PMID- 26679967
OWN - NLM
STAT- MEDLINE
DCOM- 20160927
LR  - 20221207
IS  - 2376-1032 (Electronic)
IS  - 2376-0540 (Print)
IS  - 2376-0540 (Linking)
VI  - 21
IP  - 12
DP  - 2015 Dec
TI  - A Real-World Observational Study of Time to Treatment Intensification Among 
      Elderly Patients with Inadequately Controlled Type 2 Diabetes Mellitus.
PG  - 1184-93
AB  - BACKGROUND: Among elderly patients, the management of type 2 diabetes mellitus 
      (T2DM) is complicated by population heterogeneity and elderly-specific 
      complexities. Few studies have been done to understand treatment intensification 
      among elderly patients failing multiple oral antidiabetic drugs (OADs). 
      OBJECTIVE: To examine the association between time to treatment intensification 
      of T2DM and elderly-specific patient complexities. METHODS: In this 
      observational, retrospective cohort study, elderly (aged >/= 65 years) Medicare 
      beneficiaries (n = 16,653) with inadequately controlled T2DM (hemoglobin A1c 
      >/= 8.0% despite 2 OADs) were included. Based on the consensus statement for 
      diabetes care in elderly patients published by the American Diabetes Association 
      and the American Geriatric Society, elderly-specific patient complexities were 
      defined as the presence or absence of 5 geriatric syndromes: cognitive 
      impairment; depression; falls and fall risk; polypharmacy; and urinary 
      incontinence. RESULTS: Overall, 48.7% of patients received intensified treatment 
      during follow-up, with median time to intensification 18.5 months (95% 
      CI = 17.7-19.3). Median time to treatment intensification was shorter for elderly 
      patients with T2DM with polypharmacy (16.5 months) and falls and fall risk (12.7 
      months) versus those without polypharmacy (20.4 months) and no fall risk (18.6 
      months). Elderly patients with urinary incontinence had a longer median time to 
      treatment intensification (18.6 months) versus those without urinary incontinence 
      (14.6 months). The median time to treatment intensification did not significantly 
      differ by the elderly-specific patient complexities that included cognitive 
      impairment and depression. However, after adjusting for demographic, insurance, 
      clinical characteristics, and health care utilization, we found that only 
      polypharmacy was associated with time to treatment intensification (adjusted 
      hazard ratio, 1.10; 95% CI = 1.04-1.15; P = 0.001). CONCLUSIONS: Less than half 
      of elderly patients with inadequately controlled T2DM received treatment 
      intensification. Elderly-specific patient complexities were not associated with 
      time to treatment intensification, emphasizing a positive effect of the 
      integrated health care delivery model. Emerging health care delivery models that 
      target integrated care may be crucial in providing appropriate treatment for 
      elderly T2DM patients with complex conditions.
FAU - Ajmera, Mayank
AU  - Ajmera M
AD  - RTI Health Solutions, 300 Park Offices Dr., Research Triangle Park, NC 27709. 
      majmera@rti.org.
FAU - Raval, Amit
AU  - Raval A
FAU - Zhou, Steve
AU  - Zhou S
FAU - Wei, Wenhui
AU  - Wei W
FAU - Bhattacharya, Rituparna
AU  - Bhattacharya R
FAU - Pan, Chunshen
AU  - Pan C
FAU - Sambamoorthi, Usha
AU  - Sambamoorthi U
LA  - eng
GR  - U54 GM104942/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Manag Care Spec Pharm
JT  - Journal of managed care & specialty pharmacy
JID - 101644425
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Biomarkers/blood
MH  - Blood Glucose/drug effects/metabolism
MH  - Comorbidity
MH  - *Delivery of Health Care, Integrated
MH  - Diabetes Mellitus, Type 2/blood/diagnosis/*drug therapy
MH  - Drug Therapy, Combination
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Medicare
MH  - Polypharmacy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - *Time-to-Treatment
MH  - Treatment Outcome
MH  - United States
PMC - PMC4760631
MID - NIHMS758068
EDAT- 2015/12/19 06:00
MHDA- 2016/09/28 06:00
PMCR- 2016/12/01
CRDT- 2015/12/19 06:00
PHST- 2015/12/19 06:00 [entrez]
PHST- 2015/12/19 06:00 [pubmed]
PHST- 2016/09/28 06:00 [medline]
PHST- 2016/12/01 00:00 [pmc-release]
AID - 2015(21)12: 1184-1193 [pii]
AID - 10.18553/jmcp.2015.21.12.1184 [doi]
PST - ppublish
SO  - J Manag Care Spec Pharm. 2015 Dec;21(12):1184-93. doi: 
      10.18553/jmcp.2015.21.12.1184.