Body Mass Index and Diabetes Outcomes

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Body Mass Index and Diabetes Outcomes

• West Virginia University
• Department of Community Medicine
• Office of Health Services Research
• Trisha Petitte, Kelly Bailey, Cecil Pollard,
  Megan Milam, Adam Baus, Mary Swim

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BACKGROUNDElectronic Patient Registries for
Diabetes Management in WV

• 5 years of registry use
• Two types of registries being used
• PECS supported by Health Disparities
  Collaboratives (4 sites)
• CDEMS supported by WVU Office of Health
  Services Research (OHSR) with funding from
  CDC/BPH (28 sites)

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Site Map WVU Office of Health Services Research
Hancock
Brooke
Ohio
Marshall
Monongalia
Wetzel
Marion
Morgan
Pleas-
Berkeley
Tyler
ants
Preston
Jeff-
Mineral
Taylor
erson
Dodd-
Hampshire
Harrison
ridge
Barbour
Wood
Ritchie
Grant
Tucker
Hardy
Wirt
Lewis
Gilmer
Cal-
houn
Jackson
Upshur
Randolph
Mason
Roane
Pendleton
Braxton
Putnam
Webster
Clay
Cabell
Nicholas
Kanawha
Pocahontas
Wayne
Lincoln
Boone
Fayette
Greenbrier
Logan
Mingo
Raleigh
Sum-
Wyoming
Monroe
mers
Mercer
McDowell
Last updated 03/04/2008
Last updated 03/04/2008
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Number of Patients with Diabetes being tracked in
CDEMS, PECS, and select EMR, by Quarter
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Health Centers with Established Electronic
Patient Registries, by Quarter
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CDEMS Progress Note

• Highlights lab values and services that are
  overdue and/or outside of recommended guidelines

• Provides overview of health profile

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Electronic Registries for Diabetes Management in
WV

• Electronic Patient Registries Improve Diabetes
  Care and Clinical Outcomes in Rural Community
  Health Centers
• CDCs 2007 Diabetes Conference, Atlanta
• Journal of Rural Health, in submission
• 6 Health Centers, N 661
• Improved Care Annual exams (e.g., eye, foot),
  Wellness screens (e.g., smoking, exercise),
  Education (e.g., nutrition)
• Improved Outcomes HbA1c in vulnerable patients,
  LDL, Cholesterol

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Current Studys Questions

• Does weight loss (from pre to post registry
  implementation) in overweight patients with
  diabetes improve health outcomes?
• blood pressure
• glycemic control
• Lipid concentrations
• Among those with weight loss, did care provisions
  differ?
• Screen for exercise
• Nutrition education

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Background

• Weight loss among overweight patients with
  diabetes has been shown to improve glycemic
  control (Franz et al., 2003).
• Weight loss among overweight patients with
  diabetes improves risk factors for cardiovascular
  disease, e.g., blood pressure and lipid
  concentrations (triglycerides, cholesterol, HDL
  and LDL) (see Klein et al., 2004).

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Current Studys Database

• 15 Health Centers in WV, N 1856
• Sample limited to diabetes patients who had
  received care during the year pre and post
  registry implementation
• Registrys initial data (pre registry)
• Imported demographic data for patients with DM-I
  or DM-II from billing systems
• Lab data was transferred electronically or
  hand-entered
• Medical records were reviewed and baseline data
  was entered
• Registrys maintenance (post registry)
• Lab data was transferred electronically or
  hand-entered
• Patient information, e.g., weight, blood
  pressure, patient services was gathered from
  progress note used by provider at point-of-care
  and hand-entered into registry
• An updated Progress Note with new outliers
  identified was printed and filed with patients
  chart for providers subsequent use

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Current Studys Cohort

• N 1856
• 97.8 type 2 diabetes
• Ages 18- to 97-years-old
• Mean age 60.24-years-old
• 58.4 female
• 71 taking a diabetes medication
• 42 were taking a diabetes medication causing
  weight gain during follow-up period
• 44.4 overweight patients lost weight
• 38 of these patients were taking a diabetes
  medication causing weight gain during follow-up
  period

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Current studys cohort with BMI

• Missing data from pre to post decreased from
  53.7 to 24.2.

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Health Outcome Changes (Controlling for Diabetes
Medication) Between Overweight Patients with and
without Weight Loss
p .05
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Health Outcome Changes (Controlling for Diabetes
Medication) Between Overweight Patients with and
without Weight Loss
p .05
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Health Outcome Changes (Controlling for Diabetes
Medication) Between Overweight Patients with and
without Weight Loss
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Patients with Improved Health Outcomes Between
Overweight Patients with and without Weight Loss
p lt .05
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Patients with Completed Care Between Overweight
Patients with and without Weight Loss
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Conclusions

• Similar to prior studies, weight loss among
  overweight patients with diabetes contributed to
  
• Systolic blood pressure improvements
• glycemic control improvements
• Contrary to prior studies, weight loss among
  overweight patients with diabetes did NOT
  contribute to
• Diastolic blood pressure improvements
• Lipid concentrations
• In fact, a significantly greater number of
  patients who improved their cholesterol actually
  gained weight
• Possibly due to popular diets that may increase
  cholesterol, while still contributing to weight
  loss?

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Conclusions

• Among those with weight loss, care provisions
  (screen for exercise, nutrition education) did
  not significantly differ however, more patients
  with weight loss had completed these care
  processes.
• Unfortunately, screening for exercise did not
  distinguish between those who did and did not
  exercise.