Scholars@Duke
David Edward Edelman

David Edward Edelman

Professor of Medicine
Medicine, General Internal Medicine
edelm001@duke.edu
Duke Box 104427, Durham, NC 27708
710 W. Main St., Room 133, Durham, NC 27701

Selected Publications

A Novel Approach for Patients with Risky Drinking or Tobacco Smoking and Comorbid Cardiovascular Concerns: Applying Interdisciplinary Conjoint Appointments in an Integrated Primary Care Setting.

Journal Article J Behav Health Serv Res · October 2025 Complex concerns, such as tobacco use and risky drinking in patients with cardiovascular disease (CVD) who report not being ready to change, may require multi-dimensional approaches to intervention. In this Notes from the Field, an interdisciplinary, integ ... Full text Link to item Cite

Decarbonizing Health Care: Measuring the Carbon Footprint Impact of a National VA Telehealth Program.

Journal Article NEJM Catal Innov Care Deliv · April 16, 2025 Health care systems are increasingly recognizing the environmental harms generated by medical care and are seeking to reduce their carbon footprints. They can accomplish measurable reductions in greenhouse gas emissions while maintaining high quality and e ... Full text Open Access Link to item Cite

Family-involved interventions may offer unique benefits for Veterans with posttraumatic stress disorder (PTSD) experiencing high family strain.

Journal Article Psychol Trauma · February 10, 2025 OBJECTIVE: Family strain, which reflects the overall function of the family system, could play an important role in routine posttraumatic stress disorder (PTSD) care. We examined how high/low family strain influences perceptions of a family-involved interv ... Full text Link to item Cite

Perceptions of a comprehensive telehealth intervention in patients with persistently poor type 2 diabetes control.

Journal Article J Clin Transl Sci · 2025 INTRODUCTION: To understand participant perspectives on an effective, practical, comprehensive telehealth intervention for persistently poorly controlled diabetes mellitus and examine how its components contributed to improved outcomes, with the goal of in ... Full text Link to item Cite

Feasibility of a family-involved intervention to increase engagement in evidenced-based psychotherapies for posttraumatic stress disorder: A pilot study.

Journal Article Psychol Trauma · December 2024 OBJECTIVE: To assess the feasibility of a family-involved intervention, family support in mental health recovery (FAMILIAR), for veterans with posttraumatic stress disorder (PTSD) seeking psychotherapy at a single Veterans Administration Health System. MET ... Full text Link to item Cite

Evaluating Therapeutic Inertia in Two Telehealth Interventions for Type 2 Diabetes: Secondary Analyses of a Randomized Trial.

Journal Article Telemed J E Health · June 2024 Introduction: Although therapeutic inertia is a known driver of suboptimal type 2 diabetes control, little is known about how to combat this phenomenon. We analyzed randomized trial data to determine whether a comprehensive telehealth intervention was more ... Full text Link to item Cite

Brief conjoint visits between an embedded behavioral health provider and primary care team member: When are they used and what are the barriers and facilitators?

Journal Article Fam Syst Health · December 2023 INTRODUCTION: Conjoint visits utilize the expertise of primary care providers (PCPs) and behavioral health providers (BHPs) to address complex comorbidities in patients. The objectives were to describe the use and features of conjoint visits and identify b ... Full text Link to item Cite

Mental health therapy for veterans with PTSD as a family affair: A qualitative inquiry into how family support and social norms influence veteran engagement in care.

Journal Article Psychol Serv · November 2023 Social support is important for posttraumatic stress disorder (PTSD) recovery and emerging literature indicate that social support could increase engagement in PTSD therapy. However, there is a need to understand how and why family involvement can increase ... Full text Link to item Cite

Exploring the importance of predisposing, enabling, and need factors for promoting Veteran engagement in mental health therapy for post-traumatic stress: a multiple methods study.

Journal Article BMC Psychiatry · May 27, 2023 PURPOSE: This study explored Veteran and family member perspectives on factors that drive post-traumatic stress disorder (PTSD) therapy engagement within constructs of the Andersen model of behavioral health service utilization. Despite efforts by the Depa ... Full text Link to item Cite

Factors Associated With Diabetes Distress Among Patients With Poorly Controlled Type 2 Diabetes.

Journal Article J Endocr Soc · March 6, 2023 OBJECTIVE: Examine factors associated with increased diabetes distress (DD) among patients with type 2 diabetes with DD assessed by Diabetes Distress Scale (DDS) total and subscale scores (emotional burden, physician-related distress, regimen-related distr ... Full text Link to item Cite

Simplifying therapy to assure glycemic control and engagement (STAGE) in poorly-controlled diabetes: A pilot study.

