Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus

Alonso-Fernández, Margarita; Mancera-Romero, José; Bravo, José Javier Mediavilla; Comas-Samper, José Manuel; López‐Simarro, Flora; Pérez-Unanua, M.P.; Iturralde-Iriso, Jesús

doi:10.1016/j.pcd.2015.01.006

Cited by 21 publications

(13 citation statements)

References 30 publications

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“…In addition, in the current study, patients receiving fewer unique OAD agents were more likely to receive timely treatment intensification ( Table 2 ). These findings fall towards the better end of the range of previously published literature [ 11 ]. Previous large retrospective studies suggest that anywhere between 56% and 73% of patients with type 2 diabetes do not receive treatment intensification within 3 to 6 months following the index event [ 6 , 9 , 14 , 17 ].…”

Section: Discussionsupporting

confidence: 75%

“…Several factors are associated with diabetes treatment inertia, which is defined as failure to intensify pharmacotherapy in accordance with clinical guidelines. Recent studies using primary care populations suggest that complexity of treatment [ 11 ], patient medication adherence [ 12 ], HbA1C level [ 13 ], specialty of the physician initiating the therapy [ 14 ], physician experience level [ 13 ], and other provider-, patient- and system-level barriers [ 15 ] may be linked to diabetes treatment inertia. While no study has assessed the direct relationship between timely treatment intensification and diabetes quality measure performance, it is reasonable to expect that timely treatment intensification would contribute to greater likelihood of achievement of HbA1C quality performance goals as measured by HbA1C control.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the relationship between diabetes treatment intensification and quality measure performance using electronic medical records

et al. 2018

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AimsAssess the relationship between timely treatment intensification and hemoglobin A1C (HbA1C) control quality-of-care performance measures, i.e., HbA1C levels, among patients with uncontrolled type 2 diabetes.Materials and methodsElectronic medical records and diabetes registry data from a large, accountable care organization (ACO) were used to isolate a sample of adult patients with type 2 diabetes who received at least one oral antidiabetes agent and had at least one HbA1C level measurement ≥8.0% (64 mmol/mol; i.e., uncontrolled diabetes) between 7/1/2011 and 6/30/2015. Treatment intensification status was evaluated for each patient during a 120-day treatment intensification window following the index HbA1c measure. Two-level hierarchical generalized linear models, with patients aggregated at the physician level, were used to assess the association between treatment intensification and achieving HbA1C quality performance measures.Results547 patients met study selection criteria and 480 patients had at least one HbA1C test after the treatment intensification window and were used for the statistical analyses. About 40% of patients who had uncontrolled diabetes received treatment intensification during the 120-day window. Greater index HbA1C, greater patient body mass index, and fewer unique pre-index oral antidiabetes agents were significantly associated with greater likelihood of receiving timely treatment intensification. The odds of receiving treatment intensification were about 1.8 times higher (P = 0.0027) among patients with poor index HbA1C control (HbA1c level >9.0% [75 mmol/mol]) compared to other patients (index HbA1c 8.0% - 9.0%). Hispanic patients (compared to White patients) were significantly more likely to exhibit poor control after treatment intensification (odds ratio [OR] 2.91, P = 0.0304), underscoring the difficulty of controlling diabetes in this vulnerable group. In contrast, being male and being treated primarily by an internist (compared to primary treatment by a family medicine specialist) were both significantly associated with achieving superior control (HbA1c level <8.0%) after treatment intensification (OR 0.53 [P = 0.0165]; OR 0.41 [P = 0.0275], respectively).ConclusionsTimely treatment intensification was significantly associated with greater likelihood of patients achieving superior HbA1C control (<8.0%) and better HbA1C control quality performance for the practice. Even in an ACO with resources dedicated to diabetes control, it is incumbent upon clinicians to readily identify and open dialogues with patients who may benefit from closely supervised, individualized attention.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Assessment of the relationship between diabetes treatment intensification and quality measure performance using electronic medical records

et al. 2018

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“…The proportion of participants with HbA1c levels ≤7% in this study was lower than that of the studies done in France and Spain [31,32]. In terms of comparison of the study results with that of the Al-Rowais' study of type II diabetes patients conducted in the Kingdom of Saudi Arabia [33], the percentage of participants who obtained acceptable HbA1c levels (6-8%) was almost the same.…”

