Quantifying Variation in Treatment Utilization for Type 2 Diabetes Across Five Major University of California Health Systems

Diabetes Care ◽  
2021 ◽  
pp. dc200344
Author(s):  
Thomas A. Peterson ◽  
Valy Fontil ◽  
Suneil K. Koliwad ◽  
Ayan Patel ◽  
Atul J. Butte
Keyword(s):  
Type 2 Diabetes ◽  
Health Systems ◽  
University Of California ◽  
Treatment Utilization

scholarly journals Quantifying Variation in Treatment Utilization for Type 2 Diabetes Across Five Major University of California Health Systems

2021 ◽  
Author(s):  
Thomas A. Peterson ◽  
Valy Fontil ◽  
Suneil K. Koliwad ◽  
Ayan Patel ◽  
Atul J. Butte
Keyword(s):  
Type 2 Diabetes ◽  
Los Angeles ◽  
Health Systems ◽  
San Francisco ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
University Of California ◽  
Treatment Utilization ◽  
Matching Techniques

<b>Objective:</b> Using the newly created University of California Health Data Warehouse (UCHDW), we present the first study to analyze antihyperglycemic treatment utilization across the five large University of California (UC) academic health systems (Davis, Irvine, Los Angeles, San Diego, and San Francisco). <p><b>Research Design:</b> Retrospective analysis using deidentified Electronic Health Records (EHRs; 2014-2019) including 97,231 type 2 diabetes patients from 1,003 UC-affiliated clinical settings. Significant differences between health systems and individual providers were identified using binomial probabilities with cohort matching.</p> <p><b>Results</b>: Our analysis reveals statistically different treatment utilization patterns not only between health systems but also among individual providers within health systems. We identified 21 differences among health systems, and 29 differences among individual providers within these health systems, with respect to treatment intensifications within existing guidelines on top of either metformin monotherapy or dual therapy with metformin and a sulfonylurea. Next, we identified variation for medications within the same class (e.g., glipizide vs. glyburide among sulfonylureas), with 33 differences among health systems and 86 among individual providers. Finally, we identified two health systems and 55 individual providers that more frequently utilized medications with known cardioprotective benefits for patients with high cardiovascular disease risk, but also one health system and 8 providers who prescribed such medications less frequently for these patients.</p> <p><b>Conclusions:</b> Our study utilized cohort matching techniques to highlight real-world variation in care between health systems and individual providers. This demonstrates the power of EHRs to quantify differences in treatment utilization, a necessary step towards standardizing precision care for large populations.</p>

scholarly journals Quantifying Variation in Treatment Utilization for Type 2 Diabetes Across Five Major University of California Health Systems

2021 ◽  
Author(s):  
Thomas A. Peterson ◽  
Valy Fontil ◽  
Suneil K. Koliwad ◽  
Ayan Patel ◽  
Atul J. Butte
Keyword(s):  
Type 2 Diabetes ◽  
Los Angeles ◽  
Health Systems ◽  
San Francisco ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
University Of California ◽  
Treatment Utilization ◽  
Matching Techniques

<b>Objective:</b> Using the newly created University of California Health Data Warehouse (UCHDW), we present the first study to analyze antihyperglycemic treatment utilization across the five large University of California (UC) academic health systems (Davis, Irvine, Los Angeles, San Diego, and San Francisco). <p><b>Research Design:</b> Retrospective analysis using deidentified Electronic Health Records (EHRs; 2014-2019) including 97,231 type 2 diabetes patients from 1,003 UC-affiliated clinical settings. Significant differences between health systems and individual providers were identified using binomial probabilities with cohort matching.</p> <p><b>Results</b>: Our analysis reveals statistically different treatment utilization patterns not only between health systems but also among individual providers within health systems. We identified 21 differences among health systems, and 29 differences among individual providers within these health systems, with respect to treatment intensifications within existing guidelines on top of either metformin monotherapy or dual therapy with metformin and a sulfonylurea. Next, we identified variation for medications within the same class (e.g., glipizide vs. glyburide among sulfonylureas), with 33 differences among health systems and 86 among individual providers. Finally, we identified two health systems and 55 individual providers that more frequently utilized medications with known cardioprotective benefits for patients with high cardiovascular disease risk, but also one health system and 8 providers who prescribed such medications less frequently for these patients.</p> <p><b>Conclusions:</b> Our study utilized cohort matching techniques to highlight real-world variation in care between health systems and individual providers. This demonstrates the power of EHRs to quantify differences in treatment utilization, a necessary step towards standardizing precision care for large populations.</p>

scholarly journals Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. e002153
Author(s):  
Scott J Pilla ◽  
Jennifer L Kraschnewski ◽  
Erik B Lehman ◽  
Lan Kong ◽  
Erica Francis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Systems ◽  
Emergency Department Visits ◽  
Hospital Utilization ◽  
Electronic Health Record Data ◽  
Icd 10

