The Association between Food Insecurity, Glycemic Control, Self-Care, and Quality of Life in Adults with Type 2 Diabetes

Food insecurity is the inability to obtain adequate nutritious food. Therefore, the study assessed the relationship between food insecurity, glycemic control, self-care behaviors, and quality of life in adults with type 2 diabetes (T2DM). Cross sectional study of 356 adults with T2DM recruited from an academic medical center and a veterans affairs medical center. The independent predictor was food insecurity, and the outcomes were glycosylated hemoglobin A1c, self-care behaviors, and quality of life (QOL). Logistic regression was used to assess the independent factors associated with food insecurity. Multiple linear regression was used to assess the association between food insecurity and outcomes. Stata was used for the analyses. The majority (88%) was ≥50 years old, male (70%), and non-Hispanic black (55%). Thirty-five percent were food insecure. Compared to those who had 16 years of education were less likely to be food insecure (Odds ratio (OR) 0.25; 95% Confidence Interval (CI) 0.07, 0.92). Compared to those making \u3c$10,000, those with income levels of$20,000-$34,999 (OR 0.31; 95$35,000 (OR 0.15, 95% 0.06, 0.38) were less likely to be food insecure. In adjusted modeling, food insecurity was marginally associated with glycemic control (βeta coefficient =-0.41; 95% CI -0.85, 0.02), and not significantly associated with self-care behaviors or QOL. In this sample of adults with T2DM, food insecurity was significantly associated with education and income and marginally associated with glycemic control. Further research is needed to assess the relationship between these factors

The National COVID Cohort Collaborative (N3C): Rationale, design, infrastructure, and deployment.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) poses societal challenges that require expeditious data and knowledge sharing. Though organizational clinical data are abundant, these are largely inaccessible to outside researchers. Statistical, machine learning, and causal analyses are most successful with large-scale data beyond what is available in any given organization. Here, we introduce the National COVID Cohort Collaborative (N3C), an open science community focused on analyzing patient-level data from many centers. MATERIALS AND METHODS: The Clinical and Translational Science Award Program and scientific community created N3C to overcome technical, regulatory, policy, and governance barriers to sharing and harmonizing individual-level clinical data. We developed solutions to extract, aggregate, and harmonize data across organizations and data models, and created a secure data enclave to enable efficient, transparent, and reproducible collaborative analytics. RESULTS: Organized in inclusive workstreams, we created legal agreements and governance for organizations and researchers; data extraction scripts to identify and ingest positive, negative, and possible COVID-19 cases; a data quality assurance and harmonization pipeline to create a single harmonized dataset; population of the secure data enclave with data, machine learning, and statistical analytics tools; dissemination mechanisms; and a synthetic data pilot to democratize data access. CONCLUSIONS: The N3C has demonstrated that a multisite collaborative learning health network can overcome barriers to rapidly build a scalable infrastructure incorporating multiorganizational clinical data for COVID-19 analytics. We expect this effort to save lives by enabling rapid collaboration among clinicians, researchers, and data scientists to identify treatments and specialized care and thereby reduce the immediate and long-term impacts of COVID-19

Evidence generation and reproducibility in cell and gene therapy research: A call to action.

Editoria

The problem of constitutional legitimation: what the debate on electoral quotas tells us about the legitimacy of decision-making rules in constitutional choice

Proponents of electoral quotas have a ‘dependent interpretation’ of democracy, i.e. they have formed an opinion on which decision-making rules are fair on the basis of their prior approval of the outcomes these rules are likely to generate. The article argues that this position causes an irresolvable problem for constitutional processes that seek to legitimately enact institutional change. While constitutional revision governed by formal equality allows the introduction of electoral quotas, this avenue is normatively untenable for proponents of affirmative action if they are consistent with their claim that formal equality reproduces biases and power asymmetries at all levels of decision-making. Their critique raises a fundamental challenge to the constitutional revision rule itself as equally unfair. Without consensus on the decision-making process by which new post-constitutional rules can be legitimately enacted, procedural fairness becomes an issue impossible to resolve at the stage of constitutional choice. This problem of legitimation affects all instances of constitutional choice in which there are opposing views not only about the desired outcome of the process but also about the decision-making rules that govern constitutional choice

Financial Incentives and Nurse Coaching to Enhance Diabetes Outcomes (FINANCE-DM): a trial protocol

