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April 29, 2010 Volume VI, No. 48

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue highlights a report by the CDC that provides different strategies states can implement to help reduce smoking rates among their populations, which will also reduce smoking related diseases. Since smoking affects the heart, our other stories this week answer the following questions: Do added sugars affect heart health and are diabetics at risk for atrial fibrillation?

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Do Added Sugars Increase Heart Disease Risk?
  2. Diabetics & Atrial Fibrillation Risk
  3. Teaching Physicians How to Be a Health Coach
  4. Supporting Patients with Diabetes, High BP
  5. Key Steps in the Hospital Discharge
  6. Benchmarks in Tobacco Cessation
  7. High-Impact Strategies to Reduce Smoking
  8. Obesity and Weight Management 2010

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Higher Amounts of Added Sugars Increase Heart Disease Risk Factors

Added sugars in processed foods and beverages may increase cardiovascular disease risk factors, according to a study by Emory University researchers. The study analyzed U.S. government nutritional data and blood lipid levels in more than 6,000 adult men and women between 1999 and 2006. The study subjects were divided into five groups according to the amount of added sugar and caloric sweeteners they consumed daily.

Researchers found that people who consumed more added sugar were more likely to have higher cardiovascular disease risk factors, including higher triglyceride levels and higher ratios of triglycerides to good cholesterol (HDL-C). In the U.S., total consumption of sugar has increased substantially in recent decades, largely due to an increased intake of "added sugars," defined as caloric sweeteners used by the food industry and consumers as ingredients in processed or prepared foods to increase the desirability of these foods, the researchers note. In the study, the highest-consuming group consumed an average of 46 teaspoons of added sugars per day. The lowest-consuming group consumed an average of only about 3 teaspoons daily.

This study is the first study of its kind to examine the association between the consumption of added sugars and lipid measures, such as HDL-C, triglycerides and low-density lipoprotein cholesterol (LDL-C). The study did not look at natural sugars found in fruit and fruit juices, only added sugars and caloric sweeteners.

To learn more about this research, please visit:

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Diabetics are at Higher Risk of Atrial Fibrillation

As the U.S. population keeps aging and gaining weight, diabetes is becoming increasingly common. Some research has associated diabetes with the most common kind of chronically irregular heartbeat, called atrial fibrillation, which can raise the risk for stroke and death. But results of past studies of diabetes and atrial fibrillation have conflicted. Now, a researcher from the Group Health Research Institute has linked diabetes to a 40 percent greater risk of developing atrial fibrillation; and also found that this risk rises even higher the longer people have diabetes and the less controlled their blood sugar is.

For this study, researchers tracked, for three years, more than 1,400 Group Health patients who had newly recognized atrial fibrillation. They compared these “cases” with more than 2,200 “controls.” The controls were matched to the cases by age, sex, year and whether they were treated for high blood pressure; but unlike the cases, they had no atrial fibrillation. This study was the first to examine the relationship between atrial fibrillation and the duration of patients’ diabetes and their blood sugar levels. Unlike most prior studies, this one also adjusted for patients’ weight, which is important because both diabetes and atrial fibrillation are more common in heavier people. The study found that:

  • Patients with diabetes were 40 percent more likely to be diagnosed with atrial fibrillation than were people without diabetes.
  • The risk of atrial fibrillation rose by 3 percent for each additional year that patients had diabetes.
  • For patients with high blood sugar (glycosylated hemoglobin, also known as HBA1c more than 9 percent), the risk of atrial fibrillation was twice that for people without diabetes.
  • Patients with well-controlled diabetes (HBA1c 7 percent or less) were about equally likely to have atrial fibrillation as people without diabetes.
According to Dr. Sascha Dublin of Group Health Research Institute, “When a patient with diabetes has symptoms like heart palpitations, clinicians should have a higher level of suspicion that the reason could be atrial fibrillation. This heart rhythm disturbance is important to diagnose, because it can be treated with medications like warfarin that can prevent many of the strokes that the atrial fibrillation would otherwise cause.” It is hard to establish which comes first — diabetes or atrial fibrillation — with this kind of case-control study, unlike a randomized trial, said Dr. Dublin. “But our finding that the risk of atrial fibrillation is higher with longer time since patients started medications for diabetes, and with higher blood glucose levels, is strongly suggestive that diabetes can cause atrial fibrillation.”

To learn more about this research, please visit:

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What Physicians Don't Learn in Med School: How to Be a Health Coach

In Harvard Medical School's Institute of Lifestyle Medicine's online program to teach physicians the basics of health coaching, the virtual patient is a doctor himself, explains Dr. Edward Phillips, founder and director of the institute. Physicians who have completed this training say the background enhances their relationships with patients and relieves stress, since it helps them accept that they are not directly responsible for patients' poor health choices. Dr. Phillips, assistant professor of physical medicine and rehabilitation at Harvard Medical School where the institute is based, hopes this subject will one day be covered thoroughly in medical schools. And his message to health plans seeking improved health coaching outcomes: engage the physician in the process, because as the person "sitting knee to knee" with the patient, the physician is ideally positioned to help the patient process all health messages.

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Supporting Patients with Diabetes, High Blood Pressure

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Marcus Barnes, director of the Richland Care Medical Home Network at Palmetto Health.

Question: What kind of support do you offer for patients with diabetes or high blood pressure?

Response: (Marcus Barnes) When our disease managers meet with our participants in that program, they give them special education brochures and make sure that they receive their proper medications. They also refer our diabetic participants into a diabetes education class. That is a requirement. That has been a very useful aspect of the program. Many of our diabetic patients understand that they have diabetes and need to take insulin and check their sugar, but they don’t understand what they can do to help the situation. I don’t know if it’s from a lack of knowledge, but diabetes education has been a very important aspect.

There are different classes throughout the Midland region offered at different hospitals and organizations. Our disease manager checks where she can get these people in, and she coordinates everything.

For more information on supporting patients through DM programs, please visit:

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Key Steps in the Hospital Discharge

The hospital discharge provides many opportunities to tighten care transitions and confirm the patient's understanding of the plan of care. We wanted to see which critical steps were being performed at the hospital discharge to reduce the likelihood of readmission.

Click here to view the chart.

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Benchmarks in Tobacco Cessation and Prevention Programs

Smoking is a risk factor with clearly established links to increased healthcare costs. Who are the target populations for smoking cessation programs, and how are incentives driving engagement and participation in these efforts? How do tobacco cessation programs identify candidates and deliver the information to participants? This HIN white paper examines the prevalence of tobacco cessation and prevention among 220 wellness companies, behavioral healthcare providers, PCPs, DM organizations, employers, health plans and hospital/health systems who responded to an esurvey on this topic.

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Increased Efforts, High-Impact Strategies Needed to Reduce Smoking and Save Lives

A report by the CDC encourages all states to implement coordinated, high-impact strategies to end the stall in the decline of U.S. smoking rates — a move that will prevent millions of smoking-related heart attacks, cancers, strokes and deaths. If all states supported and used a combination of proven strategies — hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices — the nation’s adult smoking rate, which has stalled at around 20 percent, would begin to decline and smoking-related diseases, deaths and healthcare costs would be substantially reduced.

Every year, nearly 1 of 5 American deaths is caused by cigarette smoking. The report provides a state-by-state assessment of tobacco use prevention and control efforts and showcases evidence-based strategies that are successful in reducing smoking rates. The report uses consistent data across all 50 states and the District of Columbia and allows states to compare their efforts with similar programs around the nation. Programs are evaluated on several key measures, including smoking prevalence, public funding for cessation support, enforcement of restrictions on cigarette advertising and promotions, and tobacco pricing.

Several states are making great strides in reducing smoking rates using these prevention strategies, while more work needs to be done in other states. National survey data show that a trend of significant reductions in smoking rates among adults and youth has stalled since 2004. According to the report, the smoking rate for American adults varies across states, with Utah (9.3 percent) and California (14 percent) reporting the lowest rates. West Virginia (26.5 percent) and Indiana (26 percent) are among states reporting the highest adult smoking rates in the country in 2008. Utah (6.5 percent) and Hawaii (6.8 percent) have the lowest youth smoking rates, while Kentucky (15.9 percent) and Wyoming (14.9 percent) have the highest.

Studies show that smoke-free laws, which ban smoking in indoor places, public spaces and work sites, are the only effective way to protect nonsmokers from the dangers of secondhand smoke. The evidence also shows that these laws motivate smokers to quit. According to the new CDC report, 24 states and the District of Columbia have comprehensive smoke-free laws. Recently, Kansas, Wisconsin and Michigan passed smoke-free laws that will go into effect later this year. Seven states — Indiana, Kentucky, Mississippi, South Carolina, Texas, West Virginia and Wyoming — do not have statewide smoke-free laws.

The CDC report also examines data from 42 states and the District of Columbia on counter-marketing media campaigns (campaigns that use commercial marketing tactics to reduce tobacco use). Hard-hitting media ads are proven to influence attitudes and behaviors about smoking when they are seen often, by many people, over an extended period. The report assessed each state anti-smoking campaign's gross rating points (GRPs), which measure the total intensity of the campaigns — the percent of households exposed, multiplied by the frequency of exposure to the ads. Among the states that presented data, counter-marketing campaigns achieved a median of 138 GRPs per quarter — only about a tenth of the CDC-recommended level of 1,200 GRPs.

The CDC report demonstrates that states that have invested in comprehensive tobacco control programs have significantly reduced smoking rates, which in turn leads to decreased smoking-related diseases, deaths, and health care costs. California, which has the longest-running tobacco control program in the country, has seen lung cancer rates decline four times faster than those in the nation as a whole. Further, the state saved $86 billion in tobacco-related healthcare costs between 1989 and 2004. Still, the report points out that no state funds its tobacco control program at levels recommended by CDC.

To learn more about this research, please visit:

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Obesity and Weight Management 2010

Despite early indicators of success on the management front, obesity is still tied to an estimated $117 billion in healthcare costs. New healthcare reform will reward prevention-related initiatives, and first lady Michelle Obama's Let's Move campaign hopes to solve the childhood obesity epidemic within a generation. Describe how your organization is working to prevent and reduce obesity and related conditions and costs in your population by taking the Obesity and Weight Management survey by April 30, and receive a free e-summary of the results. More than 80 organizations have responded so far; your responses will be kept confidential.

To participate in this survey and receive its results, please visit:

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