bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Structured Patient-Support Program on Adherence and Persistence with Basal Insulin Therapy at 12 Months
Authors: ZHOU FANG L. , YEAW JASON , KARKARE SWAPNA , DEKOVEN MITCH , REID TIMOTHY S. 
Published: June 2018

The COACH patient-support program was launched in 2015 to support and educate patients prescribed insulin glargine 300 U/mL (Gla-300). The study objective was to assess program impact on adherence and persistence among patients with T2D on Gla-300 therapy.
A retrospective cohort study was conducted, linking data from COACH to patient data in the IQVIA Integrated Data Warehouse. Overall inclusion criteria for patients identified from 2/1/2016-7/31/2016 were: ≥1 T2D diagnosis code, aged ≥18 years, ≥1 pharmacy claim for Gla-300 (first claim as index date), continuous database activity for ≥180 days preceding the 6-month pre-index, and pharmacy stability in the 6-month pre-index. Exclusion criteria were: ≥1 pharmacy claim for another basal insulin ≤14 days preceding index, and data-quality issues. Patients from the COACH Participant cohort (active participants of the program) were directly matched to a Non-COACH cohort of patients not enrolled in COACH. Patients who were insulin naive, switched from any other basal insulin to Gla-300, and with high levels of engagement to COACH were analyzed as subcohorts. Treatment persistence and adherence were measured over a 12-month follow-up.
The matched cohorts included 544 patients each. Over 12 months, a significantly greater proportion of COACH Participants were persistent (48.5% vs. 42.1%; p=0.0309) and adherent (68.0% vs. 61.4%; p=0.0201) to Gla-300 compared with patients in the Non-COACH cohort. In multivariate adjusted analyses, the odds of being adherent to index medication were 1.81 times higher (OR 1.81; p=0.0002) and the risk of discontinuation was 40% lower (HR 0.60; p&lt;0.0001) for COACH Participants. Similar results were found among naive and switching subcohorts. A higher level of engagement with COACH was associated with a lower risk of discontinuation.
Active participation in the COACH patient-support program was associated with improved adherence and persistence to Gla-300.

Disclosure
F.L. Zhou: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. Employee; Spouse/Partner; Lexicon Pharmaceuticals, Inc.. Stock/Shareholder; Spouse/Partner; Lexicon Pharmaceuticals, Inc. J. Yeaw: Other Relationship; Self; Sanofi US. S. Karkare: None. M. DeKoven: None. T.S. Reid: Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi, Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; AstraZeneca, Intarcia Therapeutics, Inc.. Speaker's Bureau; Self; Lilly.
Preserving Vision by Empowering Patients
Authors: YANG ALMIRA J. , LA VAN T. , EKE CHIBUZO U. , FIREK ANTHONY 
Published: June 2018

Diabetic retinopathy (DR) is a preventable complication of diabetes with early detection and intervention. Prior studies have shown patient engagement and empowerment improve patient knowledge and self-care resulting in better outcomes. Yet, screening and treatment of DR remain a major challenge especially in our underserved, indigent patient populations. Graphic education material is often used to improve detection of DR but its effectiveness is rarely assessed, especially in the underserved. To improve DR screening in our population, we developed a quality improvement project using in-clinic graphic material to empower patients to screen for DR, followed by post clinic surveys to evaluate the impacts on screening rates and patient engagement.
Posters in English and Spanish were placed in primary care clinics directly viewed by patients for 3 months. We surveyed 100 patients and 12 providers to evaluate the effectiveness of the intervention. We reviewed 84 and 200 charts to determine both pre- and post-intervention DR screening rates.
No difference was seen in the DR screening rate between the pre- and post-intervention periods (51.0% vs. 50.0%, p = 0.86). There were improvements in the referral rate and the retinal exam visit rate between pre- and post-intervention periods (76.2% vs. 82.2%, p = 0.142; 63.9% vs. 73.3%, p = 0.046, respectively). Among the 49 patients who saw educational posters, 69.4% reported the posters prompted them to discuss with the providers about retinal screening exams.
Our study demonstrated that posters can improve patients’ awareness of DR leading to positive engagement with their providers, and eventually improve DR screening efforts. However, multiple factors such as patient literacy, limited encounter time, and understanding may limit the effectiveness of education interventions particularly in our underserved patients. As DR particularly impacts this population, more innovative and direct interactions may need to be implemented to improve self knowledge and patient empowerment to improve DR screening.

