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ABSTRACT: To assess trends in rates of hospitalization for nontraumatic lower-extremity amputation (NLEA) in U.S. diabetic and nondiabetic populations and disparities in NLEA rates within the diabetic population.
We calculated NLEA hospitalization rates, by diabetes status, among persons aged ≥40 years on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence. We used joinpoint regression to calculate the annual percentage change (APC) and to assess trends in rates from 1988 to 2008.
The age-adjusted NLEA discharge rate per 1,000 persons among those diagnosed with diabetes and aged ≥40 years decreased from 11.2 in 1996 to 3.9 in 2008 (APC -8.6%; P < 0.01), while rates among persons without diagnosed diabetes changed little. NLEA rates in the diabetic population decreased significantly from 1996 to 2008 in all demographic groups examined (all P < 0.05). Throughout the entire study period, rates of diabetes-related NLEA were higher among persons aged ≥75 years than among those who were younger, higher among men than women, and higher among blacks than whites.
From 1996 to 2008, NLEA discharge rates declined significantly in the U.S. diabetic population. Nevertheless, NLEA continues to be substantially higher in the diabetic population than in the nondiabetic population and disproportionately affects people aged ≥75 years, blacks, and men. Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the U.S. diabetic population that are at higher risk.
Diabetes care 02/2012; 35(2):273-7. · 8.09 Impact Factor
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ABSTRACT: The increasing health and economic burden of diabetes has made preventing the disease a public health priority. But investing in such chronic disease prevention programs requires a long-term horizon because many years may be required for the downstream savings to fully offset the up-front intervention cost. Using a simulation model, we projected the costs and benefits of a nationwide community-based lifestyle intervention program for preventing type 2 diabetes. Accounting for all costs to the US health care system, our results indicate that the program would break even in fourteen years. Within twenty-five years, the program would prevent or delay about 885,000 cases of type 2 diabetes in the United States and produce savings of $5.7 billion nationwide. If restricted to people ages 65-84, the program would save $2.4 billion. Thus, implementing such a program nationwide would be an efficient use of health care resources, although it might be necessary for all health insurers to participate to share prevention costs. Our results also indicate that although a prevention program would lead to cost savings in both younger and older people, it would achieve greater health and economic gains if it were directed at people under age sixty-five.
Health Affairs 01/2012; 31(1):50-60. · 4.31 Impact Factor
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ABSTRACT: To estimate, among privately insured youth in the U.S., medical expenditures associated with diabetes and the difference in medical expenditures between individuals with insulin-treated diabetes mellitus (ITDM) and with non-ITDM (NITDM).
Using the 2007 MarketScan commercial claims and encounter database, we analyzed data for 49,356 youth (aged ≤ 19 years) who were continuously enrolled in fee-for-service health plans. Youth with diabetes (cases) were identified from inpatient, outpatient, and pharmaceutical drug claims. Each case was matched with five controls (without diabetes) by age (± 2 years), sex, census region, and urban versus rural residence. We used regression models to estimate medical expenditures in total and by component (inpatient, outpatient, and medication).
The predicted mean annual total per-person medical expenditures were $9,061 for youth with diabetes and $1,468 for those without, an excess of $7,593 for those with diabetes; of which, 43% was for prescription drugs. The predicted mean annual total expenditures were $9,333 for ITDM youth and $5,683 for NITDM youth, respectively, an excess of $3,650 for those with ITDM diabetes, of which 59% was for prescription drugs.
The excess medical expenditures associated with diabetes, ITDM in particular, among youth are substantial. Our estimates of excess expenditures can be used to assess the economic burden of diabetes overall and by diabetes treatment mode. Our estimated excess expenditure for NITDM may be used for evaluating the economic efficiency of interventions aimed at preventing type 2 diabetes in U.S. youth.
Diabetes care 05/2011; 34(5):1097-101. · 8.09 Impact Factor
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ABSTRACT: To compare the prevalence of prediabetes using A1C, fasting plasma glucose (FPG), and oral glucose tolerance test (OGTT) criteria, and to examine the degree of agreement between the measures.
We used the 2005-2008 National Health and Nutrition Examination Surveys to classify 3,627 adults aged ≥ 18 years without diabetes according to their prediabetes status using A1C, FPG, and OGTT. We compared the prevalence of prediabetes according to different measures and used conditional probabilities to examine agreement between measures.
In 2005-2008, the crude prevalence of prediabetes in adults aged ≥ 18 years was 14.2% for A1C 5.7-6.4% (A1C5.7), 26.2% for FPG 100-125 mg/dL (IFG100), 7.0% for FPG 110-125 mg/dL (IFG110), and 13.7% for OGTT 140-199 mg/dL (IGT). Prediabetes prevalence varied by age, sex, and race/ethnicity, and there was considerable discordance between measures of prediabetes. Among those with IGT, 58.2, 23.4, and 32.3% had IFG100, IFG110, and A1C5.7, respectively, and 67.1% had the combination of either A1C5.7 or IFG100.
