Improving Efficacy of Diabetes Management Using Treatment Algorithms in a Mainly Hispanic Population
Article Figures & Tables
Figures
- 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—
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—
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
- Table 1—
Characteristics of the participants at baseline
CC-TA UC-TA CC-SC Patient characteristics n 106 170 82 Women/men (%) 65/35 60/40 72/28 Age (years) 43.0 ± 1.0∗ 48 ± 0.8∗ 48 ± 1.0∗ Weight (kg) 94 ± 5.3 87 ± 4.0 90 ± 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-pay 20 16 7 Commercial insurance 8 2 12 Medicare B/Medicaid 4 7 5 Unknown 2 5 7 Metabolic characteristics HbA1c (%) 10.4 ± 0.2 10.5 ± 0.2 10.0 ± 0.3 Fasting glucose (mg/dl) 249 ± 6.0 255 ± 5.0 237 ± 8.0 Fasting lipids (mg/dl) Total cholesterol 189 ± 5.0§ 218 ± 3.0 211 ± 5.0 LDL cholesterol 113 ± 4.0 128 ± 2.0§ 117 ± 4.4 HDL cholesterol 39 ± 1.0 41 ± 1.0 41 ± 1.2 Triglycerides 188 ± 15.0§ 272 ± 12 256 ± 20.0 Systolic blood pressure (mmHg) 135 ± 2.0 142 ± 2.0‖ 130 ± 2.2 Diastolic blood pressure (mmHg) 81 ± 1.0 80 ± 0.9 81 ± 1.4 Patients with abnormal values [n (%)] Total cholesterol >200 mg/dl 246 ± 8 [34 (32)] 235 ± 3 [119 (70)] 245 ± 6 [45 (55)] LDL cholesterol >130 mg/dl 166 ± 6 [34 (32)] 154 ± 3 [70 (41)] 161 ± 8 [22 (27)] Triglycerides >150 mg/dl 275 ± 24 [35 (33)] 306 ± 13 [104 (61)] 323 ± 25 [40 (48)] Systolic blood pressure >130 mmHg 146 ± 2 [69 (65)] 150 ± 1 [129 (76)] 147 ± 2 [40 (49)] Diastolic blood pressure >80 mmHg 86 ± 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
Medications CC-TA UC-TA CC-SC n 106 170 82 Diabetes Initial treatment (100%) Glucotrol XL 96 (91) 167 (98) 48 (59) Chlorpropamide 0 0 9 (11) Glyburide 0 0 15 (18) Metformin 0 0 8 (10) Diet and exercise 10 (9) 3 (2) 2 (2) Final treatment (100%) Glucotrol XL 75 (71) 104 (61) 34 (42) Glucotrol XL/metformin 19 (18) 55 (32) 20 (25) Glucotrol XL/metformin + insulin 0 3 (2) 1 (1) Chlorpropamide 0 0 1 (1) Glyburide 0 0 6 (7) Metformin 0 0 13 (16) Insulin 0 0 2 (2) Diet and exercise 12 (11) 8 (5) 5 (6) Hypertension Initial treatment (100%) Monopril 40 (38) 93 (55) 23 (28) Benazepril 0 0 6 (7) Captopril 0 0 2 (2) Diltiazem-SR 0 0 3 (4) Enalapril 0 0 7 (9) None 66 (62) 77 (45) 41 (50) Final treatment (100%) Monopril 37 (35) 79 (47) 24 (29) Monopril/diltiazem-SR 3 (3) 14 (8) 7 (9) Monopril/diltiazem/hydrochlorothiazide 0 0 4 (5) Vera pamil 0 0 2 (2) None 66 (62) 77 (45) 45 (55) Dyslipidemia Initial treatment (100%) Pravastatin 31 (29) 29 (17) 2 (2) Gemfibrozil 7 (7) 16 (9) 9 (11) Simvastatin 0 0 4 (6) Lovastatin 0 0 2 (2) None 68 (64) 125 (74) 65 (79) Final treatment (100%) Pravastatin 31 (29) 29 (17) 2 (2) Gemfibrozil 8 (8) 16 (9) 7 (9) Simvastatin 0 0 3 (4) Lovastatin 0 0 2 (2) None 67 (63) 125 (74) 68 (83) Data are n (%).
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