National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 53 Research Studies DisplayedWaldfogel JM, Nesbit SA, Dy SM
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review.
This review systematically assessed the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. It concluded that for reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks.
AHRQ-funded; 2902015000061.
Citation: Waldfogel JM, Nesbit SA, Dy SM .
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review.
Neurology 2017 May 16;88(20):1958-67. doi: 10.1212/wnl.0000000000003882.
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Keywords: Diabetes, Chronic Conditions, Medication, Quality of Life, Patient-Centered Outcomes Research
Shah NR, Cheezum MK, Veeranna V
Ranolazine in symptomatic diabetic patients without obstructive coronary artery disease: impact on microvascular and diastolic function.
The primary aim of this study was to determine whether ranolazine would quantitatively improve exercise-stimulated myocardial blood flow and cardiac function in symptomatic diabetic patients without obstructive coronary artery disease. The investigators found that in symptomatic diabetic patients without obstructive coronary artery disease, ranolazine did not change exercise-stimulated myocardial blood flow or CFR but did modestly improve diastolic function.
AHRQ-funded; HS022998.
Citation: Shah NR, Cheezum MK, Veeranna V .
Ranolazine in symptomatic diabetic patients without obstructive coronary artery disease: impact on microvascular and diastolic function.
J Am Heart Assoc 2017 May 4;6(5). doi: 10.1161/jaha.116.005027..
Keywords: Cardiovascular Conditions, Diabetes, Medication, Patient-Centered Outcomes Research
Carlson AE, Aronson BD, Unzen M
Apathy and type 2 diabetes among American Indians: exploring the protective effects of traditional cultural involvement.
In this study researchers examined relationships between traditional cultural factors, apathy, and health-related outcomes among a sample of American Indian adults with type 2 diabetes. Their model revealed significant direct effects from cultural participation to apathy, and apathy to both health-related outcomes. Cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health-related quality of life.
AHRQ-funded; HS024180.
Citation: Carlson AE, Aronson BD, Unzen M .
Apathy and type 2 diabetes among American Indians: exploring the protective effects of traditional cultural involvement.
J Health Care Poor Underserved 2017;28(2):770-83. doi: 10.1353/hpu.2017.0073.
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Keywords: Cultural Competence, Diabetes, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Gabriel MH, Powers C, Encinosa W
AHRQ Author: Encinosa W
E-prescribing and adverse drug events: an observational study of the Medicare part D population with diabetes.
The researchers examined the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. They concluded that at the e-prescribing threshold of 75 percent and above, there were significant reductions in ADE risk.
AHRQ-authored.
Citation: Gabriel MH, Powers C, Encinosa W .
E-prescribing and adverse drug events: an observational study of the Medicare part D population with diabetes.
Med Care 2017 May;55(5):456-62. doi: 10.1097/mlr.0000000000000684.
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Keywords: Adverse Drug Events (ADE), Electronic Prescribing (E-Prescribing), Diabetes, Medicare, Medication
Karter AJ, Lipska KJ, O'Connor PJ
High rates of severe hypoglycemia among African American patients with diabetes: the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
This seven-year surveillance study (2005-2011) evaluated race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. Annual SH rates ranged from 1.8 percent to 2.1 percent during this 7-year observation period. African Americans had consistently higher SH rates compared with Whites, while Latinos and Asians had consistently lower rates compared with Whites in each of the 7 years.
AHRQ-funded; HS019859.
Citation: Karter AJ, Lipska KJ, O'Connor PJ .
High rates of severe hypoglycemia among African American patients with diabetes: the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
J Diabetes Complications 2017 May;31(5):869-73. doi: 10.1016/j.jdiacomp.2017.02.009.
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Keywords: Chronic Conditions, Diabetes, Healthcare Delivery, Health Status, Racial and Ethnic Minorities
Goins RT, Noonan C, Gonzales K
Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: does social support matter?
Among older American Indian women with type 2 diabetes (T2DM), the researchers examined the association between mental health and T2DM control and if social support modifies the association. They found that there was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support.
AHRQ-funded; HS000078.
Citation: Goins RT, Noonan C, Gonzales K .
Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: does social support matter?
J Diabetes Complications 2017 Apr;31(4):669-74. doi: 10.1016/j.jdiacomp.2017.01.004.
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Keywords: Diabetes, Elderly, Behavioral Health, Racial and Ethnic Minorities, Trauma
Palta P, Huang ES, Kalyani RR
Hemoglobin A1c and mortality in older adults with and without diabetes: Results from the National Health and Nutrition Examination Surveys (1988-2011).
