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370. Racial ethnic differences in type 2 diabetes treatment patterns and glycaemic control in the Boston Area Community Health Survey.

Author

Goonesekera, Sunali D., Yang, May H., Hall, Susan A., Fang, Shona C., Piccolo, Rebecca S., and McKinlay, John B.

Abstract

Objectives: Numerous studies continue to report poorer glycaemic control, and a higher incidence of diabetes-related complications among African--Americans and Hispanic--Americans as compared with non-Hispanic Caucasians with type 2 diabetes. We examined racial/ethnic differences in receipt of hypoglycaemic medications and glycaemic control in a highly insured Massachusetts community sample of individuals with type 2 diabetes. Setting: Community-based sample from Boston, Massachusetts, USA. Participants: 682 patients with physician-diagnosed diabetes from the third wave of the Boston Area Community Health Survey (2010-2012). The study included approximately equal proportions of African--Americans, Hispanics and Caucasians. Methods: We examined racial/ethnic disparities in diabetes treatment by comparing proportions of individuals on mutually exclusive diabetes treatment regimens across racial/ethnic subgroups. Using multivariable linear and logistic regression, we also examined associations between race/ethnicity and glycaemic control in the overall population, and within treatment regimens, adjusting for age, gender, income, education, health insurance, health literacy, disease duration, diet and physical activity. Results: Among those treated (82%), the most commonly prescribed antidiabetic regimens were biguanides only (31%), insulin only (23%), and biguanides and insulin (16%). No overall racial/ethnic differences in treatment or glycaemic control (per cent difference for African--Americans: 6.18, 95% CI -1.00 to 13.88; for Hispanic--Americans: 1.01, 95% CI -10.42 to 12.75) were observed. Within regimens, we did not observe poorer glycaemic control for African--Americans prescribed biguanides only, insulin only or biguanides combined with insulin/sulfonylureas. However, African--Americans prescribed miscellaneous regimens had higher risk of poorer glycaemic control (per cent difference=23.37, 95% CI 7.25 to 43.33). There were no associations between glycaemic levels and Hispanic ethnicity overall, or within treatment regimens. Conclusions: Findings suggest a lack of racial/ethnic disparities in diabetes treatment patterns and glycaemic control in this highly insured Massachusetts study population. Future studies are needed to understand impacts of increasing insurance coverage on racial/ethnic disparities in treatment patterns and related outcomes. [ABSTRACT FROM AUTHOR]

Published
2015
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371. Association of Moderate to Severe Lower Urinary Tract Symptoms with Incident Type 2 Diabetes and Heart Disease.

Author

Kupelian, Varant, Araujo, Andre B., Wittert, Gary A., and McKinlay, John B.

Subjects
URINARY tract infections, SYMPTOMS, DISEASE incidence, TYPE 2 diabetes, HEART diseases, EPIDEMIOLOGY, FOLLOW-up studies (Medicine)
Abstract

Purpose Increasing evidence suggests a possible link between lower urinary tract symptoms and chronic illnesses. We determined whether lower urinary tract symptoms are associated with incident type 2 diabetes and heart disease in a population based study. Materials and Methods BACH is a population based epidemiological survey of urological symptoms. A multistage, stratified, cluster sample design was used to obtain a random sample of 4,144 men and women 30 to 79 years old at baseline. Median followup was 4.8 years between baseline (2002 to 2005) and followup (2006 to 2010). Type 2 diabetes and heart disease were assessed by self-report. Lower urinary tract symptoms were assessed by the AUA-SI, and voiding and storage subscores. Logistic regression was used to estimate the OR and 95% CI, and adjust for potential confounders. Results In participants with a body mass index of 30 kg/m 2 or greater the adjusted ORs for incident heart disease were 1.89 (95% CI 1.05, 3.39) for AUA-SI 8 or greater and 2.32 (95% CI 1.33, 4.05) for a storage score of 4 or greater. In participants with abdominal obesity the adjusted ORs for incident type 2 diabetes were 2.06 (95% CI 1.19, 3.55) for AUA-SI 8 or greater and 1.81 (95% CI 1.04, 3.15) for a storage score of 4 or greater. Lower urinary tract symptoms (AUA-SI 8 or greater) were also predictive of type 2 diabetes in men and women younger than 50 years (adjusted OR 2.37, 95% CI 1.18, 4.80). Conclusions Longitudinal results of BACH suggest that lower urinary tract symptoms are a marker of increased risk for type 2 diabetes and heart disease in obese men and women. The increased risk in younger men and women suggests that lower urinary tract symptoms may be an indicator of impending disease. [ABSTRACT FROM AUTHOR]

Published
2015
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372. Associations between supplemental or dietary intake of vitamin C and severity of lower urinary tract symptoms.

