Sukyung Chung1, Beinan Zhao2, Diane Lauderdale3, Randolph Linde4, Randall Stafford5, Latha Palaniappan6. 1. Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, United States. Electronic address: chungs@pamfri.org. 2. Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States. 3. University of Chicago, Department of Health Studies, Chicago, IL, United States. 4. Palo Alto Medical Foundation, Endocrinology Department, Palo Alto, CA, United States. 5. Stanford University, Prevention Research Center, Palo Alto, CA, United States. 6. Palo Alto Medical Foundation Research Institute and Stanford University, Prevention Research Center, Palo Alto, CA, United States.
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.
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.
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