Engagement in a diabetes control program &amp; clinical biomarkers in diverse municipality workers
Creators: name: McGill, Lauren Elyse
Publisher: name: The University of Texas at Austin
Year: 2021
Subjects: Diabetes
Workplace wellness

description: 34.1 million adults (18 years or older) have diabetes (13.0% of US adults) according to the CDC (2020). Diabetes is complex and associated with comorbidities which requires both lifestyle changes and medication to successfully manage the condition (World Health Organization, 2016). The purpose of this dissertation is to investigate the engagement in, and impact of, a workplace diabetes control program while measuring clinical health biomarkers and healthcare utilization in a municipality. Secondary data analysis was conducted using a de-identified clinical dataset that was collected from the City of Austin (COA) Diabetes Control Program (DCP). Most participants enrolling in the COA DCP were engaged, completing three or more pharmacy visits during both 2018 (85%) &amp; 2019 (86%). Most participants during both 2018 (64%) &amp; 2019 (59%) had baseline HbA1c values &lt; 7%, signifying glycemic control, with averages for 2018 &amp; 2019 respectively (6.7 ± 1.3 &amp; 6.9 ± 1.3). There were significant differences between 2018 &amp; 2019 baseline values in body mass (2018: 98.1± 22.3 kg; 2019: 97.1± 21.1 kg), HbA1c (2018: 6.7 ± 1.3; 2019: 6.9 ± 1.3), LDL (2018: 54.4 ± 23.9 mg/dL; 2019: 49.8 ± 22.3 mg/dL), total cholesterol (2018: 146.6 ± 34.2 mg/dL; 2019: 137.2± 34.9mg/dL) and triglycerides (2018: 175.9± 100.2 mg/dL; 2019: 144.7±90.6 mg/dL) (p&lt;0.05). There was a trend of higher HbA1c and decreased engagement, but it was not statistically significant. Study two evaluated HbA1c change over time engaged in the COA DCP. Participants showed a significantly higher HbA1c in visit 3 in 2018 (6.95± 0.l) than in visit 1 in 2018 (6.7±0.1) (t = -4.4, p = 0.0002; Participants showed a significantly higher HbA1c in visit 1 in 2019 (6.9 ± 1.3) than in visit 1 in 2018 (6.7± 0.1) (t = -3.0, p = 0.03). In 2019, participants engaged in the COA DCP significantly improved HbA1c from baseline (visit 1) (6.9 ± 1.3) to visit 2 (6.7±0.1) (t = 3.4, p = 0.01). These results show a trend of HbA1c increasing during the 2018 COA DCP and HbA1c decreasing during the 2019 COA DCP. Study three evaluated cardiovascular clinical biomarkers while controlling for HbA1c and measured preventive healthcare utilization within the COA diabetic population. Three cardiovascular related clinical biomarkers (LDL, triglycerides, and total cholesterol) were significantly affected by year while controlling for HbA1c. LDL was significantly affected by year (t = -2.6, p = 0.01). Participants had a significantly higher LDL in 2018 (65.2 ± 1.1 mg/dl) compared to 2019 (60.3 ± 1.1 mg/dl) (t = 3.3, p &lt; 0.01). Total cholesterol was significantly affected by year (t = -4.3, p &lt;0.0001). Participants had a significantly higher total cholesterol in 2018 (146 ± 0.95 mg/dl) compared to 2019 (136 ± 0.95 mg/dl) (t = 6.9 p &lt; 0.0001). There was a significant interaction effect of visit and year on triglycerides (F = 4.9, p = 0.01). The triglycerides in 2018 decreased by each visit but increased from visit 1 to visit 2 in 2019. However, significant differences were only found in visit 1 between 2018 (178 ± 4.8) and 2019 (145 ± 4.8) (t = 4.9, p &lt; 0.01). There was no significant interaction of visit and year on systolic blood pressure, HDL &amp; Body Mass. Employees enrolled in the COA DCP completed significantly more preventive healthcare screenings than employees with diabetes not enrolled in the COA DCP. These studies help to better understand the population engaging in the COA DCP as well as evaluate clinical biomarkers in response to the COA DCP. Overall, the COA DCP population has a high percentage of participants with good glycemic control and cardiovascular clinical biomarkers within range. There should be long-term follow-up to see if these positive clinical biomarkers are maintained.