Determinants of glycaemic control in a practice setting: the role of weight loss and treatment adherence (The DELTA Study).

AIMS: Examine the association between weight loss and adherence with glycaemic goal attainment in patients with inadequately controlled T2DM. MATERIALS AND METHODS: Patients ≥ 18 years with T2DM from a US integrated health system starting a new class of diabetes medication between 11/1/10 and 4/30/11 (index date) with baseline HbA1c ≥ 7.0% were included in this cohort study. Target HbA1c and weight change were defined at 6-months as HbA1c < 7.0% and ≥ 3% loss in body weight. Patient-reported medication adherence was assessed per the Medication Adherence Reporting Scale. Structural equation modelling was used to describe simultaneous associations between adherence, weight loss and HbA1c goal attainment. RESULTS: Inclusion criteria were met by 477 patients; mean (SD) age 59.1 (11.6) years; 50.9% were female; 30.4% were treatment naïve; baseline HbA1c 8.6% (1.6); weight 102.0 kg (23.0). Most patients (67.9%) reported being adherent to the index diabetes medication. At 6 months mean weight change was -1.3 (5.1) kg (p = 0.39); 28.1% had weight loss of ≥ 3%. Mean HbA1c change was -1.2% (1.8) (p< 0.001); 42.8% attained HbA1c goal. Adherent patients (OR 1.70; p = 0.02) and diabetes therapies that lead to weight loss (metformin, GLP-1) were associated with weight loss ≥ 3% (OR 2.96; p< 0.001). Weight loss (OR 3.60; p < 0.001) and adherence (OR 1.59; p < 0.001) were associated with HbA1c goal attainment. CONCLUSIONS: Weight loss ≥ 3% and medication adherence were associated with HbA1c goal attainment in T2DM; weight loss was a stronger predictor of goal attainment than medication adherence in this study population. It is important to consider weight-effect properties, in addition to patient-centric adherence counselling, when prescribing diabetes therapy.

Evaluation of Gannon-Hahnemann Program to provide family physicians for underserved area.

The Gannon-Hahnemann Family Medicine Program is a combined B.S.-M.D. program designed to provide family practitioners to northwest Pennsylvania, a medically underserved area. The first six graduating classes (1981 through 1986) of the combined six-year curriculum contained 81 students. These students completed two years of undergraduate education at Gannon University, Erie, Pennsylvania, and four years at Hahnemann University School of Medicine. The students were required to complete the clinical rotations of their final year of medical school in Erie, and one of the rotations had to be family practice. Of the 81 combined-program graduates, 24 (29.6 percent) initially selected family practice residencies, while only 5.2 percent of the regular admission Hahnemann students selected family practice. Of these 24 graduates, 13 completed family practice residencies, and six of those chose to practice in northwest Pennsylvania. Nine graduates remained in family practice training.