Improving diabetes outcomes using a web-based registry and interactive education: a multisite collaborative approach.

INTRODUCTION: To support the adoption of guideline concordant care by primary care practices, the New York Diabetes Coalition (NYDC) promoted use of an electronic diabetes registry and developed an interactive educational module on using the registry and improving patient communication. The NYDC hypothesized that use of a registry with immediate feedback would achieve measurable and clinically meaningful improvement in the proportion of patients at goal for diabetes health metrics. RESEARCH DESIGN AND METHODS: In 2006-2007, the NYDC recruited 7 small to midsized primary care practices to implement the registry and to receive education and coaching on registry use, practice work flow, and patient engagement. The patient cohort included those with 2 or more visits with a diagnosis of diabetes within a 12-month period. Each patient's health measure status (at goal, above goal, not recorded) was assessed quarterly for hemoglobin A1C , low-density lipoprotein (LDL), and blood pressure (BP), and most recent A1C value was noted. A cohort analysis was performed using random effects regression models to assess the impact of the registry over time for each diabetes health metric. RESULTS: After controlling for variability between sites, with each subsequent quarter during the registry period patients were 1.4 times more likely to have A1C ≤ 9, almost twice (OR = 1.8) as likely to have LDL < 100, and 1.3 times more likely to have BP < 140/90. These improvements in compliance were statistically significant. Average A1C also improved over time, though this did not reach statistical significance. DISCUSSION: Utilizing a Web-based registry and interactive education, the project demonstrated improved patient outcomes, as well as the feasibility of collecting aggregate data from unrelated, independent practices.

Fat-related dietary behaviors of adult Puerto Ricans, with and without diabetes, in New York City.

OBJECTIVE: To assess the fat-related dietary behaviors of adult Puerto Ricans with and without diagnosed diabetes, living in New York City. DESIGN: A random-digit-dialing telephone survey was conducted following Behavioral Risk Factor Surveillance System procedures. Dietary behavior was assessed using a brief Fat-Related Diet Habits Questionnaire, in which higher scores indicated higher fat intake. SUBJECTS/SETTING: A total of 1,304 adult Puerto Ricans living in New York City were interviewed. Diabetes status was assessed using standard Behavioral Risk Factor Surveillance System questions. STATISTICAL ANALYSES PERFORMED: Weighted analyses using SUDAAN software for complex surveys were done, and t tests were used to assess differences in mean fat-related dietary score by sociodemographic and health characteristics. Age-adjusted least-squared means were used to compare scores between those with and without diabetes. Linear regression was used to model characteristics associated with fat-related dietary score. RESULTS: Fat-related dietary score was lower among those with diabetes and varied by population and health characteristics. Age-adjusted scores were significantly lower for those with diabetes who were younger, less educated, obese, or physically active. In the regression model, family history, weight, and exercise interacted with diabetes status. Those with diabetes were significantly more likely to modify meat consumption practices (eg, remove skin or trim fat) to reduce fat compared with those without diabetes. CONCLUSIONS: New York City Puerto Ricans with diabetes are somewhat more likely to engage in behaviors to reduce fat compared with those without diabetes. Targeted, culturally sensitive nutrition education and counseling emphasizing lower-fat food choices and other fat-reducing behaviors can help reduce risk and control diabetes. Education messages should be tailored to the individual's diabetes status and other health and sociodemographic characteristics.

Outcome and cost of a statewide diabetes screening and awareness initiative in New York.

From 1997 through 1999, a total of 365 diabetes screening and awareness events targeting high-risk populations were held throughout New York State. These events were planned and implemented by community-based coalitions that received funding from the state's Diabetes Control Program. The American Diabetes Association's diabetes risk questionnaire was administered, and those individuals identified as high risk received a capillary blood glucose test. Screened individuals with glucose readings above the cut-off value (140 mg/dl or 110 mg/dl if fasting) were referred to a physician for diagnostic testing. A total of 32,954 individuals took the questionnaire, 27,237 received the blood test, and 1,564 were referred to a physician. Among those who were successfully tracked (n = 1,113), 354 were newly diagnosed with diabetes mellitus. Seventy-two percent of participants screened were aged 45 years and older, and 67% had a body mass index of 25 or higher. Only 15% were members of ethnic minorities, and uninsured individuals were also underrepresented at 10%. The entire initiative, including planning, promotion, and administration, required 5,428 person-hours of staff time and a total cost of approximately 262,000 dollars. Fifty-seven percent of the total cost was derived from in-kind support of the coalitions. The cost of detecting each new case was 741 dollars.

Diabetes and its related risk factors among Russian-speaking immigrants in New York State.

Russian-speakers, one of the largest groups of new immigrants in New York, are characterized by high proportions of refugees, and elderly and urban residents. To understand the extent of diabetes and its risks in this population, client data from a large state-wide diabetes prevention program were used. The prevalence of diabetes among Russian-speaking immigrants aged 40 years and older (N=1,008) was 16.9% (95% confidence interval [CI]: 14.6, 19.3). Russian-speaking immigrants also exhibited a high prevalence of obesity, defined by BMI > or = 30 (33.2%, 95% CI: 30.4, 36.2), high blood pressure (53.8%, 95% CI: 50.7, 56.8), and sedentary lifestyle (69.8%, 95% CI: 67.0, 72.6). After adjusting for age, these rates were significantly higher (P<.01) than the rates for non-Hispanic Whites in the state. Women, urban residents, those with less than a high school education, and Medicaid recipients, were more likely to be at risk. The literature on Russian immigrants suggests an association between dietary behavior, economic hardship, cultural and linguistic barriers, and less favorable health outcomes.