Almost half of U.S. T2D patients (pts) have suboptimal glycemic control (A1c ≥7%). One factor that may be associated with this is clinical inertia related to physician/patient actions or lack of “conformance” to guidelines. We characterized uncontrolled pts in terms of conformance in a large U.S. database (Aetna). This study included T2D pts with at least one A1c ≥7% from Jul 2014-Aug 2015 with ≥6 months pre-index data (Era 1), 12 months post-index data to assess conformance (Era 2), and ≥6 months data post-Era 2 to assess outcomes (Era 3; Figure). Conformance was defined as high (HC) or low (LC) based on provider actions (A1c test performed, T2D office visit, or medication changed/added) and patient goal attainment (A1c <7%). There were 21,171 eligible pts who had the following characteristics: median age 60 years, 55% male, and 80% HC. In a multivariate model, odds ratios (OR) for Era 1 factors associated with HC were: comorbidities (OR=1.09 [1.07, 1.12]), A1c test (OR=1.43 [1.28, 1.60]), PCP visit (OR=3.23 [3.01, 3.47]), nephropathy screening (OR=0.84 [0.79, 0.89]), oral T2D medication use (OR=0.83 [0.77, 0.90]), age (OR=0.99 [0.98, 0.99]), GLP-1 use (OR=1.20 [1.004, 1.44]), and episode risk group score (measure of healthcare utilization; OR=1.01 [1.001, 1.03]).
In conclusion, factors associated with conformance to guidelines, as identified in this study, can help target interventions to improve clinical outcomes in these high risk subgroups.
R. Mehta: None. A. Edwards: None. S. Rajpathak: Employee; Self; Merck & Co., Inc.. A. Sharma: None. K.J. Snow: Employee; Self; Aetna Inc. K. Iglay: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc..