Paul Upham

Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus

OBJECTIVE To conduct a cost analysis and cost-effectiveness study based on a randomized clinical trial of basic nutrition care (BC) and practice guidelines nutrition care (PGC) provided by dietitians in outpatient clinics. DESIGN Subjects with non-insulin-dependent diabetes mellitus (NIDDM) from three states (Minnesota, Florida, Colorado) were randomly assigned to a group receiving BC or a group receiving PGC for a 6-month clinical trial. Along with data about medical and clinical outcomes, data about cost resources were collected. The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and glycemic outcomes for the 6 months of the study. A net cost-effectiveness ratio comparing BC and PGC, including the cost savings resulting from changes in medical therapy, was also calculated. SUBJECTS The study reports on a sample of 179 subjects with NIDDM between the ages of 38 and 76 years who completed the clinical trial. RESULTS Patients in the PGC group experienced a mean 1.1 +/- 2.8 mmol/L decrease in fasting plasma glucose level 6 months after entry to the study, for a total per-patient cost of

Low cardiorespiratory fitness in people at risk for type 2 diabetes: early marker for insulin resistance

112. PGC costs included one glycated hemoglobin assay used by the dietitian to evaluate nutrition outcomes. Patients in the BC group experienced a mean 0.4 +/- 2.7 mmol/L decrease, for a total per-patient cost of

Diabetes Medical Nutrition Therapy: Quality of Life and Behavioral Eating Competence Outcomes

42. In the PGC group, 17 persons had changes in therapy, which yielded an average 12-month cost savings prorated for all patients of

Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial.

31.49. In contrast, in the BC group, 9 persons had changes in therapy, for an average 12-month prorated cost savings of

System and method for integrating datawith guidelines to generate displays containing the guidelines and data

3.13. Each unit of change in fasting plasma glucose level from entry to the 6-month follow-up can be achieved with an investment of

Practice guidelines for nutrition care by dietetics practitioners for outpatients with non-insulin-dependent diabetes mellitus : methodologies for field-testing and cost-effectiveness analysis

5.75 by implementing BC or of

Staged Diabetes Management-decision support (SDM-ds): An internet-based system for clinical decision support

5.84 by implementing PGC. If net costs are considered (per-patient costs--cost savings due to therapy changes), the cost-effectiveness ratios become

Detection and management of hypertension in diabetes: self-monitoring of blood pressure

5.32 for BC and

System und Verfahren zur besseren Verwaltung und Verwendung von Diabetes-Daten mittels drahtloser Konnektivität zwischen Patienten und Gesundheitsleistungsbringern sowie Diabetesverwaltungsinformationsspeicher

4.20 for PGC, assuming the medical changes in therapy were maintained for 12 months. APPLICATIONS These findings suggest that individualized nutrition interventions can be delivered by experienced dietitians with a reasonable investment of resources. Cost-effectiveness is enhanced when dietitians are engaged in active decision making about intervention alternatives based on the patients needs.

Systèmes et méthodes de gestion améliorée de données sur le diabète et utilisation de liaisons sans fil entre les patients et le personnel médical, et un référentiel d'informations de gestion du diabète

PurposeThere is a significant association between insulin resistance and low cardiorespiratory fitness in nondiabetic subjects. In a population with risk factors for type 2 diabetes (T2DM), before they are insulin resistant, we investigated low exercise capacity (VO2max) as an early marker of impaired insulin sensitivity in order to determine earlier interventions to prevent development of insulin resistance syndrome (IRS) and T2DM.MethodsCross-sectional analyses of data on 369 (78 men and 291 women) people at risk for IRS and T2DM, aged 45.6 +/- 10 years (20-65 years) old from the Community Diabetes Prevention Project in Minnesota were carried out. The cardiorespiratory fitness (VO2max) by respiratory gas exchange and bicycle ergometer were measured in our at risk non insulin resistant population and compared with a control group living in the same geographic area. Both groups were equally sedentary, matched for age, gender and BMI.ResultsThe most prevalent abnormality in the study population was markedly low VO2max when compared with general work site screening control group, (n = 177; 137F; 40 M, mean age 40 ± 11 years; BMI = 27.8 ± 6.1 kg/m2). Individuals at risk for IRS and T2DM had a VO2max (22 ± 6 ml/kg/min) 15% lower than the control group VO2max (26 ± 9 ml/kg/min) (p < 0.001). It was foun that VO2max was inversely correlated with HOMA-IR (r = -0.30, p < 0.0001).ConclusionsDecreased VO2max is correlated with impaired insulin sensitivity and was the most prevalent abnormality in a population at risk for IRS and T2DM but without overt disease. This raises the possibility that decreased VO2 max is among the earliest indicators of IRS and T2DM therefore, an important risk factor for disease progression.