HOMA-IR and HOMA2-IR estimation based on glycated hemoglobin as an alternative for fasting glucose.

BACKGROUND: Diabetes mellitus is a major global public health problem. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) is a key laboratory index in the assessment of insulin resistance. The calculation of HOMA-IR and its updated version HOMA2-IR are partly based on plasma glucose determinations, which are prone to important pre-analytical errors. As glycated hemoglobin (Hb) fractions strongly correlate with fasting glucose levels and are more stable analytes, we explored the possibilities of using glycated Hb fractions for calculating HOMA-IR. METHODS: Labile Hb and HbA1c fractions were simultaneously assayed on a Tosoh G8 analyzer and expressed as %. Fasting glucose was measured in fluoride plasma using a hexokinase method. A Lumipulse G1200 luminescence immunoassay was used to measure serum insulin. The HOMA-IR and HOMA2-IR values were compared to corresponding indices calculated using glucose and glycated Hb fractions. RESULTS: Labile Hb could be measured with between-run CVs of 2.2-2.3%. Labile Hb correlated with both glycemia (r = 0.80) and HbA1c results (r = 0.73). HbA1c-derived estimated average glucose (eAG)-based HOMA calculation correlated very well with HOMA-IR (r2 = 0.9972). Based on eAG calculations, HOMA2-IR (%B, %S, and IR) gave comparable results, as compared to labile Hb-based calculations, in particular for fasting plasma glucose values between 4.44 and 6.67 mmol/L. CONCLUSIONS: HbA1c and eAG are practical alternatives for glucose for estimating HOMA-IR. The use of glycated Hb enables home sampling for HOMA-IR and HOMA2-IR calculation.

Social differences in postponing a General Practitioner visit in Flanders, Belgium: which low-income patients are most at risk?

One of the main goals of primary care is providing equitable health-care, meaning equal access, equal treatment and equal outcomes of healthcare for all in equal need. Some studies show that patients from lower socioeconomic groups visit a GP more often, while other studies show that they are more likely to postpone a visit to a GP. In this study, we want to explore within the social group of low-income patients living in Flanders, Belgium, which patients have a higher risk of postponing a visit to a GP. A face-to-face questionnaire was administered among 606 low-income users of Public Social Services. The questionnaire consisted of questions on socioeconomic and demographic characteristics, social networks, health and healthcare use. A multivariate logistic regression model was built to study the relationship between postponing or cancelling a GP visit which respondents thought they needed and variables on health, socio-demographic background. The multivariate regression indicates that depression, self-rated health and trust in the GP independently predict postponing a visit to a GP. Low-income people with a low trust in the GP, people with a poor self-rated health and people suffering from a severe depression are more likely to postpone or cancel a GP visit they thought they needed compared to other people on low incomes. This might indicate that the access to health-care for low-income people might be hindered by barriers which are not directly linked to the cost of the consultation.

The social gradient in doctor-patient communication.

OBJECTIVE: In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. METHODS: A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. RESULTS: Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. CONCLUSION: This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication.Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. PRACTICE IMPLICATIONS: By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.

Unique health care utilization patterns in a homeless population in Ghent.

BACKGROUND: Existing studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary care by homeless people compared to the general population. Homeless people are importantly hindered and/or steered in their health care use by barriers directly related to the organisation of care. Our goal is to describe the accessibility of primary health care services, secondary care and emergency care for homeless people living in an area with a universal primary health care system and active guidance towards this unique system. METHODS: Observational, cross-sectional study design. Data from the Belgian National health survey were merged with comparable data collected by means of a face-to-face interview from homeless people in Ghent. 122 homeless people who made use of homeless centres and shelters in Ghent were interviewed using a reduced version of the Belgian National Health survey over a period of 5 months. 2-dimensional crosstabs were built in order to study the bivariate relationship between health care use (primary health care, secondary and emergency care) and being homeless. To determine the independent association, a logistic model was constructed adjusting for age and sex. RESULTS AND DISCUSSION: Homeless people have a higher likelihood to consult a GP than the non-homeless people in Ghent, even after adjusting for age and sex. The same trend is demonstrated for secondary and emergency care. CONCLUSIONS: Homeless people in Ghent do find the way to primary health care and make use of it. It seems that the universal primary health care system in Ghent with an active guidance by social workers contributes to easier GP access.