Psoriasis and Cardiovascular Disease and Diabetes

Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes?

Authors: Bruce Stuart, Ph.D., Amy Davidoff, Ph.D., Ruth Lopert, B.Sc., B.Med., M.Med.Sci., Thomas Shaffer, M.H.S., J. Samantha Shoemaker, and Jennifer Lloyd, M.A.
 
Journal: Health Services Research, published online March 17, 2010
 
Contact: Jennifer Lloyd, University of Maryland School of Medicine, jlloyd@epi.umaryland.edu
 
Summary Writers: Deborah Lorber

The Issue

Research has shown that certain prescription medications—specifically, statins and rennin-angiotensin-aldosterone system (RAAS) inhibitors—can help elderly diabetic patients by preventing or delaying certain complications. In addition to improving clinical outcomes, better adherence to these medications can also reduce medical costs.

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What the Study Found

With support from The Commonwealth Fund, researchers used data from the Medicare Current Beneficiary Survey to look at medication adherence rates and Medicare expenses over three years for beneficiaries who filled prescriptions for RAAS inhibitors and statins. For patients using RAAS inhibitors, a 10-percentage-point increase in medication possession ratio (MPR)—a measure of medication adherence—was associated with a spending reduction of $285. A 10-percentage-point increase in MPR for statin users was associated with a spending reduction of $832. To put these numbers in context, the researchers estimate that the cost of the drugs, for the same period, would be $110.45 for RAAS inhibitors and $291.44 for statins.

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Conclusions

"At the margin, utilization of both drugs was associated with net savings to the Medicare program," the authors conclude.

Citation

B. Stuart, A. Davidoff, R. Lopert et al., "Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes?" Health Services Research, published online March 17, 2011.

Limb Loss Awareness Month About LLAM

April 2011 will mark the first National Limb Loss Awareness Month. The Amputee Coalition’s goal is to raise awareness about living with limb loss and to reduce preventable limb loss through education, resources and support.

Limb Loss Awareness Month will also provide local community volunteers a month to celebrate the advances in limb loss care and the success stories of those affected in their communities. You too can get involved by volunteering your time.

Below you will find an overview of this Annual Event. The Amputee Coalitions is proud of the many volunteers who have already begun this effort through support groups and committed individuals who know the power of support and knowledge. Please share your activities with the coalition so it can inspire others to get involved and make a difference.

Facts About Limb Loss

• Today there are nearly 2 million people living with limb loss in the United States.
• Annually, 185,000 Americans lose a limb.
• There are 507 amputations daily.
• The number of people living with the loss of a limb will almost double by the year 2050 to 3.6 million.
• Primary factors contributing to the increase in limb loss are escalating rates of diabetes and peripheral vascular disease, as well as war events and now natural disasters.
• Over 60% of the amputations performed in the United States each year are preventable.
• Diabetics have a 10 times higher rate of losing a limb than people without diabetes.
• Populations with a high risk of losing limbs include Pacific Islanders, Hispanic/Latino, African American, Native American – some are more than 10 times higher than other ethnicities.

What Can You Do to Help?

The Coalition reaching out to people affected by limb loss or limb difference and those who care for them to encourage community action and increased visibility of limb loss issues at a local level.

Overall Theme

The 2011 Limb Loss Awareness Month theme will be 507 amputations a day.

The Amputee Coalition will work with volunteers across the nation to help develop awareness events in their community. These events will increase the awareness of limb loss issues while providing needed resources for education for amputees and those at risk of amputation.

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Long-Term Plan Announced for Diabetes Research

By Joyce Frieden, News Editor, MedPage Today

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has announced its 10-year strategic plan for diabetes research.

"By setting priorities and identifying the most compelling research opportunities, the strategic plan will guide NIH, other federal agencies, and the investigative community in efforts to improve diabetes treatments and identify ways to keep more people healthy," NIDDK Director Griffin P. Rodgers, MD, said in a statement.

