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Biomedical subjects

Mayer B Davidson

Publications and source records attributed to Mayer B Davidson.

49 records · Page 3Linked to original sources
PubMed2003

Cost effectiveness of statin therapy for the primary prevention of major coronary events in individuals with type 2 diabetes.

OBJECTIVE: To assess the cost and cost effectiveness of hydroxymethylglutaryl (HMG)-CoA reductase inhibitor (statin) therapy for the primary prevention of major coronary events in the U.S. population with diabetes and LDL cholesterol levels > or =100 mg/dl, especially in the population with LDL cholesterol levels 100-129 mg/dl. RESEARCH DESIGN AND METHODS: Analyses were performed using population estimates from National Health and Nutrition Examination Survey (NHANES)-III, cost estimates from a health system perspective, statin LDL-lowering effectiveness from pivotal clinical trials, and treatment effectiveness from the diabetic subgroup analysis of the Heart Protection Study. RESULTS: -There are approximately 8.2 million Americans with diabetes, LDL cholesterol levels > or =100 mg/dl, and no clinical evidence of cardiovascular disease. Each year, statin therapy could prevent approximately 71,000 major coronary events in this population. In the subgroup with LDL cholesterol levels 100-129 mg/dl, the annual cost of statin treatment ranges from 600 to 1,000 US dollars per subject. In the population with LDL cholesterol levels > or =130 mg/dl, the annual cost ranges from 700 to 2,100 US dollars. Annual incremental cost per subject, defined as the cost of statin treatment plus the cost of major coronary events with statin treatment minus the cost of major coronary events without statin treatment, ranges from 480 to 950 US dollars in the subgroup with LDL cholesterol levels 100-129 mg/dl and from 590 to 1,920 US dollars in the population with LDL cholesterol levels > or =130 mg/dl. CONCLUSIONS: Statin therapy for the primary prevention of major coronary events in subjects with type 2 diabetes and LDL cholesterol levels 100-129 mg/dl is affordable and cost effective relative to statin therapy in subjects with higher LDL cholesterol levels.

Atorvastatin↗
PubMed2003

Effect of nurse-directed diabetes care in a minority population.

OBJECTIVE: To determine whether diabetes care directed by nurses following detailed protocols and algorithms and supervised by a diabetologist results in meeting the evidence-based American Diabetes Association (ADA) process and outcome measures more often than care directed under usual care in a minority population. RESEARCH DESIGN AND METHODS: Studies were mainly conducted in two Los Angeles County clinics. In clinic A, nurse-directed diabetes care was provided to 252 patients (92% Hispanic and 2% African-American) referred by their primary care providers. These patients were hierarchically matched with 252 diabetic patients in clinic B (79% Hispanic and 19% African American). When nurse-directed care was abruptly discontinued in clinic A for administrative reasons, it was reestablished in clinic B. Those patients were randomly selected from a teaching clinic, and the outcomes in 114 patients who completed 1 year were compared with outcomes derived the year before receiving nurses' care. The following process and outcome measures were assessed in the study: 1) number of visits, 2) diabetes education, 3) nutritional counseling, 4) HbA(1c), 5) lipid profiles, 6) eye exams, 7) foot exams, 8) renal evaluations, and 9) ACE inhibitor therapy in appropriate patients. RESULTS: For patients under nurse-directed diabetes care in both clinics A and B, almost all process measures were carried out significantly more frequently than for the appropriate control patients. Under the care of nurses in clinic A, HbA(1c) levels fell 3.5% from 13.3 to 9.8% in the 120 patients who were followed for at least 6 months, as compared with a 1.5% fall from 12.3 to 10.8% under usual (physician-directed) care in clinic B. During the year before enrolling in nurse-directed care in clinic B, mean HbA(1c) levels decreased from 10.0 to 8.5%. At the end of a year under the nurses' care, the values fell further to 7.1%. The median value fell from 8.3 to 6.6%. CONCLUSIONS: Specially trained nurses who follow detailed protocols and algorithms under the supervision of a diabetologist can markedly improve diabetes outcomes in a minority population. This approach could help blunt the increased morbidity and mortality noted in minority populations.

