Women are less likely than men to achieve optimal glycemic control after 1 year of treatment: A multi-level analysis of a Korean primary care cohort

<div><p>We investigated differences in the achievement of glycemic control among newly diagnosed type-2 diabetes patients according to gender using a multi-clinic retrospective cohort study. Optimal glycemic control was defined as hemoglobin A1c (HbA1c) of less than 6.5% after 1 year of diabetes management. A generalized linear mixed model, which controlled for the fixed effects of baseline characteristics and prescribed oral hypoglycemic agent (OHA), was used to calculate the probability of achieving the target HbA1c. The study included 2,253 newly diagnosed type-2 diabetes patients who completed 1 year of diabetic management, including OHA, in the 36 participating primary clinics. Within the study population, the women had an older average age, were less likely to smoke or drink alcohol, and showed lower levels of fasting blood glucose and HbA1c at the time of diagnosis. There were no significant differences by sex in prescribed OHA or median number of visits. After 1 year of diabetes management, 38.9% of women and 40.6% of men achieved the target HbA1c—a small but significant difference. This suggests that type-2 diabetes is managed less well in women than in men.</p></div

Women are less likely than men to achieve optimal glycemic control after 1 year of treatment: A multi-level analysis of a Korean primary care cohort - Fig 1

<p>Hemoglobin A1c (HbA1c) levels of women and men diagnosed with type-2 diabetes at primary care clinics (N = 2,253); (A) Initial HbA1c; and (B) Final HbA1c after 1 year.</p

Comparison of baseline demographics and clinical presentations between women and men diagnosed with type-2 diabetes at primary care clinics (N = 2,253).

<p>Comparison of baseline demographics and clinical presentations between women and men diagnosed with type-2 diabetes at primary care clinics (N = 2,253).</p

Comparison of diabetes management between women and men diagnosed with type-2 diabetes at primary care clinics (N = 2,253).

<p>Comparison of diabetes management between women and men diagnosed with type-2 diabetes at primary care clinics (N = 2,253).</p

Odds ratios for achieving the target HbA1c after 1 year of diabetes management (N = 2,253).

<p>Odds ratios for achieving the target HbA1c after 1 year of diabetes management (N = 2,253).</p

Effect of a first responder on survival outcomes after out-of-hospital cardiac arrest occurs during a period of exercise in a public place

<div><p>Introduction</p><p>The deployment of first responders in a public place is one of the interventions that is used for increasing bystander cardiopulmonary resuscitation (CPR) of out-of-hospital cardiac arrests (OHCA). We studied the association between the presence of a first responder and the survival of OHCA that occurred during a period of exercise in a public place.</p><p>Methods</p><p>All of the adult OHCAs of a presumed cardiac etiology that occurred during a period of exercise in a public place and that were witnessed by a bystander between 2013 and 2015 were analyzed. The main exposure of interest was the characteristics of the bystander (first responder vs. layperson). The endpoints were the provision of bystander CPR and good neurological recovery. Multivariable logistic regression analysis, adjusting for patient-environment and prehospital factors, was performed.</p><p>Results</p><p>A total of 870 patients had a cardiac arrest during a period of exercise in a public place, and 58 (6.7%) patients were witnessed by the first responder. The OHCAs witnessed by first responders were more likely to result in bystander CPR than those witnessed by laypersons (89.7% vs. 75.4%, <i>p</i> = 0.01, adjusted OR (95% CI): 3.51 (1.44–8.55)). In terms of good neurological recovery, the OHCAs witnessed by first responders had a higher likelihood than the patients witnessed by laypersons (37.9% vs, 24.0%, <i>p</i> = 0.02, adjusted OR (95% CI): 2.92 (1.33–6.40)).</p><p>Conclusion</p><p>The OHCAs occurred during a period of exercise in a public place and whom first responders witnessed were more likely to receive bystander CPR and to have a neurologically intact survival.</p></div

Patient enrollment flowchart.

<p>Patient enrollment flowchart.</p

Logistic regression analysis of survival to discharge and good neurological outcome by causative agent group.

<p>Logistic regression analysis of survival to discharge and good neurological outcome by causative agent group.</p

Study population.

<p>EMS: emergency medical service; OHCA: out-of-hospital cardiac arrest; CPR: cardiopulmonary resuscitation.</p

Associations between bystanders and study outcomes for study population.

<p>Associations between bystanders and study outcomes for study population.</p