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  • Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials

    Abstract Full Text
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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.6040

    This meta-analysis examines the use of medications and lifestyle modifications to reduce the progression to diabetes in persons with diabetes risks.

  • Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women

    Abstract Full Text
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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.2790

    This cohort study of US women participating in the Nurses’ Health Study II prospectively evaluates the association of a history of gestational diabetes with incident cardiovascular risk.

  • Cost-effectiveness of Testing and Treatment for Latent Tuberculosis Infection in Residents Born Outside the United States With and Without Medical Comorbidities in a Simulation Model

    Abstract Full Text
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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.3941

    This cohort simulation model evaluates the use of tests and treatment of latent tuberculosis infection in residents born outside the United States.

  • JAMA Internal Medicine October 16, 2017

    Figure 2: Effect of Tuberculin Skin Test (TST) Return and Latent Tuberculosis Infection (LTBI) Prevalence on Cost-effectiveness Conclusions in Non–US Born Patients

    A, A 1-way sensitivity analysis demonstrating the effect of TST return on the cost-effectiveness conclusions for interferon gamma release assay (IGRA) testing and IGRA plus TST for sensitivity testing. B, An illustration of the effect of LTBI prevalence on cost-effectiveness conclusions for IGRA testing and confirm negative testing. In the confirm negative strategy, patients first underwent IGRA. If that test was positive, LTBI was diagnosed. If that test was negative, then the patient underwent TST. LTBI was ruled out only if both tests were negative. For each risk population, there is a unique LTBI prevalence above which IGRA requires more investment to gain the same amount of quality-adjusted life-years (QALYs) than confirm negative. Above this point, IGRA is excluded from consideration as a viable strategy and thus is not represented in the figure. The apparent discontinuity at high prevalence (>90% non–US born patients with diabetes, >80% non–US born individuals with no comorbidities) emerges when confirm negative is not only a cost-effective strategy but becomes more favorable than other, less costly strategies. Incremental cost-effectiveness ratios (ICERs) are calculated against the next-best alternative strategy and are shown in 2015 US dollars per QALY gained. End-stage renal disease was excluded from this figure because it is cost-ineffective.
  • JAMA Internal Medicine October 16, 2017

    Figure 3: Cost-effectiveness Acceptability Curves Representing the Proportion of Simulations for Which Each Strategy Was Preferred at a Given Willingness-to-Pay Threshold

    Probabilistic sensitivity analysis was performed on reactivation rate, LTBI prevalence, and test characteristics in non–US born persons with no comorbidities (A), those with HIV (B), individuals with diabetes (C), and those with end-stage renal disease (D). IGRA indicates interferon gamma release assay; TST, tuberculin skin test.
  • Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use

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    JAMA Intern Med. 2017; 177(10):1461-1470. doi: 10.1001/jamainternmed.2017.3844

    This study develops and validates a risk stratification tool to categorize risk of future hypoglycemia-related emergency department or hospital use in patients with type 2 diabetes.

  • JAMA Internal Medicine October 1, 2017

    Figure 2: Unmet Need for Prescription Drugs Among Adults Uninsured Throughout Year 1

    Estimates from multivariable linear probability model controlling for the effects of age, sex, and race/ethnicity in year 1 and time-varying measures of household income as a percentage of the federal poverty line, self-reported health, and number chronic conditions (coronary heart disease, angina, myocardial infarction, other heart disease, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma). Decrease in unmet need for those gaining health insurance in Year 2 was significantly greater than for the continuously uninsured.
  • JAMA Internal Medicine October 1, 2017

    Figure 4: Effect of More Intensive Blood Pressure (BP) Lowering on Risk of Mortality in Patients With Chronic Kidney Disease Stratified by Subgroups

    Shown are the results among adults with estimated glomerular filtration rate less than 60 mL/min/1.73 m2. Among the 18 trials, only 12 included individuals with diabetes. BP indicates blood pressure; SBP, systolic blood pressure.
  • JAMA Internal Medicine October 1, 2017

    Figure 1: Unmet Need for Prescription Drugs Among Adults Insured Throughout Year 1

    Estimates from multivariable linear probability model controlling for the effects of age, sex, and race/ethnicity in year 1 and time-varying measures of household income as a percentage of the federal poverty line, self-reported health, and number of chronic conditions (coronary heart disease, angina, myocardial infarction, other heart disease, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma). Increase in unmet need for those losing health insurance in Year 2 was significantly greater than for the continuously insured.
  • JAMA Internal Medicine October 1, 2017

    Figure 1: Classification Tree for Hypoglycemia-Related Emergency Department (ED) or Hospital Use

