Comparative Effectiveness Research and Outcomes of Diabetes Treatment

Safford, Monika M.

doi:10.1001/jama.2014.4313

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…19, 20 Insulin use among people with diabetes may be a marker of both more severe disease and an increased risk of CVD. 21, 22 Using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we compared the risk of CHD events between participants with diabetes but no prevalent CHD and those with prevalent CHD but no diabetes and investigated whether the relative risk of CHD events associated with diabetes versus history of CHD varied by age. Additionally, we investigated the risk of CHD events associated with more severe diabetes, defined as diabetes with insulin use and/or albuminuria.…”

mentioning

confidence: 99%

Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS)

Mondesir

Brown

Muntner

et al. 2016

American Heart Journal

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Background Evidence is mixed regarding whether diabetes confers equivalent risk of coronary heart disease (CHD) as prevalent CHD. We investigated whether diabetes and severe diabetes are coronary heart disease (CHD) risk equivalents. Methods At baseline, participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white US adults ≥45 years old recruited 2003–2007) were categorized as having prevalent CHD only (self-reported or electrocardiogram evidence) (n=3,043), diabetes only (self-reported or elevated glucose) (n=4,012), diabetes and prevalent CHD (n=1,529) and neither diabetes nor prevalent CHD (n=17,155). Participants with diabetes using insulin and/or with albuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g) were categorized as having severe diabetes. Participants were followed through 2011 for CHD events (myocardial infarction or fatal CHD). Results During a mean follow-up of 5 years, 1385 CHD events occurred. The hazard ratios (HRs) of CHD events comparing participants with diabetes only, diabetes and prevalent CHD and neither diabetes nor prevalent CHD to those with prevalent CHD were 0.65 (95% CI: 0.54, 0.77), 1.54 (95% CI: 1.30, 1.83) and 0.41 (95% CI: 0.35, 0.47), respectively, after adjustment for demographics and risk factors. Compared to participants with prevalent CHD, the HR of CHD events for participants with severe diabetes was 0.88 (95% CI: 0.72, 1.09). Conclusions Participants with diabetes had lower risk of CHD events than those with prevalent CHD. However, participants with severe diabetes had similar risk as those with prevalent CHD. Diabetes severity may need consideration when deciding whether diabetes is a CHD risk equivalent.

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confidence: 99%

Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS)

Mondesir

Brown

Muntner

et al. 2016

American Heart Journal

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“…While randomized control trials (RCT) are often considered the gold standard for advancing scientific knowledge creation (Safford, 2014 ), this methodology is expensive, time intensive, and frequently not an appropriate approach for most research questions (Dreyer et al, 2010 ; Safford, 2014 ) because, the results from RCTs do not always match what is observed in real-world practice or can account for meaningful changes in the local environment as the study progresses (Dreyer et al, 2010 ). Comparative effectiveness research (CER) consisting of observational studies that are well-designed and which analyze data from large population samples can address questions that are not possible to answer using a RCT methodology alone (Dreyer et al, 2010 ; Safford, 2014 ). Intervention research is a significant CER study design and has been adopted by the National Center as the favored approach to generate data, produce information translated into knowledge.…”

Section: What Do We Need To Know To Establish Ipecp As An Effective Amentioning

confidence: 99%

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

Lutfiyya

Brandt

Delaney

et al. 2015

Journal of Interprofessional Care

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Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.

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“…RCTs have been challenged for failing to predict real‐world outcomes . The inherent poor external validity of RCTs limits the study results for generalization to more complex patient populations in real‐world clinical practice, raising concerns that more generalizable results are needed to better inform real‐world clinical decisions . Observational studies are positioned to assess the safety and effectiveness in the real‐world environment .…”

Section: Introductionmentioning

confidence: 99%

“…13 The inherent poor external validity of RCTs limits the study results for generalization to more complex patient populations in real-world clinical practice, 14 raising concerns that more generalizable results are needed to better inform real-world clinical decisions. 15 Observational studies are positioned to assess the safety and effectiveness in the real-world environment. 16,17 However, large-scale comparisons of complex insulin regimens in real-world settings, in combination with oral antidiabetic drugs (OADs), are lacking.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness and safety of different basal insulins in a real‐world setting

Zhang

Zhu

et al. 2017

Diabetes Obesity Metabolism

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Comparative Effectiveness Research and Outcomes of Diabetes Treatment

Cited by 9 publications

References 10 publications

Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS)

Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS)

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

Comparative effectiveness and safety of different basal insulins in a real‐world setting

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