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Interplay of Chronic Illness, Race, Age and Sex in Glycemic Control

慢性病、种族、年龄和性别在血糖控制中的相互作用

基本信息

批准号：
8195235
负责人：
DONALD R MILLER
金额：
--
依托单位：
VA NEW JERSEY HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8195235
关键词：
Adherence Affect African American Age American Amputation Area Arthritis Asthma Blindness Cardiovascular Diseases Caring Chronic Chronic Disease Chronic Kidney Failure Clinic Clinical Comorbidity Complex Data Data Aggregation Databases Dementia Demographic Factors Development Diabetes Mellitus Diabetic Angiopathies Disease Management Dose Elements Endocrinology Epidemiology Ethnic Origin Ethnic group Financial cost Glycosylated hemoglobin A Goals Growth Health Health Policy Healthcare High Prevalence Hispanics Individual Insulin Logistics Low Prevalence Malignant Neoplasms Managed Care Masks Measurement Measures Mediating Mediator of activation protein Medical Mental Health Mental disorders Methods Metric Minority Mission Modeling Not Hispanic or Latino Onset of illness Oral Outcome Patient Care Patients Performance Pharmaceutical Preparations Policies Prevalence Primary Health Care Private Sector Race Research Role Services Stratification Subgroup System Time Treatment Protocols Treatment outcome Variant Veterans Vietnam Visit base cohort cost diabetes management glycemic control improved medication compliance named group population health programs racial and ethnic racial/ethnic difference sex trend

项目摘要

Project Background: Achieving glycemic control is the most difficult element of management for many of the estimated 1.3 million VA patients with diabetes. The VA compares favorably with the private sector based upon performance measures. However, the use of aggregate data masks inadequate glycemic control among veterans who are younger, of minority status, and/or have mental health conditions. Despite wide-spread recognition of the importance of CCI in diabetes management, it is not known how they inter-relate with demographic factors (age, sex, race) to impact medication adherence and clinical inertia that are the major mediators of glycemic control. The specific role of inertia in insulin initiation in veterans with prevalent diabetes of longer duration, as well as initiation and intensification of oral medication in veterans with more recent onset disease is also not known. Project Objectives: Our overarching aim is to evaluate the relationship between CCI, demographic factors and glycemic treatment in veterans of different age, sex and racial/ethnic groups. Our specific objectives are: (1) To evaluate how differences in CCI are related to differences in HbA1c trends for individuals with prevalent and recent-onset diabetes. (2) To evaluate how differences in CCI are related to differences in anti- glycemic treatment, including both clinical inertia (lack of medication intensification or step up in medication dose and/or new prescription when indicated) and diabetes medication non-adherence. (3) To evaluate the extent to which variation in diabetes care among racial/ethnic groups is related to differences in the presence of CCI. Project Methods: This project will be a retrospective analysis of dynamic cohorts of veterans with diabetes identified from 1999-2006, and followed through 2009. We will identify prevalent co- morbid conditions and assign them as "concordant" or "discordant" based upon a conceptual model developed by Piette and Kerr. Analyses will be conducted separately for veterans with prevalent or incident diabetes. For the first objective, the outcome will be repeated individual HbA1c measurements and we will use growth curve models (random effects) that adjust for seasonality to evaluate individual HbA1c trend (i.e., slope). Using stratification as well as regression, we will evaluate the interaction of CCI and demographic variables on the HbA1c trend. Using Cox, logistic and linear multivariable regression models, we will evaluate the relationship of CCI and race with clinical inertia and medication adherence.

项目背景：实现血糖控制是最困难的因素为大约 130 万 VA 糖尿病患者中的许多人提供管理服务。弗吉尼亚州根据绩效衡量标准，与私营部门相比具有优势。然而，综合数据的使用掩盖了退伍军人的血糖控制不足年龄较小、属于少数族裔和/或有心理健康问题。尽管广泛传播尽管人们认识到 CCI 在糖尿病管理中的重要性，但尚不清楚他们如何与人口因素（年龄、性别、种族）相互关联，影响药物依从性和临床惯性是血糖控制的主要介质。具体作用患有长期糖尿病的退伍军人也开始使用胰岛素惰性作为最近发病的退伍军人的口服药物的开始和强化疾病也不得而知。项目目标：我们的首要目标是评估 CCI、不同年龄、性别和年龄的退伍军人的人口因素和血糖治疗种族/族裔群体。我们的具体目标是： (1) 评估 CCI 的差异与流行病和新近发病个体的 HbA1c 趋势差异有关糖尿病。 (2) 评估 CCI 差异与抗病毒差异之间的关系血糖治疗，包括临床惰性（缺乏药物强化或增加药物剂量和/或新处方（如有需要）和糖尿病药物不依从。 (3) 评估糖尿病护理的变化程度种族/族裔群体之间的差异与 CCI 存在的差异有关。项目方法：该项目将对动态群体进行回顾性分析 1999 年至 2006 年期间发现患有糖尿病的退伍军人，并跟踪至 2009 年。我们将识别普遍的共病状况并将其指定为“一致”或“不一致” 基于 Piette 和 Kerr 开发的概念模型。将进行分析对于患有普遍或突发糖尿病的退伍军人来说，单独进行。对于第一个目标，结果将重复单独的 HbA1c 测量，我们将使用生长曲线根据季节性进行调整以评估个体 HbA1c 趋势的模型（随机效应）（即坡度）。使用分层和回归，我们将评估 CCI 和人口变量对 HbA1c 趋势的影响。使用 Cox、逻辑和线性多变量回归模型，我们将评估 CCI 与种族的关系临床惯性和药物依从性。