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Impact of a Telephonic Intervention to Improve Diabetes Control on Health Care Utilization and Cost for Adults in South Bronx, New York

OBJECTIVE

Self-management education and support are essential for improved diabetes control. A 1-year randomized telephonic diabetes self-management intervention (Bronx A1C) among a predominantly Latino and African American population in New York City was found effective in improving blood glucose control. To further those findings, this current study assessed the intervention’s impact in reducing health care utilization and costs over 4 years.

RESEARCH DESIGN AND METHODS

We measured inpatient (n = 816) health care utilization for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State from 2006 to 2014. Multilevel mixed modeling was used to assess changes in health care utilization and costs between the telephonic diabetes intervention (Tele/Pr) arm and print-only (PrO) control arm.

RESULTS

During follow-up, excess relative reductions in all-cause hospitalizations for the Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; P < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; P = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; P = 0.01). Reductions in hospital use and costs were even stronger for diabetes-related hospitalizations. These outcomes were not significantly related to changes observed in hemoglobin A1c during individuals’ participation in the 1-year intervention.

CONCLUSIONS

These results indicate that the impact of the Bronx A1C intervention was not just on short-term improvements in glycemic control but also on long-term health care utilization. This finding is important because it suggests the benefits of the intervention were long-lasting with the potential to not only reduce hospitalizations but also to lower hospital-associated costs.




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Diabetic Neuropathy Is a Substantial Burden in People With Type 1 Diabetes and Is Strongly Associated With Socioeconomic Disadvantage: A Population-Representative Study From Scotland

OBJECTIVE

To assess the contemporaneous prevalence of diabetic peripheral neuropathy (DPN) in people with type 1 diabetes (T1D) in Scotland and study its cross-sectional association with risk factors and other diabetic complications.

RESEARCH DESIGN AND METHODS

We analyzed data from a large representative sample of adults with T1D (N = 5,558). We assessed the presence of symptomatic neuropathy using the dichotomized (≥4) Michigan Neuropathy Screening Instrument Patient Questionnaire score. Logistic regression models were used to investigate associations between DPN and risk factors, as well as with other complications.

RESULTS

The burden of DPN is substantial with 13% prevalence overall. Adjusting for attained age, diabetes duration, and sex, the odds of DPN increased mainly with waist-to-hip ratio, lipids, poor glycemic control (odds ratio 1.51 [95% CI 1.21–1.89] for levels of 75 vs. 53 mmol/mol), ever versus never smoking (1.67 [1.37–2.03]), and worse renal function (1.96 [1.03–3.74] for estimated glomerular filtration rate levels <30 vs. ≥90 mL/min/1.73 m2). The odds significantly decreased with higher HDL cholesterol (0.77 [0.66–0.89] per mmol/L). Living in more deprived areas was associated with DPN (2.17 [1.78–2.65]) for more versus less deprived areas adjusted for other risk factors. Finally, individuals with prevalent DPN were much more likely than others to have other diabetes complications.

CONCLUSIONS

Diabetic neuropathy remains substantial, particularly affecting those in the most socioeconomically deprived groups. Those with clinically manifest neuropathy also have a higher burden of other complications and elevated levels of modifiable risk factors. These data suggest that there is considerable scope to reduce neuropathy rates and narrow the socioeconomic differential by better risk factor control.




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Man wins nearly $800,000 from lottery ticket bought by mistake

An Australian man who scored a lottery jackpot of nearly $800,000 said he bought his ticket by mistake while attempting to play a different drawing.




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Lottery winner's prankster past made wife skeptical of $250,000 jackpot

A South Carolina man had extra trouble convincing his wife that his $250,000 lottery win was legitimate due to her memories of a past prank.




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Look: Police, firefighters fish baby geese out of highway storm sewer

Police and firefighters in Michigan came to the rescue of a family of baby geese that wandered out onto a busy highway and fell into a storm sewer.




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Look: Police investigating loose camel report find escaped emu instead

Police in the Netherlands said officers responding to reports of a loose camel ended up capturing an emu running wild through the city of Rotterdam.




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Police, public works employees rescue deer from soccer net

Police and public works employees in Wisconsin came to the rescue of a deer that found itself struggling to escape a soccer net.




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Man waiting to cash in $1,000 lottery ticket wins another $177,777

A Virginia man waiting to cash in his $1,000 winning lottery ticket ended up winning an additional $177,777 before collecting his prize.




