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Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control.

Publication ,  Journal Article
Crowley, MJ; Holleman, R; Klamerus, ML; Bosworth, HB; Edelman, D; Heisler, M
Published in: Chronic Illn
December 2014

OBJECTIVES: Patients with persistent poorly controlled diabetes mellitus (PPDM), defined as an uninterrupted hemoglobin A1c >8.0% for ≥1 year despite standard care, are at high risk for complications. Additional research to define patient factors associated with PPDM could suggest barriers to improvement in this group and inform the development of targeted strategies to address these patients' resistant diabetes. METHODS: We analyzed patients with type 2 diabetes from a multi-site randomized trial. We characterized patients with PPDM relative to other patients using detailed survey data and multivariable modeling. RESULTS: Of 963 patients, 118 (12%) had PPDM, 265 (28%) were intermittently poorly controlled, and 580 (60%) were well-controlled. Patients with PPDM had younger age, earlier diabetes diagnosis, insulin use, higher antihypertensive burden, higher low-density lipoprotein cholesterol, and lower statin use relative to well-controlled patients. Among patients with objective adherence data (Veterans Affairs patients), a larger oral diabetes medication refill gap was associated with PPDM. DISCUSSION: Strategies are needed to target-specific barriers to improvement among patients whose diabetes is resistant to standard diabetes care. Our data suggest that strategies for targeting PPDM should accommodate younger patients' lifestyles, include medication management for insulin titration and comorbid disease conditions, and address barriers to self-management adherence.

Duke Scholars

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Published In

Chronic Illn

DOI

EISSN

1745-9206

Publication Date

December 2014

Volume

10

Issue

4

Start / End Page

291 / 302

Location

United States

Related Subject Headings

  • Socioeconomic Factors
  • Sex Factors
  • Self Care
  • Risk Factors
  • Racial Groups
  • Public Health
  • Patient Compliance
  • Middle Aged
  • Medication Adherence
  • Male
 

Citation

APA
Chicago
ICMJE
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Crowley, M. J., Holleman, R., Klamerus, M. L., Bosworth, H. B., Edelman, D., & Heisler, M. (2014). Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control. Chronic Illn, 10(4), 291–302. https://doi.org/10.1177/1742395314523653
Crowley, Matthew J., Rob Holleman, Mandi L. Klamerus, Hayden B. Bosworth, David Edelman, and Michele Heisler. “Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control.Chronic Illn 10, no. 4 (December 2014): 291–302. https://doi.org/10.1177/1742395314523653.
Crowley MJ, Holleman R, Klamerus ML, Bosworth HB, Edelman D, Heisler M. Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control. Chronic Illn. 2014 Dec;10(4):291–302.
Crowley, Matthew J., et al. “Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control.Chronic Illn, vol. 10, no. 4, Dec. 2014, pp. 291–302. Pubmed, doi:10.1177/1742395314523653.
Crowley MJ, Holleman R, Klamerus ML, Bosworth HB, Edelman D, Heisler M. Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control. Chronic Illn. 2014 Dec;10(4):291–302.
Journal cover image

Published In

Chronic Illn

DOI

EISSN

1745-9206

Publication Date

December 2014

Volume

10

Issue

4

Start / End Page

291 / 302

Location

United States

Related Subject Headings

  • Socioeconomic Factors
  • Sex Factors
  • Self Care
  • Risk Factors
  • Racial Groups
  • Public Health
  • Patient Compliance
  • Middle Aged
  • Medication Adherence
  • Male