Adult↗
PubMed2003

The impact of using a low-literacy patient education tool on process measures of diabetes care in a minority population.

This study evaluated the current level of diabetes care in three county clinics serving an underserved minority population and determined if a low-literacy, diabetes reminder card would enhance certain diabetes process care measures. Patients from two intervention sites were given the low-literacy, diabetes reminder card. Two-hundred-nineteen patients (87%) showed the card to their provider, and 209 charts were reviewed. American Diabetes Association guidelines had been met 37%, 71%, and 41% for foot exam, and urine and lipid tests, respectively, at the time the card was given to the patients. Of the patients who needed a foot exam, urine test, and lipid panel that day (based on ADA guidelines), 48%, 67%, and 35% received them, respectively (card effect). In the third (nonintervention) site, charts of 218 patients were reviewed. Guidelines met were 95%, 89%, and 45% for foot exam, urine and lipid tests, respectively. Interestingly, standardized progress notes containing the first two (but not the third) process measures were used at this site. We conclude that although low-literacy reminder cards did improve the ordering of process measures somewhat, they were not as effective as the utilization of progress forms with specific diabetes-related measures.

Black or African American↗
PubMed2002

Established therapies for diabetes mellitus.

Traditional oral anti-diabetic agents for the treatment of diabetes mellitus include the sulfonylureas, metformin, and the alpha-glucosidase inhibitors. Insulin has traditionally been used in various forms with an aim to mimic physiological insulin secretion patterns. Combinations of any of these treatment classes have also been utilized for their additive effects. All of these options have specific advantages and disadvantages, making them ideal for certain patients and less ideal for others. Each of these treatment classes is briefly discussed with respect to mechanisms of action, clinical efficacy, side-effects and current controversies associated with their use. Newer agents (such as the thiazolidinediones, newer insulin secretagogues, and insulin analogues) will be discussed elsewhere.

Diabetes Mellitus↗
PubMedDate not supplied

Angiotensin-converting enzyme inhibition for the treatment of moderate to severe diabetic retinopathy in normotensive Type 2 diabetic patients. A pilot study.

A few reports have suggested that angiotensin-converting enzyme inhibitors (ACE-I) have a beneficial effect on mild diabetic retinopathy (DR). This pilot study was carried out to determine if a small dose of an ACE-I would retard the progression of moderate to severe DR in normotensive Type 2 diabetic patients. Normotensive patients were selected to isolate the effect on the ocular RAS independent of any lowering of blood pressure. Thirty-five normotensive Type 2 diabetic patients with <1+ dipstick proteinuria and with moderate to severe DR by modified Arlie House Classification criteria on seven field stereoscopic photographs through dilated pupils were randomized to an ACE-I (5 mg of enalapril) (n=18) or to a multivitamin (MVI) placebo (n=17). They were evaluated by an ophthalmologist every 3 months for a planned duration of 2 years. Endpoints of the study were progression to proliferative DR (PDR) or macular edema (ME) for which laser therapy was necessary or for the development of >/=1+ dipstick proteinuria times two (sustained proteinuria) for which an ACE-I was indicated. There were no differences in baseline age, gender, duration of diabetes, body mass indices, blood pressure, treatment of hyperglycemia or Hb A1C levels between the two groups. Blood pressure and Hb A1C levels did not change in either group during the study. The study was stopped prematurely after a mean duration of 7.2 months after an interim analysis revealed that it was very unlikely that a beneficial effect of ACE-I could be shown. At that time in the ACE-I group, four patients had progressed to PDR, three to ME and one had developed sustained proteinuria. In the MVI group, three patients had progressed to PDR, one to ME and one had developed sustained proteinuria. Small doses of an ACE-I did not exert a beneficial effect on the progression of moderate to severe DR over a short period of follow-up. An analysis of previously published clinical information on the effects of ACE-I, most of which evaluated patients with milder DR, supports only a limited (if any) beneficial effect of this class of drugs on the early stages of this microvascular complication.

Angiotensin-Converting Enzyme Inhibitors↗