.
Introduction and Objective: Prior work by the Michigan Collaborative for Type 2 Diabetes (MCT2D) demonstrated increased adherence to non-insulin guideline-directed medical therapy (NI-GDMT) for type 2 diabetes (T2D) over the past 4 years but insulin use remains unclear. We examined insulin use in MCT2D practices over this period. Methods: We analyzed pharmacy claims from 82,207 adults with T2D insured by Blue Cross Blue Shield Preferred Provider and Blue Care Network Health Maintenance Organizations and Medicare Advantage plans, receiving care in MCT2D-practices (01/2020-06/2024). Descriptive statistics examined trends in insulin use (no insulin, any, long/intermediate) by age and glycated hemoglobin (A1c). Linear regression assessed the significance of these trends (baseline group defined as <45 years old with A1c <7%). Results: Insulin use for T2D in Michigan has remained relatively steady across age and A1c categories despite increased NI-GDMT use (Figure 1). A significant positive trend was observed in individuals aged 45-64 with A1c of 8-9% not using insulin, with a stronger effect in those aged 65-74 (p=0.03 and p=0.01, respectively). Conclusion: This data suggests insulin use has remained steady despite increased NI-GDMT for T2D. A significant trend of individuals aged 45-74 with A1c of 8-9% not using insulin highlights the need to optimize treatment and ensure appropriate care for individuals with T2D. K. Kinger: None. K.R. Mizokami-Stout: None. K. Watson: None. L. Ang: None. J.J. Iyengar: None. N. Bhomia: None. J. Reiss: None. J. Rau: None. L.A. Young: None. J. Weisensel: Stock/Shareholder; Senseonics. R. Pop-Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc. Research Support; Bayer Pharmaceuticals, Inc. Other Relationship; Biogen. Research Support; Juvenile Diabetes Research Foundation (JDRF). Advisory Panel; Lexicon Pharmaceuticals, Inc, Novo Nordisk. Research Support; Novo Nordisk, National Institute of Diabetes and Digestive and Kidney Diseases. Consultant; Roche Diagnostics. C.R. Richardson: Other Relationship; Dexcom, Inc., Duke clinical research, American Diabetes Association, Annals of Family Medicine. H.L. Diez: None. L. Oshman: Stock/Shareholder; Procter & Gamble, Merck & Co., Inc, AbbVie Inc. NIDDK (K23DK13129601A1)
e18714 Background: Patients receiving antineoplastic therapy are at increased risk of severe illness and death from COVID-19. Vaccination against COVID-19 is an effective strategy to prevent serious complications of the disease. Because immunocompromised patients may have a blunted immune response to COVID-19 vaccinations, the CDC recommends these patients receive an additional vaccine dose. CDC recommendations serve as a guideline for optimal care of hematology/oncology patients, and within which we demonstrate a quality improvement project to promote community education and assess vaccination rates. Methods: Through Epic electronic medical record (EMR) reporting, we identified 250 immunocompromised patients who had not completed their primary COVID-19 vaccination series or booster and initiated antineoplastic therapy between 12/1/2020- 12/1/2021 at a community-based oncology practice in Michigan. Patients were provided an electronic patient portal letter detailing vaccination recommendations, information on how to obtain vaccination, and a survey inquiring if patients were more likely to become vaccinated after the educational intervention. 204 patients received electronic letters and 46 patients (without portal access) were sent a letter via the US postal service. Three months post intervention, we evaluated for change in COVID vaccination status, hospitalization, death rates, and patient preferences regarding vaccination. Results: Three months post intervention, a total of 44 patients responded to the survey (39 electronically and 5 via mail). The overall improvement in vaccination rate was 10.4%. Using Fisher’s exact test, we found a statistically significant difference (p = 0.002) in vaccination rates between survey responders compared to non-responders. Vaccination rates increased by 25.0% in survey responders, compared to 7.3% in patients who did not respond. During the study period, 13 patients contracted COVID-19 (1/13 vaccinated), and one patient required hospitalization due to COVID-19 (unvaccinated). No deaths due to COVID-19 were reported. Patients’ most cited reasons for declining vaccination were concerns regarding vaccination safety and lack of understanding of the CDC recommendations. Conclusions: Our study highlights the EMR as an effective means to provide community education about COVID-19 vaccination. Limitations include delayed outreach to patients without electronic patient portal access or with infrequent patient portal use. Nonetheless, our quality study design serves as a model for other implementations of electronic community outreach in oncology patients. Future directions will assess long-term vaccination rates and outcomes in these immunocompromised patients.
Background: Previous studies observed high concordance of diabetes and hypertension among married or partnered couples globally due to assortative mating and cohabitation. However, whether there is concordance in controlled blood pressure (BP) among couples with diabetes, an important risk factor for micro/macrovascular complications, is unknown. Methods: Using cross-sectional data from Health and Retirement Study (HRS 2016-17, n = 1749) and its international partner studies from China (CHARLS 2015-16, n = 923) and India (LASI 2017-19, n = 4582), we identified couples (aged 21-97 years) among whom at least one partner had diabetes and both partners had standardized BP measurements. We defined controlled BP as systolic BP < 140 mmHg and diastolic BP < 90 mmHg. We used multiple imputation and survey-weighted modified Poisson regression to study the association of controlled BP between couples for wives and husbands respectively. We adjusted for current medication use, individual and household characteristics. We additionally examined between-country differences in the association. Results: Our analytic sample consisted of 3802 wives and 4504 husbands with diabetes. The proportion of wives with controlled blood pressure were 76.6% [73.2, 80.1] in the USA, 67.5% [63.3, 71.8] in China and 65.1% [62.6, 67.6] in India. The proportion of husbands with controlled blood pressure were 70.8% [67.4, 74.1] in the USA, 63.6% [58.5, 68.6] in China and 60.0% [57.8, 62.3] in India. Partner’s control of BP was not associated with own controlled BP for wives (prevalence ratio, PR: 1.05 [0.97, 1.14]) and husbands (PR: 1.07 [0.94, 1.21]) with diabetes. Estimates of association were null across all countries. Estimates were similar when restricted to couples (n = 1076) when both partners had diabetes. Conclusions: Lack of concordance in BP control among couples with diabetes suggest continuation of strategies for individualized management of high blood pressure. Disclosure J.Varghese: None. C.Li: None. P.Lu: None.
Background: Nursing faculty members may need several mentors to succeed in scholarly productivity, career development, work-life balance, and socialization in the academy. Underrepresented (UR) faculty report additional challenges to success. Purpose: The aim of this study was to search the literature for best practices in mentoring UR faculty. Methods: An integrative review was conducted to identify best and evidence-based practices for mentoring UR faculty, including gender, sexual minority, race, ethnicity, and geographic remoteness (rural). Fifteen articles were rated on evidence and methodological quality. Results: Successful mentorship programs include honest communication, including all stakeholders in forming a mentoring program, goals and activities that come from the mentees, and guaranteed resources. Conclusions: Underrepresented nursing faculty may benefit from formal mentoring programs, but more research is needed.
