title: Clinical and economic outcomes associated with National Kidney Foundation guideline-concordant oral antidiabetic drug treatment among type 2 diabetes patients with chronic kidney disease.
abstract: OBJECTIVE
  To assess outcomes associated with oral anti-diabetic drug (OAD) treatment concordant with guidelines from the National Kidney Foundation (NKF) among type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD).
  
  
  METHODS
  Electronic health record data between 1/1/2005 and 10/31/2010 provided by an integrated health system were analyzed. T2DM patients were selected based on diagnosis from the health record. Patients with stages 3-5 CKD based on diagnosis or lab results were further identified with the date of first indicated CKD set as index date. Patients who had a medication order of OADs within three months of the index date were included. Patients were considered non-guideline-concordant if prescribed OADs that were recommended to be avoided or if they required dosage adjustment, but were unadjusted. Glycemic control, hospital admissions, and costs of encounters were assessed over a 12-month post-index period, and hypoglycemic events were evaluated until loss of follow-up. Regression analyses were performed, adjusting for patient demographic and clinical characteristics.
  
  
  RESULTS
  Among 6058 patients (mean age: 70; 42% male), 45% were not [corrected] guideline-concordant. After adjusting for patient characteristics, guideline-concordant patients had a lower risk for hypoglycemic events (HR: 0.72; 95% CI: 0.62-0.83), were less likely to have a hospital admission (OR: 0.87; 95% CI: 0.77-0.98), and more likely to have glycemic control (OR: 1.64, 95% CI: 1.46-1.84). Non-guideline-concordant patients had annual encounter costs of 1.10 times those of guideline-concordant patients (marginal cost = $731; P = 0.04).
  
  
  CONCLUSIONS
  Unobservable confounders may still exist and bias the results; therefore, findings should be interpreted as associations instead of causations. Findings were based on a single integrated health system and may not be generalizable to larger populations.
  
  
  CONCLUSIONS
  The findings of this exploratory study suggest that guideline-concordant treatment may yield better clinical and economic outcomes. Future research with a better controlled design is warranted to confirm these preliminary findings.
authors.affiliation: United BioSource Corporation, Lexington, MA, USA. shih-yin.chen@unitedbiosource.com
authors.forename: Shih-Yin
authors.initials: SY
authors.lastname: Chen
authors.forename: Kimberly
authors.initials: K
authors.lastname: Siu
authors.forename: Birgit
authors.initials: B
authors.lastname: Kovacs
authors.forename: Michael
authors.initials: M
authors.lastname: Stokes
authors.forename: Preethi
authors.initials: P
authors.lastname: Rao
authors.forename: Stephen
authors.initials: S
authors.lastname: Sander
authors.forename: Luke
authors.initials: L
authors.lastname: Boulanger
mesh_terms: D000284:Administration, Oral; D000368:Aged; D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D008297:Male
chemical_list: D007004:Hypoglycemic Agents