DIFFERENCES IN ACHIEVING HBA1C GOALS AMONG PATIENTS SEEN BY ENDOCRINOLOGISTS AND PRIMARY CARE PROVIDERS
This study evaluated whether there is a difference in the proportion of patients with type 2 diabetes who achieve a hemoglobin A1c (HbA1c)
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| Veröffentlicht in: | Endocrine practice 2019-05, Vol.25 (5), p.461-469 |
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| container_title | Endocrine practice |
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| creator | Setji, Tracy L Page, Courtney Pagidipati, Neha Goldstein, Benjamin A |
| description | This study evaluated whether there is a difference in the proportion of patients with type 2 diabetes who achieve a hemoglobin A1c (HbA1c) |
| doi_str_mv | 10.4158/EP-2018-0405 |
| format | Article |
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We conducted a retrospective, propensity-matched study of patients with type 2 diabetes that were not optimally controlled and seen within our health system from 2007-2016. We assessed differences in short term health outcomes for patients following an endocrinologist visit compared to a PCP visit.
Patients seen by endocrinologists obtained HbA1c control at a faster rate (hazard ratio = 1.226; 95% confidence interval = 1.01 to 1.488) than those seen by a PCP. Furthermore, 34.5% and 29.5% of those treated by endocrinologists and PCPs, respectively, obtained HbA1c control by one year. Endocrinologists were more likely to prescribe a new medication class within 90 days than PCPs (14.1% versus 10.3%, respectively,
= .043). There was no difference in the risk of hospitalization between groups; 24.4% and 24.1% of those treated by endocrinologists and PCPs, respectively, were hospitalized within one year.
Patients treated by endocrinology specialists were more likely to achieve a target HbA1c of <7% (53 mmol/mol) than those treated by PCPs in our health-care system. The performance difference may be partially explained by a higher rate of adding new classes of diabetes medications to the patient's pharmacologic regimens within 90 days by endocrinologists compared with PCPs. The long-term impact of these differences is unknown but has the potential to have an unfavorable impact on the health of the population.
= American College of Physicians;
= confidence interval;
= Duke University Health System;
= hemoglobin A1c;
= hazard ratio;
= primary care physician;
= standard mean difference.</description><identifier>ISSN: 1530-891X</identifier><identifier>EISSN: 1934-2403</identifier><identifier>DOI: 10.4158/EP-2018-0405</identifier><identifier>PMID: 30720349</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Confidence intervals ; Diabetes ; Diabetes Mellitus, Type 2 ; Endocrinologists ; Endocrinology ; Glucose ; Glycated Hemoglobin A ; Goals ; Hemoglobin ; Humans ; Hypoglycemia ; Insulin ; Medical referrals ; Patients ; Primary care ; Primary Health Care ; Retrospective Studies ; Studies</subject><ispartof>Endocrine practice, 2019-05, Vol.25 (5), p.461-469</ispartof><rights>Copyright Allen Press Publishing Services May 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c319t-61e81b4c1bcb78a0236b7a119fb7b0345faec6eca0b0132a7ee2f7da24283763</citedby><cites>FETCH-LOGICAL-c319t-61e81b4c1bcb78a0236b7a119fb7b0345faec6eca0b0132a7ee2f7da24283763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2236126608?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,782,786,27933,27934,64394,64396,64398,72478</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30720349$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Setji, Tracy L</creatorcontrib><creatorcontrib>Page, Courtney</creatorcontrib><creatorcontrib>Pagidipati, Neha</creatorcontrib><creatorcontrib>Goldstein, Benjamin A</creatorcontrib><title>DIFFERENCES IN ACHIEVING HBA1C GOALS AMONG PATIENTS SEEN BY ENDOCRINOLOGISTS AND PRIMARY CARE PROVIDERS</title><title>Endocrine practice</title><addtitle>Endocr Pract</addtitle><description>This study evaluated whether there is a difference in the proportion of patients with type 2 diabetes who achieve a hemoglobin A1c (HbA1c) <7% within one year following treatment by an endocrinologist or primary care physician (PCP).
We conducted a retrospective, propensity-matched study of patients with type 2 diabetes that were not optimally controlled and seen within our health system from 2007-2016. We assessed differences in short term health outcomes for patients following an endocrinologist visit compared to a PCP visit.
Patients seen by endocrinologists obtained HbA1c control at a faster rate (hazard ratio = 1.226; 95% confidence interval = 1.01 to 1.488) than those seen by a PCP. Furthermore, 34.5% and 29.5% of those treated by endocrinologists and PCPs, respectively, obtained HbA1c control by one year. Endocrinologists were more likely to prescribe a new medication class within 90 days than PCPs (14.1% versus 10.3%, respectively,
= .043). There was no difference in the risk of hospitalization between groups; 24.4% and 24.1% of those treated by endocrinologists and PCPs, respectively, were hospitalized within one year.
Patients treated by endocrinology specialists were more likely to achieve a target HbA1c of <7% (53 mmol/mol) than those treated by PCPs in our health-care system. The performance difference may be partially explained by a higher rate of adding new classes of diabetes medications to the patient's pharmacologic regimens within 90 days by endocrinologists compared with PCPs. The long-term impact of these differences is unknown but has the potential to have an unfavorable impact on the health of the population.
