Distance to glycemic goal at the time of treatment intensification in patients with type 2 diabetes mellitus failing metformin monotherapy in the United States

Figures & data

Figure 1. Patient attrition flowchart. **Goal defined as Hba1c <7.

Table 1. Demographic and clinical characteristics of the GE centricity electronic medical record cohort, United States (N = 20,704).

Characteristic	Did not achieve target HbA1c < 7.0%		Achieved target HbA1c < 7.0% (N = 13,986)
	Intensified treatment (N = 1741)	Did not intensify treatment (N = 4977))
Mean age (SD), years	57.4 (13.00)	58.1 (13.12)	60.4 (12.56)
Age, years, n %
18–24	14 (0.8%)	29 (0.6%)	81 (0.6%)
25–34	73 (4.2%)	212 (4.3%)	361 (2.6%)
35–44	192 (11.0%)	546 (11.0%)	1138 (8.1%)
45–54	427 (24.5%)	1132 (22.7%)	2658 (19.0%)
55–64	482 (27.7%)	1362 (27.4%)	4007 (28.7%)
65–74	367 (21.1%)	1070 (21.5%)	3667 (26.2%)
≥75	186 (10.7%)	626 (12.6%)	2074 (14.8%)
Male, n %	886 (50.9%)	2488 (50.0%)	6327 (45.2%)
Race, n %
Asian	31 (1.8%)	129 (2.6%)	368 (2.6%)
Black	202 (11.6%)	693 (13.9%)	1873 (13.4%)
Indian (American)	24 (1.4%)	50 (1.0%)	117 (0.8%)
Native Hawaiian or Other	2 (0.1%)	17 (0.3%)	18 (0.1%)
Unknown	202 (11.6%)	624 (12.5%)	1511 (10.8%)
White	1280 (73.5%)	3464 (69.6%)	10,099 (72.2%)
BMI n (%) (proportion of subjects with BMI measure available)	1290 (74.1%)	3580 (71.9%)	10,722 (76.7%)
Mean BMI (kg/m^2) (SD)	35.9 (7.50)	35.2 (7.49)	34.9 (7.49)
Smoker, n %	217 (12.5%)	639 (12.8%)	1754 (12.5%)
Consumed alcohol, n %	38 (2.2%)	88 (1.8%)	273 (2.0%)
HbA1c, %^a
Mean (SD)	8.3 (1.76)	7.9 (1.55)	7.0 (1.20)
Median (minimum, maximum)	7.8 (5, 16)	7.5 (5, 18)	6.7 (4, 16)
Microvascular complications, n %	531 (30.5%)	1230 (24.7%)	3833 (27.4%)
Neuropathy	283 (16.3%)	603 (12.1%)	2044 (14.6%)
Nephropathy	308 (17.7%)	769 (15.5%)	2344 (16.8%)
Diabetic Retinopathy	63 (3.6%)	89 (1.8%)	185 (1.3%)
Macrovascular complications, n %	385 (22.1%)	1068 (21.5%)	3270 (23.4%)
Arrhythmia	132 (7.6%)	396 (8.0%)	1357 (9.7%)
Revascularization procedures^b	0 (0%)	0 (0%)	0 (0%)
Stroke, TIA	71 (4.1%)	202 (4.1%)	686 (4.9%)
Congestive Heart Failure	59 (3.4%)	161 (3.2%)	416 (3.0%)
Peripheral Arterial Disease	95 (5.5%)	228 (4.6%)	714 (5.1%)
Acute Myocardial Infarction	38 (2.2%)	113 (2.3%)	279 (2.0%)
Acute Coronary Syndrome	187 (10.7%)	536 (10.8%)	1498 (10.7%)
Angina	22 (1.3%)	60 (1.2%)	202 (1.4%)
Severe or recurrent hypoglycemia, n %	52 (3.0%)	150 (3.0%)	319 (2.3%)

Abbreviations. BMI, body mass index; HbA1c, glycated hemoglobin; SD, standard deviation. TIA, transient ischemic attack.

^a Baseline HbA1c values were available for 57.2%, 47.2%, and 56.5% of the analytic groups, respectively.

^b Revascularization procedures include coronary artery bypass graft surgery.

Figure 2. HbA1c levels in patients failing metformin according to treatment intensification status.

Table 2. Distance to glycemic goal of HbA1c < 7.0% in patients who failed metformin monotherapy, GE centricity electronic medical record cohort, United States (N = 3718).

