Researchers from the University of California, Irvine were the first to report an improvement in severe diabetes-related acute complications, such as dangerously low blood sugar that led to emergency room visits or hospitalizations, among American Indian and Alaska Native (AI/AN) adults with Type 2 diabetes.
Findings from a retrospective analysis show that recent advances in diabetes management, such as reducing the use of medications that can cause severe adverse events, have helped reduce emergency room visits and hospitalizations caused by acute diabetes complications.
Study lead and corresponding author, Luohua Jiang, MD, PhD, professor of epidemiology and biostatistics at UC Irvine Joe C. Wen School of Population & Public Health, collaborated with colleagues at the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, and Indian Health Service (IHS) Division of Diabetes Treatment and Prevention, to publish findings in the journal Diabetes, Obesity & Metabolism.
“Along with increased utilization of relatively safer anti-diabetic medications, we also found that a shift in guidelines towards individualized blood sugar level targets, an increased emphasis on team-based case management and more education and awareness about interventions for these complications among both healthcare providers and patients, contributed to the decrease in complications,” Jiang said.
Using data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project, the team conducted a retrospective analysis of nearly 40,000 American Indian and Alaska Native adults with Type 2 diabetes who utilized IHS or Tribal health services between 2009 and 2013. Through a statistical model, the study found major progress in prescribing practices and the management of acute diabetes complications among American Indian and Alaska Native populations. Use of anti-diabetic medications that can cause hypoglycemia or other adverse events (i.e., sulfonylureas and TZDs) decreased dramatically, while safer medications (i.e., metformin, DPP-4 inhibitors, and safer insulin subtypes) increased significantly, which the team felt contributed to the reduced rates of severe low and high blood sugar.
Along with increased utilization of relatively safer anti-diabetic medications, we also found that a shift in guidelines towards individualized blood sugar level targets, an increased emphasis on team-based case management and more education and awareness about interventions for these complications among both healthcare providers and patients, contributed to the decrease in complications.”
– Luohua Jiang, MD, PhD
“In response to the heavy burden of diabetes in American Indian and Alaska Native people, these trends reflect a growing focus on individualized care and the adoption of newer and safer therapeutic options among an underserved population,” shares Jiahui Dai, first author and a current doctoral student at Wen Public Health.
The findings have important implications for improving diabetes management in underserved communities and demonstrate the value of ongoing surveillance and tailored healthcare interventions.
Additional authors include Jenny Chang, principal statistician at UC Irvine School of Medicine; Jung M. Choi, research specialist at Wen Public Health; Ann Bullock, family physician formerly with the Division of Diabetes Treatment and Prevention at Indian Health Service; Spero M. Manson, professor of public health and psychiatry, and Joan O’Connell, associate professor of public health from Centers for American Indian and Alaska Native Health at the Colorado School of Public Health.
This study was supported by the National Institute on Aging (R01AG061189), National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092923) and National Institute on Minority Health and Health Disparities (U54MD000507). Funding for the development of the data infrastructure was supported by the Patient-Centered Outcomes Research Institute (AD-1304-6451) and Agency for Healthcare Research and Quality (290–2006-00020-I). Opinions presented in this article are of UC Irvine Joe C. Wen School of Population & Public Health and do not reflect the opinion of the NIH.