= American College of Physicians;
= confidence interval;
= Duke University Health System;
= hemoglobin A1c;
= hazard ratio;
= primary care physician;
= standard mean difference.</description><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2</subject><subject>Endocrinologists</subject><subject>Endocrinology</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A</subject><subject>Goals</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Insulin</subject><subject>Medical referrals</subject><subject>Patients</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Retrospective Studies</subject><subject>Studies</subject><issn>1530-891X</issn><issn>1934-2403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkMtPAjEQxhujEURvnk0TLx5c7bT7PJalQBPYJbuEyKnpLl0D4eUuHPzvLQE9eJrXb76ZfAg9AnlzwQvfxcShBEKHuMS7Qm2ImOtQl7Brm3uMOGEEHy101zQrQiiJILxFLUYCSpgbtdFnT_b7IhNJLHIsE8zjoRQzmQzwsMshxoOUj3LMx6ntTPhUimSa41yIBHfnWCS9NM5kko7SgcztgCc9PMnkmGdzHPNM2CKdyZ7I8nt0U-l1Yx4usYOmfTGNh85pNeYjp2QQHRwfTAiFW0JRFkGoCWV-EWiAqCqCwn7sVdqUvik1KQgwqgNjaBUsNHVpyAKfddDLWXZf776OpjmozbIpzXqtt2Z3bBSFIPKARr5r0ed_6Gp3rLf2OUXtWaC-T0JLvZ6pst41TW0qta-XG11_KyDq5L8SE3XyX538t_jTRfRYbMziD_41nP0AW5J1mw</recordid><startdate>201905</startdate><enddate>201905</enddate><creator>Setji, Tracy L</creator><creator>Page, Courtney</creator><creator>Pagidipati, Neha</creator><creator>Goldstein, Benjamin A</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201905</creationdate><title>DIFFERENCES IN ACHIEVING HBA1C GOALS AMONG PATIENTS SEEN BY ENDOCRINOLOGISTS AND PRIMARY CARE PROVIDERS</title><author>Setji, Tracy L ; Page, Courtney ; Pagidipati, Neha ; Goldstein, Benjamin A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c319t-61e81b4c1bcb78a0236b7a119fb7b0345faec6eca0b0132a7ee2f7da24283763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Confidence intervals</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2</topic><topic>Endocrinologists</topic><topic>Endocrinology</topic><topic>Glucose</topic><topic>Glycated Hemoglobin A</topic><topic>Goals</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Insulin</topic><topic>Medical referrals</topic><topic>Patients</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Retrospective Studies</topic><topic>Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Setji, Tracy L</creatorcontrib><creatorcontrib>Page, Courtney</creatorcontrib><creatorcontrib>Pagidipati, Neha</creatorcontrib><creatorcontrib>Goldstein, Benjamin A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Endocrine practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Setji, Tracy L</au><au>Page, Courtney</au><au>Pagidipati, Neha</au><au>Goldstein, Benjamin A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>DIFFERENCES IN ACHIEVING HBA1C GOALS AMONG PATIENTS SEEN BY ENDOCRINOLOGISTS AND PRIMARY CARE PROVIDERS</atitle><jtitle>Endocrine practice</jtitle><addtitle>Endocr Pract</addtitle><date>2019-05</date><risdate>2019</risdate><volume>25</volume><issue>5</issue><spage>461</spage><epage>469</epage><pages>461-469</pages><issn>1530-891X</issn><eissn>1934-2403</eissn><abstract>This study evaluated whether there is a difference in the proportion of patients with type 2 diabetes who achieve a hemoglobin A1c (HbA1c) <7% within one year following treatment by an endocrinologist or primary care physician (PCP).
We conducted a retrospective, propensity-matched study of patients with type 2 diabetes that were not optimally controlled and seen within our health system from 2007-2016. We assessed differences in short term health outcomes for patients following an endocrinologist visit compared to a PCP visit.
Patients seen by endocrinologists obtained HbA1c control at a faster rate (hazard ratio = 1.226; 95% confidence interval = 1.01 to 1.488) than those seen by a PCP. Furthermore, 34.5% and 29.5% of those treated by endocrinologists and PCPs, respectively, obtained HbA1c control by one year. Endocrinologists were more likely to prescribe a new medication class within 90 days than PCPs (14.1% versus 10.3%, respectively,
= .043). There was no difference in the risk of hospitalization between groups; 24.4% and 24.1% of those treated by endocrinologists and PCPs, respectively, were hospitalized within one year.
Patients treated by endocrinology specialists were more likely to achieve a target HbA1c of <7% (53 mmol/mol) than those treated by PCPs in our health-care system. The performance difference may be partially explained by a higher rate of adding new classes of diabetes medications to the patient's pharmacologic regimens within 90 days by endocrinologists compared with PCPs. The long-term impact of these differences is unknown but has the potential to have an unfavorable impact on the health of the population.
= American College of Physicians;
= confidence interval;
= Duke University Health System;
= hemoglobin A1c;
= hazard ratio;
= primary care physician;
= standard mean difference.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>30720349</pmid><doi>10.4158/EP-2018-0405</doi><tpages>9</tpages></addata></record> |
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| ispartof | Endocrine practice, 2019-05, Vol.25 (5), p.461-469 |
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| language | eng |
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| source | MEDLINE; ProQuest Central UK/Ireland; Alma/SFX Local Collection |
| subjects | Confidence intervals Diabetes Diabetes Mellitus, Type 2 Endocrinologists Endocrinology Glucose Glycated Hemoglobin A Goals Hemoglobin Humans Hypoglycemia Insulin Medical referrals Patients Primary care Primary Health Care Retrospective Studies Studies |
| title | DIFFERENCES IN ACHIEVING HBA1C GOALS AMONG PATIENTS SEEN BY ENDOCRINOLOGISTS AND PRIMARY CARE PROVIDERS |
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