William H Herman

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (284)1660.36 Total impact

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    ABSTRACT: Adults with diabetes typically take multiple medications for hyperglycemia, diabetes-associated conditions, and other comorbidities. Medication adherence is associated with improved outcomes, including reduced health care costs, hospitalization, and mortality. We conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to antidiabetic medications. We extracted data on a cohort of >200,000 patients who were treated for diabetes with noninsulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011. Adherence was defined as a medication possession ratio ≥0.8. We used a modified adherence measure that accounted for switching therapies. Logistic regression analysis was performed to determine factors independently associated with adherence. Sixty-nine percent of patients were adherent. Adherence was independently associated with older age, male sex, higher education, higher income, use of mail order versus retail pharmacies, primary care versus nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. Patients who were new to diabetes therapy were significantly less likely to be adherent. Several demographic, clinical, and potentially modifiable system-level factors were associated with adherence to antidiabetic medications. Patients typically perceived to be healthy (those who are younger, new to diabetes, and on few other medications) may be at risk for nonadherence. For all patients, efforts to reduce out-of-pocket costs and encourage use of mail order pharmacies may result in higher adherence. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes care. 01/2015;
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    ABSTRACT: Type 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time. Systematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95% CIs was calculated using a random-effects model. 26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95% CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95% CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95% CI 3.44, 7.45)); 1981-90 (3.59 (95% CI 3.15, 4.09)); and those after 1990 (3.11 (95% CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95% CI 3.79-5.45)) had a larger RR estimate when compared to males (3.25 (95% CI 2.82-3.73) and the meta-regression found evidence for temporal trends and sex (p<0.01) accounting for heterogeneity between studies. Type 1 diabetes patients' mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.
    PLoS ONE 11/2014; 9(11):e113635. · 3.53 Impact Factor
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    ABSTRACT: Objective To describe patient and provider characteristics associated with outpatient revisit frequency and to examine the associations between the revisit frequency and the processes and intermediate outcomes of diabetes care. Research Design and Methods We analyzed data from Translating Research Into Action for Diabetes (TRIAD), a prospective, multicenter, observational study of diabetes care in managed care. Results Our analysis included 6,040 eligible adult participants with type 2 diabetes (42.6% ≥ 65 years of age, 54.1% female) whose primary care providers were the main provider of the participants’ diabetes care. The median (interquartile range) revisit frequency was 4.0 (3.7, 6.0) visits per year. Being female, having lower education, lower income, more complex diabetes treatment, cardiovascular disease, higher Charlson comorbidity index, and impaired mobility were associated with higher revisit frequency. The proportion of participants who had annual assessments of HbA1c and LDL-cholesterol, foot examinations, advised or documented aspirin use, and influenza immunizations were higher for those with higher revisit frequency. The proportion of participants who met HbA1c (< 9.5%) and LDL-cholesterol (< 130 mg/dL) treatment goals was higher for those with a higher revisit frequency. The predicted probabilities of achieving more aggressive goals, HbA1c < 8.5%, LDL-cholesterol < 100 mg/dL, and blood pressure < 130/85 or even < 140/90 mmHg were not associated with higher revisit frequency. Conclusions Revisit frequency was highly variable and was associated with both sociodemographic characteristics and disease severity. A higher revisit frequency was associated with better processes of diabetes care, but the association with intermediate outcomes was less clear.
    Journal of Diabetes and its Complications 11/2014; · 1.93 Impact Factor
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    ABSTRACT: Glycated hemoglobin (HbA1c), a standard measure of chronic glycemia for managing diabetes, has been proposed to diagnose diabetes and identify people at risk. The Diabetes Prevention Program (DPP) was a 3.2-year randomized clinical trial of preventing type 2 diabetes with a 10-year follow-up study, the DPP Outcomes Study (DPPOS). We evaluated baseline HbA1c as a predictor of diabetes and determined the effects of treatments on diabetes defined by an HbA1c ≥6.5% (48 mmol/mol).
    Diabetes Care 10/2014; · 8.57 Impact Factor
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    ABSTRACT: Previous studies have demonstrated lower prostate-specific antigen (PSA) concentrations in men with type 2 diabetes (T2DM), paralleling the reported lower prevalence of prostate cancer among diabetic men. Data on PSA in men with type 1 diabetes (T1DM), in whom insulin and obesity profiles differ from those in T2DM, are lacking. The objective of this study was to examine the relationship between long-term glycemic control and PSA in men with T1DM.
