RISK MODIFICATION FOR DIABETIC PATIENTS ARE OTHER RISK FACTORS TREATED AS DILIGENTLY AS GLYCEMIA?
Main Article Content
Keywords
diabetes mellitus, risk modification, drug prescriptions, administrative data
Abstract
Background
The importance of glucose control is recognized both by patients with diabetes and their physicians. However, other preventative interventions, such as using medications to manage lipid and blood pressure levels, are underused for diabetic patients.
Objectives
To determine whether patients with diligent glucose management are more likely to use medications that treat lipids and blood pressure.
Methods
Administrative data records were evaluated for all diabetic patients aged 65 or older residing in Ontario in
1999 without pre-existing coronary artery disease (n=161,553). Measures of diligent glucose management were insulin use and frequent capillary glucose testing (? 2 per day). Outcomes were prescription of a lipid-lowering drug or antihypertensive drug. Using multivariate modeling, odds ratios for each diligence measure were determined for each outcome, adjusting for age, sex, comorbidities, and other covariates.
Results
Patients using insulin did not have a clinically important difference in lipid-lowering drug use (adjusted odds ratio 0.9, 99% confidence interval 0.9–1.0, P=0.002) or antihypertensive drug use (adjusted odds ratio 1.1, 99% confidence interval 1.0–1.1, P<0.001) versus non-users. Adjusted odds ratios for frequent glucose testing were not significantly different from unity for either lipid-lowering or antihypertensive drug use.
Conclusions
Patients who required and were capable of diligent glucose management, which is invasive, expensive and time-consuming, were no more likely to use medications to control lipids or blood pressure. Preventative care for patients with diabetes may be too focused on glycemic control, and may be neglecting the management of other cardiovascular risk factors.
References
Diabetes Care 2003;26(Supp 1):S33–S50.
2. Weiner JP, Parente ST, Garnick DW, Fowles J, Lawthers AG, Palmer RH. Variation in office-based quality: a claims-based profile of care provided to Medicare patients with diabetes. JAMA
1995;273:1503–8.
3. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KMV. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med 2002;136:565–74.
4. Shah BR, Mamdani M, Kopp A. Drug use in older people with diabetes. In: Hux JE, Booth GL, Slaughter PM, Laupacis A, eds. Diabetes in Ontario: An ICES
Practice Atlas. Toronto: Institute for Clinical
Evaluative Sciences, 2003:3.51–3.75.
5. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998;317:703–13.
6. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of
complications in patients with type 2 diabetes (UKPDS
33). Lancet 1998;352:837–53.
7. Hux JE, Ivis F, Flintoft V, Bica A. Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 2002;25:512–7.
8. Bice TW, Boxerman SB. A quantitative measure of continuity of care. Medical Care 1977;15:347–9.
9. Schneeweiss S, Seeger JD, Maclure M, Wang PS,
Avorn J, Glynn RJ. Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol 2001;154:854–64.
10. Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, eds. Diabetes in America. 2nd ed. Washington, DC: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1995.
11. MacLean DR, Petrasovits A, Connelly PW, Joffres M, O’Connor B, Little JA. Plasma lipids and lipoprotein reference values, and the prevalence of
dyslipoporteinemia in Canadian adults. Can J Cardiol
1999;15:434–44.
12. Beckman TJ, Cuddihy RM, Scheitel SM, Naessens JM, Killian JM, Pankratz VS. Screening mammogram utilization in women with diabetes. Diabetes Care
2001;24:2049–53.
13. Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical
diseases. New Engl J Med 1998;338:1516–20.
14. Fontana SA, Baumann LC, Helberg C, Love RR. The delivery of preventive services in primary care practices according to chronic disease status. Am J Public Health 1997;87:1190–6.
15. Meltzer S, Leiter L, Daneman D, et al. 1998 clinical practice guidelines for the management of diabetes in Canada. Can Med Assoc J 1998;159(8
Suppl):S1–S29.
16. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2003;27(Suppl 2):S1–S115.
17. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2004;27(Suppl
1):S15–S35.
18. Berlowitz DR, Ash AS, Hickey EC, Glickman M, Friedman R, Kader B. Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care 2003;26:355–9.
19. Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ. Quality of care for patients diagnosed with diabetes at screening. Diabetes Care 2003;26:367–71.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.