Bergenheim, K.

Evans, L.M.

Ketsetzis, G.

McEwan, P.

Prettyjohns, M.

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and the implications that this entails. METHODS: It is presented as a cross-sec-
tional research, drafted in a descriptive and analytical component of data. It is
based on the application of an anonymous questionnaire to these patients, which
consists of three parts: 1) socio-demografic, clinical and disease’s characterization
data; 2) Pediatric Quality of Life Inventory Version 4.0 – PedsQLTM 4.0 and 3) Dia-
betes Quality of Life questionnaire – DQOL. The data was analyzed using SPSSâ
software – version 17 and were considered significant at p-value 0,10. RESULTS:
In total, 17 (68%) children and adolescents between 11-18 years, with an average
number of years with disease of 6,29 years, participated in this study. The dimen-
sions of PedsQLTM 4.0 “Emotional Functioning” and the “School Functioning” and
the sub-scales of DQOL “Worries about Diabetes” and “Satisfaction with treatment”
imply worst results in Health-related Quality of Life. It is observed that the vari-
ables gender, location, school performance and employment status of mother and
father can influence the level of quality of life. Moreover, this level is more satis-
factory in the presence of records related to more appropriate Body Mass index,
fewer years of disease, lower values of glycated hemoglobin type A1c and lower
number of insulin injections per day.CONCLUSIONS: It is recognized that this work
offers a partial view of the disease, but contributes to understand some implicated
factors in its control and in the level of quality of life of diabetic children and
adolescents. It is recommended that such assessments should be made regularly,
within a multi-disciplinary team which should be responsible for monitoring these
patients
Diabetes/Endocrine Disorders – Health Care Use & Policy Studies
PDB62
THE IMPACT OF CLINICAL INERTIA IN THE TREATMENT OF TYPE 2 DIABETES
McEwan P1, Prettyjohns M2, Ketsetzis G3, Evans LM4, Bergenheim K5
1HEOR Consulting, Monmouth, Monmouthshire, UK, 2Cardiff Research Consortium Ltd, Cardiff,
UK, 3Cardiff Research Consortium Ltd, Cardiff, South Glamorgan, UK, 4University Hospital
Llandough, Cardiff, UK, 5AstraZeneca, Mölndal, Sweden
OBJECTIVES: Following the introduction of the Quality and Outcomes Framework
(QOF) in the UK there has been an increase in the number of patients below-target
HbA1c levels (HbA1c7.5%) from 39.7% to 52.1% between 2006 and 2008. However,
a substantial number of patients with type 2 diabetes mellitus (T2DM) remain
poorly controlled. This study quantifies the effect of poorly controlled T2DM on the
average number of microvascular and macrovascular events. METHODS: The Car-
diff Type 2 Diabetes Model was initiated with cohort profiles consistent with cur-
rent UK clinical practice in patients newly diagnosed with T2DM. HbA1c treatment
effects were modelled to correspond with the intensive and conventional control
groups in the UKPDS over a 20-year time horizon assuming: 1) patients achieve and
maintain target control (“controlled”), and 2) patients fail to achieve target control
(“uncontrolled”) having HbA1c levels of 7.5-9.0%. Data from primary care (THIN)
were used to categorise the number of patients by HbA1c level in those on first-line
therapy or diet and exercise whose duration of diabetes was 2 years. RESULTS:
Data from THIN demonstrated that 50% of patients had HbA1c below 7%. Of the
remaining, 20%, 13%, 7% and 10% had HbA1c readings in the following ranges:
7-7.4%; 7.5-7.9; 8-8.4 and 8.5% respectively. Compared to those controlled sub-
jects, with an HbA1c 7%, the model predicts 92, 115, 138 and 162 excess macro-
vascular and microvascular complications in those in the 7-7.4%; 7.5-7.9; 8-8.4 and
 8.5% HbA1c groups respectively. CONCLUSIONS: Given current budgetary con-
straints, an ageing population, and increasing obesity, it is imperative that patients
with T2DM are optimally managed in routine clinical practice from the outset.
Failure to manage patients appropriately will have substantial implications for
both patients and the healthcare system.
PDB63
ANTI-DIABETIC THERAPEUTIC STRATEGIES FOR TYPE 2 DIABETES PATIENTS
