Prediabetes and risk of heart failure: the link grows stronger

In a recently published paper in Cardiovascular Diabetology, Sinha et al. (Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project. Cardiovasc Diabetol. 2021;20(1):66) reported that prediabetes (defined as a fasting plasma glucose concentration of 100–125 mg/dL) was associated with a higher lifetime risk of heart failure in middle-aged White adults and Black women, with the association attenuating in older Black women. This study provides important evidence that the risk of heart failure is increased in people with a fasting plasma glucose concentration as low as 100 mg/dL, supporting the definition of prediabetes according to the American Diabetes Association guideline. The study also strongly supports the notion that prediabetes should be regarded not only as a high-risk state for the development of diabetes but also as a risk factor for cardiovascular morbidity.

Trends in Receipt of American Diabetes Association Guideline-Recommended Care Among U.S. Adults With Diabetes: NHANES 2005–2018

<b>Objective: </b>To characterize national trends and characteristics of adults with diabetes receiving American Diabetes Association (ADA) guideline-recommended care. <div><p><b>Research Design and Methods: </b>We performed serial cross-sectional analyses of 4,069 adults aged≥20 years with diabetes who participated in the 2005-2018 National Health and Nutrition and Examination Survey (NHANES)</p> <p><b>Results: </b>Overall, the proportion of US adults with diabetes receiving ADA guideline-recommended care (meeting all five criteria (self-report) in the past year: having a primary doctor for diabetes and number of visits for this doctor≥1; HbA1c testing; an eye exam; a foot exam; and cholesterol testing)<b> </b>increased from 25.0% in 2005-2006 to 34.1% in 2017-2018 (P-trend=0.004). For participants with age≥65 years, it increased from 29.3% in 2005-2006 to 44.2% in 2017-2018 (P-trend=0.001), whereas for participants with age 40-64 and 20-39 years, it did not change significantly during the same time period: 25.2% to 25.8% (P-trend=0.457) and 9.9% to 26.0% (P-trend=0.401), respectively. Those who were not receiving ADA guideline-recommended care were more likely to be younger, of lower socioeconomc status, uninsured, newly diagnosed with diabetes, not on diabetes medication, and free of hypercholesterolemia. </p> <p><b>Conclusions: </b>Receipt of ADA guideline-recommended care increased only among adults with diabetes aged ≥65 years in the past decade. In 2017-2018, only 1 out of 3 US adults with diabetes reported receiving ADA guideline-recommended care, with even a lower receipt of care among those<65 years of age. Efforts are needed to improve healthcare delivery and equity in diabetes care. Insurance status is an important modifiable determinant of receiving ADA guideline-recommended care. </p></div>

Trends in Receipt of American Diabetes Association Guideline-Recommended Care Among U.S. Adults With Diabetes: NHANES 2005–2018

<b>Objective: </b>To characterize national trends and characteristics of adults with diabetes receiving American Diabetes Association (ADA) guideline-recommended care. <div><p><b>Research Design and Methods: </b>We performed serial cross-sectional analyses of 4,069 adults aged≥20 years with diabetes who participated in the 2005-2018 National Health and Nutrition and Examination Survey (NHANES)</p> <p><b>Results: </b>Overall, the proportion of US adults with diabetes receiving ADA guideline-recommended care (meeting all five criteria (self-report) in the past year: having a primary doctor for diabetes and number of visits for this doctor≥1; HbA1c testing; an eye exam; a foot exam; and cholesterol testing)<b> </b>increased from 25.0% in 2005-2006 to 34.1% in 2017-2018 (P-trend=0.004). For participants with age≥65 years, it increased from 29.3% in 2005-2006 to 44.2% in 2017-2018 (P-trend=0.001), whereas for participants with age 40-64 and 20-39 years, it did not change significantly during the same time period: 25.2% to 25.8% (P-trend=0.457) and 9.9% to 26.0% (P-trend=0.401), respectively. Those who were not receiving ADA guideline-recommended care were more likely to be younger, of lower socioeconomc status, uninsured, newly diagnosed with diabetes, not on diabetes medication, and free of hypercholesterolemia. </p> <p><b>Conclusions: </b>Receipt of ADA guideline-recommended care increased only among adults with diabetes aged ≥65 years in the past decade. In 2017-2018, only 1 out of 3 US adults with diabetes reported receiving ADA guideline-recommended care, with even a lower receipt of care among those<65 years of age. Efforts are needed to improve healthcare delivery and equity in diabetes care. Insurance status is an important modifiable determinant of receiving ADA guideline-recommended care. </p></div>