The strategic plan covers a number of areas, including:

• The relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and environment
• Autoimmune mechanisms at work in type 1 diabetes
• The biology of beta cells
• Development of artificial pancreas technologies to improve management of blood sugar levels
• Prevention of complications
• Reduction of the impact of diabetes on groups disproportionately affected by the disease, including the elderly and racial and ethnic minorities

The NIDDK plans to continue its emphasis on clinical trials in humans, "which already [have] led to highly effective methods for managing diabetes and preventing complications," Rodgers said.

Within each broad area, the strategic plan lists some specific areas of focus.

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'Diabetes Belt' Tightens Around the South

By Kristina Fiore, Staff Writer, MedPage Today

Much of the South and Appalachia fall into the newly defined "diabetes belt" identified by CDC researchers, a section of country that nearly parallels the so-called stroke belt.

The 644 counties in the diabetes belt have a significantly higher prevalence of the disease than the rest of the country: 11.7% versus 8.5%, according to Lawrence Barker, PhD, of the CDC, and colleagues, who reported their findings in the American Journal of Preventive Medicine.

The diabetes belt includes portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

That's very similar to the stroke belt, the researchers say, but there are a few differences. For instance, much of West Virginia falls in the diabetes belt but not in the stroke belt. Conversely, Indiana is part of the stroke belt but not the diabetes belt.
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Weekly Exenatide Misses Endpoint in Key Trial

By John Gever, Senior Editor, MedPage Today

An investigational once-weekly formulation of the injectable diabetes drug exenatide (Bydureon) failed to show noninferiority to daily liraglutide (Victoza), the trial's sponsors said.

In the open-label trial called DURATION-6, patients taking 2 mg of exenatide weekly showed a 1.3-point reduction in glycated hemoglobin (HbA1c) levels after 26 weeks, compared with a 1.5-point decrease in patients receiving liraglutide at 1.8 mg daily, according to a joint statement from Eli Lilly, Alkermes, and Amylin Pharmaceuticals, which are co-developing the once-weekly drug.

"Bydureon did not meet the prespecified primary endpoint of noninferiority to Victoza," the statement said.
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Why Coffee Protects Against Diabetes

ScienceDaily (2011-01-15) -- Researchers have discovered a possible molecular mechanism behind coffee's protective effect against type 2 diabetes.

Taking More Steps Every Day Can Help Ward Off Diabetes

ScienceDaily (2011-01-13) -- Simply taking more steps every day not only helps ward off obesity but also reduces the risk of diabetes, finds a new study.

Living Longer Comes With a Physical Cost - NYTimes.com

Image via CrunchBaseBy NICHOLAS BAKALAR

Americans are living longer, but those added years are more likely to be a time of disease and disability.

An analysis of government data has found that while life expectancy has steadily increased over the past decade, the prevalence of heart disease, stroke, cancer and diabetes has also increased, and disability has grown as well.

For example, in 1998 about 16 percent of men in their 70s had a mobility problem — that is, they failed one of four commonly used physical tests. By 2006, almost 25 percent failed at least one.

Writing in the January issue of The Journal of Gerontology B, the authors conclude that people live longer not because they are less likely to get sick, but because they survive longer with disease.
Full Article

QuickStats: Death Rates* For Persons Aged ≥65 Years, with Diabetes as the Underlying or a Contributing Cause, by Race and Sex --- United States, 1981--2007

* Rates are age-adjusted per 100,000 U.S. standard population aged ≥65 years. Cause of death is based on International Classification of Diseases, Ninth Revision (ICD-9) code 250 (Diabetes mellitus) for 1981--1998 and International Classification of Diseases, 10th Revision (ICD-10) codes E10--E14 (Diabetes mellitus) for 1999--2007.

Diabetes is a leading cause of death in the United States and a contributing cause of deaths from many other conditions. In 2007, diabetes was a contributing cause of death 2.4 times as often as it was the underlying cause of death for persons aged ≥65 years. Age-adjusted death rates for deaths with diabetes declined for white and black persons aged ≥65 years from 2005 to 2007, after generally increasing from 1981 to 2002. In 2007, the rate was higher for black men and women than for white men and women.

Sources: 

CDC. National Vital Statistics System. Available at http://www.cdc.gov/nchs/nvss.htm.

CDC. Health Data Interactive. Available at http://www.cdc.gov/nchs/hdi.htm.

