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Lee YT, Hsu CN, Fu CM, Wang SW, Huang CC, Li LC. Comparison of Adverse Kidney Outcomes With Empagliflozin and Linagliptin Use in Patients With Type 2 Diabetic Patients in a Real-World Setting. Front Pharmacol 2022; 12:781379. [PMID: 34992535 PMCID: PMC8724779 DOI: 10.3389/fphar.2021.781379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background: To compare the effects of empagliflozin and linagliptin use on kidney outcomes of type 2 diabetes mellitus (T2DM) patients in a real-world setting. Methods: The study involved a propensity score-matched cohort comprising new users of empagliflozin or linagliptin with T2DM between January 1, 2013 and December 31, 2018 from a large healthcare delivery system in Taiwan. Clinical outcomes assessed: acute kidney injury (AKI), post-AKI dialysis, and mortality. Cox proportional hazard model was used to estimate the relative risk of empagliflozin or linagliptin use; a linear mixed model was used to compare the average change in estimated glomerular filtration rate (eGFR) over time. Results: Of the 7,042 individuals, 67 of 3,521 (1.9%) in the empagliflozin group and 144 of 3,521 (4.1%) in the linagliptin group developed AKI during the 2 years follow-up. Patients in the empagliflozin group were at a 40% lower risk of developing AKI compared to those in the linagliptin group (adjusted hazard ratio [aHR], 0.60; 95% confidence interval [CI], 0.45-0.82, p = 0.001). Stratified analysis showed that empagliflozin users ≥65 years of age (aHR, 0.70; 95% CI, 0.43-1.13, p = 0.148), or with a baseline eGFR <60 ml/min/1.73 m2 (aHR, 0.97; 95% CI, 0.57-1.65, p = 0.899), or with a baseline glycohemoglobin ≦7% (aHR, 1.01; 95% CI, 0.51-2.00, p =0.973) experienced attenuated benefits with respect to AKI risk. A smaller decline in eGFR was observed in empagliflozin users compared to linagliptin users regardless of AKI occurrence (adjusted β = 1.51; 95% CI, 0.30-2.72 ml/min/1.73 m2, p = 0.014). Conclusion: Empagliflozin users were at a lower risk of developing AKI and exhibited a smaller eGFR decline than linagliptin users. Thus, empagliflozin may be a safer alternative to linagliptin for T2DM patients.
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Affiliation(s)
- Yueh-Ting Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Ming Fu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Wang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiang-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Hidayat B, Ramadani RV, Rudijanto A, Soewondo P, Suastika K, Siu Ng JY. Direct Medical Cost of Type 2 Diabetes Mellitus and Its Associated Complications in Indonesia. Value Health Reg Issues 2021; 28:82-89. [PMID: 34839111 DOI: 10.1016/j.vhri.2021.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/26/2021] [Accepted: 04/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To estimate the direct medical cost of type 2 diabetes mellitus (T2DM) and its complications in the Indonesian population from a payer perspective using a prevalence-based approach. METHODS The direct medical costs in 2016 were estimated using the database of Indonesia's National Health Insurance, known as Jaminan Kesehatan Nasional, which included diagnosis-related group costs and unbundled costs for patients accessing advanced care. The study population included people aged 30 years or older having a diagnosis of T2DM. T2DM and its related complications were identified using the International Classification of Diseases, 10th Revision, code. Hypoglycemia and all complications listed in the Diabetes Severity Complications Index were included. Descriptive analysis was conducted. Costs were converted to 2016 US dollar equivalent. RESULTS Of the 18.9 million Jaminan Kesehatan Nasional members who accessed secondary and tertiary care, 812 204 (4%) were identified with T2DM, of which 57% had complications. The most common complication was cardiovascular diseases (24%). The total direct medical cost was US $576 million, with 56% spent on hospitalization, 38% on specialist visits, 4% on unbundled non-diabetes-related medication, and 2% on unbundled anti-hyperglycemic medications. Approximately 74% of the total costs was used for the management of people with complications. People with complications (US $930/person/year ± US $1480/person/year) incurred twice the cost of those without complications (US $421/person/year ± US $745/person/year). CONCLUSION The direct medical cost for management of people with T2DM in Indonesia was high. Early diagnosis and optimal management of T2DM to prevent complications may reduce the costly sequelae and have a possibility of cost savings.
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Affiliation(s)
- Budi Hidayat
- Center for Health Economics and Policy Studies, Universitas Indonesia, Jawa Barat, Indonesia
| | - Royasia Viki Ramadani
- Center for Health Economics and Policy Studies, Universitas Indonesia, Jawa Barat, Indonesia
| | - Achmad Rudijanto
- Endocrine and Metabolic Division of Internal Medicine Department, Faculty of Medicine Brawijaya University-Saiful Anwar Hospital, Malang, Indonesia
| | - Pradana Soewondo
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ketut Suastika
- Department of Internal Medicine, Faculty of Medicine, Udayana University/RSUP Denpasar, Denpasar, Indonesia
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Kundi H, Coskun N, Yesiltepe M. Association of entirely claims-based frailty indices with long-term outcomes in patients with acute myocardial infarction, heart failure, or pneumonia: a nationwide cohort study in Turkey. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100183. [PMID: 34806063 PMCID: PMC8589716 DOI: 10.1016/j.lanepe.2021.100183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several countries have increasingly focused on improving care for acute myocardial infarction (AMI), heart failure (HF), and pneumonia to reduce their readmissions and mortality rates. Frailty is becoming increasingly important to accurately predict healthcare utilization for the aging population. The preferred method for the measurement of frailty remains unclear, and current risk-adjustment models do not account for frailty. We sought to compare commonly used frailty indices in terms of the ability to predict clinical adverse outcomes in AMI, HF, and pneumonia patients. METHODS A nationwide cohort study included AMI, HF, and pneumonia with 65 years and older patients in the Turkey between January 1 and December 31, 2018. The primary predictor of interest was frailty. We used two claims-based frailty indices (Johns Hopkins Claims-Based Frailty Index and Hospital Frailty Risk Score) to assess frailty. The main outcome was all-cause long-term mortality up to 3 years. Time to death was calculated as the time period between the date of first admission and the date of death. Patients were censored as of September 30, 2020, which marked the end of the follow-up period. FINDINGS Of the 200,948 patients, 35,096 (17.5%) had AMI, 62,403 (31.1%) had HF, and 103,449 (51.5%) had pneumonia. Johns Hopkins Claims-Based Frailty Index (c-statistics for long-term mortality: 0.68 in AMI, 0.61 in HF, 0.64 in pneumonia) was better compared to Hospital Frailty Risk Score (c-statistics for long-term mortality: AMI=0.62, HF=0.58, pneumonia=0.62) (DeLong p<0.001 in all). INTERPRETATION Readmission and mortality rates after AMI, HF, and pneumonia gradually increases with increasing frailty score. While the Hospital Frailty Risk Score had a better discrimination for predicting readmissions, Johns Hopkins Claims-Based Frailty Index had a better discrimination for predicting mortality. These findings should be taken into account for a better evaluation of hospital performance. FUNDING This study was supported by funding from The Scientific and Technological Research Council of Turkey (grant 120S422, HK).
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Affiliation(s)
- Harun Kundi
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
- Department of Digital Hospital and Analytical Management Unit, Ankara City Hospital, Ankara, Turkey
| | - Nazim Coskun
- Department of Digital Hospital and Analytical Management Unit, Ankara City Hospital, Ankara, Turkey
- Department of Nuclear Medicine, Ankara City Hospital, Ankara, Turkey
| | - Metin Yesiltepe
- Department of Digital Hospital and Analytical Management Unit, Ankara City Hospital, Ankara, Turkey
- Department of Pharmacology, Ankara City Hospital, Ankara, Turkey
- Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers The State University of New Jersey, NJ, USA
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Meyers J, Hoog M, Mody R, Yu M, Davis K. The Health Care Resource Utilization and Costs Among Patients With Type 2 Diabetes and Either Cardiovascular Disease or Cardiovascular Risk Factors An Analysis of a US Health Insurance Database. Clin Ther 2021; 43:1827-1842. [PMID: 34625283 DOI: 10.1016/j.clinthera.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/09/2021] [Accepted: 09/01/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE Health care costs and cardiovascular (CV) outcomes were evaluated among US patients with type 2 diabetes (T2D) and cardiovascular disease (CVD) or CV risk factors. METHODS Patients with ≥24 months of continuous enrollment were selected from the MarketScan Commercial and Medicare databases from January 1, 2014, to September 30, 2018. For the first qualifying 24-month period, months 1 to 12 defined the baseline period and months 13 to 24 defined the follow-up period. All patients had ≥2 T2D diagnoses during baseline. Two cohorts were created: (1) patients with ≥1 CVD diagnosis during baseline ("CVD cohort"); and (2) patients with ≥1 CV risk factor ("CV risk cohort") and no diagnosed CVD during baseline. The percentage of patients with subsequent CVD diagnoses and annual all-cause, T2D-related, and CV-related costs in baseline and follow-up periods were reported. FINDINGS In total, 1,106,716 patients met inclusion criteria: CVD cohort, 224,018 patients; CV risk cohort, 812,144 patients; and no diagnosed CVD or CV risk factors, 70,554. During baseline, 40.2% of the CVD cohort had 2 or more CVD diagnoses. During follow-up, 10.5% of the CV risk cohort had evidence of CVD (ie, emergent CVD). During baseline, the CVD cohort had mean (SD) all-cause costs of $38,985 ($69,936); T2D-related costs, $16,208 ($34,104); and CV-related annual costs, $18,842 ($44,457). The CV risk cohort had mean all-cause costs of $13,207 ($27,057); T2D-related costs, $5226 ($12,268); and CV-related costs, $2754 ($10,586). During follow-up, the CV risk cohort with emergent CVD had higher mean all-cause, T2D-related, and CV-related annual costs than costs among patients without CVD (all-cause, $39,365 [$67,731] vs $13,401 [$27,530]; T2D related, $18,520 [$37,256] vs $5732 [$12,540]; and CV related, $18,893 [$43,584] vs $2650 [$10,501], respectively). IMPLICATIONS Costs for patients with T2D and either CVD or CV risk are substantial. In this analysis, ∼10% of patients with CV risk were diagnosed with emergent CVD. All-cause costs among patients with emergent CVD were nearly 3 times higher than those among patients with CV risk only. Because costs associated with CVD in the T2D population are high, preventing CVD events in patients with T2D has the potential to decrease overall health care costs and avoid additional disease burden for these patients.
