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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 40 Research Studies DisplayedJiang DH, Mundell BF, Shah ND
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
The authors sought to provide a systematic literature review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes. They found that, although HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence.
AHRQ-funded; HS025517; HS024075; HS025164; HS025402.
Citation: Jiang DH, Mundell BF, Shah ND .
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
Endocr Pract 2021 Nov;27(11):1156-64. doi: 10.1016/j.eprac.2021.07.001..
Keywords: Health Insurance, Diabetes, Chronic Conditions, Outcomes, Quality of Care, Patient-Centered Outcomes Research
Rosas LG, Lv N, Xiao L
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. The purpose of this study was to determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. The investigators concluded that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
JAMA Netw Open 2020 Dec;3(12):e2027744. doi: 10.1001/jamanetworkopen.2020.27744..
Keywords: Racial and Ethnic Minorities, Obesity: Weight Management, Obesity, Cultural Competence, Diabetes, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Presley C, Agne A, Shelton T
Mobile-enhanced peer support for African Americans with Type 2 diabetes: a randomized controlled trial.
This study compared the effectiveness of a community-based diabetes self-management education (DSME) plus mobile health (mHealth)-enhanced peer support intervention to community-based DSME alone for African American adults with poorly controlled type 2 diabetes. This randomized controlled trial took place in Jefferson County, Alabama within a safety-net healthcare system with a group diagnosed with type 2 diabetes and hemoglobin A1C ≥ 7.5%. The intervention group reviewed community-based DSME plus 6 months of mHealth-enhanced peer support, including 12 weekly phone calls, then 3 monthly calls from community health workers. The control group received community based DSME only. Primary outcomes were lower A1C and secondary outcomes were lower diabetes distress, depressive symptoms, self-efficacy or confidence in their ability to manage diabetes, and social support. Of 120 participants selected, 97 completed the study. Both groups experienced clinical meaning reduction in A1C. Participants in the intervention group experienced a significantly larger reduction in diabetes distress compared to the control group.
AHRQ-funded; HS019465.
Citation: Presley C, Agne A, Shelton T .
Mobile-enhanced peer support for African Americans with Type 2 diabetes: a randomized controlled trial.
J Gen Intern Med 2020 Oct;35(10):2889-96. doi: 10.1007/s11606-020-06011-w..
Keywords: Telehealth, Health Information Technology (HIT), Patient Self-Management, Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Community-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Education: Patient and Caregiver
McCoy RG, Lipska KJ, Van Houten HK
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
Researchers examined contemporary patterns of glycemic control and use of medications known to cause hypoglycemia among adults with diabetes across age and multimorbidity. They found that the proportion of patients achieving low HbA1c levels was highest among older and multimorbid patients. Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve these HbA1c levels despite the potential for hypoglycemia and uncertain long-term benefit.
AHRQ-funded; HS024075.
Citation: McCoy RG, Lipska KJ, Van Houten HK .
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
BMJ Open Diabetes Res Care 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-001007..
Keywords: Diabetes, Medication, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Evidence-Based Practice, Risk, Chronic Conditions
Barry-Menkhaus SA, Wagner DV, Riley AR
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
In this article, the authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions among youth with type 1 diabetes.
AHRQ-funded; HS022981.
Citation: Barry-Menkhaus SA, Wagner DV, Riley AR .
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
Curr Diab Rep 2020 Jan 30;20(1):3. doi: 10.1007/s11892-020-1290-7..
Keywords: Diabetes, Patient-Centered Healthcare, Patient Self-Management, Patient Adherence/Compliance, Care Management, Patient-Centered Outcomes Research, Healthcare Delivery, Children/Adolescents
Badawy SM, Payne AB
Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus.
This study tested the hypothesis that metformin use for treatment of diabetes mellitus is associated with fewer sickle cell disease (SCD) adverse outcomes and lower health care utilization among patients with SCD and diabetes mellitus. This retrospective cohort study used data from MarketScan Medicaid claims for 2006 to 2016. SCD patients who were metformin users and nonusers were compared. Patients on hydroxyurea, insulin, or iron chelation were excluded. Metformin was found to be associated with significantly fewer inpatient and emergency department encounters in adults with SCD and diabetes mellitus.
AHRQ-funded; HS023011.
Citation: Badawy SM, Payne AB .
Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus.
Blood Adv 2019 Nov 12;3(21):3297-306. doi: 10.1182/bloodadvances.2019000838..
