Use of diabetes preventive care and complications risk in two African-American communities

BACKGROUND: We examined levels of diabetes preventive care services and glycemic and lipid control among African Americans with diabetes in two North Carolina communities. METHODS: Cross-sectional, population-based study of 625 African-American adults with diagnosed diabetes. Participants had a household interview to determine receipt of preventive care services including glycosylated hemoglobin (HbA(1c)), blood pressure, lipid, foot, dilated eye, and dental examinations; diabetes education; and health promotion counseling. A total of 383 gave blood samples to determine HbA(1c) and lipid values. RESULTS: Annual dilated eye, foot, and lipid examinations were reported by 70% to 80% of the population, but only 46% reported HbA(1c) tests. Rates of regular physical activity (31%) and daily self-monitoring of blood glucose (40%) were low. Sixty percent of the population had an HbA(1c) level >8% and one fourth had an HbA(1c) level >10%. Half of the population had a low-density lipoprotein value >130 mg/dL. Lack of insurance was the most consistent correlate of inadequate care (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.3-3.9), having HbA(1c) >9.5% (OR=2.1, 95% CI=1.1-4.2), and LDL levels >130 mg/dL (OR=2.1; 95% CI=1.0-4.5). CONCLUSIONS: Levels of diabetes preventive care services were comparable to U.S. estimates, but glycemic and lipid control and levels of self-management behaviors were poor. These findings indicate a need to understand barriers to achieving and implementing good glycemic and lipid control among African Americans with diabetes.     

Predictors of poor glycaemic control during the initial five years post-diagnosis in rural adults with type 2 diabetes

Objective: To identify factors predicting suboptimal glycaemic control in rural adults during the initial five years post‐type 2 diabetes diagnosis. Design: Retrospective medical record audit. Quantitative study. Setting: Rural community‐based primary health service, South Gippsland, Victoria, Australia. Participants: Two hundred and seventy‐two de‐identified medical records randomly selected from the type 2 diabetes outpatient database. Main outcome measures: Demographic, biochemical, anthropometric, pharmacological, co‐morbidity and lifestyle data during the first five years post‐diabetes diagnosis were retrospectively collected. Univariate analysis was performed to identify variables associated with poor diabetes control (HbA1c ≥ 7%). Results: Independent predictors of poor glycaemic control in this rural cohort were elevated fasting glucose at diagnosis (odds ratio (OR) 1.97, 95% confidence interval (CI) 1.31–2.97, P < 0.001), weight gain during the initial 2.5 years of diabetes (OR 1.33, 95% CI 1.11–1.59, P < 0.01), excessive body weight at diagnosis (OR 1.07, 95% CI 1.03–1.12, P < 0.001) and younger age at diagnosis (OR 0.94, 95% CI 0.88–1.00, P < 0.05). These variables combined explained 48% of the variation in HbA1c. Gender, body mass index, waist circumference and lifestyle factors at diagnosis were not significant predictors of diabetes control. Conclusions: Young–middle‐aged adults (≤58 years) with elevated fasting glucose (≥9.0 mmol L^?1) and excessive body weight (≥93.1 kg) at type 2 diabetes diagnosis and those unable to lose weight early in the course of the disease are more likely to experience a rapid deterioration in glucose control. Rural clinicians should target these individuals for aggressive diabetes management from the time of diagnosis.     