Journal Article J Diabetes Complications · January 2023 In this single-arm pilot study, we demonstrated feasibility and acceptability of an insulin simplification intervention in patients with persistent, poorly-controlled type 2 diabetes on complex insulin regimens. While not powered to assess clinical outcome ... Full text Link to item Cite

Adapting a family-involved intervention to increase initiation and completion of evidenced-based psychotherapy for posttraumatic stress disorder.

Journal Article SSM Ment Health · December 2022 Posttraumatic stress disorder (PTSD) is disabling condition among United States Veterans. Training programs for evidenced-based therapies have been rolled out nationally in the Veterans Health Administration (VHA), but provider adoption of these treatments ... Full text Link to item Cite

Implementation of an Intensive Telehealth Intervention for Rural Patients with Clinic-Refractory Diabetes.

Journal Article J Gen Intern Med · September 2022 BACKGROUND: Rural patients with type 2 diabetes (T2D) may experience poor glycemic control due to limited access to T2D specialty care and self-management support. Telehealth can facilitate delivery of comprehensive T2D care to rural patients, but implemen ... Full text Open Access Link to item Cite

Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control: A Randomized Clinical Trial.

Journal Article JAMA Intern Med · September 1, 2022 IMPORTANCE: Persistently poorly controlled type 2 diabetes (PPDM) is common and causes poor outcomes. Comprehensive telehealth interventions could help address PPDM, but effectiveness is uncertain, and barriers impede use in clinical practice. OBJECTIVE: T ... Full text Open Access Link to item Cite

Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes.

Journal Article Chronic Illn · June 2022 OBJECTIVES: To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. METHODS: In this secondary analysis of a randomized trial in patient ... Full text Link to item Cite

Clinical and translational science award T32/TL1 training programs: program goals and mentorship practices.

Journal Article J Clin Transl Sci · 2022 INTRODUCTION: A national survey characterized training and career development for translational researchers through Clinical and Translational Science Award (CTSA) T32/TL1 programs. This report summarizes program goals, trainee characteristics, and mentors ... Full text Link to item Cite

Clinical associations of an updated medication effect score for measuring diabetes treatment intensity.

Journal Article Chronic Illn · December 2021 OBJECTIVES: The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effe ... Full text Link to item Cite

Virtual integrated primary care teams: Recommendations for team-based care.

Journal Article Fam Syst Health · December 2021 INTRODUCTION: Integrated primary care teams are increasingly relying upon virtual care, including both telehealth and team members who are teleworking, due to the COVID-19 pandemic. This shift to virtual care can present challenges for the coordination and ... Full text Link to item Cite

Heterogeneity of Treatment Effects Among Patients With Type 2 Diabetes and Elevated Body Mass Index in a Study Comparing Group Medical Visits Focused on Weight Management and Medication Intensification.

Journal Article Med Care · November 1, 2021 BACKGROUND: Illuminating heterogeneity of treatment effect (HTE) within trials is important for identifying target populations for implementation. OBJECTIVE: The aim of this study was to examine HTE in a trial of group medical visits (GMVs) for patients wi ... Full text Link to item Cite

The direct clinic-level cost of the implementation and use of a protocol to assess and address social needs in diverse community health center primary care clinical settings

Journal Article Journal of Health Care for the Poor and Underserved · November 1, 2021 Purpose. Social determinants of health, including food insecurity, housing insta-bility, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, ... Full text Cite

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.

Journal Article BMC Health Serv Res · September 17, 2021 BACKGROUND: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients' health outcomes. To our knowledge, this is ... Full text Link to item Cite

Evaluating the association of social needs assessment data with cardiometabolic health status in a federally qualified community health center patient population.

Journal Article BMC Cardiovasc Disord · July 14, 2021 BACKGROUND: Health systems are increasingly using standardized social needs screening and response protocols including the Protocol for Responding to and Assessing Patients' Risks, Assets, and Experiences (PRAPARE) to improve population health and equity; ... Full text Link to item Cite

Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya.

Journal Article J Am Coll Cardiol · April 27, 2021 BACKGROUND: Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES: The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS: T ... Full text Link to item Cite

Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya.

Journal Article PLoS One · 2021 BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical ... Full text Link to item Cite

The Direct Clinic-Level Cost of the Implementation and Use of a Protocol to Assess and Address Social Needs in Diverse Community Health Center Primary Care Clinical Settings.

Journal Article J Health Care Poor Underserved · 2021 PURPOSE: Social determinants of health, including food insecurity, housing instability, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, ... Full text Link to item Cite

Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial.

