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Researchers focus on diabetes care

Diabetes affects nearly 8 percent of U.S. adults and 19 percent of the elderly. Although there have been promising advances in managing diabetes, much of the findings from recent research have not been integrated into clinical practice. A recent Translating Research into Practice (TRIP) study supported by the Agency for Healthcare Research and Quality examined ways to increase the probability that research findings will make their way into clinical practice to improve diabetes care. A second AHRQ-supported study revealed that short-term treatment of depression in patients with diabetes can improve symptoms associated with depression. A third AHRQ-supported study found that patients with diabetic retinopathy and glaucoma are more satisfied when they receive eye care from specialists. The three studies are summarized here.

Glasgow, R.E. (2003, August). "Translating research to practice: Lessons learned, areas for improvement, and future directions." (AHRQ grant HS10123). Diabetes Care 26, pp. 2451-2456.

There have been two positive examples of the adoption of research-based innovations in diabetes care, according to the author of this paper. First, is the paradigm shift away from provider-centered "compliance" approaches to patient "empowerment" via self-management, education, and behavior change. A second innovation that has been widely adopted, at least within leading medical centers and health care plans, involves "systems change" approaches to improving the delivery of evidence-based diabetes care.

The success of these two advances has helped to move diabetes care from a perspective that blamed poor outcomes on either the patient or the primary care provider to one that realizes that quality care delivery needs to be supported by an appropriately designed system. The author makes several recommendations for reordering translation research, including studies that demonstrate the broad impact of interventions on quality of life and economic outcomes; designing programs that are adoptable in various settings and by different clinicians; and studies with a greater focus on policies (for example, reimbursement) and social environment.

Editor's Note: A related TRIP article addresses why we don't see more translation of health promotion research into practice. For details, see: Glasgow, R.E., Liechtenstein, E., and Marcus, A.C. (2003, August). "Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition." (AHRQ grant HS10123). American Journal of Public Health 93, pp. 1261-1267.

Musselman, D.L., Betan, E., Larsen, H., and Phillips, L.S. (2003). "Relationship of depression to diabetes types 1 and 2: Epidemiology, biology, and treatment." (AHRQ grant HS09722). Biological Psychiatry 54, pp. 317-329.

Some recent studies have shown that depression and its associated symptoms constitute a major risk factor in the development of type 2 (adult-onset) diabetes and may accelerate the onset of diabetes complications. These authors reviewed studies of the pathophysiological alterations related to glucose intolerance and diabetes in depressed patients. The few randomized controlled studies of treatment of depression in patients with diabetes reveal that short-term treatment of depression in patients with diabetes improves their dysphoria (agitation or discomfort) and other signs and symptoms of depression. The researchers call for more studies to confirm whether response to psychotherapy and/or medication improves glucose control, encourages compliance with diabetes treatment, and perhaps even increases longevity among patients who have diabetes.

Escarce, J. J., Kapur, K., Solomon, M.D., and others (2003, August). "Practice characteristics and HMO enrollee satisfaction with specialty care: An analysis of patients with glaucoma and diabetic retinopathy." (AHRQ grant HS09942). Health Services Research 38(4), pp. 1135-1155.

Many patients with diabetic retinopathy (DR) and glaucoma prefer to be treated by specialists with expertise in their conditions. Financial arrangements of eye care practices are also associated with patients' eye care satisfaction, according to this study. The investigators surveyed 913 working age patients with open-angle glaucoma (OAG) or DR enrolled in six commercial managed care health plans, who were treated in 144 different eye care practices. A patient survey asked about patient characteristics and satisfaction with eye care. A survey of eye care practices gave information on practice characteristics (for example, provider specialties and financial features).

The researchers assessed the association of patient and practice characteristics with high levels of patient satisfaction. Treatment in a practice with a glaucoma specialist (for OAG) patients or a retina specialist (for DR patients) was associated with higher satisfaction. However, treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice, where providers obtained a high proportion of their incomes from bonuses, was associated with lower satisfaction.

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