Browsing by Author "Brown, Arleen F."

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    Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study
    (Elsevier, 2010-12) Waitzfelder, Beth; Gerzoff, Robert B.; Karter, Andrew J.; Crystal, Stephen; Bair, Mathew J.; Ettner, Susan L.; Brown, Arleen F.; Subramanian, Usha; Lu, Shou-En; Marrero, David; Herman, William H.; Selby, Joseph V.; Dudley, R. Adams; Department of Medicine, Division of General Internal Medicine, IU School of Medicine
    Aim The broad objective of this study was to examine multiple dimensions of depression in a large, diverse population of adults with diabetes. Specific aims were to measure the association of depression with: (1) patient characteristics
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    Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study
    (2007-10) Karter, Andrew J.; Stevens, Mark R.; Brown, Arleen F.; Duru, O Kenrik; Gregg, Edward W.; Gary, Tiffany L.; Beckles, Gloria L.; Tseng, Chien-Wen; Marrero, David G.; Waitzfelder, Beth; Herman, William H.; Piette, John D.; Safford, Monika M.; Ettner, Susan L.
    Background Our understanding of social disparities in diabetes-related health behaviors is incomplete. The purpose of this study was to determine if having less education is associated with poorer diabetes-related health behaviors. Methods This observational study was based on a cohort of 8,763 survey respondents drawn from ~180,000 patients with diabetes receiving care from 68 provider groups in ten managed care health plans across the United States. Self-reported survey data included individual educational attainment ("education") and five diabetes self-care behaviors among individuals for whom the behavior would clearly be indicated: foot exams (among those with symptoms of peripheral neuropathy or a history of foot ulcers); self-monitoring of blood glucose (SMBG; among insulin users only); smoking; exercise; and certain diabetes-related health seeking behaviors (use of diabetes health education, website, or support group in last 12 months). Predicted probabilities were modeled at each level of self-reported educational attainment using hierarchical logistic regression models with random effects for clustering within health plans. Results Patients with less education had significantly lower predicted probabilities of being a non-smoker and engaging in regular exercise and health-seeking behaviors, while SMBG and foot self-examination did not vary by education. Extensive adjustment for patient factors revealed no discernable confounding effect on the estimates or their significance, and most education-behavior relationships were similar across sex, race and other patient characteristics. The relationship between education and smoking varied significantly across age, with a strong inverse relationship in those aged 25–44, modest for those ages 45–64, but non-evident for those over 65. Intensity of disease management by the health plan and provider communication did not alter the examined education-behavior relationships. Other measures of socioeconomic position yielded similar findings. Conclusion The relationship between educational attainment and health behaviors was modest in strength for most behaviors. Over the life course, the cumulative effect of reduced practice of multiple self-care behaviors among less educated patients may play an important part in shaping the social health gradient.
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    Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study
    (BioMed Central, 2007-10-29) Karter, Andrew J.; Stevens, Mark R.; Brown, Arleen F.; Duru, O. Kenrik; Gregg, Edward W.; Gary, Tiffany L.; Beckles, Gloria L.; Tseng, Chien-Wen; Marrero, David G.; Waitzfelder, Beth; Herman, William H.; Piette, John D.; Safford, Monika M.; Ettner, Susan L.; Cellular and Integrative Physiology, School of Medicine
    Background Our understanding of social disparities in diabetes-related health behaviors is incomplete. The purpose of this study was to determine if having less education is associated with poorer diabetes-related health behaviors. Methods This observational study was based on a cohort of 8,763 survey respondents drawn from ~180,000 patients with diabetes receiving care from 68 provider groups in ten managed care health plans across the United States. Self-reported survey data included individual educational attainment ("education") and five diabetes self-care behaviors among individuals for whom the behavior would clearly be indicated: foot exams (among those with symptoms of peripheral neuropathy or a history of foot ulcers); self-monitoring of blood glucose (SMBG; among insulin users only); smoking; exercise; and certain diabetes-related health seeking behaviors (use of diabetes health education, website, or support group in last 12 months). Predicted probabilities were modeled at each level of self-reported educational attainment using hierarchical logistic regression models with random effects for clustering within health plans. Results Patients with less education had significantly lower predicted probabilities of being a non-smoker and engaging in regular exercise and health-seeking behaviors, while SMBG and foot self-examination did not vary by education. Extensive adjustment for patient factors revealed no discernable confounding effect on the estimates or their significance, and most education-behavior relationships were similar across sex, race and other patient characteristics. The relationship between education and smoking varied significantly across age, with a strong inverse relationship in those aged 25–44, modest for those ages 45–64, but non-evident for those over 65. Intensity of disease management by the health plan and provider communication did not alter the examined education-behavior relationships. Other measures of socioeconomic position yielded similar findings. Conclusion The relationship between educational attainment and health behaviors was modest in strength for most behaviors. Over the life course, the cumulative effect of reduced practice of multiple self-care behaviors among less educated patients may play an important part in shaping the social health gradient.
