The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process.

Acculturation and Diabetes Self-management of Cuban Americans: Is Age a Protective Factor?

Migration to the United States has been linked to obesity and poor diet quality. We investigated the relationship among diabetes self-management, diet, age and acculturation factors for 182 Cuban-Americans (Females = 110, Males = 72) with type 2 diabetes recruited from a randomized mailing list in South Florida. Inadequate glycemic control (β = 0.257), BMI (β = 0.251), total fat intake (β = 0.251), and smoking (β = 0.200), were positively associated, while understanding of overall diabetes care (β = -0.165), was negatively associated with migration (N = 162, adj.R2 = 0.286, F = 14.65, p < 0.001). These associations suggest that effective diabetes education targeting acculturation issues is lacking.

Diabetes Self Management: Are Cuban Americans Receiving Quality Health Care?

Objectives: We investigated the relationship among factors predicting inadequate glucose control among 182 Cuban-American adults (Females=110, Males=72) with type 2 diabetes mellitus (CAA). Study Design: Cross-sectional study of CAA from a randomized mailing list in two counties of South Florida Methods: Fasted blood parameters and anthropometric measures were collected during the study. BMI was calculated (kg/ m2). Characteristics and diabetes care of CAA were self-reported Participants were screened by trained interviewers for heritage and diabetes status (inclusion criteria: self-reported having type 2 diabetes; age  35 years, male and female; not pregnant or lactating; no thyroid disorders; no major psychiatric disorders). Participants signed informed consent form. Statistical analyses used SPSS and included descriptive statistic, multiple logistic and ordinal logistic regression models, where all CI 95%. Results: Eighty-eight percent of CAA had BMI of ≥ 25 kg/ m2. Only 54% reported having a diet prescribed/told to schedule meals. We found CAA told to schedule meals were 3.62 more likely to plan meals (1.81, 7.26), p<0.001) and given a prescribed diet, controlling for age, corresponded with following a meal plan OR 4.43 (2.52, 7.79, p<0.001). The overall relationship for HbA1c < 8.5 to following a meal plan was OR 9.34 (2.84, 30.7. p<0.001). Conclusions: The advantage of having a medical professional prescribe a diet seems to be an important environmental support factor in this sample’s diabetes care, since obesity rates are well above the national average. Nearly half CAA are not given dietary guidance, yet our results indicate CAA may improve glycemic control by receiving dietary instructions.

The relationship among serum levels of manganese superoxide dismutase and mitochondrial DNA 8-hydroxy-2'- deoxyguanosine, and dietary antioxidants intake in type 2 diabetes

Oxidative stress plays a key role in the development of Type 2 Diabetes (T2D). This cross-sectional study examined the relationship among serum levels of manganese superoxide dismutase (MnSOD), 8-hydroxy-2’-deoxyguanosine (8OHdG), dietary antioxidant intakes and glycemic control in African Americans (n=209) and Haitian Americans (n=234) with and without T2D. ^ African Americans had higher BMI (32.8 vs. 29.3 kg/m2), higher energy intake (2148 vs. 1770 kcal), and were more educated as compared to Haitian Americans; all variables were significant at p < .001. Serum levels of 8OHdG and MnSOD for African Americans (1691.0 ± 225.1 pg/ml, 2538.0 ± 1091.8 pg/ml; respectively) were significantly higher than for Haitian Americans (1626.2 ± 222.9, 2015.8 ± 656.3 pg/ml; respectively). 8OHdG was negatively correlated with MnSOD ( r = -.167, p < .001) in T2D. Having T2D was negatively correlated with MnSOD (r = -.337; p < .01) and positively correlated with 8OHdG (r = .500; p < .01). African Americans and Haitian Americans with T2D had fasting plasma glucose (FPG) levels of 143.0 ± 61.0 mg/dl and 157.6 ± 65.5 mg/dl, and A1C of 7.5 ± 1.8 % and 8.4 ± 2.4 %, respectively. African Americans and Haitian Americans without T2D had FPG levels of 95.8 ± 13.2 mg/dl and 98.7 ± 16.9 mg/dl, and A1C of 5.9 ± 0.4% and 6.0 ± 0.5%, respectively. Dietary intakes of vitamin C and vitamin D were negatively correlated with FPG (r = -.21; r = -.19, p < .05) respectively. Carotenoids negatively correlated with A1C (r = -.19, p < .05). Lower levels of MnSOD were associated with lower levels of zinc, r = .10, p < .05, and higher levels of carotenoids r = -.10, p < .05. Higher levels of 8OHdG were associated with lower levels of Vitamin D, r = -.14, p < .01, and carotenoids, r = -.09, p < .05. ^ The results demonstrate greater oxidative mtDNA damage in persons with T2D compared to those without T2D and in African Americans compared with Haitian Americans. The inverse relationship between dietary intake of antioxidants and oxidative stress implies a potential to reduce oxidative stress with diet. ^

