title: Clinical characteristics, complications, comorbidities and treatment patterns among patients with type 2 diabetes mellitus in a large integrated health system.
abstract: OBJECTIVE
  To compare the prevalence of diabetes-related complications and comorbidities, clinical characteristics, glycemic control, and treatment patterns in patients with type 2 diabetes (T2D) within a large integrated healthcare system in 2008 vs 2013.
  
  
  METHODS
  An electronic health record system was used to create a cross-sectional summary of all patients with T2D as on 1 July 2008 and 1 July 2013. Differences between the two data sets were assessed after adjusting for age, gender, race, and household income.
  
  
  RESULTS
  In 2008 and 2013, 24 493 and 41 582 patients with T2D were identified, respectively, of which the majority were male (52.3% and 50.1%) and Caucasian (79% and 75.2%). The mean ages (years) were 64.8 and 64.3. The percentages of patients across the defined A1C categories were 64.3 and 66.7 for <7%, 21.1 and 18.8 for 7-7.9%, 7.8 and 7.5 for 8-8.9%, and 6.8 and 7.0 for ≥9% in 2008 and 2013, respectively. The most prevalent T2D-related comorbidities were hypertension (82.5% and 87.2%) and cardiovascular disease (26.9% and 22.3%) in 2008 and 2013, respectively. Thiazolidinedione and sulfonylurea use decreased, whereas metformin and dipeptidyl peptidase-4 inhibitor use increased in the 5-year period.
  
  
  CONCLUSIONS
  Patients with T2D are characterized by a high number of comorbidities. Over 85% of the patients had an A1C<8% within our integrated health delivery system in 2008 and 2013. In 2008 and 2013, metformin therapy was the most commonly utilized antidiabetic agent, and sulfonylureas were the most commonly utilized oral antidiabetic agent in combination with metformin. As integrated health systems assume greater shared financial risk in newer payment models, achieving glycemic targets (A1C) and the management of comorbidities will become ever-more important, for preventing diabetes-related complications, as well as to ensure reimbursement for the medical care that is rendered to patients with diabetes.
authors.affiliation: Department of Endocrinology , Cleveland Clinic Cleveland , Cleveland, Ohio , USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Pantalone
authors.affiliation: Novo Nordisk Inc , Plainsboro, New Jersey , USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Hobbs
authors.affiliation: Wake Forrest School of Medicine , Winston-Salem, North Carolina , USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wells
authors.affiliation: Department of Health Economics and Outcomes Research , Novo Nordisk Inc , Plainsboro, New Jersey , USA.
authors.forename: Sheldon X
authors.initials: SX
authors.lastname: Kong
authors.affiliation: Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: Department of Health Economics and Outcomes Research , Novo Nordisk Inc , Plainsboro, New Jersey , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bouchard
authors.affiliation: Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of Medical Affairs , Novo Nordisk Inc , Plainsboro, New Jersey , USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Sakurada
authors.affiliation: Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Milinovich
authors.affiliation: Department of Health Economics and Outcomes Research , Novo Nordisk Inc , Plainsboro, New Jersey , USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Weng
authors.affiliation: Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Janine M
authors.initials: JM
authors.lastname: Bauman
authors.affiliation: Department of Endocrinology , Cleveland Clinic Cleveland , Cleveland, Ohio , USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zimmerman
keywords: A1C; Chronic Diabetic Complications; Chronic Disease Epidemiology; Chronic Illness Management