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Affiliation(s)
| | | | - Reema Mody
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maria Yu
- Eli Lilly and Company, Eli Lilly Canada Inc, Toronto, Ontario, Canada
| | - Keith Davis
- RTI Health Solutions, Research Triangle Park, NC, USA
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Cai CX, Li Y, Zeger SL, McCarthy ML. Social determinants of health impacting adherence to diabetic retinopathy examinations. BMJ Open Diabetes Res Care 2021; 9:e002374. [PMID: 34583972 PMCID: PMC8479983 DOI: 10.1136/bmjdrc-2021-002374] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations. RESEARCH DESIGN AND METHODS This was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment. RESULTS Of the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment. CONCLUSIONS A multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations.
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Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Scott L Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melissa L McCarthy
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Boye KS, Lage MJ, Thieu V, Shinde S, Dhamija S, Bae JP. Obesity and glycemic control among people with type 2 diabetes in the United States: A retrospective cohort study using insurance claims data. J Diabetes Complications 2021; 35:107975. [PMID: 34176723 DOI: 10.1016/j.jdiacomp.2021.107975] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To examine body mass index (BMI) and HbA1c for individuals with type 2 diabetes (T2D) in the United States. METHODS The retrospective study utilized data from IBM® MarketScan® Explorys® Claims-EMR Data for the years 2012-2019. Individuals with T2D and a recorded HbA1c laboratory result and BMI were included. The relationship between BMI and HbA1c was assessed descriptively and logistic regressions examined the relationship between benchmark BMI and the probability of having HbA1c above targets of 7% or 8% in the 1year post-period. RESULTS In our sample of 44,723 patients, results indicated that compared to individuals of normal weight, those classified as obese class I or obese class II were 24% more likely to have a last HbA1c≥7% (Odds Ratio [OR]=1.24; 95% Confidence Interval [CI] 1.14-1.35 for both obese class I and obese class II), while those classified as obese class III were 16% more likely (OR=1.16; 95% CI 1.06-1.27). Results were similar when using a HbA1c threshold of 8%. CONCLUSIONS Given the importance of glycemic control for people with T2D, these results suggest that treatments which reduce rates of obesity may help to improve health outcomes.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL 34134, United States of America.
| | - Vivian Thieu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
| | - Shraddha Shinde
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
| | - Shivanie Dhamija
- HealthMetrics Outcomes Research and The Pennsylvania State University, 9303 Shore Road, Apt 2F, Brooklyn, NY 11209, United States of America
| | - Jay Patrick Bae
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
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Baksh S, Wen J, Mansour O, Chang HY, McAdams-DeMarco M, Segal JB, Ehrhardt S, Alexander GC. Dipeptidyl peptidase-4 inhibitor cardiovascular safety in patients with type 2 diabetes, with cardiovascular and renal disease: a retrospective cohort study. Sci Rep 2021; 11:16637. [PMID: 34404825 PMCID: PMC8371013 DOI: 10.1038/s41598-021-95687-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/26/2021] [Indexed: 01/21/2023] Open
Abstract
Clinical trials investigating cardiovascular safety of dipeptidyl peptidase-IV inhibitors (DPP-4i) among patients with cardiovascular and renal disease rarely recruit patients with renal impairment, despite associations with increased risk for major adverse cardiovascular events (MACE). We investigated the risk of MACE associated with the use of DPP-4i among these high-risk patients. Using a new-user, retrospective, cohort design, we analyzed 2010–2015 IBM MarketScan Commercial Claims and Encounters for patients with diabetes, comorbid with cardiovascular disease and/or renal impairment. We compared time to first MACE for DPP-4i versus sulfonylurea and versus metformin. Of 113,296 individuals, 9146 (8.07%) were new DPP-4i users, 17,481 (15.43%) were new sulfonylurea users, and 88,596 (78.20%) were new metformin users. Exposure groups were not mutually exclusive. DPP-4i was associated with lower risk for MACE than sulfonylurea (aHR 0.84; 95% CI 0.74, 0.93) and similar risk for MACE to metformin (aHR 1.07; 95% CI [1.04, 1.16]). DPP-4i use was associated with lower risk for MACE compared to sulfonylureas and similar risk for MACE compared to metformin. This association was most evident in the first year of therapy, suggesting that DPP-4i is a safer choice than sulfonylurea for diabetes treatment initiation in high-risk patients.
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Affiliation(s)
- Sheriza Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. .,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, 21205, USA. .,Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, 2nd Floor, Baltimore, MD, 21231, USA.
| | - Jiajun Wen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Omar Mansour
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Hsien-Yen Chang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, 21205, USA.,Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Jodi B Segal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, 21205, USA.,Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, MD, 21205, USA.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, 21205, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, 21205, USA.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, 21205, USA
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Boye KS, Tokar Erdemir E, Zimmerman N, Reddy A, Benneyworth BD, Dabora MC, Hankosky ER, Bethel MA, Clark C, Lensing CJ, Sailer S, San Juan R, Heine RJ, Etemad L. Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States. Diabetes Ther 2021; 12:2223-2239. [PMID: 34275115 PMCID: PMC8286432 DOI: 10.1007/s13300-021-01110-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Diabetes has been identified as a high-risk comorbidity for COVID-19 hospitalization. We evaluated additional risk factors for COVID-19 hospitalization and in-hospital mortality in a nationwide US database. METHODS This retrospective study utilized the UnitedHealth Group Clinical Discovery Database (January 1, 2019-July 15, 2020) containing de-identified nationwide administrative claims, SARS-CoV-2 laboratory test results, and COVID-19 inpatient admissions data. Logistic regression was used to understand risk factors for hospitalization and in-hospital mortality among people with type 2 diabetes (T2D) and in the overall population. Robustness of associations was further confirmed by subgroup and sensitivity analyses in the T2D population. RESULTS A total of 36,364 people were identified who were either SARS-CoV-2+ or hospitalized for COVID-19. T2D was associated with increased COVID-19-related hospitalization and mortality. Factors associated with increased hospitalization risk were largely consistent in the overall population and the T2D subgroup, including age, male sex, and these top five comorbidities: dementia, metastatic tumor, congestive heart failure, paraplegia, and metabolic disease. Biguanides (mainly metformin) were consistently associated with lower odds of hospitalization, whereas sulfonylureas and insulins were associated with greater odds of hospitalization among people with T2D. CONCLUSION In this nationwide US analysis, T2D was identified as an independent risk factor for COVID-19 complications. Many factors conferred similar risk of hospitalization across both populations; however, particular diabetes medications may be markers for differential risk. The insights on comorbidities and medications may inform population health initiatives, including prevention efforts for high-risk patient populations such as those with T2D.
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Affiliation(s)
| | | | | | - Abraham Reddy
- OptumLabs at UnitedHealth Group, Minneapolis, MN, USA
| | | | | | | | | | | | | | - Scott Sailer
- OptumLabs at UnitedHealth Group, Minneapolis, MN, USA
| | | | | | - Lida Etemad
- OptumLabs at UnitedHealth Group, Minneapolis, MN, USA
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Prentice JC, Mohr DC, Zhang L, Li D, Legler A, Nelson RE, Conlin PR. Increased Hemoglobin A 1c Time in Range Reduces Adverse Health Outcomes in Older Adults With Diabetes. Diabetes Care 2021; 44:1750-1756. [PMID: 34127496 PMCID: PMC8385473 DOI: 10.2337/dc21-0292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Short- and long-term glycemic variability are risk factors for diabetes complications. However, there are no validated A1C target ranges or measures of A1C stability in older adults. We evaluated the association of a patient-specific A1C variability measure, A1C time in range (A1C TIR), on major adverse outcomes. RESEARCH DESIGN AND METHODS We conducted a retrospective observational study using administrative data from the Department of Veterans Affairs and Medicare from 2004 to 2016. Patients were ≥65 years old, had diabetes, and had at least four A1C tests during a 3-year baseline period. A1C TIR was the percentage of days during the baseline in which A1C was in an individualized target range (6.0-7.0% up to 8.0-9.0%) on the basis of clinical characteristics and predicted life expectancy. Increasing A1C TIR was divided into categories of 20% increments and linked to mortality and cardiovascular disease (CVD) (i.e., myocardial infarction, stroke). RESULTS The study included 402,043 veterans (mean [SD] age 76.9 [5.7] years, 98.8% male). During an average of 5.5 years of follow-up, A1C TIR had a graded relationship with mortality and CVD. Cox proportional hazards models showed that lower A1C TIR was associated with increased mortality (A1C TIR 0 to <20%: hazard ratio [HR] 1.22 [95% CI 1.20-1.25]) and CVD (A1C TIR 0 to <20%: HR 1.14 [95% CI 1.11-1.19]) compared with A1C TIR 80-100%. Competing risk models and shorter follow-up (e.g., 24 months) showed similar results. CONCLUSIONS In older adults with diabetes, maintaining A1C levels within individualized target ranges is associated with lower risk of mortality and CVD.
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Affiliation(s)
- Julia C Prentice
- VA Boston Healthcare System, Boston, MA .,Boston University School of Medicine, Boston, MA
| | - David C Mohr
- VA Boston Healthcare System, Boston, MA.,Boston University School of Public Health, Boston, MA
| | | | | | | | - Richard E Nelson
- VA Salt Lake City Healthcare System, Salt Lake City, UT.,University of Utah, Salt Lake City, UT
| | - Paul R Conlin
- VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Boston, MA
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Theis J, Galanter WL, Boyd AD, Darabi H. Improving the In-Hospital Mortality Prediction of Diabetes ICU Patients Using a Process Mining/Deep Learning Architecture. IEEE J Biomed Health Inform 2021; 26:388-399. [PMID: 34181560 DOI: 10.1109/jbhi.2021.3092969] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetes intensive care unit (ICU) patients are at increased risk of complications leading to in-hospital mortality. Assessing the likelihood of death is a challenging and time consuming task due to a large number of influencing factors. Healthcare providers are interested in the detection of ICU patients at higher risk, such that risk factors can possibly be mitigated. While such severity scoring methods exist, they are commonly based on a snapshot of the health conditions of a patient during the ICU stay and do not specifically consider a patient's prior medical history. In this paper, a process mining/deep learning architecture is proposed to improve established severity scoring methods by incorporating the medical history of diabetes patients. First, health records of past hospital encounters are converted to event logs suitable for process mining. The event logs are then used to discover a process model that describes the past hospital encounters of patients. An adaptation of Decay Replay Mining is proposed to combine medical and demographic information with established severity scores to predict the in hospital mortality of diabetes ICU patients. Significant performance improvements are demonstrated compared to established risk severity scoring methods and machine learning approaches using the Medical Information Mart for Intensive Care III dataset.
