title: Diabetes management in the real world and the impact of adherence to guideline recommendations.
abstract: OBJECTIVE
  To evaluate diabetes management in the real world, examining adherence to the American Diabetic Association (ADA) guidelines on frequency of glycated hemoglobin A1c (A1C) testing and antidiabetic treatment modifications in patients with type 2 diabetes and measuring the impact of adherence to the guidelines for achieving an A1C target <7%.
  
  
  METHODS
  Retrospective analyses of claims data were conducted in three groups of patients aged ≥18 years with at least two diagnoses of type 2 diabetes in a large US health insurance claims database between January 2009 and December 2011 and with A1C ≥7% (≥53 mmol/mol). Descriptive analyses were performed on adherence to A1C testing frequency and adherence to antidiabetic treatment modification. Pearson's chi-square test and logistic regression were conducted to estimate the odds ratios.
  
  
  RESULTS
  Of 42,837 patients evaluated for adherence to the ADA guideline for A1C testing frequency, only 7% were fully adherent for 1 year. Analysis of 95,330 patients for adherence to antidiabetic treatment modification revealed that drug therapy was modified in accordance with ADA guidelines for 39% of patients. Among 1337 treatment-naive patients meeting the selection criteria, only 3% met both testing frequency and treatment modification guidelines; the odds of achieving the A1C target of <7% were approximately five-fold higher in patients who met both guidelines versus those who did not (odds ratio 5.29; P < 0.0001).
  
  
  CONCLUSIONS
  This study, based on real-world data from a large type 2 diabetes patient population, demonstrated that adherence to ADA guidelines for A1C testing frequency and drug treatment modifications was extremely low. Achievement of glycemic control (A1C <7%) was significantly associated with adherence to both A1C testing frequency and antidiabetic treatment modification guidelines. Limitations of this study include the retrospective nature, lack of important patient clinical information, and issues with incomplete source data.
authors.affiliation: Novo Nordisk Inc. , Plainsboro, NJ , USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Lian
authors.forename: Yuanjie
authors.initials: Y
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Adherence to guidelines; Antidiabetic treatment; Patient outcome assessment; Treatment modification; Type 2 diabetes mellitus