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    Educational Disparities in Rates of Smoking Among Diabetic Adults: The Translating Research Into Action for Diabetes Study
    (2008-02) Karter, Andrew J.; Stevens, Mark R.; Gregg, Edward W.; Brown, Arleen F.; Tseng, Chien-Wen; Marrero, David G.; Duru, O Kenrik; Gary, Tiffany L.; Piette, John D.; Waitzfelder, Beth; Herman, William H.; Beckles, Gloria L.; Safford, Monika M.; Ettner, Susan L.
    Objectives. We assessed educational disparities in smoking rates among adults with diabetes in managed care settings. Methods. We used a cross-sectional, survey-based (2002–2003) observational study among 6538 diabetic patients older than 25 years across multiple managed care health plans and states. For smoking at each level of self-reported educational attainment, predicted probabilities were estimated by means of hierarchical logistic regression models with random intercepts for health plan, adjusted for potential confounders. Results. Overall, 15% the participants reported current smoking. An educational gradient in smoking was observed that varied significantly (P<.003) across age groups, with the educational gradient being strong in those aged 25 to 44 years, modest in those aged 45 to 64 years, and nonexistent in those aged 65 years or older. Of particular note, the prevalence of smoking observed in adults aged 25–44 years with less than a high school education was 50% (95% confidence interval: 36% to 63%). Conclusions. Approximately half of poorly educated young adults with diabetes smoke, magnifying the health risk associated with early-onset diabetes. Targeted public health interventions for smoking prevention and cessation among young, poorly educated people with diabetes are needed.
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    Evaluation of risk equations for prediction of short-term coronary heart disease events in patients with long-standing type 2 diabetes: the Translating Research into Action for Diabetes (TRIAD) study
    (2012-07) Lu, Shou-En; Beckles, Gloria L.; Crosson, Jesse C.; Bilik, Dorian; Karter, Andrew J.; Gerzoff, Robert B.; Lin, Yong; Ross, Sonja V.; McEwen, Laura N.; Waitzfelder, Beth E.; Marrero, David G.; Lasser, Norman; Brown, Arleen F.
    Background To evaluate the U.K. Prospective Diabetes Study (UKPDS) and Framingham risk equations for predicting short-term risk of coronary heart disease (CHD) events among adults with long-standing type 2 diabetes, including those with and without preexisting CHD. Methods Prospective cohort of U.S. managed care enrollees aged ≥ 18 years and mean diabetes duration of more than 10 years, participating in the Translating Research into Action for Diabetes (TRIAD) study, was followed for the first occurrence of CHD events from 2000 to 2003. The UKPDS and Framingham risk equations were evaluated for discriminating power and calibration. Results A total of 8303 TRIAD participants, were identified to evaluate the UKPDS (n = 5914, 120 events), Framingham-initial (n = 5914, 218 events) and Framingham-secondary (n = 2389, 374 events) risk equations, according to their prior CHD history. All of these equations exhibited low discriminating power with Harrell’s c-index <0.65. All except the Framingham-initial equation for women and the Framingham-secondary equation for men had low levels of calibration. After adjsusting for the average values of predictors and event rates in the TRIAD population, the calibration of these equations greatly improved. Conclusions The UKPDS and Framingham risk equations may be inappropriate for predicting the short-term risk of CHD events in patients with long-standing type 2 diabetes, partly due to changes in medications used by patients with diabetes and other improvements in clinical care since the Frmaingham and UKPDS studies were conducted. Refinement of these equations to reflect contemporary CHD profiles, diagnostics and therapies are needed to provide reliable risk estimates to inform effective treatment.
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    Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study
    (2010-12) Duru, O Kenrik; Bilik, Dori; McEwen, Laura N.; Brown, Arleen F.; Karter, Andrew J.; Curb, J David; Marrero, David G.; Lu, Shou-En; Rodriguez, Michael; Mangione, Carol M.
    BACKGROUND Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE To examine the associations between primary language, income, and medication intensification. DESIGN Cohort study with 18-month follow-up. PARTICIPANTS One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c ≥ 8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <15,000,patientswithincomesof15,000-39,999(OR1.43,1.07−1.92),40,000-74,999(OR1.62,1.16−2.26)or>75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.