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Cheng D, DuMontier C, Yildirim C, Charest B, Hawley CE, Zhuo M, Paik JM, Yaksic E, Gaziano JM, Do N, Brophy M, Cho K, Kim DH, Driver JA, Fillmore NR, Orkaby AR. Updating and Validating the U.S. Veterans Affairs Frailty Index: Transitioning From ICD-9 to ICD-10. J Gerontol A Biol Sci Med Sci 2021; 76:1318-1325. [PMID: 33693638 PMCID: PMC8202143 DOI: 10.1093/gerona/glab071] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Veterans Affairs Frailty Index (VA-FI) is an electronic frailty index developed to measure frailty using administrative claims and electronic health records data in Veterans. An update to ICD-10 coding is needed to enable contemporary measurement of frailty. METHOD International Classification of Diseases, ninth revision (ICD-9) codes from the original VA-FI were mapped to ICD-10 first using the Centers for Medicaid and Medicare Services (CMS) General Equivalence Mappings. The resulting ICD-10 codes were reviewed by 2 geriatricians. Using a national cohort of Veterans aged 65 years and older, the prevalence of deficits contributing to the VA-FI and associations between the VA-FI and mortality over years 2012-2018 were examined. RESULTS The updated VA-FI-10 includes 6422 codes representing 31 health deficits. Annual cohorts defined on October 1 of each year included 2 266 191 to 2 428 115 Veterans, for which the mean age was 76 years, 97%-98% were male, 78%-79% were White, and the mean VA-FI was 0.20-0.22. The VA-FI-10 deficits showed stability before and after the transition to ICD-10 in 2015, and maintained strong associations with mortality. Patients classified as frail (VA-FI > 0.2) consistently had a hazard of death more than 2 times higher than nonfrail patients (VA-FI ≤ 0.1). Distributions of frailty and associations with mortality varied with and without linkage to CMS data and with different assessment periods for capturing deficits. CONCLUSIONS The updated VA-FI-10 maintains content validity, stability, and predictive validity for mortality in a contemporary cohort of Veterans aged 65 years and older, and may be applied to ICD-9 and ICD-10 claims data to measure frailty.
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Affiliation(s)
- David Cheng
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Clark DuMontier
- New England ‡, GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Massachusetts, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Cenk Yildirim
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
| | - Chelsea E Hawley
- New England ‡, GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Massachusetts, USA
| | - Min Zhuo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julie M Paik
- New England ‡, GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Massachusetts, USA
| | - Enzo Yaksic
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
| | - J Michael Gaziano
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
| | - Nhan Do
- Boston VA Cooperative Studies Program, Massachusetts, USA
- Boston University School of Medicine, Massachusetts, USA
| | - Mary Brophy
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Jane A Driver
- New England ‡, GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Massachusetts, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathanael R Fillmore
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England ‡, GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Massachusetts, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Boye KS, Lage MJ, Kiljański J. Time to Failure on Oral Glucose-Lowering Agents for Patients with Type 2 Diabetes: A Retrospective Cohort Study. Diabetes Ther 2021; 12:1463-1474. [PMID: 33837921 PMCID: PMC8099964 DOI: 10.1007/s13300-021-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Research has shown that glycemic control is associated with lower rates of microvascular and long-term cardiovascular complications. In the analyses reported here, we examined treatment failure on oral glucose-lowering agents (GLAs), defined as having sustained hemoglobin A1c (HbA1c) ≥ 7%. METHODS This study utilized the IBM® MarketScan® Claims and Laboratory Data from 1 January 2012 through 30 June 2018. Adults with type 2 diabetes (T2D) were classified based upon the maximum number of classes of GLAs prescribed per day during the time period from 1 July 2012 through 31 December 2012. Patients were followed for 5.5 years in order to examine time to failure on oral GLAs, defined based upon receipt of ≥ 2 consecutive HbA1c results ≥ 7%. Multivariable analyses employing a Cox proportional hazards model were used to examine time to failure overall and based upon the number of index classes of oral GLAs prescribed. For patients who had sustained HbA1c above the threshold, multivariable analyses examined the duration of time that HbA1c remained above the threshold (i.e, glycemic burden) and whether or not an additional oral or injectable class of GLA was added to the patient treatment regimen (i.e., clinical inertia). RESULTS A total of 4156 patients were included in the study, of whom 16% were identified with sustained HbA1c ≥ 7% after 365 days (1 year) and 36% after 730 days (2 years), with half of all patients having sustained HbA1c above target after 1102 days (3 years). There was a statistically significant difference in time to having sustained HbA1c above target based upon index classes of therapy, with patients treated with more GLAs being quicker to have HbA1c above target (P < 0.0001). Among those patients who were found to have sustained HbA1c ≥ 7%, the average number of days in the post-period that HbA1c remained above target was 1026 (2.8 years). Only 36% of patients with sustained HbA1c above target added a GLA to their treatment regimen and, for patients who did add such a therapy, the average duration from identification of HbA1c above target until treatment intensification was 401 days (1.1 years). Multivariable analyses revealed that, among those with sustained HbA1c ≥ 7%, treatment with more classes of oral GLAs was associated with a significantly higher glycemic burden and significantly lower odds of clinical inertia. CONCLUSION These results indicate that for many patients treated with oral GLAs, glycemic control is not consistently achieved. For patients with above-target HbA1c , the results indicate a relatively large glycemic burden and clinical inertia towards treatment intensification. The findings illustrate some limitations associated with treatment of T2D with oral GLAs.
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Affiliation(s)
- Kristina S. Boye
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
| | - Maureen J. Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL 34134 USA
| | - Jacek Kiljański
- Eli Lilly Polska Sp. z o.o (Eli Lilly and Company), u.l. Żwirki I Wigury 18a, 02-092 Warsaw, Poland
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Schuemie MJ, Weinstein R, Ryan PB, Berlin JA. Quantifying bias in epidemiologic studies evaluating the association between acetaminophen use and cancer. Regul Toxicol Pharmacol 2021; 120:104866. [PMID: 33454352 DOI: 10.1016/j.yrtph.2021.104866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/19/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
Many observational studies explore the association between acetaminophen and cancer, but known limitations such as vulnerability to channeling, protopathic bias, and uncontrolled confounding hamper the interpretability of results. To help understand the potential magnitude of bias, we identify key design choices in these observational studies and specify 10 study design variants that represent different combinations of these design choices. We evaluate these variants by applying them to 37 negative controls - outcome presumed not to be caused by acetaminophen - as well as 4 cancer outcomes in the Clinical Practice Research Datalink (CPRD) database. The estimated odds and hazards ratios for the negative controls show substantial bias in the evaluated design variants, with far fewer of the 95% confidence intervals containing 1 than the nominal 95% expected for negative controls. The effect-size estimates for the cancer outcomes are comparable to those observed for the negative controls. A comparison of exposed and unexposed reveals many differences at baseline for which most studies do not correct. We observe that the design choices made in many of the published observational studies can lead to substantial bias. Thus, caution in the interpretation of published studies of acetaminophen and cancer is recommended.
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Affiliation(s)
- Martijn J Schuemie
- Department of Epidemiology, Janssen Research and Development, Titusville, NJ, USA.
| | - Rachel Weinstein
- Department of Epidemiology, Janssen Research and Development, Titusville, NJ, USA
| | - Patrick B Ryan
- Department of Epidemiology, Janssen Research and Development, Titusville, NJ, USA
| | - Jesse A Berlin
- Department of Epidemiology, Johnson & Johnson, Titusville, NJ, USA
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He X, Zhang Y, Zhou Y, Dong C, Wu J. Direct Medical Costs of Incident Complications in Patients Newly Diagnosed With Type 2 Diabetes in China. Diabetes Ther 2021; 12:275-288. [PMID: 33206365 PMCID: PMC7843809 DOI: 10.1007/s13300-020-00967-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/04/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Reliable country-specific incidence and cost data on diabetes-related complications are essential inputs for the projections of the economic burden of diabetes. The aim of this study was to provide patient-level cost estimates of managing and treating complications in patients newly diagnosed with type 2 diabetes mellitus (T2DM) in China. METHODS Patients newly diagnosed with T2DM in the Tianjin Urban Employee Basic Medical Insurance Claims database between 2008 and 2015 were identified and followed up. The cumulative incidence and descriptive costs of certain macrovascular and microvascular complications were examined. A generalized estimating equations model was used to estimate the immediate- and long-term costs for the incident complication in quarterly intervals, controlling for demographics and the confounding effects of comorbid complications. RESULTS A total of 114,847 newly diagnosed patients were identified (mean age 56.9 years, 45.5% women). After 7 years, 80.8% of the patients at risk had developed nephropathy and 75.7% had developed neuropathy. The immediate additional costs were highest for myocardial infarction during the quarterly interval that the complication first occurred (China yuan [CNY] 19,633), and the long-term costs were highest for stroke in the quarterly intervals of subsequent years (CNY 1087). The expected costs for all complications were calculated and presented as costs per quarterly interval and per year for different age and sex subgroups. CONCLUSIONS Managing complications results in substantial costs to the Chinese healthcare system. Our study contributes towards quantifying the economic burden and supports the parametrization of economic models of diabetes in China.
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Affiliation(s)
- Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Yawen Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Yan Zhou
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China.
- College of Management and Economics, Tianjin University, Tianjin, China.
| | - Chaohui Dong
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Boye KS, Lage MJ, Terrell K. Healthcare outcomes for patients with type 2 diabetes with and without comorbid obesity. J Diabetes Complications 2020; 34:107730. [PMID: 32943301 DOI: 10.1016/j.jdiacomp.2020.107730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
AIMS Examine the burden of comorbid obesity associated with type 2 diabetes (T2D). METHODS The IBM® MarketScan® Explorys Claims Electronic Medical Records Data were used to identify adults with T2D, two recorded body mass index (BMI) values, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index BMI ≥18 kg/m2 and <30 kg/m2 (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m2 (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, healthcare costs, and resource utilization. RESULTS In the matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.29; 95% Confidence Interval [CI] 1.21-1.38) and an obesity-related comorbidity (OR = 1.42; 95% CI 1.29-1.56). Obesity was also associated with significantly higher annual diabetes-related and all-cause total costs and resource utilization. CONCLUSIONS This research increases the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, United States of America.
