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Epidemiology/Health Services/Psychosocial Research

Improving Efficacy of Diabetes Management Using Treatment Algorithms in a Mainly Hispanic Population

  1. Etta L. Fanning, MD, MPH, PHD1,
  2. Beatrice J. Selwyn, SCD2,
  3. Anne C. Larme, PHD3 and
  4. Ralph A. DeFronzo, MD1
  1. 1Department of Medicine, Diabetes Division, University of Texas Health Science Center, University Center for Community Health–Texas Diabetes Institute, University Health System, San Antonio, Texas
  2. 2Discipline of Epidemiology, University of Texas Health Science Center, School of Public Health, Houston, Texas
  3. 3Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas
  1. Address correspondence and reprint requests to Etta L. Fanning, MD, MPH, PhD, Department of Medicine, Diabetes Division, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX 78284. E-mail: fanninge{at}msn.com
Diabetes Care 2004 Jul; 27(7): 1638-1646. https://doi.org/10.2337/diacare.27.7.1638
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  • Figure 1—
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    Figure 1—

    Treatment algorithm for hyperglycemia. *Diabetic patients with renal disease (serum creatinine >1.4 in women or >1.5 mg/dl in men or creatinine clearance <70 ml/min) should not receive metformin; †HbA1c, **blood pressure (BP), FPG, neutral protamine hagendorn (NPH) insulin. © 1995 Ralph A. DeFronzo, MD.

  • Figure 2—
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    Figure 2—

    Effect of treatment on HbA1c (A) and FPG concentration (B). Decrements in HbA1c and FPG at 6 and 12 months were greater (*P < 0.0001) in the UC-TA and CC-TA groups compared with the CC-SC group.

  • Figure 3—
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    Figure 3—

    Effect of lipid-lowering treatment in diabetic patients with fasting plasma LDL cholesterol >130 mg/dl (A) and plasma triglyceride >150 mg/dl (B). Decrements in LDL cholesterol and triglyceride levels were greater (**P < 0.0001) in the UC-TA and CC-TA compared with the CC-SC after 12 months. The effects of treatment of hypertension in diabetic patients with systolic blood pressure >130 mmHg (C) and diastolic blood pressure >80 mmHg (D) are also shown. Decrements in both systolic and diastolic blood pressure were similar in all three groups (P < 0.01). *P < 0.0001; **P = 0.01.

Tables

  • Figures
  • Table 1—

    Characteristics of the participants at baseline

    CC-TAUC-TACC-SC
    Patient characteristics
     n10617082
     Women/men (%)65/3560/4072/28
     Age (years)43.0 ± 1.0∗48 ± 0.8∗48 ± 1.0∗
     Weight (kg)94 ± 5.387 ± 4.090 ± 5.1
     Education (highest grade)8 ± 0.4∗9 ± 0.2∗10 ± 1.3∗
     Employed (%)60†41†49
     Mexican American (%)97†89†83*
     Financial status (%)
      Cost share program‡66†70†69†
      Self-pay20167
      Commercial insurance 8 212
      Medicare B/Medicaid 4 75
      Unknown 2 57
    Metabolic characteristics
     HbA1c (%)10.4 ± 0.210.5 ± 0.210.0 ± 0.3
     Fasting glucose (mg/dl)249 ± 6.0255 ± 5.0237 ± 8.0
     Fasting lipids (mg/dl)
      Total cholesterol189 ± 5.0§218 ± 3.0211 ± 5.0
      LDL cholesterol113 ± 4.0128 ± 2.0§117 ± 4.4
      HDL cholesterol39 ± 1.041 ± 1.041 ± 1.2
      Triglycerides188 ± 15.0§272 ± 12256 ± 20.0
     Systolic blood pressure (mmHg)135 ± 2.0142 ± 2.0‖130 ± 2.2
     Diastolic blood pressure (mmHg)81 ± 1.080 ± 0.981 ± 1.4
    Patients with abnormal values [n (%)]
     Total cholesterol >200 mg/dl246 ± 8 [34 (32)]235 ± 3 [119 (70)]245 ± 6 [45 (55)]
     LDL cholesterol >130 mg/dl166 ± 6 [34 (32)]154 ± 3 [70 (41)]161 ± 8 [22 (27)]
     Triglycerides >150 mg/dl275 ± 24 [35 (33)]306 ± 13 [104 (61)]323 ± 25 [40 (48)]
     Systolic blood pressure >130 mmHg146 ± 2 [69 (65)]150 ± 1 [129 (76)]147 ± 2 [40 (49)]
     Diastolic blood pressure >80 mmHg86 ± 1 [50 (58)]88 ± 1 [92 (54)]90 ± 9 [48 (59)]
    • Data are means ± SE, unless otherwise indicated.