 

Anti-VEGF Drugs Making Leap to Diabetic Eye Disease

By John Gever, Senior Editor, MedPage Today

Drugs approved for "wet" age-related macular degeneration also appeared to be effective in diabetic macular edema in several clinical studies, researchers said here.

Ranibizumab (Lucentis) and pegaptanib (Macugen), both of which inhibit vascular endothelial growth factor (VEGF) signalling, were highly effective in improving visual acuity in patients with this form of diabetic retinopathy in a series of randomized, controlled trials, according to reports at the American Academy of Ophthalmology's annual meeting.
Full Article

One BP Target Won't Fit All Dialysis Patients from MedPage Today

by Crystal Phend

One size doesn't fit all for blood pressure management in dialysis patients, researchers found in a large cohort study.

Age and diabetes status impacted the link with mortality -- higher at low blood pressures in some groups but high pressures in others, Philip G. Zager, MD, of the University of New Mexico Health Sciences Center and Dialysis Clinic, both in Albuquerque, N.M., and colleagues reported.

Blood pressure targets should take these factors into account, they recommended online in the Journal of the American Society of Nephrology.
Full Article

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People Over 80 Often Have Mixed Pathologies In Their Brains That Account For Their Memory Loss, Confusion

Most recent studies show that elderly people over the age of 80 often have mixed pathologies in their brains that account for their memory loss and confusion. Very few senior citizens have "pure Alzheimer disease"; therefore, this terminology should be used with caution. It now appears that vascular problems such as high blood pressure and diabetes can shrink the parts of the brain that control memory and can significantly affect at what age elderly people become demented.

The following tips may be able to postpone cognitive decline late in life:
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Diabetes Impairs But Does Not Halt Sex Among Older Adults

Many middle-aged and older adults with diabetes are sexually active according to a study of nearly 2,000 people aged 57 to 85 presented in the September 2010 issue of the journal Diabetes Care. Almost 70 percent of partnered men with diabetes and 62 percent of partnered women with diabetes engaged in sexual activity two or three times a month, comparable to those without diabetes, the study showed.

The disease took a toll, however, on both the desire and the rewards of sexual activity. Men diagnosed with diabetes were more likely to express a lack of interest in sex and to experience erectile dysfunction. Both men and women reported a higher rate of orgasm difficulties, such as climaxing too quickly (men) or not at all (men and women).
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Diabetes, Insulin Resistance Linked to Alzheimer's from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

Insulin resistance and type 2 diabetes may contribute to the development of one type of brain plaque linked to Alzheimer's disease, according to an autopsy study.

An analysis of autopsy samples from 135 Japanese men and women found that high insulin and glucose levels appeared to accelerate the formation of neuritic plaques, especially among those carrying a high-risk gene for Alzheimer's, Kensuke Sasaki, MD, PhD, of Kyushu University in Fukuoka City, Japan, and colleagues, reported.

The association of neuritic plaques with higher levels of two-hour post-load plasma glucose, fasting insulin, and insulin resistance measured in the decade before death was found to be independent of other risk factors like age, blood pressure, smoking, and cerebrovascular disease, Sasaki and co-authors wrote in the Aug. 25 issue of Neurology.

Thus, "adequate control of diabetes might contribute to a strategy for the prevention of Alzheimer's disease," they concluded.
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MIT diabetes device monitors glucose with light | Crave - CNET

Image via Wikipedia

Imagine simply shining a light on your skin to determine how much sugar is in your blood. Researchers at MIT are developing a glucose-monitoring device for diabetes patients that may help do away with finger pricks.

By scanning a user's arm or finger with near-infrared light, the device frees users from the necessity of drawing blood, a daily routine for most type 1 diabetes patients.
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Patient Monitoring Improves BP Control from MedPage Today

By Kristina Fiore, Staff Writer, MedPage Today

Patients who use telemonitoring to manage their hypertension and titrate their own medication doses see improvements in systolic blood pressure, researchers found.

Such patients saw a significantly greater reduction in mean systolic blood pressure at six months and a year compared with patients who received standard care (P=0.013 and P=0.0004, respectively) Richard J. McManus, FRCGP, of the University of Birmingham in England, and colleagues reported online in The Lancet.