Journal Article Contemp Clin Trials · November 2020 BACKGROUND: Persistent poorly-controlled type 2 diabetes mellitus (PPDM), or maintenance of a hemoglobin A1c (HbA1c) ≥8.5% despite receiving clinic-based diabetes care, contributes disproportionately to the national diabetes burden. Comprehensive telehealt ... Full text Open Access Link to item Cite

A data-driven examination of which patients follow trial protocol.

Journal Article Contemp Clin Trials Commun · September 2020 UNLABELLED: Protocol adherence in behavioral intervention clinical trials is critical to trial success. There is increasing interest in understanding which patients are more likely to adhere to trial protocols. The objective of this study was to demonstrat ... Full text Link to item Cite

Correction to: Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya.

Journal Article BMC Health Serv Res · August 12, 2020 An amendment to this paper has been published and can be accessed via the original article. ... Full text Link to item Cite

Utilization and Costs by Primary Care Provider Type: Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?

Journal Article Med Care · August 2020 OBJECTIVE: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs). RESEARCH DESIGN AND METHODS: Cohort study us ... Full text Link to item Cite

Preliminary evidence of effects of potassium chloride on a metabolomic path to diabetes and cardiovascular disease.

Journal Article Metabolomics · June 18, 2020 INTRODUCTION: Low potassium intake can affect cardiovascular disease (CVD) risk and cardiometabolic risk factors. OBJECTIVE: We hypothesize that potassium chloride (KCl) supplementation can improve cardiovascular risk metabolomic profile. METHODS: In this ... Full text Open Access Link to item Cite

Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya.

Journal Article BMC Health Serv Res · May 12, 2020 BACKGROUND: Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated earl ... Full text Link to item Cite

Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes: A Noninferiority Randomized Clinical Trial.

Journal Article JAMA Intern Med · January 1, 2020 IMPORTANCE: Traditionally, group medical visits (GMVs) for persons with diabetes improved glycemia by intensifying medications, which infrequently led to weight loss. Incorporating GMVs with intensive dietary change could enable weight loss and improve gly ... Full text Link to item Cite

In Response.

Journal Article Anesth Analg · September 2019 Full text Link to item Cite

Primary care provider type: Are there differences in patients' intermediate diabetes outcomes?

Journal Article JAAPA · June 2019 Growing demand for services is leading primary care organizations to explore new delivery models. One approach incorporates multiple primary care providers on a team. Effective incorporation of multiple clinicians into teams requires well-defined roles, in ... Full text Link to item Cite

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients.

Journal Article Health Aff (Millwood) · June 2019 Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality ... Full text Link to item Cite

Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings.

Journal Article J Am Soc Nephrol · January 2019 BACKGROUND: Outcomes of veterans with ESRD may differ depending on where they receive dialysis and who finances this care, but little is known about variation in outcomes across different dialysis settings and financial arrangements. METHODS: We examined s ... Full text Link to item Cite

Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study.

Journal Article PLoS One · 2019 OBJECTIVE: Patients with persistent poorly-controlled diabetes mellitus (PPDM) despite engagement in clinic-based care are at particularly high risk for diabetes complications and costs. Understanding this population's demographics, comorbidities and care ... Full text Open Access Link to item Cite

Characteristics and Delivery of Diabetes Shared Medical Appointments in North Carolina.

Journal Article N C Med J · 2019 BACKGROUND Successful diabetes care requires patient engagement and health self-management. Diabetes shared medical appointments (SMAs) are an evidence-based approach that enables peer support, diabetes group education, and medication management to improve ... Full text Open Access Link to item Cite

Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study.

Journal Article Ann Intern Med · December 18, 2018 BACKGROUND: Primary care provided by nurse practitioners (NPs) and physician assistants (PAs) has been proposed as a solution to expected workforce shortages. OBJECTIVE: To examine potential differences in intermediate diabetes outcomes among patients of p ... Full text Link to item Cite

Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis.

Journal Article Health Serv Res · December 2018 OBJECTIVE: Growing demand for VA dialysis exceeds its supply and travel distances prohibit many Veterans from receiving dialysis in a VA facility, leading to increased use of dialysis from non-VA providers. This study compared utilization and hospitalizati ... Full text Link to item Cite

How Views of the Organization of Primary Care Among Patients with Hypertension Vary by Race or Ethnicity.

Journal Article Mil Med · September 1, 2018 INTRODUCTION: We assessed potential racial or ethnic differences in the degree to which veterans with pharmaceutically treated hypertension report experiences with their primary care system that are consistent with optimal chronic illness care as suggested ... Full text Open Access Link to item Cite

Interpersonal continuity of primary care of veterans with diabetes: a cohort study using electronic health record data.

