乌鸦传媒

AUSTIN -- With the aid of a chronic disease registry, researchers determined predictors of improved diabetes-related outcomes, some of which included frequent visits with endocrinologists and seeing providers affiliated within the health system.

Presented at theAmerican Association of Clinical Endocrinologists annual meeting, the retrospective, cross-sectional study assessed nearly 50,000 patient medical records from an electronic diabetes registry to measure diabetes-related clinical inertia, including LDL cholesterol, mean arterial blood pressure (MAP), and HbA1c levels, according to Wael Emad Eid, MD, of St. Elizabeth Healthcare and the University of South Dakota Sanford School of Medicine in Vermillion, and colleagues.

"Despite the multiple state-of-the-art tools we have for treatment of diabetes, we are still not doing the best, nationwide, with population health," Eid told 乌鸦传媒. "There are thousands of patients not meeting their goals with diabetes, cholesterol, and blood pressure control. "

"Something is still missing in the healthcare delivery process," he continued. "So we tried to study the determinants for not achieving the goals with an approach that would assess the patient, the clinician, and the healthcare system. This way we can gear our efforts with interventions to address these barriers for hopefully a better population outcome."

A total of approximately 49,800 U.S.-based patients, who were diagnosed with type 2 diabetes beginning in 2012, were enrolled into the daily-updated Electronic Diabetes Registry.

Patients who were included in the analysis had a diabetes ICD-10 code billed out on a claim within 2 years prior; had an active issue of diabetes on his or her problem list; and/or had a minimum of two encounters with a diabetes diagnosis within the prior 2 years, although individuals who had been in the database 6 months or less were excluded.

Using a multivariate regression and logistic regression analysis, Eid's group looked at patients' last HbA1c, last LDL cholesterol, and least mean arterial blood pressure reading as "surrogate markers" for clinical inertia -- a lack of treatment intensification for patients who aren't at goal -- associated with diabetes.

When analyzing system-related factors associated with diabetes clinical inertia, Eid's group reported that patients who had an uncontrolled HbA1c at time of enrollment and subsequently had a lower last A1c reading was associated with having a healthcare provider who was affiliated with the healthcare system (P<0.01).

Also, patients who had frequent, as well as recent visits with an endocrinologist had improved last A1c and LDL cholesterol measures, despite enrollment levels (P<0.01). Similarly, significant improvement in A1c was associated with patients who had frequent visits with a primary care provider when his or her A1c was between 8% and 9% at time of enrollment (P<0.05).

"We were surprised by some of the facts," Eid explained. "It was interesting to see that the most determinants for not achieving the goals were having no future visits with either primary care provider or endocrinology despite the fact that diabetes was significantly uncontrolled. If these patients are not seen at regular, short-spaced visits, it is not expected that they will have the desired diabetes related outcomes."

Eid's group also reported that age and gender both displayed a significant role in clinical inertia. Patients who had uncontrolled HbA1c (≥9%), LDL cholesterol (>100 mg/dL), or uncontrolled MAP (≥107 mm Hg) at enrollment and time of last measurement were significantly more likely to be younger males.

Use of a statin was associated with a lower last LDL and MAP reading, which was to be expected, the authors noted (P<0.01). However, statin use was associated with having an elevated last A1c reading when these patients had a A1c of less than 8% at enrollment (P<0.01).

Patients who had a higher A1c at the time of enrollment into the database also had significantly higher last A1c, LDL cholesterol, and MAP measurement. Taking insulin was significantly associated with an elevated HbA1c in patients with diabetes, compared with those who weren't on insulin.

"We were also surprised by the fact that being on insulin even for a long time does not protect from having high HbA1c," he said. "So mostly frequent ongoing insulin titration is needed to achieve better outcomes."

Eid told 乌鸦传媒 that "We plan for intervention studies to target the barriers-to-care discovered in this project. We will try to identify those at extreme high risk and intervene before significant complications happen. Also we hope to collaborate with other resources for a bigger impact on population health."

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