"These findings seem to be the result of an increase in the number of antihypertensive drugs prescribed according to a simple titration plan," they wrote. "Thus, self-management represents an important new addition to the control of hypertension in primary care."

Only about half of patients being treated for hypertension have achieved current recommended levels, which leaves room for other interventions to lower blood pressure, such as patient self-management. Trials of this strategy have shown it to be effective, the researchers noted.

Another strategy is self-titration, in which patients make changes in their medication according to response and based on a pre-agreed formula. This has been tested only on a small scale, the researchers said, but the model has been successful in patients with conditions such as asthma and diabetes.

Continue Reading

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Chronic Health Conditions Hit Native Elders Early

New Report on Native Elder Health Finds Asthma, Diabetes, Obesity Prevalent in Native Elders Years Before General Population

Native elders are aging earlier than other elderly groups, according to a new Center report that provides the first comprehensive information on American Indians and Alaska Natives (AIAN) elder health in California.

Using the 2005 and 2007 California Health Interview Survey (CHIS), the report provides omnibus data on native elder health on topics ranging from demographics, obesity, alcohol and tobacco use, as well as cancer screening, mental health, health insurance and more.


The authors, Center researcher Delight Satter and Center Associate Director Steven P. Wallace, found significant health disparities between AIAN elders and other senior racial and ethnic groups on issues ranging from diabetes and cancer screening to the high risk of falls.

The report, which follows a fact sheet on native elder health published earlier this year, provides evidence to show that native elders are developing chronic conditions earlier than other racial and ethnic groups.

Among the findings:

Diabetes

One-quarter (26 percent) of AIANs aged 55-64 have been diagnosed with diabetes compared to 12 percent of whites.

Asthma

One in five AIAN elders ages 55-64 have been diagnosed with asthma (20 percent) compared to 9 percent of Latinos of the same age.

Obesity

Nearly one-half (44 percent) of AIAN elders age 55-64 are obese, compared to 38 percent of African-Americans, 34 percent of Latinos and 25 percent of whites.

“Chronic health problems for Natives are cresting ten years earlier than the general population,” said Satter. “While researchers have heard anecdotally about this phenomenon for a long time, this is the first data in California that shows the drastic early aging that is afflicting the native community.

“Hopefully the data will also be a rallying call to health experts, advocates, policymakers and the native community to support the programs and policies that contribute to healthier aging.”

Although national health status data exist on the AIAN population as a whole, there is a severe lack of state-level and sub-state level data focused on the health of AIAN elders. This report presents the first comprehensive population-level health data on California’s Native Elders.

This report was funded by the California Wellness Foundation, the California Area Indian Health Service, the Mayo Clinic Spirit of Eagles and the UCLA Tribal Learning Community and Educational Exchange.

Read the report: Health of American Indian and Alaska Native Elders in California


UCLA Center for Healthpolicy Research

New Policy Brief Details the "Paradox" of Food Insecurity

Image by Phil Manker via Flickr

Limited resources for purchasing food has a dramatic impact on our health and our risk of developing chronic diseases such as diabetes. Like many health conditions, there are racial and ethnic differences in the prevalence of diabetes. For example, in California, among adults ages 50 and over, the prevalence of diabetes is 11.4% among Whites, and almost twice as high among communities of color; 22.2% among African Americans, 23.2% among Latinos, and 24.8% for American Indian/Alaskan Natives. In addition, the prevalence of diabetes is twice as high among adults with less than an 8th grade education as among adults with a college education. What is even more concerning is that even after adjusting for these socio-demographic trends, adults living with the most severe levels of food insecurity have more than twice the risk of developing diabetes as adults who are not food insecure.
Read Policy Brief

Close Lipid and BP Control Fail in Diabetes

Image via Wikipedia

By Crystal Phend, Senior Staff Writer, MedPage Today

Intensive blood pressure and lipid management does little against elevated cardiovascular risk in diabetes, according to results from the ACCORD study, again proving lower isn't always better.
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• Search for Better Diabetes Therapy Falls Short (online.wsj.com)