Ambulatory Care Pharmacists’ Perception of Prediabetes

Introduction: Eighty-four million patients in the United States have prediabetes yet evidence-based interventions to prevent diabetes are infrequently used. The concept of prediabetes is contentious, although preventive interventions are guideline supported. Team-based care models incorporating pharmacists for prediabetes have been proposed; however, pharmacist perception regarding prediabetes has not been assessed. This study's objective was to assess ambulatory care pharmacists’ perception of recommendations for prediabetes. Methods: An anonymous survey was electronically distributed through the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network. The primary outcome was the proportion of respondents who reported supporting 3 main recommendations related to prediabetes (ie, screening, evidence-based lifestyle-intervention, metformin). The study was approved by the University of South Florida Institutional Review Board. Data collection and analysis occurred in 2017. Results: The survey was distributed to approximately 2209 potential participants. One hundred thirty-three surveys were completed. The American Diabetes Association guideline was the most common primarily supported guideline related to prediabetes (89%). Of the respondents, 87% supported all 3 main recommendations regarding prediabetes. Qualitative feedback demonstrated the full range of opinions; programs for prediabetes, limited intervention for prediabetes, and against prediabetes as a concept. Conclusions: The majority of ambulatory care pharmacists responding supported all main recommendations related to prediabetes and therefore may be practicable for disseminating diabetes prevention interventions. However, barriers to implementation should be expected.

Designing and Evaluating of a Guideline-Based Recommender-Interpreter System to Inform Diabetic Patients about the Status of Periodic Lab Tests

Introduction: One of the most important issues in managing diabetes is the periodic checkups and tests to prevent the secondary complications of the disease. Low level of literacy in patients with diabetes, and the widespread use of abbreviations and numbers in the lab test results, makes it difficult for the patient to understand and interpret her health status. The purpose of this study is to design an expert system based on clinical guidelines in order to interpret the laboratory test results to patients and provide relevant recommendations in a textual report.Material and Methods: The study consists of two phases: the design and the evaluation. Design phase consists of 4 stages. In the first step, based on a Delphi study, the biological and laboratory tests, periodically measured for diabetic patients, were identified. In the second phase, according to the American Diabetes Association guideline, the rules for the interpretation of tests were extracted. In the third stage, an observational study was conducted to identify the elements of explanations that were provided by the physician about the results of patients' tests. In the fourth stage, the template messages were designed. In the evaluation phase, 12 diabetic patients assessed the usability of the generated report in two aspects of the visual design and the content. Five indices of apparent attractiveness, ease of comprehension, applicability, description adequacy, and novelty of content was evaluated with a 5-point Likert scale checklist.Results: The results of the Delphi study revealed that routine tests for diabetic patients included three profiles (e.g. blood glucose, blood lipids, and kidney status), with two examinations (e.g. blood pressure and weight). The structure of the report was designed according to the patient physician communication at visit sessions. Each section of the report includes three types of feedback: descriptive, comparative, and conclusive statements. The average age of participants was 56.4 years with 72.1% women. Patients believed that the report was attractive with an average score of 9.3, and evaluated the report's comprehensiveness with an average score of 9.4. The usability (8.3), the information adequacy (8.7) and the novelty (8.2) were also perceived acceptable by patients.Conclusion: The results showed that the report was acceptable from the perspective of diabetic patients, and patients would like to get more information about their health status. The findings of this study can be used as guidance to design of the next phase of the study, e.g. evaluation of intervention effectiveness.

Accuracy of Devices Used for Self-Monitoring of Blood Glucose

We measured the inaccuracy of 17 home blood glucose monitors (two visually read, eight colorimetric and seven amperometric). Using strips from a single batch, blood glucose measurements were performed by three medical laboratory technologists on at least 50 capillary blood specimens from patients attending two diabetes clinics. Additional capillary blood was deproteinized and assayed with hexokinase to give a whole blood glucose result. A dedicated glucose analyser was also studied to cross-validate the methodology. At a mean glucose concentration of about 9 mmol/L, monitor readings differed from the reference results by −5.1 to + 19.5% with three systems failing to meet the American Diabetes Association guideline for total error of less than 15%. This problem would be alleviated by manufacturers adopting a common policy on calibration and on reporting as a plasma or whole blood value.