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL 34134, United States of America.
| | - Kendra Terrell
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, United States of America.
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Lim GJ, Liu YL, Low S, Ang K, Tavintharan S, Sum CF, Lim SC. Medical Costs Associated with Severity of Chronic Kidney Disease in Type 2
Diabetes Mellitus in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.202032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: This was a retrospective cross-sectional study to assess the impact of
chronic kidney disease (CKD) and its severity in Type 2 diabetes mellitus (T2DM) on
direct medical costs, and the effects of economic burden on CKD related complications in
T2DM in Singapore.
Methods: A total of 1,275 T2DM patients were recruited by the diabetes centre at
Khoo Teck Puat Hospital from 2011–2014. CKD stages were classified based on improving
global outcome (KDIGO) categories, namely the estimated glomerular filtration rate
(eGFR) and albuminuria kidney disease. Medical costs were extracted from the hospital
administrative database.
Results: CKD occurred in 57.3% of patients. The total mean cost ratio for CKD relative
to non-CKD was 2.2 (P<0.001). Mean (median) baseline annual unadjusted costs were
significantly higher with increasing CKD severity—S$1,523 (S$949), S$2,065 (S$1,198),
S$3,502 (S$1,613), and S$5,328 (S$2,556) for low, moderate, high, and very high risk
respectively (P<0.001). CKD (P<0.001), age at study entry (P=0.001), Malay ethnicity
(P=0.035), duration of diabetes mellitus (DM; P<0.001), use of statins/fibrates (P=0.021),
and modified Diabetes Complications Severity Index (DCSI) (P<0.001) were positively
associated with mean annual direct medical costs in the univariate analysis. In the fully
adjusted model, association with mean annual total costs persisted for CKD, CKD
severity and modified DCSI.
Conclusion: The presence and increased severity of CKD is significantly associated
with higher direct medical costs in T2DM patients. Actively preventing the occurrence
and progression in DM-induced CKD may significantly reduce healthcare resource
consumption and healthcare costs.
Keywords: Chronic kidney disease, costs, endocrinology, nephrology
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Xue L, Strotmeyer ES, Zgibor J, Costacou T, Boudreau R, Kelley D, Donohue JM. Cardiovascular disease risk and the time to insulin initiation for Medicaid enrollees with type 2 diabetes. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 22:100241. [PMID: 33294383 PMCID: PMC7691549 DOI: 10.1016/j.jcte.2020.100241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 01/01/2023]
Abstract
No CVD benefits gains from early insulin initiation in young T2D individuals. CVD possibly pre-exists or concurrent to insulin initiation or first-line therapy. Young T2D individuals needs additional management of hypertension and dyslipidemia. CVD risk before insulin initiation is examined by innovative methods in large cohort.
Aims We evaluated the relationship between the timing of insulin initiation and cardiovascular diseases (CVD) risk in Pennsylvania Medicaid enrollees with type 2 diabetes (T2D). Methods We included 17,873 enrollees (age 47.4 ± 10.3 years; range 18–64 years) initially treated with non-insulin glucose-lowering agents (GLAs) in 2008–2016. Based on clinical guidelines, we identified early (N = 1,158; 6%; insulin initiation ≤ 6 months after first-line GLAs), in-time (N = 569; 3%; 6–12 months), delayed (N = 2,761; 15%; >12 months), and non-insulin users (N = 13,385; 75%). The Prentice-Williams-Peterson (PWP) models with inverse probability weighting estimated CVD risk across the four groups and the change in risk after insulin initiation. Results Regardless of time to insulin initiation, insulin users had higher CVD risks after first-line GLAs than non-insulin users (aHR: early: 2.0 [1.5–2.5], in-time: 1.8 [1.2–2.6], delayed: 1.9 [1.6–2.3]). However, we found only a borderline increase in CVD risk after insulin initiation vs. before in early (aHR: 1.4 [1.1–1.8]) and delayed users (aHR: 1.3 [1.0–1.7]), and no increase in in-time users (aHR: 1.3 [0.9–2.0]). Conclusions We observed no gains in CVD benefits from insulin initiation in the early stages of pharmacotherapy possibly because CVD developed before insulin initiation. Additional management of hypertension and dyslipidemia may be important to reduce CVD risk in this young and middle-aged T2D cohort.
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Affiliation(s)
- Lingshu Xue
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Janice Zgibor
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tina Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - David Kelley
- Office of Medical Assistance Programs, Pennsylvania Department of Human Services, USA
| | - Julie M Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Moshfeghi A, Garmo V, Sheinson D, Ghanekar A, Abbass I. Five-Year Patterns of Diabetic Retinopathy Progression in US Clinical Practice. Clin Ophthalmol 2020; 14:3651-3659. [PMID: 33154625 PMCID: PMC7605957 DOI: 10.2147/opth.s275968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To characterize the natural course of diabetic retinopathy (DR) in contemporary clinical practice. Patients and Methods This was a retrospective analysis of US claims data collected between January 1, 2006, and April 30, 2017. Patients aged ≥18 years with continuous medical and prescription insurance coverage for 18 months before DR diagnosis (index date) and for a follow-up period of 5 years were included (N=14,490). The time and risk of progressing to severe nonproliferative DR (NPDR) or proliferative DR (PDR) and of developing diabetic macular edema (DME) were evaluated over 5 years in patients stratified by DR severity at initial diagnosis. Results The estimated probability of progressing to severe NPDR or PDR within 5 years of diagnosis was 17.6% for patients with moderate NPDR versus 5.8% for mild NPDR. The probability of developing DME within 5 years was 62.6%, 44.6%, and 28.4% for patients diagnosed with severe NPDR, moderate NPDR, and PDR, respectively, versus 15.6% for mild NPDR. Among those observed to progress, median time to severe NPDR or PDR was approximately 2.0 years in patients with moderate NPDR, whereas median time to DME was approximately 0.5 years in patients with severe NPDR, 1.3 years in moderate NPDR, and 1.6 years in PDR. Relative to mild NPDR, adjusted hazard ratios (95% confidence interval) for progression to severe NPDR or PDR within 5 years were 3.12 (2.61–3.72) in patients with moderate NPDR, and for incident DME were 5.92 (5.13–6.82), 3.54 (3.22–3.91), and 1.96 (1.80–2.14) in patients with severe NPDR, moderate NPDR, and PDR, respectively. Conclusion The risk of DR progression and DME over 5 years was highest among patients diagnosed with moderate and severe NPDR, respectively. Our findings reinforce the importance of close monitoring for these patients to avoid unobserved disease progression toward PDR and/or DME.
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Affiliation(s)
- Andrew Moshfeghi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Young CF, Shubrook JH, Valencerina E, Wong S, Henry Lo SN, Dugan JA. Associations Between Social Support and Diabetes-Related Distress in People With Type 2 Diabetes Mellitus. J Osteopath Med 2020; 120:721-731. [PMID: 33033833 DOI: 10.7556/jaoa.2020.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Diabetes is a complex, chronic condition and managing it can have psychosocial implications for patients, including an impact on relationships with their loved ones and physical wellness. The necessary modifications to daily behaviors can be very overwhelming, thus leading to diabetes-related distress. Objective To investigate the association between diabetes-related distress and perceived social support among people with type 2 diabetes. Methods This cross-sectional study surveyed a population with a lower socioeconomic status (Medi-Cal recipients, which are only given to low-income individuals) in Solano County, California. Patients who had type 2 diabetes mellitus, who were between 40 and 80 years old, and who had a medical appointment in the clinic(s) at least once between December 2015 and December 2016 were included. Patients who could not understand or speak English and patients whose primary care clinicians declined their participation in the study were excluded from the study. Each study participant was recruited at the end of their medical appointment, and the survey instrument in paper form was administered. The Problem Areas in Diabetes (PAID) scale, which indicates diabetes-related distress, and Multidimensional Scale of Perceived Social Support (MSPSS) with 3 subscales (family, friends, and significant others) were used in this study. Multiple linear regression models were used to analyze the associations between PAID and MSPSS surveys. Results For the 101 participants included in our study, multiple linear regression models showed statistically significant association between total MSPSS scores and total PAID scores (β = -.318; 95% CI, .577, -.0581; P=.017) as well as between MSPSS family subscale scores and total PAID scores (β= -.761; 95% CI, -1.35, -.168; P=.012). Among the 3 MSPSS subscales, higher perceived support from family members was found to be significantly associated with lower total PAID scores (β= -.761; 95% CI, -1.35, -.168; P=.012). Conclusion Our findings suggest that a higher level of perceived social support experienced was associated with lower diabetes-related distress among patients with type 2 diabetes. Osteopathic physicians have a central role in providing comprehensive, patient-centered, holistic care, and the attention to social support in chronic disease management can help remove barriers in providing optimal care.
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Baksh SN, Segal JB, McAdams-DeMarco M, Kalyani RR, Alexander GC, Ehrhardt S. Dipeptidyl peptidase-4 inhibitors and cardiovascular events in patients with type 2 diabetes, without cardiovascular or renal disease. PLoS One 2020; 15:e0240141. [PMID: 33057387 PMCID: PMC7561135 DOI: 10.1371/journal.pone.0240141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background Cardiovascular safety of dipeptidyl peptidase-IV inhibitors (DPP-4i) in patients without cardiovascular or renal disease, a majority of newly diagnosed patients with type 2 diabetes often excluded from clinical trials on this association, is poorly understood. Thus, we investigate the risk of major adverse cardiovascular events (MACE) associated with DPP-4i in low-risk patients with diabetes Methods Using a new-user retrospective cohort derived from IBM MarketScan Commercial Claims and Encounters (2010–2015), we identified patients aged 35–65 with type 2 diabetes, without cardiovascular or renal disease, initiating DPP-4i, sulfonylureas, or metformin. Primary composite outcome of time to first MACE was defined as the first of any of the following: myocardial infarction, cardiac arrest, coronary artery bypass graft, coronary angioplasty, heart failure, and stroke. Secondary outcomes were time to first heart failure, acute myocardial infarction, and stroke. We compared outcomes for DPP-4i versus sulfonylurea and DPP-4i versus metformin using propensity score weighted Cox proportional hazards, adjusting for demographics, baseline comorbidities, concomitant medications, and cumulative exposure. Results Of 445,701 individuals, 236,431 (53.0%) were male, median age was 51 (interquartile range: [44, 57]), 30,267 (6.79%) initiated DPP-4i, 52,138 (11.70%) initiated sulfonylureas, and 367,908 (82.55%) initiated metformin. After adjustment, DPP-4i was associated with lower risk of MACE than sulfonylurea (adjusted hazard ratio (aHR) = 0.87; 95% confidence interval (CI): 0.78–0.98), and similar risk to metformin (aHR = 1.07; 95% CI: 0.97–1.18). Risk for acute myocardial infarction (aHR = 0.70; 95% CI: 0.51–0.96), stroke (aHR = 0.57; 95% CI: 0.41–0.79), and heart failure (aHR = 0.57; 95% CI: 0.41–0.79) with DPP-4i was lower compared to sulfonylureas. Conclusion Our findings show that for this cohort of low-risk patients newly treated for type 2 diabetes, DPP-4i exhibited 13% lower risk for MACE compared to sulfonylureas and similar risk for MACE compared to metformin, suggesting DPP-4i is a low cardiovascular risk option for low-risk patients initiating antihyperglycemic treatment.
