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1.  Screening for Impaired Fasting Glucose and Diabetes Using Available Health Plan Data 
Journal of diabetes and its complications  2013;27(6):10.1016/j.jdiacomp.2013.01.003.
Aims
To develop and validate prediction equations to identify individuals at high-risk for type 2 diabetes using existing health plan data.
Methods
Health plan data from 2005–2009 from 18,527 members of a Midwestern HMO without diabetes, 6% who had fasting plasma glucose (FPG) ≥ 110 mg/dL, and health plan data from 2005–2006 from 368,025 members of a West Coast integrated delivery system without diabetes, 13% who had FPG ≥ 110 mg/dL were analyzed. Within each health plan, we used multiple logistic regression to develop equations to predict FPG ≥ 110 mg/dL for half of the population and validated the equations using the other half. We then externally validated the equations in the other health plan.
Results
Areas under the curve for the most parsimonious equations were 0.665 to 0.729 when validated internally. Positive predictive values were 14% to 32% when validated internally and 14% to 29% when validated externally.
Conclusion
Multivariate logistic regression equations can be applied to existing health plan data to efficiently identify persons at higher risk for dysglycemia who might benefit from definitive diagnostic testing and interventions to prevent or treat diabetes.
doi:10.1016/j.jdiacomp.2013.01.003
PMCID: PMC3714351  PMID: 23587840
screening; impaired fasting glucose; diabetes; administrative data
2.  Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD) 
Journal of diabetes and its complications  2013;27(6):10.1016/j.jdiacomp.2013.08.003.
Aims
The objective was to describe the prevalence of diabetes-related foot complications in a managed care population and to identify the demographic and biological risk factors.
Methods
We assessed the period prevalence of foot complications on 6,992 patients using ICD-9 diagnosis codes from health plan administrative data. Demographic and biological variables were ascertained from surveys and medical record reviews. We defined four mutually exclusive groups: any Charcot foot, DFU with debridement, amputation ± DFU and debridement, and no foot conditions.
Results
Overall, 55 (0.8%) patients had Charcot foot, 205 (2.9%) had DFU with debridement, and 101 (1.4%) had a lower-extremity amputation. There were 6,631 patients with no prevalent foot conditions. Racial/ethnic minorities were less likely to have Charcot foot (OR=0.21; 95%CI: 0.10, 0.46) or DFU (OR=0.61; 95% CI: 0.44, 0.84) compared to non-Hispanic Whites, but there were no racial/ethnic differences in amputation. Histories of micro- or macrovascular disease were associated with a two- to four-fold increase in the odds of foot complications.
Conclusion
In managed care patients with uniform access to health care, we found a relatively high prevalence of foot complications, but attenuation of the racial/ethnic differences of rates reported in the literature.
doi:10.1016/j.jdiacomp.2013.08.003
PMCID: PMC3855485  PMID: 24035357
charcot; foot ulcer; amputation; diabetes
3.  Are Health-Related Quality-of-Life and Self-Rated Health Associated with Mortality? Insights from Translating Research Into Action for Diabetes (TRIAD) 
Primary care diabetes  2009;3(1):37-42.
Aims
To determine if health-related quality-of-life and self-rated health are associated with mortality in persons with diabetes.
Methods
Survey and medical record data were obtained from 7,892 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a multicenter prospective observational study of diabetes care in managed care. Vital status at follow-up was determined from the National Death Index. Multivariable proportional hazards models were used to determine if a generic measure of health-related quality-of-life (EQ-5D) and self-rated health measured at baseline were associated with 4-year all-cause, cardiovascular, and noncardiovascular mortality.
Results
At baseline, the mean EQ-5D score for decedents was 0.73 (SD=0.20) and for survivors was 0.81 (SD=0.18) (p<0.0001). Fifty-five percent of decedents and 36% of survivors (p<0.0001) rated their health as fair or poor. Lower EQ-5D scores and fair or poor self-rated health were associated with higher rates of mortality after adjusting for the demographic, socioeconomic, and clinical risk factors for mortality.
Conclusions
Health-related quality-of-life and self-rated health predict mortality in persons with diabetes. Health-related quality-of-life and self-rated health may provide additional information on patient risk independent of demographic, socioeconomic, and clinical risk factors for mortality.
doi:10.1016/j.pcd.2009.01.001
PMCID: PMC4138696  PMID: 19269911
diabetes; mortality; QoL
4.  Effect of a Managed Care Disease Management Program on Diabetes Care 
Objective
To determine if processes and outcomes of diabetes care improved between 2000 and 2006 in a managed care health plan with a comprehensive diabetes disease management program.
