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Studies examine diabetes hospitalizations and death, diabetes self-management outcomes, and undiagnosed diabetes

Nearly 9 percent of the U.S. population suffered from diabetes in 2002. This number continues to rise, placing more people at risk of developing diabetes complications, particularly cardiovascular disease. Three studies supported by the Agency for Healthcare Research and Quality recently examined diabetes issues. The first study (AHRQ grant HS11477) concluded that the risks of institutionalization and death attributable to diabetes are large. The second study (AHRQ grant HS10123) found that patients with diabetes who used a computer program to select behavioral goals for managing their diabetes tended to make substantial behavioral changes over a 6-month period. According to the third study, (AHRQ grant HS11282) two-thirds of people with undiagnosed diabetes at the time of an acute coronary syndrome were not recognized during their hospital stay. The articles are summarized here.

Russell, L.B., Valiyeva, E., Roman, S.H., and others (2005, July). "Hospitalizations, nursing home admissions, and deaths attributable to diabetes." Diabetes Care 28, pp. 1611-1617.

Type 2 diabetes usually develops in adults and is more common among overweight adults. According to a simulation model developed by researchers, adults with diabetes are at increased risk for being admitted to a hospital or nursing home or dying. The model, based on data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Followup Study, represented the natural history of diabetes and controlled for a variety of baseline risk factors. Researchers applied the model to 6,265 participants from the NHANES III, which was conducted from 1988 to 1994.

For all the adults studied, a diagnosis of diabetes accounted for nearly 9 percent of hospitalizations, 12 percent of nursing home admissions, and 10 percent of deaths from 1988 to 1994. For people with diabetes, diabetes alone was responsible for 43 percent of hospitalizations, 52 percent of nursing home admissions, and 47 percent of deaths. Adjustment for related cardiovascular conditions increased these estimates to 51, 57, and 57 percent, respectively. Continued efforts to prevent development of diabetes and its complications could have a substantial impact on hospitalizations, nursing home admissions, and deaths and their societal costs, conclude the researchers.

Estabrooks, P.A., Nelson, C.C., Xu, S., and others (2005, May). "The frequency and behavioral outcomes of goal choices in the self-management of diabetes." The Diabetes Educator 31(3), pp. 391-400.

According to the results of this study, when patients with type 2 diabetes used an interactive CD-ROM on diabetes self-management to select behavioral goals to manage their diabetes, they tended to select personally appropriate goals that resulted in significant behavioral changes over a 6-month period. Researchers randomized 422 patients with type 2 diabetes to the Diabetes Priority Program (a goal-setting session using a CD-ROM program conducted during a diabetes-related primary care visit) or usual care.

Using a computer touchscreen, program participants completed a brief assessment of their dietary intake and physical activity. The participants received feedback on their behavior compared to the recommended guidelines. They then self-selected behavior change goals in the area of diet or exercise (or smoking for those who smoked), identified barriers and supportive activities related to the goals, and received a computer-printed personal action plan.

Six months later, those who selected a goal to reduce fat in their diet showed a significantly larger decrease in fat intake than did those who selected a goal to increase physical activity or fruit and vegetable intake. Those who selected a goal to increase fruit and vegetable intake showed significant changes in fruit and vegetable consumption, and those who selected a physical activity goal showed substantial changes in days of moderate and vigorous physical activity.

Conaway, D.G., O'Keefe, J.H., Reid, K.J., and Spertus, J. (2005, August). "Frequency of undiagnosed diabetes mellitus in patients with acute coronary syndrome." American Journal of Cardiology 96, pp. 363-365.

In this study, use of a simple fasting plasma glucose (FPG) test revealed that about 57 percent of the 1,199 patients hospitalized for acute coronary syndrome (ACS), that is, heart attack or unstable angina, had abnormal glucose metabolism. Overall, 14 percent of the ACS patients met the American Diabetes Association criteria for a new diagnosis of diabetes (that is, they had not been diagnosed previously), yet 65 percent of these patients were not diagnosed or treated for the condition by the doctors who managed them. The study also found about 33 percent of the group had impaired FPG metabolism. The population studied consisted predominantly of white men from two U.S. Midwest hospitals, so the findings may not be representative of other groups, caution the researchers.

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