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Affiliation(s)
- Sheriza N. Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Jodi B. Segal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, MD, United States of America
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States of America
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, United States of America
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, United States of America
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States of America
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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71
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Chen J, Nair R, Siadaty M, Brown K, Meah Y, Taylor AD, He X, Fan L. Treatment Patterns and Characteristics of Individuals Initiating High-Dose Insulin for Type 2 Diabetes Mellitus. J Manag Care Spec Pharm 2020; 26:839-847. [PMID: 32584684 PMCID: PMC10391183 DOI: 10.18553/jmcp.2020.26.7.839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few studies have examined patient characteristics and treatment patterns of high-dose insulin therapy (> 200 units/day) among patients with type 2 diabetes mellitus (T2DM). OBJECTIVE To understand patient characteristics, dosing, adherence, and persistence related to high-dose insulin therapy. METHODS This was a retrospective observational study that used administrative claims from a large national health plan. Patients were identified who had been diagnosed with T2DM and who were aged 18-89 years, enrolled in a commercial or Medicare Advantage Prescription Drug plan, newly initiated on a total daily dose (TDD) > 200 units of insulin between January 2011 and August 2015. Patients were required to be enrolled 6 months before and 12 months after the index date. Patients were categorized to Regimen-100 if treated with U-100 insulin only or Regimen-500 if treated with U-500R with or without U-100. Baseline demographic and clinical characteristics were evaluated. An adjustment factor for the days supply was calculated as the ratio of median time between insulin claims, and median pharmacy reported days supply for each insulin prescription. Adjusted days supply, quantity, and concentration were used to calculate TDD for each quarter after the index date. Adherence was measured as the proportion of days covered (PDC) for each regimen. Persistence was measured in 2 ways: the percentage of patients remaining on index medications in each quarter and the proportion of patients who maintained TDD > 200 units during all 4 quarters of the 12-month post-index period. RESULTS We identified 2,339 patients newly titrated up to TDD > 200 units on either Regimen-100 (2,062, 88.2%) or Regimen-500 (277, 11.8%). Patients on Regimen-500 were slightly younger with higher prevalence of comorbidities. The mean TDD (SD) for Regimen-100 decreased from 228.6 (36.0) units during the first quarter to 194.2 (181.4) units during the last quarter. The mean TDD (SD) for Regimen-500 increased from 294.2 (102.2) units in the first quarter to 304.8 (281.6) units in last quarter. The average adherence to the high-dose insulin regimen was 68.2% (30.7; median 72.6%) for the Regimen-100 cohort and 75.5% (27.0; median 85.2%) for the Regimen-500 cohort. In the Regimen-100 and Regimen-500 cohorts, 45.3% and 55.2% had a PDC ≥ 80%, respectively. Only 23.0% and 51.6% of patients maintained TDD > 200 units for the Regimen-100 and Regimen-500 cohorts, respectively, throughout the 4 quarters after the index date. CONCLUSIONS We observed that many patients did not maintain high-dose insulin use over time, especially those on standard U-100 insulin only. This dosing pattern appears to reflect the differences in patient characteristics, insulin needs, and adherence/persistence behavior between those on Regimen-100 and those on Regimen-500. DISCLOSURES This study was supported by funding from Eli Lilly and Company to Humana as a collaborative research project involving employees of both companies. Chen, Brown, Fan, Taylor, and He are employees of Eli Lilly and Company. Nair and Meah are employees of Humana, which received funding to complete this research. Siadaty was an employee of Humana at the time of this study.
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Affiliation(s)
| | - Radhika Nair
- Humana Healthcare Research, Louisville, Kentucky
| | - Mir Siadaty
- Humana Healthcare Research, Louisville, Kentucky
| | | | | | | | - Xuanyao He
- Eli Lilly and Company, Indianapolis, Indiana
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, Indiana
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72
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Boye KS, Mody R, Lage MJ, Douglas S, Patel H. Chronic Medication Burden and Complexity for US Patients with Type 2 Diabetes Treated with Glucose-Lowering Agents. Diabetes Ther 2020; 11:1513-1525. [PMID: 32447737 PMCID: PMC7324456 DOI: 10.1007/s13300-020-00838-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Most adults with type 2 diabetes (T2D) have several chronic conditions treated with complex regimens and multiple medications. The burden and complexity of multiple medication use are associated with worse patient outcomes, including reduced adherence and increased costs, hospitalizations, mortality rates, and HbA1c. This study quantifies the chronic medication burden, regimen complexity, and potential medication interactions in patients with T2D using a nationwide claims database in the USA. METHODS Adults with T2D treated for greater than half of the year with at least one glucose-lowering agent (GLA) in 2017 were included in this descriptive study. Chronic medications were defined as all GLAs and non-GLA medications prescribed for at least 90 days in 2017 to at least 2% of the cohort. Medication burden, defined as the number of medications prescribed, was examined. Medication complexity, proxied by the Medication Regimen Complexity Index (MRCI), and potential use of interacting medications were also examined. Results were investigated for all chronic medications and were reported on the basis of the disease treated (diabetes or other condition) and the route of administration (oral or other). RESULTS On average, in 2017, the 814,156 patients included in the study filled prescriptions for 4.1 chronic medications (standard deviation [SD] = 2.0), 3.7 oral chronic medications (SD = 1.9), 1.5 GLAs (SD = 0.8), and 1.1 oral GLAs (SD = 0.7). The average MRCI was 14.7 for all chronic medications (SD = 7.4), with a mean of 12.4 for all oral chronic medications (SD = 6.3), 6.6 for all GLAs (SD = 3.8), and 4.9 for oral GLAs (SD = 2.6). CONCLUSION On average, patients with T2D used multiple medications, had a complex medication regimen, and were at potential risk of medication interactions. These findings suggest that patients, practitioners, pharmacists, and payers may benefit from interventions which decrease medication burden, complexity, and/or adverse events related to the treatment of T2D.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, USA
| | - Reema Mody
- Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, USA
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL, USA.
| | - Steven Douglas
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL, USA
| | - Hiren Patel
- Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, USA
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73
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Yu Y, Ying GS, Maguire MG, VanderBeek BL. ASSOCIATION OF DIAGNOSIS CODE-BASED AND LABORATORY RESULTS-BASED KIDNEY FUNCTION WITH DEVELOPMENT OF VISION THREATENING DIABETIC RETINOPATHY. Ophthalmic Epidemiol 2020; 27:498-503. [PMID: 32500786 DOI: 10.1080/09286586.2020.1773869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine how kidney function identified by diagnosis codes compares to lab results-based kidney function for predicting the risk of vision-threatening diabetic retinopathy (VTDR). METHODS A US medical claims database was used for this retrospective observational study. Adult patients enrolled from January 1, 2002 to December 31, 2016 with nonproliferative diabetic retinopathy (NPDR) were followed. Patients were excluded if they had any previous diagnosis or treatment of VTDR or VTDR diagnosed within 2 years of insurance plan entry. ICD9/10 Chronic kidney disease (CKD) diagnoses from outpatient claims were used to classify kidney disease with or without end-stage renal disease (ESRD). Serum creatinine was used to calculate estimated glomerular filtration rates (eGFR). Multivariate Cox models with time-dependent covariates were used to assess the associations of kidney disease diagnosis and eGFR with progression to VTDR, controlling for demographics and time-dependent covariates (systemic health, laboratory results, insulin use). C-statistic (a measure of model discrimination), hazard ratio (HR) and their 95% confidence intervals (CI) were calculated from multivariate Cox models. RESULTS Among 69,982 patients with NPDR, 12,770 (18.2%) developed VTDR. C-statistic was identical (0.60, 95% CI: 0.59-0.60) for the multivariate model with eGFR and for the multivariate model with kidney diagnosis codes. eGFRs lower than 30 mL/min/1.73 m2(HR>1.14, p < .02 for all comparisons), and a diagnosis of ESRD (HR = 1.07, p = .02) were associated with higher risk of progression to VTDR. CONCLUSIONS Both diagnosis-based and lab results-based kidney function were associated with the development of VTDR and predict the development of VTDR equally well.
