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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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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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Personalized Management of Hyperglycemia in Type 2 Diabetes: Reflections from a Diabetes Care Editors' Expert Forum

Itamar Raz
Jun 1, 2013; 36:1779-1788
Diabetes Care Expert Forum




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Globalization of Diabetes: The role of diet, lifestyle, and genes

Frank B. Hu
Jun 1, 2011; 34:1249-1257
Kelly West Award Lecture




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Globalization of Diabetes: The role of diet, lifestyle, and genes

Frank B. Hu
Jun 1, 2011; 34:1249-1257
Kelly West Award Lecture




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Time Course of Normalization of Functional {beta}-Cell Capacity in the Diabetes Remission Clinical Trial After Weight Loss in Type 2 Diabetes

OBJECTIVE

To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss.

RESEARCH DESIGN AND METHODS

A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once.

RESULTS

During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480–811) pmol/min/m2 at baseline to 736 (542–998) pmol/min/m2 at 5 months, 942 (565–1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635–1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857–1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4–67] to 107 [59–163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59–201] and 125 [65–166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226–429] pmol/min/m2; P < 0.0001).

CONCLUSIONS

A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to that of NDC group participants by 12 months. This result was unchanged at 2 years with continuing remission of type 2 diabetes.




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Naturalization Trends in the United States

Nearly 22 million immigrants—about half of the overall immigrant population—were naturalized U.S. citizens in fiscal year 2017. In the same year, more than 707,000 immigrants became U.S. citizens. Naturalized citizens tend to have higher incomes and educational attainment compared to other immigrants, as this data-rich article explores.




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The decision to specialize

The question surfaces at the beginning of dental school, maybe even sooner, when the dream first takes hold. What kind of dentist do I want to be? Do I want to be a general dentist? An oral surgeon? A pediatric dentist? Every student’s path to becoming a dentist is unique. Choosing whether to specialize is no different.




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Hospitalization for Lactic Acidosis Among Patients With Reduced Kidney Function Treated With Metformin or Sulfonylureas

OBJECTIVE

To compare the risk of lactic acidosis hospitalization between patients treated with metformin versus sulfonylureas following development of reduced kidney function.

RESEARCH DESIGN AND METHODS

This retrospective cohort combined data from the National Veterans Health Administration, Medicare, Medicaid, and the National Death Index. New users of metformin or sulfonylureas were followed from development of reduced kidney function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 or serum creatinine ≥1.4 mg/dL [female] or 1.5 mg/dL [male]) through hospitalization for lactic acidosis, death, loss to follow-up, or study end. Lactic acidosis hospitalization was defined as a composite of primary discharge diagnosis or laboratory-confirmed lactic acidosis (lactic acid ≥2.5 mmol/L and either arterial blood pH <7.35 or serum bicarbonate ≤19 mmol/L within 24 h of admission). We report the cause-specific hazard of lactic acidosis hospitalization between metformin and sulfonylureas from a propensity score–matched weighted cohort and conduct an additional competing risks analysis to account for treatment change and death.

RESULTS

The weighted cohort included 24,542 metformin and 24,662 sulfonylurea users who developed reduced kidney function (median age 70 years, median eGFR 55.8 mL/min/1.73 m2). There were 4.18 (95% CI 3.63, 4.81) vs. 3.69 (3.19, 4.27) lactic acidosis hospitalizations per 1,000 person-years among metformin and sulfonylurea users, respectively (adjusted hazard ratio [aHR] 1.21 [95% CI 0.99, 1.50]). Results were consistent for both primary discharge diagnosis (aHR 1.11 [0.87, 1.44]) and laboratory-confirmed lactic acidosis (1.25 [0.92, 1.70]).

CONCLUSIONS

Among veterans with diabetes who developed reduced kidney function, occurrence of lactic acidosis hospitalization was uncommon and not statistically different between patients who continued metformin and those patients who continued sulfonylureas.




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Differing DREAMs: Estimating the Unauthorized Populations That Could Benefit under Different Legalization Bills

2017 saw the introduction of several bills—two of them by Senate Republicans in the weeks following the Trump administration’s announcement that it would terminate the Deferred Action for Childhood Arrivals (DACA) program—that would provide a pathway to conditional and then legal permanent residence to unauthorized immigrants brought to the United States as children, if they meet a range of educational, professional, and other criteria.




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CBS orders first seasons of 'Clarice,' 'Equalizer,' 'B Positive' for 2020-21

CBS said it has ordered first seasons of three new shows -- "Clarice," "The Equalizer" and "B Positive" for the 2020-21 television season.




