Julienne K. Kirk

Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis.

OBJECTIVE—Among individuals with diabetes, a comparison of HbA1c (A1C) levels between African Americans and non-Hispanic whites was evaluated. Data sources included PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health, the Cochrane Library, the Combined Health Information Database, and the Education Resources Information Center. RESEARCH DESIGN AND METHODS—We executed a search for articles published between 1993 and 2005. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for African Americans and non-Hispanic whites with diabetes were included. Diabetic subjects aged <18 years and those with pre-diabetes or gestational diabetes were excluded. We conducted a meta-analysis to estimate the difference in the mean values of A1C for African Americans and non-Hispanic whites. RESULTS—A total of 391 studies were reviewed, of which 78 contained A1C data. Eleven had data on A1C for African Americans and non-Hispanic whites and met selection criteria. A meta-analysis revealed the standard effect to be 0.31 (95% CI 0.39–0.25). This standard effect correlates to an A1C difference between groups of ∼0.65%, indicating a higher A1C across studies for African Americans. Grouping studies by study type (cross-sectional or cohort), method of data collection for A1C (chart review or blood draw), and insurance status (managed care or nonmanaged care) showed similar results. CONCLUSIONS—The higher A1C observed in this meta-analysis among African Americans compared with non-Hispanic whites may contribute to disparity in diabetes morbidity and mortality in this population.

Disparities in A1C Levels Between Hispanic and Non-Hispanic White Adults With Diabetes: A meta-analysis

OBJECTIVE—Hispanics have higher rates of diabetes and diabetes-related complications than do non-Hispanic whites. A meta-analysis was conducted to estimate the difference between the mean values of A1C for these two groups. RESEARCH DESIGN AND METHODS—We executed a PubMed search of articles published from 1993 through July 2007. Data sources included PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for Hispanics and non-Hispanic whites with diabetes were included. Studies were excluded if they included individuals <18 years of age or patients with pre-diabetes or gestational diabetes. RESULTS—A total of 495 studies were reviewed, of which 73 contained data on A1C for Hispanics and non-Hispanic whites, and 11 met the inclusion criteria. Meta-analysis revealed a statistically significant mean difference (P < 0.0001) of −0.46 (95% CI −0.63 to −0.33), correlating to an ∼0.5% higher A1C for Hispanics. Grouping studies by design (cross-sectional or cohort), method of data collection for A1C (chart review or blood sampling), and care type (managed or nonmanaged) yielded similar results. CONCLUSIONS—In this meta-analysis, A1C was ∼0.5% higher in Hispanic patients with diabetes than in non-Hispanic patients. Understanding the reasons for this disparity should be a focus for future research.

Ethnic Disparities: Control of Glycemia, Blood Pressure, and LDL Cholesterol Among US Adults with Type 2 Diabetes

OBJECTIVE: To examine ethnic disparities in the quality of diabetes care among adults with diabetes in the US through a systematic qualitative review. DATA SOURCES: Material published in the English language was searched from 1993 through June 2003 using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. STUDY SELECTION AND DATA EXTRACTION: Studies of patients with diabetes in which at least 50% of study participants were ethnic minorities and studies that made ethnic group comparisons were eligible. Research on individuals having prediabetes, those <18 years of age, or women with gestational diabetes were excluded. Reviewers used a reproducible search strategy. A standardized abstraction and grading of articles for publication source and content were used. Data on glycemia, blood pressure, and low-density lipoprotein cholesterol (LDL-C) were extracted in patients with diabetes. A total of 390 studies were reviewed, with 78 meeting inclusion criteria. DATA SYNTHESIS: Ethnic minorities had poorer outcomes of care than non-Hispanic whites. These disparities were most pronounced for glycemic control and least evident for LDL-C control. Most studies showed blood pressure to be poorly controlled among ethnic minorities. CONCLUSIONS: Control of risk factors for diabetes (glycemia, blood pressure, LDL-C) is challenging and requires routine assessment. These findings indicate that additional efforts are needed to promote diabetes quality of care among minority populations.

