Back to Wilson and Jungner: 10 good reasons to screen for type 2 diabetes mellitus.

University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
Mayo Clinic Proceedings (Impact Factor: 5.81). 02/2009; 84(1):38-42. DOI: 10.1016/S0025-6196(11)60806-9
Source: PubMed
  • Canadian Journal of Diabetes 02/2012; 36(1):3–4. DOI:10.1016/j.jcjd.2012.01.001 · 0.46 Impact Factor
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    ABSTRACT: Screening for diabetes might be more widespread if adverse associations with cardiovascular disease (CVD), resource use, and costs were known to occur earlier than conventional clinical diagnosis. The purpose of this study was to determine whether adverse effects associated with diabetes begin prior to clinical diagnosis. Veterans with diabetes were matched 1:2 with controls by follow-up, age, race/ethnicity, gender, and VA facility. CVD was obtained from ICD-9 codes, and resource use and costs from VA datasets. VA facilities in SC, GA, and AL. Patients with and without diagnosed diabetes. Diagnosed CVD, resource use, and costs. In this study, the 2,062 diabetic patients and 4,124 controls were 63 years old on average, 99 % male, and 29 % black; BMI was 30.8 in diabetic patients vs. 27.8 in controls (p<0.001). CVD prevalence was higher and there were more outpatient visits in Year -4 before diagnosis through Year +4 after diagnosis among diabetic vs. control patients (all p<0.01); in Year -2, CVD prevalence was 31 % vs. 24 %, and outpatient visits were 22 vs. 19 per year, respectively. Total VA costs/year/veteran were higher in diabetic than control patients from Year -4 ($4,083 vs. $2,754) through Year +5 ($8,347 vs. $5,700) (p<0.003) for each, reflecting underlying increases in outpatient, inpatient, and pharmacy costs (p<0.05 for each). Regression analysis showed that diabetes contributed an average of $1,748/year to costs, independent of CVD (p<0.001). VA costs per veteran are higher-over $1,000/year before and $2,000/year after diagnosis of diabetes-due to underlying increases in outpatient, inpatient, and pharmacy costs, greater number of outpatient visits, and increased CVD. Moreover, adverse associations with veterans' health and the VA healthcare system occur early in the natural history of the disease, several years before diabetes is diagnosed. Since adverse associations begin before diabetes is recognized, greater consideration should be given to systematic screening in order to permit earlier detection and initiation of preventive management. Keeping frequency of CVD and marginal costs in line with those of patients before diabetes is currently diagnosed has the potential to save up to $2 billion a year.
    Journal of General Internal Medicine 01/2015; DOI:10.1007/s11606-014-3075-7 · 3.42 Impact Factor
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    ABSTRACT: Objectives: This paper presents the history of data system development steps (1964 - 1986) for the clinical analyzers AutoChemist®, and its successor AutoChemist PRISMA® (PRogrammable Individually Selective Modular Analyzer). The paper also partly recounts the history of development steps of the minicomputer PDP 8 from Digital Equipment. The first PDP 8 had 4 core memory boards of 1 K each and was large as a typical oven baking sheet and about 10 years later, PDP 8 was a "one chip microcomputer" with a 32 K memory chip. The fast developments of PDP 8 come to have a strong influence on the development of the data system for AutoChemist. Five major releases of the software were made during this period (1-5 MIACH). Results: The most important aims were not only to calculate the results, but also be able to monitor their quality and automatically manage the orders, store the results in digital form for later statistical analysis and distribute the results to the physician in charge of the patient using thesame computer as the analyzer. Another result of the data system was the ability to customize AutoChemist to handle sample identification by using bar codes and the presentation of results to different types of laboratories. Conclusions: Digital Equipment launched the PDP 8 just as a new minicomputer was desperately needed. No other known alternatives were available at the time. This was to become a key success factor for AutoChemist. That the AutoChemist with such a high capacity required a computer for data collection was obvious already in the early 1960s. That computer development would be so rapid and that one would be able to accomplish so much with a data system was even suspicious at the time. In total, 75; AutoChemist (31) and PRISMA (44) were delivered Worldwide. The last PRISMA was delivered in 1987 to the Veteran Hospital Houston, TX USA.
    Yearbook of medical informatics 05/2014; 9(1). DOI:10.15265/IY-2014-0029


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