A 7.0–7.7% value for glycated haemoglobin is better than a &lt;7% value as an appropriate target for patient-centered drug treatment of type 2 diabetes mellitus

Nunes, José Pedro L.; DeMarco, Joseph P.

doi:10.21037/atm.2019.05.43

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…For elderly patients, it may be reasonable to suggest a slightly higher glycemic control target, because previous studies showed higher mortality at HbA 1c < 42 mmol/mol (6.0%), with the relationship showing a U-shaped curve [ 10 , 20 , 22 – 26 ]. Some studies have suggested individualized strategies for diabetes treatment, especially in the elderly [ 27 ]. This is consistent with the purpose and the results of our study, suggesting a slightly higher target HbA 1c while minimizing the risk of long-term complications.…”

Section: Discussionmentioning

confidence: 99%

Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Kim

Lee

Seo

2020

Journal of Diabetes Research

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Objective. Tight glycemic control reduces the risk of diabetes complications, but it may increase the risk of hypoglycemia or mortality in elderly patients. This study is aimed at evaluating the incidence and progression of renal complications and its association with glycemic control in elderly patients with type 2 diabetes. Methods. This retrospective cohort study examined the data of 3099 patients with type 2 diabetes who were followed for at least 10 years at the Korean Veterans Hospital and for whom glycated hemoglobin (HbA1c) was measured in 2008 and 2017. Participants were divided into six groups according to their baseline or dynamic HbA1c levels. Extended Cox models were used to calculate adjusted hazard ratios for the development of chronic kidney disease (CKD) and end-stage renal disease (ESRD) associated with specific HbA1c ranges. Results. During the 10-year follow-up period, 30% of patients developed new CKD, 50% showed progression, and ESRD developed in 1.7%. The risk of CKD was associated with baseline HbA1c from the first year of the study and dynamic HbA1c throughout the study period. The adjusted hazard ratios for CKD were 1.98 and 2.32 for baseline and dynamic HbA1c, respectively, at the level of ≥69 mmol/mol. There was no increased risk for any complications in baseline and dynamic HbA1c below 58 mmol/mol. Conclusions. A higher HbA1c≥58 mmol/mol was associated with an increased risk of diabetes complications. A less stringent glycemic target of HbA1c could be used as the threshold of renal complications.

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Section: Discussionmentioning

confidence: 99%

Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Kim

Lee

Seo

2020

Journal of Diabetes Research

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“…Pre-diabetes was defined by the highest HbA1c falling within the range of 6.0%–6.4% or through an oral glucose tolerance test, random plasma glucose test, or fasting plasma glucose test adhering to the thresholds listed in the Diabetes Canada guidelines, and no prescribed antidiabetic medications. Diabetes status was categorised as follows: as (1) HbA1c≥6.5%, if no evidence of medication, (2) meeting glycaemic targets: HbA1c values<7.0%, supported by evidence of both prescribed and dispensed medications, and (3) not meeting glycaemic targets: indicated by the highest HbA1c laboratory result closest to discharge>7.0 % 18. Another subgroup of individuals with diabetes was identified as those with appropriately intensified therapy with agents known to confer cardiorenal benefit such as (1) GLP1RA if obese or with a history of cardiovascular disease or stroke, and (2) SGLT2 if chronic kidney disease (low GFR or albuminuria) or cardiovascular disease.…”

Section: Methodsmentioning

confidence: 99%

“…Diabetes status was categorised as follows: as (1) HbA1c≥6.5%, if no evidence of medication, (2) meeting glycaemic targets: HbA1c values<7.0%, supported by evidence of both prescribed and dispensed medications, and (3) not meeting glycaemic targets: indicated by the highest HbA1c laboratory result closest to discharge>7.0 %. 18 Another subgroup of individuals with diabetes was identified as those with appropriately intensified therapy with agents known to confer cardiorenal benefit such as (1) GLP1RA if obese or with a history of cardiovascular disease or stroke, and (2) SGLT2 if chronic kidney disease (low GFR or albuminuria) or cardiovascular disease. These data were analysed using a time-series context, and all laboratory and medication records were used.…”

