Table 2:

Summary of articles focused on Economic Stability and Education

Author/Year	Study Design	Objective	Number of Participants	Sample population	Setting	Impact on Outcome
Durden, 2009 (39)	Retrospective, cross-sectional cohort	Evaluate the economic burden of privately insured patients with T2DM at two time points (2000 and 2005)	21,592 in 2000 and 127,254 in 2005 (both with matched controls)	Two cohorts: patients with T2DM with medical and prescription claims from the MarketScan Commercial Claims and Encounters database for (1) 2000 and (2) 2005. Controls met the same criteria except a diagnosis of T2DM and requirements for anti-DM treatment regimen for 2000 & 2005.	Database of claims derived from health plans with fee-for-service, fully capitated, or partially capitated payment arrangements from 1/1/99 to 12/31/00 and from 1/1/04 to 12/31/05	Adjusted health care costs of patients with T2DM were higher in both years studied (146% higher in 2000, $12,423 vs. $5058; p<0.001 and 136% higher in 2005, $12,733 vs. $5406; p<0.001). (Cost figures for 2000 were inflated to 12/2005 dollars using the medical care component of the Consumer Price Index).
Lind, 2006 (63)	Retrospective, cross-sectional cohort	Investigate whether insurance coverage for complementary and alternative medicine (CAM) providers is associated with increased health care use and expenditures	20,722 adults with diabetes (Enrollees with allowed claims=497,597; CAM users with DM=3,605)	Adult patients (18-64yrs) with T2DM who had both continuous enrollment in a single plan (directly regulated by the Every Category of Provider Law) and complete claims information in 2002 (Medicare, Medicaid, state-supplemental programs, self-insured plans all excluded) Controls: randomly chosen age and gender matched adults without T2DM (5 matches for each DM patient)	Claims data from two large insurers in Washington State for 2002	CAM users had more outpatient visits (on average, 28 vs. 16) and had higher average annual expenditures ($8,736 vs. $7,356). CAM was not statistically associated with expenditures after adjusting.
Rodbard, 2010 (75)	Cross-sectional, followed by prospective longitudinal (Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD) Study)	Assess whether patients with T2DM have a greater economic burden (prescription medications and out-of-pocket expenses) compared to patients without T2DM	12,237 (patients with T2DM=3,551 and patients without T2DM=8,686)	Adult patients with T2DM	National survey of adult patients with T2DM or risk factors for DM in over 200,000 households in the US	Patients with T2DM had a significantly higher total (mean) number of prescription medications vs. patients without T2DM (6.2 vs. 4.1, p<0.001); therefore, patients with T2DM had 2% more prescription meds (β=2.09). Patients with T2DM had significantly higher mean out-of-pocket healthcare expenses annually (>200%) vs. those without T2DM ($1158 vs. $925, p<0.001); expenses annually.
Schectman, 2002 (80)	Cross-sectional	Examined relationship between adherence to drug therapy and DM metabolic control	810	Low socioeconomic adults with T2DM receiving oral diabetes medication from clinic pharmacy	University of Virginia Health Systems primary care clinic	Adherence to medication in T2DM patients was strongly associated with metabolic control in indigent populations.
Lairson, 2008 (62)	Intervention	Evaluate the effect of a disease management program on adherence with recommended testes, health outcomes and health care expenditures for patients with T2DM	870	Adult patients with T2DM	Kelsey-Seybold Clinic Houston , Texas	The intervention increased compliance with testing for A1c and decreased A1c value and the percent of patients with A1c ≥9.5. Point estimates showed small reduction in health care cost, with cost of office visits showing the only significance (.10).
Grant, 2005 (47)	Cross sectional	To assess differences in demographics, self-care behaviors, and diabetes-related risk factor control by frequency of Internet use	909	Individuals with type 2 diabetes attending primary care clinics	Hospital-based internal medicine clinic practice in Boston, MA	Those who were internet users were not statistically significant nor more likely to have an HbA1c >7% [OR 1.0 95% CI 0.7-1.4] and blood pressure <130/80mmHg [1.3 95% CI 0.9-2.0] but there was a internet users were statistically more likely to have an LDL <100mg/dl [OR 0.7 95% CI 0.5-0.99]
Salvo, 2012 (79)	Retrospective cohort study comparing pharmacist-managed insulin to standard care Duration: 24 months	To assess the impact of pharmacist-managed insulin titration program compared to standard medical care on glycemic control and preventive care measures in an indigent population with diabetes	126	Low income patients with type 1 or type 2 diabetes using insulin therapy	St. Louis County Department of Health	At the end of the study the intervention group showed a significant difference in HbA1c compared to standard of care (−1.3% vs. −0.18%, p=0.001)
Camacho, 2002 (34)	Cross sectional	Describe and find correlates of health-related quality of life	249	Underserved, low-income patients in North Carolina with type 1 or type 2 diabetes	Public and private, non-profit, health organizations	There was an inverse relationship between glycemic control and energy and mobility (β=−4.58, p<0.05); LDL control predicted better mental health ((β=4.54, p<0.01); blood pressure was inversely associated with sexual function (β=−5.89, p<0.01)
Hills-Briggs, 2005 (52)	Randomized controlled trial Duration: 24 months	Examine medication adherence, association of medication adherence with HbA1c, and the association of medication adherence with sociodemographic and psychosocial variables	181	African Americans with type 2 diabetes who reside in an impoverished sociodemographic environment	Johns Hopkins-affiliated primary care clinics	Individuals in this impoverished environment tended to have higher HbA1c due to behaviors of carelessness in taking medications and stopping medications because of feeling better. No p-value reported.
Kollannoor-Samuel, 2011 (61)	Randomized controlled, longitudinal study	Identify demographic, socioeconomic, acculturation, lifestyle, sleeping patterns, and biomedical determinants of fasting plasma glucose and glycosylated hemoglobin	211	Latino adults with type 2 diabetes who were recruited from a metabolic syndrome clinic at Hartford Hospital	Home interview	Those who had a lower income were more likely (OR 10.4, 95% CI 1.54-69.30) to have higher HbA1c
Kogan, 2009 (60)	Cross sectional path analysis	Test the hypothesis that financial distress, community disadvantage and educational attainment contribute to poor glycemic control indirectly via depressive symptoms among rural African Americans	192	African Americans with type 2 diabetes	Rural counties in central Georgia	Structural equation modeling analyses confirmed hypothesis that financial distress, community disadvantage and educational attainment demonstrate significant indirect effects on HbA1c via depressive symptoms
Hill-Briggs, 2011 (53)	Randomized controlled trial Compare intensive and condensed program format	Determine feasibility, acceptability and effect of problem-based diabetes self-management training in low socioeconomic, low literacy population	52	Adult (25+) African Americans with type 2 diabetes	Urban African Americans in Baltimore, MD	Intensive problem-solving based program led to improvements in HbA1c (−0.72%) above that of condensed format (p=0.02). Showed clinically significant changes for those with suboptimal baseline measures in HbA1c, blood pressure, and LDL.
Khan, 2011 (57)	Randomized controlled trial Computer multimedia education program vs educational brochure (control)	Evaluate the impact of a waiting room-administered, low-literacy, computer multimedia diabetes education program on patient self-management and provider intensification therapy	129	Uninsured adults with type 2 diabetes	County clinic in Chicago, IL	There was a decrease in HbA1c when comparing the intervention and control groups (−1.5% vs −0.8%, p=0.06)