Janet M. McDowall

Do Persons With Diabetes Know Their (AIC) Number

PURPOSE The objective of this study was to compare self-reported knowledge about Al C testing with information from the medical record. METHODS A telephone survey was conducted among patients with diabetes in a rural fee-for-service practice and a community health center. Self-reported information regarding Al C testing, the last Al C value, and perceived blood glucose control was compared with the most current Al C value documented in the medical record. RESULTS Seventy five percent of survey respondents reported having 1 or more Al C tests in the past year, which generally agreed with information from their medical records. However, only 24% of those who reported having a test remembered the actual value, and the self-reported values correlated weakly with the last Al C on the medical record. Among those with a documented Al C value, half described their blood glucose as very well controlled. The last Al C value, however, was <7.0% in only half of those respondents. CONCLUSIONS Persons with diabetes were aware of their previous Al C testing but did not interpret the values accurately in relation to their own glycemic control. If clinicians expect patient knowledge and understanding of glycemic control measures to improve outcomes of care, patient education will need to emphasize the meaning of these values.

Cardiovascular disease and risk factors in Montana American Indians and non-Indians

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death for both American Indian and non-Indian adults. Few published studies have compared the prevalence of CVD and related risk factors in Indians to that in non-Indians in the same geographic area. OBJECTIVE To compare CVD and risk factors in American Indian and non-Indian populations in Montana. METHODS Adult American Indians (n=1000) living on or near Montanas seven reservations and non-Indian (n=905) Montanans statewide were interviewed through the 1999 Behavioral Risk Factor Surveillance Survey (BRFSS). RESULTS Indians aged > or =45 years reported a significantly higher prevalence of CVD compared to non-Indians (18% vs 10%). In persons aged 18-44 years, Indians were more likely to report hypertension (15% vs 10%), obesity (29% vs 12%), and smoking (42% vs 24%) compared to non-Indians. For persons aged > or =45 years, Indians reported higher rates of diabetes (24% vs 9%), obesity (38% vs 16%), and smoking (32% vs 13%) compared to non-Indians. Non-Indians aged > or =45 years reported having been diagnosed with high cholesterol more frequently than did Indians (32% vs 24%). CONCLUSIONS Both Indians and non-Indians in Montana reported a substantial burden of CVD. The CVD risk patterns differ in the two populations. Prevention programs should be tailored to the risk burdens in these communities with particular emphasis on smoking cessation and the prevention of obesity.

Three-year prevalence and incidence of diabetes among American Indian youth in Montana and Wyoming, 1999 to 2001.

OBJECTIVES To estimate the prevalence and incidence of type 2 diabetes among American Indian youth. STUDY DESIGN Medical records were reviewed annually for all patients with diabetes who were <20 years of age at 6 Indian Health Service facilities in Montana and Wyoming. All cases < or =5 years of age or weight per age < or =10th percentile at diagnosis or with islet cell antibodies were considered as probable type 1. Among the remaining cases, probable type 2 diabetes was defined when a child had one or more of the following characteristics: weight per age > or =95th percentile or acanthosis nigricans at diagnosis, elevated C-peptide or insulin, family history of type 2 diabetes; treatment with oral agents with or without insulin or no hypoglycemic therapy after 1 year of follow-up. RESULTS From 1999 to 2001, 53% of prevalent cases and 70% of incident cases were categorized as probable type 2 diabetes. The average annual prevalence of probable type 1 and type 2 diabetes was 0.7 and 1.3 per 1000. The average annual incidence rates for probable type 1, and type 2 diabetes were 5.8, 23.3 per 100,000. CONCLUSIONS The incidence of probable type 2 diabetes was approximately 4 times higher than type 1 diabetes among American Indian youth in Montana and Wyoming

Cardiovascular Risk Factors in Montana American Indians With and Without Diabetes