    The Journal of Urology 09/2014; 187(4):e33. · 3.75 Impact Factor
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    ABSTRACT: Objective To evaluate the performance of three alternative methods to identify diabetes in patients visiting Emergency Departments (EDs), and to describe the characteristics of patients with diabetes who are not identified when the alternative methods are used. Research Design and Methods We used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2009 and 2010. We assessed the sensitivity and specificity of using providers’ diagnoses and diabetes medications (both excluding and including biguanides) to identify diabetes compared to using the checkbox for diabetes as the gold standard. We examined the characteristics of patients whose diabetes was missed using multivariate Poisson regression models. Results The checkbox identified 5,567 ED visits by adult patients with diabetes. Compared to the checkbox, the sensitivity was 12.5% for providers’ diagnoses alone, 20.5% for providers’ diagnoses and diabetes medications excluding biguanides, and 21.5% for providers’ diagnoses and diabetes medications including biguanides. The specificity of all three of the alternative methods was > 99%. Older patients were more likely to have diabetes not identified. Patients with self-payment, those who had glucose measured or received IV fluids in the ED, and those with more diagnosis codes and medications, were more likely to have diabetes identified. Conclusions NHAMCS’s providers’ diagnosis codes and medication lists do not identify the majority of patients with diabetes visiting EDs. The newly introduced checkbox is helpful in measuring ED resource utilization by patients with diabetes.
    Journal of diabetes and its complications 09/2014; · 2.11 Impact Factor
  • William H Herman
    Diabetes Care 09/2014; 37(9):2424-6. · 8.57 Impact Factor
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    ABSTRACT: To examine whether previous severe hypoglycemic events were associated with the risk of all-cause mortality after major cardiovascular events (myocardial infarction [MI] or stroke) in patients with type 1 diabetes.
    Diabetes Care 08/2014; · 8.57 Impact Factor
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    ABSTRACT: Context: Previous studies have demonstrated lower testosterone concentrations in men with type 2 diabetes mellitus. Data in men with type 1 diabetes mellitus (T1DM) are limited. Objective: To determine prevalence of low testosterone in men with T1DM and identify predisposing factors. Design, Setting, and Participants: This was a cross-sectional study of men with T1DM participating in UroEDIC (n=641), an ancillary study of urologic complications in the Epidemiology of Diabetes Interventions and Complications (EDIC). Main Outcome Measures: Total serum testosterone levels were measured using mass spectrometry and sex hormone binding globulin (SHBG) levels were measured using sandwich immunoassay on samples from EDIC year 17/18. Calculated free testosterone (cFT) was determined using an algorithm incorporating binding constants for albumin and SHBG. Low testosterone was defined as total testosterone <300 mg/dL. Multivariate regression models were used to compare age, body mass index, factors related to diabetes treatment and control, and diabetic complications with testosterone levels. Results: Mean age was 51 years. Sixty-one men (9.5%) had T <300 mg/dL. Decreased testosterone was significantly associated with obesity (p<0.01), older age (p<0.01) and decreased sex hormone-binding globulin (p<0.001). Insulin dose was inversely associated with cFT (p=0.02). Hypertension retained a significant adjusted association with lower testosterone (p=0.05). There was no observed significant relationship between lower testosterone and nephropathy, peripheral neuropathy, and autonomic neuropathy measures. Conclusion: The men with T1DM in the EDIC cohort do not appear to have a high prevalence of androgen deficiency. Risk factors associated with low testosterone levels in this population are similar to the general population.
    Journal of Clinical Endocrinology &amp Metabolism 07/2014; · 6.31 Impact Factor
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    ABSTRACT: Background Current approaches to the management of type 2 diabetes focus on the early initiation of novel pharmacologic therapies and bariatric surgery. Objective The purpose of this study was to revisit the use of intensive, outpatient, behavioral weight management programs for the management of type 2 diabetes. Design Prospective observational study of 66 patients with type 2 diabetes and BMI ≥ 32 kg/m2 who enrolled in a program designed to produce 15% weight reduction over 12 weeks using total meal replacement and low- to moderate-intensity physical activity. Results Patients were 53 ± 7 years of age (mean ± SD) and 53% were men. After 12 weeks, BMI fell from 40.1 ± 6.6 to 35.1 ± 6.5 kg/m2. HbA1c fell from 7.4 ± 1.3% to 6.5 ± 1.2% (57.4 ± 12.3 to 47.7 ± 12.9 mmol/mol) in patients with established diabetes: 76% of patients with established diabetes and 100% of patients with newly diagnosed diabetes achieved HbA1c < 7.0% (53.0 mmol/mol). Improvement in HbA1c over 12 weeks was associated with higher baseline HbA1c and greater reduction in BMI. Conclusions An intensive, outpatient, behavioral weight management program significantly improved HbA1c in patients with type 2 diabetes over 12 weeks. The use of such programs should be encouraged among obese patients with type 2 diabetes.
