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. 2007 Jun;23(6):1423-30.
doi: 10.1185/030079907X199600. Epub 2007 May 14.

The complexity of medication regimens and test ordering for patients with diabetes from 1995 to 2003

Elbert S Huang  1 , Anirban Basu, Michael Finch, Jennifer Frytak, Willard Manning
Affiliations

The complexity of medication regimens and test ordering for patients with diabetes from 1995 to 2003

Elbert S Huang et al. Curr Med Res Opin. 2007 Jun.

Abstract

Objective: Diabetes care has become increasingly complex. We set out to quantify recent trends in the complexity of medication regimens and test ordering for diabetes patients continuously enrolled in health plans affiliated with a large, regional US health maintenance organization, with representation in the South and Midwest.

Research design and methods: We provide descriptive trends analysis of overall diabetes care complexity (number of components [i.e., glucose, blood pressure, cholesterol control], number of medications/tests) from 1995 to 2003 for adults with diabetes (N = 304,233).

Main outcome measures: The main outcomes were (1) the proportion of patients receiving diabetes-related medications (blood glucose, blood pressure, and cholesterol control agents), (2) the average number of medications, (3) the proportion of patients receiving diabetes-related tests (glycosylated hemoglobin [HbA1c], urine microalbumin, and serum cholesterol), (4) and the average number of tests ordered within the first year that a patient had any indication of diabetes.

Results: The proportion of patients on cholesterol lowering drugs (18% --> 39%, p < 0.01) and blood pressure lowering drugs (51% --> 62%, p = 0.04) rose significantly, while the proportion on glucose lowering drugs fell (76% --> 47%, p < 0.01). Among patients prescribed medications, the average total number of diabetes-related medications rose from 2.96 to 3.70 medications (p < 0.01) with smaller increases seen for glucose lowering (1.45 --> 1.65, p < 0.01) and blood pressure lowering regimens (2.14 --> 2.51, p < 0.01), and no change for cholesterol lowering drugs (1.23 --> 1.19, p = 0.19). For laboratory tests, the proportion receiving cholesterol (40% --> 58%), and urine microalbumin (4% --> 18%) (all p's < 0.01) rose significantly, while the testing rates for HbA(1c) remained unchanged. The average total number of tests ordered per year increased significantly from 3.34 to 4.10 (p < 0.01) with more modest increases observed for individual tests.

Limitation: Trends analyses are unadjusted for many clinical characteristics that might influence the complexity of diabetes care.

Conclusions: Diabetes care grew more complex with the largest change in the number of patients receiving multi-component diabetes care. While the use of blood pressure and cholesterol lowering drugs rose overall, the proportion of patients using glucose lowering drugs declined and the average number of prescribed glucose lowering drugs did not increase in a clinically significant manner.

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Figures

Figure 1
Figure 1
Adjusted trends in (A) the proportion of patients with any or specific types of diabetes drugs, and (B) the total number of diabetes related drugs conditional on any use of drugs (adjusted for age, age-squared, female and interactions of female with age variables)
Figure 2
Figure 2
Adjusted trends in (A) the proportion of patients with any or specific types of laboratory tests, and (B) the total number of tests conditional on any use of tests (adjusted for age, age-squared, female and interactions of female with age variables)
Figure 3
Figure 3
Unadjusted trends in the use of (A) any drugs and (B) any tests for the five smallest and five largest managed care plans
Figure 4
Figure 4
Complexity of diabetes care over time (adjusted for age, age-squared, female and interactions of female with age variables)
See this image and copyright information in PMC

References

    1. UK Prospective Diabetes Study Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet. 1998;352:837–53. - PubMed
    1. UK Prospective Diabetes Study Group Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J. 1998;317:703–13. - PMC - PubMed
    1. Pyorala K, Pedersen TR, Kjekshus J, et al. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S) Diabetes Care. 1997;20:614–20. - PubMed
    1. Goldberg RB, Mellies MJ, Sacks FM, et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol and Recurrent Events Trial. Circulation. 1998;98:2513–9. - PubMed
    1. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New Eng J Med. 2003;348:383–93. - PubMed

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