Women with diagnosed diabetes across the life stages: underuse of recommended preventive care services.
ABSTRACT Diabetes is a common and costly disease. In 2007, an estimated 24 million people in the United States had diabetes, with almost half of these being women. Diabetes increases the risk of morbidity and mortality from several conditions, including cardiovascular disease, several types of cancers, influenza and pneumococcal infection, and kidney, eye, and periodontal diseases. The aim of this study was to examine the quality of care that women with diabetes receive and to assess how receipt of some clinical preventive services and screening for common conditions associated with diabetes vary according to socioeconomic factors. Our findings indicate that use of diabetes-specific preventive care among women is low, with the youngest women (< or =45 years) and those with low educational levels being the least likely to receive the recommended services. Women with diabetes were less likely than women without diabetes to receive a Pap smear, with the oldest women (> or =65 years) being the most vulnerable. Women with diabetes who were poor and nonwhite were less likely than more affluent and white women to receive a pneumococcal vaccination. This study's findings suggest that having a chronic disease may serve as a barrier to the receipt of recommended preventive care among women. Effective interventions should be designed to meet the needs of the most vulnerable women with diabetes, in particular, those who are at the extremes of the life cycle, are poor, and have low levels of education. Programs should use a life stage approach to address the unique needs of women with diabetes.
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ABSTRACT: Background: Timely detection allows the inclusion of vulnerable populations into the cervical cancer (CC) screening programs, particularly in low-and middle-income countries. The aim was determine both the prevalence and the risk of CC in patients who have type 2 diabetes mellitus (T2DM). Methods: A cross-sectional population-based survey in Mexico was conducted using a probabilistic, multistage, and stratified cluster sampling design. The structured questionnaire included information on geographic region, personal history, and life styles, and anthropometric measures. A total of 160 cases of CC (median age 48 years, range 24-81) and 25,262 control females (median age 39 years, range 20-99) were included. Results: The prevalence of CC in women with T2DM was significantly higher compared with females without diabetes (1,336 vs. 576 subjects per 100,000 inhabitants, p<0.001). In all univariate (U) and multivariate (M) logistic regression models (LRM), the ORs for CC displayed a significant association with diabetes (ULRM OR=2.338; CI95% 1.511-3.618, p<0.001, MLRM1 OR=2.098; CI95% 1.345-3.272, p=0.001, MLRM2 OR=1.719; CI95% 1.0.33-2.862, p=0.001) and tobacco smoking (ULRM OR=1.979; CI95% 1.368-2.863, p<0.001, MLRM1 OR=1.847; CI95% 1.234-2.765, p=0.003, MLRM2 OR=1.859; CI95% 1.191-2.902, p=0.006). The ULRM indicated a significant association for separate (OR=1.906; CI95% 1.178-3.085, p=0.009), widowed (OR=1.615; CI95% 1.059-2.462, p=0.026) and single MS (OR=3.297; CI95% 1.618-6.717, p=0.001). The MLRM2 indicated a similar association for the variables sedentary (OR=8.676; CI95% 1.204-62.497, p=0.032), physical activity (OR=0.115; CI95% 0.016-0.827, p=0.032) and body fat percentage (OR=1.084; CI95% 1.023-1.149, p=0.006). Conclusion: This study supports an association between personal history of diabetes and tobacco smoking and life styles with CC. Keywords: Cervical cancer; Diabetes; Risk factors; Logistic regression; Lifestyle characteristics; Sociodemographic components
Article: FOUR AUTHORS REPLY.American journal of epidemiology 04/2014; DOI:10.1093/aje/kwu084 · 4.98 Impact Factor
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ABSTRACT: This study aims to determine the positive and negative predictive values of self-reported diabetes during the Women's Health Initiative (WHI) clinical trials. All WHI trial participants from four field centers who self-reported diabetes at baseline or during follow-up, as well as a random sample of women who did not self-report diabetes, were identified. Women were surveyed regarding diagnosis and treatment. Medical records were obtained and reviewed for documented treatment with antidiabetes medications or for physician diagnosis of diabetes supported by laboratory measurements of glucose. We identified 1,275 eligible participants; 732 consented and provided survey data. Medical records were obtained for 715 women (prevalent diabetes, 207; incident diabetes, 325; no diabetes, 183). Records confirmed 91.8% (95% CI, 87.0-95.0) of self-reported prevalent diabetes cases and 82.2% (95% CI, 77.5-86.1) of incident diabetes cases. Among those who never self-reported diabetes, there was no medical record or laboratory evidence for diabetes in 94.5% (95% CI, 89.9-97.2). Women with higher body mass index were more likely to accurately self-report incident diabetes. In a subgroup of participants enrolled in fee-for-service Medicare, a claims algorithm correctly classified nearly all diabetes cases and noncases. Among WHI clinical trial participants, there are high positive predictive values of self-reported prevalent diabetes (91.8%) and incident diabetes (82.2%) and a high negative predictive value (94.5%) when diabetes is not reported. For participants enrolled in fee-for-service Medicare, a claims algorithm has high positive and negative predictive values.Menopause (New York, N.Y.) 02/2014; DOI:10.1097/GME.0000000000000189 · 2.81 Impact Factor