Efeitos da terapia laser de baixa intensidade associada ao exercício aeróbio no reparo de tenotomia do tendão de aquiles de ratos diabéticos

Diabetes Mellitus (DM ) is a complex disease that requires continuous medical care for the reduction of risk factors in addition to glycemic control. The typical hyperglycemia of this disease produces glycosylation of proteins and so the consequence is the accumulation of glycosylation final products in various human tissues, among them, the tendon. The aerobic exercise (AE) and the low level laser therapy (LLLT) have been used to treat tendinopathies in individuals with or without DM. Objective: The aim of this study was to watch the effect of the LLLT and the AE, in association, in partial tenotomy of the tissue repair of the Achilles tendon (AT) of diabetic rats. Methods: 91 animals were utilized and divided in to the following groups: control group (GC), injured control group (GCL), diabetic group (GD), diabetic group LLLT (GD – TLBI), diabetic group trained (GD - EX) and diabetic group trained laser (GD-EX+TLBI). The animals were submitted to intervention with AE, using a protocol with a progressive increase of time (12 to 60 min) and speed of (4 to 9 m/min), and the LLLT (660 nm laser, 10mW, 4 J/cm², single point for 16 seconds, three times for week). It was analyzed morphological, biomechanical and molecular characteristics. For data showing normal distribution was used one-way ANOVA test and post hoc Tukey and data without normal distribution was used Mann Whitney test and post hoc Dunn's. It was accepted p <0.05 for statistical significance Results: The biomechanical tests indicated major improvement in the GC and GD-EX+TLBI groups when compared with the diabetic groups in the following variables: maximum load, strain, absorbed energy, stress, cross section area, elastic modulus and energy density (p<0.05). The analysis through molecular biology indicated that the association of aerobic exercise and LLLT generated an increase of the collagen I gene expression and modulated the expression of the MMP2 and MMP9 (p<0.05). No observed any major improvement in the morphological variable studied. Conclusion: the LLLT associated with aerobic exercise promotes and increase of the mechanical properties, in the control of collagen I gene expression and of the MMP2 and MMP9 of the diabetic rats.