BACKGROUND Cardiovascular disease (CVD) and diabetes are prevalent and of major concern for American-Indian communities in the United States. Health professional counseling is effective in increasing patient awareness and inducing lifestyle modification. The objective of this study was to compare the prevalence of CVD, modifiable risk factors and counseling for smoking cessation, physical activity, and a healthy diet in adult American Indians with and without diabetes. METHODS A random sample of adult American Indians living on or near the seven Montana reservations was interviewed through an adapted Behavioral Risk Factor Surveillance System telephone survey in 1999 (N=1000) and 2001 (N=1006). RESULTS Respondents with diabetes, compared to those without, had a significantly higher prevalence of CVD (27% vs 8%); overweight (89% vs 71%); high blood pressure (57% vs 24%); and high cholesterol (44% vs 22%). There were no differences for insufficient physical activity (60% vs 51%) or smoking (34% vs 41%) after adjustment for age, gender, and survey year. Respondents with diabetes, compared to respondents without diabetes, were significantly more likely to report health professional counseling for smoking cessation (83% vs 58%); physical activity (73% vs 37%); and reduced fat consumption (57% vs 24%). CONCLUSIONS The prevalence of modifiable CVD risk factors was alarmingly high among adult American Indians with and without diabetes. Strategies to increase health professional counseling for healthy diet and smoking cessation are needed.

Testing for microalbuminuria in 2002: barriers to implementing current guidelines

BACKGROUND Testing for microalbuminuria is recommended to detect early kidney damage in patients with diabetes or other diseases. However, few studies have examined laboratory practices for microalbuminuria testing in the general community. METHODS In 2002, all laboratories in Montana and reference laboratories used by Montana laboratories for microalbuminuria measurement were surveyed by mail to ascertain if they provided testing for microalbuminuria, specific tests performed, and units and cutoff values used to report microalbuminuria results. RESULTS One hundred three of 126 laboratories (82%) responded to the survey. Overall, 79% of laboratories offered quantitative testing for microalbuminuria, either on site or through a reference laboratory. Twenty-five laboratories (24%) surveyed provided quantitative testing for microalbuminuria on site. Only 14 of 23 laboratories offering albumin-creatinine ratios on site reported results in units and cutoff values consistent with current recommendations. Fewer laboratories provided 24-hour (6 of 17 laboratories) or other timed (2 of 7 laboratories) testing, and many of these laboratories did not report results using recommended units and cutoff values. Overall, only 11 of 25 laboratories (44%) with on-site testing reported microalbuminuria values from 1 or more types of specimens exclusively using recommended units and cutoff values. CONCLUSION Quantitative testing for microalbuminuria is not offered universally, and results often are reported in units and cutoff values that differ from current clinical recommendations.

Improving Access to Quality Diabetes Education in a Rural State The Montana Quality Diabetes Education Initiative

Purpose Diabetes self-management education (DSME) is an integral component of diabetes care; however, skilled educators and recognized programs are not uniformly available in rural communities. Methods To increase access to quality DSME, the Montana Diabetes Control Program and the Montana chapter of the American Association of Diabetes Educators developed a mentoring program with 3 levels: basic, intermediate, and advanced. All participants were assisted by a volunteer certified diabetes educator (CDE) mentor. In addition, the program provided technical support for recognition through the American Diabetes Association and the Indian Health Service. Results From 2000 to 2005, 90 individuals participated; 76% were nurses and 21% dietitians. Twenty-seven of the 90 enrollees (30%) completed their structured option, and 13 achieved CDE certification. Most provided services in frontier counties (66%). Statewide, the number of CDEs in Montana increased 46% from 52 in 2000 to 76 in 2005. Twenty-five of the 30 facilities that received technical assistance achieved recognition. Statewide, the number of recognized education programs increased from 2 in 2000 to 22 in 2005. Twelve (55%) of these programs were located in frontier counties. Conclusions Mentoring and technical support is an effective method to increase personnel skills for DSME and to increase access to quality education programs in rural areas.