Original Report

Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor-based electronic health record†

  1. Emily S. Brouwer1,2,
  2. Suzanne L. West1,2,*,
  3. Marianne Kluckman1,
  4. Dennis Wallace1,
  5. Andrew L. Masica3,
  6. Edward Ewen4,
  7. Rustam Kudyakov3,
  8. Dunlei Cheng3,
  9. James Bowen4,
  10. Neil S. Fleming3

Article first published online: 16 JAN 2012

DOI: 10.1002/pds.2262

Issue

Pharmacoepidemiology and Drug Safety

Pharmacoepidemiology and Drug Safety

Volume 21, Issue 9, pages 920–928, September 2012

Additional Information

How to Cite

Brouwer, E. S., West, S. L., Kluckman, M., Wallace, D., Masica, A. L., Ewen, E., Kudyakov, R., Cheng, D., Bowen, J. and Fleming, N. S. (2012), Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor-based electronic health record. Pharmacoepidem. Drug Safe., 21: 920–928. doi: 10.1002/pds.2262

Author Information

  1. 1

    RTI International, Research Triangle Park, NC, USA

  2. 2

    University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

  3. 3

    Baylor Health Care System, Dallas, TX, USA

  4. 4

    Christiana Care Health System, Newark, DE, USA

*S. West, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709–2194, USA. E-mail: swest@rti.org

  • †

    These data were presented at the 26th International Conference on Pharmacoepidemiology, Brighton, UK, August 20, 2010.

Publication History

  1. Issue published online: 4 SEP 2012
  2. Article first published online: 16 JAN 2012
  3. Manuscript Accepted: 13 SEP 2011
  4. Manuscript Revised: 29 AUG 2011
  5. Manuscript Received: 23 FEB 2011

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Keywords:

  • Type 2 Diabetes Mellitus;
  • Pharmacoepidemiology;
  • Electronic Health Records;
  • Oral hypoglycemics

ABSTRACT

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. Copyright © 2012 John Wiley & Sons, Ltd.

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