Keywords: Sickle Cell Disease, Diabetes, Chronic Conditions, Medication, Outcomes, Patient-Centered Outcomes Research
Zullo AR, Hersey M, Lee Y
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
This study analyzed outcomes of using beta-blockers that are considered “diabetes-friendly” vs “diabetes-unfriendly” in older nursing home residents with diabetes after acute myocardial infarction (AMI). Primary outcomes included hospitalizations for hypoglycemia and hyperglycemia in the 90 days after AMI and secondary outcomes functional decline, death, all-cause re-hospitalization and fracture hospitalization. Out of 2855 nursing home residents with type-2 diabetes (T2D), 29% were prescribed a diabetes-friendly beta-blocker vs. 24% without. T2D medicine showed a reduction in hospitalization for hyperglycemia but was unassociated with hypoglycemia. For secondary outcomes T2D-friendly beta-blocks were associated with a greater rate of re-hospitalization but not death, functional decline, or fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Hersey M, Lee Y .
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
Diabetes Obes Metab 2018 Dec;20(12):2724-32. doi: 10.1111/dom.13451..
Keywords: Cardiovascular Conditions, Diabetes, Elderly, Heart Disease and Health, Hospitalization, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Flory JH, Keating SJ, Siscovick D
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
Non-persistence may be a significant barrier to the use of metformin. The objective of this study was to assess reasons for metformin non-persistence, and whether initial metformin dosing or use of extended release (ER) formulations affect persistence to metformin therapy. The investigators concluded that their data supported the routine prescribing of low starting doses of metformin as a tool to improve persistence.
AHRQ-funded; HS023898.
Citation: Flory JH, Keating SJ, Siscovick D .
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
BMJ Open 2018 Jul 23;8(7):e021505. doi: 10.1136/bmjopen-2018-021505..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Adherence/Compliance, Outcomes, Patient-Centered Outcomes Research, Risk
Hedderson MM, Brown SD, Ehrlich SF
A tailored letter based on electronic health record data improves gestational weight gain among women with gestational diabetes mellitus: the Gestational Diabetes' Effects on Moms (GEM) cluster-randomized controlled trial.
The purpose of this study was to evaluate whether a tailored letter improved gestational weight gain (GWG) and whether GWG mediated a multicomponent intervention's effect on postpartum weight retention among women with gestational diabetes mellitus (GDM). The authors concluded that a tailored electronic health record-based letter improved GWG, which mediated the effect of a multicomponent intervention in reducing postpartum weight retention.
AHRQ-funded; HS019367.
Citation: Hedderson MM, Brown SD, Ehrlich SF .
A tailored letter based on electronic health record data improves gestational weight gain among women with gestational diabetes mellitus: the Gestational Diabetes' Effects on Moms (GEM) cluster-randomized controlled trial.
Diabetes Care 2018 Jul;41(7):1370-77. doi: 10.2337/dc17-1133..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Lifestyle Changes, Patient-Centered Outcomes Research, Pregnancy, Women
Pantalone KM, Misra-Hebert AD, Hobbs TM
Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set.
The failure of clinicians to intensify therapy when clinically indicated has been termed “clinical inertia.” This paper discusses clinical inertia in diabetes 2 management.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set.
Diabetes Care 2018 Jul;41(7):e113-e14. doi: 10.2337/dc18-0116..
Keywords: Care Management, Diabetes, Patient-Centered Outcomes Research
Havele SA, Pfoh ER, Yan C
Physicians' views of self-monitoring of blood glucose in patients with type 2 diabetes not on insulin.
This qualitative study examines to what extent and why physicians still prescribe self-monitoring of blood glucose in patients with non-insulin-treated type 2 diabetes when the evidence shows it increases cost without improving hemoglobin A1c, general well-being, or health-related quality of life.
AHRQ-funded; HS024128.
Citation: Havele SA, Pfoh ER, Yan C .
Physicians' views of self-monitoring of blood glucose in patients with type 2 diabetes not on insulin.
Ann Fam Med 2018 Jul;16(4):349-52. doi: 10.1370/afm.2244..
Keywords: Diabetes, Evidence-Based Practice, Ambulatory Care and Surgery, Patient-Centered Outcomes Research, Patient Self-Management
Veazie S, Winchell K, Gilbert J
Rapid evidence review of mobile applications for self-management of diabetes.
The study authors conducted a rapid evidence review to examine features, clinical efficacy, and usability of apps for self-management of type 1 and type 2 diabetes in adults. The investigators found limited evidence suggesting that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes was unclear.
AHRQ-funded; 29020120004C; 290201700003C.
Citation: Veazie S, Winchell K, Gilbert J .
Rapid evidence review of mobile applications for self-management of diabetes.
J Gen Intern Med 2018 Jul;33(7):1167-76. doi: 10.1007/s11606-018-4410-1..
