Patient Safety and Quality Improvement (PSQI)
Charlie Busby, MD & Ashley Matthews, MD
Objective: To learn the rates at which patients at UT Family Medicine–St. Francis (UTFM–SF) with type II diabetes mellitus are being prescribed recommended medications—namely metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor agonists (GLP1RAs)—whether these rates correspond to the severity of hyperglycemia (as indicated by HbA1C level). A secondary goal of the study was to investigate if HbA1C levels are being checked at recommended intervals.
Methods: A retrospective chart review was conducted using records of patients seen at the clinic in the previous four years between the ages of 18 and 65 who had visits with ICD 10 codes for type II diabetes mellitus (E11) and long term insulin use (Z79.4). Patients with an HbA1C result from January 1, 2018 or later and a chart history of an insulin prescription were selected for further analysis.
Results: 234 patients met the search criteria and were divided into three groups based on an average of the three most recent HbA1C labs: Below the American Diabetes Association (ADA) recommended HbA1C of 7% (n=40), between 7% and the insurance quality metric goal of 9% (n=66), and above 9% (n=128). A chi-square test revealed there was no significant association between HbA1C group and the rate of prescription of metformin (2-sided, p=.631), SGLT2 inhibitors (P=.221), or GLP1RAs (P=.223); a chi-square test also showed there was no association between group and the number of medications prescribed (P=.236). A one-way ANOVA revealed no statistically significant differences between group with regards to frequency of HbA1C checks (P=.295).
Conclusion: Patients at UTFM–SF with lower levels of glycemic control are not receiving significantly different treatment from patients who demonstrate better glycemic control—they are not being prescribed recommended medication classes at a different rate, they are not having medications combined at a different rate, and their HbA1Cs are not being monitored differently. Increased utilization of metformin, SGLT2 inhibitors, and GLP1Ras, as well as quarterly HbA1C checks, are necessary to bring diabetic care at UTFM–SF more in line with ADA recommendations.
Welch, Caitlin S. and Troxel, Archie , "Efficacy of Various Interventions for Achieving Target HbA1C Levels for Patients with Type II Diabetes Mellitus and on Exogenous Insulin" (2022). Longitudinal Scholar's Project. Paper 21. http://dx.doi.org/10.21007/com.lsp.2022.0018.
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