GHb Level and Subsequent Mortality Among Adults in the U.S.

OBJECTIVE To examine the association of hyperglycemia, as measured by GHb, with subsequent mortality in a nationally representative sample of adults. RESEARCH DESIGN AND METHODS We included adults aged ≥20 years who participated in Third National Health and Nutrition Examination Survey (1988–1994) and had complete information, including baseline diabetes status by self-report and measured GHb (n = 19,025) and follow-up through the end of 2000 for mortality. RESULTS In the overall population, higher levels of GHb were associated with increased risk of mortality from all causes, heart disease, and cancer. After adjustment for potential risk factors, the relative hazard (RH) for adults with GHb ≥8% compared with adults with GHb <6% was 2.59 (95% CI 1.88–3.56) for all-cause mortality, 3.38 (1.98–5.77) for heart disease mortality, and 2.64 (1.17–5.97) for cancer mortality. Among adults with diagnosed diabetes, having GHb ≥8% compared with GHb <6% was associated with higher all-cause mortality (RH 1.68, 95% CI 1.03–2.74) and heart disease mortality (2.48, 1.09–5.64), but there was no increased risk of cancer mortality by GHb category. Among adults without diagnosed diabetes, there was no significant association of all-cause, heart disease, or cancer mortality and GHb category. CONCLUSIONS These results highlight the importance of GHb levels in mortality risk among a nationally representative sample of adults with and without diagnosed diabetes and indicate that higher levels are associated with increased mortality in adults with diabetes. Hperglycemia has been associated with a wide range of adverse outcomes for individuals with glucose values both above and below the threshold for diabetes, including increased cardiovascular disease (CVD) and mortality (1). Studies have consistently found undiagnosed diabetes to be associated with increased risk of mortality (2–4), and many studies have also shown levels of glucose that are elevated, but not enough for a diagnosis of diabetes, such as impaired fasting glucose, to be associated with increased mortality (2–4). However, most of these studies are based on fasting or postprandial glucose (1–4), and few are based on GHb levels (3,5–8). The GHb level may be a better indicator of hyperglycemia because it provides a measure of an individual's average glucose levels for the previous 3 months. Thus, it may provide a more stable snapshot of glucose levels when used in prospective cohort studies to examine the association of subsequent risk. Currently, GHb is monitored in the treatment of diabetes, and GHb targets for prevention of complications among individuals with diabetes have been established (9). Interest in the use of GHb for the diagnosis of diabetes is increasing (10), and an international effort is underway to standardize the measurement of GHb (11). This focus of GHb in clinical care measures (12) raises important questions about the long-term predictability of GHb. Examination of the relationship of GHb with mortality reveals several areas of uncertainty, including whether the relationship of GHb with mortality is similar among individuals with and without diabetes from both prospective cohort studies and clinical trials. A few prospective cohort studies have examined the association of GHb with risk of mortality (5–8) and shown an increased risk of mortality with increasing GHb level. Only two studies included individuals with diabetes, but these studies did not examine GHb levels by diabetes status, and none were representative of the general U.S. population. Recently published findings from three clinical trials among adults with diabetes have added to this uncertainty. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that lower GHb levels increased risk of mortality and did not decrease CVD events (13). Whereas the Action in Diabetes and Vascular Disease—Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) study showed that lowering of GHb levels was associated with a decrease in micro- and macrovascular events and deaths from CVD (14) and the Veterans Administration Diabetes Trial reported that lower GHb levels were not associated with a reduction in cardiovascular events (15). These findings have not led to any changes in glycemic control recommendations (16). The Third National Health and Nutrition Examination Survey (NHANES III) is the first nationally representative survey to include a measure of GHb and has mortality status available through linkage to the National Death Index. The objective of this study was to examine the association of GHb with subsequent mortality in a nationally representative sample of U.S. adults

Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic

Background: Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. Methods: Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests. Results: 218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain. Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003). Conclusion: Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain

Quality of Care for Patients With Type 2 Diabetes in Primary Care in Norway Is Improving: Results of cross-sectional surveys of 33 general practices in 1995 and 2005

OBJECTIVE—To assess changes in the quality of care in Norway for patients with type 2 diabetes

Racial/Ethnic Differences in Concerns About Current and Future Medications Among Patients With Type 2 Diabetes

OBJECTIVE—To evaluate ethnic differences in medication concerns (e.g., side effects and costs) that may contribute to ethnic differences in the adoption of and adherence to type 2 diabetes treatments

Performance of an A1C and Fasting Capillary Blood Glucose Test for Screening Newly Diagnosed Diabetes and Pre-Diabetes Defined by an Oral Glucose Tolerance Test in Qingdao, China

OBJECTIVE - The study&apos;s goal was to evaluate the performance of A] C and lasting capillary blood glucose (FCG) tests as mass screening tools for diabetes and pre-diabetes, as determined by the standard oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS - Data from 2,332 individuals aged 35-74 years who participated in a population-based cross-sectional diabetes survey in Qingdao, China, were analyzed. A 2-h 75-g OGTT was used to diagnose diabetes. The performance of A1C and FCG was evaluated against the results of the OGTTs by using receiver operating characteristic curve (ROC) analysis. RESULTS - The prevalence of newly diagnosed diabetes and pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) was 11.9 and 29.5%, respectively. For subjects with newly diagnosed diabetes, the area under the ROC curve was 0.67 for A1C and 0.77 for FCG (P &lt; 0.01) in men and 0.67 and 0.75 (P &lt; 0.01) in women, whereas for pre-diabetes, these values were 0.47 and 0.64 (P &lt; 0.001) in men and 0.51 and 0.65 (P &lt; 0.001.) in women. At the optimal A1C cutoff point of &gt;= 5.6% for newly diagnosed diabetes, sensitivities (specificities) were 64.4% (61.6%) for men and 62.3% (63.3%) for women. CONCLUSIONS - As a screening tool for newly diagnosed diabetes and pre-diabetes, the FCG measurement performed better than A I C in this general Chinese population.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000275562700018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=8e1609b174ce4e31116a60747a720701Endocrinology &amp; MetabolismSCI(E)57ARTICLE3545-5503

An efficient approach for surveillance of childhood diabetes by type derived from electronic health record data: the SEARCH for Diabetes in Youth Study

Objective To develop an efficient surveillance approach for childhood diabetes by type across 2 large US health care systems, using phenotyping algorithms derived from electronic health record (EHR) data

Diabetes Care in Black and White Veterans in the Southeastern U.S.

Abstract available at publisher's web site

Prevalence and Control of Diabetes and Impaired Fasting Glucose in New York City

OBJECTIVE—To determine the prevalence of diabetes and impaired fasting glucose (IFG) and to assess clinical management indicators among adults with diabetes in a representative sample of New York City adults