Highlights
- •We examined patterns of treatment initiation for incident diabetes in an ambulatory care setting in the US.
- •Diabetes onset and treatment were identified with information from electronic health records (EHR).
- •Among insured patients who have a primary care provider, incident diabetes is treated only half the time.
- •Of the treated, 68% received a treatment within the first four weeks, and 13% after initial 16 weeks.
- •Improved algorithms for identifying incident diabetes from the EHR and team approach for monitoring may help treatment initiation.
Abstract
Objective
We examined patterns and predictors of initiation of treatment for incident diabetes
in an ambulatory care setting in the US.
Methods
Data were extracted from electronic health records (EHR) for active patients ≥35 years
in a multispecialty, multiclinic ambulatory care organization with 1000 providers.
New onset type 2 diabetes and subsequent treatment were identified using lab, diagnosis,
medication prescription, and service use data. Time from the first evidence of diabetes
until initial treatment, either medication or education/counseling, was examined using
a Kaplan–Meier hazards curve. Potential predictors of initial treatment were examined
using multinomial logistic models accounting for physician random effects.
Results
Of 2258 patients with incident diabetes, 55% received either medication or education/counseling
(20% received both) during the first year. Of the treated patients, 68% received a
treatment within the first four weeks, and 13% after initial 16 weeks. Strong positive
predictors (P < 0.01) of combined treatment were younger age, higher fasting glucose at diagnosis,
obesity, and visits with an endocrinologist.
Conclusions
Among insured patients who have a primary care provider in a multispecialty health
care system, incident diabetes is treated only half the time. Improved algorithms
for identifying incident diabetes from the EHR and team approach for monitoring may
help treatment initiation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Primary Care DiabetesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy.Diabetes Care. 2009; 32: 193-203
- Executive summary: standards of medical care in diabetes—2010.Diabetes Care. 2010; 33: S4-S10
- Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improved outcomes?.Diabetes Care. 2002; 25: 1410-1417
- 10-Year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.Lancet. 2009; 374: 1677-1686
- Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N. Engl. J. Med. 2002; 346: 393-403
- Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.Diabetes Care. 1997; 20: 537-544
- The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study.Lancet. 2008; 371: 1783-1789
- Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial.Diabetes Care. 2007; 30: 1374-1383
- Undertreatment of cardiovascular risk factors among persons with diabetes in the United States.Diabetes Res. Clin. Pract. 2007; 77: 126-133
- Prevalence and control of dyslipidemia among persons with diabetes in the United States.Diabetes Res. Clin. Pract. 2005; 70: 263-269
- Racial and ethnic differences in cardio-metabolic risk in individuals with undiagnosed diabetes: National Health and Nutrition Examination Survey 1999–2008.J. Gen. Intern. Med. 2012; 27: 893-900
- Why don’t diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification.J. Gen. Intern. Med. 2008; 23: 588-594
- Practice-based evidence study design for comparative effectiveness research.Med. Care. 2007; 45: S50-S57
- Practice-based research—“Blue Highways” on the NIH roadmap.JAMA. 2007; 297: 403-406
- Profile of General Demographic Characteristics: 2000 Census Summary File 2, 100-percent data.2000
- Standards of medical care in diabetes.Diabetes Care. 2005; 28: S4-S36
- The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).Diabetologia. 2006; 49: 289-297
- Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.N. Engl. J. Med. 2001; 344: 1343-1350
- Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP).Am. J. Cardiol. 2001; 87: 819-822
- Pay for Performance-Manuals and Program Operations.2011 (http://www.iha.org/manuals_operations.html (accessed 27.11.13))
- Incorrect and incomplete coding and classification of diabetes: a systematic review.Diabetic Med. 2010; 27: 491-497
- Ambulatory Medical Care Utilization Estimates for 2007.National Center for Health Statistics, 2011
- Guidelines for improving the care of the older person with diabetes mellitus.J. Am. Geriatr. Soc. 2003; 51: S265-S280
- Goals of glycemic control in frail older patients with diabetes.JAMA. 2011; 305: 1350-1351
- Racial disparities in diabetes care processes, outcomes, and treatment intensity.Med. Care. 2003; 41: 1221-1232
Article info
Publication history
Published online: May 05, 2014
Accepted:
April 7,
2014
Received in revised form:
April 4,
2014
Received:
December 2,
2013
Identification
Copyright
© 2014 Primary Care Diabetes Europe. Published by Elsevier Inc. All rights reserved.
