Insulin Use as a Secondary Treatment for Type 2 Diabetes Linked to Heart Disease, Death

Electronic Newsletter, Issue 427

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

June 10, 2014


AHRQ Stats

Comparing insurance coverage status for adults under 65 in 2009-2010 and 2012-2013 shows that a higher percentage of those who were uninsured in the first part of 2012 acquired insurance coverage in the subsequent year (24.6 percent) versus those who were uninsured in a comparable time period in 2009-2010 (20.2 percent). Also, a higher percentage of adults under 65 who were privately insured in the first part of 2012 remained privately insured in 2013, relative to the comparable time period in 2009-2010. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #439: Transitions in Health Insurance Coverage Over Time, 2009-2013 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Adult Population under Age 65.)

Today's Headlines

  1. Insulin Use as a Secondary Treatment for Type 2 Diabetes Linked to Heart Disease, Death.
  2. Study Finds Financially Burdened Patients Are Less Likely To Follow Prescribed Hypertension Treatment.
  3. Call for Papers: Improving User Interface To Improve Patient Outcomes.
  4. CHIPRA Quality Demonstration States Help School-Based Health Centers Strengthen Their Medical Home Features.
  5. AHRQ's Web M&M Examines Medication Discrepancies as Well as Hand Hygiene.
  6. AHRQ's Health Care Innovations Exchange Focuses on Innovations in Emergency Medical Services.
  7. AHRQ in the Professional Literature.

1. Insulin Use as a Secondary Treatment for Type 2 Diabetes Linked to Heart Disease, Death

Patients with type 2 diabetes who take a combination of metformin plus insulin may be at higher risk for cardiovascular disease and death compared with those who take a combination of metformin plus sulfonylurea, according to a new AHRQ-funded study in the June 11 issue of the Journal of the American Medical Association (JAMA). The study, a review of medical records from national databases, found a greater association between insulin as a second-line treatment and risk of death and cardiovascular disease than sulfonylureas as second-line treatment. In the new study, AHRQ-funded researchers led by Christianne L. Roumie, M.D., M.P.H., of the Tennessee Valley Veterans Affairs Medical Center in Nashville, analyzed records from databases at the Veterans Health Administration (VHA), Centers for Medicare & Medicaid Services and the National Center for Health Statistics. They studied more than 42,000 patient records and the National Death Index to assess the effects of insulin and sulfonylureas, the two medications most commonly prescribed in the study population as second-line treatment for diabetes. The retrospective cohort study compared 2,500 VHA patients who added insulin to their metformin regimen with 12,000 VHA patients who added a sulfonylurea. On average, patients were about 60 years old, and about 35 percent had history of heart disease or stroke. The patients studied had been on metformin for an average of 14 months, and their average hemoglobin A1c count (a key indicator of success in controlling blood sugar) was 8.1 percent, which is higher than is preferred, when the second medication was prescribed. The researchers identified patients who were taking one of two drug combinations: metformin-plus-insulin or metformin-plus-sulfonylurea. Then they compared the risks of heart attack, stroke or death for these patients. They found an association of metformin-plus-insulin to have a higher risk of cardiovascular events and death than metformin-plus-sulfonylureas, although harms were found for both regimens. Please go to AHRQ's press release for more information.

2. Study Finds Financially Burdened Patients Are Less Likely To Follow Prescribed Hypertension Treatment

More than 13 percent of adults under 65 who are treated for hypertension have high financial burdens, spending more than one-fifth of their income on medical expenditures, according to an article about an AHRQ-funded study published online in the May 21 issue of the American Journal of Managed Care. "Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults with Hypertension" describes a study that used AHRQ's Medical Expenditure Panel Survey data to examine the share of income spent on medical care and insurance among patients being treated for hypertension. The authors—one of whom is Didem Minbay Bernard, Ph.D., of AHRQ—further found that among those with high burdens,16 percent reported going without care and 14 percent reported delaying care due to financial reasons. The authors suggest that addressing financial barriers to care may improve patients' compliance with their prescribed hypertension treatment.

3. Call for Papers: Improving User Interface To Improve Patient Outcomes

eGEMs, the official journal of the Electronic Data Methods Forum, is now accepting papers for a special issue that will share lessons learned from innovators and leaders who developed and deployed health information technology (IT) tools to improve patient outcomes. If you developed a user-friendly health IT tool, consider submitting your insights and innovations to the special issue. Dr. Thomas McGinn, M.D., M.P.H., chair of the Department of Medicine at Hofstra North Shore-LIJ School of Medicine in Hempstead, New York, will serve as a guest editor. The deadline for the call for papers is September 10.

