Thomas A McCormick, John L Adams, Eric A Lee, Nicholas P Emptage, Darryl E Palmer-Toy, John P Martin, Benjamin I Broder, Michael H Kanter, Anna C Davis, Elizabeth A McGlynn
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Starting in 2016, HbA1c therapeutic targets were relaxed to <7.5 percent for patients age 65 to 75, and to <8.0 percent for patients over age 75 to reduce treatment intensity and adverse events.</p><p><strong>Methods: </strong>This retrospective analysis used logistic regression models to calculate the change in odds of a medication change following an HbA1c result after age-dependent HbA1c flags were introduced.</p><p><strong>Results: </strong>The odds of medication change decreased among patients whose HbA1c targets were relaxed: Odds Ratio (OR) 0.72 (95 percent CI 0.67-0.76) for patients age 65-75 and HbA1c 7.0 percent-7.5 percent; OR 0.72 (95 percent CI 0.65-0.80) for patients over age 75 and HbA1c 7.0 percent-7.5 percent; and OR 0.67 (95 percent CI 0.61-0.75) for patients over age 75 and HbA1c 7.5 percent-8.0 percent. In the age and HbA1c ranges for which the alerts did not change, the odds of medication change generally increased or stayed the same. There was little evidence of medication de-intensification in any group.</p><p><strong>Conclusions: </strong>These findings suggest that the change in therapeutic targets was associated with a reduction in medication intensification among older adults with diabetes.</p>","PeriodicalId":72880,"journal":{"name":"EGEMS (Washington, DC)","volume":" ","pages":"46"},"PeriodicalIF":0.0000,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715934/pdf/","citationCount":"0","resultStr":"{\"title\":\"Age-Dependent Hemoglobin A1c Therapeutic Targets Reduce Diabetic Medication Changes in the Elderly.\",\"authors\":\"Thomas A McCormick, John L Adams, Eric A Lee, Nicholas P Emptage, Darryl E Palmer-Toy, John P Martin, Benjamin I Broder, Michael H Kanter, Anna C Davis, Elizabeth A McGlynn\",\"doi\":\"10.5334/egems.303\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess whether implementation of age-dependent therapeutic targets for high hemoglobin A1c (HbA1c) changed clinicians' ordering of diabetes medications for older adults.</p><p><strong>Background: </strong>In 2016, Kaiser Permanente Southern California (KPSC) changed the therapeutic targets for alerting clinicians about high HbA1c results in the electronic health record, KP HealthConnect (KPHC). Previously, all HbA1c results ≥7.0 percent were flagged as high in adult patients with diabetes. Starting in 2016, HbA1c therapeutic targets were relaxed to <7.5 percent for patients age 65 to 75, and to <8.0 percent for patients over age 75 to reduce treatment intensity and adverse events.</p><p><strong>Methods: </strong>This retrospective analysis used logistic regression models to calculate the change in odds of a medication change following an HbA1c result after age-dependent HbA1c flags were introduced.</p><p><strong>Results: </strong>The odds of medication change decreased among patients whose HbA1c targets were relaxed: Odds Ratio (OR) 0.72 (95 percent CI 0.67-0.76) for patients age 65-75 and HbA1c 7.0 percent-7.5 percent; OR 0.72 (95 percent CI 0.65-0.80) for patients over age 75 and HbA1c 7.0 percent-7.5 percent; and OR 0.67 (95 percent CI 0.61-0.75) for patients over age 75 and HbA1c 7.5 percent-8.0 percent. In the age and HbA1c ranges for which the alerts did not change, the odds of medication change generally increased or stayed the same. 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引用次数: 0
摘要
目的:评估高糖化血红蛋白(HbA1c)年龄依赖性治疗靶点的实施是否会改变临床医生对老年人糖尿病药物的处方。背景:2016年,Kaiser Permanente Southern California (KPSC)改变了电子健康记录KP HealthConnect (KPHC)中提醒临床医生高HbA1c结果的治疗目标。以前,成年糖尿病患者的所有HbA1c结果≥7.0%被标记为高。从2016年开始,65 - 75岁患者的HbA1c治疗目标放宽至< 7.5%,75岁以上患者的HbA1c治疗目标放宽至< 8.0%,以降低治疗强度和不良事件。方法:本回顾性分析使用逻辑回归模型计算在引入年龄相关HbA1c标志后HbA1c结果后药物改变的几率变化。结果:在HbA1c目标放宽的患者中,药物改变的几率降低:65-75岁患者的优势比(OR)为0.72 (95% CI 0.67-0.76), HbA1c为7.0% - 7.5%;75岁以上患者的OR为0.72 (95% CI 0.65-0.80), HbA1c为7.0% - 7.5%;75岁以上患者的OR为0.67 (95% CI 0.61-0.75), HbA1c为7.5% - 8.0%。在警报没有改变的年龄和HbA1c范围内,药物改变的几率通常增加或保持不变。几乎没有证据表明在任何一组中都有药物去强化。结论:这些发现表明,在老年糖尿病患者中,治疗靶点的改变与药物强化的减少有关。
Age-Dependent Hemoglobin A1c Therapeutic Targets Reduce Diabetic Medication Changes in the Elderly.
Objective: To assess whether implementation of age-dependent therapeutic targets for high hemoglobin A1c (HbA1c) changed clinicians' ordering of diabetes medications for older adults.
Background: In 2016, Kaiser Permanente Southern California (KPSC) changed the therapeutic targets for alerting clinicians about high HbA1c results in the electronic health record, KP HealthConnect (KPHC). Previously, all HbA1c results ≥7.0 percent were flagged as high in adult patients with diabetes. Starting in 2016, HbA1c therapeutic targets were relaxed to <7.5 percent for patients age 65 to 75, and to <8.0 percent for patients over age 75 to reduce treatment intensity and adverse events.
Methods: This retrospective analysis used logistic regression models to calculate the change in odds of a medication change following an HbA1c result after age-dependent HbA1c flags were introduced.
Results: The odds of medication change decreased among patients whose HbA1c targets were relaxed: Odds Ratio (OR) 0.72 (95 percent CI 0.67-0.76) for patients age 65-75 and HbA1c 7.0 percent-7.5 percent; OR 0.72 (95 percent CI 0.65-0.80) for patients over age 75 and HbA1c 7.0 percent-7.5 percent; and OR 0.67 (95 percent CI 0.61-0.75) for patients over age 75 and HbA1c 7.5 percent-8.0 percent. In the age and HbA1c ranges for which the alerts did not change, the odds of medication change generally increased or stayed the same. There was little evidence of medication de-intensification in any group.
Conclusions: These findings suggest that the change in therapeutic targets was associated with a reduction in medication intensification among older adults with diabetes.