Diabetes Watch

DECEMBER 12, 2011

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One-on-One Diabetes Education May Be Better

A study published online October 10, 2011, in Archives of Internal Medicine compared types of patient education on glucose control and psychosocial and behavioral outcomes. The prospective, multisite, randomized, controlled parallel intervention trial followed 623 patients with type 2 diabetes mellitus identified to have a hemoglobin A1C greater than or equal to 7%. Patients were divided between group education (GE), which followed the US Diabetes Conversation Map model, individual education (IE), which consisted of multiple 1-hour sessions with a diabetic educator, and usual care (UC). Surveys were completed an average of 6.8 months after enrollment, and the primary outcome was change in A1C levels from baseline. 

The results showed that A1C was significantly lower than baseline in the GE, IE, and UC groups by absolutes of -0.27%, -0.51%, and -0.24%, respectively. Also, a larger proportion of patients receiving individual education achieved A1C levels less than 7% compared with GE and UC (IE 21.2%, GE 13.9%, UC, 12.8%; P = .03). Secondary outcomes such as physical health, nutrition score, and physical activity score were improved significantly more with IE than with GE or UC. 

The authors report that IE had higher rates of completion in the study compared with GE, most likely because of scheduling issues or patient preference. Interestingly, the total intervention time for IE was 3 hours, compared with 8 hours for GE. 

The authors state that national and local guidelines began advocating an individualized approach to A1C management as the study was implemented, with A1C less than 8% considered acceptable for some patients. This may have decreased the apparent magnitude of the study interventions on A1C changes. PT


Diabetic Patients with Lung Cancer May Live Longer

Lung cancer patients with diabetes may have increased survival compared with patients without diabetes, according to a study published in the November 2011 issue of Journal of Thoracic Oncology.

The study analyzed 1677 Norwegian patients with lung cancer (1600 with diabetes and 77 without diabetes) from 3 studies. The HUNT study, a large prospective population-based cohort study, was linked to data from the Norwegian Cancer Registry and Norwegian Cause of Death Registry. Data from the Premetrexed Gemcitabine Study (PEG) and Norwegian Lung Cancer Biobank (NLCB registry) were used as controls. For each study, survival rates were evaluated separately and then combined for increased power.

The pooled survival analysis revealed increased 3-year survival in lung cancer patients with diabetes compared with patients without diabetes (P = .005); median overall survival was 10.0 months (95% CI, 7.7-12.3) and 6.0 months (95% CI, 5.6-6.3), respectively. The 1-, 2-, and 3-year survival rates for patients with diabetes were 43%, 28%, and 19%, compared with survival rates of 11%, 3%, and 1% for patients without diabetes. Age, smoking history, and tumor histology were similar between patients with and without diabetes.

The study is limited by a decreased frequency of metastatic disease and a larger number of men in the diabetes cohort. In response, the authors assert that their analysis was adjusted for stage of disease and that increased survival was still demonstrated in their analysis of the PEG study, a study of only advanced lung cancer patients. In contrast to these findings, diabetes mellitus is associated with increased mortality in colon, pancreatic, endometrial, liver, and breast cancers. PT


Frequent Physician Visits Improve Glucose Control

More frequent visits with a primary care physician may improve glucose, cholesterol, and blood pressure control, according to a study published in the September 2011 issue of Archives of Internal Medicine

Researchers reviewed electronic medical records of 26,496 patients seen by primary care physicians affiliated with Brigham and Women’s Hospital and Massachusetts General Hospital. Patients were included in the study if they had at least 1 documented instance of A1C, blood pressure (BP), or low-density lipoprotein (LDL) cholesterol higher than treatment range, and the time to reaching the treatment target was recorded. Encounters were defined as a note in the patient’s electronic medical record. 

Study results demonstrated that as the interval between encounters increased, both time to achieving the treatment targets (in A1C, BP, and LDL) and the proportion of patients never reaching treatment target increased. Comparing patients taking insulin who were seen on average every 1 to 2 weeks with those who were seen every 6 months, the proportions of patients never reaching the A1C target were 35.4% and 55.6%, respectively. 

According to the authors, limitations of the study include patients being seen by primary care physicians from 2 different hospitals and researchers being unable to differentiate the encounters between scheduled visits and last-minute appointments. PT 

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