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16th Annual Immigration Law and Policy Conference

The 16th annual conference features thoughtful policy and legal analysis and discussion of the most important immigration topics from leading government officials, attorneys, researchers, advocates, and others.




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Democrats Under Pressure: Political Calendar Exposes Ideological Differences on Immigration

Ideological differences in the Democratic Party over immigration that were once masked by unity against President Trump’s border wall and immigration agenda are now being exposed as Democratic presidential candidates seek to stand out in a crowded field and amid controversy over an emergency border spending bill. As the 2020 electoral calendar accelerates, how the party navigates the gulf between its most liberal and conservative wings will become a greater challenge for its leaders.




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From Control to Crisis: Changing Trends and Policies Reshaping U.S.-Mexico Border Enforcement

How did the U.S. border enforcement picture go in the span of two years from the lowest levels of illegal immigration since 1971 to a spiraling border security and humanitarian crisis? This report draws on enforcement and other data as well as analysis of changing migration trends and policies to tell this story. The authors outline key elements for a new strategy that can succeed over the long term.




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Panthers' Derrick Brown to become first 2020 Round 1 pick to sign rookie deal

Former Auburn defensive tackle Derrick Brown agreed to his rookie contract with the Carolina Panthers on Friday.




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Metabolic Effects of Dietary Sucrose in Type II Diabetic Subjects

John P Bantle
Sep 1, 1993; 16:1301-1305
Short Report




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Evidence-Informed Clinical Practice Recommendations for Treatment of Type 1 Diabetes Complicated by Problematic Hypoglycemia

Pratik Choudhary
Jun 1, 2015; 38:1016-1029
Type 1 Diabetes at a Crossroads




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Loss of Incretin Effect Is a Specific, Important, and Early Characteristic of Type 2 Diabetes

Jens J. Holst
May 1, 2011; 34:S251-S257
Diabetes Treatments




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Lipid and Inflammatory Cardiovascular Risk Worsens Over 3 Years in Youth With Type 2 Diabetes: The TODAY clinical trial

TODAY Study Group
Jun 1, 2013; 36:1758-1764
TODAY Study




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Kidney Disease and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Ian H. de Boer
Jan 1, 2014; 37:24-30
DCCT/EDIC 30th Anniversary Summary Findings




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Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013

Kasia J. Lipska
Apr 1, 2017; 40:468-475
Emerging Science and Concepts for Management of Diabetes and Aging




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Feasibility of Outpatient Fully Integrated Closed-Loop Control: First studies of wearable artificial pancreas

Boris P. Kovatchev
Jul 1, 2013; 36:1851-1858
Diabetes Care Symposium




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Phase 3 Trial of Transplantation of Human Islets in Type 1 Diabetes Complicated by Severe Hypoglycemia

Bernhard J. Hering
Jul 1, 2016; 39:1230-1240
Emerging Technologies and Therapeutics




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The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading

Roy W. Beck
Aug 1, 2017; 40:994-999
Perspectives in Care




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Overnight Closed-Loop Insulin Delivery in Young People With Type 1 Diabetes: A Free-Living, Randomized Clinical Trial

Roman Hovorka
May 1, 2014; 37:1204-1211
Advances in Artificial Pancreas Development




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Vitamin E Reduction of Protein Glycosylation in Diabetes: New Prospect for Prevention of Diabetic Complications?

Antonio Ceriello
Jan 1, 1991; 14:68-72
Short Report




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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino
Aug 1, 2019; 42:1593-1603
International Consensus Report




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Serum 25-Hydroxyvitamin D3 Concentrations and Prevalence of Cardiovascular Disease Among Type 2 Diabetic Patients

Massimo Cigolini
Mar 1, 2006; 29:722-724
BR Cardiovascular and Metabolic Risk




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Efficacy and Safety of Canagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, as Add-on to Insulin in Patients With Type 1 Diabetes

Robert R. Henry
Dec 1, 2015; 38:2258-2265
Special Article Collection: Insulin




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Update on Cardiovascular Outcomes at 30 Years of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

John M. Lachin
Jan 1, 2014; 37:39-43
DCCT/EDIC 30th Anniversary Summary Findings




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High Prevalence of Hepatitis C Virus Infection in Diabetic Patients

Rafael Simó
Sep 1, 1996; 19:998-1000
Short Report




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Manufactured Shoes in the Prevention of Diabetic Foot Ulcers

