scholarly journals Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice

2021 ◽  
pp. bmjqs-2020-012026 ◽  
Author(s):  
Chisato Imai ◽  
Ling Li ◽  
Rae-Anne Hardie ◽  
Andrew Georgiou
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Glycaemic Control ◽  
Patient Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adherence Rate ◽  
Testing Frequency ◽  
High Adherence

BackgroundClinical practice guidelines emphasise the role of regular monitoring of glycated haemoglobin A1c (HbA1c) for patients with type 2 diabetes, with most recommending 6-monthly testing. Nonetheless, there are few in-depth studies evaluating the clinical impact of the recommended testing frequency for patients to underpin the significance of guideline adherence.ObjectiveThis study aimed to examine associations between patient outcomes and adherence to HbA1c testing frequencies recommended by Australian guidelines (6-monthly for patients with adequate glycaemic control and 3-monthly for patients with inadequate glycaemic control). The primary and secondary outcomes of interest were longitudinal changes in HbA1c values and development of ischaemic heart disease (IHD) and chronic kidney disease (CKD).MethodsThis 5-year retrospective cohort study (July 2013–June 2018) evaluated HbA1c testing frequency in a subset of patients with type 2 diabetes identified within data collected from approximately 250 Australian general practices. The study included patients who were aged ≥18 in 2013 and had a record of HbA1c testing in study practices during the study period. Each patient’s adherence rate was defined by the proportion of HbA1c tests performed within the testing intervals recommended by Australian guidelines. Based on the adherence rate, adherence level was categorised into low (≤33%), moderate (34%–66%) and high (>66%). Generalised additive mixed models were used to examine associations between adherence to the recommended HbA1c testing frequency and patient outcomes.ResultsIn the 6424 patients with diabetes, the overall median HbA1c testing frequency was 1.6 tests per year with an adherence rate of 50%. The estimated HbA1c levels among patients with low adherence gradually increased or remained inadequately controlled, while HbA1c values in patients with high adherence remained controlled or improved over time. The risk of developing CKD for patients with high adherence was significantly lower than for patients with low adherence (OR: 0.42, 95% CI 0.18 to 0.99). No association between IHD and adherence to the recommended HbA1c frequency was observed.ConclusionBetter adherence to guideline-recommended HbA1c testing frequency was associated with better glycaemic control and lower risk of CKD. These findings may provide valuable evidence to support the use of clinical guidelines for better patient outcomes in patients with type 2 diabetes.

scholarly journals Adherence to Basal Insulin Therapy Among People with Type 2 Diabetes: A Retrospective Cohort Study of Costs and Patient Outcomes

2018 ◽  
Vol 9 (3) ◽  
pp. 1099-1111 ◽  
Author(s):  
Magaly Perez-Nieves ◽  
Kristina S. Boye ◽  
Jacek Kiljanski ◽  
Dachung Cao ◽  
Maureen J. Lage
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Insulin Therapy ◽  
Patient Outcomes ◽  
Retrospective Cohort Study ◽  
Basal Insulin ◽  
Retrospective Cohort

scholarly journals Type 2 diabetes mellitus, glycaemic control, associated therapies and risk of rheumatoid arthritis: a retrospective cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Dawit T Zemedikun ◽  
Krishna Gokhale ◽  
Joht Singh Chandan ◽  
Jennifer Copper ◽  
Janet M Lord ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cohort Study ◽  
Glycaemic Control ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Research Database

Abstract Objective To compare the incident risk of rheumatoid arthritis (RA) in patients with type 2 diabetes mellitus (T2DM), and to explore the role of glycaemic control and associated therapeutic use on the onset of RA. Methods This study was a retrospective cohort study using patients derived from the IQVIA medical research database (IMRD-UK) between 1995 and 2019. 224 551 newly diagnosed patients with T2DM were matched to 449 101 patients without T2DM and followed up to assess their risk of RA. Further analyses investigated the effect of glycaemic control, statin use, and anti-diabetic drugs on the relationship between T2DM and RA using time-dependent Cox regression model. Results During the study period, the incidence rate for RA was 8.1 and 10.6 per 10 000 person-years in the exposed and unexposed groups respectively. Following adjustment, the hazard ratio (aHR) was 0.73 (95% CI 0.67–0.79). In patients who had not used statins in their lifetime, the aHR was 0.89 (95% CI 0.69–1.14). When quantifying the effects of glycaemic control, anti-diabetic drugs and statins using time-varying analyses, there was no association with glycaemic control (aHR 1.00 (95% CI 0.99–1.00)), use of metformin (aHR 1.00 (95% CI 0.82–1.22)), dipeptidyl peptidase-4 inhibitors (DPP4i) (aHR 0.94 (95% CI 0.71–1.24)), and the development of RA. However, statins demonstrated a protective effect for progression of RA in those with T2DM (aHR 0.76 (95% CI 0.66–0.88), with evidence of duration-response relationship. Conclusion There is a reduced risk of RA in patients with T2DM, that may be attributable to the use of statins.

scholarly journals Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Boon-How Chew ◽  
Husni Hussain ◽  
Ziti Akthar Supian
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Ldl Cholesterol ◽  
Therapeutic Inertia ◽  
Treatment Targets ◽  
Health Clinics

Abstract Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

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