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Heart failure and diabetes: collateral benefit of chronic disease management
Molly G Ware1, Carol M Flavell, Eldrin F Lewis
1Department of Medicine, Cardiovascular Division, Advanced Heart Disease Program, Brigham and Women's Hospital, Boston, MA 02115, USA.
Insights
Heart failure patients in disease management programs receive good diabetes care, contrary to concerns. This suggests heart failure care may positively impact diabetes management and patient outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Diabetes and heart failure (HF) often coexist.
- Concerns exist regarding adequate diabetes care within HF management programs.
Purpose of the Study:
- To evaluate diabetes care quality in patients enrolled in an HF disease management program.
- To test the hypothesis that HF care may compromise diabetes care.
Main Methods:
- Screened 78 diabetic patients in an HF program.
- Assessed adherence to American Diabetes Association (ADA) recommended care standards.
- Measured hemoglobin A1c and analyzed care components.
Main Results:
- 95% had hemoglobin A1c measured; 71% monitored glucose daily.
- Most received diet/exercise counseling (approx. 80% eye/foot exams).
- Mean hemoglobin A1c was 7.8+/-1.9%; no correlation with HF severity.
Conclusions:
- Patients in HF programs show diabetes care approaching ADA goals.
- HF disease management may offer collateral benefits for diabetic patients.
- Integrated care approaches can improve outcomes for comorbid conditions.
Abstract:
To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64+/-11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8+/-1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF.
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