Study Design
Cross-sectional.
Methods
A total of 1650 randomly selected members with diabetes mellitus completed surveys in 2000, and 1256 randomly selected members with diabetes completed surveys in 2006. Survey and medical record data were analyzed using multivariable regression and predictive probabilities adjusted for age, education, and comorbidities.
Results
In 2006, patients were more likely to have proteinuria assessed (85% vs 74% in 2000), foot examinations performed (90% vs 86%), glycosylated hemoglobin levels measured (94% vs 87%), lipids measured (81% vs 70%), aspirin use recommended (67% vs 56%), and influenza immunizations administered (70% vs 63%). Glycosylated hemoglobin levels decreased by 0.60% (P <.001), systolic blood pressures by 3 mm Hg (P = .002), and low-density lipoprotein cholesterol levels by 18 mg/dL (P <.001). Those who were continuously enrolled in the health plan were significantly more likely to report having had dilated retinal examinations (P = .003), aspirin use recommendations (P = .049), influenza immunizations (P = .004), and lower low-density lipoprotein cholesterol levels (by 6 mg/dL, P = .003).
Conclusions
Implementation of a disease management program was associated with substantial improvements in processes and outcomes of diabetes care over 6 years. Although secular trend likely contributed somewhat, improvement in other measures was significantly associated with duration of enrollment in the health plan, making secular trend an unlikely explanation for all of our findings.
PMCID: PMC4324455  PMID: 19747021
5.  Physical Functioning and Mortality among Individuals with Type 2 Diabetes: Insights from TRIAD 
Diabetes is a risk factor for mortality. Subjective health status, including self-reported physical functioning, may also be a marker for mortality. This study examined the association between self-reported physical functioning and mortality in people with diabetes, and determined if this association differed by race/ethnicity. We studied 7,894 type 2 diabetic patients who participated in Translating Research Into Action for Diabetes (TRIAD), a prospective study of diabetes care in managed care. At baseline in 2000, participants completed a questionnaire and had a medical record review. Physical functioning was assessed with the Short Form Health Survey (SF-12). The National Death Index was searched annually for deaths over 10 years of follow-up (2000-2009). At baseline, mean age was 61.7 years, 50% were non-Hispanic white, 22% were black, and 16% of participants reported “good physical functioning” (better than norms for U.S. adults). Over 10 years, 28% of participants died (2,111/7,894); 39% (856/2,111) due to cardiovascular disease. Relative to those reporting good functioning, those reporting poor physical functioning had a 37% higher all-cause death rate, after adjusting for age, sex, race/ethnicity, education, income, body mass index, smoking, and comorbidities (Hazard Ratio (HR)=1.37; 95% Confidence Interval (CI): 1.15, 1.63). Similarly, those reporting poor physical functioning had a 42% higher adjusted cardiovascular death rate compared to those reporting good functioning (HR= 1.42; 95% CI: 1.06, 1.90). Although blacks were less likely than whites to report good functioning (p<0.01), the association between functioning and mortality was consistent across race/ethnicity. In this managed care population with diabetes, self-reported physical functioning was a robust predictor of mortality, in addition to traditional biological risk factors, for all race/ethnic groups. Physical functioning assessments are easy to perform and may be useful benchmarks for tailoring the care of persons with chronic disease.
doi:10.1016/j.jdiacomp.2013.06.004
PMCID: PMC4278639  PMID: 23891274
6.  Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients 
Diabetes Care  2012;35(6):1301-1309.
OBJECTIVE
To examine demographic, socioeconomic, and biological risk factors for all-cause, cardiovascular, and noncardiovascular mortality in patients with type 2 diabetes over 8 years and to construct mortality prediction equations.
RESEARCH DESIGN AND METHODS
Beginning in 2000, survey and medical record information was obtained from 8,334 participants in Translating Research Into Action for Diabetes (TRIAD), a multicenter prospective observational study of diabetes care in managed care. The National Death Index was searched annually to obtain data on deaths over an 8-year follow-up period (2000–2007). Predictors examined included age, sex, race, education, income, smoking, age at diagnosis of diabetes, duration and treatment of diabetes, BMI, complications, comorbidities, and medication use.
RESULTS
There were 1,616 (19%) deaths over the 8-year period. In the most parsimonious equation, the predictors of all-cause mortality included older age, male sex, white race, lower income, smoking, insulin treatment, nephropathy, history of dyslipidemia, higher LDL cholesterol, angina/myocardial infarction/other coronary disease/coronary angioplasty/bypass, congestive heart failure, aspirin, β-blocker, and diuretic use, and higher Charlson Index.