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Can Return Migration Revitalize the Baltics? Estonia, Latvia, and Lithuania Engage Their Diasporas, with Mixed Results

Faced with high emigration rates and shrinking, aging populations, the Baltic states—Estonia, Latvia, and Lithuania—are exploring different ways to lure back nationals who have emigrated and establish or solidify ties with members of the diaspora. Of the three countries, Estonia is proving the most successful, while Latvia appears to be ignoring the looming demographic crisis and lacks an immigration plan.




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Beyond Work: Reducing Social Isolation for Refugee Women and Other Marginalized Newcomers

As migrant- and refugee-receiving countries in Europe, North America, and beyond prioritize services that are focused on employment, language instruction, and civic integration, newcomers who are not in the workplace are at high risk for social isolation. As a result, societies should reconsider what successful integration looks like for vulnerable newcomers who will never find traditional employment or who need a longer-than-average timeline to get there.




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Cardiac Manifestations of Congenital Generalized Lipodystrophy

Vani P. Sanon
Oct 1, 2016; 34:181-186
Feature Articles




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Why it's so hard to talk about the N-word | Elizabeth Stordeur Pryor

Historian Elizabeth Stordeur Pryor leads a thoughtful and history-backed examination of one of the most divisive words in the English language: the N-word. Drawing from personal experience, she explains how reflecting on our points of encounter with the word can help promote productive discussions and, ultimately, create a framework that reshapes education around the complicated history of racism in the US.




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It's OK to feel overwhelmed. Here's what to do next | Elizabeth Gilbert

If you're feeling anxious or fearful during the coronavirus pandemic, you're not alone. Offering hope and understanding, author Elizabeth Gilbert reflects on how to stay present, accept grief when it comes and trust in the strength of the human spirit. "Resilience is our shared genetic inheritance," she says. (This virtual conversation is part of the TED Connects series, hosted by head of TED Chris Anderson and head of curation Helen Walters. Recorded April 2, 2020)




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A history of Indigenous languages -- and how to revitalize them | Lindsay Morcom

Indigenous languages across North America are under threat of extinction due to the colonial legacy of cultural erasure, says linguist Lindsay Morcom. Highlighting grassroots strategies developed by the Anishinaabe people of Canada to revive their language and community, Morcom makes a passionate case for enacting policies that could protect Indigenous heritage for generations to come.




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What's missing from the American immigrant narrative | Elizabeth Camarillo Gutierrez

Recounting her story of finding opportunity and stability in the US, Elizabeth Camarillo Gutierrez examines the flaws in narratives that simplify and idealize the immigrant experience -- and shares hard-earned wisdom on the best way to help those around us. "Our world is one that flourishes when different voices come together," she says.




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How visualizing inferential uncertainty can mislead readers about treatment effects in scientific results

STANDARD ERRORS VS STANDARD DEVIATIONS Click to enlarge There’s an ancient haiku that goes: People confuse a well-estimated mean with a certain outcome Ok, that’s not true. But Jake Hofman, Dan Goldstein, and Jessica Hullman have a new paper (recently accepted at CHI 2020) about this. They bet you’ll think the results of their paper […]

The post How visualizing inferential uncertainty can mislead readers about treatment effects in scientific results appeared first on Decision Science News.




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The Year in Personalized Learning: 2017 in Review

The Chan Zuckerberg Initiative, states like Vermont and Rhode Island, and companies such as AltSchool all generated headlines about personalized learning in 2017.




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Rhode Island Announces Statewide K-12 Personalized Learning Push

The Chan-Zuckerberg Initiative and other funders are supporting Rhode Island's efforts to define and research personalized learning in traditional public schools.




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Treatment of post separation contributions / presented by Meredith Dickson, Elizabeth Evatt Chambers.




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Forum 2019 : 7C Family law update / paper presented by: Meredith Dickson, Elizabeth Evatt Chambers.




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Damned if I do / Elizabeth Stevens.

Told from two points of view: Drake: Most guys like their dads. Most guys aren't the son of the literal devil. When Daddy Dearest tells me its unseemly for the last living son of the Lord of Hell to be unmarried, I hate to think who he has in mind. Until, I remember I'm technically already married. Yeah, she's human and I was all of eight at the time. But, still counts. Now I just need to get my wife to Hell for a meet and greet with Pops and send her back home. Except, our marriage won't technically be legit until it's consummated. And I don't know that I want to send her home... Wren: Most girls live normal lives. Most girls aren't married to the devil's son. There is something weirdly familiar about the new guy next door, but I can't place it. Then a weird little demon thing turns up in my room to tell me a prince of Hell wishes for an audience with me. Oh, yeah. And, apparently - while I'm not even eighteen yet - he's my husband? So, I find myself stuck in Hell with a husband. And, I guess I don't hate it as much as I thought I would. There's always something going on and things to discover. And soon, I don't know that I want to go home.




