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The Association Between Poor Glycemic Control and Health Care Costs in People With Diabetes: A Population-Based Study

OBJECTIVE

To analyze the differences in health care costs according to glycemic control in people with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Data on health care resource utilization from 100,391 people with type 2 diabetes were extracted from the electronic database used at the Catalan Health Institute. Multivariate regression models were carried out to test the impact of glycemic control (HbA1c) on total health care, hospital admission, and medication costs; model 1 adjusted for a variety of covariates, and model 2 also included micro- and macrovascular complications. Glycemic control was classified as good for HbA1c <7%, fair for ≥7% to <8%, poor for ≥8% to <10%, and very poor for ≥10%.

RESULTS

Mean per patient annual direct medical costs were 3,039 ± SD 6,581. Worse glycemic control was associated with higher total health care costs: compared with good glycemic control, health care costs increased by 18% (509.82) and 23% (661.35) in patients with very poor and poor glycemic control, respectively, when unadjusted and by 428.3 and 395.1, respectively, in model 2. Medication costs increased by 12% in patients with fair control and by 28% in those with very poor control (model 2). Patients with poor control had a higher probability of hospitalization than those with good control (5% in model 2) and a greater average cost when hospitalization occurred (811).

CONCLUSIONS

Poor glycemic control was directly related to higher total health care, hospitalization, and medication costs. Preventive strategies and good glycemic control in people with type 2 diabetes could reduce the economic impact associated with this disease.




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Diabetic Neuropathy Is a Substantial Burden in People With Type 1 Diabetes and Is Strongly Associated With Socioeconomic Disadvantage: A Population-Representative Study From Scotland

OBJECTIVE

To assess the contemporaneous prevalence of diabetic peripheral neuropathy (DPN) in people with type 1 diabetes (T1D) in Scotland and study its cross-sectional association with risk factors and other diabetic complications.

RESEARCH DESIGN AND METHODS

We analyzed data from a large representative sample of adults with T1D (N = 5,558). We assessed the presence of symptomatic neuropathy using the dichotomized (≥4) Michigan Neuropathy Screening Instrument Patient Questionnaire score. Logistic regression models were used to investigate associations between DPN and risk factors, as well as with other complications.

RESULTS

The burden of DPN is substantial with 13% prevalence overall. Adjusting for attained age, diabetes duration, and sex, the odds of DPN increased mainly with waist-to-hip ratio, lipids, poor glycemic control (odds ratio 1.51 [95% CI 1.21–1.89] for levels of 75 vs. 53 mmol/mol), ever versus never smoking (1.67 [1.37–2.03]), and worse renal function (1.96 [1.03–3.74] for estimated glomerular filtration rate levels <30 vs. ≥90 mL/min/1.73 m2). The odds significantly decreased with higher HDL cholesterol (0.77 [0.66–0.89] per mmol/L). Living in more deprived areas was associated with DPN (2.17 [1.78–2.65]) for more versus less deprived areas adjusted for other risk factors. Finally, individuals with prevalent DPN were much more likely than others to have other diabetes complications.

CONCLUSIONS

Diabetic neuropathy remains substantial, particularly affecting those in the most socioeconomically deprived groups. Those with clinically manifest neuropathy also have a higher burden of other complications and elevated levels of modifiable risk factors. These data suggest that there is considerable scope to reduce neuropathy rates and narrow the socioeconomic differential by better risk factor control.




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Watch: Driver accidentally reverses onto two parked cars outside Florida bank

A Florida sheriff's office said a driver reversing out of a bank parking lot accidentally ended up backing up onto two other cars.




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Watch: Escaped bull goes wandering on Massachusetts highway

A young bull went wandering on a Massachusetts highway after escaping from a trailer and was captured without causing any incidents, police said.




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Escaped emu found playing in sprinkler one day later

A Michigan family said their 6-foot-tall emu was found playing in another resident's sprinkler about a mile from home one day after escaping.




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Watch: Girl, 14, accepted into eight California universities

A California 14-year-old who graduated high school at the age of 13 said she has now been accepted into the music programs at eight California universities.




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Former pet snake mistakenly released into the wild in Ontario

Conservation officials in Ontario are asking members of the public to be on the lookout for a former pet snake that was mistakenly released into the wild near a conservation area.




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Iowa man receives postcard mailed 33 years earlier

An Iowa man who received a postcard from his sister said he was surprised to note the card had been mailed in 1987.




