Clinical Outcomes and Adherence to Medications Measured by Claims Data in Patients With Diabetes

IntroductionPatients with diabetes in China have low health literacy, which likely leads to poor clinical outcomes. This study aimed to assess the effectiveness of health literacy and exercise interventions on clinical measurements in Chinese adults with type 2 diabetes mellitus (T2DM).Research design and methodsA cluster randomized controlled trial was conducted from February 2015 through April 2017 in Shanghai, China. 799 patients with T2DM aged 18 years or older recruited from eight Community Healthcare Centers were randomized into one control arm and three intervention arms receiving 1-year health literacy intervention, exercise intervention or both as the comprehensive intervention. Propensity score matching was employed to minimize potential imbalance in randomization. The intervention-attributable effects on main clinical outcomes were estimated using a difference-in-difference regression approach.ResultsAfter propensity score matching, 634 patients were included in the analysis. The three intervention groups had decreased hemoglobin A1c (A1c) level after 12 months of intervention. The largest adjusted decrease was observed in the health literacy group (−0.95%, 95% CI: −1.30 to −0.59), followed by the exercise group (−0.81%, 95% CI: −1.17 to −0.45). However, A1c was observed to increase in the health literacy and the comprehensive groups from 12 to 24 months. No obvious changes were observed for other measurements including high-density and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures.ConclusionsHealth literacy and exercise-focused interventions improve glycemic control in Chinese patients with diabetes after 12 months of intervention, and the health literacy intervention shows the greatest effect. Our results suggest that the interventions may have the potential to improve diabetes self-management and reduce diabetes burden in China.Trial registration numberISRCTN76130594.

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The clinical outcomes of patients with diabetes and hypertension in a peri-urban area, Johannesburg, South Africa

Primary Care Diabetes ◽

10.1016/j.pcd.2020.08.010 ◽

2020 ◽

Author(s):

Leisha P. Genade ◽

Elizabeth M. Webb ◽

Jacqueline E. Wolvaardt ◽

Charl Janse Van Rensburg

Keyword(s):

South Africa ◽

Clinical Outcomes ◽

Urban Area ◽

Patients With Diabetes

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Letter by Mordi et al Regarding Article, “Metformin Use and Clinical Outcomes Among Patients With Diabetes Mellitus With or Without Heart Failure or Kidney Dysfunction: Observations From the SAVOR-TIMI 53 Trial”

Circulation ◽

10.1161/circulationaha.119.043268 ◽

2020 ◽

Vol 141 (4) ◽

Author(s):

Ify R. Mordi ◽

Mohapradeep Mohan ◽

Chim C. Lang

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Clinical Outcomes ◽

Kidney Dysfunction ◽

Patients With Diabetes

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Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Journal of Diabetes Science and Technology ◽

10.1177/1932296820924469 ◽

2020 ◽

Vol 14 (4) ◽

pp. 813-821 ◽

Cited By ~ 111

Author(s):

Bruce Bode ◽

Valerie Garrett ◽

Jordan Messler ◽

Raymie McFarland ◽

Jennifer Crowe ◽

...

Keyword(s):

United States ◽

Mortality Rate ◽

Data Warehouse ◽

Clinical Outcomes ◽

The United States ◽

Severe Illness ◽

Median Length ◽

Acute Hyperglycemia ◽

Patients With Diabetes ◽

Period Data

Introduction: Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia. Methods: This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec’s data warehouse. Results: Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia ( P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001). Conclusion: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.

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