title: Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
abstract: OBJECTIVE
  We examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US.
  
  
  METHODS
  Data were extracted from electronic health records (EHR) for active patients ≥ 35 years in a multispecialty, multiclinic ambulatory care organization with 1000 providers. New onset type 2 diabetes and subsequent treatment were identified using lab, diagnosis, medication prescription, and service use data. Time from the first evidence of diabetes until initial treatment, either medication or education/counseling, was examined using a Kaplan-Meier hazards curve. Potential predictors of initial treatment were examined using multinomial logistic models accounting for physician random effects.
  
  
  RESULTS
  Of 2258 patients with incident diabetes, 55% received either medication or education/counseling (20% received both) during the first year. Of the treated patients, 68% received a treatment within the first four weeks, and 13% after initial 16 weeks. Strong positive predictors (P < 0.01) of combined treatment were younger age, higher fasting glucose at diagnosis, obesity, and visits with an endocrinologist.
  
  
  CONCLUSIONS
  Among insured patients who have a primary care provider in a multispecialty health care system, incident diabetes is treated only half the time. Improved algorithms for identifying incident diabetes from the EHR and team approach for monitoring may help treatment initiation.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, United States. Electronic address: chungs@pamfri.org.
authors.forename: Sukyung
authors.initials: S
authors.lastname: Chung
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States.
authors.forename: Beinan
authors.initials: B
authors.lastname: Zhao
authors.affiliation: University of Chicago, Department of Health Studies, Chicago, IL, United States.
authors.forename: Diane
authors.initials: D
authors.lastname: Lauderdale
authors.affiliation: Palo Alto Medical Foundation, Endocrinology Department, Palo Alto, CA, United States.
authors.forename: Randolph
authors.initials: R
authors.lastname: Linde
authors.affiliation: Stanford University, Prevention Research Center, Palo Alto, CA, United States.
authors.forename: Randall
authors.initials: R
authors.lastname: Stafford
authors.affiliation: Palo Alto Medical Foundation Research Institute and Stanford University, Prevention Research Center, Palo Alto, CA, United States.
authors.forename: Latha
authors.initials: L
authors.lastname: Palaniappan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents
keywords: Ambulatory care; Diabetes treatment; Incident diabetes