Author

Curto, Teresa M., Giovannucci, Edward L., McKinlay, John B., and Maserejian, Nancy N.

Subjects
PHYSIOLOGICAL effects of vitamin C, DIETARY supplements, PREVENTION of disease progression, URINARY tract infections, OVERACTIVE bladder, PHYSIOLOGY
Abstract

Objective To examine the association between long-term dietary vitamin C intake and recent use of vitamin C supplements with the progression and severity of lower urinary tract symptoms ( LUTS). Participants and Methods Baseline and 5-year follow-up interviews were completed by 2825 black, Hispanic or white men and women aged 30-79 years in the Boston Area Community Health survey. Dietary and supplemental vitamin C intake was assessed using a validated food frequency questionnaire. LUTS were assessed using the validated American Urological Association Symptom Index. Multivariable models were used to test the associations between baseline vitamin C and progression of LUTS over the follow-up period, and between recent vitamin C intake and LUTS severity. Results In multivariable models, baseline dietary vitamin C was associated with lower odds of progression of daytime storage symptoms in men (e.g. quartile 4 vs 1, odds ratio [ OR] = 0.63, 95% confidence interval [ CI]: 0.41-0.97), or urgency symptoms in women ( P trend = 0.02). Recent vitamin C intake at follow-up was also associated with better symptom scores among men. In contrast, among women, vitamin C supplement intake was associated with worse symptom scores, particularly daytime storage problems (500 mg/day vs none, OR = 1.66, 95% CI: 1.18-2.35, P trend = 0.01). Recent dietary vitamin C was not associated with LUTS in women. Conclusion Vitamin C intake from foods and beverages was inversely associated with progression of daytime urinary storage symptoms in men or urgency symptoms in women at 5-year follow-up, therefore, the present results do not support a widespread avoidance for patients with LUTS of foods and beverages naturally rich in vitamin C. Supplemental vitamin C use above recommended daily intake levels was associated with higher odds of daytime urinary storage symptoms in women, and this finding is worthy of further attention and confirmation in future clinical trials. [ABSTRACT FROM AUTHOR]

Published
2015
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399. How are patient characteristics relevant for clinical decisions in diabetes?: Results from a cross-national experiment.

Author

Lutfey, Karen E., Campbell, Stephen M., Renfrew, Megan R., Marceau, Lisa D., Roland, Martin, and McKinlay, John B.

Subjects
MEDICAL consultation, DECISION making, DIABETES, PHYSICIAN-patient relations
Abstract

Variations in medical practice have been widely documented and are a linchpin in explanations of health disparities. Evidence shows that clinical decision making (CDM) varies according to patient, provider and health system (country) characteristics. However, little is known about the cognitive processes involved when physicians choose treatment plans, and how various patient characteristics influence their decisions. We analyze open-ended, qualitative interview data from 244 physicians to examine how treatment decisions are made and which patient characteristics physicians identify as relevant for their clinical decision making for patients with diagnosed diabetes. These data are from a factorial experiment using videotaped vignettes to measure simultaneously the effects of: (a) patient attributes (age, gender, race and socioeconomic status); (b) physician characteristics (gender and years of clinical experience); and (c) features of the healthcare system in two countries (United States, United Kingdom) on clinical decision making for diabetes. We find that physicians used patients' demographic characteristics as a starting point for more detailed assessments about cognitive ability, motivation, social support and other factors they consider predictive of adherence with medical recommendations. Our results show that physicians consider a wide range of issues when making treatment decisions and rely more universally on perceived social, cognitive, and psychological characteristics of patients than traditional biophysiologic markers of risk factors such as race, gender, and age. Types of explanations varied somewhat according to the patient characteristics in the vignette that was viewed, and we also observed minor differences according to the country in which the interview took place. Overall, these results show that basic demographic characteristics do not adequately capture the patient information physicians draw from doctor-patient encounters that leads to differential clinical decision making. [ABSTRACT FROM AUTHOR]

Published
2008

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