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Watch: Utah man reunited with class ring 38 years after it was lost in Germany

A Utah man who lost his high school class ring in Germany in 1982 was reunited with the ring thanks to a man who found it on a beach in the United States.




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Look: Police investigating loose camel report find escaped emu instead

Police in the Netherlands said officers responding to reports of a loose camel ended up capturing an emu running wild through the city of Rotterdam.




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Look: Dangling raccoon rescued from under California highway on-ramp

Animal rescuers in California said they reached over the side of a freeway on-ramp to rescue a raccoon seen dangling from a metal beam under the ramp.




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Look: Fox rescued from between walls of home, garage

Animal rescuers in Britain said a fox was rescued from the narrow gap between the external walls of a house and its garage.




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Crisis in the Courts: Is the Backlogged U.S. Immigration Court System at Its Breaking Point?

With a backlog of more than 1 million removal cases, the U.S. immigration court system is in crisis. Pressure from external forces, internal challenges, and lagging resources for the courts at a time of massive increases in spending on immigration enforcement have contributed to the backlog. This article explores how the system got to the breaking point, and what opportunities for reform exist.




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Drug may curb dangerous urges in pedophiles, study says

A testosterone-lowering drug can reduce male pedophiles' risk of sexually abusing children, according to a new Swedish study.




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Evidence-Informed Clinical Practice Recommendations for Treatment of Type 1 Diabetes Complicated by Problematic Hypoglycemia

Pratik Choudhary
Jun 1, 2015; 38:1016-1029
Type 1 Diabetes at a Crossroads




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Kidney Disease and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Ian H. de Boer
Jan 1, 2014; 37:24-30
DCCT/EDIC 30th Anniversary Summary Findings




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New Insulin Glargine 300 Units/mL Versus Glargine 100 Units/mL in People With Type 2 Diabetes Using Oral Agents and Basal Insulin: Glucose Control and Hypoglycemia in a 6-Month Randomized Controlled Trial (EDITION 2)

Hannele Yki-Järvinen
Dec 1, 2014; 37:3235-3243
Emerging Technologies and Therapeutics




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Day and Night Home Closed-Loop Insulin Delivery in Adults With Type 1 Diabetes: Three-Center Randomized Crossover Study

Lalantha Leelarathna
Jul 1, 2014; 37:1931-1937
Emerging Technologies and Therapeutics




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Feasibility of Outpatient Fully Integrated Closed-Loop Control: First studies of wearable artificial pancreas

Boris P. Kovatchev
Jul 1, 2013; 36:1851-1858
Diabetes Care Symposium




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Phase 3 Trial of Transplantation of Human Islets in Type 1 Diabetes Complicated by Severe Hypoglycemia

Bernhard J. Hering
Jul 1, 2016; 39:1230-1240
Emerging Technologies and Therapeutics




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Overnight Closed-Loop Insulin Delivery in Young People With Type 1 Diabetes: A Free-Living, Randomized Clinical Trial

Roman Hovorka
May 1, 2014; 37:1204-1211
Advances in Artificial Pancreas Development




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National Standards for Diabetes Self-Management Education and Support

Linda Haas
Jan 1, 2014; 37:S144-S153
National Standards




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Exploring the Potential of the SGLT2 Inhibitor Dapagliflozin in Type 1 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

Robert R. Henry
Mar 1, 2015; 38:412-419
Evolving Tactics With Inhibition of Sodium-Glucose Cotransporters




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Vitamin E Reduction of Protein Glycosylation in Diabetes: New Prospect for Prevention of Diabetic Complications?

Antonio Ceriello
Jan 1, 1991; 14:68-72
Short Report




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Empagliflozin as Add-On to Metformin in Patients With Type 2 Diabetes: A 24-Week, Randomized, Double-Blind, Placebo-Controlled Trial

Hans-Ulrich Häring
Jun 1, 2014; 37:1650-1659
Emerging Technologies and Therapeutics




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Glucagon-Like Peptide 1 Receptor Agonist or Bolus Insulin With Optimized Basal Insulin in Type 2 Diabetes

Michaela Diamant
Oct 1, 2014; 37:2763-2773
Emerging Technologies and Therapeutics




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Personalized Management of Hyperglycemia in Type 2 Diabetes: Reflections from a Diabetes Care Editors' Expert Forum

Itamar Raz
Jun 1, 2013; 36:1779-1788
Diabetes Care Expert Forum




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Manufactured Shoes in the Prevention of Diabetic Foot Ulcers

