Use of an Electronic Medical Record (EMR) to Identify Glycemic Intensification Strategies in Type 2 Diabetes

Korytkowski, Mary T.; Brooks, Maria M.; Lombardero, M.; DeAlmeida, Dilhari R.; Kanter, Justin; Magaji, Vasudev; Orchard, Trevor J.; Siminerio, Linda M.

doi:10.1177/1932296814564183

Cited by 6 publications

(11 citation statements)

References 35 publications

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“…This study was performed using data from an earlier study investigating prescribing patterns for patients with T2D and HbA1c values ≥7.0% (53 mmol/mol) while receiving treatment with one or two ODM. 25 The results for prevalent and incident CVD events are reported according to treatment strategy employed among patients having available follow-up data from this earlier report. The results of this study are consistent with prior studies demonstrating a high prevalence and incidence of CVD in a patient population with T2D ( table 2 , figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

“… 34 The reasons for the infrequent use of these agents (3.6% of those receiving therapeutic intensification) are not known, but it is possible that this class of agents are being prescribed to participants who were not candidates for inclusion in this study, including those with HbA1c <7% (53 mmol/mol), who may be treated with >2 ODM, or who may already be receiving INS therapy. 25 …”

Section: Discussionmentioning

confidence: 99%

“… 26 Data extraction methods for this study were previously described. 25 Briefly, ambulatory de-identified EHR information from a large institutional data repository was searched to identify any patient visit that listed an oral diabetes medication (ODM) as an active therapy between June 2005 and November 2011. Patients with glycated hrmoglobin (HbA1c) ≥7% (53 mmol/mol) (index HbA1c value) who had existing prescriptions for one or two ODM, documentation of at least one follow-up visit after the index HbA1c, and available ICD-9 codes (n=3331) were included in this study (see online supplementary appendix A).…”

Section: Methodsmentioning

confidence: 99%

“…Prevalent and incident CVD events were examined separately for all patients with or without baseline evidence of a CVD event, and according to therapeutic intensification with any insulin (INS) therapy, a glucagon-like peptide-1 receptor agent (GLP-1RA) (exenatide or liraglutide), a new class of ODM or no additional therapy (NAT). 25 …”

Section: Methodsmentioning

confidence: 99%

“…The primary aim of this study was to examine the ability of an EHR to accurately identify pre-existing and incident CVD events using the ICD-9 codes in a cohort of patients with T2D previously identified in another study investigating the ability of an EHR to identify patterns of therapeutic intensification of glucose-lowering therapies in patients with T2D. 25 …”

Section: Introductionmentioning

confidence: 99%

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Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy

Korytkowski

French

Brooks

et al. 2016

BMJ Open Diab Res Care

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BackgroundThe increasing use of electronic health records (EHRs) in clinical practice offers the potential to investigate cardiovascular outcomes over time in patients with type 2 diabetes (T2D).ObjectiveTo develop a methodology for identifying prevalent and incident cardiovascular disease (CVD) in patients with T2D who are candidates for therapeutic intensification of glucose-lowering therapy.MethodsPatients with glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol) while receiving 1–2 oral diabetes medications (ODMs) were identified from an EHR (2005–2011) and grouped according to intensification with insulin (INS) (n=372), a different class of ODM (n=833), a glucagon-like peptide receptor 1 agonist (GLP-1RA) (n=59), or no additional therapy (NAT) (n=2017). Baseline prevalence of CVD was defined by documented International Classification of Diseases Ninth Edition (ICD-9) codes for coronary artery disease, cerebrovascular disease, or other CVD with first HbA1c ≥7% (53 mmol/mol). Incident CVD was defined as a new ICD-9 code different from existing codes over 4 years of follow-up. ICD-9 codes were validated by a chart review in a subset of patients.ResultsSensitivity of ICD-9 codes for CVD ranged from 0.83 to 0.89 and specificity from 0.90 to 0.96. Baseline prevalent (INS vs ODM vs GLP-1RA vs NAT: 65% vs 39% vs 54% vs 59%, p<0.001) and incident CVD (Kaplan-Meier estimates: 58%, 31%, 52%, and 54%, p=0.002) were greater in INS group after controlling for differences in baseline HbA1c (9.2±2.0% vs 8.3±1.2% vs 8.2±1.3% vs 7.7±1.1% (77 vs 67 vs 66 vs 61 mmol/mol), p<0.001) and creatinine (1.15±0.96 vs 1.10±0.36 vs 1.01±0.35 vs 1.07±0.45 mg/dL, p=0.001).ConclusionsAn EHR can be an effective method for identifying prevalent and incident CVD in patients with T2D.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy

Korytkowski

French

Brooks

et al. 2016

BMJ Open Diab Res Care

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Ertugliflozin and Sitagliptin Co-initiation in Patients with Type 2 Diabetes: The VERTIS SITA Randomized Study

Miller

Krumins

Zhou³

et al. 2018

Diabetes Ther

109

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IntroductionErtugliflozin is an oral sodium-glucose cotransporter 2 inhibitor that is being developed to treat type 2 diabetes mellitus (T2DM). This study assessed the efficacy and safety of co-initiation of ertugliflozin and sitagliptin compared with placebo in patients with T2DM inadequately controlled on diet and exercise.MethodsIn this phase III, randomized, double-blind, multicenter, placebo-controlled 26-week study (NCT02226003), patients with T2DM and glycated hemoglobin (HbA1c) 8.0–10.5% on diet/exercise were randomized 1:1:1 to ertugliflozin 5 mg once daily (QD) and sitagliptin 100 mg QD (E5/S100), ertugliflozin 15 mg QD and sitagliptin 100 mg QD (E15/S100), or placebo. The primary efficacy endpoint was the change from baseline in HbA1c at week 26.ResultsThe mean baseline HbA1c of the randomized patients (n = 291) was 8.9%. At week 26, both ertugliflozin/sitagliptin treatments provided significant reductions from baseline in HbA1c compared with placebo [least squares mean HbA1c change (95% confidence intervals) from baseline was − 0.4% (− 0.7, − 0.2), − 1.6% (− 1.8, − 1.4), and − 1.7% (− 1.9, − 1.5) for placebo, E5/S100, and E15/S100, respectively]. At week 26, 8.3%, 35.7%, and 31.3% of patients receiving placebo, E5/S100, and E15/S100, respectively, had HbA1c < 7.0%. Significant reductions in fasting plasma glucose, 2-h post-prandial glucose, body weight, and systolic blood pressure were observed with both ertugliflozin/sitagliptin groups compared with placebo. The incidence of adverse events (AEs) was similar across the groups. The incidences of the pre-specified AEs of urinary tract infection, genital mycotic infection, symptomatic hypoglycemia, and hypovolemia were low and not meaningfully different across groups.ConclusionCo-initiation of ertugliflozin with sitagliptin in patients with T2DM inadequately controlled on diet and exercise provided a clinically meaningful improvement in glycemic control over 26 weeks.Clinical Trial RegistrationClinicaltrials.gov NCT02226003.Electronic supplementary materialThe online version of this article (10.1007/s13300-017-0358-0) contains supplementary material, which is available to authorized users.

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Effect of Treatment of OSA With CPAP on Glycemic Control in Adults With Type 2 Diabetes: The Diabetes Sleep Treatment Trial (DSTT)

et al. 2022

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Use of an Electronic Medical Record (EMR) to Identify Glycemic Intensification Strategies in Type 2 Diabetes

Cited by 6 publications

References 35 publications

Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy

Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy

Ertugliflozin and Sitagliptin Co-initiation in Patients with Type 2 Diabetes: The VERTIS SITA Randomized Study

Effect of Treatment of OSA With CPAP on Glycemic Control in Adults With Type 2 Diabetes: The Diabetes Sleep Treatment Trial (DSTT)

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