    Journal of Diabetes and its Complications 07/2014; · 1.93 Impact Factor
  • Robert M Cohen, William H Herman
    The lancet. Diabetes & endocrinology. 04/2014; 2(4):264-5.
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    ABSTRACT: The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes (eg, genetic, lifestyle, and behavioural risk factors) has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes, taking into account its many origins and heterogeneity. Thus, research needs to be directed at improved understanding of the potential role of determinants such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programmes.
    The lancet. Diabetes & endocrinology. 01/2014; 2(1):56-64.
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    ABSTRACT: To evaluate the impact of a managed care obesity intervention that requires enrollment in an intensive medical weight management program, a commercial weight loss program, or a commercial pedometer-based walking program to maintain enhanced benefits. Prospective observational study involving 1,138 adults with BMI ≥ 32 kg m(-2) with one or more comorbidities or BMI ≥ 35 kg m(-2) enrolled in a commercial, independent practice association-model health maintenance organization. Body mass index, blood pressure, lipids, HbA1c or fasting glucose, and per-member per-month costs were assessed 1 year before and 1 year after program implementation. Program uptake (90%) and 1 year adherence (79%) were excellent. Enrollees in all three programs exhibited improved clinical outcomes and reduced rates of increase in direct medical costs compared to members who did not enroll in any program. A managed care obesity intervention that offered financial incentives for participation and a variety of programs was associated with excellent program uptake and adherence, improvements in cardiovascular risk factors, and a lower rate of increase in direct medical costs over 1 year.
    Obesity 10/2013; · 4.39 Impact Factor
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    ABSTRACT: To assess the impact of weight loss on health-related quality-of-life (HRQL), to describe the factors associated with improvements in HRQL after weight loss, and to assess the relationship between obesity as assessed by body mass index (BMI) and HRQL before and after weight loss. We studied 188 obese patients with BMI ≥ 32 kg/m(2) with one or more comorbidities or ≥35 kg/m(2). All patients had baseline and follow-up assessments of BMI and HRQL using the EuroQol (EQ-5D) and its visual analog scale (VAS) before and after 6 months of medical weight loss that employed very low-calorie diets, physical activity, and intensive behavioral counseling. At baseline, age was 50 ± 8 years (mean ± SD), BMI was 40. 0 ± 5.0 kg/m(2), EQ-5D-derived health utility score was 0.85 ± 0.13, and VAS-reported quality-of-life was 0.67 ± 0.18. At 6-month follow-up, BMI decreased by 7.0 ± 3.2 kg/m(2), EQ-5D increased by 0.06 [interquartile range (IQR) 0.06-0.17], and VAS increased by 0.14 (IQR 0.04-0.23). In multivariate analyses, improvement in EQ-5D and VAS were associated with lower baseline BMI, greater reduction in BMI at follow-up, fewer baseline comorbidities, and lower baseline HRQL. For any given BMI category, EQ-5D and VAS tended to be higher at follow-up than at baseline. Measured improvements in HRQL between baseline and follow-up were greater than predicted by the reduction in BMI at follow-up. If investigators use cross-sectional data to estimate changes in HRQL as a function of BMI, they will underestimate the improvement in HRQL associated with weight loss and underestimate the cost-utility of interventions for obesity treatment.
