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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Improving IV Insulin Administration in a Community Hospital
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Does Rapid Diffusion of HbA1c Testing Affect Amputation Rates?

Kimon Bekelis1, Daniel Gottlieb2, Karina Newhall3

  • 1Department of Surgery, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA kbekelis@gmail.com.

Vascular and Endovascular Surgery
|March 11, 2016
PubMed
Summary
This summary is machine-generated.

The speed of Hemoglobin A1C (HbA1c) testing adoption showed a moderate link to changes in lower extremity amputation rates in diabetes patients. Improvements in HbA1c testing may not instantly improve patient outcomes like amputations.

Keywords:
HbA1c testingMedicarediabeteslower extremity amputationtemporal diffusion patterns

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Area of Science:

  • Health Services Research
  • Diabetes Care Outcomes
  • Health Quality Improvement

Background:

  • The relationship between the adoption rate of Hemoglobin A1C (HbA1c) testing and changes in critical diabetes outcomes, such as amputation, is debated.
  • Understanding this association is crucial for evaluating the impact of quality improvement initiatives.

Purpose of the Study:

  • To investigate the correlation between the speed of HbA1c testing diffusion and temporal changes in lower extremity amputation rates among diabetic patients.
  • To determine if faster adoption of HbA1c testing is associated with quicker declines in amputation rates.

Main Methods:

  • Retrospective cohort study utilizing Medicare fee-for-service claims data (2002-2012).
  • Analysis focused on hospital referral regions (HRRs) as the unit of analysis.
  • Examined the association between the rate of HbA1c testing diffusion and changes in amputation rates, adjusting for baseline factors.

Main Results:

  • A cohort of 11,096,270 diabetic patients was analyzed, with 106,340 (0.96%) undergoing lower extremity amputations.
  • A moderate association was found between the speed of HbA1c testing diffusion and lower extremity amputations (adjusted difference: -0.7%).
  • Risk-adjusted HRR-level diffusion of testing correlated significantly with the diffusion of amputations (r = .250, P < .001).

Conclusions:

  • A moderate association exists between the speed of HbA1c testing diffusion and lower extremity amputations in Medicare diabetic patients.
  • Improvements in quality metrics like HbA1c testing may not yield immediate, tangible improvements in patient outcomes.