Publication Type: Abstract
Abstract: Background: Type 2 diabetes is prevalent among African Americans. In 2002, the Mile Square Health Center in Chicago, serving a predominantly underserved African American population, received a Clinical Pharmacy Demonstration Project grant from the Bureau of Primary Health Care to establish a pharmacist managed diabetes service.
Objective: To investigate whether the pharmacist managed diabetes service reduced the burden of diabetes.
Methods: A full-time pharmacist was assigned to organize and deliver the diabetes service. Patients were provided with diet and exercise modification, disease and medication education, self-monitoring of blood glucose, and medication management. Clinical outcome indicator was the glycated hemoglobin A1c level. Patients received intervention from August 2002 through March 2004 were included. The longitudinal trends of quarterly-averaged A1c level during 2.5 years before and 2 years after the first intervention were evaluated with random effects regression model.
Results: 110 patients received intervention during their routine visits. Most of the patients were African American (88%), female (60%) and had a mean age of 53.6 years. The A1c differed significantly when comparing 3-month pre-and-post or 12-month pre-and-post of the initial intervention (paired-t test, P<0.01). Significant heterogeneity was found in the baseline and trends of A1c (random effects models, p<0.05). The A1c before the intervention showed an increasing trend (p<0.05), while it had a downward trend after the intervention (p<0.0001), controlling for age, gender and race.
Implications: The pharmacist managed diabetes service is effective in reducing the A1c level. Random effects model is efficient in comparing trends in study with one-group pre-post design.

Publication Type: Abstract
Abstract: Authors: H. Shelton Brown (shelton.brown@utb.edu), School of Public Health, University of Texas, Jose A Pagan, University of Texas-Pan American, Craig Hanis, School of Public Health, University of Texas

Title: The Impact of Diabetes and Diabetes Management on Labor Productivity: A Genetic IV Approach

Rationale: Diabetes has been shown to have a detrimental impact on employment and labor market productivity, which results in lost work days and lower wages. However, unobservables are correlated with diabetes and labor productivity, leading to endogeneity problems in estimates. Brown, Pagan and Bastida have recently shown that ignoring endogeneity results in an overestimate (underestimate) of the negative impact of diabetes on female (male) employment (2005). With endogeneity addressed, there was no effect of diabetes on female working propensity in their study. It is possible that gender differences in diabetes management, where female diabetics adhere to management better than males, may account for the differential impact of diabetes on labor productivity.

Objective: To determine whether diabetes, when managed, is related to labor productivity by gender.

Methodology: To account for the endogeneity of diabetes, we use family history of diabetes as genetic instrumental variables in determining diabetes. In order to determine the level of self-management, diabetes is interacted with laboratory-measured blood-sugar levels. Note that in our data, diabetes is measured rather than self-reported. Wage equations and working propensity equations are estimated, by gender. The data are from a new random sample from a largely Mexican-American community in Texas on the border of Mexico.

Results: Self-management is an important, but heretofore, unobservable effect in labor supply. Our results are particularly relevant in the case of populations where genetic predisposition has an important role in the etiology of diabetes.

Conclusions: Our results shed light on the reasons for the differential impact of diabetes on male and female labor productivity. Further, our results inform policy-makers about how to allocate health care resources between prevention of diabetes and diabetes management for those already diagnosed with diabetes.

Disclosure information: Nil.

Publication Type: Abstract
Abstract: Objective: To determine if personal experience with Self-Monitoring of Blood Glucose (SMBG) and carbohydrate (carb) counting in a diabetes care course changes student attitudes and beliefs about diabetes self-care. Methods: Students enrolled in an intensive three-day elective diabetes care course were required to monitor their serum glucose and count their carbohydrate intake for the duration of the course. They were given minimal advanced instruction about SMBG and carbohydrate counting. They were asked to reflect each day on aspects of these personal experiences. Results: A series of nine reflective questions were asked over the 3 days concerning personal impressions of SMBG and carb counting. Changes in attitudes and beliefs were observed over the 3-day period. Following the course, the formative and summative student self-reflections were reviewed and categorized thematically to assess attitudes and beliefs regarding diabetes self-care. Implications: In addition to enhancing knowledge and skills, requiring students to gain practical hands-on experience in this course changed many of their attitudes and beliefs about diabetes patients. The experiences provided insight into the complexity and challenges of diabetes self-care and the important role the pharmacist can play to positively impact chronic disease management.

Publication Type: Abstract
Abstract: Technology has opened a vast array of pathways to bring the most comprehensive education to students. The DM Educate Comprehensive Diabetes Management web based elective course has been developed to provide a multidisciplinary foundation for health professionals in the principles of diabetes management. The contributing faculty are outstanding educators and practitioners from the fields of pharmacy, nursing, medicine, behavioral psychology, dietetics, and exercise physiology located across the country. Utilizing this web based course, a pilot elective course was designed for 15 pharmacy students to view video lectures, integrated with discussion sessions, assignments and exams. The overall direction for the course is provided by two faculty course coordinators. Students access video lectures via the web at their convenience, consisting of approximately 45 hours of content (equivalent to 3 credit course), completing approximately one section per week. In addition, the students will also complete two case assignments and two examinations. A pre- and post-test will be utilized to evaluate the students’ interpretation of course content. The students will also be active in providing feedback on the usability and function of the web site through surveys, as well as a pre- and post test on general views of web based teaching. Outcomes from the students’ surveys and evaluated course materials will be presented.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Background: Older diabetes patients’ access to diabetes information may shape their preferences for treatment approaches and the shared decision-making process.

Objectives: To investigate 1) older diabetes patients’ access to sources of diabetes information and how that is conditioned by patient characteristics; 2) how older diabetes patients’ access to sources of diabetes information is associated with their preferences for treatment approaches; 3) how their access to diabetes information is associated with the interaction between patients’ and their physicians’ preferences for treatment approaches.

Subjects: 557 diabetic patients >=65 years; 69 physicians.

Measurements: Access to diabetes information is measured by whether patients had access to an array of information sources. Patient preferences are measured by time trade-off values for treatment intensity. Physician preferences are measured by the most aggressive treatment physicians identified for a particular patient.

Results: Patients reported obtaining diabetes information from an average of 2.7 (SD 1.3) sources and 67% supplemented clinical sources of information with non-clinical sources. Patients who had access to more sources of diabetes information were more tolerant of traditional treatment and preferred more aggressive treatments. Patients’ and their physicians’ preferences for treatment approaches were in general not correlated.

Conclusions: This study identified vulnerable groups within older diabetes patients who had limited access to diabetes information. Strengthening patients’ access to diabetes information may increase their utilities for both traditional and intensive treatments. Increasing physicians’ awareness of and abilities to elicit individual older patients’ preferences, and continuing to empower older diabetes patients may strengthen the shared decision-making process.