PURPOSE: Antihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetes patients. METHODS: This retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6 months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to/addition of insulin 31-365 days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time-dependent variable. RESULTS: Among 41,233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12 months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (<1%). HbA1c% was strongly associated with intensification (adjusted hazard ratios [HR] 1.59, 3.62, 4.44, and 5.52 for HbA1c 6.5% to <7%, 7% to <7.5%, 7.5 to <8%, and ≥8%, respectively, all P < 0.001, compared with HbA1c < 6.5%). In patients initially on monotherapy, age modified the HbA1c effect: at HbA1c < 7%, the HR differed little between middle-aged and older patients; at HbA1c ≥ 7%, the HR decreased with older age (e.g., age 40-49 years and HbA1c ≥ 8%: HR 8.14; age ≥ 80 years and HbA1c ≥ 8%: HR 4.44; compared with age ≥ 80 years and HbA1c < 6.5%). Within 1 year, 84.3% achieved HbA1c < 8%; 65.1% achieved HbA1c < 7%. CONCLUSIONS: Clinicians appear to be applying treatment intensification guidelines and individualizing therapy by considering patient age, achieving glycemic control among most incident diabetes patients.
PURPOSE: Antihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetespatients. METHODS: This retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6 months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to/addition of insulin 31-365 days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time-dependent variable. RESULTS: Among 41,233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12 months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (<1%). HbA1c% was strongly associated with intensification (adjusted hazard ratios [HR] 1.59, 3.62, 4.44, and 5.52 for HbA1c 6.5% to <7%, 7% to <7.5%, 7.5 to <8%, and ≥8%, respectively, all P < 0.001, compared with HbA1c < 6.5%). In patients initially on monotherapy, age modified the HbA1c effect: at HbA1c < 7%, the HR differed little between middle-aged and older patients; at HbA1c ≥ 7%, the HR decreased with older age (e.g., age 40-49 years and HbA1c ≥ 8%: HR 8.14; age ≥ 80 years and HbA1c ≥ 8%: HR 4.44; compared with age ≥ 80 years and HbA1c < 6.5%). Within 1 year, 84.3% achieved HbA1c < 8%; 65.1% achieved HbA1c < 7%. CONCLUSIONS: Clinicians appear to be applying treatment intensification guidelines and individualizing therapy by considering patient age, achieving glycemic control among most incident diabetespatients.
Authors: Reimar W Thomsen; Lisbeth M Baggesen; Mette Søgaard; Lars Pedersen; Helene Nørrelund; Esben S Buhl; Christiane L Haase; Søren P Johnsen Journal: Diabetologia Date: 2015-08-16 Impact factor: 10.122
Authors: Ram D Pathak; Emily B Schroeder; Elizabeth R Seaquist; Chan Zeng; Jennifer Elston Lafata; Abraham Thomas; Jay Desai; Beth Waitzfelder; Gregory A Nichols; Jean M Lawrence; Andrew J Karter; John F Steiner; Jodi Segal; Patrick J O'Connor Journal: Diabetes Care Date: 2015-12-17 Impact factor: 19.112
Authors: Julie A Schmittdiel; Jay Desai; Emily B Schroeder; Andrea R Paolino; Gregory A Nichols; Jean M Lawrence; Patrick J O'Connor; Kris A Ohnsorg; Katherine M Newton; John F Steiner Journal: Healthc (Amst) Date: 2015-03-13
Authors: Marsha A Raebel; Susan M Shetterly; Bharati Bhardwaja; Andrew T Sterrett; Emily B Schroeder; Joseph Chorny; Tyson P Hagen; David J Silverman; Rex Astles; Ira M Lubin Journal: Popul Health Manag Date: 2019-05-20 Impact factor: 2.459
Authors: Marsha A Raebel; LeeAnn M Quintana; Emily B Schroeder; Susan M Shetterly; Lisa E Pieper; Paul L Epner; Laura K Bechtel; David H Smith; Andrew T Sterrett; Joseph A Chorny; Ira M Lubin Journal: Arch Pathol Lab Med Date: 2018-12-10 Impact factor: 5.534
Authors: Jennifer Elston Lafata; Andrew J Karter; Patrick J O'Connor; Heather Morris; Julie A Schmittdiel; Scott Ratliff; Katherine M Newton; Marsha A Raebel; Ram D Pathak; Abraham Thomas; Melissa G Butler; Kristi Reynolds; Beth Waitzfelder; John F Steiner Journal: J Gen Intern Med Date: 2016-02 Impact factor: 5.128
Authors: Julie A Schmittdiel; Gregory A Nichols; Wendy Dyer; John F Steiner; Andrew J Karter; Marsha A Raebel Journal: Med Care Date: 2015-04 Impact factor: 2.983