    Hypoglycemic-related utilization was defined by having any ED visit with a primary diagnosis of hypoglycemia or a hospitalization with a principal diagnosis of hypoglycemia. Hypoglycemia cases were ascertained with any of the following International Classification of Diseases, Ninth Revision, codes: 251.0, 251.1, 251.2, 962.3, or 250.8, without concurrent 259.8, 272.7, 681.XX, 682.XX, 686.9X, 707.1-707.9, 709.3, 730.0-730.2, or 731.8 codes. The classification tree was developed using the 808 out of 165 148 T2D adults (derivation sample) from Kaiser Permanente who had such utilization (4.9 events per 1000 person-years) in 2014. The classification is based on 6 predictor variables from the electronic medical record and resulted in 10 mutually exclusive leaf nodes. The criterion for each node is displayed with the corresponding number of individuals (n) who met that criterion. The 12-month observed rate of any hypoglycemia-related ED or hospital use is displayed in each leaf node and categorized as high (>5% risk), intermediate (1%-5% risk), or low risk (<1% risk). CKD indicates chronic kidney disease.
  • Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

    Abstract Full Text
    JAMA Intern Med. 2017; 177(9):1354-1360. doi: 10.1001/jamainternmed.2017.2922

    This cohort study assesses the performance of a lifestyle-based risk tool to estimate atherosclerotic cardiovascular disease events over 25 years in adults before 55 years of age.

  • The Importance of Independent Evaluation

    Abstract Full Text
    JAMA Intern Med. 2017; 177(9):1343-1343. doi: 10.1001/jamainternmed.2017.3044
  • Association Between Extending CareFirst’s Medical Home Program to Medicare Patients and Quality of Care, Utilization, and Spending

    Abstract Full Text
    JAMA Intern Med. 2017; 177(9):1334-1342. doi: 10.1001/jamainternmed.2017.2775

    This difference-in-differences analysis tests whether extending CareFirst’s program to Medicare fee-for-service patients improves care processes and reduces hospitalizations, emergency department visits, and spending.

  • JAMA Internal Medicine August 1, 2017

    Figure: Subgroup Analyses of Effect of Cardiac Testing Per 1000 Patients at 1 Year

    Results are presented as the change in outcome associated with performing testing in 1000 patients (standard error) in each subgroup, estimated using the average marginal effect for each subgroup. Presented P values are the difference between the average marginal effects in paired subgroups (ie, women and men) in 1000 bootstrapped samples. Cardiac testing includes either noninvasive test (exercise electrocardiography, stress echocardiography, myocardial perfusion scan, and cardiac computed tomographic angiography) or coronary angiography. Analyses were adjusted for age; sex; comorbid conditions (diabetes, hypertension, hyperlipidemia, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, tobacco use); and history of ischemic heart disease, noninvasive test in the previous year, coronary angiography in the previous year, antiplatelet medication use, and antihyperlipidemic medication use. Revascularization is either coronary artery bypass graft surgery or percutaneous coronary intervention. AMI indicates acute myocardial infarction; ED, emergency department. Error bars indicate standard error.
  • Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial

    Abstract Full Text
    JAMA Intern Med. 2017; 177(7):948-954. doi: 10.1001/jamainternmed.2017.0926

    This randomized clinical trial of Latino adults with poorly controlled type 2 diabetes compares the effect of a community health worker intervention vs enhanced usual care on blood pressure, LDL cholesterol, and hemoglobin A1c levels.

  • Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial

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    JAMA Intern Med. 2017; 177(7):920-929. doi: 10.1001/jamainternmed.2017.1233

    This randomized trial compares 3 approaches of self-monitoring of blood glucose levels for effects on hemoglobin A1c levels and health-related quality of life among patients with non–insulin-treated type 2 diabetes in primary care practice.

  • The Need to Test Strategies Based on Common Sense

    Abstract Full Text
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    JAMA Intern Med. 2017; 177(7):929-929. doi: 10.1001/jamainternmed.2017.1251
  • Thiazolidinediones and Advanced Liver Fibrosis in Nonalcoholic Steatohepatitis: A Meta-analysis

    Abstract Full Text
    JAMA Intern Med. 2017; 177(5):633-640. doi: 10.1001/jamainternmed.2016.9607

    This meta-analysis synthesizes the evidence about the association of thiazolidinedione therapy with advanced liver fibrosis in nonalcoholic steatohepatitis.

  • Association of Patient-Physician Language Concordance and Glycemic Control for Limited–English Proficiency Latinos With Type 2 Diabetes

    Abstract Full Text
    JAMA Intern Med. 2017; 177(3):380-387. doi: 10.1001/jamainternmed.2016.8648

    This pre-post, differences-in-differences study evaluates the changes in risk factor control among limited–English proficiency Latinos with diabetes who switched from language-discordant (English-only) primary care physicians (PCPs) to language-concordant (Spanish-speaking) PCPs.

  • JAMA Internal Medicine March 1, 2017

    Figure: Randomized Clinical Trials of Drugs for Type 2 Diabetes With a Primary Cardiovascular Outcome

    Number of patients assigned to each drug class in randomized clinical trials of drugs for type 2 diabetes with a primary cardiovascular outcome, based on a search of clinicaltrials.gov from inception to November 3, 2016. The UKPDS study, which predated the registry, is also included. The height of each bar represents the number of patients randomized.