Journal Article BMC Fam Pract · July 30, 2018 BACKGROUND: Continuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors associated with interpersonal continuity of ca ... Full text Link to item Cite

KCNJ11 variants and their effect on the association between serum potassium and diabetes risk in the Atherosclerosis Risk in Communities (ARIC) Study and Jackson Heart Study (JHS) cohorts.

Journal Article PLoS One · 2018 BACKGROUND: In the Atherosclerosis Risk in Communities (ARIC) Study and Jackson Heart Study (JHS) cohorts, serum potassium (K) is an independent predictor of diabetes risk, particularly among African-American participants. Experimental studies show that se ... Full text Link to item Cite

Effects of potassium supplements on glucose metabolism in African Americans with prediabetes: a pilot trial.

Journal Article Am J Clin Nutr · December 2017 Background: Low potassium has been identified both as a risk factor for type 2 diabetes and as a mediator of the racial disparity in diabetes risk. Low potassium could be a potentially modifiable risk factor, particularly for African Americans.Objective: W ... Full text Open Access Link to item Cite

A problem-solving intervention for cardiovascular disease risk reduction in veterans: Protocol for a randomized controlled trial.

Journal Article Contemp Clin Trials · September 2017 BACKGROUND: Health behaviors related to diet, tobacco usage, physical activity, medication adherence, and alcohol use are highly determinative of risk for developing cardiovascular disease. This paper describes a study protocol to evaluate a problem-solvin ... Full text Link to item Cite

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment.

Journal Article J Clin Sleep Med · August 15, 2017 STUDY OBJECTIVES: Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that ... Full text Open Access Link to item Cite

Jump starting shared medical appointments for diabetes with weight management: Rationale and design of a randomized controlled trial.

Journal Article Contemp Clin Trials · July 2017 BACKGROUND: Rates of glycemic control remain suboptimal nationwide. Medication intensification for diabetes can have undesirable side effects (weight gain, hypoglycemia), which offset the benefits of glycemic control. A Shared Medical Appointment (SMA) int ... Full text Link to item Cite

Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study.

Journal Article Am Heart J · June 2017 BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of m ... Full text Link to item Cite

Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: the Jackson Heart Study.

Journal Article Am J Clin Nutr · February 2017 BACKGROUND: Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. OBJECTIVES: We sought to confirm the associatio ... Full text Open Access Link to item Cite

Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes.

Journal Article Patient Prefer Adherence · 2017 OBJECTIVE: We studied a telemedicine intervention for persistent poorly controlled diabetes mellitus (PPDM) that combined telemonitoring, self-management support, and medication management. The intervention was designed for practical delivery using existin ... Full text Open Access Link to item Cite

Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus.

Journal Article Inquiry · January 1, 2017 Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associ ... Full text Link to item Cite

To condition or not condition? Analysing 'change' in longitudinal randomised controlled trials.

Journal Article BMJ Open · December 30, 2016 OBJECTIVE: The statistical analysis for a 2-arm randomised controlled trial (RCT) with a baseline outcome followed by a few assessments at fixed follow-up times typically invokes traditional analytic methods (eg, analysis of covariance (ANCOVA), longitudin ... Full text Link to item Cite

Open-label randomized trial of titrated disease management for patients with hypertension: Study design and baseline sample characteristics.

Journal Article Contemp Clin Trials · September 2016 Despite the availability of efficacious treatments, only half of patients with hypertension achieve adequate blood pressure (BP) control. This paper describes the protocol and baseline subject characteristics of a 2-arm, 18-month randomized clinical trial ... Full text Open Access Link to item Cite

The utilization of video-conference shared medical appointments in rural diabetes care.

Journal Article Int J Med Inform · September 2016 AIM: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings. METHODS: We conduct ... Full text Link to item Cite

Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial.

Journal Article Telemed J E Health · May 2016 BACKGROUND: Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled ... Full text Link to item Cite

Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial.

Journal Article Phys Ther · May 2016 BACKGROUND: Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA). OBJECTIVE: This trial compared group-based versus individual physical therapy interventions for management of knee OA. D ... Full text Open Access Link to item Cite

Potassium Measures and Their Associations with Glucose and Diabetes Risk: The Multi-Ethnic Study of Atherosclerosis (MESA).

Journal Article PLoS One · 2016 BACKGROUND: Recent studies have found low-normal potassium (K) to be associated with increased diabetes risk. We sought to verify these associations in a multi-ethnic US cohort; and to determine if these associations extend to US Hispanics and Asian-Americ ... Full text Open Access Link to item Cite

Novel Risk Factors for Type 2 Diabetes in African-Americans.

