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- W3204118732 abstract "In this study, we aimed to characterize time to treatment intensification (TTI) in people on metformin with uncontrolled hyperglycemia, and estimated the frequency of physician visits until intensification.This work was a cohort study of Albertan adults with glycated hemoglobin (A1C) of >7.5% after at least 3 months of metformin monotherapy, using administrative databases from 2009 to 2018, with each subject followed for up to 4 years. Therapeutic intensification was defined as dispensation of an additional class of antihyperglycemic medication. Median TTI and the median number of physician visits were estimated from Kaplan-Meier functions within age/A1C strata. A Cox proportional hazards model was fitted to examine predictors of therapeutic intensification.We included 38,846 people (average age, 57 years; 37% female; mean A1C, 8.8%). Overall, therapeutic intensification was observed in 23,077 (59%; 40% at 1 year). Median TTI was 1.4 years, varying from 0.7 years (A1C >8.5%, age <65 years) to 3.3 years (age ≥75 years, any A1C). The median number of physician visits until intensification was 9, varying between 5 (A1C >8.5%, age <65 years) and ≥30 (age ≥75 years); 93% of people awaiting intensification had at least 2 visits by 1 year. Higher A1C and younger age were the strongest predictors of intensification. Results were similar in people with ischemic heart disease.Despite ample contacts with community physicians, TTI exceeds the 6-month target recommended by guidelines, particularly in older adults. Further study is needed to better understand these foregone opportunities as guidelines call for wider promulgation of agents with cardiorenal benefits." @default.
- W3204118732 created "2021-10-11" @default.
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- W3204118732 date "2021-09-01" @default.
- W3204118732 modified "2023-09-23" @default.
- W3204118732 title "Foregone opportunities? Time-to-treatment intensification among adults with type 2 diabetes and elevated HbA1c on metformin monotherapy, 2009-2018" @default.
- W3204118732 doi "https://doi.org/10.1016/j.jcjd.2021.09.006" @default.
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- W3204118732 hasPublicationYear "2021" @default.
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