A Retrospective Observational Analysis of Clinical Outcomes before and after the Publication of the AACE/ACE Guidelines ()
ABSTRACT
Background: The
influence of the American Association of Clinical Endocrinologists/American
College of Endocrinology (AACE/ACE) guidelines (hereafter, “guidelines”) on
clinical outcomes of patients with diabetes is yet to be assessed. Objectives:
To determine if differences occurred in type of: 1) medication class
prescribed; 2) therapy by A1c strata in type 2 diabetic (T2DM) patients
before and after guidelines were published (December 2009). Methods: Data for
this retrospective cohort study were extracted from community health center
clinics’ electronic medical records for patients who: 1) were adults (18 - 80
years) with T2DM; and 2) had at least one A1c value before and after
guidelines. Demographic characteristics and clinical outcomes [oral anti-diabetic
(OAD) medication class, therapy type (mono, dual, triple), and A1c values] were
collected. A1c was stratified into four levels: <6.5; 6.5 - 7.5; 7.6 - 9.0;
>9.0. Descriptive and inferential statis-tics were used. Results: The
random sample of 302 patients was 55.4 ± 11.7 years of age, primarily female
(65.9%) and Hispanic (68.8%). Regarding medication class, most (68.5% before
and 72.2% after guidelines) patients were prescribed metformin. The proportion
of patients across individual medication classes increased significantly (p <
0.05) between the periods before and after guidelines, with the greatest
percentage increase observed with dipeptidyl peptidase-4 (DPP-4) inhibitors
(36.2%). Chi-square results revealed a significant difference (p < 0.0001)
between type of therapy and A1c strata. Before guidelines, 55.7% of patients
with A1c values < 6.5% were on monotherapy, while 44.1% of patients with A1c
values > 9% were on dual therapy. After guidelines, 48.4% of patients with
A1c values < 6.5% were on monotherapy, while 31.8% of patients with A1c
values > 9% were on dual therapy. Almost one-half (48.3%) of patients
remained in the same A1c strata before and after guidelines were published and
there were no significant changes in mean A1c. Conclusions: DPP-4 inhibitor use
showed the largest increase after guidelines were issued, however, there were
no improvements in A1c. Additional research is warranted to evaluate
healthcare providers’ adherence to AACE/ACE guidelines and how this influences
patients’ health outcomes.
Share and Cite:
Peddaiahgari, R. , Adeyemi, A. , Barner, J. , Lopez, D. and Jokerst, J. (2014) A Retrospective Observational Analysis of Clinical Outcomes before and after the Publication of the AACE/ACE Guidelines.
International Journal of Clinical Medicine,
5, 717-723. doi:
10.4236/ijcm.2014.512098.