University of Pittsburgh Researchers Present Findings at American Diabetes Association 71st Scientific Sessions, June 24 to 28
PITTSBURGH, June 24, 2011 – Researchers from the University of Pittsburgh will present findings from several studies at the American Diabetes Association 71st Scientific Sessions, June 24 to 28, in San Diego. Highlights of their findings are included below.
Chronic Care Model Improves Patient Goal-Setting in Diabetes Care
Most diabetes care is provided in primary care practices which are not structured for management of those with chronic diseases such as diabetes. The Pennsylvania Chronic Care Commission is implementing the Chronic Care Model aligned with the Patient Centered Medical Home to address these issues. Diabetes is a lifelong disease that requires the patient to engage in self-management. Substantial evidence demonstrates the usefulness of collaborative goal setting with patients; however, physicians are not routinely trained to engage in this process.
Linda Siminerio, R.N., Ph.D., C.D.E., director of the University of Pittsburgh Diabetes Institute, and colleagues trained physicians in primary care to set self-management goals with their patients. In this study, practices documented and reported monthly percentages of diabetes patients who had established a health-related goal with their physician. During the reported period, there was a dramatic increase in goal-setting with patients, suggesting the process can serve as a model for patient-centered approaches in other regions to transform health care. Abstract Number 0720-P
Hypoglycemia Treatment Protocol Improves Care in Military Hospital
Hypoglycemia is a barrier to intensification of insulin therapy in the hospital. Use of standardized protocols is particularly important in military hospitals with frequent staff turnover related to deployments. To address this, Linda Siminerio and colleagues compared hypoglycemic events using nurse-directed Hypoglycemic Treatment Protocol (HTP) versus no HTP at Wilford Hall Medical Center, Lackland Air Force Base, Texas. Between November 2009 and August 2010, 260 hypoglycemic events occurred. Those treated with HTP reached target blood glucose range in 52 minutes as opposed to 79 minutes for those treated with non-HTP. In addition, the mean length of stay for those treated with HTP was 8.02 hospital days versus 12.08 days for non-HTP treatment. The findings support use of HPT for improved patient care and safety in a military hospital setting. Abstract Number 1176-P
Studying Haptoglobin, Hemoglobin and Coronary Artery Disease
Haptoglobin (Hp) is a plasma protein that binds free hemoglobin, thereby inhibiting hemoglobin-induced oxidative damage. There are three major Hp genotypes in humans – Hp1-1, Hp 2-1 and Hp 2-2 – and it has been shown that people with type 1 diabetes and either the Hp 2-1 or Hp 2-2 genotypes are more likely to have coronary artery disease than those with type 1 diabetes and the Hp 1-1 genotype. Therefore, Trevor J. Orchard, M.D., professor of epidemiology, pediatrics and medicine, University of Pittsburgh, and colleagues examined whether hemoglobin relates to coronary artery disease and, if so, whether this association differs by Hp genotype in the same Epidemiology of Diabetes Complications study cohort.
During 18 years of follow-up, 15.1 percent of individuals with Hp 1-1, versus 31.5 percent of those with the Hp 2-1 or Hp 2-2 genotype developed coronary artery disease. Hemoglobin levels were similar between those with and without subsequent coronary artery disease. However, among those with the Hp 1-1 genotype, both hematocrit and hemoglobin were modestly increased in coronary artery disease cases. Conversely, both hematocrit and hemoglobin were decreased in coronary artery disease cases among those with the Hp 2-1 or the Hp 2-2 genotype. In this cohort of individuals with childhood-onset type 1 diabetes, a strong interaction was observed between hemoglobin and the Hp genotype in terms of coronary artery disease incidence, which merits further exploration. Abstract Number 0271-OR