The impact of diabetes mellitus on pulmonary TB

OBJECTIVE:To compare the clinical characteristics and laboratory results of pulmonary TB (PTB) patients with and without diabetes mellitus (DM) and the relationship between haemoglobin A1C (HbA1c) concentration and mycobacterial load at county level area in Sichuan Province, China.METHODS:A retrospective study was performed from January 2018 to July 2019 inJianyang People’s Hospital, Sichuan Province. Clinical characteristics and laboratory results of newly diagnosed TB patients were collected. Univariable and multivariable logistic regression analyses were performed. The Kruskal-Wallis test was used to compare HbA1c level and mycobacterial load.RESULTS:The final sample included 415 patients with TB, of whom 45 were diagnosed with DM (10.8%). Uni-variable logistic regression showed that PTB patients with concomitant DM were more likely to present with haemoptysis, positive acid-fast bacilli (AFB) smear, cavity, higher erythrocyte sedimentation rate (ESR), higher serum C-reactive protein (CRP), lower serum albumin (ALB), or higher fasting blood glucose (FBG). Multivariate logistic regression analyses showed that AFB smear positivity (OR 15.81, 95% CI 3.09–80.95) and FBG (OR 1.88, 95% CI 1.53–2.31) were independent risk factors of DMPTB. The mycobacterial load was heaviest when the HbA1c was 7.9 mmol/L (95% CI 7.35–11.1) and declined along with HbA1c rising up. But it has not been significantly associated with HbA1c.CONCLUSIONS:Patients with PTB over 45 years old, with haemoptysis, positive AFB, cavity, higher ESR, higher CRP, lower ALB or higher FBG are more likely to present with concomitant DM. Patients with PTB with these factors need to be targeted for DM screening. The mycobacterial load has not been significantly associated with HbA1c.     

Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey.

Summary Objectives: To assess the association of socioeconomic position with health (care) outcomes in type 2 diabetes with a particular focus on glycaemic control. Methods: A cross-sectional survey in the region of Augsburg (Germany) on 373 men and women with type 2 diabetes, drawn from representative MONICA surveys and the myocardial infarct register. Analysis of association of socioeconomic position with HbA1c levels, cardiovascular risk factors and long-term macro- and microvascular diabetes complications using logistic regression models. Results: Glycaemic control, measured by HbA1c levels, is strongly associated with indicators of socioeconomic position favouring the better off. Comparison of the lowest with the highest socioeconomic group showed an odds ratio of 2.49 (95% CI: 1.22–5.07) for the MI register subgroup and 1.80 (95% CI: 0.80–4.06) for the survey subgroup for failure to achieve the recommended HbA1c target. This association could not be accounted for by differences across social groups in age, sex, diabetes duration, obesity, or physical activity. Conclusions: Social inequalities in glycaemic control do exist. This finding may indicate a level of diabetes care that is inappropriate to the need of socially disadvantaged groups. Submitted: 22 June 2005; Revised: 15 September 2006; Accepted: 13 March 2007     

Initiating insulin therapy in patients with diabetes mellitus type 2: in a transmural setting is at least as effective as in an outpatient setting; a retrospective study with a 4-year follow-up

OBJECTIVE: Assessing whether the initiation of insulin therapy in patients with diabetes mellitus type 2 can be delivered as effectively in a structured transmural care model as in the more usual outpatients structure. DESIGN: Retrospective comparative cohort study. METHOD: In 1997 data were collected from 52 patients with diabetes mellitus type 2 all of whom were above 40 years of age and transferred to insulin therapy in 1993: 25 in a transmural care setting and 27 in an outpatients setting, both in Amsterdam, the Netherlands. Both groups were treated according to one protocol concerning the initiation and monitoring of insulin therapy, treatment goals and follow-up. Outcome measures were: percentage of glycated haemoglobin (HbA1c), health status, self-care behaviour and patient satisfaction. In 1993 the mean age was (transmural/outpatients setting): 67.5/65.3 years; percentage of men: 32%/48%; mean duration of diabetes: 7.3/10.6 years; HbA1c: 9.1%/9.3%; mean body mass index: 27.4/29.1 kg/m2. RESULTS: In the period 1993-1997 the mean HbA1c decreased from 9.1% to 7.2% in the transmural care group and from 9.3% to 7.6% in the outpatients care group (both: p = 0.000). The percentage of patients with poor glycaemic control (HbA1c > 8%) decreased from 60 to 8 in the transmural care group and from 59 to 15 in the outpatients care group. The percentage of patients with good glycaemic control (HbA1c < 7%) increased from 4 to 52 in the transmural care group and from 11 to 30 in the outpatients care group. No statistically significant differences were found between the patient groups with respect to health status, self-care behaviour and patient satisfaction. CONCLUSION: The transfer of patients with diabetes mellitus type 2 insulin therapy in a shared care setting was at least as effective as in an outpatients setting.     

