Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study
This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans. A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DV...
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| Veröffentlicht in: | PloS one 2010-11, Vol.5 (11), p.e14024 |
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| creator | Vitry, Agnes I Roughead, Elizabeth E Preiss, Adrian K Ryan, Philip Ramsay, Emmae N Gilbert, Andrew L Caughey, Gillian E Shakib, Sepehr Esterman, Adrian Zhang, Ying McDermott, Robyn A |
| description | This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans.
A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DVA) claims database between July 2000 and June 2008. The study included new users of metformin or sulfonylurea medicines. The outcome was the time to addition or switch to another antidiabetic treatment. The total number of comorbid conditions unrelated to diabetes was identified using the pharmaceutical-based comorbidity index, Rx-Risk-V. Competing risk regression analyses were conducted, with adjustments for a number of covariates that included age, gender, residential status, use of endocrinology service, number of hospitalisation episodes and adherence to diabetes medicines. Overall, 20,134 veterans were included in the study. At one year, 23.5% of patients with diabetes had a second medicine added or had switched to another medicine, with 41.4% progressing by 4 years. The number of unrelated comorbidities was significantly associated with the time to addition of an antidiabetic medicine or switch to insulin (subhazard ratio [SHR] 0.87 [95% CI 0.84-0.91], P |
| doi_str_mv | 10.1371/journal.pone.0014024 |
| format | Article |
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A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DVA) claims database between July 2000 and June 2008. The study included new users of metformin or sulfonylurea medicines. The outcome was the time to addition or switch to another antidiabetic treatment. The total number of comorbid conditions unrelated to diabetes was identified using the pharmaceutical-based comorbidity index, Rx-Risk-V. Competing risk regression analyses were conducted, with adjustments for a number of covariates that included age, gender, residential status, use of endocrinology service, number of hospitalisation episodes and adherence to diabetes medicines. Overall, 20,134 veterans were included in the study. At one year, 23.5% of patients with diabetes had a second medicine added or had switched to another medicine, with 41.4% progressing by 4 years. The number of unrelated comorbidities was significantly associated with the time to addition of an antidiabetic medicine or switch to insulin (subhazard ratio [SHR] 0.87 [95% CI 0.84-0.91], P<0.001). Depression, cancer, chronic obstructive pulmonary disease, dementia, and Parkinson's disease were individually associated with a decreased likelihood of therapeutic progression. Age, residential status, number of hospitalisations and adherence to anti-diabetic medicines delayed therapeutic progression.
Increasing numbers of unrelated conditions decreased the likelihood of therapeutic progression in veterans with diabetes. These results have implications for the development of quality measures, clinical guidelines and the construction of models of care for management of diabetes in elderly people with comorbidities.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0014024</identifier><identifier>PMID: 21103337</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Analysis ; Antidiabetics ; Australia - epidemiology ; Cancer ; Chronic illnesses ; Chronic obstructive lung disease ; Chronic obstructive pulmonary disease ; Cohort analysis ; Cohort Studies ; Comorbidity ; Databases, Factual - statistics & numerical data ; Dementia ; Dementia disorders ; Development and progression ; Diabetes ; Diabetes and Endocrinology ; Diabetes and Endocrinology/Type 2 Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - pathology ; Diabetes therapy ; Diabetics ; Discipline ; Disease Progression ; Drug therapy ; Endocrinology ; Female ; Geriatrics ; Health services ; Humans ; Hypoglycemic agents ; Hypoglycemic Agents - therapeutic use ; Incidence ; Insulin ; Lung cancer ; Lung diseases ; Male ; Medical research ; Medicine ; Mental depression ; Metformin ; Movement disorders ; Neurodegenerative diseases ; Obstructive lung disease ; Older people ; Parkinson's disease ; Patients ; Pharmacy ; Population ; Prescriptions ; Public health ; Quality ; Regression Analysis ; Sulfonylurea ; Treatment Outcome ; Type 2 diabetes ; Veterans - statistics & numerical data</subject><ispartof>PloS one, 2010-11, Vol.5 (11), p.e14024</ispartof><rights>COPYRIGHT 2010 Public Library of Science</rights><rights>2010 Vitry et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Vitry et al. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-c0bd70333f0e7bf88f824d70ce7b1c84614bdcc0aebba6d0b115f568b49f15dc3</citedby><cites>FETCH-LOGICAL-c691t-c0bd70333f0e7bf88f824d70ce7b1c84614bdcc0aebba6d0b115f568b49f15dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984440/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984440/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21103337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Fadini, Gian Paolo</contributor><creatorcontrib>Vitry, Agnes I</creatorcontrib><creatorcontrib>Roughead, Elizabeth E</creatorcontrib><creatorcontrib>Preiss, Adrian K</creatorcontrib><creatorcontrib>Ryan, Philip</creatorcontrib><creatorcontrib>Ramsay, Emmae N</creatorcontrib><creatorcontrib>Gilbert, Andrew L</creatorcontrib><creatorcontrib>Caughey, Gillian E</creatorcontrib><creatorcontrib>Shakib, Sepehr</creatorcontrib><creatorcontrib>Esterman, Adrian</creatorcontrib><creatorcontrib>Zhang, Ying</creatorcontrib><creatorcontrib>McDermott, Robyn A</creatorcontrib><title>Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans.