Profil d’activité physique des enfants et adolescents diabétiques de type 1

Les patients diabétiques de type 1 (DT1) ont avantage à avoir un bon contrôle glycémique pour réduire les effets négatifs à court et long terme d’un mauvais contrôle glycémique sur leur santé. Pour contrôler leur glycémie, ils doivent prendre de l’insuline, mais il est aussi recommandé qu’ils aient de bonnes habitudes de vie comme une nutrition appropriée et une pratique adéquate d’activité physique. Par contre, les patients DT1 ne suivent généralement pas les recommandations en activité physique et une partie du problème vient de leurs barrières personnelles à un style de vie actif, telle la peur des hypoglycémies. L’utilisation de la pompe comme traitement à l’insuline aide à mieux contrôler la glycémie, plus précisément l’hémoglobine glyquée, que les injections d’insuline, et le dispositif est de plus en plus prescrit chez les enfants et adolescents. Par contre, son impact sur la pratique des activités sédentaire et physique n’est pas encore bien connu. L’objectif de la présente étude est donc de révéler le profil d’activité physique complet, incluant les barrières à l’exercice et les habitudes de vie des parents, des enfants et adolescents DT1, selon leur type de traitement à l’insuline (pompe ou injections). L’étude a été conduite à la clinique d’endocrinologie du Centre hospitalier universitaire de Sainte-Justine (Montréal, Canada). Un questionnaire auto-administré a été complété par 188 patients DT1 âgés de 6 à 17 ans et un de leurs parents. Soixante pourcent des patients étaient des utilisateurs de la pompe à insuline. Il n’y avait pas de différence significative pour aucune des composantes du profil d’activité physique, des habitudes sédentaires et des barrières à l’exercice entre les patients DT1 utilisant les injections et ceux utilisant la pompe. La peur de faire des hypoglycémies était la barrière à l’activité physique principale pour les deux groupes de traitement. Les adolescents dont les parents pratiquaient une plus grande variété d’activités physiques faisaient plus d’activité physique d’intensité moyenne à élevée et passaient moins de temps devant les écrans. En conclusion, le type de traitement n’était pas associé à un style de vie plus sain chez les patients pédiatriques DT1, mais un profil d’activité physique parental varié était le facteur principal d’intérêt pour des habitudes de vie plus saines chez les adolescents DT1.

Glycated hemoglobin, body weight and blood pressure in type 2 diabetes patients initiating dapagliflozin treatment in primary care:a retrospective study

Introduction - The present study aimed to describe characteristics of patients with type 2 diabetes (T2D) in UK primary care initiated on dapagliflozin, post-dapagliflozin changes in glycated hemoglobin (HbA1c), body weight and blood pressure, and reasons for adding dapagliflozin to insulin. Methods - Retrospective study of patients with T2D in the Clinical Practice Research Datalink with first prescription for dapagliflozin. Patients were included in the study if they: (1) had a first prescription for dapagliflozin between November 2012 and September 2014; (2) had a Read code for T2D; (3) were registered with a practice for at least 6 months before starting dapagliflozin; and (4) remained registered for at least 3 months after initiation. A questionnaire ascertained reason(s) for adding dapagliflozin to insulin. Results - Dapagliflozin was most often used as triple therapy (27.7%), dual therapy with metformin (25.1%) or added to insulin (19.2%). Median therapy duration was 329 days [95% confidence interval (CI) 302–361]. Poor glycemic control was the reason for dapagliflozin initiation for 93.1% of insulin-treated patients. Avoiding increases in weight/body mass index and insulin resistance were the commonest reasons for selecting dapagliflozin versus intensifying insulin. HbA1c declined by mean of 9.7 mmol/mol (95% CI 8.5–10.9) (0.89%) 14–90 days after starting dapagliflozin, 10.2 mmol/mol (95% CI 8.9–11.5) (0.93%) after 91–180 days and 12.6 mmol/mol (95% CI 11.0–14.3) (1.16%) beyond 180 days. Weight declined by mean of 2.6 kg (95% CI 2.3–2.9) after 14–90 days, 4.3 kg (95% CI 3.8–4.7) after 91–180 days and 4.6 kg (95% CI 4.0–5.2) beyond 180 days. In patients with measurements between 14 and 90 days after starting dapagliflozin, systolic and diastolic blood pressure decreased by means of 4.5 (95% CI −5.8 to −3.2) and 2.0 (95% CI −2.9 to −1.2) mmHg, respectively from baseline. Similar reductions in systolic and diastolic blood pressure were observed after 91–180 days and when follow-up extended beyond 180 days. Results were consistent across subgroups. Conclusion - HbA1c, body weight and blood pressure were reduced after initiation of dapagliflozin in patients with T2D in UK primary care and the changes were consistent with randomized clinical trials.

