title: Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death.
abstract: OBJECTIVE
  Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality.
  
  
  METHODS
  Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8).
  
  
  RESULTS
  Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93).
  
  
  CONCLUSIONS
  Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.
authors: Department of Economics, Duke University, 213 Social Sciences Building, Box 90097, Durham, NC, 27708. Electronic address: yiqun.chen@duke.edu.
authors: Yiqun
authors: Y
authors: Chen
authors: Department of Economics, Duke University, 213 Social Sciences Building, Box 90097, Durham, NC, 27708. Electronic address: fsloan@duke.edu.
authors: Frank A
authors: FA
authors: Sloan
authors: Department of Economics, Duke University, 213 Social Sciences Building, Box 90097, Durham, NC, 27708. Electronic address: arseniy.yashkin@duke.edu.
authors: Arseniy P
authors: AP
authors: Yashkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D042241:Early Diagnosis; D005260:Female; D006293:Health Promotion; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D016344:Medicare Part A; D016345:Medicare Part B; D055118:Medication Adherence; D009043:Motor Activity; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012306:Risk; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents
keywords: Diabetes complications; Guidelines; Health and Retirement Study; Mortality; Physical activity