Chung S, Zhao B, Lauderdale D, Linde R, Stafford R, Palaniappan L., Prim Care Diabetes. 9(1):23-30. doi: 10.1016/j.pcd.2014.04.005. Epub 2014 May 5., 2015 Feb 01
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.