Cardiovascular risk profile of type 2 diabetic patients cared for by general practitioners or at a diabetes clinic: a population-based study.

The aims of this study were to compare the cardiovascular risk profiles of patients with type 2 diabetes mellitus cared for by general practitioners and those regularly attending a diabetes center. Out of an Italian population-based cohort of 1967 diabetic patients, 1574 (80%) were investigated. Patients exclusively cared for by general practitioners (23.8%) were older and showed lower prevalence of hypertension (79.0% vs 85.9%, P < 0.001), poor blood glucose control (HbA1c >8.0, 33.4% vs 47.9%, P < 0.001) and coronary heart disease (18.1% vs 22.3%, P = 0.003), and lower plasma fibrinogen (3.5 +/- 0.8 vs 3.7 +/- 0.9 g/L, P < 0.001). In logistic regression analysis, they had significantly lower ORs for HbA1c >8.8% (OR 0.67, 95% CI 0.45-0.99), hypertension (OR 0.53, 95% CI 0.36-0.78), fibrinogen >4.1 g/L (OR 0.50, 95% CI 0.32-0.77), smoking (OR 0.60, 95% Cl 0.36-1.00), and coronary heart disease (OR 0.65, 95% CI 0.45-0.93), after adjustment for age, sex, duration of diabetes, BMI, and antidiabetic treatment. Patients regularly cared for at a diabetes clinic had a higher cardiovascular risk profile, suggesting selective referral to the clinics of patients with more difficult management and/or severity of the disease. These findings have implications in the interpretation of morbidity and mortality clinic-based studies.     

Social capital – a neglected issue in diabetes control: a cross‐sectional survey in Iran

Glycaemic control is an essential component in diabetes management. There is growing attention on the protective effects of social capital on health, where social capital comprises features of society that facilitate co‐operation for mutual benefit. The aim of this study was to investigate its role as a social determinant of health in the glycaemic control of diabetes mellitus. A cross‐sectional study was conducted in a diabetes care charity institute, Isfahan, Iran from July 2010 to September 2010. Based on the level of HbA1c, all patients were divided into two groups: HbA1c level ≤ 7 as controlled diabetes and HbA1c level > 7 as uncontrolled diabetes. Sixty patients were randomly selected from each group (controlled diabetes and uncontrolled diabetes) and all agreed to participate. Social capital was measured using the Integrated Questionnaire for the Measurement of Social Capital (SC‐IQ). The mean age of participants in the controlled diabetes group was 51.3 (SD: 7.8) years and 50.1(SD: 7.2) in the uncontrolled group. The mean social capital score was 185.1 (CI 95% 181.4–188.6) in the controlled group and 175.4 (CI 95% 171.8–178.8) in the uncontrolled group. There was a significant negative correlation between empowerment and political action and trust and solidarity dimensions and the level of HbA1c. In multiple regression analysis, trust and solidarity and empowerment and political action were significant predictors of the HbA1c. The results of this study suggest that social participation, trust, and empowerment and political action may determine how effectively the patient’s diabetes has been managed. This initial finding warrants subsequent experimental investigations designed to identify strategies that can be used to foster the creation of social capital to improve diabetes control.     

