Real-world evidence studies into treatment adherence, thresholds for intervention and disparities in treatment in people with type 2 diabetes in the UK

Abstract

PurposeThe University of Surrey-Lilly Real World Evidence (RWE) diabetes cohort has been established to provide insights into the management of type 2 diabetes mellitus (T2DM). There are 3 areas of study due to be conducted to provide insights into T2DM management: exploration of medication adherence, thresholds for changing diabetes therapies, and ethnicity-related or socioeconomic-related disparities in management. This paper describes the identification of a cohort of people with T2DM which will be used for these analyses, through a case finding algorithm, and describes the characteristics of the identified cohort.ParticipantsA cohort of people with T2DM was identified from the Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) data set. This data set comprises electronic patient records collected from a nationally distributed sample of 130 primary care practices across England with scope to increase the number of practices to 200.Findings to dateA cohort (N=58 717) of adults with T2DM was identified from the RCGP RSC population (N=1 260 761), a crude prevalence of diabetes of 5.8% in the adult population. High data quality within the practice network and an ontological approach to classification resulted in a high level of data completeness in the T2DM cohort; ethnicity identification (82.1%), smoking status (99.3%), alcohol use (93.3%), glycated haemoglobin (HbA1c; 97.9%), body mass index (98.0%), blood pressure (99.4%), cholesterol (87.4%) and renal function (97.8%). Data completeness compares favourably to other, similarly large, observational cohorts. The cohort comprises a distribution of ages, socioeconomic and ethnic backgrounds, diabetes complications, and comorbidities, enabling the planned analyses.Future plansRegular data uploads from the RCGP RSC practice network will enable this cohort to be followed prospectively. We will investigate medication adherence, explore thresholds and triggers for changing diabetes therapies, and investigate any ethnicity-related or socioeconomic-related disparities in diabetes management.

An instrument to identify computerised primary care research networks, genetic and disease registries prepared to conduct linked research: TRANSFoRm International Research Readiness (TIRRE) survey

“…The only exception to this in the UK is the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC);29 this network extracts data from all the different brand of medical record systems. It has published a cohort profile about patients in the RCGP RSC database with diabetes, one of the TRANSFoRm use-case areas30 Notwithstanding the RSCHP RSC success, the relatively simple task of linking data from this small number of brands of computer within the UK has proved challenging, both in terms of creating a summary care record31 and in developing a common data extraction system 32…”

Ethnicity Recording in Primary Care Computerised Medical Record Systems: An Ontological Approach

“…Since defining this ontological process we have since applied the method to ethnicity identification in a population with diabetes 23. In this group the data quality was sufficiently higher and ethnicity identification using the ontological process set out here was 82.1%.…”

Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors: Comparing Trial and Real World Use (Study Protocol)

“…To this end, we use a two-stage informatics ontology-based process to identify people with T2DM [21]. This is a concept-based approach to case and outcome identification [26].…”

“…Diabetes data are particularly well recorded, although care is needed to accurately find cases and to differentiate between the different ways data are recorded on the different computerised medical record systems used by GPs [19, 20]. Sufficient details on prescription data are available to facilitate the study of the use and persistence of medicine in real world therapy [21]. …”