Luigi Uccioli
Oct 1, 1995; 18:1376-1378
Short Report




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Breaking Up Prolonged Sitting With Standing or Walking Attenuates the Postprandial Metabolic Response in Postmenopausal Women: A Randomized Acute Study

Joseph Henson
Jan 1, 2016; 39:130-138
IDF-ADA Translational Symposium




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New Insulin Glargine 300 Units/mL Versus Glargine 100 Units/mL in People With Type 2 Diabetes Using Basal and Mealtime Insulin: Glucose Control and Hypoglycemia in a 6-Month Randomized Controlled Trial (EDITION 1)

Matthew C. Riddle
Oct 1, 2014; 37:2755-2762
Emerging Technologies and Therapeutics




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Increased Carotid Intima-Media Thickness and Stiffness in Obese Children

Arcangelo Iannuzzi
Oct 1, 2004; 27:2506-2508
Brief Reports




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Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Catherine L. Martin
Jan 1, 2014; 37:31-38
DCCT/EDIC 30th Anniversary Summary Findings




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Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?: Health Be Damned! Pour on the Sugar

George A. Bray
Apr 1, 2014; 37:950-956
Current Concepts of Type 2 Diabetes Prevention




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Metformin Improves Glucose, Lipid Metabolism, and Reduces Blood Pressure in Hypertensive, Obese Women

Dario Giugliano
Oct 1, 1993; 16:1387-1390
Short Report




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Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial

Saila B. Koivusalo
Jan 1, 2016; 39:24-30
Considerations in the Management of Gestational Diabetes Mellitus




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Cardiovascular Outcomes Trials in Type 2 Diabetes: Where Do We Go From Here? Reflections From a Diabetes Care Editors Expert Forum

William T. Cefalu
Jan 1, 2018; 41:14-31
Diabetes Care Expert Forum




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Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endo

Gina Agiostratidou
Dec 1, 2017; 40:1622-1630
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up

The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
May 1, 2016; 39:686-693
Cardiovascular Disease and Diabetes




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Improved Glycemic Control in Poorly Controlled Patients with Type 1 Diabetes Using Real-Time Continuous Glucose Monitoring

Dorothee Deiss
Dec 1, 2006; 29:2730-2732
BR Emerging Treatments and Technologies




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Undiagnosed NIDDM: Clinical and Public Health Issues

Maureen I Harris
Apr 1, 1993; 16:642-652
Kelly West Lecture 1992




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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

Kellee M. Miller
Jun 1, 2015; 38:971-978
Type 1 Diabetes at a Crossroads




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At least 194 killed in Kenya flooding this month

Flooding in Kenya's rainy season has killed 194 people and displaced more than 100,000 households this month, officials said Wednesday.




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Gas leak at India chemical plant kills 8, sickens hundreds

At least eight people died and hundreds were hospitalized after toxic gas leaked from a chemical factory in southern India early Thursday, officials said.




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Report: South Korea tested new ballistic missile with larger warhead

South Korea's military tested a ballistic missile capable of carrying a 2-ton warhead in March, according to local reports on Thursday.




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Former intelligence chief Mustafa al-Kadhini named Iraqi prime minister

Former intelligence chief Mustafa al-Kadhini was named prime minister of Iraq on Thursday, after five months of political instability in the Middle Eastern nation.




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Google-related company pulls plug on Toronto 'smart city' project

A Google-related company has pulled the plug on its ambitious high-tech waterfront city project in Toronto, citing financial strains from the coronavirus, but the project had also run into local opposition.




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South Korea sees new cluster of COVID-19 cases tied to nightclubs

Just days after South Korea loosened its social distancing guidelines, a new COVID-19 cluster of infections has sprung up in the capital city of Seoul tied to several nightclubs.




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Subdued ceremonies in Europe mark 75th anniversary of VE Day

French President Emanuel Macron led a series of events in Europe Friday that commemorate the 75th anniversary of Victory in Europe Day, with a small ceremony in Paris.




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Northrop Grumman awarded $123.5M to integrate Navy LAIRCM system

Northrop Grumman received a $123.5 million contract modification Friday to integrate the Department of Navy Large Aircraft Infrared Countermeasures system onto aircraft for the U.S. military and two allied governments.




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U.S. Navy ships, trailed by Russia, visit Barents Sea above Arctic Circle

U.S. Navy ships on Monday entered the Barents Sea between Norway and Russia, for the first time since the 1980s, "to assert freedom of navigation and demonstrate seamless integration among allies," the U.S. Navy said.