<b>Objective:</b> To assess patient characteristics and treatment
factors associated with uncontrolled type 2 diabetes (T2D) and the probability
of A1C goal attainment.
<p><b>Research
Design and Methods</b>: Retrospective
cohort study using the electronic health record at Cleveland Clinic. Patients
with uncontrolled T2D (A1C>9%) were identified on the index date of
12/31/2016 (n=6,973), grouped by attainment (n=1,653 [24.7%) or non-attainment (n=5,320
[76.3%]) of A1C<8% by 12/31/2017, and subgroups compared on a number of
demographic and clinical variables. Based on these variables, a nomogram was
created for predicting probability of A1C goal attainment. </p>
<p><b>Results:</b> For the entire population, median age at index date was
57.7 years (53.3% male), and the majority were white (67.2%). Median A1C was
10.2%. Obesity (50.6%), cardiovascular disease (46.9%) and psychiatric disease (61.1%)
were the most common comorbidities. Metformin (62.7%) and sulfonylureas (38.7%)
were the most common anti-diabetes medications. Only 1,653 (24%) patients achieved an A1C <8%. Predictors
of increased probability of A1C goal attainment were older age,
white/non-Hispanic race/ethnicity, Medicare health insurance, lower baseline
A1C, higher frequency of endocrinology/primary care visits, DPP-4i use,
thiazolidinedione use, metformin use, GLP-1RA use, and fewer classes of
anti-diabetes drugs. Factors associated with lower probability included insulin
use and longer time in the T2D database (both presumed as likely surrogates for
duration of T2D). </p>
<p><b>Conclusions:</b> A minority of patients with an A1C>9% achieved an
A1C<8% at one year. While most identified predictive factors are
non-modifiable by the clinician, pursuit of frequent patient engagement and
tailored drug regimens may help improve A1C goal attainment. </p>