Section: Discussioncontrasting

confidence: 55%

Predictors of Good Glycemic Control Among Type Ii Diabetes Patients in Palestine

Mosleh

Aziz

Ali

et al. 2017

Asian J Pharm Clin Res

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Objectives: The aim of this study is to assess glycemic control and its relationship with patient characteristics, health-care system factors, and self-care management in type II diabetes patients. Methods:A retrospective cross-sectional study was conducted among 330 type II diabetes patients who met the inclusion criteria and whose medical records covered a period of 1 year. Data concerning patient characteristics, health-care system factors, self-care management, and available last reading of hemoglobin A1c (HbA1c) were collected through personal interviews and a medical records' review using structured questionnaires and data collection forms. Good glycemic control was defined as HbA1c ≤7%. To assess the results, the Statistical Package for Social Sciences (version 16) was used to undertake descriptive, univariate, and multivariate analyses. Results:The mean±standard deviation age was 60±9.7 years. More than half of the participants were male (51.2%), and the majority had additional chronic diseases (88.5%). Of the total 271 participants whose HbA1c levels have been monitored, 16.7% had good glycemic control. Multivariate analysis showed that unemployment was significantly related to a decreased odds of good glycemic control (odds ratio=0.34; 95% confidence interval=0.12-0.98; p<0.05). Conclusion:The study noted that the proportion of patients with good glycemic control was low, a result comparable to studies from many countries. Further investigation and improvement of inappropriate health-care system factors and self-care management together with educational programs that emphasize the importance of self-care management and the health-care providers' role would be of great benefit in glycemic control.

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“…10 A multicentre study conducted in Spain in 2015 showed that only 45% of people with diagnosed DM had good glycaemic control while previous studies in Europe showed similar results of 54% in Belgium and 61% in Germany. 11 Similarly, in the USA only 55.5% of participants achieved good glycaemic control. 12 Access to resources and support systems, patients' attitude and expected treatment efforts, comorbidities, disease duration and risk of hypoglycaemia are the main factors that are related to inadequate glucose control.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle factors, self-management and patient empowerment in diabetes care

Lambrinou

Hansen

Beulens³

2019

Eur J Prev Cardiolog

173

101

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Although management of diabetes mellitus is improving, inadequately managed cases still exist. Prevention of diabetes mellitus requires an integrated and holistic approach based on the origin of the disease. In Europe only half of diagnosed patients with diabetes mellitus have good glycaemic control. Inadequate glycaemic control is significantly increasing the use of healthcare resources, the medical costs and mortality rates. A review was conducted in order to summarise and discuss central themes for prevention. A search of the databases PubMed, CINAHL, Cochrane and Google Scholar between January 2010–May 2019 was undertaken. The following keywords: ‘diabetes mellitus’, ‘cardiovascular diseases’, ‘empowerment’, ‘self-management education’ and ‘lifestyle factors’ were used in different combinations to identify eligible articles. Important variables for the prevention of diabetes mellitus and its complications are self-management of diabetes mellitus and the management of risk factors. Education and support for self-management are fundamental when caring for people with a chronic disease like diabetes mellitus. In order to achieve effective self-management including lifestyle modification it is also crucial to motivate people. In this review, the role of the three main pillars in diabetes care are identified and discussed; patient empowerment, self-management education and lifestyle modification in the management of people with diabetes mellitus.

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Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus

Cited by 21 publications

References 30 publications

Assessment of the relationship between diabetes treatment intensification and quality measure performance using electronic medical records

Assessment of the relationship between diabetes treatment intensification and quality measure performance using electronic medical records

Predictors of Good Glycemic Control Among Type Ii Diabetes Patients in Palestine

Lifestyle factors, self-management and patient empowerment in diabetes care

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