Hp. Wetzler et Jw. Snyder, Linking pharmacy and laboratory data to assess the appropriateness of carein patients with diabetes, DIABET CARE, 23(11), 2000, pp. 1637-1641
OBJECTIVE - To use pharmacy and laboratory data to assess diabetes care wit
hin a medical group and between medical groups and to determine dispensing
patterns and the extent to which providers change therapy based on HbA(1c)
results.
RESEARCH DESIGN AND METHODS - Participating groups submitted 1 year of data
for continuously enrolled patients. Required data included date of birth,
all diabetes-specific prescriptions (oral hypoglycemic agents and insulin),
date of prescription, National Drug Code, all HbA(1c) values, lower and up
per normal limits, and date of testing.
RESULTS - Few changes in therapy were noted despite the large percentages o
f patients with suboptimal control. Nearly 90% of the patients treated with
medications received a monotherapy regimen involving one of three therapeu
tic agents: sulfonylureas, metformin, or insulin. More than three-fourths o
f the patients remained on the same therapy during the observation period d
espite the fact that 27% of these patients had HbA(1c) values greater than
or equal to8%. Nearly one-fifth (18%) of patients had an HbA(1c) level of g
reater than or equal to8% and no further testing for at least 90 days after
the "actionable" HbA(1c) result was obtained. Furthermore, 54% of patients
with actionable HbA(1c) results did not have a change in therapy initiated
after the result was available.
CONCLUSIONS - The American Diabetes Association recommendations to act on H
bA(1c) values greater than or equal to8% and to follow up regularly on pati
ents found to be in suboptimal control do not appear to be applied in a con
sistent manner based on the pharmacy and laboratory data analyzed in this s
ample.