The prevalence of prediabetes varied by the indicator used to measure risk; there was considerable discordance between indicators and the characteristics of individuals with prediabetes. Programs to prevent diabetes may need to consider issues of equity, resources, need, and efficiency in targeting their efforts.
Diabetes care 02/2011; 34(2):387-91. · 8.09 Impact Factor
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ABSTRACT: We assessed whether local health departments (LHDs) were conducting obesity prevention programs and diabetes screening programs, and we examined associations between LHD characteristics and whether they conducted these programs.
We used the 2005 National Profile of Local Health Departments to conduct a cross-sectional analysis of 2300 LHDs nationwide. We used multivariate logistic regressions to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Approximately 56% of LHDs had obesity prevention programs, 51% had diabetes screening programs, and 34% had both. After controlling for other factors, we found that employing health educators was significantly associated with LHDs conducting obesity prevention programs (OR = 2.08; 95% CI = 1.54, 2.81) and diabetes screening programs (OR = 1.63; 95% CI = 1.23, 2.17). We also found that conducting chronic disease surveillance was significantly associated with LHDs conducting obesity prevention programs (OR = 1.66; 95% CI = 1.26, 2.20) and diabetes screening programs (OR = 2.44; 95% CI = 1.90, 3.15). LHDs with a higher burden of diabetes prevalence were more likely to conduct diabetes screening programs (OR = 1.20; 95% CI = 1.11, 1.31) but not obesity prevention programs.
The presence of obesity prevention and diabetes screening programs was significantly associated with LHD structural capacity and general performance. However, the effectiveness and cost-effectiveness of both types of programs remain unknown.
American Journal of Public Health 08/2010; 100(8):1434-41. · 3.93 Impact Factor
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ABSTRACT: Diabetes can be prevented or delayed in high-risk adults through lifestyle modifications, including dietary changes, moderate-intensity exercise, and modest weight loss. However, the extent to which U.S. adults with prediabetes are making lifestyle changes consistent with reducing risk is unknown.
This study aimed to study lifestyle changes consistent with reducing diabetes risk and factors associated with their adoption among adults with prediabetes.
In 2009, data were analyzed from 1402 adults aged > or =20 years without diabetes who participated in the 2005-2006 National Health and Nutrition Examination Survey and had valid fasting plasma glucose and oral glucose tolerance tests. The extent to which adults with prediabetes report that in the past year they tried to control or lose weight, reduced the amount of fat or calories in their diet, or increased physical activity or exercise was estimated and factors associated with the adoption of these behaviors were examined.
Almost 30% of the U.S. adult population had prediabetes in 2005-2006, but only 7.3% (95% CI=5.5%, 9.2%) were aware they had it. About half of adults with prediabetes reported performing diabetes risk reduction behaviors in the past year, but only about one third of adults with prediabetes had received healthcare provider advice about these behaviors in the past year. In multivariate analyses, provider advice, female gender, and being overweight or obese were positively associated with all three risk reduction behaviors.
Adoption of risk reduction behaviors among U.S. adults with prediabetes is suboptimal. Efforts to improve awareness of prediabetes, increase promotion of healthy behaviors, and improve availability of evidence-based lifestyle programs are needed to slow the growth in new cases of diabetes.
American journal of preventive medicine 04/2010; 38(4):403-9. · 4.24 Impact Factor
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ABSTRACT: To estimate trends in the prevalence and comorbidities of diabetes mellitus (DM) in U.S. nursing homes from 1995 to 2004.
SAS callable SUDAAN was used to adjust for the complex sample design and assess changes in prevalence of DM and comorbidities during the study period in the National Nursing Home Surveys. Trends were assessed using weighted least squares linear regression. Multiple logistic regressions were used to calculate predictive margins.
A continuing series of two-stage, cross-sectional probability national sampling surveys.
Residents aged 55 and older: 1995 (n=7,722), 1997 (n=7,717), 1999 (n=7,809), and 2004 (n=12,786).
DM and its comorbidities identified using a standard set of diagnosis codes.
The estimated crude prevalence of DM increased from 16.9% in 1995 to 26.4% in 2004 in male nursing home residents and from 16.1% to 22.2% in female residents (all P<.05). Male and female residents aged 85 and older and those with high functional impairment showed a significant increasing trend in DM (all P<.05). In people with DM, multivariate-adjusted prevalence of cardiovascular disease increased from 59.6% to 75.4% for men and from 68.1% to 78.7% for women (all P<.05). Prevalence of most other comorbidities did not increase significantly.
The burden of DM in residents of U.S. nursing homes has increased since 1995. This could be due to increasing DM prevalence in the general population or to changes in the population that nursing homes serve. Nursing home care practices may need to change to meet residents' changing needs.
Journal of the American Geriatrics Society 04/2010; 58(4):724-30. · 3.74 Impact Factor
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ABSTRACT: OBJECTIVES: To estimate trends in the prevalence and comorbidities of diabetes mellitus (DM) in U.S. nursing homes from 1995 to 2004.DESIGN: SAS callable SUDAAN was used to adjust for the complex sample design and assess changes in prevalence of DM and comorbidities during the study period in the National Nursing Home Surveys. Trends were assessed using weighted least squares linear regression. Multiple logistic regressions were used to calculate predictive margins.SETTING: A continuing series of two-stage, cross-sectional probability national sampling surveys.PARTICIPANTS: Residents aged 55 and older: 1995 (n=7,722), 1997 (n=7,717), 1999 (n=7,809), and 2004 (n=12,786).MEASUREMENTS: DM and its comorbidities identified using a standard set of diagnosis codes.RESULTS: The estimated crude prevalence of DM increased from 16.9% in 1995 to 26.4% in 2004 in male nursing home residents and from 16.1% to 22.2% in female residents (all P<.05). Male and female residents aged 85 and older and those with high functional impairment showed a significant increasing trend in DM (all P<.05). In people with DM, multivariate-adjusted prevalence of cardiovascular disease increased from 59.6% to 75.4% for men and from 68.1% to 78.7% for women (all P<.05). Prevalence of most other comorbidities did not increase significantly.CONCLUSION: The burden of DM in residents of U.S. nursing homes has increased since 1995. This could be due to increasing DM prevalence in the general population or to changes in the population that nursing homes serve. Nursing home care practices may need to change to meet residents' changing needs.
Journal of the American Geriatrics Society 03/2010; 58(4):724 - 730. · 3.74 Impact Factor
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ABSTRACT: Kidney disease is the ninth leading cause of death in the United States. In 2000, more than 26 million adults were estimated to have chronic kidney disease (CKD), placing them at risk of progressing to kidney failure. The number of new cases of kidney failure treated by using dialysis or transplantation in the United States has more than doubled since 1990, and it is expected to continue to increase with the aging of the population and the increasing prevalence of such risk factors as diabetes. In recognition of this problem, Congress passed legislation to build capacity and infrastructure at the Centers for Disease Control and Prevention (CDC) for a public health approach to CKD. This Kidney Disease Initiative at the CDC includes surveillance, epidemiology, state-based demonstration projects, and economic studies. The objectives, in collaboration with partners, are to assess and monitor the burden of CKD in the United States, determine its risk factors and rates of preventive practices, develop methods to identify and monitor populations at risk of developing CKD, document the costs of kidney disease, and develop models to help predict the progression of this disease and test the cost-effectiveness of various public health strategies for preventing CKD.
American Journal of Kidney Diseases 04/2009; 53(3 Suppl 3):S121-5. · 5.43 Impact Factor
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Diabetes 12/2008; 57(11):2911-4. · 8.29 Impact Factor
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Ann Albright
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ABSTRACT: Many infectious diseases are recognized as a public health problem. If one were to apply the criteria for designating an infectious disease as a public health problem to diabetes mellitus, how would diabetes rate? The evidence that justifies referring to diabetes as a public health problem includes the burden on society caused by the number of complications and premature mortality, the growth in the number of people diagnosed with the disease since the early 1990s, and the growing public concern. Because diabetes is a public health problem, it warrants public health solutions. This review examines selected components of a framework that provides a useful way to examine what the public health community is doing to combat this growing epidemic.
Journal of the American Dietetic Association 05/2008; 108(4 Suppl 1):S12-8. · 3.59 Impact Factor
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Ann Albright
The American Journal of Nursing 07/2007; 107(6 Suppl):39-42; quiz 42. · 1.12 Impact Factor
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ABSTRACT: To identify adults who might have undiagnosed type 2 diabetes.
Using social marketing methods, we identified the characteristics and preferences of the pilot communities. Risk assessment tests were developed to reflect these preferences. Clinics with registries provided quantitative evaluation data and all clinics shared qualitative data.
Baseline and intervention period data showed that the number of newly detected cases of diabetes increased by 11.5 per month for the 8 registry clinics.
Findings have advanced our understanding of screening by identifying ways of improving the identification of undiagnosed diabetes.
American journal of health behavior 31(6):632-42. · 1.31 Impact Factor
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ABSTRACT: The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management.
Medline (1990-2007), CINAHL (1990-2007), and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies.
Intervention studies that addressed reducing risks to help prevent or minimize diabetes complications were included.
Study design, sample characteristics, interventions, and outcomes were extracted.
Thirty-three studies, represented by 39 articles, met the criteria for inclusion and were classified as smoking cessation (n = 3), eye examination (n = 2), foot care (n = 10), oral health (n = 2), vaccination (n = 1), cardiovascular risk reduction (n = 9), and comprehensive risk reduction (n = 6). Only 46.3% of the 283 outcomes measured in the 33 studies were significantly improved.
Reducing risks involves implementing effective risk reduction behaviors to prevent or slow the progression of diabetes complications. Recognizing risk factors for complications and what constitutes optimal preventive care is an important part of managing diabetes. Intervention studies are lacking in some areas of reducing risks. Further studies are needed to test specific interventions to reduce the risks of diabetes complications.
The Diabetes Educator 33(6):1053-77; discussion 1078-9. · 1.96 Impact Factor