Diet and weight gain of elderly diabetic patients

Abstract

Objective: To assess glycaemic control among Estonian patients with type 2 diabetes mellitus (DM2) and to find patient and disease related factors associated with adequate glycaemic control. Methods: A cross-sectional study of 200 randomly selected DM2 patients from a primary care setting. Data on each patient's glycosylated haemoglobin (HbA1c), body mass index, blood pressure, and medications for treatment of DM2 were provided by family doctors. A structured patient questionnaire was administered as a telephone interview (n = 166). The patients’ self-management behaviour, awareness of the HbA1c test and its recent value were inquired. Results: The mean HbA1c of the DM2 patients was 7.5%. The targets of DM2 treatment were achieved as follows: 39% of the patients had HbA1c below 6.5% and half the patients had HbA1c below 7%. More than third of the patients had systolic blood pressure below 140 mmHg and in 51% of the patients diastolic blood pressure was below 85 mmHg. Six per cent of the patients were in normal weight (<25 kg/m²). Fifty-two per cent of the patients were aware of the HbA1c test and 36% of them knew its recent value. In multivariate regression analysis, awareness of the HbA1c test but not the HbA1c value, longer duration of diabetes and not having a self-monitoring device were independently associated with adequate glycaemic control (HbA1c< 6.5%).

Conclusion: The studied DM2 patients often did not reach the clinical targets suggested in the guidelines. Awareness of the HbA1c test was related to better glycaemic control. However, advanced stage of the disease had a negative effect on HbA1c.     

Different types of soluble fermentable dietary fibre decrease food intake,body weight gain and adiposity in young adult male rats

Diet is an important component of type 2 diabetes therapy. Low adherence to current therapeutic diets points out to the need for alternative dietary approaches. This study evaluated the effect of a different dietary approach, the macrobiotic Ma-Pi 2 diet, and compared it with standard diets recommended for patients with type 2 diabetes. A randomized, controlled, open-label, 21-day trial was undertaken in patients with type 2 diabetes comparing the Ma-Pi 2 diet with standard (control) diet recommended by professional societies for treatment of type 2 diabetes. Changes in fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) were primary outcomes. HbA1c, insulin resistance (IR), lipid panel and anthropometrics were secondary outcomes. After correcting for age, gender, BMI at baseline, and physical activity, there was a significantly greater reduction in the primary outcomes FBG (95% CI: 1.79; 13.46) and PPBG (95% CI: 5.39; 31.44) in those patients receiving the Ma-Pi 2 diet compared with those receiving the control diet. Statistically significantly greater reductions in the secondary outcomes, HbA1c (95% CI: 1.28; 5.46), insulin resistance, total cholesterol, LDL cholesterol and LDL/HDL ratio, BMI, body weight, waist and hip circumference were also found in the Ma-Pi 2 diet group compared with the control diet group. The latter group had a significantly greater reduction of triglycerides compared with the Ma-Pi 2 diet group. Intervention with a short-term Ma-Pi 2 diet resulted in significantly greater improvements in metabolic control in patients with type 2 diabetes compared with intervention with standard diets recommended for these patients. Current Controlled Trials ISRCTN10467793 .     

Social disadvantage: Its impact on the use of Medicare services related to diabetes in NSW

Objective: To use Medicare data to examine the impact of social disadvantage on the use of health services related to diabetes.
Method: Information on number of diabetic individuals and number of services for select Medicare item codes were retrieved by New South Wales postcodes using a Health Insurance Commission data file. The postcodes were graded into quintiles of social disadvantage.
Results: People at most social disadvantage were significantly less likely to be under the care of a general practitioner (adjusted OR 0.41; 95% CI 0.40–0.41) or consultant physician (adjusted OR 0.50; 95% CI 0.48–0.53), despite this group having the highest prevalence of diabetes. The difference in attendance to other specialists was less marked but nevertheless significant (adjusted OR 0.71; 95% CI 0.68–0.75). Once under a doctor's care, patients at most disadvantage were slightly more likely to undergo HbA1c or microalbuminuria estimation (adjusted OR 1.04; 95% CI 1.00–1.10 and adjusted OR 1.22; 95% CI 1.12–1.33, respectively) but were less likely to undergo lipid or HDL cholesterol estimation (adjusted OR 0.81; 95% CI 0.48–0.53 and adjusted OR 0.85; 95% CI 0.79–0.90, respectively).
Conclusion: While access to medical care is decreased for people at most social disadvantage, once under a doctor's care they receive a level of monitoring that is relatively equal to that provided to people less disadvantaged.
Implication: Strategies are required to ensure equal access to medical services for all persons with diabetes, especially for persons who are at most social and medical disadvantage.     