Patient sample	Intensified treatment	Did not intensify treatment
A: All patients, N	(N = 1741)	(N = 4977)
HbA1c, % (HbA1c at the time of intensification or one year after inclusion in the cohort)
Mean (SD)	8.7 (1.6)	8.0 (1.4)
Median (Q1, Q3)	8.2 (7.5, 9.5)	7.5 (7.2, 8.3)
Distance to Goal, (target of 7%)
Mean (SD)	1.7 (1.6)	1.0 (1.4)
Median (Q1, Q3)	1.2 (0.5, 2.5)	0.5 (0.2, 1.3)
Proportion of pts ≥1.5% away from target
7%	44.57%	21.94%
7.5%	33.60%	15.93%
8%	25.62%	11.93%
B: Patients <65 years old without a history of micro- or macrovascular complications and severe hypoglycemia, N	(N = 788)	(N = 2349)
HbA1c, %
Mean (SD)	9.0 (1.8)	8.2 (1.5)
Median (Q1, Q3)	8.5 (7.6, 9.9)	7.6 (7.2, 8.6)
Distance to Goal, (target of 7%)
Mean (SD)	2.0 (1.8)	1.2 (1.5)
Median (Q1, Q3)	1.5 (0.6, 2.9)	0.6 (0.2, 1.6)
Proportion of pts ≥1.5% away from target
7%	51.52%	27.84%
7.5%	41.37%	21.37%
8%	32.61%	16.69%
C: Patients <75 years old without a history of micro- or macrovascular complications and severe hypoglycemia, N	(N = 962)	(N = 2920)
HbA1c, %
Mean (SD)	8.9 (1.7)	8.2 (1.5)
Median HbA1c, % (Q1, Q3)	8.4 (7.6, 9.7)	7.6 (7.2, 8.5)
Distance to Goal, (target of 7%)
Mean (SD)	1.9 (1.7)	1.2 (1.5)
Median (Q1, Q3)	1.4 (0.6, 2.7)	0.6 (0.2, 1.5)
Proportion of pts ≥1.5% away from target
7%	49.90%	25.72%
7.5%	38.25%	19.49%
8%	29.73%	14.90%

Abbreviations. HbA1c, glycated hemoglobin; SD, standard deviation; TIA, transient ischemic attack.

