Presented at the 74th Scientific Sessions of the American Diabetes Association, San Francisco, June 15, 2014.<\/p>\n
Authors: MARCIA A. TESTA, DONALD C. SIMONSON, Boston, MA<\/p>\n
Glycemic control treatment targets for T2DM are intended to trigger clinical action in the management of patients; however, targets are usually benchmarked against averaged, population outcomes, and are not specific to individual patient characteristics. To explore treatment effectiveness heterogeneity (TEH) and to pilot test a personalized diabetes treatment benchmarking tool, we developed a causal model, statistical algorithm and a prototype interactive calculator using a pooled database of clinical, demographic and outcomes data from 19 diabetes RCTs (N=6870; 989 clinics) with rigorous protocols as the high quality benchmark standard. The prototype was developed from a database subsample of new or recently diagnosed patients with two treatment options using multiple logistic regression equations to obtain estimated high benchmark probabilities (HBPs) for achieving 12-wk, HbA1c < 7% and < 8.0%. The Excel-based calculator required input of individual patient pretreatment characteristics including HbA1c and FPG after 3 wks of diet and exercise only (D&E), sex, age, BMI, diabetes duration, race\/ethnicity, prior treatment and planned treatment option (monotherapy or D&E). The HBPs for a White male, age 50 yrs, BMI = 30, FPG = 150 mg\/dl and HbA1c = 9%, diabetes duration = 1 yr and treated previously with D&E were 0.51 and 0.94 for HbA1c < 7% and < 8% after 12 weeks on sulfonylurea monotherapy, and 0.06 and 0.48 if remaining on D&E. HBPs for a Black female, age 50 yrs, BMI = 36, FPG = 150 mg\/dl, HbA1c = 9.5%, diabetes duration = 1 yr and treated previously with D&E were 0.41 and 0.78 on sulfonylurea, and 0.04 and 0.18 if remaining on D&E. Mean (SD) clinic-specific HBPs with case mix adjustment for personalized data were 0.35 (0.18) and 0.67 (0.17) for HbA1c < 7% and < 8% respectively indicating substantial TEH among clinics reflecting the variability in patient characteristics. Personalized benchmarking can provide a more equitable and patient-centered quality of care standard for T2DM.<\/p>\n","protected":false},"excerpt":{"rendered":"
Presented at the 74th Scientific Sessions of the American Diabetes Association, San Francisco, June 15, 2014. Authors: MARCIA A. TESTA, DONALD C. SIMONSON, Boston, MA Glycemic control treatment targets for T2DM are intended to trigger clinical action in the management of patients; however, targets are usually benchmarked against averaged, population outcomes, and are not specific to individual patient characteristics. To explore treatment effectiveness heterogeneity (TEH) and to pilot test a personalized diabetes treatment benchmarking tool, we developed a causal model, statistical algorithm and a prototype interactive calculator using a pooled database of clinical, demographic and outcomes data from 19 diabetes RCTs (N=6870; 989 clinics) with rigorous protocols as the high quality benchmark standard. The prototype was developed from a database subsample of new or recently diagnosed patients with two treatment options using multiple logistic regression equations to obtain estimated high benchmark probabilities (HBPs) for achieving 12-wk, HbA1c < 7% and < 8.0%. The Excel-based calculator required input of individual patient pretreatment characteristics including HbA1c and FPG after 3 wks of diet and exercise only (D&E), sex, age, BMI, diabetes duration, race\/ethnicity, prior treatment and planned treatment option (monotherapy or D&E). The HBPs for a White male, age 50 yrs, BMI = 30, FPG = 150 mg\/dl and HbA1c = 9%, diabetes duration = 1 yr and treated previously with D&E were 0.51 and 0.94 for HbA1c < 7% and < 8% after 12 weeks on sulfonylurea monotherapy, and 0.06 and 0.48 if remaining on D&E. HBPs for a Black female, age 50 yrs, BMI = 36, FPG = 150 mg\/dl, HbA1c = 9.5%, diabetes duration = 1 yr and treated previously with D&E were 0.41 and 0.78 on sulfonylurea, and 0.04 and 0.18 if remaining on D&E. Mean (SD) clinic-specific HBPs with case mix adjustment for personalized data were 0.35 (0.18) and 0.67 (0.17) for HbA1c < 7% and < 8% respectively indicating substantial TEH among clinics reflecting the variability in patient characteristics. Personalized benchmarking can provide a more equitable and patient-centered quality of care standard for T2DM.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0},"categories":[7],"tags":[],"_links":{"self":[{"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/posts\/204"}],"collection":[{"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/comments?post=204"}],"version-history":[{"count":6,"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/posts\/204\/revisions"}],"predecessor-version":[{"id":283,"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/posts\/204\/revisions\/283"}],"wp:attachment":[{"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/media?parent=204"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/categories?post=204"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/phasevtech.net\/pcori\/wp-json\/wp\/v2\/tags?post=204"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}