PMID- 22250059
OWN - NLM
STAT- MEDLINE
DCOM- 20130125
LR  - 20211203
IS  - 1099-1557 (Electronic)
IS  - 1053-8569 (Linking)
VI  - 21
IP  - 9
DP  - 2012 Sep
TI  - Initial and subsequent therapy for newly diagnosed type 2 diabetes patients 
      treated in primary care using data from a vendor-based electronic health record.
PG  - 920-8
LID - 10.1002/pds.2262 [doi]
AB  - BACKGROUND: Diabetes is a leading cause of death and disability, and its 
      prevalence is increasing. When diet fails, patients with type 2 diabetes mellitus 
      (T2DM) are prescribed oral hypoglycemics for glycemic control. Few studies have 
      explored initial use or change from initial oral hypoglycemic therapy in the 
      primary care setting. We aimed to describe the utilization of initial oral 
      hypoglycemics among newly diagnosed patients with diabetes from 1998-2009 and 
      changes from initial to subsequent therapy among patients prescribed older oral 
      hypoglycemic agents using electronic health records. 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. We used incidence 
      density sampling and conditional logistic regression models to evaluate 
      predictors of regimen change. RESULTS: 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. CONCLUSIONS: Clinical and 
      demographic characteristics influence choice and duration of initial oral 
      hypoglycemic treatment as well as regimen changes.
CI  - Copyright (c) 2012 John Wiley & Sons, Ltd.
FAU - Brouwer, Emily S
AU  - Brouwer ES
AD  - RTI International, Research Triangle Park, NC, USA.
FAU - West, Suzanne L
AU  - West SL
FAU - Kluckman, Marianne
AU  - Kluckman M
FAU - Wallace, Dennis
AU  - Wallace D
FAU - Masica, Andrew L
AU  - Masica AL
FAU - Ewen, Edward
AU  - Ewen E
FAU - Kudyakov, Rustam
AU  - Kudyakov R
FAU - Cheng, Dunlei
AU  - Cheng D
FAU - Bowen, James
AU  - Bowen J
FAU - Fleming, Neil S
AU  - Fleming NS
LA  - eng
GR  - HHSA29020050036I/PHS HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20120116
PL  - England
TA  - Pharmacoepidemiol Drug Saf
JT  - Pharmacoepidemiology and drug safety
JID - 9208369
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Administration, Oral
MH  - Age Factors
MH  - Aged
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Electronic Health Records/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/administration & dosage/*therapeutic use
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Primary Health Care
MH  - Racial Groups
MH  - Regression Analysis
MH  - Time Factors
MH  - United States
EDAT- 2012/01/18 06:00
MHDA- 2013/01/26 06:00
CRDT- 2012/01/18 06:00
PHST- 2011/02/23 00:00 [received]
PHST- 2011/08/29 00:00 [revised]
PHST- 2011/09/13 00:00 [accepted]
PHST- 2012/01/18 06:00 [entrez]
PHST- 2012/01/18 06:00 [pubmed]
PHST- 2013/01/26 06:00 [medline]
AID - 10.1002/pds.2262 [doi]
PST - ppublish
SO  - Pharmacoepidemiol Drug Saf. 2012 Sep;21(9):920-8. doi: 10.1002/pds.2262. Epub 
      2012 Jan 16.