Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor-based electronic health record
Pharmacoepidemiology and Drug Safety, 04/26/2012
Brouwer ES et al. – Clinical and demographic characteristics influence choice and duration of initial oral hypoglycemic treatment as well as regimen changes.Methods
- This observational cohort study used electronic health records from newly diagnosed patients with T2DM between 1 January 1998 and 31 March 2009 at two large health systems in the USA.
- Oral hypoglycemics included older (biguanide, sulfonylurea, and thiazolidinedione) and newer agents (incretin mimetic agents, alpha-glucosidase inhibitors, and D-phenylalanine derivatives).
- Multinomial regression models were fit to evaluate initial older oral hypoglycemic medication.
- The authors used incidence density sampling and conditional logistic regression models to evaluate predictors of regimen change.
- Most patients were treated from the biguanide class of oral hypoglycemics (67%), but there were differences in initial prescribing by age and race.
- HbA1c (Odds Ratio for HbA1c 7.0–8.9 vs < 7.0, 5.87 [95% Confidence Interval: 3.62–9.52]; Odds Ratio for HbA1c ≥ 9 vs < 7.0, 20.25 [95% Confidence Interval: 8.32–49.29] and Black people (Odds Ratio, 0.29 [95% Confidence Interval: 0.14, 0.60]) versus White people were associated with regimen change in the adjusted analysis.