The ABCs of diabetes: diabetes self-management education program for African Americans affects A1C, lipid-lowering agent prescriptions, and emergency department visits.

PURPOSE: The purpose of the study was to examine the feasibility and impact of a concise community-based program on diabetes self-management education (DSME), according to frequency of emergency department visits and knowledge of, prescriptions for, and control of A1C, blood pressure, and low-density lipoprotein (LDL) cholesterol. METHODS: A free community-based DSME program was placed in a public library. Adults with diabetes (N, 360) consented to participate in this prospective nonrandomized cohort study with preintervention-postintervention design. The small-group interactive DSME (two 2.5-hour classes) focused on improving cardiovascular disease risk factors and facilitating communication with the primary care physician. RESULTS: An increase in knowledge of American Diabetes Association-recommended targets for A1C, blood pressure, and LDL cholesterol from baseline to postintervention was seen among participants. Significant clinical outcomes included reduction in self-reported emergency department visits and reduction in mean A1C. However, despite an increase in prescriptions written for lipid-lowering drugs, blood pressure and LDL cholesterol did not change. Participants who started on insulin were more likely to achieve or maintain A1C < 7% compared to those who either did not take or stopped taking insulin during the study. CONCLUSIONS: Offering DSME classes for African Americans at a public library was feasible and significantly affected 6-month clinical outcomes, including a reduction in A1C, an increased likelihood of attaining a target A1C of < 7% if insulin was started during the study period, and a two-thirds reduction in emergency department visits for uncontrolled diabetes. Observed results suggest that partnering with community-based organizations such as public libraries offers an accessible and well-received location for offering DSME programs.

Change in thrombus length on venous ultrasound and recurrent deep vein thrombosis.

BACKGROUND: Despite successful treatment, deep vein thrombosis may not fully resolve in some patients. Consequently, in patients with new symptoms in a previously affected leg, noncompressibility on ultrasound cannot be assumed to be due to recurrent thrombosis; therefore, we sought to determine interobserver agreement on ultrasound measurements of thrombus length and identify the change in length that is likely to indicate thrombus extension. METHODS: Cross-sectional study of patients with previous proximal deep vein thrombosis and residual ultrasound abnormalities, but without symptoms suggestive of recurrence. The patients had a standardized series of measurements of thrombus length independently performed by 2 ultrasonographers. The outcome measure was the agreement between the ultrasonographers on the distance of thrombus margins from 4 anatomical landmarks. RESULTS: There was good interobserver agreement on thrombus length when measured from the saphenofemoral junction, mid-popliteal fossa, and mid-patella (93% or more of the variance was accounted for by the paired measurements). Using these landmarks, the 95th percentile for the absolute difference between paired measurements was 8.9 cm for the saphenofemoral junction, 8.5 cm for the mid-popliteal fossa, and 8.4 cm for the mid-patella. CONCLUSIONS: When 2 ultrasound examinations are compared, an apparent increase in thrombus length of 9 cm or greater is likely to be supportive of a diagnosis of recurrent deep vein thrombosis. Increases in thrombus length of less than 9 cm appear to be within the bounds of measurement error.