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Damned if I don't / Elizabeth Stevens.




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Caden : a loving the Sykes novel / Elizabeth Stevens.




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Chaos & the geek : a Grace Grayson novel / Elizabeth Stevens.




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Drastic Fabric : Elizabeth Jenner, Carly Snoswell, Henry Jock Walker and Sera Waters / [text by] Andrew Purvis.




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The Queen's bed : an intimate history of Elizabeth's court / Anna Whitelock.

Elizabeth I, Queen of England, 1533-1603 -- Sexual behavior.




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Honourable healers : pioneering women doctors : Elizabeth Blackwell, Elizabeth Garrett Anderson and Constance Stone / Merrilyn Murnane.

Stone, E. Constance (Emma Constance), 1856-1902.




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Storytelling with data : a data visualization guide for business professionals / Cole Nussbaumer Knaflic.

Information visualization.




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Single and free : female migration to Australia, 1833 - 1837 / Elizabeth Rushen.

Women immigrants -- Australia -- History.




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Anastasia : from Callan to Stockyard Creek / Elizabeth Rushen & Kathlyn Gibson.

Thornley, Anastasia.




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John Marshall : shipowner, lloyd's reformer and emigration agent / Elizabeth Rushen.

Marshall, John, 1787-1861.




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Global meat : social and environmental consequences of the expanding meat industry / edited by Bill Winders and Elizabeth Ransom.

Meat industry and trade -- Environmental aspects.




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Book of beasts : the bestiary in the medieval world / edited by Elizabeth Morrison with the assistance of Larisa Grollemond.

Illumination of books and manuscripts, Medieval -- Themes, motives -- Exhibitions.




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Die Lehre von den Giften, in medizinischer, gerichtlicher und polizeylicher Hinsicht / von K.F.H. Marx.

Gottingen : Dieterich, 1827-




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Die Trichinen : eine wissenschaftliche Abhandlung nach eigenen, besonders im sanitats-polizeilichen und staats-thierarztlichen Interesse angestellten Versuchen und Beobachtungen / von A.C. Gerlach.

Hannover : Schmorl & von Seefeld, 1866.




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A digest of facts relating to the treatment and utilization of sewage / by W.H. Corfield.

London : Macmillan, 1870.




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El cólera en Valencia en 1885 : memoria de los trabajos realizados durante la epidemia / presentada por la Alcaldía al Excmo. Ayuntamiento en nombre de la Junta Municipal de Sanidad.

Valencia : M. Alufre, 1886.




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First report of the British Association Committee on the treatment and utilization of sewage : drawn up at the request of the Committee / by Dr. Benjamin H. Paul.

London : Longmans, Green, Reader and Dyer, 1870.




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Report of the Committee on the treatment and utilization of sewage : reappointed at Exeter, 1869.

London : [Published not identified], 1871.




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Report of the Committee on the treatment and utilization of sewage : reappointed at Liverpool, 1870.

London : [Published not identified], 1872.




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Report of the Committee on the treatment and utilization of sewage : reappointed at Edinburgh, 1871.

London : [Published not identified], 1873.




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Fifth report of the Committee on the treatment and utilization of sewage : reappointed at Brighton, 1872.

London : [Published not identified], 1874.




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Sixth report of the Committee on the treatment and utilization of sewage : reappointed at Bradford, 1873.

London : [Published not identified], 1875.




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Seventh report of the Committee on the treatment and utilization of sewage : reappointed at Belfast, 1874.

London : [Published not identified], 1876.




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Report on the treatment and utilization of sewage.

[London] : [Published not identified], [1877]




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Adolescent drug abuse : analyses of treatment research / editors, Elizabeth R. Rahdert, John Grabowski.

Rockville, Maryland : National Institute on Drug Abuse, 1988.




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Drug abuse treatment client characteristics and pretreatment behaviors : 1979-1981 TOPS admission cohorts / Robert L. Hubbard, Robert M. Bray, Elizabeth R. Cavanaugh, J. Valley Rachal, S. Gail Craddock, James J. Collins, Margaret Allison ; Research Triang

Rockville, Maryland : National Institute on Drug Abuse, 1986.