PMID- 24195723
OWN - NLM
STAT- MEDLINE
DCOM- 20140904
LR  - 20181202
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 17
IP  - 1
DP  - 2014 Jan
TI  - Glycemic control among patients with type 2 diabetes who initiate basal insulin: 
      a retrospective cohort study.
PG  - 21-31
LID - 10.3111/13696998.2013.862538 [doi]
AB  - OBJECTIVE: To examine changes in glycemic control for patients with type 2 
      diabetes mellitus (T2DM) after initiation of basal insulin and factors associated 
      with improved glycemic control. METHODS: An analysis of retrospective medical 
      records of patients with T2DM was examined using Humedica's electronic medical 
      records database (January 2007-August 2012). Patients with T2DM, initiating basal 
      insulin, age >/= 21 years, with a recorded HbA1c test in both the 1 year prior and 
      the 2 years post-initiation were included. A multivariate regression examined 
      factors associated with changes in glycemic control. Logistic regressions 
      examined factors associated with improvements or worsening of glycemic control, 
      compared to relatively unchanged glycemic control. RESULTS: Many (14,457) 
      individuals met the inclusion-exclusion criteria. Multivariate analyses revealed 
      that older age (p < 0.0001), residence in the Western region of the US (vs South) 
      (p < 0.0001), Medicare insurance vs Medicaid or being uninsured (p = 0.0138), and 
      higher household income (p = 0.0065) were associated with improved glycemic 
      control. Patients diagnosed with comorbid peripheral vascular disease 
      (p = 0.0072), cancer (p = 0.0019), obesity (p = 0.0002), moderate (p = 0.0103), 
      and severe chronic kidney disease (p < 0.0001), or end-stage renal disease 
      (p = 0.0075) in the pre-period were found to have significantly improved glycemic 
      control in the post-period. Use of prandial insulin (p = 0.0087), pre-mix insulin 
      (p = 0.0003) in the pre-period, a higher pre-period HbA1c score (p < 0.0001), and 
      longer duration between pre-period and post-period HbA1c testing (p < 0.0001) 
      were significantly associated with higher HbA1c levels in the post-period. 
      LIMITATIONS: Analyses rely on electronic medical records which cannot capture 
      patient healthcare utilization occurring outside of the data capture system. 
      Analyses do not control for insulin dosage or type of basal insulin prescribed. 
      CONCLUSIONS: Among patients with T2DM treated with basal insulin, a number of 
      factors may influence glycemic outcomes. These findings suggest a role for a more 
      personalized approach to the treatment of patients with T2DM.
FAU - Curtis, Bradley
AU  - Curtis B
AD  - Global Health Outcomes, Eli Lilly and Company , Indianapolis, IN , USA.
FAU - Lage, Maureen J
AU  - Lage MJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131121
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin, Long-Acting)
SB  - IM
MH  - Absenteeism
MH  - Blood Glucose/analysis/*drug effects
MH  - Canada
MH  - Diabetes Mellitus, Type 2/*drug therapy/*economics
MH  - Employment
MH  - Female
MH  - Glycemic Index
MH  - Health Services/statistics & numerical data
MH  - Humans
MH  - Hypoglycemic Agents/*administration & dosage
MH  - Insulin, Long-Acting/*administration & dosage
MH  - Male
MH  - Qualitative Research
MH  - Retrospective Studies
MH  - Surveys and Questionnaires
EDAT- 2013/11/08 06:00
MHDA- 2014/09/05 06:00
CRDT- 2013/11/08 06:00
PHST- 2013/11/08 06:00 [entrez]
PHST- 2013/11/08 06:00 [pubmed]
PHST- 2014/09/05 06:00 [medline]
AID - 10.3111/13696998.2013.862538 [doi]
PST - ppublish
SO  - J Med Econ. 2014 Jan;17(1):21-31. doi: 10.3111/13696998.2013.862538. Epub 2013 
      Nov 21.