Disclosure
A.J. Yang: None. V.T. La: None. C.U. Eke: None. A. Firek: None.
Racial Disparities in the Burden of End-Stage Renal Disease due to Diabetes among Medicare Beneficiaries
Authors: GLANTZ NAMINO M. , DUNCAN IAN , AHMED TAMIM , KERR DAVID 
Published: June 2018

Diabetes disproportionately impacts minority populations in the United States. In particular, Hispanics are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes and have higher rates of end-stage renal disease (ESRD) due to diabetes. We analyzed data from the Medicare 5% sample file by race/ethnicity for type 1 (T1D) and type 2 diabetes (T2D) to determine the economic burden of ESRD.
For the years 2012-13 we identified 1,397,933 enrollees from the publicly-available Medicare 5% sample &gt; 65 years without Medicare Advantage coverage (HMO).
The prevalence of T1D was 2.0% and 21.9% for T2D. ESRD affected 5.4% of the T1D and 1.9% of T2D populations. Rates of ESRD were significantly higher for other races for both T1D and T2D compared to whites.
Comparing costs, allowed amount (claims less discounts/ineligible charges) for treating ESRD was higher for T1D Hispanics than T1D whites ($8,946 vs. $8,332 per member/month, P&lt;0.001). In contrast to other races, T2D Hispanics with ESRD were not more costly than whites ($6,634 vs. $6,542). Similar results were seen for net paid costs taking into account cost-sharing. Average cost-sharing for all patients with ESRD was $730 (no diabetes), $1,177 (T1D) and $939 (T2D) per member/month respectively.
In conclusion, the burden of ESRD due to T1D and T2D and the associated cost for T1D with ESRD were higher for Hispanics than for white Medicare enrollees.

Disclosure
N.M. Glantz: Research Support; Self; Eli Lilly and Company. I. Duncan: Consultant; Self; Eli Lilly and Company. T. Ahmed: None. D. Kerr: Advisory Panel; Self; Glooko, Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Sanofi-Aventis. Stock/Shareholder; Self; Cellnovo. Advisory Panel; Self; Novo Nordisk Inc..
Quality of Diabetes Care—Comparisons between Rzeszow, Podkarpacie, Poland and Waukesha, Wisconsin, U.S.
Authors: IDSO JOHN , TELEGA GRZEGORZ , DąBROWSKI MARIUSZ , KIDAMBI SRIVIDYA 
Published: June 2018

Introduction: Poland spent 6.4% of its GDP on healthcare in 2013, while the United States (U.S.) spent 16.9%, despite similar life expectancies. Type 2 diabetes mellitus (DM) was estimated to have cost the U.S. $176 billion in 2012. This study compares the quality of DM care between Waukesha in Wisconsin, U.S. and Rzeszow in Podkarpacie region of Poland—cities comparable in population size, age, race, and income levels.
Methods: DM quality data for the Polish cohort was abstracted from the charts of 144 DM patients attending a regional diabetes clinic in Rzeszow, Podkarpacie from 2013-2014. Podkarpacie DM cost data was attained from the Polish National Health Fund. One hundred and forty-four DM patients, matched for age, BMI, and sex, from a diabetes clinic in Waukesha, WI were chosen as comparators. DM quality data was obtained through the Clinical Research Data Warehouse at the Medical College of Wisconsin. Cost data for WI was inferred from a previously published cost estimate for WI.
Results: The mean (SD) for glycosylated hemoglobin (HbA1C, %) in the Polish and U.S. cohorts was 7.4 (1.3) and 7.8 (1.9) respectively (p=0.04). Mean systolic/diastolic blood pressures (BP, mm Hg) in the Polish and U.S. cohorts were 148 (20)/81 (0.3) and 132 (16)/74 (11) (p &lt;0.001, p&lt;0.001) respectively. Insulin was prescribed in 38% of patients in Poland and 58% in U.S. The cost of hospitalizations, outpatient care, and medications per Polish patient with DM was $781 or 3.2% of the gross national income (GNI) per capita. In 2012, the direct medical cost was estimated at $8,926 per adult with DM in Wisconsin, or 15.9% GNI income per capita.
Discussion: Based on our results, Polish cohort had a slightly better HbA1C. The U.S. cohort had much better BP control compared to the Polish cohort. The cost of care at Podkarpacie was ∼10-fold lower compared to Waukesha. While both countries operate under different political and economic conditions, each could benefit from a deeper understanding of the other’s quality practices and cost structures.