IntroductionHypoglycemia is the most common serious adverse effect of diabetes treatment and a major cause of medication-related hospitalization. This study aimed to identify trends and predictors of hospital utilization for hypoglycemia among patients with type 2 diabetes using electronic health record data pooled from six academic health systems.Research design and methodsThis retrospective open cohort study included 549 041 adults with type 2 diabetes receiving regular care from the included health systems between 2009 and 2019. The primary outcome was the yearly event rate for hypoglycemia hospital utilization: emergency department visits, observation visits, or inpatient admissions for hypoglycemia identified using a validated International Classification of Diseases Ninth Revision (ICD-9) algorithm from 2009 to 2014. After the transition to ICD-10 in 2015, we used two ICD-10 code sets (limited and expanded) for hypoglycemia hospital utilization from prior studies. We identified independent predictors of hypoglycemia hospital utilization using multivariable logistic regression analysis with data from 2014.ResultsYearly rates of hypoglycemia hospital utilization decreased from 2.7 to 1.6 events per 1000 patients from 2009 to 2014 (p-trend=0.023). From 2016 to 2019, yearly event rates were stable ranging from 5.6 to 6.6, or 6.3 to 7.3, using the limited and expanded ICD-10 code sets, respectively. In 2014, the strongest independent risk factors for hypoglycemia hospital utilization were chronic kidney disease (OR 2.86, 95% CI 2.33 to 3.57), ages 18–39 years (OR 2.43 vs age 40–64 years, 95% CI 1.78 to 3.31), and insulin use (OR 2.13 vs no diabetes medications, 95% CI 1.67 to 2.73).ConclusionsRates of hypoglycemia hospital utilization decreased from 2009 to 2014 and varied considerably by clinical risk factors such that younger adults, insulin users, and those with chronic kidney disease were at especially high risk. There is a need to validate hypoglycemia ascertainment using ICD-10 codes, which detect a substantially higher number of events compared with ICD-9.

349-P: Hospital Utilization for Hypoglycemia among Patients with Type 2 Diabetes Using Pooled Data from Six Health Systems

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 349-P
Author(s):  
SCOTT J. PILLA ◽  
JENNIFER L. KRASCHNEWSKI ◽  
ERIK LEHMAN ◽  
LAN KONG ◽  
ERICA FRANCIS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Systems ◽  
Hospital Utilization ◽  
Pooled Data

scholarly journals Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

PLoS ONE ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. e0195086 ◽  
Author(s):  
Suan Ee Ong ◽  
Joel Jun Kai Koh ◽  
Sue-Anne Ee Shiow Toh ◽  
Kee Seng Chia ◽  
Dina Balabanova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Treatment Adherence ◽  
Health Systems ◽  
And Control

scholarly journals Vertical Sleeve Gastrectomy Improves Glucose and Lipid Metabolism and Delays Diabetes Onset in UCD-T2DM Rats

Endocrinology ◽  
2012 ◽  
Vol 153 (8) ◽  
pp. 3620-3632 ◽  
Author(s):  
Bethany P. Cummings ◽  
Ahmed Bettaieb ◽  
James L. Graham ◽  
Kimber L. Stanhope ◽  
Mark Kowala ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Tolerance ◽  
University Of California ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Vertical Sleeve Gastrectomy ◽  
Diabetes Onset ◽  
Oral Glucose Tolerance Tests ◽  
Glucose Tolerance Tests

Vertical sleeve gastrectomy (VSG) has gained interest as a low morbidity bariatric surgery, which is effective in producing weight loss and causing type 2 diabetes resolution. However, the efficacy of VSG to prevent the onset of type 2 diabetes has not been previously investigated. VSG or sham surgery was performed on 2-month-old prediabetic male University of California Davis-type 2 diabetes mellitus rats. Sham-operated animals were either sham-operated ad libitum fed (S-AL) or were weight-matched to VSG-operated animals (S-WM). Diabetes onset was determined by weekly nonfasting blood glucose measurements. Animals underwent oral glucose tolerance tests at 1 and 4 months after surgery and indirect calorimetry at 1.5 months after surgery. VSG surgery significantly delayed diabetes onset compared with both S-AL and S-WM animals. VSG-operated animals ate 23% less and weighed 20% less than S-AL. Energy expenditure did not differ between VSG-operated animals and controls. Results from the oral glucose tolerance tests demonstrate improved glucose tolerance and islet function in VSG-operated animals compared with S-AL and S-WM. Nutrient-stimulated glucagon-like peptide (GLP)-1, GLP-2, and peptide YY excursions were greater in VSG-operated animals. VSG surgery resulted in decreased fasting plasma insulin, ghrelin and lipid concentrations, and markedly higher fasting plasma adiponectin and bile acid concentrations, independent of body weight. Increases of circulating bile acid concentrations were due to selective increases of taurine-conjugated bile acids. Thus, VSG delays type 2 diabetes onset in the University of California Davis-type 2 diabetes mellitus rat, independent of body weight. This is potentially mediated by increases of circulating bile acids, adiponectin, and nutrient-stimulated GLP-1 secretion and decreased circulating ghrelin concentrations.

Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia

2018 ◽  
Vol 6 (12) ◽  
pp. 992-1002 ◽  
Author(s):  
Andrew P Hills ◽  
Anoop Misra ◽  
Jason M R Gill ◽  
Nuala M Byrne ◽  
Mario J Soares ◽  
...  
Keyword(s):  
Public Health ◽  
Type 2 Diabetes ◽  
South Asia ◽  
Health Systems

scholarly journals Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Gholami ◽  
Nicholas J. Jackson ◽  
Un Young Rebecca Chung ◽  
O. Kenrik Duru ◽  
Kelly Shedd ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Outcomes ◽  
Weight Change ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
University Of California ◽  
The University ◽  
Diabetes And Obesity

Abstract Background Type 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system. Methods The goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as  the degree of program adoption and maintenance. Discussion Our study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.

Impact of two different health systems on the burden of type 2 diabetes

2013 ◽  
Vol 19 (2) ◽  
pp. 69-76 ◽  
Author(s):  
Naomh Gallagher ◽  
Kathleen Bennett ◽  
Susan M Smith ◽  
Dermot O’Reilly
Keyword(s):  
Type 2 Diabetes ◽  
Health Systems
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