In this paper, the investigators sought to estimate the risk of mortality by HbA1c levels among older adults with and without diabetes. They concluded that an HbA1c >8.0% was associated with increased risk of all-cause and cause-specific mortality in older adults with diabetes. The investigators suggest that their results support the idea that better glycemic control is important for reducing mortality; however, they also indicate that there is a need for individualized glycemic targets for older adults with diabetes depending on their demographics, duration of diabetes, and existing comorbidities.
AHRQ-funded; HS018542.
Citation: Palta P, Huang ES, Kalyani RR .
Hemoglobin A1c and mortality in older adults with and without diabetes: Results from the National Health and Nutrition Examination Surveys (1988-2011).
Diabetes Care 2017 Apr;40(4):453-60. doi: 10.2337/dci16-0042.
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Keywords: Cancer, Cardiovascular Conditions, Diabetes, Elderly, Mortality, Risk
Gunter KE, Nocon RS, Gao Y
Medical home characteristics and quality of diabetes care in safety net clinics.
The researchers examined associations between patient-centered medical home (PCMH) characteristics and quality of diabetes care in 15 safety net clinics in five states. They found that PCMH characteristics had mixed, inconsistent associations with the quality of diabetes care. The PCMH model may require refinement in design and implementation to improve diabetes care among vulnerable populations.
AHRQ-funded; HS000084.
Citation: Gunter KE, Nocon RS, Gao Y .
Medical home characteristics and quality of diabetes care in safety net clinics.
J Community Health 2017 Apr;42(2):303-11. doi: 10.1007/s10900-016-0256-9.
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Keywords: Diabetes, Patient-Centered Healthcare, Quality of Care, Chronic Conditions
Maciejewski ML, Hammill BG, Bayliss EA
Prescriber continuity and disease control of older adults.
The objective of this study was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications. It concluded that multiple prescribers were associated with worse disease control, possibly because patients with more severe diabetes or dyslipidemia have multiple prescribers or because care fragmentation is associated with worse disease control.
AHRQ-funded; HS023085.
Citation: Maciejewski ML, Hammill BG, Bayliss EA .
Prescriber continuity and disease control of older adults.
Med Care 2017 Apr;55(4):405-10. doi: 10.1097/mlr.0000000000000658.
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Keywords: Elderly, Medication, Diabetes, Patient Adherence/Compliance, Healthcare Delivery
Tung EL, Baig AA, Huang ES
Racial and ethnic disparities in diabetes screening between asian americans and other adults: BRFSS 2012-2014.
The researchers assessed racial and ethnic disparities in diabetes screening between Asian Americans and other adults. They found that Asian Americans were the least likely racial and ethnic group to receive recommended diabetes screening. Overall, Asian Americans had 34 percent lower adjusted odds of receiving recommended diabetes screening compared to non-Hispanic whites.
AHRQ-funded; HS000078.
Citation: Tung EL, Baig AA, Huang ES .
Racial and ethnic disparities in diabetes screening between asian americans and other adults: BRFSS 2012-2014.
J Gen Intern Med 2017 Apr;32(4):423-29. doi: 10.1007/s11606-016-3913-x.
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Keywords: Racial and Ethnic Minorities, Diabetes, Screening, Disparities, Prevention
Brennan MB, Hess TM, Bartle B
Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.
Diabetic foot ulcers are associated with an increased risk of death. This study evaluated whether ulcer severity at presentation predicts mortality. It concluded that initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke.
AHRQ-funded; HS018542.
Citation: Brennan MB, Hess TM, Bartle B .
Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.
J Diabetes Complications. 2017 Mar;31(3):556-561. doi: 10.1016/j.jdiacomp.2016.11.020..
Keywords: Diabetes, Mortality, Chronic Conditions, Pressure Ulcers
Flory J
Will cardiovascular outcomes data on newer diabetes drugs bury the older agents?
This paper comments on the variety of drug treatment options for patients with type 2 diabetes. The authors assert that the FDA has an opportunity to champion public health because the agency exerts great influence on how type 2 diabetes drugs are studied. The authors also suggest that the FDA’s influence and regulatory powers should be used to improve the health of patients with diabetes who now face many uninformed choices between newer and older drugs.
AHRQ-funded; HS023898.
Citation: Flory J .
Will cardiovascular outcomes data on newer diabetes drugs bury the older agents?