Disclosure
J. Idso: None. G. Telega: Research Support; Self; Kadmon Corporation. M. Dąbrowski: Other Relationship; Self; Ascensia Diabetes Care, AstraZeneca, Berlin-Chemie AG, Eli Lilly and Company, MSD K.K., Sanofi-Aventis, Servier. S. Kidambi: None.
Body Weight (BW) Outcomes with Canagliflozin 300 mg (CANA) vs. Glucagon-Like Peptide-1 Receptor Agonists (GLP-1s) in a Real-World (RW) Setting
Authors: COLEMAN CRAIG I. , HERMAN WILLIAM H. , PANDYA SHIVANI , WANG LI , BASER ONUR , CAI JENNIFER , BOOKHART BRAHIM 
Published: June 2018

CANA and GLP-1s have demonstrated weight loss (WL) in patients with type 2 diabetes mellitus (T2DM) in clinical trials. We compared the effects of CANA vs. GLP-1s on BW outcomes in routine practice using claims and electronic health record data from the U.S. Optum integrated database for adults with T2DM and ≥1 prescription claim for CANA or any GLP-1 from 1/1/13-3/31/15. BW outcomes and achievement of clinically significant WL ≥5% were assessed in matched patients with both ≥1 BW measurement during baseline (BL) and &gt;31 days post-index. Inverse probability of treatment weighting (IPTW) accounted for differences in BL covariates. Weighted Cox regression was used to examine the hazard ratio (HR) and 95% confidence interval (CI) of WL ≥5%. After IPTW, covariates were balanced between cohorts except for BL BMI (CANA: n = 213; GLP-1: n = 235). Significant differences in BW were seen in the CANA vs. GLP-1 cohort over 9 months of follow-up (Figure). CANA cohort patients were more likely to achieve WL ≥5% (HR 1.93; 95% CI: 1.40-2.66) with a significantly longer duration at WL ≥5% (133 vs. 103 days; P = 0.01) than GLP-1 cohort patients.
In summary, superior WL of &gt;9 kg at 9 months, &gt;17% more patients achieving WL ≥5%, and longer duration of WL ≥5% as seen in the CANA vs. GLP-1 cohort may have important clinical implications due to links between BW reduction and other clinical/economic outcomes.

Disclosure
C.I. Coleman: Research Support; Self; Janssen Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc. W.H. Herman: Other Relationship; Self; Merck Sharp & Dohme Corp., Lexicon Pharmaceuticals, Inc.. Consultant; Self; Janssen Scientific Affairs, LLC.. Research Support; Spouse/Partner; Nestlé. Other Relationship; Self; American Diabetes Association. Advisory Panel; Self; National Committee for Quality Assurance (NCQA). S. Pandya: Other Relationship; Self; Janssen Scientific Affairs, LLC. L. Wang: Other Relationship; Self; Janssen Scientific Affairs, LLC.. O. Baser: None. J. Cai: Employee; Self; Janssen Scientific Affairs, LLC. B. Bookhart: Employee; Self; Janssen Scientific Affairs, LLC..
Cost-Effectiveness Analysis of Empagliflozin Compared with Canagliflozin or Standard of Care (SoC) in Patients with T2DM and Established Cardiovascular (CV) Disease
Authors: KANSAL ANURAAG , REIFSNIDER ODETTE , LEE JOSEPH , FAHRBACH KYLE , GANDHI PRANAV , PFARR EGON , USTYUGOVA ANASTASIA V. 
Published: June 2018

Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, is FDA approved to reduce the risk of CV death in adults with T2DM and established CV disease. EMPA-REG OUTCOME showed a significant reduction in major adverse CV event (MACE), CV death, and hospitalization for heart failure (HHF) for empagliflozin vs. placebo in addition to SoC. Recently, CANVAS showed significant reduction in MACE and HHF with canagliflozin vs. placebo in addition to SoC. The objective of this study was to assess the cost-effectiveness of empagliflozin vs. canagliflozin or SoC in patients with T2DM and established CV disease in the U.S. A discrete event simulation model was used to simulate CV, renal, and select adverse events from EMPA-REG OUTCOME. Occurrence of each event was modeled using event-free survival curves with time-dependent covariates. A hazard ratio for canagliflozin vs. empagliflozin on each modeled event was estimated from published CANVAS data and EMPA-REG OUTCOME using an indirect treatment comparison. U.S. costs and utilities were taken from public sources. Patients receiving empagliflozin were predicted to live longer by 0.93 years vs. canagliflozin and 1.86 years vs. SoC due to lower CV death rates. When compared to SoC, empagliflozin had fewer or similar events per 100 patients-years, except for nonfatal stroke (NFST) and genital mycotic infection (GMI). For empagliflozin vs. canagliflozin, there were less amputation (0.58 vs. 1.08), kidney injury (0.33 vs. 0.47), and bone fracture (1.12 vs. 1.45); similar nonfatal myocardial infarction (1.93 vs. 1.85), HHF (1.74 vs. 1.65), albuminuria progression (5.96 vs. 6.14), composite renal outcome (1.16 vs. 1.20), and GMI (1.80 vs. 1.79); but more NFST (1.20 vs. 0.85). Based on a $100,000/QALY threshold, empagliflozin was cost-effective compared with canagliflozin or SoC at $2,932/QALY or $55,489/QALY, respectively.