Profil d’activité physique des enfants et adolescents diabétiques de type 1

Les patients diabétiques de type 1 (DT1) ont avantage à avoir un bon contrôle glycémique pour réduire les effets négatifs à court et long terme d’un mauvais contrôle glycémique sur leur santé. Pour contrôler leur glycémie, ils doivent prendre de l’insuline, mais il est aussi recommandé qu’ils aient de bonnes habitudes de vie comme une nutrition appropriée et une pratique adéquate d’activité physique. Par contre, les patients DT1 ne suivent généralement pas les recommandations en activité physique et une partie du problème vient de leurs barrières personnelles à un style de vie actif, telle la peur des hypoglycémies. L’utilisation de la pompe comme traitement à l’insuline aide à mieux contrôler la glycémie, plus précisément l’hémoglobine glyquée, que les injections d’insuline, et le dispositif est de plus en plus prescrit chez les enfants et adolescents. Par contre, son impact sur la pratique des activités sédentaire et physique n’est pas encore bien connu. L’objectif de la présente étude est donc de révéler le profil d’activité physique complet, incluant les barrières à l’exercice et les habitudes de vie des parents, des enfants et adolescents DT1, selon leur type de traitement à l’insuline (pompe ou injections). L’étude a été conduite à la clinique d’endocrinologie du Centre hospitalier universitaire de Sainte-Justine (Montréal, Canada). Un questionnaire auto-administré a été complété par 188 patients DT1 âgés de 6 à 17 ans et un de leurs parents. Soixante pourcent des patients étaient des utilisateurs de la pompe à insuline. Il n’y avait pas de différence significative pour aucune des composantes du profil d’activité physique, des habitudes sédentaires et des barrières à l’exercice entre les patients DT1 utilisant les injections et ceux utilisant la pompe. La peur de faire des hypoglycémies était la barrière à l’activité physique principale pour les deux groupes de traitement. Les adolescents dont les parents pratiquaient une plus grande variété d’activités physiques faisaient plus d’activité physique d’intensité moyenne à élevée et passaient moins de temps devant les écrans. En conclusion, le type de traitement n’était pas associé à un style de vie plus sain chez les patients pédiatriques DT1, mais un profil d’activité physique parental varié était le facteur principal d’intérêt pour des habitudes de vie plus saines chez les adolescents DT1.

The relationship among serum levels of manganese superoxide dismutase and mtDNA 8-hydroxy-2'-deoxyguanosine, and dietary antioxidants intake in Type 2 Diabetes

