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  • Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults

    Abstract Full Text
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    JAMA Intern Med. 2018; doi: 10.1001/jamainternmed.2017.8094

    This cross-sectional, nationally representative, population-based study determines the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics.

  • Association of Baseline Statin Use Among Older Adults Without Clinical Cardiovascular Disease in the SPRINT Trial

    Abstract Full Text
    online first
    JAMA Intern Med. 2018; doi: 10.1001/jamainternmed.2017.7844

    This secondary analysis of the Systolic Blood Pressure Intervention trial examines whether a treatment program aimed at reducing systolic blood pressure to a lower goal than currently recommended would reduce cardiovascular disease risk among patients without diabetes.

  • Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study

    Abstract Full Text
    online first
    JAMA Intern Med. 2018; doi: 10.1001/jamainternmed.2017.7978

    This 30-year prospective cohort study examines the association between lactation and progression to diabetes using biochemical testing both before and after pregnancy, accounting for prepregnancy cardiometabolic measures, gestational diabetes, and lifestyle behaviors.

  • JAMA Internal Medicine January 2, 2018

    Figure 2: Gabapentinoid Use by Subgroups, 2002 Through 2015

    The figure identifies the proportion of gabapentinoid users among adults stratified by age (<65 vs ≥65 years), presence of diabetes, Elixhauser comorbidity index, and concomitant use of opioids (0-2 and ≥3 prescriptions) and benzodiazepines (any benzodiazepine prescription).
  • JAMA Internal Medicine January 1, 2018

    Figure: Flowchart of Patients in the Study

    Cohort criteria included receiving a prescription for ramipril or telmisartan between January 2003 (start of available data) and September 2009 (prior to the Food and Drug Administration approval of the supplemental indication). ACE-I indicates angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CAD, coronary artery disease; CHF, congestive heart failure; CVD, cerebrovascular disease; MI, myocardial infarction; PAD, peripheral arterial disease; PCI, percutaneous coronary intervention; T2DM, type 2 diabetes mellitus; and TIA, transient ischemic attack.
  • JAMA Internal Medicine December 26, 2017

    Figure: Cumulative Incidence of Dysglycemia During Hospice Admission

    Cumulative incidence of severe hypoglycemia (glucose <50 mg/dL [to convert to mmol/L, multiply by 0.0555]), hypoglycemia (glucose <70 mg/dL) and hyperglycemia (glucose ≥400 mg/dL) in (A) all veteran patients with type 2 diabetes on hospice in nursing homes; (B) hospice patients treated with insulin; and (C) hospice patients not treated with insulin. Each outcome is shown with competing risk of death over 180 days.
  • Hypoglycemia in Hospice Patients With Type 2 Diabetes in a National Sample of Nursing Homes

    Abstract Full Text
    online first
    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.7744

    This retrospective cohort study examines whether patients with type 2 diabetes on hospice are assessed for dysglycemia, receive insulin or oral hypoglycemic medications, or experience hypoglycemia and hyperglycemia in the nursing home setting.

  • JAMA Internal Medicine December 18, 2017

    Figure: Variation in the Share of Intensification vs Deintensification Recommendations

    Guidelines for cardiovascular disease management included ischemic heart disease, hypertension, hyperlipidemia, heart failure, atrial fibrillation, acute coronary syndrome, myocardial infarction, and cognitive or mental health sequelae. The evidence strength of the recommendations was based on the evidence ratings provided by the guideline developers. Recommendations were drawn from the following guidelines (N = 22 total guidelines). American Diabetes Association (n = 1): Standards of Medical Care in Diabetes—2016 (2016). Eighth Joint National Committee (n = 1): Management of High Blood Pressure in Adults. American Geriatrics Society (n = 1): Improving the Care of Older Adults With Diabetes Mellitus: 2013 Update (2013). Veterans Health Administration (n = 2): Diagnosis and Management of Hypertension in the Primary Care Setting (2014); Management of Dyslipidemia for Cardiovascular Risk Reduction (2014). US Preventive Services Task Force (n = 6): Screening for Coronary Heart Disease With Electrocardiography (2012); Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer (2014); Screening for High Blood Pressure in Adults (2015); Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus (2015); Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (2015; draft); Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication (2015; draft). American College of Cardiologists/American Heart Association (n = 9): Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease (2011); Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women (2011); Diagnosis and Management of Patients With Stable Ischemic Heart Disease (2012; jointly issued with the American College of Physicians); Assessment of Cardiovascular Risk (2013); Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013); Management of Heart Failure (2013); Management of Patients With Atrial Fibrillation (2014); Management of Adult Patients With Supraventricular Tachycardia (2015; only for the recommendations related to atrial fibrillation); Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (2016). American College of Physicians (n = 3): Diagnosis and Management of Patients With Stable Ischemic Heart Disease (2012; jointly issued with the American College of Cardiologists/American Heart Association); Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus (2012); Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging (2015).
  • An Examination of Deintensification Recommendations in Clinical Practice Guidelines: Stepping Up or Scaling Back?

