 patients with diabetes and NSTE-ACS from a registry-based population between October 2010 and April 2016. The primary endpoint was 30-day all-cause mortality. The secondary endpoint was the composite outcome of 30-day all-cause mortality and left ventricular dysfunction (ejection fraction <40%). We undertook analyses to explore the heterogeneity of treatment effects using meta-classification (MC) algorithms followed by propensity score matching and inverse-probability-of-treatment weighting (IPTW) from a landmark of 24 hours from hospitalization. Results Of 1,250 NSTE-ACS first-day survivors with diabetes (median age 67 years; 59%, men), 470 (37.6%) received early PCI and 780 routine medical treatment. The overall 30-day all-cause mortality rates were higher in the routine medical treatment than the early PCI group (6.3% vs. 2.5%). The prediction results of the MC algorithms accounted for only one interaction term that was statistically significant: age ≥65 years. After propensity-matched analysis as well as IPTW, early PCI was associated with reduced 30-day all-cause mortality in the older age (OR: 0.35; 95% CI: 0.14 to 0.92 and 0.43; 95% CI: 0.21 to 0.86, respectively), whereas younger age had no association with the primary endpoint. Similar results were also obtained for the secondary endpoint. Conclusions Among patients with diabetes hospitalized for NSTE-ACS, an early, within 24 hours, PCI strategy is associated with reduced odds of 30-day mortality only for patients aged 65 years or over. MC algorithms provide accurate identification of treatment effect modifiers.

The impact of genetic polymorphisms on weight regain after successful weight loss

2020 ◽  
Vol 124 (8) ◽  
pp. 809-823
Author(s):  
Chanisa Thonusin ◽  
Krekwit Shinlapawittayatorn ◽  
Siriporn C. Chattipakorn ◽  
Nipon Chattipakorn
Keyword(s):  
Weight Loss ◽  
Genetic Polymorphisms ◽  
Weight Regain ◽  
Risk Estimation ◽  
Weight Maintenance ◽  
Obesity Prevalence ◽  
Physiological Factors ◽  
Increased Risk ◽  
Successful Weight Loss ◽  
The Impact

AbstractObesity is associated with an increased risk of various diseases and mortality. Although nearly 50 % of adults have been reported trying to lose weight, the prevalence of obesity has increased. One factor that hinders weight loss-induced decrease in obesity prevalence is weight regain. Although behavioural, psychological and physiological factors associated with weight regain have been reviewed, the information regarding the relationship between weight regain and genetics has not been previously summarised. In this paper, we comprehensively review the association between genetic polymorphisms and weight regain in adults and children with obesity after weight loss. Based on this information, identification of genetic polymorphism in patients who undergo weight loss intervention might be used to estimate their risks of weight regain. Additionally, the genetic-based risk estimation may be used as a guide for physicians and dietitians to provide each of their patients with the most appropriate strategies for weight loss and weight maintenance.

Prognostic value of nutritional status for esophageal cancer patients undergoing neoadjuvant therapy and resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 133-133 ◽  
Author(s):  
Sabrina D Saeed ◽  
Jacques Fontaine ◽  
Luis Pena ◽  
Sarah E. Hoffe ◽  
Jessica Frakes ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Feeding Tube ◽  
Tube Placement ◽  
Significant Weight Loss ◽  
Increased Risk ◽  
The Impact

