Type 2 Diabetes Mellitus (T2DM) “Remission” in Non-bariatric Patients 65 Years and Older

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older. Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as “remission”). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM “remission.” Results: 4.97% of patients studied met the definition of T2DM “remission” in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p \u3c 0.05). Conclusion: T2DM “remission” in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients

Exploring patient information needs in type 2 diabetes: A cross sectional study of questions

This study set out to analyze questions about type 2 diabetes mellitus (T2DM) from patients and the public. The aim was to better understand people's information needs by starting with what they do not know, discovered through their own questions, rather than starting with what we know about T2DM and subsequently finding ways to communicate that information to people affected by or at risk of the disease. One hundred and sixty-four questions were collected from 120 patients attending outpatient diabetes clinics and 300 questions from 100 members of the public through the Amazon Mechanical Turk crowdsourcing platform. Twenty-three general and diabetes-specific topics and five phases of disease progression were identified; these were used to manually categorize the questions. Analyses were performed to determine which topics, if any, were significant predictors of a question's being asked by a patient or the public, and similarly for questions from a woman or a man. Further analysis identified the individual topics that were assigned significantly more often to the crowdsourced or clinic questions. These were Causes (CI: [-0.07, -0.03], p < .001), Risk Factors ([-0.08, -0.03], p < .001), Prevention ([-0.06, -0.02], p < .001), Diagnosis ([-0.05, -0.02], p < .001), and Distribution of a Disease in a Population ([-0.05,-0.01], p = .0016) for the crowdsourced questions and Treatment ([0.03, 0.01], p = .0019), Disease Complications ([0.02, 0.07], p < .001), and Psychosocial ([0.05, 0.1], p < .001) for the clinic questions. No highly significant gender-specific topics emerged in our study, but questions about Weight were more likely to come from women and Psychosocial questions from men. There were significantly more crowdsourced questions about the time Prior to any Diagnosis ([(-0.11, -0.04], p = .0013) and significantly more clinic questions about Health Maintenance and Prevention after diagnosis ([0.07. 0.17], p < .001). A descriptive analysis pointed to the value provided by the specificity of questions, their potential to disclose emotions behind questions, and the as-yet unrecognized information needs they can reveal. Large-scale collection of questions from patients across the spectrum of T2DM progression and from the public-a significant percentage of whom are likely to be as yet undiagnosed-is expected to yield further valuable insights

Using a Tetradic Network Technique and a Transaction Cost Economic Analysis to illustrate an economic model for an open access medical journal

There is a crisis in scholarly publishing. The value of the scholarly information is frequently much less than the cost of providing that information. Consequently, libraries are suffering and scholars do not have access to information that they need. However, certain for-profit publishers and scientific societies are benefiting substantially from the current system. The Internet has demonstrated the potential to change this structure. The Budapest, Berlin and Bethesda initiatives show there is significant worldwide interest to replace the current controlled system with one that allows open access of scholarly information to anyone with Internet access. An examination of the scholarly publishing process is offered using a Tetradic Network Technique (TNT) and a Transaction Cost Economic (TCE) analysis as applied to a traditional subscription-based, print medical journal, Medical Physics, and a Web-based, open access medical journal, the Journal of Applied Clinical Medical Physics. The analysis identifies stakeholders and considers transaction and production costs. TCE analysis is performed between each of the following: Libraries, Scholars, Publishers and Societies, for a total of six transaction exchanges for both the traditional and the open access journal. This analysis allows costs to be compared more easily between the two types of journals, and provides the basis for a model online journal pro forma. Results demonstrate that while production costs remain approximately equivalent for the traditional and open access journal, total transaction costs are reduced by a factor of between 5 and 10 for the open access journal. While the cost of producing an eight-page article in a traditional medical journal is approximately US$2500, the cost of publishing the same article in an open access journal is less than US$500. Recommendations are offered that illustrate how an open access online journal may be produced by a university for approximately the cost of several library print journal subscriptions and physical storage of the printed material. Universities may therefore benefit through greater involvement with the scholarly publishing process. There are several considerations and recommendations that one may draw from this investigation. Universities pay for scholarly research, and then pay again to obtain access to published results. University libraries, always a significant cost center, are now in financial crisis. Scientific societies and large publishers gain under the traditional scholarly publication model. The copyright is essential; the one that holds the copyright holds the power in scholarly publishing. Modern open access initiatives state that scholars should retain copyright and publish online. Universities should require promotion and tenure committees to give equal weight to open access publications. Universities should go into the publishing business with scientific societies and control dissemination of scholarly knowledge for the public good