Introduction Given the burden of diabetes in ethnic minorities and emerging data on the efficacy of financial incentives in type 2 diabetes mellitus (T2DM), it is critical to examine the efficacy of financial incentives across and within racial/ethnic groups.Methods and analysis This trial is an ongoing 5-year, randomised clinical trial designed to test the efficacy of a Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes (FINANCE-DM) intervention composed of (1) nurse education, (2) home telemonitoring and (3) structured financial incentives; compared with an active control group (nurse education and home telemonitoring alone). The study also will evaluate whether intervention effects are sustained 6 months after the financial incentives are withdrawn (ie, 18 months post-randomisation) and whether the intervention is differentially efficacious across racial/ethnic groups. Participants will include 450 adults with a clinical diagnosis of T2DM and HbA1c of 8% or higher who self-identify as White, African American or Hispanic. Participants will be randomised to one of two groups: the FINANCE intervention or Active Control. The location and setting of this study include primary care clinics at the Medical College of Wisconsin (MCW) in Milwaukee, WI and community partner sites affiliated with the Center for Advancing Population Science at MCW.Ethics and dissemination This trial was approved by IRB at MCW under PRO00033788.Trial registration number Registration for this trial on the United States National Institute of Health Clinical Trials Registry can be found under ID: NCT04203173 and online (https://clinicaltrials.gov/ct2/show/NCT04203173?id=NCT04203173&draw=2&rank=1)

Sex differences in healthcare expenditures among adults with diabetes: evidence from the medical expenditure panel survey, 2002–2011

Abstract Background The evidence assessing differences in medical costs between men and women with diabetes living in the United States is sparse; however, evidence suggests women generally have higher healthcare expenditures compared to men. Since little is known about these differences, the aim of this study was to assess differences in out-of-pocket (OOP) and total healthcare expenditures among adults with diabetes. Methods Data were used from 20,442 adults (≥18 years of age) with diabetes from the 2002–2011 Medical Expenditure Panel Survey. Dependent variables were OOP and total direct expenditures for multiple health services (prescription, office-based, inpatient, outpatient, emergency, dental, home healthcare, and other services). The independent variable was sex. Covariates included sociodemographic characteristics, comorbid conditions, and time. Sample demographics were summarized. Mean OOP and total direct expenditures for health services by sex status were analyzed. Regression models were performed to assess incremental costs of healthcare expenditures by sex among adults with diabetes. Results Fifty-six percent of the sample was composed of women. Unadjusted mean OOP costs were higher for women for prescriptions ($1177; 95$1117–$1237 vs.$959; 95% CI $918–$1000; p  $50 OOP for office-based visits (p$55 total expenditures for home healthcare (p = 0.041) compared to men after adjustments. Conclusions Our findings show women with diabetes have higher OOP and total direct expenditures compared to men. Additional research is needed to investigate this disparity between men and women and to understand the associated drivers and clinical implications. Policy recommendations are warranted to minimize the higher burden of costs for women with diabetes

Trends in sex differences in the receipt of quality of care indicators among adults with diabetes: United States 2002-2011

Abstract Background Evidence suggests disparities in quality of care (QoC) indicators based on sex exist in adults diagnosed with diabetes; however, this research is limited. Therefore, the objective of this research study was to assess differences in QOC indicators in a nationally representative sample of men and women with diabetes. Methods Cross-sectional study of 17,702 men and women (≥18 years of age) with diabetes from the 2002–2011 Medical Expenditure Panel Survey Household Component. Sex was the main predictor variable, and the dependent variables were five binary indicators to measure QOC, which included testing of hemoglobin A1c, examining feet annually, getting eyes dilated, checking blood pressure, and visiting the doctor annually. Sample demographics by sex were assessed. Unadjusted analyses were computed for descriptive statistics by sex and proportions of QOC indicators over time. Logistic regression evaluated associations between QOC indicators and sex, while controlling for sociodemographic characteristics, time, and comorbid conditions. Results Approximately 44% and 56% of the sample was comprised of men and women, respectively. Unadjusted analyses showed significant differences in A1c testing (p < 0.001) and foot examinations (p = 0.002) for the entire sample, and significant differences in A1c testing (p = 0.027), foot examinations (p = 0.01), and dilated eye exams (p = 0.026) among men and A1c testing (p < 0.001) among women overtime. Adjusted analyses found women to be significantly more likely to have dilated eye examinations during a given year (OR = 1.14; 95% CI 1.04, 1.24), to get their blood pressure checked by a doctor in a given year (OR = 1.44; 95% CI 1.13, 1.84), and to visit a doctor annually (OR = 1.39; 95% CI 1.22, 1.58) compared to men. Conclusions In this sample of adults with diabetes, women had significantly higher odds of receiving quality of care compared to men. These findings suggest the importance of educating patients about appropriate metrics of diabetes management, especially men, and the need for continuous empowerment of women to receive proper and optimal care. Additional research is needed to identify causes and reduce sex and gender disparities associated with diabetes quality of care

Adjusted linear regression model of the relationship between neighborhood crime and neighborhood violence and glycemic control by race.

Adjusted linear regression model of the relationship between neighborhood crime and neighborhood violence and glycemic control by race.</p