IntroductionAlthough glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years.MethodsThis retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006. We conducted multivariable logistic regressions to examine factors related to sustained poor control, some glycemic variability, and wide glycemic variability during the next 3 years. Independent variables evaluated as possible predictors were age, sex, type of insurance coverage, morbidity, diabetes duration, history of cardiovascular disease, and number of medications.ResultsLonger duration of diabetes, being under age 35, and taking 15 or more medications were significantly associated with sustained poor glycemic control. Preferred provider organization and Medicare (vs health maintenance organization) enrollees and patients with high morbidity were less likely to have sustained poor glycemic control. Wide glycemic variability was significantly related to being younger than age 50, longer duration of diabetes, having coronary artery disease, and taking 5 to 9 medications per year.ConclusionResults indicate that duration of diabetes, age, number of medications, morbidity, and type of insurance coverage are risk factors for sustained poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Patients younger than age 50 and those with a history of coronary heart disease should be warned of the health risks of wide glycemic variability.

This systematic and actionable approach to reviewing and categorizing potentially preventable medication-related admissions can facilitate improvement in care and document the value of pharmacists serving in patient care roles.

The 2014 American Diabetes Association guidelines denote four means of diagnosing diabetes. The first of these is a glycosylated hemoglobin (HbA1c) >6.5%. This literature review summarizes studies (n=47) in the USA examining the significance, strengths, and limitations of using HbA1c as a diagnostic tool for diabetes, relative to other available means. Due to the relatively recent adoption of HbA1c as a diabetes mellitus diagnostic tool, a hybrid systematic, truncated review of the literature was implemented. Based on these studies, we conclude that HbA1c screening for diabetes has been found to be convenient and effective in diagnosing diabetes. HbA1c screening is particularly helpful in community-based and acute care settings where tests requiring fasting are not practical. Using HbA1c to diagnose diabetes also has some limitations. For instance, HbA1c testing may underestimate the prevalence of diabetes, particularly among whites. Because this bias differs by racial group, prevalence and resulting estimates of health disparities based on HbA1c screening differ from those based on other methods of diagnosis. In addition, existing evidence suggests that HbA1c screening may not be valid in certain subgroups, such as children, women with gestational diabetes, patients with human immunodeficiency virus, and those with prediabetes. Further guidelines are needed to clarify the appropriate use of HbA1c screening in these populations.

Background and Purpose: The present body of literature has little information regarding factors behind gaps in health status affecting Asian American, Native Hawaiian and Pacific Islander (AANHPI) communities, and methods to address them. We sought to examine pharmacists’ and other health care professionals’ perceptions of AANHPI health disparities and their ideas for solutions involving pharmacists, pharmacy schools, and the U.S. Food and Drug Administration (FDA). Methods: In-depth individual interviews were conducted with ten academic pharmacists and four other health care professionals knowledgeable about AANHPI disparities, with a focus on medication-related disparities. Results: Commonly identified factors behind disparities included poor communication, low socioeconomic status, cultural inhibitions creating a reluctance to seek care, and limited access to care. Suggested strategies for community pharmacists to reduce disparities included one-on-one care focused on outcomes, translated materials and translation services, and tracking adherence to medications. Participants suggested that colleges of pharmacy could continue community health events, encourage students to be culturally aware, and conduct health disparities research, and that the FDA could provide translated information, research funding, and requirements for greater ethnic diversity in clinical trials. Conclusion: Experts believe that pharmacists have the potential to help close the health care gap for AANHPI populations.

OBJECTIVES:To estimate the clinical and economic impact of saxagliptin (SAXA) versus sulfonylurea (SU), both with metformin (MET), on the reduction of hypoglycemia among individuals with type 2 diabetes (T2D) in clinical practice. METHODS: Our analysis combined data from several sources to estimate outcomes on a perpatient and health plan-population level. Patient survey data (nϭ91) were used to estimate real-world rates of hypoglycemia for patients treated with SUϩMET, while the relative risk reduction observed in the pivotal SAXA clinical trial was applied to estimate the proportion of patients receiving SAXAϩMET who experience Ն1 hypoglycemia event. Costs associated with hypoglycemia treatment were obtained from an administrative claims analysis (nϭ813) and epidemiologic data were obtained from the literature. Costs are reported in 2011 USD. RESULTS: Treatment with SAXAϩMET was estimated to reduce the probability of experiencing Ն1 event from 68.1% to. 5.6% (net -62.5%). At these rates, resultant annual costs when all diabetes-related medical claims were considered were $435/patient treated with SUϩMET and $36/patient treated with SAXAϩMET, an annual cost savings of $399/patient receiving SAXAϩMET. If 50% of eligible patients in a 100,000-member health plan were switched from SUϩMET to SAXAϩMET, the net diabetes-related cost savings due to reduced hypoglycemia was estimated at ϳ$216,000 in 2011, increasing to ϳ$230,000 by 2013 (net savings of ϳ$0.19 per-member-per-month). When only confirmed events [i.e., symptom(s) ϩ blood glucose Ͻ70mg/dL] were considered, the net reduction in event rate was -24.2%, with annual cost savings predicted at $209/patient or ϳ$113,000-121,000 on a health plan level (savings of ϳ$0.10 per-member-per-month). CONCLUSIONS: When clinical trial results for SAXAϩMET are translated to actual clinical practice, the model predicts the lower rate of hypoglycemia (considering all events as well as confirmed events only) relative to treatment with SUϩMET will result in considerable cost savings on both a per-patient and health-plan level. OBJECTIVES:To examine the relationship between sustained glycemic control and health care costs among patients with diabetes with an initial hemoglobin A1c (HbA1c)Ͼ9%. METHODS: We conducted a retrospective analysis of administrative data from patients with diabetes and initial poor HbA1c control enrolled in a large health plan in Hawai'i (nϭ1304). We used propensity scores to identify a comparable cohort based on age, gender, type of coverage, diabetes duration, number of medications, location of residence, comorbidity conditions, and morbidity level. We examined the relationship between reduced HbA1c values and costs in the same year as well as the impact of achieving sustained HbA1c control (at Ͻ 7%) for three years on changes in health care costs using generalized linear models. RESULTS: In cross-sectional comparisons, the average annual direct medical costs for patients with a HbA1c less than 7% was $14,821 compared to $12,108 for the A177