CONCLUSIONS
Risk of death can be predicted in people with type 2 diabetes using simple demographic, socioeconomic, and biological risk factors with fair reliability. Such prediction equations are essential for computer simulation models of diabetes progression and may, with further validation, be useful for patient management.
doi:10.2337/dc11-2281
PMCID: PMC3357242  PMID: 22432119
7.  Self-efficacy, social support, and associations with physical activity and body mass index among women with histories of gestational diabetes mellitus 
The Diabetes educator  2008;34(4):719-728.
Purpose
To examine the associations between 2 potential facilitators of healthy behaviors (self-efficacy and social support), and both physical activity and body mass index (BMI) among women with histories of gestational diabetes mellitus (GDM)
Methods
We surveyed 228 women with histories of GDM enrolled in a managed care plan. In a cross-sectional analysis, we assessed the association between women’s social support from family and friends for physical activity and self-efficacy for physical activity with women’s physical activity levels. We also examined the association between women’s social support from family and friends for healthy diet and self-efficacy for not overeating and their dietary habits. Finally, we assessed the association between all of these psychosocial constructs and body mass index (BMI) before and after adjustment for covariates.
Results
Participants reported low to moderate social support and self-efficacy scores, suboptimal performance of physical activity, suboptimal dietary scores, and high BMIs. Self-efficacy and social support from family and friends for physical activity were associated with physical activity. Social support from family and friends for a healthy diet was associated with better dietary scores and the association between self-efficacy for not overeating and healthy diet bordered on significance. No significant associations existed between psychosocial constructs and BMI.
Conclusions
Psychosocial constructs such as social support and self-efficacy are associated with physical activity and dietary habits. However, associations with BMI are weak. Further exploration of constructs associated with BMI may be needed to design effective weight-loss interventions in this population.
doi:10.1177/0145721708321005
PMCID: PMC4139034  PMID: 18669814
8.  Temporal Trends in Recording of Diabetes on Death Certificates 
Diabetes Care  2011;34(7):1529-1533.
OBJECTIVE
To determine the frequency that diabetes is reported on death certificates of decedents with known diabetes and describe trends in reporting over 8 years.
RESEARCH DESIGN AND METHODS
Data were obtained from 11,927 participants with diabetes who were enrolled in Translating Research into Action for Diabetes, a multicenter prospective observational study of diabetes care in managed care. Data on decedents (N = 2,261) were obtained from the National Death Index from 1 January 2000 through 31 December 2007. The primary dependent variables were the presence of the ICD-10 codes for diabetes listed anywhere on the death certificate or as the underlying cause of death.
RESULTS
Diabetes was recorded on 41% of death certificates and as the underlying cause of death for 13% of decedents with diabetes. Diabetes was significantly more likely to be reported on the death certificate of decedents dying of cardiovascular disease than all other causes. There was a statistically significant trend of increased reporting of diabetes as the underlying cause of death over time (P < 0.001), which persisted after controlling for duration of diabetes at death. The increase in reporting of diabetes as the underlying cause of death was associated with a decrease in the reporting of cardiovascular disease as the underlying cause of death (P < 0.001).
CONCLUSIONS
Death certificates continue to underestimate the prevalence of diabetes among decedents. The increase in reporting of diabetes as the underlying cause of death over the past 8 years will likely impact estimates of the burden of diabetes in the U.S.
doi:10.2337/dc10-2312
PMCID: PMC3120163  PMID: 21709292
9.  Competing Demands for Time and Self-Care Behaviors, Processes of Care, and Intermediate Outcomes Among People With Diabetes 
Diabetes Care  2011;34(5):1180-1182.
OBJECTIVE
To determine whether competing demands for time affect diabetes self-care behaviors, processes of care, and intermediate outcomes.
RESEARCH DESIGN AND METHODS
We used survey and medical record data from 5,478 participants in Translating Research Into Action for Diabetes (TRIAD) and hierarchical regression models to examine the cross-sectional associations between competing demands for time and diabetes outcomes, including self-management, processes of care, and intermediate health outcomes.
RESULTS
Fifty-two percent of participants reported no competing demands, 7% reported caregiving responsibilities only, 36% reported employment responsibilities only, and 6% reported both caregiving and employment responsibilities. For both women and men, employment responsibilities (with or without caregiving responsibilities) were associated with lower rates of diabetes self-care behaviors, worse processes of care, and, in men, worse HbA1c.
CONCLUSIONS
Accommodations for competing demands for time may promote self-management and improve the processes and outcomes of care for employed adults with diabetes.
doi:10.2337/dc10-2038
PMCID: PMC3114509  PMID: 21464464
10.  The impact of a managed care obesity intervention on clinical outcomes and costs: A prospective observational study 
Obesity (Silver Spring, Md.)  2013;21(11):2157-2162.
