Impact of Expanding Access to Continuous Glucose Monitoring Systems Among Insulin Users with Type 1 or Type 2 Diabetes.

Background: Despite increased use of continuous glucose monitoring (CGM) systems, studies to quantify patterns of CGM use are limited. In December 2018, a policy change by a commercial insurer expanded coverage of CGM through the pharmacy benefit, creating an opportunity to evaluate the impact of this change on CGM utilization. Research Design and Methods: Pharmacy and medical claims from 2016 to 2020 were used to estimate the prevalence of CGM use among insulin users with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) before and after the policy change. Change in CGM use was assessed using an interrupted time series design. Results: At the beginning of the study period, 18.8% of T1DM patients and 1.2% of T2DM patients used CGM. Use rose to 30.5% and 6.6% in the quarter before the policy change. The policy resulted in an immediate 9.5% (P < 0.0001) and 2.8% (P < 0.0001) change in use and increased the rate of quarterly change by 0.5% (P = 0.002) and 0.8% (P < 0.0001). At the end of the study period, 58.2% and 14.9% of T1DM and T2DM patients used CGM. Conclusion: CGM use significantly increased after addition to the pharmacy benefit. Rate of change in CGM use was lower in T1DM compared to the T2DM population, but overall use remained higher among patients with T1DM. Increased CGM use in the population studied aligns with those whose clinical guidelines suggest would most likely benefit. Additional work is needed to evaluate the impact of this benefit change on health care spending and outcomes.

Opening Cuboid Wedge Osteotomy (Zoom Osteotomy) for Triplanar Correction of Flexible Pes Planovalgus Deformities.

Surgical correction of flexible pes planovalgus often involves reestablishing the length of the lateral column. This is a review of a cohort of patients who underwent an opening cuboid osteotomy with interpositional graft for triplanar correction of flexible pes planovalgus. The medical records of 35 patients involving 51 feet were reviewed. All patients were treated with an opening wedge osteotomy of the cuboid in combination with adjunctive procedures as needed for correction of the pes planovalgus deformity. Radiographs were obtained before and a minimum of 12 months after surgery. Preoperative and postoperative cuboid abduction and Meary's (lateral talometatarsal) angles were measured using the radiographs, and adjunctive procedures and complications were recorded. Mean follow-up was 46 (range, 12-85) months. The mean cuboid abduction angle improved from 20.3° (range, 8°-31°) to 6.6° (range, 0°-15°), and the mean Meary's angle improved from 10.5° (range, 0°-25°) to 2° (range, -3° to 15°). All patients also underwent adjunctive procedures at the time of cuboid osteotomy. In the 51 feet treated, there were 3 (6%) complications, including wound dehiscence, neuritis, and deep vein thrombosis. There were no recurrences. Triplanar correction of flexible pes planovalgus can be performed safely and successfully with an opening cuboid osteotomy as an alternative to the Evans Osteotomy.

Adding non-contrast and delayed phases increases the diagnostic performance of arterial CTA for suspected active lower gastrointestinal bleeding.

OBJECTIVES: When assessing for lower gastrointestinal bleed (LGIB) using CTA, many advocate for acquiring non-contrast and delayed phases in addition to an arterial phase to improve diagnostic performance though the potential benefit of this approach has not been fully characterized. We evaluate diagnostic accuracy among radiologists when using single-phase, biphasic, and triphasic CTA in active LGIB detection. METHOD AND MATERIALS: A random experimental block design was used where 3 blinded radiologists specialty trained in interventional radiology retrospectively interpreted 96 CTA examinations completed between Oct 2012 and Oct 2017 using (1) arterial only, (2) arterial/non-contrast, and (3) arterial/non-contrast/delayed phase configurations. Confirmed positive and negative LGIB studies were matched, balanced, and randomly ordered. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive and negative predictive values, and time to identify the presence/absence of active bleeding were examined using generalized estimating equations (GEE) with sandwich estimation assuming a binary distribution to estimate relative benefit of diagnostic performance between phase configurations. RESULTS: Specificity increased with additional contrast phases (arterial 72.2; arterial/non-contrast 86.1; arterial/non-contrast/delayed 95.1; p < 0.001) without changes in sensitivity (arterial 77.1; arterial/non-contrast 70.2; arterial/non-contrast/delayed 73.1; p = 0.11) or mean time required to identify bleeding per study (s, arterial 34.8; arterial/non-contrast 33.1; arterial/non-contrast/delayed 36.0; p = 0.99). Overall agreement among readers (Kappa) similarly increased (arterial 0.47; arterial/non-contrast 0.65; arterial/non-contrast/delayed 0.79). CONCLUSION: The addition of non-contrast and delayed phases to arterial phase CTA increased specificity and inter-reader agreement for the detection of lower gastrointestinal bleeding without increasing reading times. KEY POINTS: • A triphasic CTA including non-contrast, arterial, and delayed phase has higher specificity for the detection of lower gastrointestinal bleeding than arterial-phase-only protocols. • Inter-reader agreement increases with additional contrast phases relative to single-phase CTA. • Increasing the number of contrast phases did not increase reading times.

Synergism between obesity and poor oral health associated with diabetes in an elderly human population.

We investigated associations between type 2 diabetes (DM) and several variables, including poor oral health and overweight/obesity, among a group of elderly Hmong subjects (60 years and older) who emigrated to the United States following the Vietnam conflict. Each subject was interviewed and their weight, height and waist circumference were measured. Each subject had an oral health examination. Each subject's saliva was analyzed for seven components related to inflammation. The presence of DM was correlated with poor oral health (POH) and overweight/obesity (OW) separately. There was a strong correlation between concurrent POH and OW and the presence of DM: all subjects with both POH and OW had DM. Logistic multivariate analysis of OW, POH, age, years of residence in California, and stress level revealed a significant association between the presence of DM and concurrent OW and POH. A change in diet after immigration was excluded as an explanatory variable. Subjects with DM and concurrent OW and POH had significantly elevated salivary levels of five analyses related to chronic inflammation. The association between POH and OW and the presence of DM needs further study.