Race and Long-Term Diabetes Self-Management in an HMO

HMO 中的种族和长期糖尿病自我管理

• 批准号: 6778879
• 负责人: Dennis Ross-Degnan
• 金额: $ 4.5万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-01-15 至 2004-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6778879
• 关键词: African American; behavioral /social science research tag; caucasian American; cooperative study; diabetes mellitus; diabetes mellitus therapy; diabetic nephropathy; diabetic retinopathy; disease /disorder proneness /risk; epidemiology; extended care; human data; human therapy evaluation; longitudinal human study; managed care; medical records; metabolism disorder chemotherapy; outcomes research; patient oriented research; racial /ethnic difference; self care; therapy compliance

DESCRIPTION (provided by applicant): This project will examine the complex relationships between race, diabetes self-management (including self-monitoring of blood glucose and diabetes drug therapy), glycemic control, and diabetes complications in a managed care setting over a nine-year period. African Americans with diabetes are less likely to be in glycemic control, a major risk factor for development of complications, including nephropathy, retinopathy, and peripheral vascular disease. Randomized controlled trials suggest that diabetes self-management including patient education, drug therapy, changes in diet, and regular exercise can improve glycemic control in the African American population. However, there is little epidemiological evidence regarding the role of race/ethnicity as a determinant of adherence to recommended diabetes self-management practices, or regarding the relationship between self-management, glycemic control, and subsequent clinical outcomes. Further, previous studies of race and diabetes self-management have been limited by short study periods, inadequate sample size, and reliance on self-reported measures of self-monitoring of blood glucose. The clinical setting for this study is Harvard Vanguard Medical Associates (HVMA), a large multi-site, multi-specialty group affiliated with Harvard Pilgrim Health Care. HVMA consists of 14 health centers serving over 300,000 people in the Boston area. We will use an open cohort design to enroll all adult (l8 years) patients between 1991 and 1999 who have 24 months or more of uninterrupted enrollment in HVMA following ascertainment of non-gestational diabetes, defined by (1) hospital discharge diagnosis of diabetes mellitus, (2) outpatient diagnoses of diabetes mellitus, HbAlc lab test result 8.0, or use of a diabetes drug (insulin, sulfonylurea, or metformin). We estimate that the cohort will include approximately 1,800 adults identified as African American and 5,000 identified as Caucasian. Access to HVMA computerized medical records, hospital emergency room and inpatient claims, lab, and pharmacy data will allow us to create reliable, objective measures of self-monitoring (home glucose monitor test strip use), drug therapy. glycemic control (HbAlc lab results), and diabetes complications (as measured in outpatient visits, emergency room visits, and hospitalizations). Stratifying by type of drug therapy (insulin/combined therapy vs. oral therapy), we will use descriptive analyses, generalized linear mixed models, and proportional hazards models to (1) identify racial differences in self-management practices and diabetes-related health outcomes over time; (2) assess whether African American race is an independent predictor of self-monitoring practice or adherence to drug regimen; and (3) whether there are racial/ethnic differences in the association between self-management and specific clinical endpoints, including glycemic control (HbAlc<8.0) and the incidence of diabetes-related complications over the nine-year study period.

描述（由申请人提供）：本项目将研究复杂的 种族、糖尿病自我管理（包括自我监测） 血糖和糖尿病药物治疗）、血糖控制和糖尿病 并发症在一个管理的护理设置超过九年的时间。非洲 患有糖尿病的美国人不太可能控制血糖， 并发症的发展因素，包括肾病，视网膜病变， 和外周血管疾病。随机对照试验表明， 糖尿病自我管理，包括患者教育、药物治疗、 饮食和定期锻炼可以改善非裔美国人的血糖控制 人口然而，几乎没有流行病学证据表明， 人种/种族作为坚持推荐糖尿病治疗的决定因素的作用 自我管理的做法，或关于之间的关系 自我管理、血糖控制和随后的临床结果。此外，本发明还 以前关于种族和糖尿病自我管理的研究受到限制， 研究时间短，样本量不足，依赖自我报告 血糖自我监测措施。 本研究的临床环境是哈佛先锋医疗协会 （HVMA），一个隶属于哈佛的大型多站点、多专业组织 朝圣者医疗中心HVMA由14个健康中心组成，为30多万人提供服务。 波士顿地区的人。我们将采用开放队列设计， 1991年至1999年期间，患有24个月或以上 在确定非妊娠后不间断入组HVMA 糖尿病，定义为（1）出院诊断为糖尿病，（2） 门诊诊断为糖尿病，HbAlc实验室检测结果8.0，或使用 糖尿病药物（胰岛素、磺脲类药物或二甲双胍）。我们估计 队列将包括大约1，800名被确定为非裔美国人的成年人 其中5,000人被确认为白种人访问HVMA计算机化的医疗记录， 医院急诊室和住院病人索赔、实验室和药房数据将允许 我们创造可靠的，客观的自我监测措施（家庭葡萄糖 监测测试条使用）、药物治疗。血糖控制（HbAlc实验室结果）， 和糖尿病并发症（如在门诊、急诊室 访问和住院）。按药物治疗类型分层 （胰岛素/联合治疗与口服治疗），我们将使用描述性分析， 广义线性混合模型和比例风险模型（1） 确定自我管理实践和糖尿病相关的种族差异 随着时间的推移，健康结果;（2）评估非洲裔美国人种族是否是一个 自我监测实践或药物方案依从性的独立预测因子; 和（3）是否有种族/民族之间的关联差异， 自我管理和特定临床终点，包括血糖控制 （HbAlc<8.0）和糖尿病相关并发症的发生率。 九年的学习时间。