title: Quality measure attainment in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  This study examined the demographics, comorbidities, clinical characteristics, and treatments of people with type 2 diabetes mellitus (T2DM) treated with metformin and sulfonylurea as well as an elderly subgroup. Achievement of predefined quality measure goals (glycated hemoglobin [A1C], blood pressure [BP], low-density lipoprotein cholesterol [LDL-C], body mass index [BMI]) and their association with diabetes-related healthcare costs were assessed.
  
  
  METHODS
  The study applied a retrospective longitudinal cohort design.
  
  
  METHODS
  Health insurance claims and electronic medical records from 14,532 adults with T2DM (2007- 2011) were used to identify a sample receiving metformin and sulfonylurea (MET+SU) concomitantly. The index date was the first dispensing of MET+SU after 6 months of eligibility. Clinical characteristics were assessed during baseline. Quality measure attainment (A1C <8%, BP <140/90 mm Hg, LDL-C level <100 mg/dL, BMI <30 kg/m²), was evaluated during the 12 months following the index date. Association between attainment and diabetes-related costs was evaluated using non-parametric bootstrap methods adjusting for imbalance in baseline characteristics between cohorts.
  
  
  RESULTS
  Among 2044 patients, including 1283 patients 65 years and older, hyperlipidemia, hypertension, and cardiovascular disease were the most common baseline comorbidities. Quality measure goal attainment was 63.9% for A1C, 33.1% for BP, 68.2% for LDL-C level, and 34.4% for BMI, and was associated with significantly lower diabetes-related costs per patient per year compared with nonattainment (adjusted mean cost differences: -$1445 for A1C; -$1218 for BMI; -$2029 for A1C and BMI; -$2073 for A1C, BMI, and BP; all P <.05).
  
  
  CONCLUSIONS
  This study highlights the high incidence of comorbidities and potential financial implications of attaining T2DM quality outcomes.
authors: Groupe d'Analyse, Ltée, 1000 De La Gauchetiere West, Suite 1200, Montreal, QC, Canada H3B 4W5. E-mail: mlafeuille@analysisgroup.com.
authors: Marie-Hélène
authors: MH
authors: Lafeuille
authors: Amanda M
authors: AM
authors: Grittner
authors: Jonathan
authors: J
authors: Gravel
authors: Robert A
authors: RA
authors: Bailey
authors: Silas
authors: S
authors: Martin
authors: Lawrence
authors: L
authors: Garber
authors: Mei
authors: M
authors: Sheng Duh
authors: Patrick
authors: P
authors: Lefebvre
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D007345:Insurance Claim Review; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D049994:Sodium Potassium Chloride Symporter Inhibitors; D013453:Sulfonylurea Compounds