Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.

<h4>Background</h4>This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans.<h4>Methodology/principal findings</h4>A retrospective cohort study was u...

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Autores principales:	Agnes I Vitry, Elizabeth E Roughead, Adrian K Preiss, Philip Ryan, Emmae N Ramsay, Andrew L Gilbert, Gillian E Caughey, Sepehr Shakib, Adrian Esterman, Ying Zhang, Robyn A McDermott
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a66d58b084ca4502ba4f47a00cad7661
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spelling	oai:doaj.org-article:a66d58b084ca4502ba4f47a00cad76612021-11-18T07:36:44ZInfluence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.1932-620310.1371/journal.pone.0014024https://doaj.org/article/a66d58b084ca4502ba4f47a00cad76612010-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21103337/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans.<h4>Methodology/principal findings</h4>A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DVA) claims database between July 2000 and June 2008. The study included new users of metformin or sulfonylurea medicines. The outcome was the time to addition or switch to another antidiabetic treatment. The total number of comorbid conditions unrelated to diabetes was identified using the pharmaceutical-based comorbidity index, Rx-Risk-V. Competing risk regression analyses were conducted, with adjustments for a number of covariates that included age, gender, residential status, use of endocrinology service, number of hospitalisation episodes and adherence to diabetes medicines. Overall, 20,134 veterans were included in the study. At one year, 23.5% of patients with diabetes had a second medicine added or had switched to another medicine, with 41.4% progressing by 4 years. The number of unrelated comorbidities was significantly associated with the time to addition of an antidiabetic medicine or switch to insulin (subhazard ratio [SHR] 0.87 [95% CI 0.84-0.91], P<0.001). Depression, cancer, chronic obstructive pulmonary disease, dementia, and Parkinson's disease were individually associated with a decreased likelihood of therapeutic progression. Age, residential status, number of hospitalisations and adherence to anti-diabetic medicines delayed therapeutic progression.<h4>Conclusions/significance</h4>Increasing numbers of unrelated conditions decreased the likelihood of therapeutic progression in veterans with diabetes. These results have implications for the development of quality measures, clinical guidelines and the construction of models of care for management of diabetes in elderly people with comorbidities.Agnes I VitryElizabeth E RougheadAdrian K PreissPhilip RyanEmmae N RamsayAndrew L GilbertGillian E CaugheySepehr ShakibAdrian EstermanYing ZhangRobyn A McDermottPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 11, p e14024 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Agnes I Vitry Elizabeth E Roughead Adrian K Preiss Philip Ryan Emmae N Ramsay Andrew L Gilbert Gillian E Caughey Sepehr Shakib Adrian Esterman Ying Zhang Robyn A McDermott Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.
description	<h4>Background</h4>This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans.<h4>Methodology/principal findings</h4>A retrospective cohort study was undertaken using data from the Australian Department of Veterans' Affairs (DVA) claims database between July 2000 and June 2008. The study included new users of metformin or sulfonylurea medicines. The outcome was the time to addition or switch to another antidiabetic treatment. The total number of comorbid conditions unrelated to diabetes was identified using the pharmaceutical-based comorbidity index, Rx-Risk-V. Competing risk regression analyses were conducted, with adjustments for a number of covariates that included age, gender, residential status, use of endocrinology service, number of hospitalisation episodes and adherence to diabetes medicines. Overall, 20,134 veterans were included in the study. At one year, 23.5% of patients with diabetes had a second medicine added or had switched to another medicine, with 41.4% progressing by 4 years. The number of unrelated comorbidities was significantly associated with the time to addition of an antidiabetic medicine or switch to insulin (subhazard ratio [SHR] 0.87 [95% CI 0.84-0.91], P<0.001). Depression, cancer, chronic obstructive pulmonary disease, dementia, and Parkinson's disease were individually associated with a decreased likelihood of therapeutic progression. Age, residential status, number of hospitalisations and adherence to anti-diabetic medicines delayed therapeutic progression.<h4>Conclusions/significance</h4>Increasing numbers of unrelated conditions decreased the likelihood of therapeutic progression in veterans with diabetes. These results have implications for the development of quality measures, clinical guidelines and the construction of models of care for management of diabetes in elderly people with comorbidities.
format	article
author	Agnes I Vitry Elizabeth E Roughead Adrian K Preiss Philip Ryan Emmae N Ramsay Andrew L Gilbert Gillian E Caughey Sepehr Shakib Adrian Esterman Ying Zhang Robyn A McDermott
author_facet	Agnes I Vitry Elizabeth E Roughead Adrian K Preiss Philip Ryan Emmae N Ramsay Andrew L Gilbert Gillian E Caughey Sepehr Shakib Adrian Esterman Ying Zhang Robyn A McDermott
author_sort	Agnes I Vitry
title	Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.
title_short	Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.
title_full	Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.
title_fullStr	Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.
title_full_unstemmed	Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.
title_sort	influence of comorbidities on therapeutic progression of diabetes treatment in australian veterans: a cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/a66d58b084ca4502ba4f47a00cad7661
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Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.

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