JAMA Intern Med 2017 Mar;177(3):301-02. doi: 10.1001/jamainternmed.2016.8284..
Keywords: Cardiovascular Conditions, Diabetes, Medication
Huguet N, Angier H, Marino M
Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers.
It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. Data collection will include information on changes in health insurance, service receipt, and health outcomes, spanning 9 years (pre- and post-expansion), comparing states that expanded Medicaid, and those that did not.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Marino M .
Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers.
Implement Sci 2017 Feb 10;12(1):14. doi: 10.1186/s13012-017-0543-6.
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Keywords: Diabetes, Policy, Access to Care, Health Insurance
Makam AN, Nguyen OK
An evidence-based medicine approach to antihyperglycemic therapy in diabetes mellitus to overcome overtreatment.
This article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK .
An evidence-based medicine approach to antihyperglycemic therapy in diabetes mellitus to overcome overtreatment.
Circulation 2017 Jan 10;135(2):180-95. doi: 10.1161/circulationaha.116.022622.
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Keywords: Shared Decision Making, Diabetes, Evidence-Based Practice, Patient and Family Engagement, Patient-Centered Outcomes Research
Sarkar U, Lyles C, Steinman M
Changes in medication use after dementia diagnosis in an observational cohort of individuals with diabetes mellitus.
The researchers assessed changes in medication use after a diagnosis of dementia in individuals with type 2 diabetes mellitus. After adjustment, the number of chronic medications and the subset of cardiovascular medications declined after a dementia diagnosis in the overall cohort and in age-, sex-, and time-matched reference individuals, but the decline was significantly greater in the group with dementia.
AHRQ-funded; HS023558.
Citation: Sarkar U, Lyles C, Steinman M .
Changes in medication use after dementia diagnosis in an observational cohort of individuals with diabetes mellitus.
J Am Geriatr Soc 2017 Jan;65(1):77-82. doi: 10.1111/jgs.14429.
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Keywords: Medication, Diabetes, Dementia, Elderly, Healthcare Utilization
Saeed MJ, Olsen MA, Powderly WG
Diabetes mellitus is associated with higher risk of developing decompensated cirrhosis in chronic hepatitis C patients.
This study investigated the association of diabetes with risk of decompensated cirrhosis in patients with chronic hepatitis C (CHC). In a privately insured US population with CHC, the rates of decompensated cirrhosis per 1000 person-years were: 185.5 for persons with baseline cirrhosis and diabetes, 119.8 for persons with cirrhosis and no diabetes, 35.3 for persons with no cirrhosis and diabetes, and 17.1 for persons with no cirrhosis and no diabetes.
AHRQ-funded; HS019455.
Citation: Saeed MJ, Olsen MA, Powderly WG .
Diabetes mellitus is associated with higher risk of developing decompensated cirrhosis in chronic hepatitis C patients.
J Clin Gastroenterol 2017 Jan;51(1):70-76. doi: 10.1097/mcg.0000000000000566.
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Keywords: Chronic Conditions, Diabetes, Hepatitis, Risk
Flory JH, Roy J, Gagne JJ
Missing laboratory results data in electronic health databases: implications for monitoring diabetes risk.
Researchers assessed the value of lab results added to diagnosis codes and dispensing claims to identify incident diabetes. Inclusion of lab results increased the number of diabetes outcomes identified by 21 percent. In settings where capture of lab results was relatively complete, the absence of lab results was associated with implausibly low rates of the outcome.
AHRQ-funded; HS023898.
Citation: Flory JH, Roy J, Gagne JJ .
Missing laboratory results data in electronic health databases: implications for monitoring diabetes risk.
J Comp Eff Res 2017 Jan;6(1):25-32. doi: 10.2217/cer-2016-0033.
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Keywords: Diabetes, Diagnostic Safety and Quality, Electronic Health Records (EHRs)
Leung MY, Carlsson NP, Colditz GA
The burden of obesity on diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012.
The researchers analyzed the risk of developing diabetes and the annual cost of diabetes for a US general population. Their results suggested that the annual health care expenditure differentials between those with and without diabetes of age 50 years were the highest for individuals with class II ($12,907) and class III ($9,703) obesity.
AHRQ-funded; HS022330.
Citation: Leung MY, Carlsson NP, Colditz GA .
The burden of obesity on diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012.
Value Health 2017 Jan;20(1):77-84. doi: 10.1016/j.jval.2016.08.735.