WITH CHRONIC KIDNEY DISEASE IN FRANCE
Amalric F1, Attali C2, Joly D3, Simon D4, Verges B5, Grandfils N6, Briand Y7
1IMS Health, PUTEAUX, France, 2Cabinet Médical des Docteurs Attali - Chemoul - Cherqui - Le
Roux, Epinay sous sénart, France, 3Hopital Necker, PARIS, France, 4Hôpital de la Pitié, Paris,
France, 5CHU de Dijon, DIJON, France, 6IMS Health, Paris, France, 7Boehringer Ingelheim France,
Paris, France
OBJECTIVES: To assess how general practitioners (GPs) in France adapt their anti-
diabetic therapeutic strategies among type 2 diabetes mellitus (T2DM) patients
who also had chronic kidney disease (CKD). METHODS: A multi-centric cross-sec-
tional and retrospective study was undertaken, investigating patient characteris-
tics, disease severity, therapeutic strategies, reasons for changes thereof through
questionnaires filled by GPs, coupled with drug treatments extracted from the IMS
Disease Analyser database. RESULTS: The study sample included 120 T2DM pa-
tients (median age  76.0, 45% men): 37 with stage 3a CKD (45GFR60 ml/min,
median age 75.1, 57% men) and 83 with stage 3b or severe CKD (GFR45 ml/min,
median age 76.4, 38% men). Oral anti-diabetic treatments were widely prescribed
among CKD patients: of those with stage 3a and 3b, respectively 37.5% and 39.3%
had oral monotherapy, while 40.6% and 28.6% had oral double or triple therapy.
21.9% and 32.1% had insulin therapy (3 a and 3 b, respectively). 65% of patients were
treated with an anti-diabetic drug which is either contraindicated or not recom-
mended for CKD patients; GPs adapted the anti-diabetic strategy during the previ-
ous year for 43% patients, 53% of the time due to CKD. Mean HbA1c was 7.1% and
7.2% among CKD stage 3a and 3b patients, respectively; with 58% (3a) and 54% (3b)
having HbA1c7. Only 23% of patients achieved control of diabetes (GP assess-
ment), with treatment that does not include a drug either contraindicated or not
recommended for this patient group; 2/3 of these patients received insulin.
CONCLUSIONS: Treating T2DM patients with CKD remains a challenge for GPs:
data suggest that GPs are favouring glycemic control over safety by using anti-
diabetic drugs that are either contraindicated or not recommended for CKD pa-
tients. New oral treatments that would allow physicians to control glycemia while
appropriately considering impaired renal function are needed.
PDB64
CRITERIA FOR REFERRAL OF TYPE 2 DIABETES PATIENTS FROM PRIMARY CARE
TO SPECIALIZED CARE AND VICE VERSA IN SPAIN. PATHWAYS STUDY
Font B1, Lahoz R1, Casamor R1, Escalada FJ2, Ezkurra P3, Ferrer JC4, Ortega C5
1Novartis Farmacéutica S.A., Barcelona, Spain, 2Clínica Universidad de Navarra, Pamplona,
Navarra, Spain, 3Centro de Salud Zumaia, Zumaia, Guipuzcoa, Spain, 4Hospital General
Universitario de Valencia, Valencia, Spain, 5Centro de Salud Pozoblanco, Córdoba, Spain
OBJECTIVES: To assess the causes for referral of type 2 diabetes (T2DM) patients
from primary care (PC) to specialized care (SC) in Spain. To assess the degree of
compliance with referral quality markers established in national
guidelines/recommendations. METHODS: Observational, cross-sectional, multi-
centre national study, in PC and SC. Each physician provided data on usual practice
for T2DM patient referral and clinical status of patients with T2DM for 6 referred
patients. Inclusion criteria for patients were: written consent, previous T2DM di-
agnosis and age over 18; exclusion criteria: T1DM, MODY, LADA and secondary
diabetes. Recommendations of the Spanish Society for Endocrinology and Nutri-
tion (SEEN) and the National Health System (SNS), were used as reference docu-
ments to assess compliance. RESULTS: Data from clinical practice of 143 endocri-
nologists and 641 general practitioners (GPs), and from referrals of 805 patients to
PC and 3624 to SC are presented. PC to SC referrals: 31.8% of GPs reported the
existence of a coordination protocol with endocrinologists. The most frequent
communication tool with SC was Consultation Report (89.2%). The referral criterion
that most GPs reported to apply in usual practice was Metabolic Instability (80.5%).
The most frequent cause for referral among the patients studied was Reassess-
