Background: Bone-health risk assessment and treatment among prostate-cancer patients on androgen-deprivation therapy (ADT) is often inadequately completed in clinical practice. Objective: To determine the impact of a population-management program on bone-health risk assessment and bisphosphonate therapy among prostate-cancer patients on ADT. Methods: We used retrospective data from a large integrated healthcare system to identify men aged 41-89 years diagnosed with prostate cancer in 2011-2024 who received ≥1 ADT dose. We compared adherence to internal guideline-recommended bone mineral density (BMD) testing, laboratory evaluation, and bisphosphonate prescriptions at baseline and during follow-up between men enrolled in the population-health program with men and men who were not enrolled (non-enrolled). Results: Among the 9934 eligible patients, 1680 (17%) were enrolled in the program and 8254 (83%) were non-enrolled. The proportion of enrolled patients completing BMD scans within 1 year before or after ADT initiation (80.6%) was substantially higher than among non-enrolled patients (23.8%, P < 0.0001). More enrolled patients were treated with antiresorptive therapy (26.4%) than among non-enrolled patients (14.1%, P < 0.0001). Overall, enrollees were more likely to have ever received any guideline-indicated intervention (78.7% vs 27.8%, P < 0.0001). The average coverage percentage for BMD screening was 24.4% among non-enrolled patients vs 81.1% among enrolled patients (P < 0.0001). Among antiresorptive-treatment-eligible patients, the average coverage percentage for bisphosphonate therapy was 35.5% among non-enrolled patients compared with 46.1% among enrolled patients (P < 0.0001). Conclusion: The population-management program significantly outperformed usual care in adherence to BMD testing, laboratory evaluation, and indicated antiresorptive osteoporosis-medication treatment among men with prostate cancer on ADT.
Purpose Validate the semiquantitative (SQ)-MRI score for chronic pancreatitis (CP) diagnosis in an independent, multicenter cohort. Methods We analyzed MRIs performed at baseline in 337 participants with acute (AP) or recurrent AP (RAP) and 67 with non-calcific chronic pancreatitis (NCCP) enrolled in the PROCEED study from 6/2017 to 3/2023. MRIs were performed at multiple clinical centers using site-specific clinical protocols and a variety of MRI vendors to evaluate the SQ-MRI score in a real-world setting. The SQ-MRI score was calculated using the T1 signal intensity ratio of the pancreas to the spleen (T1 score), arteriovenous enhancement ratio (AVR), and pancreatic body diameter (PBD). We adjusted for confounding by participant characteristics via propensity score weighting. Results Median AVR was higher in AP/RAP (1.18, IQR: 0.97–1.44) than in the NCCP group (1.03, IQR: 0.78–1.22, p = 0.007). Pancreatic body diameters were larger in AP/RAP than in the NCCP group − 7–14 mm (10% vs 25%), 14–20 mm (40% vs 54%), and > 20 mm (50% vs 21%), respectively ( p < 0.01). Median T1 score was higher in AP/RAP (1.18, IQR: 0.96–1.40) than in the NCCP group (1.04, IQR: 0.86–1.32, p = 0.10). Median SQ-MRI score in the AP/RAP group was significantly lower, 1.91 (IQR: 0.97, 2.95), than in the NCCP group, 2.74 (IQR: 2.04–4.03) ( p < 0.001). The propensity score-adjusted AUC for SQ-MRI to distinguish AP/RAP from NCCP was 0.64, which was higher than for individual parameters. Conclusion We have validated the SQ-MRI score in a multicenter cohort using an independent, real-world MRI dataset.
Continuous glucose monitoring (CGM) may improve self-management and reduce hypoglycemia risk among individuals with diabetes. However, little is known about how older adults with insulin-treated type 2 diabetes (T2D) experience and incorporate this technology into their daily lives. To explore experiences, preferences, barriers, and questions related to using CGM among older adults with insulin-treated T2D with and without experience using CGM. Qualitative focus group study. English-speaking older adults with T2D in a large, integrated healthcare delivery system. Groups included either experienced CGM users or adults who had not previously used CGM. Recruitment efforts prioritized individuals ≥ 75 years of age. Transcripts were analyzed using the Framework Method to identify perspectives on CGM. Specific thematic categories were hypoglycemia-related benefits, general benefits, usefulness and ease of use concerns, and CGM questions. The study included 26 participants: 17 (65
Background: Substance use disorder (SUD) is a risk factor for diabetes complications and hospitalizations, though a full continuum of diabetes care quality and health outcomes has not been examined among patients with diabetes accessing substance use treatment. Objective: To improve care delivery, this study compared patients with diabetes and co-occurring SUD to those with diabetes and no SUD. Population: In all, 4325 patients with diabetes and a SUD specialty treatment visit versus 255,652 patients with diabetes and no SUD diagnosis in a large, integrated delivery system from 2016 to 2021 were included. Research Design: Retrospective cohort study using electronic health record data. Modified Poisson regression models estimated relationships for co-occurring SUD and each outcome, adjusting for sociodemographic and clinical factors. Measures: Care quality measures included HbA1c, blood pressure, retinal and cholesterol screening, HbA1c < 8 % , blood pressure < 140/90 mm Hg, and LDL-cholesterol < 100 mg/dL. Diabetes complications included cardiovascular, cerebrovascular, retinopathy, and lower limb conditions. Hospitalization types included diabetes-related and other conditions, for example, chronic liver disease, and psychiatric. Results: Patients with co-occurring SUD, compared with those without SUD, were more often male, younger, non-Hispanic White, and had a mood disorder. Co-occurring SUD was associated with more HbA1c screening and higher prevalence of HbA1c <8, yet also with elevated risks for nearly all complication types, and all but one hospitalization type, especially chronic liver disease and chronic pain-related hospitalization. Conclusions: Despite comparable or better diabetes care quality, elevated risk of complications and hospitalization persisted among patients with co-occurring SUD. Both biopsychosocial and system-based mechanisms likely contribute to these elevated risks. Silo-bridging care coordination may help address multifaceted health needs.
Alcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment. To examine diabetes-related health monitoring, clinical outcomes, and acute health care use among patients with T2DM and AUD newly accessing specialty addiction treatment. This retrospective cohort study included electronic health record data from a large, integrated health care delivery system. Adults with T2DM and an index outpatient health care visit during 2016–2021 were included. Patients whose index visit was an initial AUD-related visit in specialty addiction treatment were in the AUD group. The comparison group had no AUD or addiction medicine visits. Outcomes were diabetes-related health monitoring, achievement of treatment targets, complications, and acute health care use during the 12 months post–index visit. The study included 222,334 adults with T2DM, 1,998 with AUD. Relative to the comparison group, participants with AUD had elevated risk for hypoglycemia (adjusted risk ratio [aRR] = 2.14; 95