Journal Article Curr Diab Rep · December 2015 In the USA, compared to whites, African-Americans are disproportionately impacted by the diabetes epidemic. Traditional diabetes risk factors, such as obesity, are more common among African-Americans, but these traditional risk factors do not explain all o ... Full text Link to item Cite

Does Type 2 Diabetes Genetic Testing and Counseling Reduce Modifiable Risk Factors? A Randomized Controlled Trial of Veterans.

Journal Article J Gen Intern Med · November 2015 OBJECTIVE: We examined the clinical utility of supplementing type 2 diabetes mellitus (DM) risk counseling with DM genetic test results and counseling. RESEARCH DESIGN AND METHODS: In this randomized controlled trial, non-diabetic overweight/obese veteran ... Full text Link to item Cite

Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

Journal Article J Gen Intern Med · May 2015 BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTI ... Full text Open Access Link to item Cite

Long-term outcomes of analogue insulin compared with NPH for patients with type 2 diabetes mellitus.

Journal Article Am J Manag Care · March 1, 2015 BACKGROUND: Long-acting insulin analogues (eg, insulin glargine and insulin detemir) are an alternative to neutral protamine Hagedorn (NPH) insulin for maintaining glycemic control in patients with diabetes. Clinical trials comparing analogue insulin and N ... Link to item Cite

Potassium and glucose measures in older adults: the Cardiovascular Health Study.

Journal Article J Gerontol A Biol Sci Med Sci · February 2015 BACKGROUND: We sought to determine the impacts of serum and dietary potassium measures on glucose metabolism and diabetes risk in older adults. METHODS: Among participants of the Cardiovascular Health Study, a community-based cohort of older American adult ... Full text Link to item Cite

Shared medical appointments for patients with diabetes mellitus: a systematic review.

Journal Article J Gen Intern Med · January 2015 OBJECTIVES: Shared medical appointments (SMAs) are an increasingly used system-redesign strategy for improving access to and quality of chronic illness care. We conducted a systematic review of the existing literature on SMA interventions for patients with ... Full text Link to item Cite

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

Journal Article 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 associate ... Full text Open Access Link to item Cite

Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes.

Journal Article Value Health · December 2014 BACKGROUND: Clinical trials often compare hypoglycemic medications on the basis of glycemic control but do not examine long-term outcomes (e.g., mortality). This study demonstrates an alternative approach to lengthening clinical trials to assess these long ... Full text Link to item Cite

Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?

Journal Article Circ Cardiovasc Qual Outcomes · March 2014 BACKGROUND: Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longer-term economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after com ... Full text Open Access Link to item Cite

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): rationale for a tailored behavioral and educational pharmacist-administered intervention for achieving cardiovascular disease risk reduction.

Journal Article Telemed J E Health · February 2014 BACKGROUND: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and ... Full text Open Access Link to item Cite

Can group medical clinics improve lipid management in diabetes?

Journal Article Am J Med · February 2014 BACKGROUND: Group medical clinics may improve diabetes and hypertension control, but data about dyslipidemia are limited. We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension. METHODS: Prespec ... Full text Link to item Cite

Non-traditional risk factors are important contributors to the racial disparity in diabetes risk: the atherosclerosis risk in communities study.

Journal Article J Gen Intern Med · February 2014 BACKGROUND: Traditional risk factors, particularly obesity, do not completely explain the excess risk of diabetes among African Americans compared to whites. OBJECTIVE: We sought to quantify the impact of recently identified, non-traditional risk factors o ... Full text Link to item Cite

Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics.

Journal Article Contemp Clin Trials · September 2013 BACKGROUND: Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both ... Full text Open Access Link to item Cite

Impact of baseline insulin regimen on glycemic response to a group medical clinic intervention.

Journal Article Diabetes Care · July 2013 OBJECTIVE: Group medical clinics (GMC) combine medication management and self-management training, and may improve diabetes outcomes. It remains unclear which patients benefit most from GMC. This secondary analysis examined the impact of baseline insulin r ... Full text Link to item Cite

Effects of changes in potassium with valsartan use on diabetes risk: Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial.

Journal Article Am J Hypertens · June 2013 BACKGROUND: Low and low-normal serum potassium is associated with an increased risk of diabetes. We hypothesized that the protective effect of valsartan on diabetes risk could be mediated by its effect of raising serum potassium. METHODS: We analyzed data ... Full text Link to item Cite

Telemedicine cardiovascular risk reduction in veterans.

Journal Article Am Heart J · April 2013 BACKGROUND: Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to a ... Full text Open Access Link to item Cite

Group physical therapy for veterans with knee osteoarthritis: study design and methodology.