Variants in Intron 13 of the ELMO1 Gene are Associated with Diabetic Nephropathy in African Americans

Variants in the engulfment and cell motility 1 (ELMO1) gene are associated with nephropathy due to type 2 diabetes mellitus (T2DM) in a Japanese cohort. We comprehensively evaluated this gene in African American (AA) T2DM patients with end‐stage renal disease (ESRD). Three hundred and nine HapMap tagging SNPs and 9 reportedly associated SNPs were genotyped in 577 AA T2DM‐ESRD patients and 596 AA non‐diabetic controls, plus 43 non‐diabetic European American controls and 45 Yoruba Nigerian samples for admixture adjustment. Replication analyses were conducted in 558 AA with T2DM‐ESRD and 564 controls without diabetes. Extension analyses included 328 AA with T2DM lacking nephropathy and 326 with non‐diabetic ESRD. The original and replication analyses confirmed association with four SNPs in intron 13 (permutation p‐values for combined analyses = 0.001–0.003), one in intron 1 (P = 0.004) and one in intron 5 (P = 0.002) with T2DM‐associated ESRD. In a subsequent combined analysis of all 1,135 T2DM‐ESRD cases and 1,160 controls, an additional 7 intron 13 SNPs produced evidence of association (P = 3.5 × 10−5– P = 0.05). No associations were seen with these SNPs in those with T2DM lacking nephropathy or with ESRD due to non‐diabetic causes. Variants in intron 13 of the ELMO1 gene appear to confer risk for diabetic nephropathy in AA.

Performance of Three Blood Glucose Meters

OBJECTIVE: To evaluate the performance of three blood glucose meters. METHODS: The One Touch II (LifeScan, Milpitas, CA), Glucometer Elite (Bayer, Elkhart, IN), and Accu-Chek Advantage (Boehringer Mannheim, Indianapolis, IN) were compared with a reference laboratory method (Technicon Chem System, Tarrytown, NY). Blood glucose meters used in this study were validated by a clinically oriented approach known as the error grid analysis (EGA), for which the performance of the meters was compared to a laboratory standard, and by the criteria of the American Diabetes Association (ADA). Limits of agreement were evaluated using differences from the reference laboratory method and 95% CIs. Capillary blood was obtained from study participants in fasting state with the morning blood draw and tested on the three meters simultaneously. RESULTS: A total of 120 blood glucose meter readings were analyzed; values ranged from 62 to 396 mg/dL. For all three meters, at least 75% of the capillary blood glucose values fell into zone A (acceptable) of the EGA. The number of values falling into zone B (unacceptable) were 10, 8, and 6 for the Accu-Chek Advantage, the One Touch II, and the Glucometer Elite, respectively. Only 15–25% of the meter glucose readings met the ADA criteria of being within 5% of the laboratory standard. The mean difference from the reference values was least with the Glucometer Elite. CONCLUSIONS: The majority of blood glucose determinations obtained on the meters used in this study were within the acceptable limits using the EGA. The Glucometer Elite meter had the fewest values in the unacceptable range and had the least mean difference from reference laboratory values.

Cost-Minimization and the Number Needed to Treat in Uncomplicated Hypertension

The goal of this study was to compare the direct costs associated with the prescription of thiazide diuretics, beta-receptor blockers (beta-blockers), angiotensin converting enzyme inhibitors (ACEI), a-receptor blockers (alpha-blockers), and calcium channel blockers (CCB) for the prevention of stroke, myocardial infarction (MI) and premature death in uncomplicated hypertension. We performed a cost-minimization analysis based on numbers-needed-to-treat (NNT) derived from the metaanalysis of 15 major clinical trials of hypertension treatment, and the average wholesale prices of both the most commonly prescribed and the least expensive drugs in each class. The inclusion criteria for clinical trials were that they be randomized, controlled trials of drug therapy of uncomplicated mild-to-moderate hypertension with stroke, MI, or death as endpoints. The wholesale drug costs and the total direct outpatient treatment costs to prevent a stroke, MI or death among middle-aged and elderly hypertensives were our outcome measures. The estimated wholesale drug acquisition cost to prevent one major event (MI or stroke or death) ranged from

Tolerability of Dipeptidyl Peptidase-4 Inhibitors: A Review

4730 to

Phytoestrogens as therapeutic alternatives to traditional hormone replacement in postmenopausal women

346,236 among middle-aged patients, and from

Performance of Health Literacy Tests Among Older Adults with Diabetes

1595 to

Disparities in HbA1c Levels Between African-American and Non-Hispanic White Adults With Diabetes

116,754 in the elderly; generic diuretic or beta-blocker therapy was more economical than treatment with an ACEI, alpha-blocker, or CCB. The associated 5-year NNT was 86 for middle-aged patients and 29 for elderly patients. Diuretic therapy remained more cost-effective even under the unlikely assumption that the newer drugs were 50% more effective than diuretics at preventing these major events. The costs associated with potassium supplementation did not eliminate the advantage of diuretics. Treatment costs to prevent major hypertensive complications are much lower with diuretics and beta-blockers than with ACEI, CCB, or alpha-blockers, especially in middle-aged patients.