    Quality of Life Research 10/2013; · 2.86 Impact Factor
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    ABSTRACT: OBJECTIVE Examine 12-month effects of a booster-enhanced preconception counseling (PC) program (READY-Girls) on family planning for teen girls with type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODS Participants 13-19 years of age (n = 109) were randomized to a standard care control group (CG) or intervention group (IG) that received PC over three consecutive clinic visits. Prepost data were collected at baseline, 3- and 6-month booster sessions, and a 12-month follow-up visit.RESULTSMean age was 15.8 years; 9 (8%) subjects had type 2 diabetes; and 18 (17%) subjects were African American. At baseline, 20% (n = 22 of 109) had been sexually active, and of these, 50% (n = 11) had at least one episode of unprotected sex. Over time, IG participants retained greater PC knowledge (F[6,541] = 4.05, P = 0.0005) and stronger intentions regarding PC (significant group-by-time effects) especially after boosters. IG participants had greater intentions to discuss PC (F[6, 82.4] = 2.56, P = 0.0254) and BC (F[6,534] = 3.40, P = 0.0027) with health care providers (HCPs) and seek PC when planning a pregnancy (F[6,534] = 2.58, P = 0.0180). Although not significant, IG participants, compared with CG, showed a consistent trend toward lower rates of overall sexual activity over time: less sexual debut (35 vs. 41%) and higher rates of abstinence (44 vs. 32%). No pregnancies were reported in either group throughout the study.CONCLUSIONSREADY-Girls appeared to have long-term sustaining effects on PC knowledge, beliefs, and intentions to initiate discussion with HCPs that could improve reproductive health behaviors and outcomes. Strong boosters and providing PC at each clinic visit could play important roles in sustaining long-term effects.
    Diabetes care 10/2013; · 7.74 Impact Factor
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    ABSTRACT: Objective. Diabetes treatment should be effective and cost-effective. The HbA1c-associated complications are costly. Would patient-centred care be more (cost-)effective if it was targeted to patients within specific HbA1c-ranges? Research, Design and Methods. This prospective, cluster-randomised, controlled trial involved 13 hospitals (clusters), in the Netherlands, and 506 patients with type 2 diabetes randomized to patient-centred (n=237) or usual care (controls) (n=269). Primary outcomes were change in HbA1c and quality-adjusted life-years (QALYs); costs and incremental costs (USD) after one year were secondary outcomes. We applied non-parametric bootstrapping and probabilistic modelling over a lifetime using a validated Dutch model. The baseline-HbA1c strata were<7.0% (53 mmol/mol), 7.0%-8.5%, and >8.5% (69 mmol/mol). Results. Patient-centred care was most effective and cost-effective in those with baseline-HbA1c >8.5% (69 mmol/mol). Further studies should assess varying HbA1c-strata and additional risk profiles, accounting for heterogeneity among patients in a comparative approach.
    Diabetes Care 10/2013; Oct;3(10):3054-61. · 8.57 Impact Factor
  • Urology 10/2013; 82(4):881-886. · 2.13 Impact Factor
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    ABSTRACT: The relationships between smoking and glycaemic variables have not been well explored. We compared HbA1c, fasting plasma glucose (FPG) and 2 h plasma glucose (2H-PG) in current, ex- and never-smokers. This meta-analysis used individual data from 16,886 men and 18,539 women without known diabetes in 12 DETECT-2 consortium studies and in the French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) and Telecom studies. Means of three glycaemic variables in current, ex- and never-smokers were modelled by linear regression, with study as a random factor. The I (2) statistic was used to evaluate heterogeneity among studies. HbA1c was 0.10% (95% CI 0.08, 0.12) (1.1 mmol/mol [0.9, 1.3]) higher in current smokers and 0.03% (0.01, 0.05) (0.3 mmol/mol [0.1, 0.5]) higher in ex-smokers, compared with never-smokers. For FPG, there was no significant difference between current and never-smokers (-0.004 mmol/l [-0.03, 0.02]) but FPG was higher in ex-smokers (0.12 mmol/l [0.09, 0.14]). In comparison with never-smokers, 2H-PG was lower (-0.44 mmol/l [-0.52, -0.37]) in current smokers, with no difference for ex-smokers (0.02 mmol/l [-0.06, 0.09]). There was a large and unexplained heterogeneity among studies, with I (2) always above 50%; I (2) was little changed after stratification by sex and adjustment for age and BMI. In this study population, current smokers had a prevalence of diabetes that was 1.30% higher as screened by HbA1c and 0.52% lower as screened by 2H-PG, in comparison with never-smokers. Across this heterogeneous group of studies, current smokers had a higher HbA1c and lower 2H-PG than never-smokers. This will affect the chances of smokers being diagnosed with diabetes.