Keywords: Diabetes, Evidence-Based Practice, Patient-Centered Outcomes Research, Patient Self-Management
Misra-Hebert AD, Pantalone KM, Ji X
Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015.
hospitalizations for hypoglycemia, in patients with type 2 diabetes receiving care in a large health system and to identify patient characteristics associated with severe hypoglycemia events. The study found that patients with severe hypoglycemia had previous nonsevere hypoglycemia diagnoses more frequently than those without.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Pantalone KM, Ji X .
Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015.
Diabetes Care 2018 Jun;41(6):1164-71. doi: 10.2337/dc17-1834.
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Keywords: Diabetes, Medication, Patient-Centered Outcomes Research
Pantalone KM, Misra-Hebert AD, Hobbs TM
Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes.
The aim of the present study was to assess the longitudinal accumulation of diabetes-related complications and the effect of glycemic control on the Diabetes Complications Severity Index (DCSI) score in people with newly diagnosed type 2 diabetes (T2D). The study concluded that baseline glycemic control had no apparent effect on longitudinal changes in DCSI score. Worsening or persistently poor glycemic control was associated with an increased risk of an increase in the DCSI score.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes.
J Diabetes 2018 Mar;10(3):192-99. doi: 10.1111/1753-0407.12613..
Keywords: Diabetes, Patient-Centered Outcomes Research, Risk
Misra-Hebert AD, Hu B, Le PH
Effect of health plan financial incentive offering on employees with prediabetes.
Researchers studied the effect of employee health plan financial incentives on health outcomes for employees with prediabetes. They found that employees who participated in disease management lost more weight than those who did not. A worksite wellness program offering health plan financial incentives for participation and outcomes was associated with improvements not only in weight but also in HbA1c.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Le PH .
Effect of health plan financial incentive offering on employees with prediabetes.
Am J Med 2018 Mar;131(3):293-99. doi: 10.1016/j.amjmed.2017.09.024.
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Keywords: Healthcare Costs, Patient-Centered Outcomes Research, Patient Self-Management, Obesity: Weight Management, Diabetes, Health Status
Evaristo E, Stocco FG, Shah NR
Ranolazine reduces repolarization heterogeneity in symptomatic patients with diabetes and non-flow-limiting coronary artery stenosis.
In symptomatic diabetic patients with non-flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, the authors explored whether ranolazine reduces T-wave heterogeneity (TWH). They found that, in the studied population, ranolazine reduced TWH at rest but not during exercise; reduction in repolarization abnormalities appears to be independent of alterations in myocardial blood flow.
AHRQ-funded; HS022998.
Citation: Evaristo E, Stocco FG, Shah NR .
Ranolazine reduces repolarization heterogeneity in symptomatic patients with diabetes and non-flow-limiting coronary artery stenosis.
Ann Noninvasive Electrocardiol 2018 Jan;23(1). doi: 10.1111/anec.12480.
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Keywords: Cardiovascular Conditions, Diabetes, Medication, Patient-Centered Outcomes Research
Cooper LB, Lippmann SJ, Greiner MA
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
Perceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (MRA) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease. In their study, the investigators found that among patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all-cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.
AHRQ-funded; HS021092.
Citation: Cooper LB, Lippmann SJ, Greiner MA .
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
J Am Heart Assoc 2017 Dec 23;6(12):pii: e006540. doi: 10.1161/jaha.117.006540..
Keywords: Cardiovascular Conditions, Chronic Conditions, Diabetes, Evidence-Based Practice, Heart Disease and Health, Kidney Disease and Health, Outcomes, Patient-Centered Outcomes Research, Registries
Ehrlich SF, Hedderson MM, Brown SD
Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes.
The aim of the study was to assess the association of regular, unsupervised sports and exercise during pregnancy, by intensity level, with glycaemic control in women with gestational diabetes (GDM). The study concluded that higher volumes of moderate intensity sports and exercise, reported shortly after GDM diagnosis, were significantly associated with increased odds of achieving glycaemic control.
AHRQ-funded; HS019367.
Citation: Ehrlich SF, Hedderson MM, Brown SD .
Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes.
Diabetes Metab 2017 Oct;43(5):416-23. doi: 10.1016/j.diabet.2017.01.006..
Keywords: Diabetes, Lifestyle Changes, Outcomes, Patient-Centered Outcomes Research, Pregnancy, Women
Shortell SM, Poon BY, Ramsay PP
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
For adult primary care practices seeing patients with diabetes and/or cardiovascular disease, researchers examined the relationship between selected practice characteristics, patient engagement, and patient-reported outcomes of care. They found that having a patient-centered culture was positively associated with fewer depression symptoms and better physical function scores. Patient activation was positively associated with fewer depression symptoms.