ment (48.4%), a criterion not included in national guidelines. 46.8% of GPs applied in
usual practice all SNS, 3.9% all SEEN referral criteria. SC to PC referrals: 46.2% of
endocrinologists reported the existence of a coordination protocol with PC. The
most frequent communication channel with PC was Medical History (47.2%). The
referral criterion reported by a higher number of endocrinologists (96.5%) was Goal
Achievement, most frequent cause for referral also among the patients studied.
CONCLUSIONS:These findings emphasise the need of improving coordination pro-
cesses to optimize and homogenize referrals. The number of reported coordination
protocols is low, and the compliance with national guidelines poor.
PDB65
UNMET NEED AND DRUG MANAGEMENT CHALLENEGES IN ELDERLY TYPE 2
DIABETES MEDICARE PART D POPULATION
Kuan R1, Schwartz EL2, Davis EA2, Schnecker AM3
1PriceSpective, El Segundo, CA, USA, 2PriceSpective, San Diego, CA, USA, 3PriceSpective, San
Diego , CA, USA
OBJECTIVES: To identify patient barriers, clinical management concerns, and drug
coverage issues for elderly type 2 diabetes patients in the Medicare Part D
population METHODS: A literature review was conducted using PubMed with
searches limited to studies published in the last 2 years, in English, and in aged 65.
Searches included combinations of the following terms: diabetes mellitus, mortal-
ity, prevention and control, Medicare, diabetes management, treatment guide-
lines, control. Hand searching of clinical management guidelines and diabetes
conferences (2007-present) was conducted to identify further issues pertaining to
the research questions of interest. RESULTS: The literature search by key word
yielded 141 relevant articles, 42 of which were included after abstract review for
relevance. Literature on clinical management challenges identified a high preva-
lence of untreated disease in this patient population due to a significantly large
number of elderly type 2 diabetes patients being undiagnosed. Adherence to treat-
ment guidelines in this patient population is challenging due to the high level of
co-morbidities that may complicate the goal of intensive glucose management. As
more oral antidiabetic agents become available as treatment options, patients be-
come more likely to change therapies with more elderly patients switching from
single-agent to combination therapy. Literature on cost-sharing in Medicare Part D
and the current coverage gap suggest that patients covered under the benefit face
a high out of pocket burden for treatment and that such costs lead to medication
non-adherence and physician switching to less efficacious alternatives
CONCLUSIONS: Clinical management challenges and economic barriers to access
are more pronounced for elderly Medicare Part D than in the general population of
type 2 diabetes patients. Further insight and research are needed to explore how
policy changes for coverage and treatment guidelines may be able to address these
concerns.
PDB66
ACHIEVEMENT OF GLYCEMIC CONTROL AND RELAPSE AMONG PATIENTS
INITIATING BASAL INSULIN FROM A GEOGRAPHICALLY-DIVERSE US
ELECTRONIC MEDICAL RECORD (EMR) DATABASE
Aargen M1, Wu N2, Boulanger L2, Lamothe K2
1Novo Nordisk Inc., Princeton, NJ, USA, 2United BioSource Corporation, Lexington, MA, USA
OBJECTIVES: To describe demographic and clinical characteristics of diabetic pa-
tients who initiated basal insulin and assess their glycemic control. METHODS:
Physician encounters recorded in the General Electric EMR Database (2005-2010)
were assessed. Patients with type II diabetes (T2DM) who initiated basal insulin
between February 2006 and August 2009 were selected, with initiation defined as
no prescription record of insulin in prior 15 months. Patients were followed for an
average of 2.5 years after insulin initiation, and the proportion achieving A1C7%
(“goal”) and time to achieving goal were assessed. Among patients who reached
A483V A L U E I N H E A L T H 1 4 ( 2 0 1 1 ) A 2 3 3 - A 5 1 0


PDB62 The Impact of Clinical Inertia in the Treatment of Type 2 Diabetes 

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PDB62 The Impact of Clinical Inertia in the Treatment of Type 2 Diabetes

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