Disclosure
A. Kansal: None. O. Reifsnider: Consultant; Self; Evidera. J. Lee: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. K. Fahrbach: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. P. Gandhi: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. E. Pfarr: None. A.V. Ustyugova: Employee; Self; Boehringer Ingelheim GmbH.
The Association of Glucose Values at Hospital Discharge with 30-Day Readmission and Post-discharge Mortality Rates in Patients with Diabetes
Authors: SPANAKIS ELIAS , UMPIERREZ GUILLERMO E. , SIDDIQUI TARIQ , ZHAN MIN , SNITKER SOREN , FINK JEFFREY C. , SORKIN JOHN D. 
Published: June 2018

Objective: Thirty-day readmission and post-discharge mortality rates reflect quality of care. Little is known about the association of glucose values of the last day of the inpatient stay with the risk of readmission and mortality after discharge.
Design: Nationwide cohort of 836,189 admissions of DM patients admitted to non ICU setting in 110 Veteran Affairs hospitals, between 2000-2014. Demographic, social economic variables and several comorbidities were collected. General estimating equations were used to determine if the minimum glucose values of the last 24 hours of hospital stay were associated with 30-day readmission rate, 30, 90 and 180-day mortality rates, and combined 30-day readmission/mortality.
Results: The 30-day readmission rate was 17.2% and the 30, 90 and 180-day mortality rates were 2.3%, 6.1% and 10% respectively, with a combined 18.8% for 30-day mortality/readmission rates. There was a sharp increase of the 30-day readmission rate with glucose values below 98 mg/dl. The post-discharge mortality rates increased with glucose values below 68.3 mg/dl, and the combined 30-day readmission/mortality rate increased with glucose values below 86.4 mg/dl (Figure).
Conclusions: DM patients with glucose values below 98 mg/dl and 68.3 mg/dl at the last day of hospitalization in the non ICU setting are at a higher risk for 30-day readmission and 180-day mortality.

Disclosure
E. Spanakis: Research Support; Self; Dexcom, Inc. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc.. T. Siddiqui: None. M. Zhan: None. S. Snitker: Employee; Self; Novo Nordisk Inc.. J.C. Fink: None. J.D. Sorkin: None.
Economic Evaluation of Dapagliflozin as Add-On to Metformin in T2DM in the Israeli Health Care Setting
Authors: MOSHEL SHAI , VEXBERG MICHAL HIRSCH , SHAVIT OREN , TOLEDANO YOEL 
Published: June 2018

Background: Dapagliflozin is a potential for combination therapy with metformin in T2DM. However, its cost-effectiveness relative to other alternatives in the Israeli healthcare setup remains unknown.
Objective: To evaluate the cost-effectiveness of dapagliflozin 10mg as add-on to metformin, compared to common alternatives (sitagliptin 100mg, glimepiride 2mg, liraglutide 1.2mg) based on Meuhedet health services database.
Methods: A cost-effectiveness evaluation was performed using the Cardiff diabetes model. A cohort of 1000 T2DM patients (ages 21 and older) who had received additional medication to metformin was randomly chosen from Meuhedet’s database. Baseline values for demographic and clinical variables prior to the add-on therapy, along with data from clinical trials served as inputs to the model. Simulation was performed for each drug, calculating its total costs and benefits (QALYs). The model’s time horizon was set to 40 years, annual discount rate for both costs and benefits was 3.5% and incremental cost effectiveness ratio (iCER) threshold was £20,000/QALY. Finally, single-variable and multivariable sensitivity analyses were performed.
Results: In the base-case scenario, dapagliflozin was found cost-effective compared to sitagliptin, liraglutide and glimepiride (iCER values of £1,232, £-16,517 and £13,476, respectively). For all comparisons, iCER was driven by differences in costs, while differences in QALYs were minimal. Dapagliflozin remained cost-effective even after performing sensitivity analyses. However, when performing the simulation under comparators’ generic competition scenario, dapagliflozin was no longer cost-effective compared to liraglutide (iCER =£24,900/QALY).
Conclusion: Dapagliflozin as add-on treatment to metformin was cost-effective compared to several alternatives in T2DM patients in Israel’s healthcare system. Additional research is needed in order to evaluate the effects of evolving new clinical data.