4. CHIPRA Quality Demonstration States Help School-Based Health Centers Strengthen Their Medical Home Features

The eighth Evaluation Highlight from the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program is now available on the national evaluation Web site. This Highlight focuses on a joint CHIPRA quality demonstration project in Colorado and New Mexico in which the quality improvement goals include integrating the patient-centered medical home (PCMH) approach into school-based health centers. It describes what motivated these states and school-based health centers to adopt the PCMH model and how other states can support such centers in becoming medical homes. If you have questions or comments about the evaluation of the CHIPRA Quality Demonstration Grant Program, please contact the national evaluation team via Email.

5. AHRQ's Web M&M Examines Medication Discrepancies as Well as Hand Hygiene

The current issue of AHRQ Web M&M features a Spotlight Case describing an 80-year-old woman with a history of dementia who was admitted to the hospital with abdominal pain and diagnosed with a bowel obstruction, secondary to a new diagnosis of colon cancer. She underwent an uncomplicated surgical resection of the colon cancer with relief of the obstruction. Postoperatively she developed confusion and agitation consistent with acute delirium. A geriatric psychiatry consulting service at the hospital spoke with the family and reviewed the official medication reconciliation list, which a pharmacist had documented at admission. The family said the patient was on "memory medicine," but the reconciliation list did not include medicine to treat dementia. The consulting service contacted the outpatient pharmacy and learned the patient was prescribed a cholinesterase inhibitor patch for dementia that was to be replaced weekly. In addition, the Perspective section of the issue features an article by Alexandre R. Marra, M.D., and Michael B. Edmond, M.D., M.P.H., M.P.A., that describes barriers to hand hygiene compliance in health care along with strategies to enhance and measure it. Also featured is a conversation about hand hygiene with Didier Pittet, M.D., M.S., director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, Switzerland. 

6. AHRQ's Health Care Innovations Exchange Focuses on Innovations in Emergency Medical Services

The latest issue of AHRQ's Health Care Innovations Exchange features profiles of two programs that used innovative strategies to reduce the use of emergency medical services (EMS) by frequent 911 callers, leading to major cost savings and increased capacity in area emergency departments (EDs). A third profile describes a state policy that banned ambulance diversions to other nearby EDs, resulting in reduced ED length of stay and ambulance turnaround time. One featured profile describes a program implemented by San Diego's EMS system to identify individuals who frequently call 911 and arrange for them to receive relevant medical, social service and other interventions that can reduce their future reliance on emergency services. This initiative, known as the Resource Access Program, uses sophisticated health information technology that immediately recognizes and notifies a program coordinator whenever a frequent user of emergency services calls 911. The coordinator, an experienced paramedic, then alerts a network of community stakeholders (for example, physicians, social workers, police officers, case managers, housing providers) and works with them to implement measures to address the caller's immediate and underlying health and social needs. The program has significantly reduced EMS transports for frequent 911 callers, leading to major cost savings.

7. AHRQ in the Professional Literature

Encinosa WE, Bae J. Will meaningful use electronic medical records reduce hospital costs? Am J Manag Care 2013 Nov;19(10 Spec No):eSP19-eSP25. Select to access the abstract on PubMed®.

Lannon CM, Peterson LE. Pediatric collaborative networks for quality improvement and research. Acad Pediatr 2013 Nov-Dec;13(6 Suppl):S69-S74. Select to access the abstract on PubMed®.

Motzkus-Feagans C, Pakyz AL, Ratliff SM, et al. Statin use and infections in veterans with cirrhosis. Aliment Pharmacol Ther 2013 Sep;38(6):611-18. Epub 2013 Jul 29. Select to access the abstract on PubMed®.

Howren MB, Christensen AJ, Hynds Karnell L, et al. Influence of pretreatment social support on health-related quality of life in head and neck cancer survivors: results from a prospective study. Head Neck 2013 Jun;35(6):779-87. Epub 2012 Jun 19. Select to access the abstract on PubMed®. 

Kanaan AO, Donovan JL, Duchin NP, et al. Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers Criteria medications. J Am Geriatr Soc 2013 Nov;61(11):1894-9. Epub 2013 Oct 1. Select to access the abstract on PubMed®. 

Parry GJ, Carson-Stevens A, Luff DF, et al. Recommendations for evaluation of health care improvement initiatives. Acad Pediatr 2013 Nov-Dec;13(6 Suppl):S23-S30. Select to access the abstract on PubMed®.

Basu J, Friedman B. Adverse events for hospitalized Medicare patients: is there a difference between HMO and FFS enrollees? Soc Work Public Health 2013;28(7):639-51. Select to access the abstract on PubMed®. ®.

Wisk LE, Allchin A, Witt WP. Disparities in human papillomavirus vaccine awareness among U.S. parents of preadolescents and adolescents. Sex Transm Dis 2014 Feb;41(2):117-22. Select to access the abstract on PubMed®.


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Current as of June 2014
Internet Citation: Insulin Use as a Secondary Treatment for Type 2 Diabetes Linked to Heart Disease, Death: Electronic Newsletter, Issue 427. June 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/427.html