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Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Healthcare Costs, Risk
Sohn MW, Epstein N, Huang ES
Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes.
This study examined the relationship between systolic blood pressure (SBP) variability and the risk of microvascular complications in a non-elderly diabetic population. Compared to individuals with the least SBP variability (Quartile 1), those with most variability (Quartile 4) had 81 percent and 19 percent higher incidence of nephropathy, retinopathy, neuropathy, and any complication, respectively, after adjusting for mean SBP, demographic and clinical factors.
AHRQ-funded; HS018542.
Citation: Sohn MW, Epstein N, Huang ES .
Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes.
J Diabetes Complications 2017 Jan;31(1):195-201. doi: 10.1016/j.jdiacomp.2016.09.003.
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Keywords: Blood Pressure, Diabetes, Risk, Chronic Conditions
Taliani CA, Bricker PL, Adelman AM
Implementing effective care management in the patient-centered medical home.
The investigators explored how a disparate group of patient-centered medical homes (PCMHs) embedded care management in their team care environment to identify best practices. They concluded that PCMHs may want to ensure that care managers are available to meet with patients during visits, support patient self-management, fully leverage the electronic medical record for team messaging and patient tracking, and ensure integration into the care team with office huddles and ongoing communication.
AHRQ-funded; HS019150.
Citation: Taliani CA, Bricker PL, Adelman AM .
Implementing effective care management in the patient-centered medical home.
Am J Manag Care 2013 Dec;19(12):957-64.
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Keywords: Care Management, Diabetes, Healthcare Delivery, Patient-Centered Healthcare, Quality Improvement, Teams
Neugebauer R, Fireman B, Roy JA
Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes.
This study used comparative effectiveness research methods to compare the effect of four distinct glucose-control strategies on subsequent myocardial infarction and nephropathy in type 2 diabetes. It found that in a large group of adults with type 2 diabetes, more aggressive glucose-control strategies have mixed short-term effects on microvascular complications and do not reduce the myocardial infarction rate over 4 years of follow-up.
AHRQ-funded; 29020050033I.
Citation: Neugebauer R, Fireman B, Roy JA .
Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes.
Diabetes Care 2013 Nov;36(11):3510-6. doi: 10.2337/dc12-2675..
Keywords: Comparative Effectiveness, Diabetes, Outcomes, Patient-Centered Outcomes Research, Treatments
Everett C, Thorpe C, Palta M
Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.
The investigators compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. They found that outcomes were generally equivalent in thirteen comparisons but mixed in seven others, so that no role was best for all outcomes. They concluded that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett C, Thorpe C, Palta M .
Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.
Health Aff 2013 Nov;32(11):1942-8. doi: 10.1377/hlthaff.2013.0506.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Zhang M, Shubina M, Morrison F
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
To find out whether copied documentation of lifestyle counseling was used to justify higher evaluation and management (E&M) charges, researchers investigated 12,527 patient encounters in which lifestyle counseling was documented. When time spent on counseling was recorded, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charges.
AHRQ-funded; HS017030
Citation: Zhang M, Shubina M, Morrison F .
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
BMC Health Serv Res. 2013 Oct 2;13:377. doi: 10.1186/1472-6963-13-377..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Insurance, Lifestyle Changes, Payment
Bobo WV, Cooper WO, Stein CM
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
This study found that in a group of 25, 834 Medicaid-enrolled children and youth who had recently initiated use of either an antipsychotic or a control psychotropic drug, antipsychotic users had a risk of a newly diagnosed type 2 diabetes 3 times greater than the propensity-score matched controls. This group was confined to those who had not been diagnosed with conditions for which antipsychotics were the only recognized pharmacotherapy.
AHRQ-funded; HS0116974
Citation: Bobo WV, Cooper WO, Stein CM .
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
JAMA Psychiatry. 2013 Oct;70(10):1067-75. doi: 10.1001/jamapsychiatry.2013.2053..
Keywords: Children/Adolescents, Behavioral Health, Diabetes, Medication, Medicaid
Everett CM, Thorpe CT, Palta M
Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.
The investigators described the division of patients and services between primary care providers for older diabetes patients on panels with varying levels of PA/NP involvement. They concluded that understanding how patients and services are divided between PA/NPs and physicians will assist in defining provider roles on primary care teams.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett CM, Thorpe CT, Palta M .
Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.
Med Care Res Rev 2013 Oct;70(5):531-41. doi: 10.1177/1077558713495453.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams