Elbert S Huang

• MD
• Managing Director at University of Chicago

Importance Despite the clinical benefits of treating obesity and related complications, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are not yet covered by Medicare Part D, partly due to high drug costs. The Biden administration’s proposal to expand Part D coverage underscores the need to assess the balance between fiscal costs and benefits...

Importance Newer antiobesity medications lead to greater weight loss and lower cardiometabolic risks. However, the high costs of these medications have raised policy questions about their value and coverage decisions. Objective To compare the cost-effectiveness of 4 antiobesity medications with lifestyle modification vs lifestyle modification alon...

Fracture risk calculators, such as the Fracture Risk Assessment Tool (FRAX), calculate the risk of major osteoporotic (MOF) and hip fracture, but do not account for the excess risk of fracture in people with diabetes. We examined the predictive performance of FRAX without BMD in ethnically diverse, older patients with diabetes. Patients included we...

Background Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of patients' self‐reported perspectives with subsequent deprescribing of diabetes medications in older adults with type 2 diabetes. Methods Longitudinal cohort study of 16...

Importance Male gender expressivity (MGE), which reflects prevalent sociocultural pressures to convey masculinity, has been associated with health. Yet, little is known about associations of MGE with the diagnosis and treatment of modifiable cardiovascular disease (CVD) risks. Objective To investigate associations of MGE with modifiable CVD risk d...

Background Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health‐related social risks (HRSRs) in clinical settings, the accuracy of these risk‐based screening tools for detecting unmet social needs is unknown. Methods We used...

This study leveraged data from 11 independent international diabetes models to evaluate the impact of unrelated future medical costs on the outcomes of health economic evaluations in diabetes mellitus. Eleven models simulated the progression of diabetes and occurrence of its complications in hypothetical cohorts of individuals with type 1 (T1D) or...

Objectives To present the Real‐World Progression In Diabetes (RAPIDS) 2.0 Risk Engine, the only simulation model to study the long‐term trajectories of outcomes arising from dynamic sequences of glucose‐lowering treatments in type 2 diabetes (T2DM). Research Design and Methods The RAPIDS model's risk equations were re‐estimated using a Least Absol...

BACKGROUND Racial and ethnic disparities in type 2 diabetes outcomes are a major public health concern. Interventions targeting multiple barriers may help address disparities. PURPOSE To conduct a systematic review and meta-analysis of diabetes self-management education (DSME) interventions in minority populations. We hypothesized that interventio...

Background and Objectives The role of social factors in diabetes onset has been obscured by wide variation in their conceptualization and operationalization. We apply three theoretical frameworks to categorize social relationship variables along several dimensions and identify which dimension(s) are robustly associated with incident diabetes in the...

Background and Aims Multiple diabetes care guidelines have called for the personalization of risk factor goals, medication management, and self‐care plans among older patients. Study of the implementation of these recommendations is needed. This study aimed to test whether a patient survey embedded in the Electronic Healthcare Record (EHR), coupled...

Racial and ethnic minorities are disproportionately affected by diabetes. Social characteristics, such as family structure, social support, and loneliness, may contribute to these health disparities. In a nationally representative sample of diverse older adults, we evaluated longitudinal rates of both progression from prediabetes to diabetes and re...

Background Two propensity score (PS) based balancing covariate methods, the overlap weighting method (OW) and the fine stratification method (FS), produce superb covariate balance. OW has been compared with various weighting methods while FS has been compared with the traditional stratification method and various matching methods. However, no study...

Severe hypoglycemia is a serious adverse drug event associated with hypoglycemia-prone medications; older patients with diabetes are particularly at high risk. Economic food insecurity (food insecurity due to financial limitations) is a known risk factor for hypoglycemia; however, less is known about physical food insecurity (due to difficulty cook...

Background To examine the willingness of older patients to take less diabetes medication (de‐intensify) and to identify characteristics associated with willingness to de‐intensify treatment. Methods Survey conducted in 2019 in an age‐stratified, random sample of older (65–100 years) adults with diabetes on glucose‐lowering medications in the Kaise...

Background Federally qualified health centers (FQHCs) are integral to the U.S. healthcare safety net and uniquely situated in disadvantaged neighborhoods. The 2009 American Recovery and Reinvestment Act (ARRA) invested $2 billion in FQHC stimulus during the Great Recession; but it remains unknown whether this investment was associated with extended...

Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified...

Background CommunityRx is an evidence-based social care intervention delivered to family and friend caregivers (“caregivers”) at the point of healthcare to address health-related social risks (HRSRs). Two CommunityRx randomized controlled trials (RCTs) are being fielded concurrently on Chicago’s South Side, a predominantly African American/Black co...

Objective We evaluated the economic impact of group visits (GV) in adults with uncontrolled diabetes in community health centers (CHCs) in the United States. Research design and methods In this prospective controlled trial, we implemented 6 monthly GV sessions in 5 CHCs and compared intervention patients (n=49) to control patients (n=72) receiving...

Background: For older adults with type 2 diabetes (T2D) treated with insulin or sulfonylureas, Endocrine Society guideline recommends HbA1c between 7% to <7.5% for those in good health, 7.5% to <8% for those in intermediate health, and 8% to <8.5% for those in poor health. Our aim was to examine associations between attained HbA1c below, within (r...

Background. Older and sicker adults with type 2 diabetes (T2D) were underrepresented in randomized trials of glucagon-like peptide 1 receptor-agonist (GLP1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2I), and thus, health benefits are uncertain in this population. Objective. To assess the impact of age, health status, and life expectancy...

The integration of technologies such as continuous glucose monitors, insulin pumps, and smart pens into diabetes management has the potential to support the transformation of health care services that provide a higher quality of diabetes care, lower costs and administrative burdens, and greater empowerment for people with diabetes and their caregiv...

The past decade of population research for diabetes has seen a dramatic proliferation of the use of real-world data (RWD) and real-world evidence (RWE) generation from non-research settings, including both health and non-health sources, to influence decisions related to optimal diabetes care. A common attribute of these new data is that they were n...

This letter comments on the letter by Christiaens

Background: Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed. Objective: Develop an...

Background: We set out to identify empirically-derived health status classes of older adults with diabetes based on clusters of comorbid conditions which are associated with future complications. Methods: We conducted a cohort study among 105,786 older (≥65 years of age) adults with type 2 diabetes enrolled in an integrated healthcare delivery s...

This cohort study uses data from continuous glucose monitoring to validate a hypoglycemia risk stratification tool.

Background CommunityRx is an evidence-based social care intervention delivered to family and friend caregivers ("caregivers") at the point of healthcare to address health-related social risks (HRSRs). CommunityRx-Hunger is a double-blind randomized controlled trial (RCT) that enrolls caregivers of hospitalized children. CommunityRx-Dementia is a si...

BACKGROUND Prediction models are increasingly utilized in clinical practice but the optimal approach to collecting the needed inputs is unknown. OBJECTIVE Our objective was to compare a mortality prediction model inputs and scores based on chart abstraction versus patient survey. METHODS Older patients with type 2 diabetes at an urban, Chicago pr...

Background Prediction models are being increasingly used in clinical practice, with some requiring patient-reported outcomes (PROs). The optimal approach to collecting the needed inputs is unknown. Objective Our objective was to compare mortality prediction model inputs and scores based on electronic health record (EHR) abstraction versus patient...

Background: Guidelines recommend sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists as second-line therapy for patients with type 2 diabetes. Expanding their use as first-line therapy has been proposed but the clinical benefits may not outweigh their costs. Objective: To evaluate the lifetime c...

Policy Points As essential access points to primary care for almost 29 million US patients, of whom 47% are Medicaid enrollees, health centers are positioned to implement the population health management necessary in value-based payment (VBP) contracts. Primary care payment reform requires multiple payment methodologies used together to provide fle...

Objective: The objective of this study was to evaluate indicators of diabetes quality of care for US nonelderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHCs) versus non-FQHCs. Research design and methods: We analyzed diabetes process measures and acute health services utilization with 2012...

Introduction Glycemic control is challenging for adolescents with type 1 diabetes (T1D). Team Clinic, a shared medical appointment model, has improved psychosocial outcomes in middle school patients with T1D. We aimed to evaluate the costs of delivering Team Clinic. Method Participants were randomized into Team Clinic (n = 44) or usual care (n = 4...

Purpose: The purpose of this study is to develop a diabetes outcomes model for the US (DOMUS) using a multi-ethnic, real-world-data cohort of newly diagnosed Type II diabetics that can predict outcomes for a U.S. multi-ethnic type 2 diabetes population. Methods: The Kaiser Permanente Northern California (KPNC) Diabetes Registry, which is a well-des...

Background: Medical care delivery has been substantially disrupted during the COVID-19 pandemic, leading to delays in medical care, particularly among older adults. Less is known about how these delays have affected different segments of this population. Understanding the negative health consequences older adults face from delayed care will provid...

Objectives: To describe the Health Resources and Services Administration's Quality Improvement Award (QIA) program, award patterns, and early lessons learned. Study setting: 1413 health centers eligible for QIA from 2014 to 2018. Study design: We assessed cumulative QIA funding earned and modified funding excluding payments for per-patient bon...

Introduction: Antihyperglycemic agents are significant contributors to adverse drug events, responsible for emergency department visits, hospitalizations, and death. Nationally, the rate of serious hypoglycemic events associated with these agents remains high despite widespread efforts to improve drug safety. Transitions of care between healthcare...

Informal caregivers of people with Alzheimer’s disease and related dementias (ADRD) are a vulnerable, often isolated population with high rates of financial strain and need for community resource supports. Little is known about how best to connect these caregivers to resources, especially during the COVID-19 pandemic. CommunityRx-Caregiver is an ev...

Objectives: Our primary objective was to examine the distribution of 3-m usual walk, five repeated chair stands, and three static balance stance performances among age and gender subgroups of adults at least 65 years in two national data sets. We secondarily determined whether demographic-function associations varied across data sets, birth cohort...

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are a recent class of medication approved for the treatment of type 2 diabetes (T2D). Previous meta-analyses have quantified the benefits and harms of SGLT2Is; however, these analyses have been limited to specific outcomes and comparisons and included trials of short duration. We compre...

CommunityRx (CRx), an information technology intervention, provides patients with a personalized list of healthful community resources (HealtheRx). In repeated clinical studies, nearly half of those who received clinical “doses” of the HealtheRx shared their information with others (“social doses”). Clinical trial design cannot fully capture the im...

Background Previous meta-analyses of the benefits and harms of glucagon-like peptide-1 receptor agonists (GLP1RAs) have been limited to specific outcomes and comparisons and often included short-term results. We aimed to estimate the longer-term effects of GLP1RAs on cardiovascular risk factors, microvascular and macrovascular complications, mortal...

CommunityRx is a theory‐driven, information technology‐based intervention, developed with and in a predominantly African American/Black community, that provides patients with personalized information (a “HealtheRx”) about self‐management and social care resources in their community. We described patient and clinician information sharing after expos...

Objective To determine the cost effectiveness of pembrolizumab/lenvatinib (P/L) versus standard-of-care carboplatin/paclitaxel (C/T) as first-line systemic therapy for patients with advanced/recurrent endometrial cancer. Methods We designed a Markov model to simulate treatment outcomes for advanced/recurrent endometrial cancer patients whose tumor...

Background: Adults with type 2 diabetes and Medicaid insurance are a highly vulnerable population. Despite the vital role of primary care for diabetes management, few studies have examined how the type of primary care setting affects quality of care for this population, and existing studies have not examined data across the US. Since federally qual...

Background Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to re-examine the 2005-06 classification systems in participants who are now five years older. Methods We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and...

Aging is considered a significant risk factor for diabetes, and over the next decade, the largest increase in diabetes prevalence is expected to be in older adults. Our study aimed to investigate the challenges in managing type 2 diabetes in older adults and its multifactorial components that affect diabetes goal setting. “My Diabetes GOAL” hypothe...

Aim: This study evaluated costs and healthcare utilization associated with a culturally-sensitive, medical and education program for pediatric Latino patients with type 1 diabetes. Methods: Program participants included Latino children ages 1-20 years old diagnosed with type 1 diabetes (n=57). Control subjects with type 1 diabetes were matched b...

In the past 2 decades, managing type 2 diabetes has become more expensive, mostly because of higher spending on prescription medications, principally insulin.¹ Approximately 20% to 30% of patients with type 2 diabetes require insulin to achieve a desired glycemic control target, and insulin has increased in price by more than 300% during the past d...

Objectives: Falls represent a significant cause of morbidity and mortality in older adults, and are more common among those living alone. We aimed to determine if there is an association between loneliness and falls. Methods: Participants were surveyed in three waves separated by 5 years. We used the three-item UCLA Loneliness Scale to measure lone...