Journal Article Contemp Clin Trials · March 2013 Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that ... Full text Open Access Link to item Cite

Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus.

Journal Article J Am Geriatr Soc · September 2012 OBJECTIVES: To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus. DESIGN: Controlled clinical trial. SETTING: Primary care ... Full text Open Access Link to item Cite

Examining the impact of genetic testing for type 2 diabetes on health behaviors: study protocol for a randomized controlled trial.

Journal Article Trials · August 1, 2012 BACKGROUND: We describe the study design, procedures, and development of the risk counseling protocol used in a randomized controlled trial to evaluate the impact of genetic testing for diabetes mellitus (DM) on psychological, health behavior, and clinical ... Full text Link to item Cite

Low HDL predicts differential blood pressure effects from two weight-loss approaches: a secondary analysis of blood pressure from a randomized, clinical weight-loss trial.

Journal Article Diabetes Obes Metab · April 2012 Examining predictors of blood-pressure (BP) response to weight-loss diets might provide insight into mechanisms and help guide clinical care. We examined whether certain baseline patient characteristics (e.g. diet, medical history and laboratory tests) pre ... Full text Link to item Cite

Shared Medical Appointments for Chronic Medical Conditions: A Systematic Review

Journal Article · 2012 The most successful health care systems offer ready access to high-quality primary care—an approach that is embedded in the fundamental design of Veterans Affairs (VA) health care and which is consistent with the Institute of Medicine’s definition of high- ... Cite

Examining the interrelatedness of patient and spousal stress in heart failure: conceptual model and pilot data.

Journal Article J Cardiovasc Nurs · 2012 BACKGROUND AND RESEARCH OBJECTIVE: Recent research has highlighted the positive influence that spouses can have on patient outcomes. It is not clear whether patients and spouses influence each other's well-being reciprocally or whether spousal well-being a ... Full text Link to item Cite

Lessons learned when innovations go awry: a baseline description of a behavioral trial-the Enhancing Fitness in Older Overweight Veterans with Impaired Fasting Glucose study.

Journal Article Transl Behav Med · November 2011 Individuals diagnosed with impaired glucose tolerance (i.e., prediabetes) are at increased risk for developing diabetes. We proposed a clinical trial with a novel adaptive randomization designed to examine the impact of a home-based physical activity (PA) ... Full text Open Access Link to item Cite

Potassium and risk of Type 2 diabetes.

Journal Article Expert Rev Endocrinol Metab · September 2011 The rising incidence and prevalence of Type 2 diabetes worldwide requires us to try to identify the determinants of this epidemic and to identify improved measures to prevent and treat this condition. While obesity is a major risk factor for diabetes, ther ... Full text Link to item Cite

Employment of mid-level providers in primary care and control of diabetes.

Journal Article Prim Care Diabetes · April 2011 Featured Publication AIMS: Examine potential associations between inclusion of mid-level providers in United States Veterans Affairs (VA) primary care programs and diabetes control. METHODS: We established a cohort of diabetes patients (alive October 1, 1999) using the VA Diab ... Full text Link to item Cite

Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach.

Journal Article Patient Prefer Adherence · July 21, 2010 Featured Publication To determine subtypes of adherence, 636 hypertensive patients (48% White, 34% male) reported adherence to medications, diet, exercise, smoking, and home blood pressure monitoring. A latent class analysis approach was used to identify subgroups that adhere ... Full text Open Access Link to item Cite

Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial.

Journal Article Ann Intern Med · June 1, 2010 Featured Publication BACKGROUND: Group medical clinics (GMCs) are widely used in the management of diabetes and hypertension, but data on their effectiveness are limited. OBJECTIVE: To test the effectiveness of GMCs in the management of comorbid diabetes and hypertension. DESI ... Full text Link to item Cite

Do diabetic veterans use the Internet? Self-reported usage, skills, and interest in using My HealtheVet Web portal.

Journal Article Telemed J E Health · June 2010 OBJECTIVE: The Veterans Health Administration has developed My HealtheVet (MHV), a Web-based portal that links veterans to their care in the veteran affairs (VA) system. The objective of this study was to measure diabetic veterans' access to and use of the ... Full text Open Access Link to item Cite

The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: study design and methodology.

Journal Article Am Heart J · September 2009 BACKGROUND: Cardiovascular disease (CVD) and diabetes account for over one third of the mortality difference between African Americans and white patients. The increased CVD risk in African Americans is due in large part to the clustering of multiple CVD ri ... Full text Link to item Cite

Tests for screening and diagnosis of type 2 diabetes

Journal Article Clinical Diabetes · September 1, 2009 Full text Cite

Comparison of medicine resident diabetes care between Veterans Affairs and academic health care systems.

