Browsing by Subject "Diabetics"
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Item 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 The school-based lived experiences of being an adolescent with type 1 diabetes mellitus(2011-05) Wang, Yueh-Ling; Horner, Sharon D.; Brown, Sharon A., 1943-School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure.Item The Investigation of the Effects of Low Light Laser Therapy on Insulin Secretion in Porcine Islets, a Pilot StudyRaptis, Darren James; Huang, Floyd; Mason, Carolyn; Moore, KellyLED light technology is used in this pilot study to demonstrate the ability to create a cost effective light apparatus using 1-watt LEDs with wavelengths of 740nm,850nm, and 940nm to test for an increased insulin response using porcine islet of Langerhans cells. This is building on recent research showing increased insulin response in rat islet cells when exposed to LED light. However, due to the high variance and low sample size, statistically significant changes were not measured when irradiating cells with 740nm, 850nm, and 940nm LED light using 7.9 J/cm2 and 15.8 J/cm2 dosages along with low and high glucose conditions. There are however possible trends of increased insulin secretion that may become significant with increased sample size. There is a need to repeat this study to definitively determine if increased insulin secretion does occur in porcine islet of Langerhans cells along with any potential negative effects and what the optimal wavelengths and dosages would be. Using the cost effective light apparatus, additional wavelengths can be experimented with to cover between 300nm to over 1600nms. The information garnered from this research has the potential to improve islet of Langerhans cell transplantation for type one diabetes (T1D) patients by decreasing the number of cells needed to be therapeutic and increasing insulin release.