Table 3 .
Correlates of treatment regimen change after index HbA1c testing
| Treatment intensification | Treatment deintensification | ||||
|---|---|---|---|---|---|
| Odds ratio (95% CI) | P | Odds ratio (95% CI) | P | ||
| Patient age (years) | |||||
| 18-44 | Ref | Ref | Ref | Ref | |
| 45-54 | 1.13 (1.04 to 1.23) | 0.003 | 1.08 (1.00 to 1.17) | 0.04 | |
| 55-64 | 1.06 (0.99 to 1.14) | 0.10 | 0.93 (0.87 to 1.00) | 0.04 | |
| 65-74 | 0.92 (0.83 to 1.02) | 0.10 | 0.92 (0.84 to 1.02) | 0.11 | |
| ≥75 | 0.70 (0.62 to 0.80) | <0.001 | 0.84 (0.74 to 0.95) | 0.005 | |
| Sex | |||||
| Male | Ref | Ref | Ref | Ref | |
| Female | 1.06 (1.01 to 1.11) | 0.03 | 1.06 (1.01 to 1.11) | 0.02 | |
| Race | |||||
| White | Ref | Ref | Ref | Ref | |
| Non-white | 1.00 (0.95 to 1.04) | 0.82 | 1.07 (1.03 to 1.11) | 0.002 | |
| US census region | |||||
| South | Ref | Ref | Ref | Ref | |
| Midwest | 0.79 (0.70 to 0.88) | <0.001 | 0.93 (0.83 to 1.04) | 0.18 | |
| Northeast | 0.90 (0.83 to 0.98) | 0.01 | 0.96 (0.88 to 1.04) | 0.34 | |
| West | 1.28 (1.14 to 1.44) | <0.001 | 1.09 (0.97 to 1.21) | 0.18 | |
| Year of index HbA1c test | |||||
| 2001-02 | Ref | Ref | Ref | Ref | |
| 2003-04 | 0.90 (0.77 to 1.05) | 0.18 | 0.89 (0.75 to 1.05) | 0.15 | |
| 2005-06 | 1.07 (0.95 to 1.20) | 0.28 | 1.02 (0.89 to 1.17) | 0.75 | |
| 2007-08 | 0.97 (0.89 to 1.05) | 0.40 | 1.04 (0.94 to 1.15) | 0.45 | |
| 2009-10 | 0.80 (0.74 to 0.87) | <0.001 | 1.15 (1.04 to 1.27) | 0.007 | |
| 2011 | 0.79 (0.70 to 0.89) | <0.001 | 1.26 (1.11 to 1.42) | <0.001 | |
| Index HbA1c | |||||
| ≤5.6% | Ref | Ref | Ref | Ref | |
| 5.7-6.4% | 0.88 (0.82 to 0.93) | <0.001 | 0.96 (0.91 to 1.02) | 0.21 | |
| 6.5-6.9% | 1.72 (1.61 to 1.85) | <0.001 | 0.79 (0.74 to 0.84) | <0.001 | |
| Charlson comorbidity index | |||||
| 0-1 | Ref | Ref | Ref | Ref | |
| 2 | 1.02 (0.94 to 1.12) | 0.59 | 0.97 (0.89 to 1.07) | 0.56 | |
| 3 | 1.01 (0.92 to 1.11) | 0.85 | 1.00 (0.91 to 1.09) | 0.92 | |
| ≥4 | 1.04 (0.94 to 1.15) | 0.42 | 1.07 (0.97 to 1.18) | 0.15 | |
| Frequency of HbA1c testing | |||||
| Recommended (≤2 tests/year) | Ref | Ref | Ref | Ref | |
| Frequent (3-4 tests/year) | 0.96 (0.90 to 1.03) | 0.23 | 0.92 (0.86 to 0.98) | 0.009 | |
| Excessive (≥5 tests/year) | 1.35 (1.22 to 1.50) | <0.001 | 1.08 (0.97 to 1.20) | 0.18 | |
| No of healthcare providers per year | 1.01 (0.98 to 1.04) | 0.51 | 1.05 (1.02 to 1.09) | <0.001 | |
| Baseline treatment | |||||
| Lifestyle | Ref | Ref | — | — | |
| 1 drug | 0.80 (0.74 to 0.86) | <0.001 | Ref | Ref | |
| 2 drugs | 0.79 (0.72 to 0.87) | <0.001 | 0.84 (0.79 to 0.89) | <0.001 | |
| ≥3 drugs | 0.80 (0.70 to 0.92) | 0.001 | 2.30 (2.15 to 2.45) | <0.001 | |
| Specialties involved | |||||
| Endocrinology | 1.27 (1.20 to 1.34) | <0.001 | 1.05 (0.99 to 1.11) | 0.09 | |
| Cardiology | 1.01 (0.96 to 1.06) | 0.68 | 0.96 (0.91 to 1.01) | 0.11 | |
| Ophthalmology | 1.01 (0.95 to 1.06) | 0.80 | 0.95 (0.90 to 1.00) | 0.07 | |
| Gynecology | 0.94 (0.89 to 1.00) | 0.06 | 1.01 (0.95 to 1.08) | 0.68 | |
| Nephrology | 1.09 (0.99 to 1.20) | 0.09 | 1.10 (1.01 to 1.20) | 0.04 | |
Odds ratio compares the odds of treatment intensification or deintensification after index HbA1c test with either no treatment change or drug class change only. The intensification group includes all patients, while the deintensification group includes only those patients receiving at least one glucose lowering drug at baseline.
CI=confidence interval; Ref=reference group.