Journal Article J Gen Intern Med · August 2009 BACKGROUND: Although others have reported national disparities in the quality of diabetes care between the Veterans Affairs (VA) and private health care delivery systems, it is not known whether these differences persist among internal medicine resident pr ... Full text Link to item Cite

Concordance between self-reported race/ethnicity and that recorded in a Veteran Affairs electronic medical record.

Journal Article N C Med J · 2009 BACKGROUND: Using information from electronic health records (EHRs) to examine racial/ethnic health disparities is increasingly common. This study examines the degree of concordance between administratively recorded race/ethnicity and the criterion standar ... Link to item Cite

The association of emotional well-being and marital status with treatment adherence among patients with hypertension.

Journal Article J Behav Med · December 2008 We were interested in examining the relationship between psychosocial factors and hypertension-related behaviors. We hypothesized that lower emotional well-being and unmarried status would be related to higher BP, poorer medication adherence, greater diffi ... Full text Link to item Cite

A new look at screening and diagnosing diabetes mellitus.

Journal Article J Clin Endocrinol Metab · July 2008 Featured Publication OBJECTIVE: Diabetes is underdiagnosed. About one third of people with diabetes do not know they have it, and the average lag between onset and diagnosis is 7 yr. This report reconsiders the criteria for diagnosing diabetes and recommends screening criteria ... Full text Link to item Cite

A retrospective analysis of facial fracture etiologies.

Journal Article Ann Plast Surg · April 2008 The medical records of 437 patients with 929 facial fractures were retrospectively analyzed. Fracture patterns were classified based on the presence or absence of fractures in each of 4 anatomic subunits (frontal, upper midface, lower midface, and mandible ... Full text Link to item Cite

Racial/ethnic and educational-level differences in diabetes care experiences in primary care.

Journal Article Prim Care Diabetes · February 2008 AIMS: To assess potential racial/ethnic and educational-level differences in the degree to which patients with diabetes who receive primary care from a Veterans Affairs Medical Center report that experiences with the diabetes care system are consistent wit ... Full text Link to item Cite

Late diagnosis of HIV infection: the role of age and sex.

Journal Article Am J Med · April 2007 BACKGROUND: Late diagnosis of human immunodeficiency virus (HIV) infection is detrimental to infected persons and to the public health. The objective of this study was to identify factors associated with late diagnosis of HIV infection, defined as an initi ... Full text Link to item Cite

Colorectal cancer screening in young patients with poor health and severe comorbidity.

Journal Article Arch Intern Med · November 13, 2006 BACKGROUND: Young patients with poor health and a high risk of mortality from comorbid diseases have less chance of deriving a survival benefit from colorectal cancer screening. The aim of this study was to examine the relationship between colorectal cance ... Full text Link to item Cite

Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients.

Journal Article J Gen Intern Med · October 2006 Featured Publication BACKGROUND: Guidelines recommend tight control of hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) for patients with diabetes. The degree to which these intermediate outcomes are simultaneously controlled has not ... Full text Link to item Cite

A multidimensional integrative medicine intervention to improve cardiovascular risk.

Journal Article J Gen Intern Med · July 2006 Featured Publication BACKGROUND: Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascular risk-reductio ... Full text Link to item Cite

Veterans Affairs primary care organizational characteristics associated with better diabetes control.

Journal Article Am J Manag Care · April 2005 Featured Publication OBJECTIVE: To examine organizational features of Veterans Affairs (VA) primary care programs hypothesized to be associated with better diabetes control, as indicated by hemoglobin A1C (HbA1C) levels. STUDY DESIGN: Cross-sectional cohort. METHODS: We establ ... Link to item Cite

Utility of hemoglobin A1c in predicting diabetes risk.

Journal Article J Gen Intern Med · December 2004 Featured Publication BACKGROUND: There is controversy surrounding the issue of whether, and how, to screen adults for type 2 diabetes. Our objective was to measure the incidence of new diabetes among outpatients enrolled in a health care system, and to determine whether hemogl ... Full text Link to item Cite

APOE genotype is a risk factor for neuropathy severity in diabetic patients.

Journal Article Neurology · March 25, 2003 Featured Publication This cross-sectional study tested the hypothesis that APOE genotype is a risk factor for diabetic neuropathy severity. A model with age, duration of diabetes, and APOE genotype was found to predict (p = 0.0083) severity on the Neuropathy Impairment Score i ... Full text Link to item Cite

Quality of care for patients diagnosed with diabetes at screening.