Clinical practice guidelines are a critical medium for the standardization of practices within the overall medical community. However, several studies have shown that, in general, there is a significant delay in the adoption of recommendations in such guidelines. Surveys have identified multiple barriers, including clinical inertia, organizational...

The Justice Community Opioid Innovation Network (JCOIN) will generate real-world evidence to address the unique needs of people with opioid use disorder (OUD) in justice settings. Evidence regarding the economic value of OUD interventions in justice populations is limited. Moreover, the variation in economic study designs is a barrier to defining s...

The National Alzheimer’s Project Act (PL-111-375) calls for connecting dementia caregivers to community resources, but few caregiver interventions have focused on this component of support. CRx-D is a theory-driven, scalable intervention that addresses common caregiver needs through: (1) education to normalize needs, (2) coaching on resource activa...

Background: Frailty is associated with lower mean activity; however, hourly activity is highly variable among older individuals. We aimed to relate frailty to hourly activity variance beyond frailty's association with mean activity. Methods: Using the 2010-2011 National Social Life, Health and Aging Project wrist accelerometry data (n=647), we e...

Older adults with diabetes are heterogeneous in their medical, functional, and cognitive status, and require careful individualisation of their treatment regimens. However, in the absence of detailed information from clinical trials involving older people with varying characteristics, there is little evidence-based guidance, which is a notable limi...

Introduction: Medications are major cost drivers in the treatment of patients with inflammatory bowel disease. Recent analyses suggest that there is no added efficacy in continuing nor harm in stopping 5-aminosalicylate (ASA) therapy in patients with inflammatory bowel disease escalated to biological therapies or tofacitinib. We assessed the cost-...

Objectives: Bacteremia and fungemia can cause life-threatening illness with high mortality rates, which increase with delays in antimicrobial therapy. The objective of this study is to develop machine learning models to predict blood culture results at the time of the blood culture order using routine data in the electronic health record. Design:...

Background In October 2018, the U.S. heart allocation system expanded the number of priority “status” tiers from 3 to 6 and added cardiogenic shock requirements for some heart transplant candidates listed with specific types of treatments. Objectives This study sought to determine the impact of the new policy on the treatment practices of transpla...

Objective: We examined how diabetes medication initiation after first diagnosis varied by race/ethnicity. Method: We conducted a retrospective cohort study of 66,939 patients with newly diagnosed diabetes using data from a large integrated healthcare system. We classified patients into 12 race/ethnicity groups (see Table) and assessed their associa...

Background: Several large randomized trials suggest GLP-1RAs may reduce mortality in addition to lowering A1c in patients with T2D. Treatment algorithms from the ADA/EASD now recommend a GLP-1RA be initiated in patients with T2D who either have or are at high risk of atherosclerotic cardiovascular (CV) disease, regardless of A1c level. To better qu...

Background: Several large randomized trials suggest SGLT2Is may reduce mortality in addition to lowering A1c in patients with T2D. Treatment algorithms from the ADA and EASD now recommend a SGLT2I be initiated in patients with T2D who have chronic kidney disease or heart failure, regardless of A1c level. To better quantify the efficacy and safety o...

Older adults (≥65 years) represent >40% of patients living with diabetes. Multiple practice guidelines call for stratifying risk factor goals based on health status. “My Diabetes GOAL” is an intervention designed to introduce ADA guidelines to patients and to collaborate with them on setting glycemic goals. Participants ≥ 65 years, with type 2 DM,...

This chapter summarizes recent evidence on insurance policy as a tool to improve prevention, diagnosis, and treatment of diabetes. We note several key findings. First, recent availability of insurance coverage for diabetes prevention programs could have a significant impact on the diabetes epidemic, if coverage leads to adoption of these effective...

Background: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. Methods: We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-va...

To describe how patient characteristics influence physician decision-making about glycemic goals for Type 2 diabetes. 2016 survey of 357 US physicians. The survey included two vignettes, representing a healthy patient and an unhealthy patient, adapted from a past survey of international experts and a factorial design vignette that varied age, heart...

Background: The Centers for Medicare and Medicaid Services provide nationwide hospital ratings that may influence reimbursement. These ratings do not account for the social risk of communities and may inadvertently penalize hospitals that service disadvantaged neighborhoods. Objective: This study examines the relationship between neighborhood so...

