Browsing by Author "Lu, Shou-En"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    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
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.