Journal Article Diabetes Care · February 2003 Featured Publication OBJECTIVE: Screening for diabetes has the potential to be an effective intervention, especially if patients have intensive treatment of their newly diagnosed diabetes and comorbid hypertension. We wished to determine the process and quality of diabetes car ... Full text Link to item Cite

Relationship between obesity and health-related quality of life in men.

Journal Article Obes Res · October 2002 OBJECTIVE: Few studies examining the relationship between obesity and health-related quality of life (HRQOL) have used a medical outpatient population or demonstrated a relationship in men. Furthermore, most studies have not adequately considered comorbid ... Full text Link to item Cite

Impact of diabetes screening on quality of life.

Journal Article Diabetes Care · June 2002 OBJECTIVE: Diagnosis of a chronic illness can have a negative impact on patients' perception of their well-being ("labeling" effect). We sought to determine the effects of a new diagnosis of diabetes, discovered by systematic screening, on patients' health ... Full text Link to item Cite

Outpatient diagnostic errors: unrecognized hyperglycemia.

Journal Article Eff Clin Pract · 2002 CONTEXT: To estimate the prevalence of unrecognized diabetes in a large managed care organization (MCO). DESIGN: Retrospective data analysis. PATIENTS AND SETTING: All patients over age 30 enrolled in the (staff-model) MCO of Duke University Medical Center ... Link to item Cite

Screening for diabetes in an outpatient clinic population.

Journal Article J Gen Intern Med · January 2002 Featured Publication BACKGROUND: Opportunistic disease screening is the routine, asymptomatic disease screening of patients at the time of a physician encounter for other reasons. While the prevalence of unrecognized diabetes in community populations is well known, the prevale ... Full text Link to item Cite

A comparison of three health status measures in primary care outpatients.

Journal Article J Gen Intern Med · December 1999 Our objective was to compare a brief, relatively new global health status measure, the Health Utilities Index Mark II (HUI), to two commonly applied health status measures (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] and the Sickness Jg ... Full text Link to item Cite

Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research.

Journal Article J Gen Intern Med · July 1999 OBJECTIVE: We compared the reproducibility and accuracy of conventional clinical examination of the diabetic foot to monofilament examination. We also sought to simplify the monofilament examination by reducing it to fewer touch points. METHODS: In a cross ... Full text Link to item Cite

Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II.

Journal Article Pharmacoeconomics · February 1999 The objective of this article was to describe and illustrate a comprehensive approach for estimating clinically important differences (CIDs) in health-related quality-of-life (HR-QOL). A literature review and pilot study were conducted to determine whether ... Full text Link to item Cite

Foot education improves knowledge and satisfaction among patients at high risk for diabetic foot ulcer.

Journal Article Diabetes Educ · 1999 PURPOSE: The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer. METHODS: We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic ... Full text Link to item Cite

Reproducibility and accuracy among primary care providers of a screening examination for foot ulcer risk among diabetic patients.

Journal Article Prev Med · 1998 BACKGROUND: A clinical examination has been shown to stratify patients by risk for diabetic foot ulcer; it is unknown whether primary care providers can reproducibly perform this examination. METHODS: One hundred forty-seven consecutive diabetic patients a ... Full text Link to item Cite

Prognostic value of the clinical examination of the diabetic foot ulcer.

Journal Article J Gen Intern Med · September 1997 OBJECTIVE: To determine the value of the history, physical examination, and magnetic resonance imaging (MRI) in predicting successful primary healing of a foot ulcer in a diabetic patient. DESIGN: Prospective cohort study. SETTING: Durham (NC) Veterans Aff ... Full text Link to item Cite

Clinical and radiographic findings that lead to intervention in diabetic patients with foot ulcers. A nationwide survey of primary care physicians.

Journal Article Diabetes Care · July 1996 OBJECTIVE: To determine which elements of clinical history, physical examination, and diagnostic tests are important to primary care physicians in their management of foot ulcers in diabetic patients. RESEARCH DESIGN AND METHODS: We conducted a national ma ... Full text Link to item Cite

Clinical and radiology findings that lead to intervention in diabetic patients with a foot ulcer: A nationwide survey of primary care physicians

Journal Article Journal of Investigative Medicine · January 1, 1996 We conducted a national mail survey of 600 primary care physicians to determine which elements of the clinical history and physical examination, and which diagnostic tests, influence their decisions to order radiology studies, surgical referral, and hospit ... Cite

Outpatient surgical utilization in Veterans Affairs hospitals, 1981-1989.

Journal Article Med Care · March 1995 In the 1980s, there was a large increase in the percentage of surgical operations performed in the United States without an overnight hospital admission. This shift may have been related to changes in reimbursement for outpatient surgery; studies of this r ... Full text Link to item Cite