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Management of newly treated diabetes in Medicare beneficiaries with and without heart failure.

Publication ,  Journal Article
Cooper, LB; Mi, X; Mentz, RJ; Green, JB; Anstrom, KJ; Hernandez, AF; Curtis, LH
Published in: Clin Cardiol
January 2017

BACKGROUND: Several diabetes mellitus (DM) therapies are associated with worse heart failure (HF) outcomes, yet limited data exist characterizing routine DM management based on HF status. HYPOTHESIS: DM medications prescribed for patients with HF will differ in meaningful ways from patients without HF, and co-morbidities will impact the choice of medications prescribed. METHODS: Using Medicare fee-for-service claims data, we identified patients with newly treated DM between 2008 and 2011 and used multivariable logistic regression to assess associations between baseline HF status and DM medication use. We used the cumulative incidence function to describe outcomes at 1 year by HF status and DM medication use. RESULTS: Of 35 603 patients with newly treated DM, 8965 (25.2%) had HF at baseline. Patients with HF had greater comorbidity, including renal dysfunction. After adjustment for baseline covariates, patients with HF had higher odds of initiation on insulin monotherapy (odds ratio: 1.72, 95% confidence interval: 1.59-1.87, P < 0.001) and lower odds of initiation on metformin (odds ratio: 0.66, 95% confidence interval: 0.62-0.71, P < 0.001) compared with patients without HF. Cumulative incidence of 1-year mortality was higher among patients with HF than among those without (22.4% vs 6.4%) and highest among those prescribed insulin. CONCLUSIONS: Patients with HF were more likely to be initiated on insulin monotherapy than were patients without HF, who were more likely to be initiated on metformin. Studies of comparative effectiveness and safety are needed for DM treatment options in patients with comorbid HF.

Duke Scholars

Published In

Clin Cardiol

DOI

EISSN

1932-8737

Publication Date

January 2017

Volume

40

Issue

1

Start / End Page

38 / 45

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Retrospective Studies
  • Metformin
  • Medicare
  • Male
  • Hypoglycemic Agents
  • Humans
  • Heart Failure
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
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Cooper, L. B., Mi, X., Mentz, R. J., Green, J. B., Anstrom, K. J., Hernandez, A. F., & Curtis, L. H. (2017). Management of newly treated diabetes in Medicare beneficiaries with and without heart failure. Clin Cardiol, 40(1), 38–45. https://doi.org/10.1002/clc.22603
Cooper, Lauren B., Xiaojuan Mi, Robert J. Mentz, Jennifer B. Green, Kevin J. Anstrom, Adrian F. Hernandez, and Lesley H. Curtis. “Management of newly treated diabetes in Medicare beneficiaries with and without heart failure.Clin Cardiol 40, no. 1 (January 2017): 38–45. https://doi.org/10.1002/clc.22603.
Cooper LB, Mi X, Mentz RJ, Green JB, Anstrom KJ, Hernandez AF, et al. Management of newly treated diabetes in Medicare beneficiaries with and without heart failure. Clin Cardiol. 2017 Jan;40(1):38–45.
Cooper, Lauren B., et al. “Management of newly treated diabetes in Medicare beneficiaries with and without heart failure.Clin Cardiol, vol. 40, no. 1, Jan. 2017, pp. 38–45. Pubmed, doi:10.1002/clc.22603.
Cooper LB, Mi X, Mentz RJ, Green JB, Anstrom KJ, Hernandez AF, Curtis LH. Management of newly treated diabetes in Medicare beneficiaries with and without heart failure. Clin Cardiol. 2017 Jan;40(1):38–45.
Journal cover image

Published In

Clin Cardiol

DOI

EISSN

1932-8737

Publication Date

January 2017

Volume

40

Issue

1

Start / End Page

38 / 45

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Retrospective Studies
  • Metformin
  • Medicare
  • Male
  • Hypoglycemic Agents
  • Humans
  • Heart Failure
  • Follow-Up Studies