Section: Methodsmentioning

confidence: 99%

Exploring the reliability of inpatient EMR algorithms for diabetes identification

Lee,

Martin,

Pan

et al. 2023

BMJ Health Care Inform

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IntroductionAccurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on integrating various sources of administrative data, but at times, there is a considerable lag in obtaining and linking these data. Our study objective was to develop electronic medical records (EMR) data-based inpatient diabetes phenotyping algorithms.Materials and methodsA chart review on 3040 individuals was completed, and 583 had diabetes. We linked EMR data on these individuals to the International Classification of Disease (ICD) administrative databases. The following EMR-data-based diabetes algorithms were developed: (1) laboratory data, (2) medication data, (3) laboratory and medications data, (4) diabetes concept keywords and (5) diabetes free-text algorithm. Combined algorithms usedorstatements between the above algorithms. Algorithm performances were measured using chart review as a gold standard. We determined the best-performing algorithm as the one that showed the high performance of sensitivity (SN), and positive predictive value (PPV).ResultsThe algorithms tested generally performed well: ICD-coded data, SN 0.84, specificity (SP) 0.98, PPV 0.93 and negative predictive value (NPV) 0.96; medication and laboratory algorithm, SN 0.90, SP 0.95, PPV 0.80 and NPV 0.97; all document types algorithm, SN 0.95, SP 0.98, PPV 0.94 and NPV 0.99.DiscussionFree-text data-based diabetes algorithm can yield comparable or superior performance to a commonly used ICD-coded algorithm and could supplement existing methods. These types of inpatient EMR-based algorithms for case identification may become a key method for timely resource planning and care delivery.

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Evaluating the coding accuracy of type 2 diabetes mellitus among patients with non-alcoholic fatty liver disease

Lee,

Shaheen,

Campbell

et al. 2024

BMC Health Serv Res

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Background Non-alcoholic fatty liver disease (NAFLD) describes a spectrum of chronic fattening of liver that can lead to fibrosis and cirrhosis. Diabetes has been identified as a major comorbidity that contributes to NAFLD progression. Health systems around the world make use of administrative data to conduct population-based prevalence studies. To that end, we sought to assess the accuracy of diabetes International Classification of Diseases (ICD) coding in administrative databases among a cohort of confirmed NAFLD patients in Calgary, Alberta, Canada. Methods The Calgary NAFLD Pathway Database was linked to the following databases: Physician Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, Pharmaceutical Information Network database, Laboratory, and Electronic Medical Records. Hemoglobin A1c and diabetes medication details were used to classify diabetes groups into absent, prediabetes, meeting glycemic targets, and not meeting glycemic targets. The performance of ICD codes among these groups was compared to this standard. Within each group, the total numbers of true positives, false positives, false negatives, and true negatives were calculated. Descriptive statistics and bivariate analysis were conducted on identified covariates, including demographics and types of interacted physicians. Results A total of 12,012 NAFLD patients were registered through the Calgary NAFLD Pathway Database and 100% were successfully linked to the administrative databases. Overall, diabetes coding showed a sensitivity of 0.81 and a positive predictive value of 0.87. False negative rates in the absent and not meeting glycemic control groups were 4.5% and 6.4%, respectively, whereas the meeting glycemic control group had a 42.2% coding error. Visits to primary and outpatient services were associated with most encounters. Conclusion Diabetes ICD coding in administrative databases can accurately detect true diabetic cases. However, patients with diabetes who meets glycemic control targets are less likely to be coded in administrative databases. A detailed understanding of the clinical context will require additional data linkage from primary care settings.

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A 7.0–7.7% value for glycated haemoglobin is better than a <7% value as an appropriate target for patient-centered drug treatment of type 2 diabetes mellitus

Cited by 3 publications

References 37 publications

Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Exploring the reliability of inpatient EMR algorithms for diabetes identification

Evaluating the coding accuracy of type 2 diabetes mellitus among patients with non-alcoholic fatty liver disease

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