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Using the population based real world experience & evidence in NHS England to identify the opportunities to improve the outcomes and use of resources in treating Type 2 Diabetes (T2DM)

Author: Mike Stedman & Dr Adrian Heald

Published: Poster presentation - ISPOR 19th Annual European Congress, 29 October-2 November 2016, Austria Center Vienna, Vienna, Austria

Introduction Examine the NHS England public published diabetes data in GP practices to see if varying levels of intervention could be related to changes in outcome.

Methods Data collated from National Diabetes Audit (NDA) 2013_15, GP Practice Prescribing and Defined Daily Dose (DDD), average adult maintenance daily dose for drug, published by WHO. Epidemiological measures and Service measures linked by regression to the Target Glycaemic Control (TGC) (% patients last HBA1C <58mmol/mol) in each practice.

Results 3,575 practices (>100 diabetic patients), over 2 years provided 7,151 data points with 2.9 million diabetes years. TGC in top practice decile was 78% and bottom decile 52%. Epidemiological regression analysis accounted for 14.4% of TGC variance. TGC increases with age (%T2DM >65 years) standardised ?-coefficient 0.36 and decreases with number of T2DM patients (practice register % overall average), ?-coefficient -0.05. Disadvantage (%T2DM patients in most deprived class) and ethnicity (%T2DM non-white patients) had little impact on TGC. Service delivery regression accounted for 8.5% of TGC variance. TGC decreased with use of generic medication (DDD/T2DM patient) ?-coefficient -0.21, use of insulins (% T2DM patients on insulin) ?-coefficient -0.14, and prescribing spend (£/patient) ?-coefficient -0.03. TGC increased with use of patented medications (DDD/T2DM patient) ?-coefficient 0.02, BGM strip usage (strips/unit insulin) ?-coefficient 0.01 & average accuracy (+/-% deviation covering 95% of results) ?-coefficient 0.02.

Conclusion Findings that glycaemic control improves with age, use of patented medications, and investment in blood glucose monitoring, and that increased prescribing of generic medication lower glycaemic control, merit further exploration.


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Surprising findings from National Diabetes Audit: Prescribing of more generic oral medication especially sulphonylurea, result in poorer HbA1C control GP practice level

Author: Mike Stedman & Dr Adrian Heald

Published: Poster presentation - ISPOR 19th Annual European Congress, 29 October-2 November 2016, Austria Center Vienna, Vienna, Austria

Introduction UK 2016 NICE (NG28) guidance includes generic metformin as first line medication and pioglitazone/sulphonylureas as part of dual and triple therapy options. Use public published diabetes data in GP practices to show how outcome reflect levels of generic medication use.

Methods Data collated from National Diabetes Audit (NDA) 2013_15, GP Practice Prescribing and Defined Daily Dose (DDD), average adult maintenance daily dose for drug, published by WHO. We compared practices in top and bottom prescribing deciles and multi-variant regression to Target Glycaemic Control (TGC) (% patients last HBA1C <58mmol/mol) in each practice.

Results 3,575 practices (>100 diabetes patients), 1,275,000 T2DM patients over two years, 1,134,000 annual DDD generic medication average of 1.17 DDD/T2DM patient/year. Top decile 1.6 DDD/T2DM patient, gave TGC of 64.1% and bottom decile 0.83DDD/T2DMpatient gave TGC of 68.2%: Regression β-coefficient -0.21 reflected this decline. Main generic medications covered were

Conclusion These results bring into question the early prescribing of generic oral medication and that sulphonylureas should be carefully targeted.


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