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Affiliation(s)
- Yinxi Yu
- Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA
| | - Maureen G Maguire
- Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA
| | - Brian L VanderBeek
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA.,Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA
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74
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Seo D, Park YR, Lee Y, Kim JY, Park JY, Lee JH. The Use of Mobile Personal Health Records for Hemoglobin A1c Regulation in Patients With Diabetes: Retrospective Observational Study. J Med Internet Res 2020; 22:e15372. [PMID: 32484447 PMCID: PMC7298631 DOI: 10.2196/15372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The effectiveness of personal health records (PHRs) in diabetes management has already been verified in several clinical trials; however, evidence of their effectiveness in real-world scenarios is also necessary. To provide solid real-world evidence, an analysis that is more accurate than the analyses solely based on patient-generated health data should be conducted. OBJECTIVE This study aimed to conduct a more accurate analysis of the effectiveness of using PHRs within electronic medical records (EMRs). The results of this study will provide precise real-world evidence of PHRs as a feasible diabetes management tool. METHODS We collected log data of the sugar function in the My Chart in My Hand version 2.0 (MCMH 2.0) app from Asan Medical Center (AMC), Seoul, Republic of Korea, between December 2015 and April 2018. The EMR data of MCMH 2.0 users from AMC were collected and integrated with the PHR data. We classified users according to whether they were continuous app users. We analyzed and compared their characteristics, patterns of hemoglobin A1c (HbA1c) levels, and the proportion of successful HbA1c control. The following confounders were adjusted for HbA1c pattern analysis and HbA1c regulation proportion comparison: age, sex, first HbA1c measurement, diabetes complications severity index score, sugar function data generation weeks, HbA1c measurement weeks before MCMH 2.0 start, and generated sugar function data count. RESULTS The total number of MCMH 2.0 users was 64,932, with 7453 users having appropriate PHRs and diabetes criteria. The number of continuous and noncontinuous users was 133 and 7320, respectively. Compared with noncontinuous users, continuous users were younger (P<.001) and had a higher male proportion (P<.001). Furthermore, continuous users had more frequent HbA1c measurements (P=.007), shorter HbA1c measurement days (P=.04), and a shorter period between the first HbA1c measurement and MCMH 2.0 start (P<.001). Diabetes severity-related factors were not statistically significantly different between the two groups. Continuous users had a higher decrease in HbA1c (P=.02) and a higher proportion of regulation of HbA1c levels to the target level (P=.01). After adjusting the confounders, continuous users had more decline in HbA1c levels than noncontinuous users (P=.047). Of the users who had a first HbA1c measurement higher than 6.5% (111 continuous users and 5716 noncontinuous users), continuous users had better regulation of HbA1c levels with regard to the target level, 6.5%, which was statistically significant (P=.04). CONCLUSIONS By integrating and analyzing patient- and clinically generated data, we demonstrated that the continuous use of PHRs improved diabetes management outcomes. In addition, the HbA1c reduction pattern was prominent in the PHR continuous user group. Although the continued use of PHRs has proven to be effective in managing diabetes, further evaluation of its effectiveness for various diseases and a study on PHR adherence are also required.
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Affiliation(s)
- Dongjin Seo
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Young Kim
- Medical Information Office, Asan Medical Center, Seoul, Republic of Korea
| | - Joong-Yeol Park
- Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Ho Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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75
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Tuan Kiet Pham H, Tuyet Mai Kieu T, Duc Duong T, Dieu Van Nguyen K, Tran NQ, Hung Tran T, Yi Siu Ng J. Direct medical costs of diabetes and its complications in Vietnam: A national health insurance database study. Diabetes Res Clin Pract 2020; 162:108051. [PMID: 32027924 DOI: 10.1016/j.diabres.2020.108051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 01/22/2023]
Abstract
AIM To estimate the direct medical cost of type 2 diabetes mellitus (T2DM) and its complications in Vietnam. METHODS Using the public payer perspective, the direct medical cost was estimated using routine data in the national claims database in Vietnam in 2017. People were identified as being diagnosed with T2DM if they were aged ≥ 30 years and who either (1) had at least one ICD-10 code E11 or (2) had been prescribed with oral antihyperglycemic medication on two separate visit records. The Diabetes Severity Complications Index was used to assess the presence of diabetes-related complications. All costs were standardized to 2017 United States dollars (USD). RESULTS Of the 1,395,204 people identified with T2DM, 55% had diabetes-related complications. The most common complication was cardiovascular diseases (34%). The total direct medical cost was USD 435 million, of which 24% was spent on hospitalization, 20% on outpatient care, 7% on emergency care, 36% on non-diabetes-related medication, and 13% on antihyperglycemic medication. About 70% of the total direct medical costs were attributed to diabetes-related complications. CONCLUSION The high proportion of hospitalization and complications costs in Vietnam suggests that the possibility exists to make economic savings through better preventative care.
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Affiliation(s)
| | - Thi Tuyet Mai Kieu
- Department of Pharmaceutical Management and Pharmacoeconomics, Hanoi University of Pharmacy, Viet Nam
| | - Tuan Duc Duong
- North Center for Medical Review and Tertiary Care Payment, Vietnam Social Security, Viet Nam
| | | | - Nam Quang Tran
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Tien Hung Tran
- North Center for Medical Review and Tertiary Care Payment, Vietnam Social Security, Viet Nam
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76
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Kieu TTM, Trinh HN, Pham HTK, Nguyen TB, Ng JYS. Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey. BMJ Open 2020; 10:e032303. [PMID: 32132135 PMCID: PMC7059501 DOI: 10.1136/bmjopen-2019-032303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The prevalence of diabetes in Vietnam has increased from 2.5% in 2007 to 5.5% in 2017, but the burden of direct non-medical and indirect costs is unknown. The objective of this study was to estimate the direct non-medical costs and indirect costs due to type 2 diabetes mellitus (T2DM) and its associated complications among Vietnam Health Insurance System (VHIS) enrollees in Vietnam. DESIGN The first phase was a cross-sectional survey of patients with T2DM. In the second phase, data from the previous phase were used to predict direct non-medical costs and presenteeism costs of VHIS enrollees diagnosed with T2DM based on demographic and clinical characteristics in 2017. The human-capital approach was used for the calculation of indirect costs. SETTING AND PARTICIPANTS This study recruited 315 patients from a national hospital, a provincial hospital and a district hospital aged 18 or above, diagnosed with T2DM, enrolled in VHIS, and having at least one visit to hospitals between 1 June and 30 July 2018. The VHIS dataset contained 1,395,204 patients with T2DM. OUTCOME MEASURES The direct non-medical costs and presenteeism were collected from the survey. Absenteeism costs were estimated from the VHIS database. Costs of premature mortality were calculated based on the estimates from secondary sources. RESULTS The total direct non-medical and indirect costs were US$239 million in 2017. Direct non-medical costs were US$78 million, whereas indirect costs were US$161 million. Costs of absenteeism, presenteeism and premature mortality corresponded to 17%, 73% and 10% of the indirect costs. Patients incurred annual mean direct non-medical costs of US$56. Annual mean absenteeism and presenteeism costs for patients in working age were US$61 and US$267, respectively. CONCLUSIONS The impact of T2DM on direct non-medical and indirect costs on diabetes is substantial. Direct non-medical and absenteeism costs were higher in patients with complications.
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Affiliation(s)
- Thi Tuyet Mai Kieu
- Department of Pharmaceutical Management and Pharmacoeconomics, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | - Hong Nhung Trinh
- Department for Health Economics, Hanoi Medical University, Hanoi, Viet Nam
| | - Huy Tuan Kiet Pham
- Department for Health Economics, Hanoi Medical University, Hanoi, Viet Nam
| | - Thanh Binh Nguyen
- Department of Pharmaceutical Management and Pharmacoeconomics, Hanoi University of Pharmacy, Hanoi, Viet Nam
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77
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Chao CT, Wang J, Huang JW, Chan DC, Chien KL. Hypoglycemic episodes are associated with an increased risk of incident frailty among new onset diabetic patients. J Diabetes Complications 2020; 34:107492. [PMID: 31806427 DOI: 10.1016/j.jdiacomp.2019.107492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
AIMS Patients with diabetes mellitus (DM) are at risk for developing frailty due to the complex interplay between different cardiometabolic factors. We examined whether hypoglycemia could independently increase frailty risk besides these factors. METHODS From the Longitudinal Cohort of Diabetic Patients, 210,254 patients with new onset DM between 2004 and 2011 were identified, among whom 2119 non-frail patients had at least 1 hypoglycemic episode within 3 years of DM diagnosis. They were propensity score-matched to 8432 non-frail ones without hypoglycemia throughout the study period. Both groups were followed up longitudinally for incident physical frailty according to a modified FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and Loss of weight). We analyzed the risk of frailty (primary) and mortality (secondary outcome) introduced by hypoglycemia, adjusted for known risk factors of frailty. RESULTS The mean age of patients (46.2% male) was 65.9 ± 14 years; diabetic patients with hypoglycemia had significantly higher comorbidity burden than those without. After 2.68 years, 172 (1.6%) patients with hypoglycemia developed incident frailty, representing a 60% higher risk (hazard ratio [HR] 1.599, 95% confidence interval [CI] 1.14-2.42). After adjusting for other risk factors, those with hypoglycemia had a significantly higher risk of frailty than those without (HR 1.443, 95% CI 1.01-2.05). Additionally, the mortality of those with hypoglycemia was 2-fold higher than those without, and the risk persisted despite confounder adjustment (HR 1.462, 95% CI 1.3-1.65). CONCLUSION In this population-based cohort, hypoglycemic episodes among diabetic patients increased the risk of incident frailty and mortality.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan; Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Jenq-Wen Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital ChuTung branch, HsinChu County, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
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He M, Santiago Ortiz AJ, Marshall J, Mendelsohn AB, Curtis JR, Barr CE, Lockhart CM, Kim SC. Mapping from the International Classification of Diseases (ICD) 9th to 10th Revision for Research in Biologics and Biosimilars Using Administrative Healthcare Data. Pharmacoepidemiol Drug Saf 2019; 29:770-777. [PMID: 31854053 DOI: 10.1002/pds.4933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE The Centers for Medicare and Medicaid Services (CMS) mandated the transition from ICD-9 to ICD-10 codes on October 1, 2015. Postmarketing surveillance of newly marketed drugs, including novel biologics and biosimilars, requires a robust approach to convert ICD-9 to ICD-10 codes for study variables. We examined three mapping methods for health conditions (HCs) of interest to the Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) and compared their prevalence. METHODS Using CMS General Equivalence Mappings, we applied forward-backward mapping (FBM) to 108 HCs and secondary mapping (SM) and tertiary mapping (TM) to seven preselected HCs. A physician reviewed the mapped ICD-10 codes. The prevalence of the 108 HCs defined by ICD-9 versus ICD-10 codes was examined in BBCIC's distributed research network (September 1, 2012 to March 31, 2018). We visually assessed prevalence trends of these HCs and applied a threshold of 20% level change in ICD-9 versus ICD-10 prevalence. RESULTS Nearly four times more ICD-10 codes were mapped by SM and TM than FBM, but most were irrelevant or nonspecific. For conditions like myocardial infarction, SM or TM did not generate additional ICD-10 codes. Through visual inspection, one-fifth of the HCs had inconsistent ICD-9 versus ICD-10 prevalence trends. 13% of HCs had a level change greater than +/-20%. CONCLUSION FBM is generally the most efficient way to convert ICD-9 to ICD-10 codes, yet manual review of converted ICD-10 codes is recommended even for FBM. The lack of existing guidance to compare the performance of ICD-9 with ICD-10 codes led to challenges in empirically determining the quality of conversions.