Social disadvantage: its impact on the use of Medicare services related to diabetes in NSW

OBJECTIVE: To use Medicare data to examine the impact of social disadvantage on the use of health services related to diabetes. METHOD: Information on number of diabetic individuals and number of services for select Medicare item codes were retrieved by New South Wales postcodes using a Health Insurance Commission data file. The postcodes were graded into quintiles of social disadvantage. RESULTS: People at most social disadvantage were significantly less likely to be under the care of a general practitioner (adjusted OR 0.41; 95% CI 0.40-0.41) or consultant physician (adjusted OR 0.50; 95% CI 0.48-0.53), despite this group having the highest prevalence of diabetes. The difference in attendance to other specialists was less marked but nevertheless significant (adjusted OR 0.71; 95% CI 0.68-0.75). Once under a doctor's care, patients at most disadvantage were slightly more likely to undergo HbA1c or microalbuminuria estimation (adjusted OR 1.04; 95% CI 1.00-1.10 and adjusted OR 1.22; 95% CI 1.12-1.33, respectively) but were less likely to undergo lipid or HDL cholesterol estimation (adjusted OR 0.81; 95% CI 0.48-0.53 and adjusted OR 0.85; 95% CI 0.79-0.90, respectively). CONCLUSION: While access to medical care is decreased for people at most social disadvantage, once under a doctor's care they receive a level of monitoring that is relatively equal to that provided to people less disadvantaged. IMPLICATION: Strategies are required to ensure equal access to medical services for all persons with diabetes, especially for persons who are at most social and medical disadvantage.     

Relationship of diabetes-specific knowledge to self-management activities, ambulatory preventive care, and metabolic outcomes

BACKGROUND: Educational interventions increase diabetes patients' knowledge and self-care activities, but their impact on the use of health services to prevent diabetes complications is unclear. We sought to determine the relationship of patients' diabetes-specific knowledge with self-management behaviors, use of ambulatory preventive care, and metabolic outcomes. METHODS: We surveyed 670 adults with diabetes from three managed care plans to assess diabetes knowledge (using an eight-item scale) and self-management activities. With chart review, we assessed five processes of care--retinal and foot examinations, low-density lipoprotein cholesterol (LDL-C) testing, hemoglobin A1c (HbA1c) testing, and urine microalbumin testing--and three metabolic outcomes--HbA1c < or = 9.5%, LDL-C <130 mg/dL (3.36 mmol/L), and last blood pressure <140/90 mm Hg. RESULTS: In adjusted analyses, a one-point increase on the knowledge scale was associated with following a diabetes diet (OR 1.23, 95% CI 1.10-1.38), blood glucose self-measurement (OR 1.29, 95% CI 1.13-1.48), and regular exercise (OR 1.15, 95% CI 1.03-1.28) but not with processes of care or metabolic outcomes. CONCLUSIONS: Knowledgeable patients were more likely to perform self-management activities but not to receive recommended ambulatory care or reach metabolic outcome goals. Providing patient education about diabetes care processes should be tested as a means of increasing ambulatory care to prevent diabetes complications.     

2型糖尿病患者糖化血红蛋白控制与自我管理相关因素的关系研究

目的了解2型糖尿病患者血糖化血红蛋白(HbA1c)控制水平与自我管理相关因素的关系。方法采用横断面调查的方法,从4个城市15家医院内分泌科门诊连续募集现患病例。由经过统一培训的调查员采用问卷调查的方式收集患者的一般人口学信息、自我管理信息,同时采集患者5μl指尖血送各城市指定医院进行HbA1c检测。运用logistic回归模型探讨自我管理相关因素与患者HbA1c控制水平的关系。结果共收集有效问卷1524份。多因素分析结果显示控制饮食(OR=0.49,95%CI:0.34～0.72),遵从医嘱(OR=0.63,95% CI:0.40～0.98),监测血糖(≤4次/月:OR=0.66,95% CI:0.50～0.87;>4次/月:OR=0.51。95% CI:0.36～0.73),知晓糖尿病相关知识(OR=0.60,95% CI:0.46～0.80)和检测HbA1c(≥3次/年:OR=0.33,95% CI:0.23～0.48;0～3次/年:OR=0.57,95% CI:0.43～0.74)是HbA1c控制的促进因素。结论自我管理有助于2型糖尿病患者的HbA1c控制,建议加强患者的自我管理以促进HbA1c控制。     