    Diabetologia 09/2013; · 6.88 Impact Factor
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    ABSTRACT: The objective was to describe the prevalence of diabetes-related foot complications in a managed care population and to identify the demographic and biological risk factors. We assessed the period prevalence of foot complications on 6992 patients using ICD-9 diagnosis codes from health plan administrative data. Demographic and biological variables were ascertained from surveys and medical record reviews. We defined four mutually exclusive groups: any Charcot foot, DFU with debridement, amputation±DFU and debridement, and no foot conditions. Overall, 55 (0.8%) patients had Charcot foot, 205 (2.9%) had DFU with debridement, and 101 (1.4%) had a lower-extremity amputation. There were 6631 patients with no prevalent foot conditions. Racial/ethnic minorities were less likely to have Charcot foot (OR=0.21; 95% CI: 0.10, 0.46) or DFU (OR=0.61; 95% CI: 0.44, 0.84) compared to non-Hispanic Whites, but there were no racial/ethnic differences in amputation. Histories of micro- or macrovascular disease were associated with a two- to four-fold increase in the odds of foot complications. In managed care patients with uniform access to health care, we found a relatively high prevalence of foot complications, but attenuation of the racial/ethnic differences of rates reported in the literature.
    Journal of diabetes and its complications 09/2013; · 2.11 Impact Factor
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    ABSTRACT: OBJECTIVE Diabetes treatment should be effective and cost-effective. HbA1c-associated complications are costly. Would patient-centered care be more (cost-) effective if it was targeted to patients within specific HbA1c ranges? RESEARCH DESIGN AND METHODS This prospective, cluster-randomized, controlled trial involved 13 hospitals (clusters) in the Netherlands and 506 patients with type 2 diabetes randomized to patient-centered (n = 237) or usual care (controls) (n = 269). Primary outcomes were change in HbA1c and quality-adjusted life years (QALYs); costs and incremental costs (USD) after 1 year were secondary outcomes. We applied nonparametric bootstrapping and probabilistic modeling over a lifetime using a validated Dutch model. The baseline HbA1c strata were <7.0% (53 mmol/mol), 7.0-8.5%, and >8.5% (69 mmol/mol).RESULTS Patient-centered care was most effective and cost-effective in those with baseline HbA1c >8.5% (69 mmol/mol). After 1 year, the HbA1c reduction was 0.83% (95% CI 0.81-0.84%) (6.7 mmol/mol [6.5-6.8]), and the incremental cost-effectiveness ratio (ICER) was 261 USD (235-288) per QALY. Further studies should assess different HbA1c strata and additional risk profiles to account for heterogeneity among patients.
    Diabetes care 08/2013; · 7.74 Impact Factor

Publication Stats

13k Citations
1,660.36 Total Impact Points


  • 1991–2014
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 1990–2014
    • University of Michigan
      • • Division of Metabolism, Endocrinology & Diabetes
      • • Department of Internal Medicine
      • • Medical School
      • • Department of Clinical, Social, and Administrative Sciences
      Ann Arbor, Michigan, United States
  • 2013
    • George Washington University
      • Biostatistics Center
      Washington, Washington, D.C., United States
  • 1994–2013
    • Centers for Disease Control and Prevention
      • • Division of Diabetes Translation
      • • National Center for Chronic Disease Prevention and Health Promotion
      Atlanta, MI, United States
  • 2012
    • The Ohio State University
      Columbus, Ohio, United States
    • University of California, San Francisco
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      San Francisco, CA, United States
    • Baker IDI Heart and Diabetes Institute
      • Clinical Diabetes and Epidemiology Research Group
      Melbourne, Victoria, Australia
  • 2011
    • Park Nicollet Health Services
      Minneapolis, Minnesota, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2003–2011
    • Wayne State University
      • Department of Pharmacy Practice
      Detroit, MI, United States
  • 2006–2009
    • University of California, Los Angeles
      • Division of General Internal Medicine and Health Services Research
      Los Angeles, CA, United States
    • Indiana University-Purdue University Indianapolis
      • Department of Medicine
      Indianapolis, IN, United States
  • 2003–2009
    • Kaiser Permanente
      Oakland, California, United States
  • 2007–2008
    • RTI International
      Durham, North Carolina, United States
  • 2005–2006
    • University of Florida
      • Department of Medicine
      Gainesville, FL, United States
    • Oakland University
      • School of Nursing
      Rochester, MI, United States
  • 2004
    • University of California, San Diego
      • Division of Endocrinology & Metabolism
      San Diego, California, United States
  • 2000
    • Arizona Department of Health Services
      Phoenix, Arizona, United States
  • 1997
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States