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Affiliation(s)
- Mengdong He
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adrian J Santiago Ortiz
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Marshall
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Aaron B Mendelsohn
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey R Curtis
- Division of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Charles E Barr
- Biologics and Biosimilars Collective Intelligence Consortium, Academy of Managed Care Pharmacy, Alexandria, Virginia
| | - Catherine M Lockhart
- Biologics and Biosimilars Collective Intelligence Consortium, Academy of Managed Care Pharmacy, Alexandria, Virginia
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Metcalfe A, Hutcheon JA, Sabr Y, Lyons J, Burrows J, Donovan LE, Joseph KS. Timing of delivery in women with diabetes: A population-based study. Acta Obstet Gynecol Scand 2019; 99:341-349. [PMID: 31654401 PMCID: PMC7065101 DOI: 10.1111/aogs.13761] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Abstract
Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week‐specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population‐based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week‐specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age‐specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks’ gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks’ gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks’ gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks’ gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal‐fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks’ gestation may optimize neonatal outcomes among women with diabetes.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasser Sabr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynecology, King Saud University, Riyadh, Saudi Arabia
| | - Janet Lyons
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Burrows
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lois E Donovan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - K S Joseph
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Ustulin M, Park SY, Choi H, Chon S, Woo JT, Rhee SY. Effect of Dipeptidyl Peptidase-4 Inhibitors on the Risk of Bone Fractures in a Korean Population. J Korean Med Sci 2019; 34:e224. [PMID: 31496139 PMCID: PMC6732257 DOI: 10.3346/jkms.2019.34.e224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/24/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There have been equivocal results in studies of the effects of dipeptidyl peptidase-4 inhibitors (DPP-4i) on fractures. In this study, we analyzed the effect of DPP-4i on bone fracture risk in a Korean population. METHODS We extracted subjects (n = 11,164) aged 50 years or older from the National Health Insurance Service-National Sample Cohort 2.0 from 2009 to 2014. Our control group included subjects without diabetes (n = 5,582), and our treatment groups with diabetes included DPP-4i users (n = 1,410) and DPP-4i non-users (n = 4,172). The primary endpoint was the incidence of a composite outcome consisting of osteoporosis diagnosis, osteoporotic fractures, vertebral fractures, non-vertebral fractures, and femoral fractures. The secondary endpoint was the incidence of each individual component of the composite outcome. Survival analysis was performed with adjustment for age, gender, diabetes complications severity index, Charlson comorbidity index, hypertension medication, and dyslipidemia treatment. RESULTS The incidence of the composite outcome per 1,000 person-years was 0.089 in DPP-4i users, 0.099 in DPP-4i non-users, and 0.095 in controls. There was no significant difference in fracture risk between DPP-4i users and DPP-4i non-users or controls after the adjustments (P > 0.05). The incidences of osteoporosis diagnosis, osteoporotic fractures, vertebral fractures, non-vertebral fractures, and femoral fractures were not significantly different between DPP-4i users and non-users. The results of subgroup analyses by gender and age were consistent. CONCLUSION DPP-4i had no significant effect on the risk of fractures in a Korean population.
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Affiliation(s)
- Morena Ustulin
- Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - So Young Park
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, Korea
| | - Hangseok Choi
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Suk Chon
- Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong Taek Woo
- Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
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81
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Kim K, Unni S, Brixner DI, Thomas SM, Olsen CJ, Sterling KL, Mitchell M, McAdam‐Marx C. Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes. Diabetes Obes Metab 2019; 21:1725-1733. [PMID: 30848039 PMCID: PMC6618330 DOI: 10.1111/dom.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 11/30/2022]
Abstract
AIMS To identify change in glycated haemoglobin (HbA1c) for 1 year after treatment intensification in patients with HbA1c >53 mmol/mol (7.0%) while on two classes of oral antidiabetic drugs (OADs). MATERIAL AND METHODS A retrospective cohort study was conducted using a regional health plan claims database for the period January 1, 2010 to March 31, 2017. Patients with type 2 diabetes (T2DM) whose treatment was intensified with insulin, a glucagon-like peptide-1 receptor agonist or a third OAD within 365 days of having HbA1c ≥53 mmol/mol (7.0%) on two OADs were included. The HbA1c trajectory for 1 year after intensification was estimated using a mixed-effects regression model. RESULTS The analysis included 1226 patients with a mean ± SD HbA1c at treatment intensification of 74.2 ± 18.7 mmol/mol (8.93 ± 1.7%). HbA1c was higher in the insulin group (74.2 mmol/mol) than in the non-insulin group (70.6 mmol/mol), as was the HbA1c decrease (P < 0.01) over the 1-year follow-up, particularly in patients with baseline HbA1c >9%. After intensification, insulin- and non-insulin-treated patients achieved an average change by month in HbA1c of -4.7 mmol/mol and -2.6 mmol/mol points, respectively. The analysis predicted HbA1c to be the lowest at 6 to 10 months post intensification, depending on intensification treatment and HbA1c at intensification; however, on average, HbA1c remained above 64.0 mmol/mol (8.0%). CONCLUSION In patients with T2DM, intensification following an HbA1c value ≥53 mmol/mol (7.0%) while on two OADs was associated with a significant improvement in glycaemic control. Patients intensified with insulin had a higher baseline HbA1c but greater HbA1c reduction than those intensified with a non-insulin agent. However, HbA1c remained above 64 mmol/mol (8.0%) overall. Additional opportunity exists to further intensify therapy to improve glycaemic control.
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Affiliation(s)
- Kibum Kim
- Pharmacotherapy Outcomes Research Center and Department of PharmacotherapyUniversity of UtahSalt Lake CityUtah
| | - Sudhir Unni
- Pharmacotherapy Outcomes Research Center and Department of PharmacotherapyUniversity of UtahSalt Lake CityUtah
| | - Diana I. Brixner
- Pharmacotherapy Outcomes Research Center and Department of PharmacotherapyUniversity of UtahSalt Lake CityUtah
| | - Sheila M. Thomas
- Global Health Economics and Value Assessment, Sanofi Inc.BridgewaterNew Jersey
| | | | | | | | - Carrie McAdam‐Marx
- Pharmacotherapy Outcomes Research Center and Department of PharmacotherapyUniversity of UtahSalt Lake CityUtah
- Pharmaceutical Evaluation and Policy DivisionUniversity of Arkansas for Medical SciencesLittle RockArkansas
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82
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Zghebi SS, Panagioti M, Rutter MK, Ashcroft DM, van Marwijk H, Salisbury C, Chew-Graham CA, Buchan I, Qureshi N, Peek N, Mallen C, Mamas M, Kontopantelis E. Assessing the severity of Type 2 diabetes using clinical data-based measures: a systematic review. Diabet Med 2019; 36:688-701. [PMID: 30672017 DOI: 10.1111/dme.13905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 01/11/2023]
Abstract
AIMS To identify and critically appraise measures that use clinical data to grade the severity of Type 2 diabetes. METHODS We searched MEDLINE, Embase and PubMed between inception and June 2018. Studies reporting on clinical data-based diabetes-specific severity measures in adults with Type 2 diabetes were included. We excluded studies conducted solely in participants with other types of diabetes. After independent screening, the characteristics of the eligible measures including design and severity domains, the clinical utility of developed measures, and the relationship between severity levels and health-related outcomes were assessed. RESULTS We identified 6798 studies, of which 17 studies reporting 18 different severity measures (32 314 participants in 17 countries) were included: a diabetes severity index (eight studies, 44%); severity categories (seven studies, 39%); complication count (two studies, 11%); and a severity checklist (one study, 6%). Nearly 89% of the measures included diabetes-related complications and/or glycaemic control indicators. Two of the severity measures were validated in a separate study population. More severe diabetes was associated with increased healthcare costs, poorer cognitive function and significantly greater risks of hospitalization and mortality. The identified measures differed greatly in terms of the included domains. One study reported on the use of a severity measure prospectively. CONCLUSIONS Health records are suitable for assessment of diabetes severity; however, the clinical uptake of existing measures is limited. The need to advance this research area is fundamental as higher levels of diabetes severity are associated with greater risks of adverse outcomes. Diabetes severity assessment could help identify people requiring targeted and intensive therapies and provide a major benchmark for efficient healthcare services.
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Affiliation(s)
- S S Zghebi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - M Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - M K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, Manchester
| | - D M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - H van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton
| | - C Salisbury
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, Bristol
| | - C A Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire
| | - I Buchan
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Health eResearch Centre, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool
| | - N Qureshi
- Primary Care Stratified Medicine (PriSM) group, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham
| | - N Peek
- Health eResearch Centre, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester
| | - C Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire
| | - M Mamas
- Keele Cardiovascular Research group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - E Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
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83
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Ito Y, Van Schyndle J, Nishimura T, Sugitani T, Kimura T. Characteristics of Patients with Diabetes Initiating Sodium Glucose Co-transporter-2 Inhibitors (SGLT2i): Real-World Results from Three Administrative Databases in Japan. Diabetes Ther 2019; 10:549-562. [PMID: 30730037 PMCID: PMC6437244 DOI: 10.1007/s13300-019-0577-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the characteristics of new users of sodium glucose co-transporter-2 inhibitors (SGLT2i) in comparison with those of new users of other oral antidiabetic drugs (OADs) using data retrieved from three administrative databases in Japan. METHODS This study included adult patients from each database who started an OAD between 2014 and 2017. Outpatients who started SGLT2i therapy were included in the SGLT2i cohort. The remaining outpatients were grouped according to the OAD class of their earliest initial prescription after no use of the index OAD during the 6-month pre-index period. Diabetes-related complications were evaluated using the Diabetes Complication Severity Index. RESULTS In total, 176,355 patients in the hospital-based administrative database (H-dataset), 98,361 in the pharmacy claims database (P-dataset) and 37,786 in the insurance claims database (I-dataset) were analyzed. In the H-dataset, SGLT2i users, compared with users of other OADs, tended to be younger (mean age at index: 57.7 vs. 60.3-69.2 years) and to have a higher prevalence of hypercholesterolemia (73.5 vs. 55.2-71.4%), a higher mean body weight (74.4 vs. 60.5-70.8 kg), a higher body mass index (27.6 vs. 23.5-26.4 kg/m2) and a higher glycated hemoglobin level (8.4 vs. 7.4-8.1%). There were no distinct differences in the prevalence of complications between SGLT2i users and users of other OADs in the H-dataset. Similar trends were noted in the other datasets. CONCLUSION Patients initiating SGLT2i therapy differed in several characteristics from new users of other OADs. SGLT2i were prescribed more frequently to younger patients, those at increased cardiovascular risk or those with poorer glycemic control. FUNDING Astellas Pharma Inc., Tokyo, Japan.