Objective
To evaluate the impact of a managed care obesity intervention that requires enrollment in an intensive medical weight management program, a commercial weight loss program, or a commercial pedometer-based walking program to maintain enhanced benefits.
Design and Methods
Prospective observational study involving 1,138 adults with BMI ≥32 kg/m2 with one or more comorbidities or BMI ≥35 kg/m2 enrolled in a commercial, independent practice association-model health maintenance organization. Body mass index, blood pressure, lipids, HbA1c or fasting glucose, and per-member per-month costs were assessed one year before and one year after program implementation.
Results
Program uptake (90%) and one year adherence (79%) were excellent. Enrollees in all three programs exhibited improved clinical outcomes and reduced rates of increase in direct medical costs compared to members who did not enroll in any program.
Conclusions
A managed care obesity intervention that offered financial incentives for participation and a variety of programs was associated with excellent program uptake and adherence, improvements in cardiovascular risk factors, and a lower rate of increase in direct medical costs over one year.
doi:10.1002/oby.20597
PMCID: PMC3947418  PMID: 24136667
weight loss; cost analysis; managed care
11.  Predictors and Impact of Intensification of Antihyperglycemic Therapy in Type 2 Diabetes 
Diabetes Care  2009;32(6):971-976.
OBJECTIVE
The purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C.
RESEARCH DESIGN AND METHODS
We analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months.
RESULTS
Of 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 ± 12 years, had diabetes duration of 11 ± 9 years, and had A1C of 9.1 ± 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C (P < 0.0001), a 3-pound increase in weight (P = 0.003), and no change in anxiety/depression (P = 0.5) or health status (P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits.
CONCLUSIONS
Treatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control.
doi:10.2337/dc08-1911
PMCID: PMC2681018  PMID: 19228862
12.  Is the Physical Functioning of Older Adults with Diabetes Associated with the Processes and Outcomes of Care? Evidence from Translating Research Into Action for Diabetes (TRIAD) 
Aims
To examine the relationship between physical function limitations and diabetes self-management, processes of care, and intermediate outcomes in adults ≥65 years of age with type 2 diabetes.
Methods
We studied 1,796 participants 65 years of age and older in managed care health plans enrolled in Translating Research into Action for Diabetes (TRIAD). Physical functioning was assessed at baseline with the Physical Component Summary of the Short Form-12 (SF-12) Health Survey. Diabetes self-management was assessed with follow-up surveys, and processes of care (eye exams, urine microalbumin testing, foot exams, etc.) and intermediate health outcomes (HbA1c, blood pressure, LDL-c) were assessed with medical chart reviews. Multivariate regression models were constructed to examine the associations between physical function limitations and outcomes.
Results
Frequency of eye exams (OR 0.69, 95% CI 0.49 - 0.99) was the only process of care that was worse for participants with physical function limitations (n=573) compared to those without limitations (n=618). Neither self-management nor intermediate outcomes differed by whether patients had or did not have physical function limitations.
Conclusion
Limitations in physical functioning as assessed by the SF-12 were not associated with substantial difference in diabetes care in adults ≥65 years of age enrolled in managed care health plans.
doi:10.1111/j.1464-5491.2012.03584.x
PMCID: PMC3557946  PMID: 22268866
physical function; quality of care; geriatrics
13.  Thiazolidinediones, Cardiovascular Disease and Cardiovascular Mortality: Translating Research Into Action For Diabetes (TRIAD) 
Background
Studies have associated thiazolidinedione (TZD) treatment with cardiovascular disease (CVD) and questioned whether the two available TZDs, rosiglitazone and pioglitazone, have different CVD risks. We compared CVD incidence, cardiovascular (CV) and all-cause mortality in type 2 diabetic patients treated with rosiglitazone or pioglitazone as their only TZD.
Methods
We analyzed survey, medical record, administrative, and National Death Index (NDI) data from 1999 through 2003 from Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Medications, CV procedures, and CVD were determined from health plan (HP) administrative data, and mortality was from NDI. Adjusted hazard rates (AHR) were derived from Cox proportional hazard models adjusted for age, sex, race/ethnicity, income, history of diabetic nephropathy, history of CVD, insulin use, and HP.