Background Connecting patients to community-based resources is now a cornerstone of modern healthcare that supports self-management of health. The mechanisms that link resource information to behavior change, however, remain poorly understood. Objective To evaluate the impact of CommunityRx, an automated, low-intensity resource referral interventi...

Importance In the United States, the number of deceased donor hearts available for transplant is limited. As a proxy for medical urgency, the US heart allocation system ranks heart transplant candidates largely according to the supportive therapy prescribed by transplant centers. Objective To determine if there is a significant association between...

The epidemic increase in diabetes prevalence (primarily type 2) is a public health crisis. We hypothesized that the rates of movement among diabetic states depend in part on one’s social relationships and environment. Using population-based samples from both NSHAP and HRS, collected in 2005–15, we found that having more friends was associated with...

Implementing frailty assessment into routine clinical practice is a priority. Gait speed and performance on 5 repeated chair stands are two measures of frailty. We face a number of clinical implementation challenges: (1) We lack normative data for U.S. older adults and (2) The clinical relevance of change in frailty measures is unclear. The Nationa...

Wearable sensors may improve our ability to identify frailty in the community. Frailty has been historically defined, in part, by reduced average activity; however, new analytic methods of aggregate, free-living accelerometry data suggest that frailty may be more fully characterized above and beyond reduced average activity. Using mixed-effect regr...

Objective: In the U.S., genetic testing for maturity-onset diabetes of the young (MODY) is frequently delayed because of difficulty with insurance coverage. Understanding the economic implications of clinical genetic testing is imperative to advance precision medicine for diabetes. The objective of this article is to assess the cost-effectiveness...

Importance Among older individuals with type 2 diabetes, those with poor health have greater risk and derive less benefit from tight glycemic control with insulin. Objective To examine whether insulin treatment is used less frequently and discontinued more often among older individuals with poor health compared with those in good health. Design,...

Purpose of Review A patient’s prognosis and risk of adverse drug effects are important considerations for individualizing care of older patients with diabetes. This review summarizes the evidence for risk assessment and proposes approaches for clinicians in the context of current clinical guidelines. Recent Findings Diabetes guidelines vary in the...

Objective: Young adults with type 1 diabetes (T1D) often struggle to achieve glycemic control and maintain routine clinic visits. We aimed to evaluate the societal cost-effectiveness of the Colorado young adults with T1D (CoYoT1) Clinic, an innovative care model of shared medical appointments through home telehealth. Research design and methods:...

In 2014, the Affordable Care Act (ACA) provided funding for states to expand Medicaid coverage to include citizens who earned up to 138% of the federal poverty line. We sought to ascertain whether physicians practicing in Medicaid expansion states reported an increase in Medicaid or newly insured patients with type 2 diabetes in their panels, compa...

Maturity onset diabetes of the young (MODY) is an autosomal dominant form of monogenic diabetes that is often misdiagnosed as type 1 diabetes (T1D) or type 2 diabetes (T2D). The most common MODY types are due to heterozygous mutations in the HNF1A, HNF4A, or GCK genes. Sulfonylureas are the first line treatment for HNF1A-/HNF4A-MODY, with stable or...

Purpose In order to better rank-order candidates by medical urgency, the US has adopted a 6-status therapy-based system that reduces allocation priority for three groups that previously were Status 1A: candidates with 1) left ventricular assist devices (LVAD) listed with “elective” time, 2) LVAD complications and 3) intra-aortic balloon pump or hig...

Purpose Deceased donor hearts are scarce with a third of US candidates failing to receive transplants. Transplant centers have varying approaches to candidate selection, however it is unknown how this variation impacts the effectiveness of heart allocation. Methods Using Scientific Registry of Transplant Recipients data on all US adult heart-alone...

Background The patient-centered medical home (PCMH) is a widely adopted primary care model. However, it is unclear whether changes in provider and staff perceptions of clinic PCMH capability are associated with changes in provider and staff morale, job satisfaction, and burnout in safety net clinics. Objective To determine how provider and staff P...

Objectives: To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. Methods: A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 t...

Introduction: To develop and validate the first real-world data-based type 2 diabetes progression model (RAPIDS) employing econometric techniques that can study the comparative effects of complex dynamic patterns of glucose-lowering drug use. Methods: The US Department of Veterans Affairs (VA) electronic medical record and claims databases were...