    • *

      ↵* P < 0.0001;

    • †

      ↵† P < 0.1, for employment (CC-TA versus UC-TA), Mexican-American ethnicity (CC-TA versus UC-TA and CC-TA versus CC-SC), and financial status (CC-TA versus CC-SC and UC-TA versus CC-SC);

    • ‡

      ↵‡ cost share program is a financial assistance program based on need and eligibility (U.S. Department of Health and Human Services);

    • §

      ↵§ P < 0.01, for LDL cholesterol (CC-SC versus UC-TA), total cholesterol (CC-SC versus CC-TA), and triglycerides (CC-SC versus CC-TA);

    • ‖

      ↵‖ P < 0.0001, for systolic blood pressure (CC-SC versus UC-TA and CC-TA versus UC-TA).

  • Table 2—

    Treatment regimens at the end of 12 months

    MedicationsCC-TAUC-TACC-SC
    n10617082
    Diabetes
     Initial treatment (100%)
      Glucotrol XL96 (91)167 (98)48 (59)
      Chlorpropamide009 (11)
      Glyburide0015 (18)
      Metformin008 (10)
      Diet and exercise10 (9)3 (2)2 (2)
     Final treatment (100%)
      Glucotrol XL75 (71)104 (61)34 (42)
      Glucotrol XL/metformin19 (18)55 (32)20 (25)
      Glucotrol XL/metformin + insulin03 (2)1 (1)
      Chlorpropamide001 (1)
      Glyburide006 (7)
      Metformin0013 (16)
      Insulin002 (2)
      Diet and exercise12 (11)8 (5)5 (6)
    Hypertension
     Initial treatment (100%)
      Monopril40 (38)93 (55)23 (28)
      Benazepril006 (7)
      Captopril002 (2)
      Diltiazem-SR003 (4)
      Enalapril007 (9)
      None66 (62)77 (45)41 (50)
     Final treatment (100%)
      Monopril37 (35)79 (47)24 (29)
      Monopril/diltiazem-SR3 (3)14 (8)7 (9)
      Monopril/diltiazem/hydrochlorothiazide004 (5)
      Vera pamil002 (2)
      None66 (62)77 (45)45 (55)
    Dyslipidemia
     Initial treatment (100%)
      Pravastatin31 (29)29 (17)2 (2)
      Gemfibrozil7 (7)16 (9)9 (11)
      Simvastatin004 (6)
      Lovastatin002 (2)
      None68 (64)125 (74)65 (79)
     Final treatment (100%)
      Pravastatin31 (29)29 (17)2 (2)
      Gemfibrozil8 (8)16 (9)7 (9)
      Simvastatin003 (4)
      Lovastatin002 (2)
      None67 (63)125 (74)68 (83)
    • Data are n (%).

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Improving Efficacy of Diabetes Management Using Treatment Algorithms in a Mainly Hispanic Population
Etta L. Fanning, Beatrice J. Selwyn, Anne C. Larme, Ralph A. DeFronzo
Diabetes Care Jul 2004, 27 (7) 1638-1646; DOI: 10.2337/diacare.27.7.1638

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Improving Efficacy of Diabetes Management Using Treatment Algorithms in a Mainly Hispanic Population
Etta L. Fanning, Beatrice J. Selwyn, Anne C. Larme, Ralph A. DeFronzo
Diabetes Care Jul 2004, 27 (7) 1638-1646; DOI: 10.2337/diacare.27.7.1638
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