    Abstract Full Text
    online first
    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.7198

    In light of initiatives to decrease use of unnecessary services, this article examines whether current guidelines for diabetes and cardiovascular disease preferentially recommend intensification rather than deintensification of care.

  • JAMA Internal Medicine December 1, 2017

    Figure 2: Relative Risks (RRs) and Diabetes Incidence Rates Among Lifestyle Modification Intervention Studies Stratified by Intervention Strategy at the End of the Active Intervention Period

    Nineteen studies including 24 comparisons were analyzed. Active intervention mean (SD) duration was 2.6 (1.7) years (range, 0.5-6.0 years). Overall RR is the pooled effect for all studies; subgroup RR is the pooled effect for a subgroup of studies. DPP indicates Diabetes Prevention Program; DPS, Diabetes Prevention Study; EDIPS, European Diabetes Prevention Study; IDPP, Indian Diabetes Prevention Programme; and SLIM, Study on Lifestyle-Intervention and Impaired Glucose Tolerance Maastricht.aSecond arm of the same study.bThird arm of the same study.
  • JAMA Internal Medicine December 1, 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 December 1, 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.
  • JAMA Internal Medicine December 1, 2017

    Figure 3: Relative Risks (RRs) and Diabetes Incidence Rates Among Medication Studies Stratified by Drug Class at the End of the Active Intervention Period

    Twenty-one studies including 24 comparisons were analyzed. Active treatment mean (SD) duration was 3.1 (1.5) years (range, 1.0-6.3 years). Overall RR is the pooled effect for all studies; subgroup RR is the pooled effect for a subgroup of studies. ACE indicates angiotensin-converting enzyme; ACT NOW, Actos Now for Prevention of Diabetes; BIP, Bezafibrate Infarction Prevention Study; CANOE, Canadian Normoglycemia Outcomes Evaluation; DAISI, Dutch Acarbose Intervention Study in Persons With Impaired Glucose Tolerance; DIANA, Diabetes and Diffuse Coronary Narrowing; DPP, Diabetes Prevention Program; DREAM, Diabetes Reduction Assessment With Ramipril and Rosiglitazone Medication; ER, extended release; HERS, Heart and Estrogen/progestin Replacement Study; IDPP, Indian Diabetes Prevention Programme; NAVIGATOR, Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research; ORIGIN, Outcome Reduction With Initial Glargine Intervention; RAS, renin-angiotensin system; STOP-NIDDM, Study to Prevent Non–Insulin-Dependent Diabetes Mellitus; TRANSCEND, Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease; and XENDOS, Xenical in the Prevention of Diabetes in Obese Subjects.aSecond arm of the same study.
  • Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials

    Abstract Full Text
    JAMA Intern Med. 2017; 177(12):1808-1817. 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; 177(12):1735-1742. 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
    JAMA Intern Med. 2017; 177(12):1755-1764. 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 November 20, 2017

    Figure: Flowchart of Patients in the Study

    Cohort criteria included receiving a prescription for ramipril or telmisartan between January 2003 (start of available data) and September 2009 (prior to the Food and Drug Administration approval of the supplemental indication). ACE-I indicates angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CAD, coronary artery disease; CHF, congestive heart failure; CVD, cerebrovascular disease; MI, myocardial infarction; PAD, peripheral arterial disease; PCI, percutaneous coronary intervention; T2DM, type 2 diabetes mellitus; and TIA, transient ischemic attack.
  • JAMA Internal Medicine November 13, 2017

    Figure: Readmission Rates Before and After the Hospital Readmission Reduction Program (HRRP)

    Anemia indicates deficiency anemia; diabetes, diabetes, uncomplicated; fluid/electrolytes, fluid and electrolyte disorders; heart failure, congestive heart failure; hypertension, hypertension, complicated and uncomplicated; neurologic, other neurologic disorders; peripheral vascular, peripheral vascular disorders; pulmonary, chronic pulmonary disease; and renal, renal failure.
  • 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.