133 Background: Malnutrition, linked to decreased patient tolerance to chemotherapy and increased rates of therapy-related toxicity, negatively affects cancer prognosis. Esophageal carcinomas (EC) frequently present with dysphagia and significant weight loss which may be exacerbated by neoadjuvant chemoradiation, placing EC patients at an increased risk of malnutrition. We therefore aim to assess the prognostic value of pre-operative malnutrition for esophageal cancer patients undergoing neoadjuvant therapy (NAT). Methods: Query of our institution’s IRB approved database of 1113 EC patients (pts) identified 725 individuals who underwent NAT followed by resection from 1994-2018. Seventy-six pts were considered to be at higher nutritional risk during NAT, as indicated by significant weight loss and enteral feeding tube requirement (ETF+), while 644 did not receive pre-operative feeding tube placement (ETF–). Clinicopathologic characteristics, post-operative outcomes, and survival were compared between ETF+ and ETF– using various statistical methods. Results: Of the included pts, 83% were male with a median age of 64.5 (28-86) years. Between ETF+ (n = 76) and ETF– (n = 644), pt characteristics were balanced in terms of initial stage, age, histology and tumor location. A higher percentage of ETF+ pts had > 5% weight loss before NAT (32 vs. 6%; p < .01). ETF+ was associated with a significantly worse median survival (27 vs. 77 m; p < .01), but not with increased post-operative length of hospital stay (p = .69), complications (p = .20) or tumor recurrence (p = .89). Although completion of chemotherapy (p = .46) and radiation (p = .49) were comparable between ETF+ and ETF–, tumor response was worse in the ETF+ group (71 vs. 60% non-complete response; p = .02). Conclusions: Our results suggest that baseline malnutrition is a risk factor for poor survival and negatively impacts the efficacy of neoadjuvant therapy in EC patients. Poor response to NAT in malnourished patients may stem from impaired immune function. Future prospective studies should evaluate other parameters for nutritional assessment to further assess the impact of malnutrition on tumor regression and survival after NAT.

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease—A Review

2012 ◽  
Vol 9 (2) ◽  
pp. 108-111
Author(s):  
Donald E Cutlip
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularization has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for caBG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

Pre-Transplant Weight Loss and Total Serum Protein Predict Relapse Of Acute Myeloid Leukaemia After Allogeneic Stem Cell Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3314-3314
Author(s):  
Thomas Luft ◽  
Sascha Dietrich ◽  
Aleksandar Radujkovic ◽  
Friedrich Stölzel ◽  
Christine Falk ◽  
...  
Keyword(s):  
Weight Loss ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Total Serum ◽  
Metabolic Risk ◽  
Increased Risk ◽  
The Impact ◽  
Acute Myeloid

Abstract Background Although allogeneic stem cell transplantation (alloSCT) represents a curative chance for higher risk acute myeloid leukaemia (AML), relapse occurs in a significant proportion of patients. The impact of nutritional status on the outcome of allogeneic stem cell transplantation (alloSCT) is controversial. This study investigates the influence of pre-transplant body mass index (BMI), weight loss, and serological indicators of nutritional homeostasis on relapse and death of acute myeloid leukemia (AML) after alloSCT. Methods Pre-transplant weight loss and BMI along with serum levels of total serum protein (TSP), albumin, C-reactive protein, and leptin were collected retrospectively in a training cohort of 149 patients allografted for AML and correlated with clinical outcome. A metabolic risk score was established and tested in an independent validation cohort (n=167). Results Pre-transplant weight loss exceeding 2%, TSP lower than 70 g/L, and decreased leptin levels were associated with a significantly increased risk of relapse and death. In contrast, we did not observe a consistent pattern for the impact of nutritional indicators on non-relapse mortality (NRM). Multivariate analyses adjusting for age, cytogenetic risk, treatment line, blast count at alloSCT, donor, and conditioning confirmed weight loss and low TSP as independent risk factors of relapse and overall survival, but not of NRM. Weight loss >2% and low TSP were used to build a metabolic score for prediction of relapse risk and mortality. In multivariate analyses with clinical confounders, patients with both metabolic risk factors had a strongly increased risk of relapse (p=0.0003, HR 15.62, 95%CI 3.51-69.71) and death (p=0.002, HR 3.64, 95%CI 1.62-8.18) compared to patients without metabolic risk factor. The risk prediction of the metabolic score could be confirmed in the validation cohort (Figure 1). Conclusions Altered nutritional homeostasis prior to alloSCT predicts the risk of recurrence of AML after transplantation. Studies addressing pretransplant nutritional interventions in order to reduce AML relapse rates are warranted. Disclosures: No relevant conflicts of interest to declare.