Oxidative stress plays a key role in the development of Type 2 Diabetes (T2D). This cross-sectional study examined the relationship among serum levels of manganese superoxide dismutase (MnSOD), 8-hydroxy-2’-deoxyguanosine (8OHdG), dietary antioxidant intakes and glycemic control in African Americans (n=209) and Haitian Americans (n=234) with and without T2D. African Americans had higher BMI (32.8 vs. 29.3 kg/m2), higher energy intake (2148 vs. 1770 kcal), and were more educated as compared to Haitian Americans; all variables were significant at p < .001. Serum levels of 8OHdG and MnSOD for African Americans (1691.0 ± 225.1 pg/ml, 2538.0 ± 1091.8 pg/ml; respectively) were significantly higher than for Haitian Americans (1626.2 ± 222.9, 2015.8 ± 656.3 pg/ml; respectively). 8OHdG was negatively correlated with MnSOD (r = -.167, p < .001) in T2D. Having T2D was negatively correlated with MnSOD (r = -.337; p < .01) and positively correlated with 8OHdG (r = .500; p < .01). African Americans and Haitian Americans with T2D had fasting plasma glucose (FPG) levels of 143.0 ± 61.0 mg/dl and 157.6 ± 65.5 mg/dl, and A1C of 7.5 ± 1.8 % and 8.4 ± 2.4 %, respectively. African Americans and Haitian Americans without T2D had FPG levels of 95.8 ± 13.2 mg/dl and 98.7 ± 16.9 mg/dl, and A1C of 5.9 ± 0.4% and 6.0 ± 0.5%, respectively. Dietary intakes of vitamin C and vitamin D were negatively correlated with FPG (r = -.21; r = -.19, p < .05) respectively. Carotenoids negatively correlated with A1C (r = -.19, p < .05). Lower levels of MnSOD were associated with lower levels of zinc, r = .10, p < .05, and higher levels of carotenoids r = -.10, p < .05. Higher levels of 8OHdG were associated with lower levels of Vitamin D, r = -.14, p < .01, and carotenoids, r = -.09, p < .05. The results demonstrate greater oxidative mtDNA damage in persons with T2D compared to those without T2D and in African Americans compared with Haitian Americans. The inverse relationship between dietary intake of antioxidants and oxidative stress implies a potential to reduce oxidative stress with diet. African Americans were significantly younger (53.3 vs. 55.6 years), had higher BMI (32.8 vs. 29.3 kg/m2), higher energy intake (2148 vs. 1770 kcal), and were more educated as compared to Haitian Americans; all variables were significant at p < .001. Serum levels of 8OHdG and MnSOD for African Americans (1691.0 ± 225.1 pg/ml, 2538.0 ± 1091.8 pg/ml; respectively) were significantly higher than for Haitian Americans (1626.2 ± 222.9, 2015.8 ± 656.3 pg/ml; respectively). 8OHdG was negatively correlated with MnSOD (r = -.167, p < .001) in T2D. Having T2D was negatively correlated with MnSOD (r = -.337; p < .01) and positively correlated with 8OHdG (r = .500; p < .01). African Americans and Haitian Americans with T2D had fasting plasma glucose (FPG) levels of 143.0 ± 61.0 mg/dl and 157.6 ± 65.5 mg/dl, and A1C of 7.5 ± 1.8 % and 8.4 ± 2.4 %, respectively. African Americans and Haitian Americans without T2D had FPG levels of 95.8 ± 13.2 mg/dl and 98.7 ± 16.9 mg/dl, and A1C of 5.9 ± 0.4% and 6.0 ± 0.5%, respectively. Dietary intakes of vitamin C and vitamin D were negatively correlated with FPG (r = -.21; r = -.19, p < .05) respectively. Carotenoids negatively correlated with A1C (r = -.19, p < .05). Lower levels of MnSOD were associated with lower levels of zinc, r = .10, p < .05, and higher levels of carotenoids r = -.10, p < .05. Higher levels of 8OHdG were associated with lower levels of Vitamin D, r = -.14, p < .01, and carotenoids, r = -.09, p < .05. The results demonstrate greater oxidative mtDNA damage in persons with T2D compared to those without T2D and in African Americans compared with Haitian Americans. The inverse relationship between dietary intake of antioxidants and oxidative stress implies a potential to reduce oxidative stress with diet.

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.

Pregnancy Planning and Diabetes:A Qualitative Exploration of Women's Attitudes Toward Preconception Care

Introduction: Seeking preconception care is recognized as an important health behavior for women with preexisting diabetes. Yet many women with diabetes do not seek care or advice until after they are pregnant, and many enter pregnancy with suboptimal glycemic control. This study explored the attitudes about pregnancy and preconception care seeking in a group of nonpregnant women with type 1 diabetes mellitus. Methods: In-depth semistructured interviews were completed with 14 nonpregnant women with type 1 diabetes. Results: Analysis of the interview data revealed 4 main themes: 1) the emotional complexity of childbearing decisions, 2) preferences for information related to pregnancy, 3) the importance of being known by your health professional, and 4) frustrations with the medical model of care. Discussion: These findings raise questions about how preconception care should be provided to women with diabetes and highlight the pivotal importance of supportive, familiar relationships between health professionals and women with diabetes in the provision of individualized care and advice. By improving the quality of relationships and communication between health care providers and patients, we will be better able to provide care and advice that is perceived as relevant to the individual, whatever her stage of family planning. © 2012 by the American College of Nurse-Midwives.

