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Research indicates that cognitive function is not directly impacted by mild diabetes or impaired glucose tolerance. Patients were identified through oral glucose tolerance tests. After multiple regression analysis was applied to cognition test results and adjusted for factors such as obesity, age, education and depression, no significant correlations were made between blood sugar levels and cognitive function.

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Background:Despite their effectiveness in reducing low-density lipoprotein-cholesterol (LDL-C) and cardiovascular disease (CVD) risk, high-intensity statins are underutilized among patients with LDL-C ≥ 190 mg/dL. We aimed to determine if a patient outreach program (KP Sure Net) automating high-intensity statin orders and lipid panels improved statin initiation and lab completions.Methods:Kaiser Permanente Southern California adults 20-60 years of age with LDL-C ≥ 190 mg/dL and no recent statin use were compared pre- (January 2016-September 2018, n=3,534) and post- (April 2019-July 2021, n=3,555) program implementation to examine statin prescriptions and fills, lab completions, and improved LDL-C (<190 mg/dL) at 6 months. Using Poisson regression with robust variance, we calculated relative risks (RR) and 95% confidence intervals (CI) for the association of program implementation with statin prescriptions, fills, lab completions, and improved LDL-C, separately, adjusting for sociodemographics, insurance, comorbidity burden, and non-statin medication use.Results:Among adults identified during pre- and post-implementation, 759 (21.5%) and 976 (27.5%), respectively, received a statin prescription. Adults with a prescription post- versus pre-implementation were more likely to be younger, identify as Black or Asian ethnicity, be English-speaking and have higher income, but were similar by sex, education, insurance, and comorbidity burden. (Table) After multivariable adjustment, adults post- versus pre-implementation had a higher likelihood of receiving a statin prescription (RR 1.36, 95% CI 1.25, 1.48), filling their statin (RR 1.32, 95% CI 1.26, 1.38), completing their lipid panel (RR 1.60, 95% CI 1.44, 1.78), and improving LDL-C (RR 1.36, 95% CI 1.20, 1.53).Conclusion:Automating statin orders and lipid panels for high-risk adults improved prescription rates, fills and LDL-C. Understanding facilitators and barriers to adherence is an important next step in improving patients’ health.

BACKGROUND Primary nonadherence occurs when new prescriptions are not dispensed. Little is known about how to reduce primary nonadherence. We performed a randomized controlled trial to evaluate an automated system to decrease primary nonadherence to statins for lowering cholesterol. METHODS Adult members of Kaiser Permanente Southern California with no history of statin use within the past year who did not fill a statin prescription after 1 to 2 weeks were passively enrolled. The intervention group received automated telephone calls followed 1 week later by letters for continued nonadherence; the control group received no outreach. The primary outcome was a statin dispensed up to 2 weeks after delivery of the letter. Secondary outcomes included refills at intervals up to 1 year. Intervention effectiveness was determined by intent-to-treat analysis and Fisher exact test. Subgroups were examined using logistic regression. RESULTS There were 2606 participants in the intervention group and 2610 in the control group. Statins were dispensed to 42.3% of intervention participants and 26.0% of control participants (absolute difference, 16.3%; P &lt; .001). The relative risk for the intervention vs control group was 1.63 (95% CI, 1.50-1.76). Intervention effectiveness varied slightly by age (P = .045) but was effective across all age strata. Differences in the frequency of statin dispensations persisted up to 1 year (P &lt; .001). CONCLUSIONS The intervention was effective in reducing primary nonadherence to statin medications. Because of low marginal costs for outreach, this strategy appears feasible for reducing primary nonadherence. This approach may generalize well to other medications and chronic conditions.

Introduction:Sex differences in comorbidities and care received during hospitalization for acute myocardial infarction (AMI) may lead to disparities in short-term outcomes following discharge. We examined the association between sex and 30-day all-cause mortality among adults hospitalized with AMI in a diverse, integrated healthcare delivery system.Methods:We identified 44,142 Kaiser Permanente Southern California members (aged >35 years) with a primary discharge diagnosis of AMI between 2000 and 2014. Incident AMI hospitalization was defined as the first AMI event identified in the electronic health record between 2000 and 2014, with no prior AMI hospitalizations. Death was ascertained from administrative sources, state death data, and Social Security Administration files. We compared characteristics of women and men hospitalized for AMI and estimate relative risks (RR) and 95% confidence intervals (CI) for the association between sex and 30-day all-cause mortality.Results:Women were older and more likely to be black, more likely to have hypertension and chronic obstructive pulmonary disease, and less likely to receive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) during AMI hospitalization compared to men. (Table) Overall, 12.0% of women and 8.9% of men died within 30 days of discharge. After adjustment for age, race, and year of hospitalization women compared to men had an increased likelihood of 30-day mortality (RR 1.08, 95% CI 1.02, 1.14). The addition of comorbidities and AMI type did not change this association (RR 1.09, 95% CI 1.03, 1.15). After additional adjustment for CABG and PCI, men and women had an equal likelihood of 30-day mortality (RR 1.04, 95% CI 0.98, 1.10).Conclusion:Women compared to men had a higher likelihood of 30-day mortality independent of sociodemographic and clinical characteristics. This disparity may be attributable to differences in in-hospital care.