AHRQ-funded; HS024075.
Citation: Shortell SM, Poon BY, Ramsay PP .
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
J Gen Intern Med 2017 Jun;32(6):640-47. doi: 10.1007/s11606-016-3980-z.
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Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Primary Care, Chronic Conditions, Diabetes, Cardiovascular Conditions
Waldfogel JM, Nesbit SA, Dy SM
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review.
This review systematically assessed the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. It concluded that for reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks.
AHRQ-funded; 2902015000061.
Citation: Waldfogel JM, Nesbit SA, Dy SM .
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review.
Neurology 2017 May 16;88(20):1958-67. doi: 10.1212/wnl.0000000000003882.
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Keywords: Diabetes, Chronic Conditions, Medication, Quality of Life, Patient-Centered Outcomes Research
Shah NR, Cheezum MK, Veeranna V
Ranolazine in symptomatic diabetic patients without obstructive coronary artery disease: impact on microvascular and diastolic function.
The primary aim of this study was to determine whether ranolazine would quantitatively improve exercise-stimulated myocardial blood flow and cardiac function in symptomatic diabetic patients without obstructive coronary artery disease. The investigators found that in symptomatic diabetic patients without obstructive coronary artery disease, ranolazine did not change exercise-stimulated myocardial blood flow or CFR but did modestly improve diastolic function.
AHRQ-funded; HS022998.
Citation: Shah NR, Cheezum MK, Veeranna V .
Ranolazine in symptomatic diabetic patients without obstructive coronary artery disease: impact on microvascular and diastolic function.
J Am Heart Assoc 2017 May 4;6(5). doi: 10.1161/jaha.116.005027..
Keywords: Cardiovascular Conditions, Diabetes, Medication, Patient-Centered Outcomes Research
Carlson AE, Aronson BD, Unzen M
Apathy and type 2 diabetes among American Indians: exploring the protective effects of traditional cultural involvement.
In this study researchers examined relationships between traditional cultural factors, apathy, and health-related outcomes among a sample of American Indian adults with type 2 diabetes. Their model revealed significant direct effects from cultural participation to apathy, and apathy to both health-related outcomes. Cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health-related quality of life.
AHRQ-funded; HS024180.
Citation: Carlson AE, Aronson BD, Unzen M .
Apathy and type 2 diabetes among American Indians: exploring the protective effects of traditional cultural involvement.
J Health Care Poor Underserved 2017;28(2):770-83. doi: 10.1353/hpu.2017.0073.
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Keywords: Cultural Competence, Diabetes, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Makam AN, Nguyen OK
An evidence-based medicine approach to antihyperglycemic therapy in diabetes mellitus to overcome overtreatment.
This article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK .
An evidence-based medicine approach to antihyperglycemic therapy in diabetes mellitus to overcome overtreatment.
Circulation 2017 Jan 10;135(2):180-95. doi: 10.1161/circulationaha.116.022622.
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Keywords: Shared Decision Making, Diabetes, Evidence-Based Practice, Patient and Family Engagement, Patient-Centered Outcomes Research
Flory JH, Ukena JK, Floyd JS
Novel anti-glycemic drugs and reduction of cardiovascular risk in diabetes: expectations realized, promises unmet.
The researchers review evidence on cardiovascular risks and benefits of new treatments for type 2 diabetes mellitus. Their review reports new evidence suggesting that the newest diabetes drugs are safe from a cardiovascular perspective. Evidence on benefit from at least some members of the GLP-1 receptor agonist and SGLT-2 inhibitor classes is encouraging but not yet decisive.
AHRQ-funded; HS023898.
Citation: Flory JH, Ukena JK, Floyd JS .
Novel anti-glycemic drugs and reduction of cardiovascular risk in diabetes: expectations realized, promises unmet.
Curr Atheroscler Rep 2016 Dec;18(12):79. doi: 10.1007/s11883-016-0633-y.
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Keywords: Patient-Centered Outcomes Research, Medication, Diabetes, Cardiovascular Conditions, Risk
Patil SJ, Ruppar T, Koopman RJ
Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes.
This study aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A1c (HbA1c) levels in adults. It found that peer support interventions for diabetes overall achieved a statistically significant but minor improvement in HbA1c levels.
AHRQ-funded; HS022140.
Citation: Patil SJ, Ruppar T, Koopman RJ .
Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes.
Ann Fam Med 2016 Nov;14(6):540-51. doi: 10.1370/afm.1982.
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Keywords: Care Management, Diabetes, Patient-Centered Outcomes Research