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84
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Glucose sensing in the anterior chamber of the human eye model using supercontinuum source based dual wavelength low coherence interferometry. SENSING AND BIO-SENSING RESEARCH 2019. [DOI: 10.1016/j.sbsr.2019.100277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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85
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Kim K, Unni S, McAdam-Marx C, Thomas SM, Sterling KL, Olsen CJ, Johnstone B, Mitchell M, Brixner D. Influence of Treatment Intensification on A1c in Patients with Suboptimally Controlled Type 2 Diabetes After 2 Oral Antidiabetic Agents. J Manag Care Spec Pharm 2019; 25:314-322. [PMID: 30816811 PMCID: PMC10397830 DOI: 10.18553/jmcp.2019.25.3.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the United States, more than 50% of patients with type 2 diabetes mellitus (T2DM) have hemoglobin A1c (A1c) levels that fail to achieve the recommended target of < 7.0%. Of these, 30%-45% have an A1c > 9.0%, the threshold for poorly controlled T2DM per National Committee for Quality Assurance (NCQA) measures. Treatment inertia is a known challenge. However, recent treatment intensification patterns and outcomes after treatment fails 2 classes of oral antidiabetic agents (OADs) are not well understood. OBJECTIVE To characterize treatment intensification patterns and glycemic control outcomes in patients with A1c ≥ 7.0% on 2 OADs. METHODS A retrospective cohort study was conducted in patients with T2DM from a regional health plan claims dataset augmented with A1c results between January 1, 2010, and March 31, 2017. Patients were identified with an A1c ≥ 7.0% (baseline), while on 2 OADs, and whose treatment was intensified with basal/biphasic insulin (insulin), glucagon-like peptide-1 receptor antagonist (GLP-1RA), or a third OAD within 365 days after the baseline A1c ≥ 7.0%. Patients had at least 1 A1c value 60-365 days (follow-up period) after treatment intensification. The proportion of patients with an A1c < 7.0% and < 9.0% at follow-up were identified by therapeutic intensification strategy. Odds ratios for achieving A1c < 7.0% and < 9.0% were calculated. RESULTS 1,226 patients were included in the analysis, and 33.5% of the patients had a baseline A1c ≥ 9.0%. 24% of patients received insulin; 16% received GLP-1RA; and 60% received a third OAD for the treatment intensification. Overall, 26.0% achieved A1c < 7.0% and 76.1% of patients achieved < 9.0%, with a median follow-up of 119 days. The proportion of patients intensified with insulin who had an A1c ≥ 9.0% at follow-up was 34.6% versus 53.2% at baseline (P < 0.01). The corresponding percentages for those intensified with a GLP-1RA and OAD were 21.6% versus 27.1% (P = 0.24) and 20.1% versus 27.3% (P < 0.01). After controlling for baseline characteristics, the odds ratio (95% CI) of achieving A1c < 7.0% and < 9.0% was 2.05 (1.45-2.90) for GLP-1RA and 0.92 (0.61-1.40) for OAD. The association between goal attainment and GLP-1RA versus OAD intensification was influenced by the time to the A1c follow-up and baseline A1c. CONCLUSIONS Treatment intensification was associated with improved glycemic control in patients after therapy failed 2 OADs. Patients with higher A1c at baseline were likely to initiate insulin, which was associated with a greater drop in A1c. GLP-1RA was associated with a higher likelihood of achieving NCQA-suggested glycemic control compared with a third OAD. However, the association varied by the follow-up period. These findings are important to health plans seeking to improve patient outcomes as reflected in high performance on NCQA diabetes quality measures by promoting effective and timely treatment intensification. DISCLOSURES Research funding was provided by Sanofi to the Pharmacotherapy Outcomes Research Center at the University of Utah and SelectHealth to conduct this study. Thomas, Sterling, and Johnstone are employees and stock/shareholders of Sanofi. Kim, Unni, McAdam-Marx, and Brixner are employees of the Department of Pharmacotherapy at the University of Utah. Brixner also has served as an advisory board member and presenter for Sanofi. McAdam-Marx also reports grants to the Department of Pharmacotherapy, University of Utah, from AstraZeneca and Janssen, outside of the submitted work. Olsen is employed by SelectHealth. Part of the results of this study was presented at the Academy of Managed Care & Specialty Pharmacy Annual Meeting 2018 in Boston, MA, during April 23-26, 2018.
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Affiliation(s)
- Kibum Kim
- Department of Pharmacotherapy, University of Utah, Salt Lake City
| | - Sudhir Unni
- Department of Pharmacotherapy, University of Utah, Salt Lake City
| | | | | | | | | | | | | | - Diana Brixner
- Department of Pharmacotherapy, University of Utah, Salt Lake City
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Crangle CE, Bradley C, Carlin PF, Esterhay RJ, Harper R, Kearney PM, McCarthy VJC, McTear MF, Savage E, Tuttle MS, Wallace JG. Exploring patient information needs in type 2 diabetes: A cross sectional study of questions. PLoS One 2018; 13:e0203429. [PMID: 30444868 PMCID: PMC6239280 DOI: 10.1371/journal.pone.0203429] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/21/2018] [Indexed: 01/02/2023] Open
Abstract
This study set out to analyze questions about type 2 diabetes mellitus (T2DM) from patients and the public. The aim was to better understand people's information needs by starting with what they do not know, discovered through their own questions, rather than starting with what we know about T2DM and subsequently finding ways to communicate that information to people affected by or at risk of the disease. One hundred and sixty-four questions were collected from 120 patients attending outpatient diabetes clinics and 300 questions from 100 members of the public through the Amazon Mechanical Turk crowdsourcing platform. Twenty-three general and diabetes-specific topics and five phases of disease progression were identified; these were used to manually categorize the questions. Analyses were performed to determine which topics, if any, were significant predictors of a question's being asked by a patient or the public, and similarly for questions from a woman or a man. Further analysis identified the individual topics that were assigned significantly more often to the crowdsourced or clinic questions. These were Causes (CI: [-0.07, -0.03], p < .001), Risk Factors ([-0.08, -0.03], p < .001), Prevention ([-0.06, -0.02], p < .001), Diagnosis ([-0.05, -0.02], p < .001), and Distribution of a Disease in a Population ([-0.05,-0.01], p = .0016) for the crowdsourced questions and Treatment ([0.03, 0.01], p = .0019), Disease Complications ([0.02, 0.07], p < .001), and Psychosocial ([0.05, 0.1], p < .001) for the clinic questions. No highly significant gender-specific topics emerged in our study, but questions about Weight were more likely to come from women and Psychosocial questions from men. There were significantly more crowdsourced questions about the time Prior to any Diagnosis ([(-0.11, -0.04], p = .0013) and significantly more clinic questions about Health Maintenance and Prevention after diagnosis ([0.07. 0.17], p < .001). A descriptive analysis pointed to the value provided by the specificity of questions, their potential to disclose emotions behind questions, and the as-yet unrecognized information needs they can reveal. Large-scale collection of questions from patients across the spectrum of T2DM progression and from the public-a significant percentage of whom are likely to be as yet undiagnosed-is expected to yield further valuable insights.
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Affiliation(s)
- Colleen E. Crangle
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Paul F. Carlin
- South Eastern Health and Social Care Trust, Research Office, Dundonald, Northern Ireland, United Kingdom
| | - Robert J. Esterhay
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Roy Harper
- Department of Endocrinology & Diabetes, The Ulster Hospital, South Eastern Health and Social Care Trust, Dundonald, Northern Ireland, United Kingdom
| | - Patricia M. Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | | | - Michael F. McTear
- School of Computing and Mathematics, University of Ulster at Jordanstown, Jordanstown, Northern Ireland, United Kingdom
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mark S. Tuttle
- Board of Directors, Apelon Inc., Hartford, Connecticut, United States of America
| | - Jonathan G. Wallace
- School of Computing and Mathematics, University of Ulster at Jordanstown, Jordanstown, Northern Ireland, United Kingdom
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Østergaard L, Mogensen UM, Bundgaard JS, Dahl A, Wang A, Torp-Pedersen C, Gislason G, Køber L, Køber N, Dejgaard TF, Frandsen CS, Fosbøl EL. Duration and complications of diabetes mellitus and the associated risk of infective endocarditis. Int J Cardiol 2018; 278:280-284. [PMID: 30291010 DOI: 10.1016/j.ijcard.2018.09.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/14/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Long duration of diabetes mellitus (DM) is associated with an increased risk of infection, however no studies have yet focused on the duration of DM and the associated risk of infective endocarditis (IE). METHODS Patients with DM were identified through the Danish Prescription Registry, 1996-2015. Duration of DM was split in follow-up periods of: 0-5 years, 5-10 years, 10-15 years, and >15 years. Multivariable adjusted Poisson regression was used to calculate incidence rate ratios (IRR) according to study groups. DM late-stage complications and the associated risk of IE were investigated as time-varying covariates using the validated Diabetes Complications Severity Index (DCSI). RESULTS We included 299,551 patients with DM. In patients with DM duration of 0-5 years, 5-10 years, 10-15 years, and >15 years, the incidence rates of IE were 0.24, 0.33, 0.58, and 0.96 cases of IE/1000 person years, respectively. Patients with DM duration 5-10 years, 10-15 years, and >15 years were associated with a higher risk of IE with an IRR of 1.24 (95% CI: 1.02-1.51), 1.92 (95% CI: 1.52-2.43) and 3.05 (95% CI: 2.11-4.40), respectively, compared with DM duration 0-5 years. Patients with a DCSI score of 2, 3 and >3 were associated with a higher risk of IE compared with patients with a DCSI score of 0, IRR = 1.78 (95% CI: 1.34-2.36), IRR = 2.34 (95% CI: 1.73-3.16), and IRR = 2.59 (95% CI: 1.92-3.48), respectively. CONCLUSION This study shows a stepwise increase in the risk of IE with DM duration and severity independent of age and known comorbidity.
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Affiliation(s)
| | - Ulrik M Mogensen
- Zealand University Hospital, Roskilde, Department of Cardiology, Denmark
| | | | - Anders Dahl
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Christian Torp-Pedersen
- Department of Health Science and Technology, Aalborg University, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
| | - Gunnar Gislason
- Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Lars Køber
- Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Nana Køber
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
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