Predictors of metabolic control at one year in a population of pediatric patients with type 2 diabetes mellitus: a retrospective study

A review of treatment response in type 2 diabetes: assessing the role of patient heterogeneity

The response to treatment for type 2 diabetes typically varies among individuals within a study population. This variation is known as heterogeneity of treatment response. We conducted a comprehensive literature review to identify factors that account for heterogeneity of treatment response in patients treated for type 2 diabetes. Three databases (PubMed, EMBASE and Cochrane Library) were searched for articles published in the last 10 years describing investigations of factors associated with treatment response and outcomes among people with type 2 diabetes receiving pharmacological treatment. Of the 43 articles extracted and summarized, 35 (81%) discussed clinical factors, 31 (72%) described sociodemographic factors and 17 (40%) reported on comorbidity or behavioural factors. Clinical factors identified included baseline glycated hemoglobin A1c or fasting plasma glucose (FPG) levels, insulin response or sensitivity, C-peptide, body composition, adipose tissue proteins, lipid profile, plasma albumin levels and duration of disease or insulin treatment. Other factors identified included age, sex, race, socioeconomic status and comorbidities. This review identified the following research gaps: use of multiple definitions for response, few patient-reported measures and lack of evidence regarding whether factors were associated with treatment response for only specific medications or across pharmacological therapies. Furthermore, identification of factors associated with type 2 diabetes treatment response was generally a secondary objective in the research reviewed. Understanding which patient subgroups are more likely to respond to treatment and identifying factors associated with response may result in targeted treatment decisions and alter the interpretation of efficacy or effectiveness of results. In conclusion, accounting for these factors in clinical trials and when making clinical treatment decisions may improve therapy selection and individual patient outcomes.

Adherence to guidelines for and disparities in diabetes care utilization in Medicaid children

1999-2002 Medicaid administrative data on 360 children with diabetes mellitus were used to study disparities in and utilization of health care in Missouri, United States. Measures of ambulatory care and its utilization were based on clinical guidelines. Their association with readmission in hospitals and emergency rooms were examined using multivariate analyses. Many children did not visit their doctor's office, have blood tests for glycosylated hemoglobin, or monitor their blood glucose level. There were no sex or race differences in the utilization of ambulatory care or its outcome for all children, except for blood glucose test strip use. Older age and non-white race increased the odds of rehospitalization and three or more physician encounters decreased this risk. Non-white race increased the odds of visiting emergency rooms. In some subpopulations, there were age, sex, and race disparities in ambulatory care utilization. Adherence to diabetes care guidelines was associated with lower risk of re-hospitalization.