Disclosure
S. Moshel: Research Support; Self; AstraZeneca. M. Hirsch Vexberg: None. O. Shavit: None. Y. Toledano: None.
Lifestyle Interventions Lower Cardiovascular Disease in Chinese Adults with IGT—Thirty-Year Follow-Up of Da Qing Diabetes Prevention Study
Authors: GONG QIUHONG , ZHANG PING , MA JIXIANG , WANG JINPING , AN YALI , CHENG YILING J. , ZHANG BO , LI HUI , CHEN YANYAN , HU YINGHUA , GREGG EDWARD W. , BENNETT PETER H. , LI GUANGWEI 
Published: June 2018

Lifestyle interventions can prevent or delay type 2 diabetes (T2DM) but their long-term effect on cardiovascular disease (CVD) remains unclear. We assessed the effect of lifestyle interventions on the incidence of CVD events among Chinese adults with impaired glucose tolerance (IGT) who participated in the Da Qing Diabetes Prevention Study (DQDPS) and who were followed for up to 30 years after randomization. DQDPS was a 6-year clinical trial conducted in Da Qing, China from 1986 to 1992 in which 576 adults with IGT were randomized by clinic to a control group (138) or one of three lifestyle intervention groups (438) (diet or exercise or both). After the 6-year active intervention, participants were followed to assess their first CVD events until December 31st 2016. CVD was defined as fatal or nonfatal CVD, which included myocardial infarction, congestive heart failure, stroke, and amputation. The intervention effect on CVD was assessed using Cox proportional hazards analysis. 542 (94.1%) of the original participants had data for CVD events. 192 in the combined intervention group and 79 in the control group had a first CVD event during the follow-up. The 30-year cumulative incidence of CVD was 51.8% (95% CI 47.1-56.5) in the intervention group and 65.7% (95% CI 57.8-73.6) in the control group. CVD incidence per 1000 person-years was 21.8 (95% CI 18.8-25.1) in the intervention group compared to 29.0 (95% CI 23.0-36.2) in the control. After accounting for clinic cluster, the intervention reduced the risk of the first CVD event by 27% (HR 0.73, 95% CI 0.55-0.96; p=0.024).Our study is the first to show that a lifestyle intervention program in persons with IGT significantly reduces the incidence of CVD. Our results provide further justification to adopt lifestyle interventions as public health measures to prevent T2DM.

Disclosure
Q. Gong: None. P. Zhang: None. J. Ma: None. J. Wang: None. Y. An: None. Y.J. Cheng: None. B. Zhang: None. H. Li: None. Y. Chen: None. Y. Hu: None. E.W. Gregg: None. P.H. Bennett: None. G. Li: None.
A Population-Based Program Improving Diabetes Care
Authors: MARIOTTO ALDO , MONTE ARIELLA DE 
Published: June 2018

Objective: The aim of this study was to evaluate whether implementation of an integrated regional program can be effective in producing improvement in diabetes care.
Methods: Friuli Venezia Giulia is an Italian region accounting for about 1,250,000 population. A diabetic patients register based on administrative databases merging accounted in 2015 for a morbidity prevalence rate of 6.7%. Guidelines on diabetes integrated care were approved by the regional government. They were disseminated through a multifaceted intervention based on training, incentives to family physicians, primary care reorganization, modeling and proactive medicine. The program was assessed through the before-after intervention measure of process indicators. Analysis excluded gestational patients, those who didn’t consent for privacy reasons and those not included in the same family physician administrative list over the study period.
Results: Regionally, significant improvement in 2016 vs. 2015 was observed for all measures. Analysis included 54593 patients. The percentage of patients who received one ore more: A1C test arose from 73.8% in 2015 to 79.1% in 2016 (+7.2%), Microalbuminuria test arose from 44.7% in 2015 to 56.3 in 2016 (+26.0%), Blood Creatinine test arose from 70.7% in 2015 to 76.2% in 2016 (+7.8%), Lipid profile arose from 69.6% in 2015 to 72.6% in 2016 (+4.3%). Those who received at least one Fundus Oculi arose from 42.1% in 2014-2015 to 47.9% in 2015-2016 (+13.8%). Hospital specific diabetes patients admission rate decreased from 342/1000 in 2015 to 328/1000 in 2016 (-4.2%). However, there was significant regional variation among all measures.
Conclusions: The evidence based introduction of an integrated professional and organizational intervention improved adherence to diabetes specific process measures in 2016 compared with 2015 baseline for patients assisted in Friuli Venezia Giulia region. A better integration with hospital care and a partial revision of IT system are needed.

Disclosure
A. Mariotto: None. A. De Monte: None.