Results
Across TRIAD’s ten HPs, 1,815 patients (24%) filled prescriptions for a TZD, 773 (10%) for only rosiglitazone, 711 (10%) for only pioglitazone, and 331 (4%) for multiple TZDs. In the seven HPs using both TZDs, 1,159 patients (33%) filled a prescription for a TZD, 564 (16%) for only rosiglitazone, 334 (10%) for only pioglitazone, and 261 (7%) for multiple TZDs. For all CV events, CV and all-cause mortality, we found no significant difference between rosiglitazone and pioglitazone.
Conclusions
In this relatively small, prospective, observational study, we found no statistically significant differences in CV outcomes for rosiglitazone- compared to pioglitazone-treated patients. There does not appear to be a pattern of clinically meaningful differences in CV outcomes for rosiglitazone- versus pioglitazone-treated patients.
doi:10.1002/pds.1954
PMCID: PMC3548906  PMID: 20583206
Thiazolidinediones; rosiglitazone; pioglitazone; diabetes
14.  Evaluation of risk equations for prediction of short-term coronary heart disease events in patients with long-standing type 2 diabetes: the Translating Research into Action for Diabetes (TRIAD) study 
Background
To evaluate the U.K. Prospective Diabetes Study (UKPDS) and Framingham risk equations for predicting short-term risk of coronary heart disease (CHD) events among adults with long-standing type 2 diabetes, including those with and without preexisting CHD.
Methods
Prospective cohort of U.S. managed care enrollees aged ≥ 18 years and mean diabetes duration of more than 10 years, participating in the Translating Research into Action for Diabetes (TRIAD) study, was followed for the first occurrence of CHD events from 2000 to 2003. The UKPDS and Framingham risk equations were evaluated for discriminating power and calibration.
Results
A total of 8303 TRIAD participants, were identified to evaluate the UKPDS (n = 5914, 120 events), Framingham-initial (n = 5914, 218 events) and Framingham-secondary (n = 2389, 374 events) risk equations, according to their prior CHD history. All of these equations exhibited low discriminating power with Harrell’s c-index <0.65. All except the Framingham-initial equation for women and the Framingham-secondary equation for men had low levels of calibration. After adjsusting for the average values of predictors and event rates in the TRIAD population, the calibration of these equations greatly improved.
Conclusions
The UKPDS and Framingham risk equations may be inappropriate for predicting the short-term risk of CHD events in patients with long-standing type 2 diabetes, partly due to changes in medications used by patients with diabetes and other improvements in clinical care since the Frmaingham and UKPDS studies were conducted. Refinement of these equations to reflect contemporary CHD profiles, diagnostics and therapies are needed to provide reliable risk estimates to inform effective treatment.
doi:10.1186/1472-6823-12-12
PMCID: PMC3433369  PMID: 22776317
15.  Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study 
ABSTRACT
BACKGROUND
Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity.
OBJECTIVE
To examine the associations between primary language, income, and medication intensification.
DESIGN
Cohort study with 18-month follow-up.
PARTICIPANTS
One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care.
MEASUREMENTS
Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c ≥ 8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan.
RESULTS
Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race.
CONCLUSIONS
Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-010-1588-2) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-010-1588-2
PMCID: PMC3077478  PMID: 21174165
16.  Stress Urinary Incontinence in Women with a History of Gestational Diabetes Mellitus 
Journal of Women's Health  2008;17(5):783-792.
Abstract
Objective
Stress urinary incontinence may serve as a barrier to lifestyle modification among women at high risk for diabetes, but the prevalence of stress urinary incontinence among women with histories of gestational diabetes mellitus (hGDM) is unknown. The purpose of this study was to examine the prevalence of stress incontinence among women with hGDM and to examine its association with their current physical activity.
Methods
We surveyed women with hGDM within the past 5 years who were currently enrolled in a managed care plan (n = 228). In a cross-sectional analysis, self-reported weekly or more frequent stress incontinence was the primary independent variable and measures of physical activity and body mass index (BMI) were the outcomes of interest. We constructed multivariable models that adjusted for participant characteristics associated with the measure of incontinence or outcomes in bivariate analyses.
Results
Of the 228 women with hGDM, 49% reported weekly or more frequent incontinence during pregnancy, and 28% reported that incontinence affected their activities during pregnancy. Fifty percent reported weekly or more frequent incontinence after delivery, with 27% reporting interference of incontinence with activity. Less than a third of women reported optimal physical activity, and 42% were obese. After adjustment for characteristics associated with measures of activity and incontinence, there was minimal association between levels of activity and stress urinary incontinence; similarly, there was no association between BMI and measures of stress incontinence.
Conclusions
Stress urinary incontinence is common among women with hGDM but does not appear to be associated with physical activity levels or BMI.
doi:10.1089/jwh.2007.0616
PMCID: PMC2942747  PMID: 18537481

Results 1-16 (16)