A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DVA) claims database between July 2000 and June 2008. The study included new users of metformin or sulfonylurea medicines. The outcome was the time to addition or switch to another antidiabetic treatment. The total number of comorbid conditions unrelated to diabetes was identified using the pharmaceutical-based comorbidity index, Rx-Risk-V. Competing risk regression analyses were conducted, with adjustments for a number of covariates that included age, gender, residential status, use of endocrinology service, number of hospitalisation episodes and adherence to diabetes medicines. Overall, 20,134 veterans were included in the study. At one year, 23.5% of patients with diabetes had a second medicine added or had switched to another medicine, with 41.4% progressing by 4 years. The number of unrelated comorbidities was significantly associated with the time to addition of an antidiabetic medicine or switch to insulin (subhazard ratio [SHR] 0.87 [95% CI 0.84-0.91], P<0.001). Depression, cancer, chronic obstructive pulmonary disease, dementia, and Parkinson's disease were individually associated with a decreased likelihood of therapeutic progression. Age, residential status, number of hospitalisations and adherence to anti-diabetic medicines delayed therapeutic progression.
Increasing numbers of unrelated conditions decreased the likelihood of therapeutic progression in veterans with diabetes. These results have implications for the development of quality measures, clinical guidelines and the construction of models of care for management of diabetes in elderly people with comorbidities.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Antidiabetics</subject><subject>Australia - epidemiology</subject><subject>Cancer</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive lung disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Databases, Factual - statistics & numerical data</subject><subject>Dementia</subject><subject>Dementia disorders</subject><subject>Development and progression</subject><subject>Diabetes</subject><subject>Diabetes and Endocrinology</subject><subject>Diabetes and Endocrinology/Type 2 Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - pathology</subject><subject>Diabetes therapy</subject><subject>Diabetics</subject><subject>Discipline</subject><subject>Disease Progression</subject><subject>Drug therapy</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Health services</subject><subject>Humans</subject><subject>Hypoglycemic agents</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Incidence</subject><subject>Insulin</subject><subject>Lung cancer</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Mental depression</subject><subject>Metformin</subject><subject>Movement disorders</subject><subject>Neurodegenerative diseases</subject><subject>Obstructive lung disease</subject><subject>Older people</subject><subject>Parkinson's disease</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Population</subject><subject>Prescriptions</subject><subject>Public health</subject><subject>Quality</subject><subject>Regression Analysis</subject><subject>Sulfonylurea</subject><subject>Treatment Outcome</subject><subject>Type 2 diabetes</subject><subject>Veterans - 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A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DVA) claims database between July 2000 and June 2008. The study included new users of metformin or sulfonylurea medicines. The outcome was the time to addition or switch to another antidiabetic treatment. The total number of comorbid conditions unrelated to diabetes was identified using the pharmaceutical-based comorbidity index, Rx-Risk-V. Competing risk regression analyses were conducted, with adjustments for a number of covariates that included age, gender, residential status, use of endocrinology service, number of hospitalisation episodes and adherence to diabetes medicines. Overall, 20,134 veterans were included in the study. At one year, 23.5% of patients with diabetes had a second medicine added or had switched to another medicine, with 41.4% progressing by 4 years. The number of unrelated comorbidities was significantly associated with the time to addition of an antidiabetic medicine or switch to insulin (subhazard ratio [SHR] 0.87 [95% CI 0.84-0.91], P<0.001). Depression, cancer, chronic obstructive pulmonary disease, dementia, and Parkinson's disease were individually associated with a decreased likelihood of therapeutic progression. Age, residential status, number of hospitalisations and adherence to anti-diabetic medicines delayed therapeutic progression.
Increasing numbers of unrelated conditions decreased the likelihood of therapeutic progression in veterans with diabetes. These results have implications for the development of quality measures, clinical guidelines and the construction of models of care for management of diabetes in elderly people with comorbidities.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21103337</pmid><doi>10.1371/journal.pone.0014024</doi><tpages>e14024</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1292203115 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Aged, 80 and over Analysis Antidiabetics Australia - epidemiology Cancer Chronic illnesses Chronic obstructive lung disease Chronic obstructive pulmonary disease Cohort analysis Cohort Studies Comorbidity Databases, Factual - statistics & numerical data Dementia Dementia disorders Development and progression Diabetes Diabetes and Endocrinology Diabetes and Endocrinology/Type 2 Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - pathology Diabetes therapy Diabetics Discipline Disease Progression Drug therapy Endocrinology Female Geriatrics Health services Humans Hypoglycemic agents Hypoglycemic Agents - therapeutic use Incidence Insulin Lung cancer Lung diseases Male Medical research Medicine Mental depression Metformin Movement disorders Neurodegenerative diseases Obstructive lung disease Older people Parkinson's disease Patients Pharmacy Population Prescriptions Public health Quality Regression Analysis Sulfonylurea Treatment Outcome Type 2 diabetes Veterans - statistics & numerical data |
| title | Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T17%3A58%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Influence%20of%20comorbidities%20on%20therapeutic%20progression%20of%20diabetes%20treatment%20in%20Australian%20veterans:%20a%20cohort%20study&rft.jtitle=PloS%20one&rft.au=Vitry,%20Agnes%20I&rft.date=2010-11-17&rft.volume=5&rft.issue=11&rft.spage=e14024&rft.pages=e14024-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0014024&rft_dat=%3Cgale_plos_%3EA473832498%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1292203115&rft_id=info:pmid/21103337&rft_galeid=A473832498&rft_doaj_id=oai_doaj_org_article_a66d58b084ca4502ba4f47a00cad7661&rfr_iscdi=true |