The Impact of a Podiatric Lead Limb Preservation Team on Disease Outcomes and Risk Prediction in the Diabetic Lower Extremity

2010 ◽  
Vol 100 (4) ◽  
pp. 235-241 ◽  
Author(s):  
Vickie R. Driver ◽  
Russell A. Goodman ◽  
Matteo Fabbi ◽  
Michael A. French ◽  
Charles A. Andersen
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Medical Specialty ◽  
Medical Setting ◽  
Limb Preservation ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Chart Abstraction ◽  
Hospital Stays ◽  
The Impact

Background: We used a model of lower-extremity ulceration to determine the impact of a podiatric lead limb preservation team on identified relationships among risk factors, predictors of ulceration, amputation, and clinical outcomes of lower-extremity disease in patients with diabetes mellitus. Methods: A total of 485 patients with diabetes mellitus were randomly selected from the diabetic population and included in this retrospective cohort study. Patients were then stratified into two groups: those who received specialty podiatric medical care and those who did not. Data covering a 5-year period were collected using electronic medical records and chart abstraction to capture detailed treatment characteristics, ulcer status, and surgical outcomes. Results: Overall, the frequencies of inpatient and outpatient encounters and the durations of hospital stays were significantly greater with increasing wound depth and in the presence of infection. In addition, the overall ulcer incidence was greater in patients with callus (34.3% versus 10.3%, P &lt; .0001) with and without neuropathy (20.4% and 4.1%, P &lt; .0001). Among patients treated in a specialty multidiscipline podiatric medical setting, the proportion of all amputations that were “minor” was significantly increased (33.7% versus 67.3%, P = .0006), and survival was significantly improved (19.5% versus 7.7%, P &lt; .0001). Conclusions: Early identification of individuals at increased risk for lower-extremity ulceration and subsequent referral for advanced multidiscipline podiatric medical specialty care may decrease rates of ulceration and proximal amputation and improve survival in patients with diabetes mellitus who are at high risk for ulceration and limb loss. (J Am Podiatr Med Assoc 100(4): 235–241, 2010)

scholarly journals The Impact of Disease Comorbidities in Alzheimer's Disease

2021 ◽  
Vol 13 ◽  
Author(s):  
Jose A. Santiago ◽  
Judith A. Potashkin
Keyword(s):  
Alzheimer’S Disease ◽  
Cardiovascular Disease ◽  
Alzheimer's Disease ◽  
Underlying Mechanism ◽  
Increased Risk ◽  
Wide Range ◽  
Patients With Diabetes ◽  
Different Populations ◽  
Relationship Of ◽  
The Impact

A wide range of comorbid diseases is associated with Alzheimer's disease (AD), the most common neurodegenerative disease worldwide. Evidence from clinical and molecular studies suggest that chronic diseases, including diabetes, cardiovascular disease, depression, and inflammatory bowel disease, may be associated with an increased risk of AD in different populations. Disruption in several shared biological pathways has been proposed as the underlying mechanism for the association between AD and these comorbidities. Notably, inflammation is a common dysregulated pathway shared by most of the comorbidities associated with AD. Some drugs commonly prescribed to patients with diabetes and cardiovascular disease have shown promising results in AD patients. Systems-based biology studies have identified common genetic factors and dysregulated pathways that may explain the relationship of comorbid disorders in AD. Nonetheless, the precise mechanisms for the occurrence of disease comorbidities in AD are not entirely understood. Here, we discuss the impact of the most common comorbidities in the clinical management of AD patients.

Special conditions: acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 929-935
Author(s):  
Baris Gencer ◽  
Marco Roffi
Keyword(s):  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Positive Impact ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Intensive Glucose Lowering ◽  
The Impact

Diabetes is a major risk factor for cardiovascular disease and is associated with an increased risk of mortality in the setting of acute coronary syndromes. Like patients without diabetes, ST elevation and non-ST elevation myocardial infarction patients mandate immediate and within 24 h coronary angiography, respectively. Even in the absence of troponin elevation, all patients with diabetes with suspected acute coronary syndromes should undergo coronary angiography within 72 h due to their increased risk (which is not the case for individuals without diabetes). Antiplatelet treatment should be handled as in patients without diabetes, and the more potent P2Y12 inhibitors prasugrel and ticagrelor should be preferred over clopidogrel. Overall, trials investigating the impact of intensive glucose-lowering therapies in the acute phase of acute coronary syndromes did not show a positive impact on clinical outcomes. In the long term, efforts in secondary prevention to reach recommended global preventive targets are especially important in this patient population to improve survival and reduce the recurrence of ischaemic events.

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