Glycaemic control of Type 2 diabetes in older patients visiting general practitioners: An examination of electronic medical records to identify risk factors for poor control

ObjectiveTo compare the glycaemic control and cardiovascular risk factor profiles of younger and older patients with type 2 diabetes. Cross-sectional analysis of data from the 2015 Australian National Diabetes Audit was undertaken.MethodsData were obtained from adults with type 2 diabetes presenting to Australian secondary/tertiary diabetes centres. Logistic regression examined associations with glycated haemoglobin A1c (HbA1c) >7% (53 mmol/mol) and cardiovascular risk factors.ResultsData from 3492 patients were analysed. Mean (±SD) age was 62.9±12.5 years, mean diabetes duration 13.5±9.4 years and mean HbA1c 8.2%±1.8%. Mean HbA1c was 8.6%±2.1% and 8.0%±1.6% for the younger (<60 years) and older subgroups (≥60 years), respectively (p<0.001). The adjusted OR (aOR) of HbA1c above >7.0% was 1.5 times higher (95% CI 1.22 to 1.84) for younger patients compared with older patients after adjustment for gender, smoking, diabetes duration, renal function and body mass index. Younger patients were also more likely to have dyslipidaemia (aOR 2.02, 95% CI 1.53 to 2.68; p<0.001), be obese (aOR 1.25, 95% CI 1.05 to 1.49; p<0.001) and be current smokers (aOR 2.13 95% CI 1.64 to 2.77; p<0.001) than older patients.ConclusionsYounger age was associated with poorer glycaemic control and adverse cardiovascular risk factor profiles. It is imperative to optimise and monitor treatment in order to improve long-term outcomes.

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Automatic identification of type 2 diabetes, hypertension, ischaemic heart disease, heart failure and their levels of severity from Italian General Practitioners' electronic medical records: a validation study

BMJ Open ◽

10.1136/bmjopen-2016-012413 ◽

2016 ◽

Vol 6 (12) ◽

pp. e012413 ◽

Cited By ~ 13

Author(s):

Rosa Gini ◽

Martijn J Schuemie ◽

Giampiero Mazzaglia ◽

Francesco Lapi ◽

Paolo Francesconi ◽

...

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Electronic Medical Records ◽

General Practitioners ◽

Validation Study ◽

Medical Records ◽

Automatic Identification

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Comparative Retinopathy Risk in People with Type 2 Diabetes Treated with Post Metformin Second-line Incretin Therapies: Study Based on US Electronic Medical Records

Journal of Diabetes Metabolism and its Complications ◽

10.31487/j.jdmc.2020.02.03 ◽

2020 ◽

pp. 1-5

Author(s):

Sanjoy Ketan Paul ◽

Jennie Best ◽

Olga Montvida

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Electronic Medical Records ◽

Medical Records ◽

Second Line ◽

Adjusted Risk ◽

Increased Risk ◽

One Year

Studies have reported conflicting results of the association of incretin-based treatment with the risk of diabetic retinopathy (DR), while the risk of DR in people treated with different antidiabetic drugs (ADD) in the context of glycaemic control in real-world settings is limited. This study aimed to evaluate (1) the risk of developing DR in metformin-treated patients with type 2 diabetes (T2DM) who initiated secondline ADD and (2) if glycaemic control over one-year post-therapy initiation is associated with DR risk during follow-up . From US Electronic Medical Records (EMR), those who received second line DPP-4 inhibitor (DPP-4i), GLP-1 receptor agonist (GLP-1RA), sulfonylurea, thiazolidinedione, or insulin for ≥3 months post-2004 were analysed. Based on 237,133 people with an average of 3.2 years follow-up, compared to people who initiated second-line with sulfonylurea, those with DPP-4i/GLP1RA/thiazolidinedione had 30%/31%/15% significantly lower adjusted risk of developing DR; insulin users had 84% increased risk (all p< 0.01), with significantly better sustainable HbA1c control over one year in incretin groups. This population representative EMR based study suggests that DR risk is not higher in people treated with incretins, versus other ADD, with the benefit of better glycaemic control.

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