title: Change in claims-based diabetes medications is a diabetes improvement indicator.
abstract: BACKGROUND
  Because laboratory test results are less available to researchers than claims data, a claims-based indicator of diabetes improvement would be valuable.
  
  
  OBJECTIVE
  To determine whether a decrease in medication use for diabetes parallels clinical improvement in glycemic control.
  
  
  METHODS
  This was a retrospective cohort study using up to 3.5 years of pharmacy and laboratory data from 1 private insurer. Data included 104 patients with diabetes who underwent bariatric surgery and had at least 1 glycated hemoglobin (A1C) test before and after surgery.
  
  
  METHODS
  We assigned each A1C test to a 90-day interval before or after surgery. Medication availability was noted for the midpoint of the interval (on insulin, on oral medications, count of medications). Each subject could contribute 1 presurgery and up to 3 postsurgery observations. We recorded the changes in A1C test results and medication use from the presurgery to the postsurgery period. Using the A1C test as the reference standard, positive and negative predictive values of medication-based indicators were calculated.
  
  
  RESULTS
  After bariatric surgery, A1C test values decreased by more than 1% and the count of unique medications decreased by 0.6. All 3 medication-based indicators had high positive predictive values (0.85) and low negative predictive values (0.20), and count of medications had better performance than the other indicators.
  
  
  CONCLUSIONS
  Without clinical information, a decrease in use of medications can serve as a proxy for clinical improvement. Validation of results in other settings is needed.
authors.affiliation: Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA. hchang2@jhsph.edu
authors.forename: Hsien-Yen
authors.initials: HY
authors.lastname: Chang
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Richards
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Weiner
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
mesh_terms: D050110:Bariatric Surgery; D054598:Blue Cross Blue Shield Insurance Plans; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents