Yet, in our patient populace, mean HbA1c levels were lower among patients with comorbidities compared with patients without, especially if the comorbidities were unrelated to diabetes or were advanced: 7.4% with no comorbidities, 7.3% with only concordant comorbidities, 7.1% with only discordant comorbidities (decreasing further as the number of discordant comorbidities increased), and 7.0% with advanced comorbidities. type 2 diabetes included in OptumLabs Data Warehouse, 1 January 2014 Duocarmycin A to 31 December 2016. Comorbidity burden was assessed by counts of any of 16 comorbidities specified by guidelines as warranting relaxation of HbA1c targets, classified as being diabetes concordant (diabetes complications or risk factors), discordant (unrelated to diabetes), or advanced (life limiting). Results Among 194?157 patients with type 2 diabetes included in the study, 45.2% had only concordant comorbidities, 30.6% concordant and discordant, 2.7% only discordant, and 13.0% had 1 advanced comorbidity. Mean HbA1c was 7.7% among 18C44?year-olds versus 6.9% among 75 year-olds, and was higher among patients with comorbidities: 7.3% with concordant only, 7.1% with discordant only, Duocarmycin A 7.1% with concordant and discordant, and 7.0% with advanced comorbidities compared with 7.4% among patients without comorbidities. The odds of insulin use decreased with age (OR 0.51 (95% CI 0.48 to 0.54) for age 75?vs 18C44 years) but increased with accumulation of concordant (OR 5.50 (95% CI 5.22 to 5.79) for 3?vs none), discordant (OR 1.72 (95% CI 1.60 to 1 1.86) for 3?vs none), and advanced (OR 1.45 (95% CI 1.25 to 1 1.68) for 2?vs none) comorbidities. Conversely, sulfonylurea use increased with age (OR 1.36 (95% CI 1.29 to 1 1.44) for age 75?vs 18C44 years) but decreased with accumulation of concordant (OR 0.76 (95% CI 0.73 to 0.79) for 3?vs none), discordant (OR 0.70 (95% CI 0.64 to 0.76) for 3?vs none), but not advanced (OR 0.86 (95% CI 0.74 to 1 1.01) for 2?vs none) comorbidities. Conclusions The proportion of patients achieving low HbA1c levels was highest among older and multimorbid patients. Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve these HbA1c levels despite potential for hypoglycemia and uncertain long-term benefit. bolus insulin claims no sulfonylurea claims, were considered to have type 1 diabetes and therefore excluded.20 25 Duocarmycin A 26 Patients with only gestational diabetes (International Classification of Diseases Ninth Revision (ICD-9) 648.8x, ICD-10 O024.4xx) were not included. Explanatory variables Glycemic management was ascertained by (1) age group: 18C44, 45C64, 65C74, 75 years; (2) each of the 16 guideline-specified comorbidities; (3) Charlson Comorbidity Index, categorized as 0C1, 2, 3, 4; and (4) type of diabetes-specific comorbidity profile: none, concordant conditions only (1, 2, 3 total), discordant conditions only (1, 2, 3 total), both concordant and discordant conditions Mouse monoclonal to CD48.COB48 reacts with blast-1, a 45 kDa GPI linked cell surface molecule. CD48 is expressed on peripheral blood lymphocytes, monocytes, or macrophages, but not on granulocytes and platelets nor on non-hematopoietic cells. CD48 binds to CD2 and plays a role as an accessory molecule in g/d T cell recognition and a/b T cell antigen recognition (1, 2, 3 total), and advancedconcordant/discordant conditions (1, 2, 3 total). The Charlson index weighs comorbid conditions by the strength of their association with 1-12 months mortality27 28; it has been previously validated for use in diabetes.29 Additionally, specific comorbidities were ascertained from among the 16 health conditions specified by the ADA,1 17 AGS,16 and/or VA/DoD2 3 guidelines using claims from 12 months preceding the index HbA1c date (online supplementary table S1). These were categorized as (CKD stages 3C4, heart failure, myocardial infarction, hypertension, cerebrovascular disease, proliferative retinopathy, and peripheral neuropathy), (liver disease/cirrhosis, depressive disorder, COPD, urinary incontinence, falls, arthritis), or (dementia, ESRD, cancer (excluding non-melanoma skin cancer)) based on the framework delineated by Piette and Kerr.19 Comorbidities were counted within each category and presented as the number of concordant only, discordant only, both concordant and discordant, and advancedany additional concordant or discordant conditions. Supplementary data bmjdrc-2019-001007supp001.pdf Outcome Glycemic management was examined as the proportion of people treated with sulfonylurea (without insulin) or insulin (with or without sulfonylurea), each with or without other glucose-lowering medications, at each HbA1c level for the different age and comorbidity subsets. HbA1c levels were categorized as 5.6%, 5.7%C6.4%, 6.5%C6.9%, 7.0%C7.9%, 8.0%C8.9%, 9.0%C9.9%, and 10.0%. Diabetes medications were identified from ambulatory pharmacy fills during 100 days preceding the index HbA1c, classified as insulin (basal only, bolusbasal), sulfonylurea, or other (metformin, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose transport protein 2 (SGLT2) inhibitors, -glucosidase inhibitors, thiazolidinediones, meglitinides, and amylin analogs). Independent variables Patient age, sex, annual household Duocarmycin A income, and race/ethnicity were identified from OLDW enrollment files. Statistical analysis We calculated overall frequencies (percentages) and means (SD) for all those patient characteristics, including age, sex, race/ethnicity, annual household income, comorbidities, index HbA1c, and the different glucose-lowering regimens using 2 and t-tests, as appropriate. HbA1c level categories and use of sulfonylurea and insulin were assessed by age group, each comorbidity, and each comorbidity profile. The main analysis considered comorbidity burden as the total number of concordant, discordant, and advanced comorbidities present. Secondary analyses modeled multimorbidity as a function of (1) the Charlson Comorbidity Index or (2) the presence of concordant only, discordant only, both concordant and discordant, and any advanced comorbidities as compared with none. Variables associated with insulin and sulfonylurea use (age, sex, race/ethnicity, annual household income.