Table

	ICD-9-CM	ICD-10-CM
Type 2 Diabetes Mellitus (T2DM)*	250.x0, 250.x2	E11.xx
Neuropathy	356, 250.6, 358.1, 951.0, 951.1, 951.3, 354.0–355.9, 713.5, 357.2, 596.54, 337.0, 337.1, 564.5, 536.3, 458.0	G60, E11.49, G73.3, S04.10XA, S04.20XA, S04.40XA, G56.0–G58.9, M14.60, E08.42, E09.42, E10.42, E11.42, E13.42, N31.9, G90.0, G99.0, K59.1, K31.84, I95.1, G60–G65
Nephropathy	580.4 , 580.81, 580.89, 580.9, 581.0, 581.1, 581.2, 581.3, 581.81, 581.89, 581.9, 582.0, 582.1, 582.2, 582.4, 582.81, 582.89, 582.9, 583.0, 583.1, 583.2, 583.4, 583.6, 583.7, 583.81, 583.89, 583.9, 584.5, 584.6, 584.7, 584.8, 584.9, 585, 585.1, 585.2, 585.3, 585.4, 585.5, 585.6, 585.9, 586, 587, 588.0, 588.1, 588.8, 588.81, 588.89, 588.9, 589.0, 589.1, 589.9, 590.00, 590.01, 590.10, 590.11, 590.2, 590.3, 590.80, 590.81, 590.9, 591, 592.0, 592.1, 592.9, 593.0, 593.1, 593.2, 593.3, 593.4, 593.5, 593.6, 593.7, 593.70, 593.71, 593.72, 593.73, 593.81, 593.82, 593.89, 593.9, 788.0, 792.5, V13.01, V42.0, V45.1, V56.0, V56.1, V56.2, V56.31, V56.32, V56.8, 016.0, 016.00, 016.01, 016.02, 016.03, 016.04, 016.05, 016.06, 250.4, 250.40, 250.41, 250.42, 250.43, 274.1, 274.10, 274.11, 274.19, 403, 403.0, 403.00, 403.01, 403.1, 403.10, 403.11, 403.9, 403.90, 403.91, 580.0	N00.3, N00.9, N01.3, N04.4, N02.2, N04.3, N04.0, N04.9, N03.2, N03.3, N03.5, N03.8, N03.9, N05.9, N05.2, N05.5, N17.1, N17.2, N17.0, N17.1, N17.2, N17.8, N17.9, N18.1, N18.2, N18.3, N18.4, N18.5, N18.6, N18.9, N19, 526.9, N25.0, N25.1, N25.9, N27.0, N27.1, N27.9, N15.1, N28.84, N28.85, N28.86, N15.9, N13.30, N20.0, N20.1, N20.9, N28.83, N28.81, N28.1, N13.5, N13.8, N13.4, R80.2, N28.9, N23, R88.0, Z87.442, Z94.0, Z95.818, Z99.2, Z49.31, Z49.02, Z49.31, Z49.32, M10.30, N20.0, M10.9, E11.29, E10.29, E11.21, E11.65, E10.21, E10.65, I12.9, I12.0, I12.9
Diabetic retinopathy*	250.5x, 362.0x, 362.1, 362.2, 362.83, 362.53, 362.81, 362.82, 361.xx, 369.xx, 379.23	E11.39, E11.319, H35.0, H35.23, H35.81, H35.359, H35.60, H35.89, H33, H54, H43.13, H35
Arrhythmia	427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.5, 427.6, 427.61, 427.69, 427.81, 427.89, 427.9, 785.0	I47, I49, R00.0
Revascularization** procedures	33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 34001, 35001, 35002, 35201, 35231, 35286, 35301, 35390, 35400, 35501, 35506, 35508, 35509, 35510, 35526, 35601, 35606, 35626, 35642, 35691, 35694, 35701, 35901, 34201, 34203, 34401, 34421, 34451, 34501, 34530, 35131, 35141, 35142, 35151, 35152, 35302, 35303, 35304, 35305, 35306, 35355, 35363, 35371, 35372, 35400, 35456, 35459, 35460, 35470, 35474, 35476, 35483, 35485, 35485, 35493, 35495, 35500, 35539, 35540, 35548, 35549, 35551, 35556, 35558, 35565, 35566, 35571, 35572, 35583, 35585, 35587, 35621, 35623, 35646, 35647, 35651, 35654, 35656, 35661, 35665, 35666, 35671, 35686, 35621, 35700, 35721, 35741, 35761, 35879, 35881, 35883, 35884, 93668, 37220, 33520, 33515
Stroke, TIA	430, 431, 432, 433, 434, 435	I60.9, I61.9, I62.1, I62.00, I62.9, I63.22, I65.29, I63.139, I63.239, I65.09, I63.019, I63.019, I63.119, I63.219, I65.8, I63.59, I65.9, I63.20, I66.09, I66.19, I66.29, I63.30, I66.09, I66.19, I66.29, I63.30, I66.09, I66.19, I66.29, I63.30, I66.09, I66.19, I63.29, I66.9, I63.40, I66.9, I63.40, I66.9, I63.50, G45.0, G45.8, G45.1, G45.9, I67.848
Congestive heart failure	398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 425.4, 425.5, 425.7, 425.8, 425.9, 428	I09.81, I11.0, I11.0, I11.0, I13.0, I13.2, I13.0, I13.2, I13.0, I13.2, I42.8, I42.5, I42.6, I43, I43, I42.7, I50
Peripheral arterial disease	093.0, 437.3, 440, 441, 443.1 , 443.2 , 443.3, 443.4, 443.5 , 443.6, 443.7 , 443.8 , 443.9 , 443.9, 447.1, 557.1 , 557.9 , V43.4	A52.01, I67.1, I70.0, I70.209, I70.1, I70.219, I70.229, I70.25, I70.269, I70.299,I70.399, I70.499, I70.599, I70.92, I70.8, I70.91, I73.1, I71.00, I71.01, I71.02,I71.03, I71.1, I71.2, I71.3, I71.4, I71.8, I71.5, I71.6, I71.9,I77.71, I77.72, I77.73, I77.74, I77.75, I77.76, I77.77, I77.79, I79.8, I73.81, I73.89, I77.1, K55.1, K55.9, Z95.828, I73.9
Acute myocardial infarction	411, 410, 412	I21, I22, I23
Acute coronary syndrome	410, 411, 412, 412, 413, 414	I20, I21, I22, I23, I24, I25
Angina	413	I20 , I25.11
Severe or recurrent hypoglycemia	251.0, 251.1, 251.2, 250.8	E15, E16.0, E16.1, E16.2, E11.69

*Where x can take any value from 0–9. **CPT codes.