Browsing by Subject "Diabetes mellitus"
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Item Evaluating predictors of physician visits among children with symptoms of diabetes(Texas Tech University, 2003-05) Venati, GirikumarNot availableItem Performance of comorbidity adjustment measures to predict healthcare utilization and expenditures for patients with diabetes using a large administrative database(2010-12) Cheng, Lung-I; Rascati, Karen L.; Barner, Jamie C.; Lawson, Kenneth A.Objective: The objective of this study was to compare the use of different comorbidity measures to predict future healthcare utilization and expenditures for diabetic patients. Methods: This was a retrospective study that included 8,704 diabetic patients enrolled continuously for three years in the Department of Defense TRICARE program. Administrative claims data were used to calculate six comorbidity measures: number of distinct medications, index-year healthcare expenditures, two versions of the Charlson Comorbidity Index (CCI), and two versions of the Chronic Disease Score (CDS). Linear regression models were used to estimate three health outcomes for one- and two-year post-index periods: healthcare expenditures (COST), number of hospitalizations (HOS), and number of emergency department visits (ED). Logistic regression models were used to estimate binary outcomes (above or below the 90th percentile of COST; [greater than or equal to] 1 HOS or none; [greater than or equal to] 1 ED or none). Comparisons were based on adjusted R², areas under the receiver-operator-curve (c statistics), and the Hosmer-Lemeshow goodness-of-fit tests. Results: The study population had a mean age of 51.0 years (SD = 10.5), and 46.3 percent were male. After adjusting for age and sex, the updated CCI was the best predictor of one-year and two-year HOS (adjusted R² = 8.1%, 9.3%), the number of distinct medications was superior in predicting one-year and two-year ED (adjusted R² = 9.9%, 12.4%), and the index-year healthcare expenditures explained the most variance in one-year and two-year COST (adjusted R² = 35.6%, 31.6%). In logistic regressions, the number of distinct medications was the best predictor of one-year and two-year risks of emergency department use (c = 0.653, 0.654), but the index-year healthcare expenditures performed the best in predicting one-year and two-year risks of hospitalizations (c = 0.684, 0.676) and high-expenditure cases (c = 0.810, 0.823). The updated CCI consistently outperformed the original CCI in predicting the outcomes of interest. Conclusions: In a diabetic population under age 65, the number of distinct medications and baseline healthcare expenditures appeared to have superior or similar powers compared to the CCI or CDS for the prediction of future healthcare utilization and expenditures. The updated CCI was a better predictor than the original CCI in this population.Item Regulation of calcium stores in normal and diabetic endothelial cells(Texas Tech University, 2000-12) Sanka, Shankar ChittaranjanCytosolic Ca^^ ([Ca^^]*'^^) mediates many cellular ftinctions, e.g.. cell growth, motility, secretion, etc. In many cell types, ion transport processes appear to be dependent on metabolism of glucose for maximal activity. In certain cell types, a strict coupling between glycolysis and the acfivity of Endoplasmic Reticulum Ca^"-ATPases (SERCA). involved in regulating Ca^^ homeostasis, has been suggested. In diabetes, glucose homeostasis is altered. We hypothesize that Ca^^ homeostasis in microvascular endothelial cells from diabetic animals is altered due to a dysfunction of glycolysis coupling the activity of SERCA. We further hypothesize that endosomal/lysosomal (E/L) compartments exhibiting SERCA are involved in this dysfunction. Our data indicated that agonist stimulation (ATP, vasopressin, angiotensin-II)elicited [Ca^"]^^* increases (independent of extracellular Ca^^) that were larger in endothelial cells from diabetic than from normal animals. Simultaneous measurements of [Ca^^]'^^' and Ca^^ in E/L compartments ([Ca^^]^) using fluorescence spectroscopy, indicated that E/L compartments released Ca^^ following agonist-stimulation. The magnitude of the Ca'* release was significantly larger in microvascular endothelial cells from diabetic rats. SERCA inhibitors elicited Ca^^ releases from E/L compartments in both normal and diabetic models. The magnitude of the [Ca^^]^ release was however similar among normal and diabetic cells. Immunocytochemical experiments demonstrated that 60% of E/L compartments exhibited SERCA. These data indicate that (a) E/L compartments are important for Ca^^ homeostasis in microvascular endothelial cells from both normal and diabetic models; (b) Ca^^ regulation in E/L compartments is different in cells from a diabefic model, (c) the compartment involved in altered Ca'* homeostasis in diabetes is unknown.Item Use of antidepressant agents and the incidence of type 2 diabetes mellitus : a methodological comparison(2011-05) Khoza, Star; Barner, Jamie C.; Bohman, Thomas M.; Lawson, Kenneth A.; Rascati, Karen L.; Wilson, James P.The main study purposes were to determine: whether antidepressant (AD) use increases the risk of type 2 diabetes mellitus; and whether results differ when using different methodological designs: retrospective cohort design and nested case-control design. A retrospective Texas Medicaid database analysis of new AD (exposed cohort) and benzodiazepine (unexposed cohort [BZ]) users from January 1, 2002 to December 31, 2009 was conducted. Patients aged 18-64 years without diabetes at cohort entry were included. The primary outcome was incident diabetes and the main independent variable was AD vs. BZ use. Covariates included age, gender, race/ethnicity, medication adherence, persistence, number of concomitant diabetogenic medications, Chronic Disease Score, treatment duration, year of cohort entry, and use of both AD and BZ at index. Regression analyses (adjusted) were used to address the study purposes. Of the study cohort (N=44,715), 35,552 (79.5%) were AD users and 9,163 (20.5%) were BZ users. Patients were followed for an average of 2.3±1.9 years (Median=1.8 years), were on average 38.6±14.2 years old, and 69.3% were female. Using the retrospective cohort design, AD use was associated with a 48.9% increase (logistic regression) and 60.0% increase (Cox regression) in the risk of diabetes compared to BZ use (logistic regression analysis: RR[subscript adj]. =1.489; 95% CI: 1.331-1.667; Cox regression analysis: HR[subscript adj]. =1.600; 95% CI: 1.437 - 1.783). Using a nested case-control design within the entire study cohort, AD use was associated with a 54.1% increase in the risk of diabetes compared to BZ use (OR[subscript adj]. =1.541; 95% CI: 1.368 - 1.735). Using a nested case-control design within the exposed cohort, current AD use was associated with a two-fold higher risk of diabetes compared to former AD use (OR[subscript adj]. =1.995; 95% CI: 1.759 - 2.264). Among antidepressant classes, TCAs, SSRIs, SNRIs, and Other ADs were associated with a higher diabetes risk compared with BZs. The results from the present study suggest that AD use is associated with an increased risk of diabetes. Clinicians may need to take this into account when choosing treatment for depression in patients at high risk of diabetes.