血清糖化血红蛋白、空腹血糖、胰岛素抵抗指数对2型糖尿病合并涂阳肺结核患者强化期治疗后痰菌未阴转的预测价值

目的探讨2型糖尿病合并涂阳肺结核患者2个月强化期治疗后痰菌未阴转的影响因素以及早期血清糖化血红蛋白(HbA1c)、空腹血糖(FBG)及胰岛素抵抗指数(HOMA-IR)对痰菌未阴转的预测价值。方法选取在本院治疗的2型糖尿病合并涂阳肺结核患者87例,同时选取同期40例单纯肺结核患者为对照组,分析2型糖尿病合并涂阳肺结核患者痰菌未阴转的危险因素,并通过绘制ROC曲线分析早期血清HbA1c、FBG、HOMA-IR对强化期治疗后痰菌未阴转的预测价值。结果2型糖尿病合并涂阳肺结核组治疗后痰菌阴转率明显低于对照组,且血清HbA1c、FBG及HOMA-IR较治疗前明显降低(P<0.05)。有空洞及治疗前、2个月强化期治疗后血清HbA1c、FBG、HOMA-IR的高水平均是影响2型糖尿病合并涂阳肺结核患者痰菌未阴转的独立危险因素(P<0.05)。血清HbA1c、FBG预测痰菌未转阴的AUC均明显高于HOMA-IR(P<0.05);HbA1c预测痰菌未转阴的敏感度>FBG>HOMA-IR,而HOMA-IR的特异度>HbA1c=FBG。结论早期、定期对血清HbA1c、FBG及HOMA-IR进行综合监测对提高2型糖尿病合并涂阳肺结核患者2个月强化期治疗后痰菌阴转率具有重要价值。     

Effect of Camel Milk on Glucose Homeostasis in Patients with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The effects of camel milk (CM) intake on glycemic control in patients with diabetes are controversial. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of CM intake on glucose homeostasis parameters in patients with both types of diabetes mellitus; T1DM and T2DM. We searched Google Scholar, PubMed/MEDLINE, EBSCO host, CINAHL, ScienceDirect, Cochrane, ProQuest Medical, Web of Science, and Scopus databases from inception until the end of November 2021. Relevant RCTs were identified, and the effect size was reported as mean difference (MD) and standard deviation (SD). Parameters of glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG), fasting serum insulin (FI), insulin resistance (expressed in terms of HOMA-IR), insulin dose (ID) received, serum insulin antibody (IA), and C-peptide (CP) were tested. Out of 4054 collected articles, 14 RCTs (total 663 subjects) were eligible for inclusion. The pooled results obtained using a random-effects model showed a statistically significant decrease in HbA1c levels (MD, −1.24, 95% confidence interval (CI): −2.00, −0.48, p < 0.001 heterogeneity (I²) = 94%) and ID received (MD, −16.72, 95% CI: −22.09, −11.35 p < 0.00001, I² = 90%), with a clear tendency was shown, but non-significant, to decrease FBG (MD, −23.32, 95% CI: −47.33, 0.70, p = 0.06, I² = 98%) in patients with diabetes who consumed CM in comparison to those on usual care. Conversely, the consumption of CM did not show significant reductions in the rest of the glucose homeostasis parameters. Subgroup analysis revealed that patients with T2DM were more beneficially affected by CM intake than those with T1DM in lowering FBG, while patients with T1DM were more beneficially affected by CM intake than those with T2DM in lowering HbA1c. Both fresh and treated (pasteurized/fermented) CM gave similar beneficial effects in lowering HbA1c. Lastly, a relatively superior effect for longer duration on shorter duration (>6 months, ≤6 months, respectively) of CM intake is found in lowering HbA1c. To conclude, long-term consumption of CM by patients with diabetes could be a useful adjuvant therapy alongside classical medications, especially in lowering the required insulin dose and HbA1c. Due to the high heterogeneity observed in the included studies, more controlled trials with a larger sample size are warranted to confirm our results and to control some confounders and interfering factors existing in the analyzed articles.     

