Diabetes-related complications, glycemic levels, and healthcare utilization outcomes after therapeutic inertia in type 2 diabetes mellitus

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes Pub Date : 2024-04-01 DOI:10.1016/j.pcd.2023.12.004

Cassidi C. McDaniel , Wei-Hsuan Lo-Ciganic , Chiahung Chou

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Abstract

Aims

To assess diabetes-related complications, glycemic levels, and healthcare utilization 12 months after exposure to therapeutic inertia among patients with type 2 diabetes mellitus (T2D).

Methods

This retrospective cohort study analyzed data from the OneFlorida Clinical Research Consortium (electronic health records from Florida practices/clinics). The cohort included adult patients (≥18 years old) with T2D who had an HbA1c≥7.0% (53 mmol/mol) recorded from January 1, 2014-September 30, 2019. Therapeutic inertia (exposed vs. not exposed) was evaluated during the six months following HbA1c≥7.0% (53 mmol/mol). The outcomes assessed during the 12-month follow-up period included diabetes-related complications (continuous Diabetes Complications and Severity Index (DCSI)), glycemic levels (continuous follow-up HbA1c lab), and healthcare utilization counts. We analyzed data using multivariable regression models, adjusting for covariates.

Results

The cohort included 26,881 patients with T2D (58.94% White race, 49.72% female, and mean age of 58.82 (SD=13.09)). After adjusting for covariates, therapeutic inertia exposure was associated with lower DCSI (estimate=−0.14 (SE=0.03), p < 0.001), higher follow-up HbA1c (estimate=0.14 (SE=0.04), p < 0.001), and lower rates of ambulatory visits (rate ratio=0.79, 95% CI=0.75–0.82).

Conclusions

Findings communicate the clinical practice implications and public health implications for combating therapeutic inertia in diabetes care.

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2 型糖尿病治疗惰性后的糖尿病相关并发症、血糖水平和医疗保健利用率结果

目的评估 2 型糖尿病 (T2D) 患者接触治疗惰性 12 个月后的糖尿病相关并发症、血糖水平和医疗保健利用率。方法这项回顾性队列研究分析了来自 OneFlorida 临床研究联合会（佛罗里达州诊所/诊所的电子健康记录）的数据。该队列包括2014年1月1日至2019年9月30日期间记录的HbA1c≥7.0%（53 mmol/mol）的T2D成年患者（≥18岁）。在HbA1c≥7.0%（53 mmol/mol）后的6个月内评估治疗惰性（暴露与未暴露）。12 个月随访期间的评估结果包括糖尿病相关并发症（连续的糖尿病并发症和严重程度指数（DCSI））、血糖水平（连续的随访 HbA1c 实验室）和医疗保健使用计数。我们使用多变量回归模型对数据进行了分析，并对协变量进行了调整。结果队列中包括 26881 名 T2D 患者（58.94% 为白种人，49.72% 为女性，平均年龄为 58.82 岁（SD=13.09））。调整协变量后，治疗惰性与较低的 DCSI（估计值=-0.14（SE=0.03），p <0.001）、较高的随访 HbA1c（估计值=0.14（SE=0.04），p <0.001）和较低的门诊就诊率（比率比=0.79，95% CI=0.75-0.82）相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Primary Care Diabetes ENDOCRINOLOGY & METABOLISM-PRIMARY HEALTH CARE

CiteScore

5.00

自引率

3.40%

发文量

134

审稿时长

47 days

期刊介绍： The journal publishes original research articles and high quality reviews in the fields of clinical care, diabetes education, nutrition, health services, psychosocial research and epidemiology and other areas as far as is relevant for diabetology in a primary-care setting. The purpose of the journal is to encourage interdisciplinary research and discussion between all those who are involved in primary diabetes care on an international level. The Journal also publishes news and articles concerning the policies and activities of Primary Care Diabetes Europe and reflects the society''s aim of improving the care for people with diabetes mellitus within the primary-care setting.