The Relationship of Diet Quality and Blood Serum Lipid Levels in a Population at High Risk for Diabetes: The Strong Heart Family Study

Thesis (Master's)--University of Washington, 2016-08

Influence d'un incitatif financier destiné aux médecins de famille sur la gestion du diabète des Néo-Brunswickois

Résumé: Problématique : En réponse à la prévalence accrue de la maladie du diabète et au fardeau économique important que représente cette maladie sur le système de santé international, des programmes incitatifs pour les maladies chroniques furent instaurés à travers le monde. Ces programmes visent à inciter les médecins à appliquer les lignes directrices chez leurs patients avec besoin complexe en vue d’améliorer la santé des patients et par la suite de réduire les coûts incombés par le système de santé. Les programmes incitatifs étant nombreux et différents d’un pays à l’autre, les études actuelles ne semblent pas s’entendre sur les répercussions de tels programmes sur la santé des patients atteints de diabète. L’objectif de cette étude est d’évaluer les retombées d’un incitatif financier sur le contrôle glycémique de la population atteinte de diabète du Nouveau-Brunswick, au Canada. Méthodes : Cette étude transversale répétée et de cohorte a été menée grâce à des bases de données administratives du Nouveau-Brunswick contenant des données sur dix ans pour 83 580 patients adultes atteints de diabète et 583 médecins de famille éligibles. La santé des patients a été évaluée au niveau du contrôle glycémique, en mesurant les valeurs moyennes d’A1C annuelles à l’aide de régressions linéaires multivariées. Afin d’évaluer si les médecins changeaient leur pratique avec l’implantation du programme incitatif, nous regardions au niveau de la probabilité de recours annuel à au moins deux tests d’A1C en utilisant des régressions logistiques multivariées. Résultats : La probabilité de recours annuel à au moins deux tests d’A1C était plus élevée dans quatre sous-groupes étudiés : les patients nouvellement diagnostiqués après l’implantation du programme avaient des cotes plus élevées comparées aux nouveaux patients avant l’implantation du programme (OR=1.23 [1.18-1.28]); les patients pour lesquels un médecin avait réclamé l’incitatif comparés aux patients pour lesquels aucun médecin n’avait réclamé l’incitatif (OR=2.73 [2.64-2.81]); les patients pour lesquels un médecin avait réclamé l’incitatif avaient des cotes plus élevées après l’implantation du programme comparé à avant (OR=1.89 [1.80-1.98]); et finalement, les patients suivis par un médecin de famille qui a déjà réclamé l’incitatif avaient des cotes 24% plus élevées (OR=1.24 [1.15-1.34]). Il n’y avait pas de différence dans les valeurs d’A1C annuelles entre les 4 sous-groupes étudiés. Conclusion : L’implantation du programme incitatif a démontré que les médecins ont une meilleure probabilité de prescrire au moins deux tests d’A1C, ce qui suggère une meilleure prise en charge des patients. Cependant, le manque de changement au niveau du contrôle glycémique du patient suggère que l’étude des répercussions de l’incitatif devra être poursuivie afin de voir si elle mène à une amélioration d’issues cliniques chez les patients.

Seasonal variation of haemoglobin A1c in a Portuguese adult population

Haemoglobin A1c (Hb A1c) is routinely used for monitoring glycemic control in patients with diabetes. Hb A1c seasonal fluctuations can be directly related to different biological, geographical and cultural influences. Our purpose was to evaluate seasonal variation of Hb A1c in a hospital-based adult population over a period of 5 years.