Diabetes treatment and control: the effect of public health insurance for the poor in Mexico

Objective

To analyse the effect of enrolment in the public health insurance scheme known as Seguro Popular [People’s Insurance] on access to health resources, treatment and blood glucose control among poor adults with diabetes in Mexico.

Methods

We analysed cross-sectional data from the 2006 National Health and Nutrition Survey and compared health care access and biological health outcomes, specifically glycosylated haemoglobin (HbA1c) levels, among adults with diabetes who were enrolled in the Seguro Popular (treatment group) and those who had no health insurance (control group). Standard propensity score matching was used to create a highly comparable control group.

Findings

Adults with diabetes who were enrolled in the Seguro Popular had significantly more access than comparable uninsured adults to some type of blood glucose control test (by a difference of 9.5 percentage points; 95% confidence interval, CI: 2.4–16.6) and to insulin injections (3.13 more per week; 95% CI: 0.04–6.22). Those with insurance were also significantly more likely to have appropriately-controlled blood glucose levels (HbA1c ≤ 7%) than their uninsured counterparts (by a difference of 5.6 percentage points; 95% CI: 0.9–10.3). Very poor glucose control (HbA1c > 12%) was found in a significantly smaller proportion of adults in the insured group than in the uninsured group (by a difference of 17.5 percentage points; 95% CI: 6.5–28.5).

Conclusion

The Seguro Popular appears to have improved access to health care and blood glucose control among poor adults with diabetes in Mexico, and it may have had a positive effect on the management of other chronic health conditions, but its long-term effects are yet to be demonstrated. Although the findings are most relevant to Mexico, they may also be applicable to other developing countries seeking to improve health-care coverage for the poor by expanding their public health insurance programmes.     

Longitudinal study of a diabetes education and care intervention: predictors of improved glycemic control.

BACKGROUND: This study prospectively identifies those characteristics of office patients with diabetes that predict subsequent improvement in glycemic control in response to an educational intervention. METHODS: Data on demographic factors, disease characteristics, and glycemic control were obtained on a consecutive series of patients referred by their primary physician to a 4-day outpatient diabetes education and care program. Follow-up measurement of glycosylated hemoglobin (HbA1C) was obtained from the same laboratory 2 months later. Analysis using logistic response models identified baseline characteristics associated with improved HbA1C. RESULTS: Among the 169 study subjects, 74 (44 percent) had at least a 20 percent improvement in HbA1C levels 2 months after the program. Among these subjects, mean HbA1C level was 10.6 percent before and 7.4 percent 2 months after the program. Factors associated with improvement in HbA1C values in bivariate and multivariate logistic models included duration of diabetes less than 2 years (risk ratio = 1.90, 95 percent confidence interval (CI) 1.30-2.76) and initial HbA1C level greater than 10 percent (risk ratio = 2.75, 95 percent CI 2.08-4.01). Baseline functional status, health locus of control, social support, knowledge of diabetes self-care, age, weight as percentage of ideal body weight, age at diagnosis, race, sex, family history of diabetes, type of diabetes, and mode of treatment were not significant predictors of improved HbA1C. CONCLUSIONS: Patients with shorter duration of diabetes and poor baseline glycemic control were most likely to have clinically significant glycemic responses to this program. Severity of disease and regression to the mean were unable to account for this association, leaving unanswered the question of the mechanism of this association. The data also identified a group of patients who do not respond well to this educational approach and for whom novel approaches to behavior change should be considered.