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Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study
- Source :
- PLoS ONE, PLoS ONE, Vol 5, Iss 11, p e14024 (2010)
- Publication Year :
- 2010
- Publisher :
- US : Public Library of Science, 2010.
-
Abstract
- Background: 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. Conclusions/significance: 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. Methodology/principal findings: 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, 20134 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
- Subjects :
- Male
Gerontology
medicine.medical_specialty
Databases, Factual
Science
030209 endocrinology & metabolism
Comorbidity
Disease
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Internal medicine
Diabetes mellitus
Humans
Hypoglycemic Agents
Medicine
Dementia
Diabetes and Endocrinology/Type 2 Diabetes
030212 general & internal medicine
Depression (differential diagnoses)
Aged
Veterans
Aged, 80 and over
Geriatrics
Multidisciplinary
business.industry
Incidence
Australia
Retrospective cohort study
medicine.disease
3. Good health
Diabetes and Endocrinology
Treatment Outcome
Diabetes Mellitus, Type 2
Disease Progression
Regression Analysis
Female
business
Research Article
Cohort study
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- PLoS ONE, PLoS ONE, Vol 5, Iss 11, p e14024 (2010)
- Accession number :
- edsair.doi.dedup.....0cbe4814fa3a2627802958ca4965ffb6