Luigi Uccioli
Oct 1, 1995; 18:1376-1378
Short Report




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Breaking Up Prolonged Sitting With Standing or Walking Attenuates the Postprandial Metabolic Response in Postmenopausal Women: A Randomized Acute Study

Joseph Henson
Jan 1, 2016; 39:130-138
IDF-ADA Translational Symposium




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A Low-Glycemic Load Diet Facilitates Greater Weight Loss in Overweight Adults With High Insulin Secretion but Not in Overweight Adults With Low Insulin Secretion in the CALERIE Trial

Anastassios G. Pittas
Dec 1, 2005; 28:2939-2941
BR Clinical Care/Education/Nutrition




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Rapid Rise in Hypertension and Nephropathy in Youth With Type 2 Diabetes: The TODAY clinical trial

TODAY Study Group
Jun 1, 2013; 36:1735-1741
TODAY Study




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A Mathematical Model for the Determination of Total Area Under Glucose Tolerance and Other Metabolic Curves

Mary M Tai
Feb 1, 1994; 17:152-154
Short Report




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Increased Carotid Intima-Media Thickness and Stiffness in Obese Children

Arcangelo Iannuzzi
Oct 1, 2004; 27:2506-2508
Brief Reports




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Acute Effects of Insulin in the Control of VLDL Production in Humans: Implications for the insulin-resistant state

Gary F Lewis
Apr 1, 1996; 19:390-393
Symposium On Insulin Resistance




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Prevalence of Diabetes in Mexican Americans, Cubans, and Puerto Ricans From the Hispanic Health and Nutrition Examination Survey, 1982-1984

Katherine M Flegal
Jul 1, 1991; 14:628-638
Supplement 3: Diabetes in Hispanic Americans




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Depressive Symptoms in Children and Adolescents With Type 1 Diabetes: Association with diabetes-specific characteristics

Korey K. Hood
Jun 1, 2006; 29:1389-1389
BR Epidemiology/Health Services/Psychosocial Research




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Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Catherine L. Martin
Jan 1, 2014; 37:31-38
DCCT/EDIC 30th Anniversary Summary Findings




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Beneficial Effect of Low-Glycemic Index Diet in Overweight NIDDM Subjects

Thomas M S Wolever
Apr 1, 1992; 15:562-564
Short Report




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Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?: Health Be Damned! Pour on the Sugar

George A. Bray
Apr 1, 2014; 37:950-956
Current Concepts of Type 2 Diabetes Prevention




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Liraglutide, a Long-Acting Human Glucagon-Like Peptide-1 Analog, Given as Monotherapy Significantly Improves Glycemic Control and Lowers Body Weight Without Risk of Hypoglycemia in Patients With Type 2 Diabetes

Tina Vilsbøll
Jun 1, 2007; 30:1608-1610
BR Emerging Treatments and Technologies




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Insulinotropic Action of Glucagonlike Peptide-I-(7-37) in Diabetic and Nondiabetic Subjects

David M Nathan
Feb 1, 1992; 15:270-276
Short Report




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Sodium-Glucose Cotransporter 2 Inhibition and Glycemic Control in Type 1 Diabetes: Results of an 8-Week Open-Label Proof-of-Concept Trial

Bruce A. Perkins
May 1, 2014; 37:1480-1483
Novel Communications in Diabetes




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Effects of Gastric Bypass Surgery in Patients With Type 2 Diabetes and Only Mild Obesity

Ricardo V. Cohen
Jul 1, 2012; 35:1420-1428
Diabetes Care Symposium




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Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association

Caroline S. Fox
Sep 1, 2015; 38:1777-1803
Scientific Statement




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Diabetic Cardiomyopathy

Frederick S Fein
Nov 1, 1990; 13:1169-1179
Supplement 4: Diabetes 80 Black Populations: Current State of Knowledge




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Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endo

Gina Agiostratidou
Dec 1, 2017; 40:1622-1630
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association

Sarah D. de Ferranti
Oct 1, 2014; 37:2843-2863
Scientific Statement




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Lipoprotein Physiology in Nondiabetic and Diabetic States: Relationship to Atherogenesis

Henry N Ginsberg
Sep 1, 1991; 14:839-855
Diet and Diabetes




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HbA1c Levels Are Significantly Lower in Early and Late Pregnancy

Lene R. Nielsen
May 1, 2004; 27:1200-1201
Brief Reports